Thursday, July 18, 1996
Got a letter from CalaCare, this guy named George Eisenstadt. I can't believe it. They expect me to turn over all the transcripts of patient sessions to them. And it's not even for some form of consultation or even professional evaluation. Rather, it's so they can expedite their review of their caseload!

I wrote CalaCare a letter but had to throw it in the trash. I'll sound more professional when I cool down a bit.

Friday, July 19, 1996
Wrote CalaCare a response and spent a good portion of the day getting the files together that I promised to them.

Wednesday, July 24, 1996
Got another letter from George Eisenstadt of CalaCare. These guys are intent on getting my patient files. I can't figure out why they would want the transcripts of the therapy sessions, but of course there is no way that I can ever give them that material. They aren't satisfied with what I sent them before. Eisenstadt is trying to intimidate me into giving up the file, with a bunch of veiled threats about canceling my HMO contract. I am going to have to write them again. Perhaps I can find the privilege statute in California and quote it in the letter to get them off my back.

Monday, July 29, 1996
I wrote a letter to Eisenstadt at CalaCare today. Told him about the privilege statute in California. I hope this works.

Monday, August 5, 1996
I got a letter from Gerald Barkel, a lawyer at CalaCare dated August 2. He is incredibly patronizing in tone. He argues that there is a form contract which the personnel at SII all sign which waives the privilege. He says that "confidentiality is maintained by the company as a whole," whatever that means. He also says that in my agreement with CalaCare there is a provision where I agree to give "all relevant records and data that the company...should reasonably require." I'm going to have to come up with some response, but I'm going to be out of my depth if I have to argue law with this guy.

Friday, August 9, 1996
I wrote a letter to Gerald Barkel of CalaCare. I wrote a stirring defense of doctor/patient privlege, but I'm afraid he is just going to spout more legal gibberish. These guys aren't going to be stopped merely by a doctor explaining about ethics. I'm trying to imagine them all sitting around with my letter saying, "You know, this guy's right. We really shouldn't be asking for this stuff." I don't think so. I'm afraid I'm in for more trouble from CalaCare.

Monday, August 19, 1996
I received another letter from Gerald Barkel of CalaCare, dated August 16, 1996. Barkel is asserting that since I refuse to send him the information he seeks, that he is entitled to an indemnification. He sends one which I am to sign and return to him. The indemnity agreement is horrendous and I can't think of a reason to sign it, except to stay in CalaCare's good graces, which I've probably already lost anyway. Barkel is charming, as usual. He completely ignores the issue of the waivers being voluntary, etc. and just skips over my request to have new voluntary waivers executed for the files that they are seeking.

Monday, August 26, 1996
I wrote a letter to Barkel at CalaCare, but I barely conceal my growing contempt for these clowns. The indemnity agreement that they asked me to sign was ridiculous. So I state in writing, and somewhat catagorically, that I was unwilling to give them the information they sought, and invited them to wave that statement around in a courtroom if they ever needed that opportunity. It was a grand gesture, but I'm a bit worried, actually. I think it is a foolish idea, but what if there is some sort of exception to the normal rules governing malpractice for CalaCare if they are denied access to the information. Here, they can build a case because I'm clearly refusing to deliver confidential materials. It almost seems like they're trying to set me up to be the patsy.

Thursday, October 3, 1996
Received a letter from George Eisenstadt. I had almost thought these goons had forgotten about me, but no--they've cooked up a whole new scheme to make sport of me. They've concocted this elaborate form that I am to complete on each new patient and on all of my current ones every four weeks. I am supposed to certify under penalty of perjury about a host of mental conditions and give my opinion as to a person's general mental state. The form is machine readable too--I get to press hard and use number 2 pencils. The form is ludicrous. It clearly was not created by a medical professional. Do they assume that I can squeeze my patients into little check marks on a page? They might as well have asked me: "On a scale from 1 to 10, rate the patient's sanity." "On a scale from 0 to 100, what is the likelihood that the patient will suffer a mental breakdown?--In the next two months? In the next three months?" It seems that some lawyer must have told them that they have more liability having a therapist in the HMO plan that not--they are desperate to cover their ass in case something goes wrong. As much as I hate to admit it, with employees like Joseph Mazurka, they might be right. I think I may take the turtle approach. Perhaps if I ignore them and pull into my shell, they'll go away.

Monday, November 25, 1996
Received another letter from George Eisenstadt of CalaCare HMO. Here it comes. They are putting the squeeze on me. While acknowledging they are contractually bound to pay my fee, wouldn't I voluntarily agree to a lower fee so that we can all advance the goal of lower health care costs together? Right! Apparently I was correct and they are sending patients to another psychology group instead of directing them to me. I couldn't understand why I hadn't received any new patients from SII in the longest time. Now I know. They are actively directing patients away from my care. I'm certain that my stand on the confidentiality of patient records hasn't helped my cause much. When my contract expires, I don't think it is likely to be renewed. I'm not sure what to do. If I lower my rates, how do I pay the medical school loans and still have enough to pay rent? This solo practice puts me completely at the mercy of the HMO, and I initially turned to the HMO contract to gain security in this new venture. Perhaps the answer is to more actively recruit patients who are not controlled by the HMO's whims.


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