TLPJ Press Release header

FOR RELEASE ON: December 6, 2000	
Jonathan Hutson, TLPJ, 202-797-8600 x 246
Arthur Bryant, TLPJ, 510-622-8150 x 202
Sharon Arkin, Lead Co-Counsel, 949-720-1288 


Mandatory Pill-Splitting Policy Values HMO's Profits over Patients' Health

Trial Lawyers for Public Justice (TLPJ) filed a class action lawsuit today charging that the country's largest HMO, Kaiser Permanente, is violating California law by forcing its members to split prescription pills. The suit charges that Kaiser's mandatory pill-splitting policy endangers patients' health solely to enhance the HMO's profits. It seeks a court order barring Kaiser from forcing its members to split pills and requiring the HMO to disgorge all profits it made from this dangerous policy.

"Kaiser's mandatory pill-splitting policy is an outrageous example of an HMO valuing its profits over its members' health and safety," said TLPJ Executive Director Arthur H. Bryant, co-counsel in the case. "It makes Kaiser millions, but it has no possible therapeutic value and it puts patients' health at risk."

Kaiser adopted its pill-splitting policy because it allows Kaiser to profit from the fact that smaller dose versions of most prescription pills cost Kaiser almost as much as larger dose versions of the same pills. So, Kaiser forces patients prescribed the smaller dose pills to accept and split the larger dose pills - and pockets the enormous cost difference. For example, 50-milligram tablets of Zoloft, a commonly used anti-depressant, cost approximately $227 per 100, so it would ordinarily cost Kaiser $454 to provide a patient prescribed 50 milligrams per day with 200 daily doses. But 100-milligram tablets of Zoloft cost about $233 per 100, so Kaiser can increase its profits by $221 on a single prescription by forcing the patient to accept and split the 100-milligram tablets to obtain 50 milligrams per day. That is what Kaiser does, telling some patients to split the pills by hand and providing others with a small "pill splitter" -- a razor blade centered in a plastic frame. It does not share the savings with the patients or warn them of the health risks involved.

"Kaiser promises in its advertisements that patients come first and that cost is the last consideration, but its pill-splitting policy puts patients last and money first," said TLPJ lead co-counsel Sharon J. Arkin of Robinson, Calcagnie & Robinson in Newport Beach, California. "It is hard to imagine a more blatant consumer fraud. And it is particularly disturbing that Kaiser is endangering those who need its help the most -- the elderly, frail, and sick."

The American Medical Association (AMA), the American Society of Consultant Pharmacists (ASCP), and the American Pharmaceutical Association (APhA) have all condemned mandatory pill-splitting because of the health risks involved. Medical research shows that, even when able-bodied people try to split pills, dosages can vary by up to 40%. Pills split unevenly, crumble, and shatter. As a result, pill-splitting causes both overdoses and underdoses -- a serious danger to many patients. Pill-splitting is nearly impossible for some elderly patients, patients with Parkinson's disease or other conditions that cause hand tremors, and patients with cognitive or visual impairments. And it is confusing to patients taking many medications, who struggle to remember which pills to split and which not to split. Yet Kaiser requires splitting of a wide variety of pills -- including blood pressure medicine, anti-depressants, and certain antibiotics -- without regard to the patients' condition.

The named plaintiffs in TLPJ's class action lawsuit, Timmis v. Kaiser Permanente, are six patients who Kaiser forced to split pills and Dr. Charles Phillips, a physician with 31 years of experience who witnessed the effects of the policy while working in a Kaiser Permanente emergency room in Fresno, California. Phillips discovered that many patients suffering from severe hypertension, heart attacks, and strokes had been receiving uneven dosages of their blood pressure medication because Kaiser had told them to split pills. Phillips was even forced to split pills when he tried to fill a personal prescription at a Kaiser pharmacy.

"As a doctor, I have a duty to prevent harm to my patients," said Phillips. "I have seen the dangers of requiring patients to split pills, and I cannot conceive of any health benefit from this risky practice. I am also troubled by the role that Kaiser is making its pharmacists play. The laws against compounding prohibit pharmacists from splitting pills. Kaiser should not be allowed to skirt those laws by having its pharmacists force patients to split pills themselves."

Plaintiff Audrey Timmis, a 72-year-old woman who suffers from severe emphysema, said, "When I tried to split the pills - which were slightly smaller than an aspirin - I usually ended up launching them across the room like tiddly-winks or crushing them into powder between my fingers. When I finally managed to get two pieces, they were certainly not the same size. I took them, but I started getting intense headaches every afternoon."

Ms. Timmis recounted her futile attempts to change her prescription to a dosage that would not require splitting. "I complained about my headaches and the uneven split pills to my Kaiser doctor, but the doctor refused to change my prescription," recalled Ms. Timmis. "Because my complaints went unanswered, it was clear to me then that Kaiser didn't care about me or my health. All they cared about was saving money."

The complaint in Timmis v. Kaiser Permanente was filed in California Superior Court in Oakland this morning. It charges the HMO with violating California Business and Professions Code Section 17200, which bars unfair business practices; Section 17500, which bars false advertising; and the state Consumer Legal Remedies Act.

In addition to Bryant and Arkin, TLPJ's litigation team in the case includes lead co-counsel Mark P. Robinson, Jr., of Robinson, Calcagnie & Robinson in Newport Beach, California, and TLPJ Staff Attorney Victoria Ni. 


Trial Lawyers for Public Justice is the only national public interest law firm dedicated to using trial lawyers' skills and resources to advance the public good. Founded in 1982, TLPJ utilizes a nationwide network of more than 2,200 outstanding trial lawyers to pursue precedent-setting and socially significant litigation. It has a wide-ranging litigation docket in the areas of consumer rights, worker safety, civil rights and liberties, toxic torts, environmental protection, and access to the courts. TLPJ is the principal project of The TLPJ Foundation, a not-for-profit membership organization. It has offices in Washington, DC, and Oakland, CA. TLPJ's State Coordinators for California are J. Gary Gwilliam in Oakland, tel. (510) 832-5411; and Monica M. Jimenez in Santa Ana, tel. (714) 542-7395. The TLPJ web site address is