Genesee Valley Psychiatric Association A District Branch of the American Psychiatric Association September 2006 Newsletter more important to current and prospective psychiatrist trainees President‘s Column developing their professional identities. The community problem of the aging and shrinking pool of Robert B. Young, M.D. psychiatrists is already limiting access to quality mental health care. Stephen Dvorin, MD, our long-serving Secretary and This is most acute for child psychiatry, with growing consequences Ethics Chair, and former Public Affairs Chair, was recognized in to the care of our young people. The University Department is our April by the Mental Health Association as this year‘s John Romano region‘s primary source of new practitioners, as it is our core Award honoree. He richly deserves this, for his many years of psychiatric educator and creative partner. Any change that attracts selfless efforts to combat stigma against the mentally ill and to fewer talented residents will worsen access to psychiatrists for a promote good treatment opportunities, especially for the severely long time. and persistently mentally ill. He has a broad view of these problems, as a long-standing private practitioner who left that a few The GVPA Council requested I write Dr. Caine, assuring years ago to devote himself to Strong Ties‘ chronically ill him and the Department of the GVPA‘s support for working to population. He has been a central figure at the MHA of Rochester attract a highly qualified Child & Adolescent psychiatrist to the head for many years. the Division. We strongly endorse the Department, the School of Medicine, and the University in intensifying this search, and would This award, named for its first recipient, John Romano, help in whatever way possible. Dr. Caine wrote back, expressing MD, has gone to a long and distinguished list of regional leaders in his commitment to ensuring that the clinical and educational work of mental health. These have included, just to name a few, Haroutun Child Psychiatry within the Department be led by such a Babigian, MD, the previous Chair of the URMC Department of psychiatrist. He and the WNYCCAP have met since to plan how to Psychiatry, Bernice Skirboll of Compeer, our own Jack McIntyre, continue working toward this together. MD of Unity Behavioral Health, Sr. Sheila Briody, DMin of St. Joseph‘s Neighborhood Center, George Roets of RPC and then *There are two interesting projects underway whose goals BPC, Glenn Gravino of CCSI, Dante Cicchetti, PhD of the Mt. Hope are to better represent physicians in third party payor contracting Family Center, and Emory Cowen, PhD for the Primary Mental and quality of care. Health Project. Steve‘s name joins a list of people celebrated for generous contributions to the well-being of our patients, and so The first is GRIPA‘s Clinical Integration initiative, which is adds further to the luster of that company. Congratulations, Steve, our area‘s first attempt to develop a panel of physicians whose from all of us! practice and performance are continually assessed for quality, standards, and marketing purposes, ―integrated‖ across office, On another subject, the Child & Adolescent residents at hospital, laboratory and testing interventions. It will be able to the URMC Department of Psychiatry became concerned about the negotiate with payors as a group, including fees. This is a possibility that a psychologist might be appointed to head the GRIPA/RGH project in which any member can participate. The Department‘s Division of Child & Adolescent Psychiatry. They only other successful model nationwide is a plan in Colorado, and it wrote Eric Caine, MD, the Chair of the Department of Psychiatry, is hoped that our local plan may become the next nationwide the Western New York Council on Child & Adolescent Psychiatry model. I attended a meeting in August, and found it interesting and (WNYCCAP), other concerned parties in the School of Medicine creative. One necessary aspect that may give pause to and the University Medical Center, and us in the GVPA. psychiatrists is the requirement that diagnostic and procedure data for ALL of a participant‘s patients (not just those covered by a There have certainly been difficulties recruiting a strong GRIPA plan) be provided to the shared database for clinical access physician educator and researcher for the directorship of the by any other participating provider, as well as for quality Division, despite significant efforts since the departure of John management purposes. That is clearly problematic from a Glazer, MD. The long interim status of this position is itself confidentiality perspective, and as it stands, does not seem easily problematic, and would best be resolved by recruiting just such solved. The initiative‘s chair, Eric Neilson, MD, readily recognized another respected child psychiatrist leader. There are many this problem and agreed to look into this, since it is likely of reasons that this is vital, from ensuring accreditation, to maintaining widespread implications beyond just psychiatry. (Think of patients the Department‘s national reputation for the highest quality medical with HIV or drug abuse diagnoses, employees of GRIPA or teaching and research, to the significance of that position in ViaHealth, as well as those with psychiatric diagnoses who would attracting future trainees. Identifying with that leader could not be not want anyone to know. September 2006 September 2006 I can‘t end this column at this time this year without The only current solution would be the physician‘s option mentioning the great news that the New York State Legislature, to notify the database manager to delete a particular patient‘s Assembly and Senate, has agreed on a Mental Health Parity information entirely, but that would adversely affect access to other measure that is to be passed on their return to session in parts of the patient‘s record that might be desirable to keep September. The devil is always in the details, but this would mark available. The second is the Rochester Community Private Practice a real advance in the recognition and support of the importance of Physician Organization (RC3PO, with credit to the Star Wars). This psychiatric care to the health of nearly all New Yorkers. The developed this year with the implicit support of the Monroe County Governor has not yet announced that he will sign it, so there will be Medical Society, over concerns about Excellus‘ plan to shift to further lobbying to do. That will be led as ever by NYSPA along direct contracting with area physicians. While it is understandable with the MSSNY and allied mental health advocacy groups. Upon that Excellus wants to standardize its contracting system across its its passage, all will deserve a great thank you. Please be sure to entire Upstate New York coverage area, it is potentially negative contribute your voice when asked to insisting that Governor Pataki that it will stop contracting through RIPA, which was able to sign the bill! represent our panel of providers and negotiate with Excellus. The point of the RC3PO is to educate the private practitioner about the * * * * * * * leverage one does have, both in ―respecting one‘s signature‖ (as has been a theme for years regarding contract participation) and There is a lot going on in our world. As always, please let opportunities to influence Excellus‘ positions. One interesting me know how we are doing for you, and please join us at the message is that anti-trust regulations only prohibit independent Council meetings (usually every second Wednesday evening at physicians from jointly negotiating fees; they do not prevent us from 7:30 pm at the Rochester Academy of Medicine). We are in the considering advice about that, or from actually negotiating virtually midst of updating our Constitution and Bylaws, which will later be any other contract term together. presented for a vote by the entire membership in order to be enacted. Please ask me or Sue Diesel, our Executive Director, or Many of us have reviewed and/or signed the Excellus any officer or Council member about whatever may be of interest to contract offered. You may not realize that those terms have you! improved subsequent to January‘s initial mailing. (Interestingly, though I‘ve been listed all year as having signed, I am actually waiting to see a contract myself.) It‘s been argued whether RC3PO‘s appearance is what influenced Excellus to improve its offer (e.g., permitting opting out of particular plans), but it seems a Stephen Dvorin, M.D. Receives healthy process that should be positive for physicians‘ futures as participating providers in such plans. I‘d emphasize that our local John Romano Award acquaintances within Excellus are extremely valuable and that as things stand, we may have been better served than some other places in the nation. Tom Meyer, Excellus‘ Director of Provider The Mental Health Association presented the 24th Annual st Relations, makes himself very available; Gene Schneider, MD, John Romano award to Stephen Dvorin, M.D. at its 1 Annual th Excellus Behavioral Health Medical Director advocates well the Gottschalk Lecture, held May 4 , 2006. Created in honor of the primacy of quality care. Yet physicians‘ reimbursement was late Dr. John Romano, founding chairman of the University of reduced and has stalled for some years now, and our work Rochester‘s Department of Psychiatry, the award recognizes a deserves much better. Look at www.RC3PO.com for all the distinguished leader in the local mental health field. information to date that this initiative has developed; this may be very helpful in clarifying options for dealing with the new contracting The award comes in recognition of Dr. Dvorin‘s exemplary approach. This may be beginning an appropriate shift in the thirty-three year career as a psychiatrist in Rochester. Dr. Dvorin dynamics of our relationships with major payors, which correlating began his career at Genesee Mental Health Center, continued for with the general movement away from plans with withholds, etc. many years in private practice, and joined Strong Ties Community Rather sympathetic articles have also appeared in local media, for Support Program in 1996, where he is preparing to retire as example ―Doctor Contract in Dispute‖, Rochester D & C, 8/11/06. Medical Director. Throughout his career, Dr. Dvorin has remained very active in the community, having served in volunteer leadership Finally, in the context of working with our colleagues in positions with groups including the Mental Health Association, East health care plans, Tom Neilans, PhD, now Preferred Care‘s Senior House, the Monroe County Medical Society, and the Genesee Behavioral Health Manager, spent time with the GVPA Council in Valley Psychiatric Association. May discussing changes and possible future developments there. As a long-time private practitioner, we are glad to see him there, In particular, community mental health groups recognize and applauded the Behavioral Health section‘s easing the pre- him for hosting a planning group of local mental health providers, certification process along with Preferred Care‘s market leading consumers, and advocacy groups to plan and coordinate activities reimbursement and dropping of withhold. We felt encouraged by during Mental Illness Awareness Week, observed annually during Tom‘s interest in seeking to eliminate all pre-certification the first week of October. requirements for outpatient mental health care, beginning with psychiatrists. I followed up with a formal letter to him summarizing Founded in 1932, the Mental Health Association of our appreciation of our meeting, and promoting our goals for those Rochester promotes lasting mental wellness for all people in our measures along with further encouraging access to treatment, community by offering information, advocacy, and support services. especially for children, and supporting the idea of a community mental health crisis beds. September 2006 September 2006 • Involvement of professional and paraprofessional Newsletter Editor counselors from the recovering community • Integrated Mental Health and Substance Abuse Thomas E. Gift, M.D. Treatment • Coordination with Systems (Corrections, Primary Care, It's very nice to have Margot Fass, M.D. be such a reliable Social Services) and fecund contributor to our newsletter. As many of us know, she • Continuum of services (one-stop shop) - case is the chairperson of the religion and psychiatry committee and also management - medical care - social services a frequent contributor to the Democrat and Chronicle. She‘s sent • Enlist people with mental illness and substance use along some photos, and although I‘m never sure how pictures are disorders as advocates going to turn out when printed, they seem always to be nice • Focus on Recovery additions but a little disappointing in their quality. If there are • Outreach, Education, Prevention (i.e. Use of culturally District Branch members who have expertise in this area I would tailored educational videotape) very much welcome their help. Along with Robb, I would like to commend Steve Dvorin on his well-earned and well-deserved award. There‘s a piece herein regarding a daring water rescue by David Sauter, know to many of us as the Janssen rep. It‘s not often that we encounter heroes in our daily lives. The report re disclosure of Medicare data is interesting in part for the phrase ―compliance with guidelines.‖ Ed Gein is, I believe, something of a forgotten man in American psychiatry. In order to remedy this, I‘ve included a bit about him in this publication My interest was stoked when a psychologist I worked with told me that Ed was interviewed by Carl Rogers, but my powers of imagination are grossly insufficient to envision how this might have gone. Rochester Religion and Psychiatry Conference Margot Foss, M.D. As the United States becomes more diverse, psychiatrists need to appreciate that difference from the mainstream is not deviance, and one size does not fit all. Labeling, as some do, the consideration of race, ethnicity, and culture in clinical care as ‗political correctness‘ is counterproductive and irresponsible,‖ wrote Dr. Annelle Primm of Johns Hopkins University in Focus magazine. (focus.psychiatryonline.org). Dr. Annelle Primm Over the past several years the American Psychiatric Association (APA) has emphasized the importance of reaching In line with the latter objective, she has developed two diverse and otherwise underserved communities. The APA teaching videos regarding depression, one entitled ―Black & Blue‖, selected Dr. Primm to take the position of Deputy Director of aimed at African-Americans, and another called ―Gray & Blue‖, for Minority and National Affairs of the APA. older adults. In her job, Dr. Primm serves as an ambassador to APA One outcome of this outreach has been the increase in committees, caucuses and constituencies of underrepresented partnerships between mental health service providers and religious groups, as well as interacting with many national associations communities. involved with legislation and minorities (such as the NAACP), and th advocacy groups (such as NAMI and the Mental Health On March 8 , the D&C published a front-page article in Association). the local and state section entitled ―UR offers ministers a mental health lesson.‖ It is encouraging that the learning process was Dr. Primm has written and lectured widely on the subjects described as a mutual one. of cultural issues in psychiatric illness, including substance abuse. Indeed, that is how good education works. It is helpful and She is an advocate for culturally appropriate care, which healing to pay attention to, listen to, and learn from one another. includes the following goals: • Services attended by members of the specific ethnic Thanks to the work of David Larson, MD in the 1960‘s and groups others following him, religious ideas or the inclination to pray are no • Employment of appropriate ethnic staff at all levels longer automatically considered an indication of a diagnosable psychiatric disorder. ―The goal is not to dissuade people from September 2006 September 2006 prayer and faith,‖ explains Dr. Primm. ―Rather, we need to find a way to incorporate both, so religious beliefs are honored and people also realize that seeking the help of a mental professional is a positive thing to do.‖ The Rochester based Interfaith Forum has expressed its appreciation of the need for more of this kind of information and interaction between clergy of all faiths and mental health providers. Dr. Primm, along with Dr. Michael Torres (photo below), a Baltimore psychiatrist and pastor, and Jacqueline Mattis, PhD, Associate Professor at New York University, whose specialty is religiosity and spirituality, were the special guests of the Genesee Valley Psychiatric Association (GVPA), Unity Department of Psychiatry and Behavioral Health, and Colgate Rochester Crozer th th Divinity School (CRCDS) on April 6 and 7 . Dr. Joanne McGriff th On Friday, April 7 , Dr. McIntyre opened the morning session of the Annual Unity Department of Psychiatry & Behavioral Health Spring Conference with a quotation from an editorial by his friend and colleague Jan Fawcett (who also has been a previous speaker at this event). The March 2006 Psychiatric Annals issue was focused on Spirituality in Psychiatric Practice. Dr. Fawcett asked, ―What is Spirituality?‖ and partly answered the question by Dr. Michael Torres writing ―It‘s looking for a spark of divinity within myself, but also in every person I meet – even if they have no idea they have such a th The events began on Thursday, April 6 , at the Hyatt spark (and sometimes are not terribly nice people). th Regency Hotel, for the 13 annual Martin Luther King, Jr. Corporate/Community Luncheon, with keynote speaker Rev. Dr. John Walker, distinguished civil rights activist, professor, minister In the afternoon, Dr. McIntyre was pleased to note that for and mentor. The GVPA, CRCDS, and the University of Rochester the first time, unlike in previous years, there actually seemed to be (U of R) Department of Psychiatry all showed their commitment to more people in the audience. He interpreted this as a reflection of this important community outreach by sponsoring tables at this our hunger for greater understanding of both cultural diversity and event. Drs. Izhar Mustafa and Syed Farooq are pictured in the the place and purpose of faith in our practice. photo on the next page; not shown but in attendance from the GVPA were Drs. Jack McIntyre, Richard Ciccone, Bill Lewek, Dr. Primm (see photo) spoke first, on Diversity and Michael Torres, and myself. Dr. Primm unfortunately was unable to Behavioral Health: A National Perspective, followed by a arrive in Rochester until the following day. We also had two guests presentation by Dr. Torres on Integrating Spirituality and Mental from the Program of Black Church Studies PEARL program at our Health. table, Ms. Nancy Walters and Ms. Tomacia Benjamin. Later that afternoon, Dr. Joanne McGriff (photo next column) who had been at the U of R table with our own Sue Diesel, Dr. Paul Duberstein, Maia McGill, Bishop Herman and Mrs. Elaine Dailey, (and others) found herself filling in with Dr. Torres for Dr. Primm in the panel discussion following a presentation by Dr. Jacqueline Mattis. Dr. Mattis, Associate Professor of Applied Psychology at The Steinhardt School of New York University, spoke on the subject of ―Clothed and in Your Right Mind― - African- American Mental Health and Faith. August 2006 August 2006 A fine panel discussion monitored by Dr. Torres came last, with representatives from the Islam, Catholic, Jewish, Hindu, and Protestant faiths - Syed Farooq, MD, Assistant Clinical Professor of Psychiatry and Family Medicine, SUNY at Buffalo, Emeritus, Sheila Briody, SSJ, DMin, Director of Counseling, St. Joseph‘s Neighborhood Center, Kimberly Kalish, PhD, Director of Clinical Services, Jewish Family Service of Rochester, Kaushal Nanavati, MD, Family Medicine and Reverend Laurence Hargrave, M.Div, Acting Dean Black Church Studies, Colgate Rochester Crozer Divinity School. We are grateful to them all for their participation. The audience participated actively, and in spite of the fact that he has now retired from Unity (but is keeping his same e-mail address), Dr. McIntyre invited persons interested in helping us continue to bridge the gap in understanding between mental health practitioners and clergy, and discover ways in which we might further work together, to send him an e-mail at firstname.lastname@example.org. I am most grateful to him for his openness, generosity, and wisdom in helping to bring this all about Doctors Izhar Mustafa and Syed Farooq September 2006 September 2006 Friends of the American Psychiatric Foundation WHAT IS A FRIEND OF THE FOUNDATION? Friend n a person whom one knows, likes, and trusts; a person with whom one is allied in a struggle or cause; a comrade; one who supports, sympathizes with, or patronizes a group, cause, or movement. This is how Webster defines a friend. At the American Psychiatric Foundation, our friends define who we are as an organization and as a community. As a completely self-supporting organization, the Foundation is funded solely by its friends. But there are many way to support an organization beyond the monetary. That’s why the Foundation created the Friends of the Foundation program. How can I be a friend of the Foundation? The gift of time…at the American Psychiatric Foundation, we know that yours is valuable. But there’s more than one way that you can give to the Foundation and that’s through volunteering your time to the Foundation. Here are several ways you can help. Learn more about the Foundation: The more you know, the more you can do. Join our new regular e-mail to keep up to date on Foundation activities and learn how we can work together. Spread the word: You believe in the Foundation and its mission. Let your colleagues know by sending an e-mail, speaking at a district branch meeting, writing a letter, or making a phone call. Your demonstration of support will encourage others to join you in supporting the Foundation. Host an event: There are a wide variety of ways that the Foundation can work with you to host programming in your community from holding a Foundation fundraiser or benefit, to bringing a speaker to an event, to providing education about our grant programs. We will work with you to find the right event for your community. Help us find other Foundation friends: Help the Foundation identify like-minded members of your community who are interested in supporting the Foundation’s mission and programs. Publicize the work of the Foundation: Keep the work of the Foundation “front and center” by finding opportunities to include information on the Foundation in local communications. Branch out: The Foundation’s grants and programs are directed toward public awareness of mental illnesses and the availability of treatment. Our goals are shared by many others in your community. You can play a role in bringing prospective partners to the attention of the Foundation. FRIENDS OF THE FOUNDATION 1000 Wilson Boulevard Suite 1825 Arlington, VA 22209 Yes, I’d like to participate in Friends of the Foundation. ___ Please add me to Friends of the Foundation communications ___ Contact me about hosting a local event. __ Other Name:________________________________________________________________ Address:_______________________________________________________________ City, State and Zip:_______________________________________________________ Phone Number:________________________________________________________________ E-mail Address:___________________________________________________________ For more information, contact Lori Karbeling, Development Officer on 703.907.8503 or email@example.com September 2006 September 2006 Medical Staff Prevails in Bylaws Ethics The Principles of Medical Ethics with Annotations Especially Case Applicable to Psychiatry (which includes the APA‘s Procedures for Handling Complaints of Unethical Conduct), 2006 Edition has been April 4, 2006 posted to the Ethics page of the APA website, With the AMA's help, the medical staff at a Florida hospital http://www.psych.org/psych_pract/ethics/ethics.cfm. The 2006 Editi recently won a landmark victory in court for patients and physicians. on includes recent Board of Trustees actions. Copies of the new A Leon County Circuit Court ordered a summary judgment for edition will be mailed (after the Annual Meeting) to each District Lawnwood Regional Medical Center's medical staff, a defendant in Branch/State Association. On December 11, 2005, the Board of a closely watched lawsuit with the hospital's board of trustees. The Trustees approved the recommendation of the APA Ethics March 24 judgment ensures that issues of medical staff privileges, Committee for a new annotation. Section 7, Annotation 5: quality assurance, peer review and contracts for hospital-based ―Psychiatrists shall not participate in torture.‖ services remain in the hands of physicians, where they belong, instead of the hospital's board of trustees. The AMA Organized The Board also approved the Committee's requested Medical Staff Section attempted to mediate the dispute during the change in procedures - that the Chair of the Ethics Committee, process, and the AMA Litigation Center contributed financially to rather than the APA Secretary (or Secretary-Treasurer), will the medical staff's legal expenses. respond to requests from complainants for a review of the decision by a district branch that complaint did not warrant investigation (this The suit focused on the constitutionality of a state law that change is consistent with the elimination of the Ethics Appeals applied only to the hospitals of a single county — St. Lucie County Board, which was chaired by the APA Secretary). This change will — in Florida. That law, enacted in 2003 after the hospital lobbied be made in letters each district branch sends to complaints in this heavily for it, handed the hospital authority to alter the medical circumstance. staff's bylaws. The hospital had unsuccessfully tried to accomplish this during several previous attempts to remove medical staff officers and suspend physicians. With the AMA's help, the physicians foiled these attempts by suing the hospital. After losing repeatedly in court, the hospital convinced the Florida Legislature to enact this unusual law. Dr. Desai said that many physicians at the hospital had been unaware of the unusual legislation until a state Loss of Richard Kraus, M.D. Honeoye Falls: Richard Kraus, M.D. peacefully lawmaker, just days before the vote, informed the medical staff that April 21, 2006, after a brief illness, at the age of 75. Dr. Kraus they should "wake up" and see what the hospital was about to do. was a graduate of Aquinas Institute, Niagara University and In an attempt to overwhelm the physicians, the hospital, owned by Georgetown University, where he received his MD degree. He Hospital Corporation of America, sued the medical staff in interned at St. Mary's Hospital and did his residencies at Tallahassee, instead of the county seat in Fort Pierce, where the Georgetown Medical School and Seton Psychiatric Institute in hospital is located. This added nearly 400 extra miles to trips to Baltimore, MD. court and was a transparent device to pile extra expenses on to the legal proceedings. It didn't work. He was formerly a private psychiatrist in general practice in Severna Park and has been in private practice as a forensic In finding the law unconstitutional, the judge wrote that the psychiatrist in Honeoye Falls, NY. He was also a supervisor of hospital board's argument for holding authority over the bylaws students at Seton Psychiatric Institute in Baltimore MD and a "cannot support the constitutionality of a law that rewrites the director of the psychiatric residency program, Crownsville State Medical Staff Bylaws for the sole purpose of taking away powers Hospital, Crownsville, Maryland. Dr. Kraus had been a clinical that the Medical Staff currently possesses." assistant professor of psychiatry, University of Rochester Medical Center, and acting director, Rochester Psychiatric Center, where he The judgment is especially significant because the court was director of residency training. He was also the chief of clearly articulated the role of the medical staff within the hospital, psychiatry at the Veterans Administration Medical Center in said Edgewood, Ky., urologist William Monnig, MD, chair of the Canandaigua, NY. He held positions at DePaul Mental Health AMA Organized Medical Staff Section, which has long advocated to Services, Genesee County Mental Health Center and Wayne strengthen medical staffs' right to self-governance. The AMA Behavioral Health Networks. He held memberships in the supported Lawnwood's medical staff with financial assistance and American Psychiatric Association, the Maryland Psychiatric advice and counsel, in part, because the hospital's actions Society, the GVPA, the American Association of Psychiatric represented a threat to medical staff autonomy over issues Administrators, the American Association of Directors of Psychiatric surrounding the quality of patient care, and because the hospital's Residency Training Programs and the National Association of VA board, after being previously unsuccessful in court, convinced Physicians. He was certified by the American Board of Psychiatry lawmakers to pass a new law that gave the board the authority it and Neurology. wanted. Such a tactic could have been replicated by other hospitals unhappy with their medical staff bylaws, but the judgment in Florida He will be sadly missed by his children, Richard Kraus of recognizes a constitutional barrier against such a maneuver. FL, Michael Kraus of Maine, Katherine Kraus of Virginia, John "The judge made it clear that the medical staff bylaws are a binding (Rhonda) Kraus of Maryland, Elizabeth Kraus of MD Paul (Gwen) agreement between the two parties," said Dr. Monnig. "Once Kraus of Maryland and their mother, Jeanne Smith Kraus MD, also approved, all parties have to adhere to them." of Maryland. Memorial contributions may be made to the Missionaries of the Poor P.O. Box 8525, 3 North Street, Kingston C.S.O Jamaica, W.I. September 2006 September 2006 SUPPORT THE ROCHESTER Recent Changes in Membership ACADEMY OF MEDICINE Status The following GVPA members advanced from Member in Training to 271-1313 General Member: Lisa Boyle, Geania Costea, Aurelian Niculescu, Louis Profenno, Elizabeth Santos, Lisa Slimmer, Lesllie Tomek The following GVPA members advanced from General Member to Fellow: John Bezirganian, Shirish Patel, Joseph Vasile, Karen Wiener SUPPORT THE The following GVPA members advanced from Fellow to Distinguished Fellow: Barbara Gracious MONROE COUNTY MEDICAL The following GVPA members advanced from Distinguished Fellow to Distinguished Life Fellow: Nancy Cain, Christopher Hodgman, Stephen SOCIETY Dvorin, Melvin Pisetzner 473-4072 The following GVPA members advanced from General Member to Distinguished Fellow: Margot Fass, Robert Weisman Happiness Insights World Without Doctors We can get used to a world without doctors. As John Lantos, Numerous studies have found that our happiness level a pediatrician and ethicist at the University of Chicago points out, we through our lives follows a U-shaped path, with folks becoming have got gotten used to a world where we have shoes but no cobblers. increasingly dissatisfied as they approach their '40's and then We can copy documents without scriveners, make tools without bouncing back from there. " That U-shap is just so robust, across so blacksmiths and produce books in the absence of bookbinders; we many studies and across so many countries,‖ says an economics have left the Old World behind, and for the most part we don‘t miss it. professor at the University of Wisconsin. It could be that we become increasingly disenchanted through our 20's and '30's as realize our As of the figure of the traditional doctor fades away it is being lives won't be everything we hoped. Eventually, however, we adapt, replaced by a figure akin to the drug rap, one whose responsibilities are which is why our happiness rises as we grow older. Alternatively, it to compete as vigorously as possible in the medical marketplace. could be that midlife unhappiness reflects the pressure of time, with Patients are being replaced by health care consumers who shop for the folks in their '40's caught between family demands and long hours at best medical bargains they can find. work. This model of medicine is not like that advanced 30 years ago Folks with higher incomes tend to be happier, and a jump in by Robert Sade, a surgeon at my old medical school, the medical your salary will briefly boost your spirits. But soon enough, you'll get University of South Carolina. Writing in The New England Journal of used to the higher income, and you will once again find yourself with Medicine, he argued, medical care is neither a right nor privilege: It is a a sense of dissatisfaction. Experts sometimes refer to this as the " service provided by doctors and others to people who wish to purchase hedonic treadmill" or " hedonic adaptation," the notion that we rapidly it. He is now the vice chair of the AMA‘s Council on ethical and Judicial adapt to improvements in our lives - and thus can end up feeling little Affairs … or no better off. "The most important thing, if you can pull it off, is to get job security," says Andrew Oswald, an economics professor at Whether doctors and reps are that different from one another Warwick University. ―In international data and U.S. data, it‘s the is no longer clear. Doctors know a lot more about medicine, and drug single strongest correlate with the overall job satisfaction." The data reps dress a lot better, but these days both are Organization Men, small regarding children are especially jarring. Reported happiness does cogs in the vast health-care machine. They‘re just doing their job in a indeed rise as the birth of a first child approaches. But the data market-driven health care bureaucracy that Americans have designed indicate parents' happiness tends to plummet immediately afterward. and that we defend vigorously to critics elsewhere in the world. Like anyone else, doctors and reps are responding to the pressures and What can you do about all this? Think carefully about how incentives of the system in which they work you spend your spare time. The temptation is to opt for stuff that Atlantic Monthly April 2006 page 91 Carl Elliott seems fun and easier, especially if you're getting run ragged at the office. But studies indicate that you‘ll likely be happier if you make a point of trying activities that are enriching or challenging. Cultivate friendships. Research indicates of friends are one of the biggest contributors to happiness. Among the most enjoyed activities, socializing with friends ranks second only to sex. Wall Street Journal Wednesday October 5, 2005 September 2006 September 2006 walk away from the canal with any regrets. ― Ten years from now. I False Promises: ―Consumer wouldn‘t want to look back on that day in May 2006 and wish I had Driven Health Plans‖ done something different. I just did something I would hope anyone would do for someone in my family.― A promotional pamphlet for a health savings account Democrat and Chronicle May 26 ‗06 boasts ―If you plan correctly, you may find that you spend far less for health care than ever before. ― True if you could plan to avoid cancer, being hit by car, or growing older. But you can‘t. Plan to Attend! Alexandria M. Toktanian, M.D., Ph.D, the Wilhelm A. and Three million Americans have signed up for high deductible Hildegarde R. Hassenschlager Professor of Contemporary and health plans which are often paired with tax vantaged health savings Comparative Psychiatry and Psychology at Harvard Medical School, accounts designed to give them the funds they need to pay those Boston Mass., and the Associate Director of the Martin L. and Roxanne deductibles. Proponents call this ―consumer driven health care. ― E. Showalter Center for the Investigation and Treatment of Autism, They claim that patients who have to take on more of the cost Asperger's and Related Conditions in the Department of Psychology themselves will avoid unnecessary care and look for medical and Human Services of the William P. FitzSimmons Center for the providers who deliver high-quality care at the lowest price, thus Exploration and Study of Medicine, Psychology and Obstetrics in the driving down costs. Humanities will speak in Rochester. Her topic will be "Are Academic Titles Too Long?" Health savings accounts do nothing to address the factors that really drive up health costs: care for those with chronic diseases; overuse of technology; hospital care; prescription drugs; and end of life care. But Are They Comfortable? Although health savings accounts work on the premise that Reading X-Rays in Asbestos Suits Enriched Doctor consumers have access to reliable cost estimates and comparative information about providers, that information all too often does not New York Times headline 11/29/05 exist. Consumer Reports May 2006 Depression Treatment Coming Drug Rep Saves Woman Soon? Officials say death was certain if not for passerby's heroic Everyday low prices on strep-throat exams. action. For a $30 flu shot, a $45 treatment for an ear infection or other routine David Sauter didn't want to jump into the Erie Canal on services from a posted price list, patients can visit nurse practitioners in Thursday. But as he stood on the bank and tried to verbally coax a independently operated clinics set up within the stores — whose own woman out of her sinking car, he heard the women say she couldn't pharmacies can fill prescriptions. That‘s the basic idea behind a retail swim. That's when he realized he had to go in after her. " I was kind approach to routine medical care now catching on among consumers of hoping that the car would float for a while. I didn't want to go in and entrepreneurs. At Wal-Mart, CVS and other chain stores, walk-in the water because I knew it would be cold and I'm not a good health clinics are springing up as an antidote to the expense and swimmer, but I knew I couldn't just stand there and watch her inconvenience of full-service doctors' offices or the high-cost and drown.‖ impersonal last resort of emergency rooms. For a $30 flu shot, a $45 treatment for an ear infection or other routine services from a posted The woman, who had driven her car into the canal, didn't price list, patients can visit nurse practitioners in independently drown, and emergency responders say his effort is the reason why. operated clinics set up within the stores — whose own pharmacies can "She would have died, no ifs, ands, or buts, if he hadn't pulled her fill prescriptions. out,‖ said Pittsford Fire Chief Scott Joergner, who was the first professional responder on the accident scene. "This man is above a Having someone in the store writing prescriptions could be a hero. He went above and beyond what makes someone a hero." boon for pharmacy chains. "Pharmacy is 70 percent of our business," said Jim Maritan, a CVS vice president for strategy and business Dave, who lives in Canandaigua, said he was driving to a development. "It is a great experience having a nurse practitioner clinic work appointment along Route 96 when he saw a large splash in the on site." canal near the corner of East Road. Soon he swam out about 30 yards. By the time he reached the woman, her head was under With no need for expensive medical equipment or office water. ―I told her, ma‘am, I‘m here to help you; don‘t pull me under.― space, the clinics tend to be cheap to operate — particularly since the As he swam back the chill of the 50 degree water started to nurse practitioners are paid $30 to $45 an hour, compared with the $65 penetrate his muscles and he began to lose energy. He told the or much more an hour that a primary care doctor can command. woman to just lie on her back so he could pull her along. ― I thought New York Times Sun May 14 2006 there might be two people who drown today. You hear all the time of people who drown trying to rescue someone else. I thought this might be one of those times.‖ Dave said he was just glad he didn‘t September 2006 September 2006 information. "You can't make good health care decisions unless there's They Said That !(?)! transparency in the marketplace," he said on Wednesday in Connecticut. Much of contemporary entertainment slakes a thirst for the pain and abasement of others. Fiction doesn't cut it anymore The White House has said that doctors, hospitals and because no one really and truly suffers. insurance companies should "make information about prices and quality readily available to all Americans." Julia Glass, author of the forthcoming novel "The Whole World Over," won the National Book Award for Fiction in 2002. That sentiment gets passionate support from the Business New York Times Sat Feb 11 06 Roundtable, which represents chief executives from 160 of the nation's largest companies, including Citigroup, Exxon Mobil and General While men have choices, progress has been slow on sex Electric. Health benefits are a major expense for these companies. drugs for women. Wall Street Journal 8-21-06 pR1 "The Centers for Medicare and Medicaid Services should release 100 percent of the Medicare claims database," said Robert W. They‘re going to just totally take away all the personality of Lane, chairman of Deere & Company, the world's largest maker of farm the airport. It‘s going to look like a hospital in there. equipment and a member of the Business Roundtable. "This is Nancy Jurs, local artist essential to measuring cost efficiency and compliance with clinical Democrat and Chronicle 8-21-06 p8A guidelines." The teenagers started the tradition last year. Wall Street Journal April 11, 2006 D & C Thursday Nov 24 05 Employers Push White House to Ed Gein Disclose Medicare Data Ed Gein may be America's most famous murderer, although his name is seldom heard and barely recognized today. Four decades have passed since he first made the headlines, but Gein is will with us, The White House is clashing with the nation's largest in spirit. His crimes inspired the movie Psycho and its sequels, spinning employers over their request for huge amounts of government data off in later years to terrify another generation as The Texas Chainsaw on the cost and quality of health care provided by doctors around the Massacre, and then even more recently, Silence of The Lambs. (The country. latter film, billed as "a true story," changed literally everything except the grim décor of Gein's peculiar residence.) While other slayers have President Bush has repeatedly urged private insurers to surpassed Gein's body-count and notoriety, America has never seen disclose such data, saying it will help consumers choose doctors and his equal in the field of mental aberration. hospitals. But Medicare, the nation's largest insurer, has turned down a request for its data from the Business Roundtable, whose Gein was born August 8, 1906, in Lacrosse, Wisconsin, but his member companies provide coverage to more than 25 million family soon moved to a farm outside Plainfield. His father held jobs as a people. tanner and carpenter when he wasn't working the farm, and Gein's mother emerged as the dominant parent, settling most family decisions Employers want to use the data to compare and rate on her own. Devoutly religious, she warned her two sons against doctors and to rein in soaring health costs — the very purpose premarital sex, but Gein recalled that she was "not as strong" in her advocated by the president. The data would show, for example, opposition to masturbation. Ed's father died in 1940, and his brother which doctors performed the most knee operations with the fewest Henry was lost four years later, while fighting a marsh fire. His mother complications. Employers said they could then compare the average suffered a stroke that same year, and a second one killed her in 1945, cost per case for different doctors. And they could steer patients — following an argument with one of her neighbors. Alone at last, Gein workers, and retirees and their dependents — to doctors who nailed her bedroom shut and set about "redecorating" in his own achieved the best results and offered the best value. inimitable style. "The Medicare data would be a gold mine of information," From childhood, Gein had been ambiguous about his said Maria M. Ghazal, director of public policy at the Business masculinity, considering amputation of his penis on several occasions. Roundtable. Medicare handles more than a billion claims a year. With Christine Jorgenson much in the headlines, Gein considered transsexual surgery, but the process was costly and frightening. There Administration officials said they shared the employers' must be other ways, he thought, of "turning female" on a part-time goals, but were constrained by court rulings that limited the basis. disclosure of data showing Medicare payments to individual doctors, identified by name. Employers disagree, saying those court rulings Between 1950 and 1954, Gein haunted three local cemeteries, are no longer relevant. opening an estimated nine or ten graves in his nocturnal raids. He might remove whole corpses or settle for choice bits and pieces; a few Touring the country in recent weeks, Mr. Bush has said the bodies were later returned to their resting place, but Ed recalled that best way to control health costs is to "empower consumers" with there were "not too many." Aided in the early days by "Gus," a simple- minded neighbor, Gein continued excavations on his September 2006 September 2006 own when his assistant died. At home, he used the ghoulish relics as Brother Henry was suggested, by Judge Gollmar, as a likely domestic decorations. Skulls were mounted on the bedposts, victim, inasmuch as there was no autopsy or investigation of his death. severed skullcaps However that may be, there is a stronger case for murder in the disappearance of a man named Travis and his unnamed male serving Gein as bowls. He fashioned hanging mobiles out of noses, companion, last seen at the time they hired Ed Gein to be their hunting lips, and labia, sporting a belt of nipples around the house. Human guide. One victim's jacket was recovered from the woods skin was variously utilized for lampshades, the construction of wastebaskets, and the upholstery of chairs. near Plainfield, and while Gein professed to know the whereabouts of Travis's body - blaming his death on "a neighbor" - police never The choicer bits were specially preserved for Gein to wear followed up on the case. The search of Gein's home turned up two at home. For ceremonial occasions, such as dancing underneath the "fresh" vaginas, removed from young women, that could not be moon, he wore a human's scalp and face, a skinned-out "vest" matched to existing cemetery record. Judge Gollmar suggests that one complete with breasts, and female genitalia strapped above his own. likely victim was Evelyn Hartley, abducted from LaCrosse on a night By "putting on" another sex and personality, Gein seemed to find a when Gein was visiting relatives, two blocks from her home. A pool of measure of contentment, but his resurrection raids eventually failed blood was found in the family garage after she vanished, with the trail to satisfy a deeper need. disappearing at curbside. Mary Weckler was reported missing a short time late, from Jefferson, Wisconsin, with a white Ford seen in the area. On December 8, 1954, 51-year-old Mary Hogan When searchers scoured Gein's property, they found a while Ford disappeared from the tavern she managed in Pine Grove, sedan on the premises, though no one in Plainfield could ever recall Ed Wisconsin. Authorities found a pool of blood on the floor, an driving such a car. No other evidence exists to name Gein's victims, but overturned chair, and one spent cartridge from a .32-caliber pistol. if he did not dispose of Hartley and Wechler, he must have killed two Foul play was the obvious answer, and while deputies recall Ed Gein other women, their names still unknown. as a suspect in the case, no charges were filed at the time. (Three years later, the shell casing would be matched to a pistol found in http://www.carpenoctem.tv/killers/gein.html Gein's home.) On November 16, 1957, 58-year-old Bernice Worden disappeared from her Plainfield hardware store under strikingly similar circumstances. There was blood on the floor, a thin trail of it leading out back, where the victim's truck had last been seen. Worden's son recalled that Gein had asked his mother for a date, and on the day before she disappeared, Ed mentioned that he needed anti-freeze. A sales receipt for anti-freeze was found inside the store, and deputies went looking for their suspect. What they found would haunt them all for the remainder of their lives. Inside a shed, behind Gein's house, the headless body of Bernice Worden hung from the rafters, gutted like a deer, the genitals carved out along with sundry bits of viscera. A tour of the cluttered house left searchers stunned. Worden's heart was found in a saucepan, on the stove, while her head had been turned into a macabre ornament, with twine attached to nails inserted in both ears. Her other organs occupied a box, shoved off to molder in a corner. Deputies surveyed Gein's decorations and his "costumes," counting skins from ten skulls in one cardboard drum, taking hasty inventory of implements fashioned from human bones. In custody, Gein readily confessed the Hogan and Worden murders, along with a series of unreported grave robberies. Confirmation of the latter was obtained by opening three graves: in one, the corpse was mutilated as described by Gein; the second held no corpse at all; a casket in the third showed pry-marks, but the body was intact, as Gein remembered. On January 16, 1958, a judge found Gein insane and packed him off to Central State Hospital, at Waupun, Wisconsin. A decade later, Ed was ordered up for trial, with the proceedings held in mid-November 1968. Judge Robert Gollmar found Gein innocent by reason of insanity, and he returned to Waupun, where he died in 1984. Gein willingly confessed the murders and was tried for one, but were there others? And, if so, how many?