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					                    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 jmcintyre@unityhealth.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 lkarbeling@psych.org
 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?

				
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