I read with interest the article in the January 5 issue describing a pro forma meeting between several prominent members of APA (but not officially representing APA), together with the leaders of the top five mental health managed care companies. Also participating were several psychologists, social workers, and lawyers, including the New York attorney who had filed the class-action lawsuit, the settlement of which required that the above meeting be held.

It is clear from the Psychiatric News report that this meeting was as fruitless and absent of substance as was the original suit itself. Despite the report that Dr. Harold Eist retains "inveterate optimism," which I had not realized extended to negotiations with managed care companies, the facts are that the MCO representatives sat and listened to a justified litany of criticisms and complaints about the way they do business, and they responded that they would like to improve relations with their clinicians, but offered no specific suggestions for change. I am reminded of a similar meeting in December 1997 that included the top management of Magellan/Green Spring (held at the company’s request), together with the top leadership of APA. During this meeting the same complaints were very directly laid out, and this meeting also was followed by no positive changes (in fact, the problems worsened!). I should mention that at the time of that meeting, I also was a member of the Magellan Professional Advisory Board. I had a role in brokering the meeting, at that time still sharing with Dr. Eist some optimism about negotiating with managed care. I resigned from that advisory board in 1998 when I became convinced that the advisory board, which included many distinguished colleagues, really functioned as a Potemkin Village for Magellan, providing both criticism and cover, but which could not point to a single constructive or positive change in the way the company did its business.

To return to the issue at hand, when the APA Board of Trustees was first approached to become a party to this suit, it was pointed out that this class-action suit had many concerns associated with it, and that now, through the APA litigation committee, the lawyer was requesting funds to support his ongoing expenses in bringing suit. Among members of the Board with whom I have spoken there were many members who were enthusiastic about providing such support, and many others with reservations, myself included, who were concerned that this was the wrong suit in the wrong venue. It was my personal position at that time that when APA became a party to a legal action against managed care, it should do so with a level of legal experience, expertise, and resources equal to those representing the MCOs. The differences and reservations were resolved back then by a compromise—to provide support from the APA litigation fund, but not to sign on as a party to the suit.

As proved to be the case once discovery got under way, there was insufficient legal ground to support the suit, and the parties reached a settlement that in my opinion included some face-saving provisions for the plaintiffs but essentially no significant concessions from the defendant MCOs beyond those that they already had been prepared to make. All that being said, it remains that combinations of legislation and litigation strategies are the only realistic means by which change will occur in the corporate structures, incentives, value systems, and practices of the MCOs. Legislation and litigation should continue to be vigorously pursued and supported and perhaps even some suits provided funding simply for their assertive and proactive message. However, both in legislation and litigation, APA must choose very carefully on a cost-benefit basis where and when it will expend its human and financial resources.

Dr. Wiener is a former APA president.