• SoftBank-backed telehealth startup Cerebral is under federal scrutiny for its prescribing practices.
  • 30 interviews and over 2,000 documents suggest the company put growth ahead of patient safety.
  • A Cerebral spokesperson said the reports represented a small fraction of patients and that the former nurse's comment is baseless.

An online mental health startup that launched just ahead of the pandemic appears to have cast aside clinical psychiatry standards in the pursuit of growth, an investigation by Insider's Shelby Livingston and Blake Dodge has found.

Cerebral, the SoftBank-backed telehealth company that raised $462 million in funding, is currently under investigation by federal agencies including the Department of Justice, the Drug Enforcement Administration, and the Federal Trade Commission.

Now, a trove of internal documents including more than 2,000 incident reports and interviews with more than 30 current and former employees paint a detailed picture of Cerebral's business and medical practices.

A spokesperson for Cerebral, Dan Childs, said in a statement to Insider that the volume of incident reports should be placed in context with the size of the company's patient population.  

The reports are from a seven-month period in 2021, and Childs would not provide the total number of patients Cerebral treated in 2021. The startup had more than 210,000 active patients across 50 states and the UK at the end of March 2022, according to a presentation by Cerebral leadership obtained by Insider.

Under a temporary rule change due to the pandemic, healthcare providers have been allowed to prescribe certain controlled substances, such as Adderall, after an online visit, without an in-person consultation first.

The investigation also found the company relied heavily on hiring family nurse practitioners, who are trained in a wide range of primary-care services. Many FNPs were assigned to treat patients with serious conditions outside their training, the documents and workers said.

Prescriptions of controlled substances ballooned, ranging from around 7,800 to more than 13,000 per week earlier this year, according to company documents.

A psychiatric nurse practitioner who formerly worked for Cerebral told Insider they commonly saw Cerebral clinicians incorrectly treat conditions such as mood swings or depression.

"FNPs will just throw antipsychotics around like it's fucking candy — and it's not," the nurse said. "These are very serious medications with very serious side effects."

Childs said this comment is baseless and unsupported by any evidence.

Cerebral nurses in some instances also prescribed addictive medication to some patients who were already on medications like buprenorphine and Suboxone, resulting in potentially lethal drug combinations, according to several incident reports.

"The synergistic effects between these drugs slows respiration and heart rate, puts them to sleep, and they don't wake up again," said Dr. Anna Lembke, a professor of psychiatry and addiction medicine at Stanford University's school of medicine, describing the worst outcome.

Childs said the company conducts weekly drug screenings to monitor and prevent this.

An incident report quoted a Cerebral patient as saying, "You're sending me powerful neurological modifiers in a happy-colored box filled with Easter egg grass without doing the due diligence required to make sure none of these agents could kill me."

One former senior employee told Insider that cofounder and former CEO Kyle Robertson mostly didn't attend meetings about compliance matters.

"Kyle doesn't care," the employee said. "If it's not about profit, he just doesn't want to hear it." 

When reached for comment independently, Robertson deferred to his lawyer, who did not return Insider's request for comment.

Leaders who did attend compliance meetings, including cofounder and then-chief medical officer Dr. David Mou, would typically spend a just a few minutes reviewing incident reports before growing overwhelmed and defensive, two former senior employees told Insider.

Childs said the reports are monitored by various teams at Cerebral and used to identify areas of improvement.

When urgent patient-safety matters were raised, the executives refused to investigate, the former senior employees said.

Read Insider's investigation into Cerebral here.

Read the original article on Business Insider