BULLETIN NEW YORK STATE PSYCHIATRIC ASSOCIATION Fall 2001, Vol. 44, #3 • Bringing New York State Psychiatrists Together President’s Message: Responding Coping With Bioterrorism Anxiety to Disaster and Aftermath The following is a press release from the APA central office. It is intended for the lay press and is reproduced here for your use with your patients and to help answer questions from the by Jim Nininger, M.D., President, New York State Psychiatric Association public. Feel free to distribute as needed. –Ed.
s I write this referral. Members should ear and anxiety are normal dren, especially when it is viewed message, thou- contact their district human reactions to a perceived repetitively. A sands of psychia- branches directly. Hospi- Fthreat or danger. But such Find ways to distract yourself from trists in New York City, tals, clinics and social uncertainty is manageable if people thinking about the potential for harm. New York State and service agencies also are keep the threat in perspective, the Get involved in an activity that you across the country are offering counseling and American Psychiatric Association said can control: work in the garden, clean responding to the attack referral. Help is out there. today. the basement, do volunteer work, take on the World Trade Psychiatrists are espe- “The reports and images of the up an old hobby, take a “time out” Center and the Pentagon. cially prepared by their September 11 atrocity and recent and go to the movies or a play. There are thousands of training and expertise to bioterrorism are frightening to all of casualties, tens of Jim Nininger, M.D. address the short and long us,” says Richard K. Harding, M.D., [See Bioterrorism on page 2] thousands of family term impact of this event. APA President. “But knowledge and members who must deal with the loss Whether it is called shell shock, battle information based on fact can help us As we were going to press, the of loved ones and millions of virtual fatigue, Vietnam War syndrome or manage our understandable anxiety.” eyewitnesses in every corner of this post traumatic stress disorder, psychia- The Association offers the follow- tragic events of September 11, nation who saw over and over, and in trists know about the impact of this ing advice on how to live with the fear 2001 were unfolding. This issue excruciating detail, the face of evil on type of disaster. The true scope of the and anxiety caused by the threat of of the Bulletin is over one month September 11th. psychiatric problems from this tragedy bioterrorism. late and contains a mixture of NYSPA has responded to a request will be seen not just over the ensuing Educate yourself about the poten- pre-September 11 and post- from Commissioner Stone of the NYS months, but over years, and not only tial danger. Facts are frequently less Office of Mental Health and prepared among those who were at “ground frightening than rumors and myth. September 11 items. You are a list of psychiatrists who are ready to zero” or who lost, or feared they had The federal Centers for Disease encouraged to e-mail me with volunteer their services to those in lost, a family member or friend, but Control is an excellent source at any news from your individual need. Psychiatrists who want to add also among those who only viewed www.cdc.gov
Dr. Crowner is on staff at Manhattan Psychiatric Center. What follows is a description of the Legislative Year in Review sometimes mysterious disciplinary processes in place in New York State. Additional by Richard Gallo, NYSPA Legislative Consultant information can be found at
Page 2 New York State Psychiatric Association • THE BULLETIN Fall 2001 AREA II TRUSTEE’S REPORT Central APA Reorganization and Money Issues by Herb Peyser, M.D.
PA’s reorganization action item on that. tion in governance for women and mitment, can be permitted. The is moving APA’s other minorities. death penalty for juveniles was Getting Help From opposed. APA will again strongly Ashape towards a Money Experts The Board retreat, held with more vertical, organized, increased austerity in accordance with press the World Psychiatric Associa- centralized, corporate and In addition I devel- the reallocation, focused on access to tion to be more active in its investi- efficient one, more a oped, and NYSPA and care, with, among other matters, gation into the question of the pyramid than the horizon- the Assembly approved, developing how to work with family misuse of psychiatry in China tally layered stack of a plan to develop an practitioners in the area of mental against the Falun Gong. pancakes it seemed before advisory council of health care. APA members will be informed regarding the new federal privacy (DBs, Areas, Assembly, neutral business and Revenues Board, management). It financial experts from guidelines, especially of psycho- the outside, with some APA net non–dues was defined and therapy notes. The Board pushed for had ought to be done but, Herb Peyser, M.D. as with everything, there members appointed by revenue sharing of that with the DBs limiting the prescribing of restraint are positives and negatives. and for governance (Board and will proceed along last year’s lines, and seclusion orders to licensed Assembly), and others similarly by with $5,000 to each state and distrib- physicians. An initiative for public New Executive Committee and for management. Their input uting the rest per capita. The APA dues disclosure of managed behavioral The Board now has a seven person regarding our enterprises, available rate moratorium will continue. health care carve–out cost contain- Executive Committee, officers only, as soon as possible, will help the Review with an eye to cost–efficient ment strategies was supported. that meets biweekly by phone and can Board maintain its fiduciary respon- organization of central staff office The Borderline Personality take action if necessary. It plans to act sibility. space is in process. Disorder guidelines were approved. ■ only in “housekeeping” and emer- The importance of representa- PAC gency situations and will report tional governance’s full understand- regularly to the full Board by e-mail ing and oversight of APA’s The PAC was set up now that we WANTED and at the regular quarterly Board entrepreneurial activities cannot be are a 501[c][6] corporation, and a meetings. The fourteen other voting overemphasized. Pyramids may be check–off box will appear on the dues Editor-in-Chief for The Board members have requested some more efficient than pancakes but notice. Funds were approved for Bulletin of the New York parameters and plan to be carefully they have their problems. Mississippi and Iowa for work in the State Psychiatric area of parity legislation, and for Association. attentive. Remember the Sunbeam Georgia and Louisiana in the area of Fiasco If interested please send cover letter Power to Amend By–Laws scope of practice legislation. with CV to Bulletin Search Committee, c/ For one disturbing example, APA’s Similarly, the reorganization had Sexual Predators and Other o Donna Gajda, NYSPA, 100 Quentin AMA delegation reviewed what granted the Board more power re Legal Issues Roosevelt Blvd, Garden City, NY 11530 happened in pyramid–structured amending APA’s By–Laws in BEFORE FEBRUARY 1, 2002. The AMA several years ago in that unfor- An amicus brief will argue for “housekeeping” and emergency successful applicant will be appointed tunate Sunbeam matter where AMA limitations on the circumstances in situations. Concerns expressed in Associate Editor for the remainder of had to withdraw at great expense which special non-criminal commit- the DBs and Assembly have resulted 2002 and then take the helm on from that questionably proper ment of “sexual predators,” outside in including the Assembly more. January 1, 2003. (There can always be a referendum enterprise. AMA then let its Executive the normal standards of civil com- of the members.) Vice President and top staff go. Money, Money, Money Echoes of Sunbeam continue to reverberate along with concerns over Then there’s central APA’s signifi- an unhappy real estate matter, and cant involvement in activities with AMA has now let its new Executive major legal, business and financial Vice President go too; he then sued implications. APA, as other profes- AMA. Informed governance participa- sional organizations, is suffering tion such as we work for in APA and gradual membership attrition and in that action item might have entering an era of projected poten- helped AMA prevent such things. ABBOTT tial budget deficits. In addition to Data, Data, Data decreasing expenditures and con- LABORATORIES serving reserves APA continues After working on this for a couple seeking non-dues income produc- of years I think we are on the road to NEUROSCIENCE ing initiatives to support its advo- getting our Information Service to cacy and education work, but work. It has not been easy. I have members properly get concerned gotten central APA together with the Makers of DEPAKOTE (Divalproex Sodium) when it appears APA might be DB execs, governance and our getting in bed with pharmaceutical components experts, and now they and managed care industries. Major agree first to fix what is broken: the expenditures, such as Information dues billing, reports to the DBs, To contact: Service purchases, Medem.com, transfers, applications, reinstate- etc., have to be watched closely. ments, the database, etc., and then Peter Mastrandrea - NYC District Manager Lack of Money Smarts work with the DBs on simplifying the complex, expensive membership 631-427-3267 The Board, with fiduciary respon- categories and procedures. Only sibility, has a watchdog mandate but when this is done and credibility is unlike most boards of for–profit restored will they work incrementally and other non–profit organizations, toward an overall integrated system, Dino G. Garistina - NJ and Long Island Sales Manager which include many business and proceeding only after each clearly financial people. APA, however, is a established success. The final system 856-231-1287 membership organization, elects will be expensive, over $3 million. only members to its Board, people No commitment yet. As several of us without major business and finan- insisted, the Information Service Gretchen Gedroiz - NY State (except NYC and Long Island) cial expertise. APA’s Trustees must must prove itself first. The Board nevertheless vote on issues involving voted about $130,000 this year (and 518-434-0827 significant expenditures and initia- perhaps $70,000 more next) to get tives with legal, business and the broken parts fixed. financial risk, and have done so on Responsiveness of Central Benedetto (Ben) Palombo - NY/NJ Medical Liaison various occasions without full Staff and Other Matters neutral expert input. 609-221-4449 Before business and financial Other matters: The Board sup- documents are signed or enacted ported the Assembly in requesting APA’s Counsel should review and the Medical Director to report on the explain them to governance before matter of adequate responsiveness of and at the meetings where they are the central staff to membership voted on. This is usually but should requests. Movement will be made in always be done, and I’ll develop an the direction of parity of representa-
Fall 2001 New York State Psychiatric Association • THE BULLETIN Page 3 NYSPA COMMITTEE REPORTS
Addiction Submission of these forms to NYSPA This list would be helpful in identify- organizational responsibility within will make it possible for NYSPA to ing regions or programs with fewer the American Academy of Psychiatry Psychiatry approach either managed care compa- members thereby enabling us to focus and the Law (AAPL) and/or the nies individually or the Insurance our recruitment efforts where they are American Academy of Forensic Committee Department with patterns of actions – most needed. Sciences (AAFS). It has, for example, by Michael M. Scimeca, M.D. or inactions. Without this effort, This autumn the Committee will become customary to invite the out- psychiatrists are left on their own and be launching a new annual Area 2 going president of the Tri–State The NYSPA Addiction Psychiatry are likely to be treated by both the MIT Newsletter to inform MIT’s about Chapter of AAPL to join the NYSPA Committee has met approximately managed care administrators and the upcoming events and issues such as Committee on Psychiatry and the Law. every two months between September Insurance Department as isolated the Area Council Meetings. It is The Committee functions as a and June 2001. situations. hoped that this will stimulate candi- “think tank” considering both issues The member- The third area relates to CEA dates to apply for nomination to MIT referred to it for evaluation by the ship has member participation in the Empire Deputy Representative to the Assem- elected officers of NYSPA and issues increased, Medical Services Carrier Advisory bly, as well as disseminate informa- raised by its members. The task is to including Committee. Edward Gordon, M.D. is tion about the APA to residents. apply psychiatric expertise to legal participation the representative from NYSPA to the The election process of the Area 2 issues that impact on the practice of from Westchester and Long Island as CAC. This year, EMS revised its Local MIT Deputy Representative has been a psychiatry, regulation of psychiatry well as the New York City District Medical Review Policy regarding Part topic of discussion for some time and socio–legal policy. Much of the Branches. The committee has paid B Mental Health. The originally now. While it was considered impor- work of the Committee now takes careful attention to developments in proposed policy was extraordinarily tant to maintain an elected position, place by email, whereas in the past OBOT, that is, Office–Based Opioid restrictive and totally unacceptable. at the same time, we considered face-to-face meetings were needed to Therapy. Buprenorphine, in a combi- For instance, it noted that psycho- methods to alter the process some- conduct business. On occasion, the nation form, is expected to be avail- therapy was an “adjunctive” treatment what, in order to give applicants from Committee meets jointly with other able for all licensed physicians to that was “rarely” indicated. Dr. upstate a better chance, despite NYSPA Committees to consider how prescribe probably in 2002. The Gordon and Seth Stein worked population differentials. We are best to implement action on specific Committee has expressed concerns extremely hard on explaining the limited by the fact that training is issues. about the need for special training so inadequacies and inequities implicit brief, and it can be difficult to get Among the matters that have been that this medication and all other in their proposal. The final policy — trainees involved within such a short considered this past year by the opioids agonists are properly pre- issued in May 2001 — while not all time. The election process remains Committee scribed and patients get appropriate we requested, is much improved. At one of our top priorities, which we on Psychia- psychosocial treatments. The Commit- this current time, the CAC is consider- will continue to address in the try and the tee recently had a very informative ing its drug screening policy. Again, upcoming year. Law have update from the new Medical Director their original policy was extremely Over the past year, the MIT Com- been (1) of the NYS Office of Alcohol and restricted (it did not permit any mittee wrote and presented several the con- Substance Abuse Services and will psychiatric diagnoses as a justification Action Papers on the APA Assembly tinuation cosponsor educational/training events for drug screening) and Ed and Seth Floor. One such Action Paper was and in the future and serve as a conduit for have been attempting to educate the passed to explore the establishment of expansion other addiction treatment informa- EMS staff. a formal fellowship award in Child of the tion. Members of the committee also We have not reached closure on Psychiatry so as to attract more Assisted share updates in clinical practice and any of these issues. We expect all of interest in this underserved specialty. Outpatient Treatment program, (2) other professional information. them to be current in the coming year. Several other ideas for Action Papers the potential impact of legislation to How to confront issues such as are currently being explored as well. mandate the civil incarceration of phantom networks has vexed us. For Communication among MIT’s has sexual offenders after completion of Committee on that issue, we would be dependent improved substantially this year with their prison terms, (3) whether or not upon patients informing us of the the establishment of monthly confer- the use of video equipment by Economic Affairs difficulties they have finding psychia- ence calls involving the MIT represen- voyeurs should be made a felony– trists, while not tarnishing the reputa- tatives of the Area District Branches. level offense. by L. Mark Russakoff, M.D. tion of psychiatry in the state. Although this has now become a On the matter of Assisted Outpa- regular activity for our MIT Commit- tient Treatment (i.e. civil involuntary Over the past year, members of the tee, our goal is to improve the variable outpatient commitment), the Com- Committee have been involved in Member-In- attendance in the coming year. To this mittee was concerned that the three major projects. end, it has been proposed that each research project that had analyzed The first project was the collabora- Training District Branch appoint an alternate the results of the trial program at tive Committee representative to attend conference Bellevue Hospital had reached an develop- calls if the appointed representative is equivocal conclusion. Further, the ment of by Shauna P. Reinblatt, M.D. unavailable. In the last year we have Utilization identified all but a few missing Review Addressing declining resident mem- District Branch representatives whom CLASSIFIED standards bership in our Area of the APA has we continue to seek. ADVERTISEMENTS for Medic- been a top priority for the Committee At the last Spring Area Council aid. This of Members-In-Training over the last Meeting, the MIT Committee decided task was year. Various outreach efforts are that any interested MIT (in addition Rates for classified ads are $60 (minimum) directed by members of NYS Office of to the District Branch Representatives for the first three lines, $10 per line Mental Health. NYSPA was repre- to NYSPA) would be welcome to thereafter. NYSPA members receive a 50% sented by Jim Spencer, M.D. Notable attend future Area Council Meetings. discount on the minimum rate. All ads must in the final product were reasons to This should help to attract and retain be prepaid. Contact Donna Sanclemente for extend a patient’s stay beyond the motivated members and thus expose pricing of your copy and payment point of loss of acute risk for danger- them to opportunities available arrangements: 732-438-0954 or email ous behavior. The inclusion of real within our Committee. [email protected]. clinical criteria into the UR standard We have made progress improving set was not an easy task. Dr. Spencer the lines of resident communication, PATIENTS WITH ALCOHOL PROB- alerted OMH and DOH of the impor- ongoing with the aim of enhancing but more work remains to be done. LEMS? Dr. Conor Farren and Mount tance of educating psychiatrists about communication among the resident The recruitment and retention of Sinai School of Medicine are conduct- the criteria, and volunteered to members of our association. One resident members will be of utmost ing a research treatment study of the participate in such activities. such measure involves the establish- priority, so as to ensure the continued combination of two medications plus The second project was developed ment of Interbranch Member-In- and future success of our committee psychotherapy for alcohol dependence. by Eliot Roy Singer, M.D. from Training (MIT) meetings. With the and our organization. Call Amelia 718-584-9000 x6969 for Westchester. Dr. Singer’s efforts have fragmentation of our large geographic information or referral. GCO # 99.598 been directed against the abuses of area into many smaller District Approved through 8/31/02. Managed Care. He noted that there Branches, activities to reduce the Committee on are few strict rules to which we can distance among residents would PSYCHIATRIST(S) - FT/PT, Board Cer- hold the managed care companies. increase our cohesiveness and help to Psychiatry and tified or within 3 years of completion The one area in New York which is increase membership. ‘Movie Nights’ the Law of residency. VA Hudson Valley Health clear relates to prompt payment of and similar events would encourage Care Services, Castle Point Campus. bills. The result of this effort has been MIT discussion, interest, and partici- by Richard Rosner, M.D. Work in Mental Health Clinic, Consul- the creation of the Prompt Payment pation in the APA. Another member- tation-liaison with medical and long Complaint Form. The purpose of this ship project involves the creation of a The NYSPA Committee on Psychiatry term care units, PTSD patients. May in- endeavor is to collate information database of psychiatry residents and the Law is composed of Board clude PT at Community Based Clinics about how the various managed care within our Area so that they might be Certified forensic psychiatrists, who in Orange, Sullivan, Dutchess and companies are treating psychiatrists. informed in future membership plans. usually have held prior positions of Putnam Counties. Contact Ms. Monica DeRonda at 914-737-4400 X 2567. NYSPA COMMITTEE REPORTS
Committee was concerned that the The video–voyeurism case that minority representation and area • Goals Implementation: In Sep- consequences of violating the terms caught the attention of the legislature and district branch leadership. tember 1999 a planning day was of the Assisted Outpatient Treatment involved a building superintendent Chaired by Deborah Cross, M.D. held for all NYSPA committees to program were "toothless", i.e. failure who had secretly videotaped selected and Ann Sullivan, M.D., the com- develop action plans based on the to comply with civil involuntary tenants in various states of mittee first met in September 1998 NYSPA mission of aggressive outpatient treatment did not auto- undress.The issue was complicated and will finalize its report in Octo- advocacy. Plans were submitted to matically lead to involuntary com- because relatively little research has ber 2001. the council for review and en- mitment. The proposed legislation been done on this subpopulation of dorsement. included a broader potential popula- voyeurs, so that empirical data to tion for civil involuntary commit- guide legislation is extremely limited. • Communication: A committee of ment than had been included in the However, as the current penalty is District Branch Presidents was trial program at Bellevue Hospital only 15 days in New York State, it established to enhance communi- (e.g. forensic patients and patients was felt that a felony-level penalty for cation between NYSPA and the who did not freely agree to particpate the offense would give law enforce- District Branches. It was recom- in the program) so that it was ment personnel more leverage in mended that committee chairs uncertain that the Bellevue Hospital persuading video-voyeurs to partici- periodically join Executive experience could be extrapolated pate in treatment programs, increas- Committee meetings. Bulletin soundly and effectively to the larger ing the potential long-term articles emphasized membership recruitment and input into the potential population. Some of these protection of the public at large. Highlights of the committee’s planning process. matters were considered in articles The Committee appreciates the actions and recommendations to previously published in The Bulletin. opportunity afforded by this special date include: • NYSPA Administration Structure The psychiatric hospitalization of issue of The Bulletin to bring its work • NYSPA adopted the Mission and Budget Review: Comparing convicted sexual offenders after the to the attention of the NYSPA Statement: Aggressive Advocacy the overall Budget of NYSPA to completion of their prison terms membership. for our patients and our profes- other comparable state District raised concerns about the appropri- sion Branches found it to be efficient ateness of placing criminals with and cost effective. NYSPA cur- • Member Input: A survey to assess difficult-to-change personality rently spends approximately 60% Strategic Planning what membership expected of disorders in hospitals designed to of its budget on advocacy activi- NYSPA was randomly sent to 700 treat persons with Axis One DSM-IV Committee ties, the most valued activity by members and 161 responded. diagnosis. There was the problem its members. The overwhelmingly important that, once admitted, such persons by Ann Sullivan, M.D. activities to the members involved The Strategic Planning Committee would be unlikely ever to be released active legislative advocacy; will endorse its final report in the into the community (because of the Planning for the future energizes an Legislative efforts to regulate fall of 2001. However, the need for difficulty in guaranteeing their organization, gathers new ideas and managed care; Parity; supporting ongoing suggestions, creative ideas safety), so that they would gradually recommends key actions. The litigation against insurance and critical review by the member- take up more and more of the NYSPA Area Council established a discrimination; protecting psy- ship continues. Remember to inform limited bed space available for Strategic Planning Committee in chiatrists scope of practice. your Assembly Representatives of persons whose conditions could be 1998 to develop a comprehensive Members also placed major what NYSPA can do for your and treated effectively. The Committee mission and specific goals for the emphasis on the camaraderie and your colleagues. felt that such persons should be held next four years. The committee fellowship of the organization in correctional facilities rather than included area representation state and patient advocacy issues. ■ in psychiatric facilities. wide, ECP’s, members in training,
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revised copy coming (wrong format originally sent) PORTRAIT OF A PSYCHIATRIST The Psychiatrist As Artist & A Concert for NARSAD by Roxanne Lanquetot
Dr. Kogan was a member of my residency training class at NYU-Bellevue 1983-87 and is a philanthropy that raises funds for Council. Dr. Greengard received very nice guy. We see each other at the APA Annual Meetings where for the past three years research in mental illness, concentrat- NARSAD’s Lieber prize for Schizo- he has delighted audiences with his musical and psychiatric insights into the lives of famous ing on all brain disorders but espe- phrenia Research in 1996 and a composers from Beethoven to Gershwin -Ed. cially the most disruptive to patients’ Distinguished Investigator Grant in lives—schizophrenia and manic– 1992. Dr. Kandel was awarded ncreasingly rare in this period of depression. Since its inception in Distinguished Investigator grants in over–specialization, a few Renais- 1987, this not-for-profit organization 1995 and 2000. The third awardee, I sance men can still be found in has raised more than $112 million in Arvid Emil Carlsson, M.D., received medicine. With two careers, one as a research grants for 1,300 scientists at the Lieber prize in 1994. concert pianist and another as a 172 universities and medical research NARSAD and Families psychiatrist, Richard Kogan, M.D. is institutions worldwide. It is supported probably as close as anyone around. by contributions from individuals, I am a member of NARSAD’s Dr. Kogan studied piano with Nadia families of the mentally ill, founda- Leadership Council, mainly family Reisenberg at the Julliard School from tions, and corporations. Every dollar members who are faithful supporters age six to eighteen, supplementing his given to NARSAD goes to funding of the organization. Council mem- training with the legendary teacher, research grants, because the operating bers organize benefits such as this Nadia Boulanger, at the Ecole de expenses are covered by separate concert. They hold seminars to inform Fontainbleau, in France. His mother, grants from two family foundations. the general public about mental formerly a music teacher, recognized The Scientific Council, volunteers illness in order to alleviate the stigma her son’s innate talent and perfect composed of 65 leading national attached to being mentally ill. When I pitch when he was only four-years-old research scientists, identifies the most joined, I felt that I gained a new and steered him towards the piano, promising research among the many family, and in fact, NARSAD support- his first profession. Another influence applicants. Constance Lieber is the ers are often called “the NARSAD was that of his father, a gastroenter- President of the Board of Directors FAMILY”. Bound by the tragedies of ologist, who introduced him to and Jerry Callaghan the Chairman. our children’s lost lives, we work medicine, his second profession, by Members of the board have relatives together for a common cause. allowing his young son to accompany who are mentally ill, which gives The researchers I have met at Richard Kogan, M.D. him on medical rounds. He was them a vital personal interest in NARSAD are kind, friendly and playing concerts by age seven, but due cycle of the four stages of lovemaking- making the organization successful.. helpful. to his wide variety of interests, he desire, arousal, climax, and resolu- Grant Programs Always ready to answer questions chose to attend Harvard College after tion-are represented in the structure of and explain their work without being graduation from high school rather music, for example in Wagner’s NARSAD has three grant programs. condescending or overly simplistic, than a conservatory where the focus “Liebestod” or the last movement of The Young Investigator Program they make it comprehensible to those would have been almost exclusively Robert Schumann’s “Fantasy”, a secret awards grants of $30,000 per year for of us who are not scientists. Every fall on music. His roommate at Harvard love letter to Clara. “Good music, like two years to young scientists who are Young Investigators present a series of was Yo-Yo Ma, whom he met at good sex, relies on prolongation, on beginning their careers. Constance seminars to explain their work, and Juilliard, and the two formed a trio delaying the satisfaction of expecta- Lieber believes that young investiga- the seminars are open to everyone. In with the violinist Lynn Chang, tions. Great composers, like great tors are the hope of the future. July we had the honor of hearing a another Harvard student destined to lovers, know this instinctively,” said Independent Investigator Awards for speech by Eric Kandel and seeing a become a musician. Dr. Kogan. Beethoven was thwarted in more established researchers amount videotape of the Nobel Prize Awards acting on his sexual and emotional to $50,000 per year for two years. Ceremony in Stockholm. Onto Harvard Medical Distinguished Investigator Awards of Dr. Kogan’s response when I asked School feelings, which he consequently poured out into music. Schumann, an $100,000 are for full professors him to give this concert for NARSAD By the time Dr. Kogan began obsessive personality, used sex as a involved in unique research. In reflects his concern and care about the Harvard Medical School, he was way of organizing his life. Franz Liszt’s addition three special awards are mentally ill. His offer to volunteer his already an accomplished musician. hypersexual personality comes out in given for momentous contributions to time and talent to raise money for The dean of the Harvard Medical his flashy, virtuosic music. the field — the Lieber Prize for NARSAD research comes from his Schizophrenia Research, the Nola belief that the organization is ex- School created a special five year Creativity and Madness schedule which allowed him to travel Maddox Falcone Prize for Affective tremely important in furthering better and concertize between his medical One of Dr. Kogan’s main interests Disorders Research, and the Ruane treatments and cures for psychiatric clerkships. He won first prize in the is the relationship between creativity Prize for Outstanding Research in disorders. Tools now available for Chopin Competition of the and mental illness, and he gives Childhood and Adolescent Psychiatry. clinicians and researchers promote Kosciuszko Foundation while still an lecture/performance demonstrations Amounting to $50,000 each, they are discoveries that weren’t possible undergraduate, and then the Concert on the emotional lives of great the largest awards especially aimed at before. Schizophrenia and Bi-polar Artists Guild Award and Portland composers and the ways their psycho- brain disorder research. illness affect millions of people who Symphony National Piano Competi- logical problems influenced their art The NARSAD–Nobel may be helped due to NARSAD’s tion. He has performed as a recitalist and creativity. Would artists such as Connection effort to conquer the mysteries of and orchestra soloist throughout the Robert Schumann have been as mental illness. The promise of United States, Europe, and Asia and as creative if they were not mentally ill? The three winners of the Nobel NARSAD holds HOPE for these a chamber musician with Yo-Yo Ma How do composers sublimate their Prize in Medicine in the year 2000 are people and their families. and Lynn Chang. suffering and convert it into creativity? affiliated with NARSAD. Eric Kandel, For information about the concert M.D. and Paul Greengard, Ph.D are please call Kristi Dodson at NARSAD, Mind and Music Desire to Help currently on NARSAD’s Scientific 516-829-0091. ■ Dr. Kogan’s two principal interests When I first spoke to Dr. Kogan led to his exploration of the connec- about this article, his mellifluous tion between music and the mind. voice made me remember him from “Music and medicine are both about his rotation on the children’s ward at healing,” he said. He decided to Bellevue where I worked, and I was specialize in Psychiatry, because he delighted to renew our relationship. I had always been fascinated by the recalled how intently he listens in brain. His interest in treating people order to understand and communi- with sexual dysfunctions developed cate with you. Caring deeply about during his residency in Psychiatry at improving patients’ lives, he gives NYU/Bellevue when he became aware benefit concerts for health related of the widespread prevalence of sexual organizations such as the Hadassah, problems and sought to develop the the American Cancer Society, the skills necessary to improve these National Multiple Sclerosis Society, frequently treatable conditions. He is and Music for Healing. On March 6, currently the Director of the Human 2002 he is scheduled to give a concert Sexuality Program at the Weill– for NARSAD (the National Associa- Cornell Medical Center and New York tion for Research in Schizophrenia Presbyterian Hospital. and Depression) in Weill Recital Hall Sex and Music at Carnegie Hall. NARSAD Descriptions of the profound connections between sex and music NARSAD is the largest donor- can be found in the Kamasutra. The supported, non–governmental Page 6 New York State Psychiatric Association • THE BULLETIN Fall 2001 Discipline policy, there is no such thing as High Fees case is closed. Both physician and the consensual sexual relations between complainant are notified in writing Continued from page 1 Patients often complain that a doctor of any specialty and his or and a record of the investigation is physician’s fees are too high. Charging her patient. Sexual relationships kept in OPMC files for possible Initial Review what the patient believes is too much between a psychiatrist and his or her future reference. is not considered misconduct but Complaints are first reviewed by patient is, per se, misconduct. The charging for services that were never When Misconduct is staff of the OPMC to decide which Miller case, heard in the 1990’s, delivered is fraud, which is. Fraud is Established may be complaints of physician served as a precedent by which an act intending to deceive. Physicians misconduct as defined by state law physicians in other specialties who At the next level, where investiga- can also be charged with excessive and and which are not. Most complaints have sexual relationships with their tors believe there is evidence of unnecessary testing, another form of are not. Patients and their families patients can be prosecuted for misconduct, they refer an investiga- fraud, and with promoting the sale of often report behavior which may not misconduct. tive report to a committee made of goods and services in a way that be the best practice, but which does three members of the Board. Two Impaired Physicians exploits the patient. Fraud is the not meet the legal definition of committee members must be physi- second most common reason for misconduct. The law also addresses physician cians and one a layperson. The Board physician discipline in New York State impairment. It identifies four types: has about 160 members, 2/3 of What is Misconduct? and one of the most common reasons physical, mental, by alcohol, and by which are physicians, who are for revocation of licenses. There are 48 types of medical other drugs. To be considered appointed by the Commissioner of misconduct enumerated in New York misconduct a physical disability must Promising a Cure Health after an internal vetting State Education Law. These include impair the physician’s ability to process and a review by the When appropriate treatment does negligence and incompetence. practice in his or her chosen area of Governor’s appointment office. not result in cure, or the outcome the Negligence is defined as the failure to practice. Therefore, while a blind patient wished, the physician may not Final Steps treat a patient, as would a reasonably doctor could not legally (or practi- necessarily be charged with miscon- prudent physician in the same cally) perform surgery, he or she After the committee reviews the duct, but when the physician guaran- situation. Patient injury is not could maintain a psychotherapy evidence it recommends one of tees a cure he or she could certainly be required to demonstrate negligence, practice. The other three types of several options to the Director of charged. Misconduct is also perform- though it is in malpractice cases. impairment need not be in the OPMC who, after consultation with ing services the patient did not Either one act of gross negligence or practice of medicine to qualify as the Executive Secretary, makes the authorize and failure to maintain multiple acts of less serious negli- misconduct. final decision. The committee may gence can constitute misconduct. appropriate patient records. Rudeness recommend further investigations. It Incompetence is lack of requisite Investigations may recommend a physician impair- skills or knowledge to practice Patients or their family members ment exam or an assessment of After initial triage, those cases, medicine. As with negligence, a often complain of rudeness or long clinical skills. It may recommend which seem to meet the standards for physician must be found practicing waiting times. Rudeness or lack of a warnings, an action, which is not misconduct or raise serious suspi- with incompetence on more than caring attitude (as perceived by the punitive but educational. OPMC cions, are investigated by an OPMC one occasion or to have committed patient) may not of itself be miscon- issued 121 such administrative staff member and a physician coordi- one gross act to be prosecuted. duct, but willfully harassing, abusing warnings in 2000. The committee nator. Nearly always the investigator Negligence and incompetence often or intimidating a patient is. Miscon- may decide there is insufficient interviews the physician and the occur together and are prosecuted duct is also denying care because of a evidence to support charges of party who complained and reviews together. patient’s race, ethnicity or religious misconduct. If it does, the case is relevant medical records. At this background. Misconduct is abandon- closed, the physician and complain- Sexual Abuse interview stage and at all stages of the ing or neglecting a person who is in ant are notified and a record is kept process the physician has the right to Sexual abuse of patients is also need of immediate care after a in OPMC offices. Or, the committee have legal representation present. misconduct, whether the abuse is by doctor–patient relationship has been may decide there is sufficient evi- Investigators may or may not find verbal means, as in suggestive established. dence to warrant charges. If there is remarks, or by inappropriate touch- enough evidence to support a charge ing or by genital contact. By State of misconduct. If they do not, the [See DISCIPLINE on page 8]
on counseling or coordination of care, MediComment: in which case the time spent controls the level of billed service. You would Coding Q & A have to document the time spent, the nature of the coordination of care By Edward Gordon, M.D. given. In the absence of a patient present, the note still would not withstand audit. 99213 is entitled: “Office or other outpatient visit for the evaluation and management...” Hard to evaluate an absent patient. Better, and safer, to bill the family for the services provided to them. Code it 90887: Interpretation or ELI LILLY AD explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data Ed Gordon, M.D. to family or other responsible per- sons, or advising them how to assist patient. Q. I was scheduled to see a de- 90887 is not a Medicare covered mented patient yesterday for medica- service. You are free to use it for your tion management, but she was unable own purposes, and can bill family to attend. Her daughter and a members directly. It is a good idea to caregiver did come, and I spent 20 advise them of the non-covered status minutes with them reviewing recent in advance. symptoms, medication management, ■ prognosis. I didn’t bill anything yet, but can that be billed under 99213? Send questions regarding The CPT descriptor that the service needs to be provided “face–to–face coding, Medicare, managed with the patient and/or family.” care practices and denials, A. For E/M services, the patient is documentation, other problems intended to be examined, and there- with managed care, or other fore present. In situations such as this, practice problems that you where family members need help in managing the patient, I usually advise have experienced, together the family that his is not a Medicare with documentation to : covered service, and that they will be MediComment c/o The Bulletin privately billed. They generally agree. (address on page 2) or by e- You are then free to charge any mail to NYSPA at reasonable fee that can be agreed upon. [email protected]. You are making the point that you are providing an E/M service, based
Fall 2001 New York State Psychiatric Association • THE BULLETIN Page 7 Legislative Update Discipline Continued from page 1 Continued from page 7
Mental Health Practitioners introduction by Senator John Marchi an imminent danger the health can also suspend, revoke or annul (R-Staten Island) of Senate bill 5381 commissioner may immediately the license. The organizations representing — a companion bill to A.4506. suspend the physician’s license. the mental health practitioners, (i.e. Appeals Senator Marchi’s action marks the the marriage and family therapists, The Hearing first time the two houses have had At the 5th and last step, either the mental health counselors, creative identical bills on parity sponsored When the committee recom- state or the physician can appeal to arts therapists and psychoanalysts) by members of their respective mends proceeding with charges, the the Administrative Review Board of have agreed to major changes in majorities. Director, after consultation with the the Board of Professional Medical their bill. The changes accommodate A.4506/S.5381, if enacted, would Executive Secretary, can order the Conduct. This board is composed of most of the concerns voiced by require health benefit plans in New legal department to draw up three physicians and two laypersons. organized medicine, including York State to cover mental illness to charges and to proceed to a hearing, The disciplinary system in New language prohibiting the four the same extent, terms and condi- which is much like a trial. The case York is large and complex because it professions from treating seriously tions as any other illness covered by is heard by another three–member values due process for doctors. Due mentally ill persons without a case the plan. Plans without benefits for committee of the Board, composed process is the right to be heard in a by case medical evaluation and mental illness would be required to of two physicians and a layperson. timely fashion. The system also consultation with a physician to initiate them on an equal basis with One physician member is nearly values quality care and conscien- determine whether medical care is other covered illnesses and condi- always trained in the same specialty tious, careful professional behavior. indicated for such persons. tions. The bill excludes ERISA as the physician who is charged This article was prepared after Regarding the licensing of psycho- exempt and Workers’ Compensa- when patient care is an issue. Both discussions with executive staff at analysts, we have been unsuccessful tion/No-Fault plans. the respondent (the physician OPMC. For more information call 1- in our effort to defeat the proposal Watch for more on the New York charged) and New York State are 800-663-6114 or log on to the web for a separate profession of psycho- State ECT saga in the next issue of represented by lawyers who call and site
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