Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy

Saturday, December 31, 2011

Anti-Gay Student's Suit Rejected

By Scott Jaschik
Inside Higer Ed

A federal appeals court has upheld the right of Augusta State University to enforce standards of its counseling graduate program -- even when a religious student objects to requirements to treat gay people in a nondiscriminatory manner.

While the ruling may be appealed, it represents a strong victory for advocates of counseling standards that require that students be trained to treat a range of clients in supportive, nonjudgmental ways. The student who sued Augusta State, and already lost in a lower court, maintained that her First Amendment rights were violated when the university required her to complete a "remediation plan" over her willingness to treat gay people.

She had stated her intent to recommend "conversion therapy" to gay clients and to tell them that they could choose to be straight. (A wide consensus among psychology and sexuality experts holds that people don't select their sexual orientation and that encouraging people to change their orientation can be seriously harmful to them.)

The student, Jennifer Keeton, argues that her religiously motivated beliefs are being challenged by Augusta State's policies -- and that a public university may not do so. Keeton was expelled when she declined to participate in the remediation plan, and she asked a federal district court and the appeals court to order her reinstatement in the program.

A three-judge panel of the U.S. Court of Appeals for the 11th Circuit found that Augusta State had legitimate, nondiscriminatory reasons to enforce its rules. The counseling program's accreditation depended in part on adhering to a code of conduct, and faculty members believed it was their responsibility to train students to work with a wide range of clients, the court found. The decision placed the counseling department's actions at Augusta State in the broader context of faculty members training professionals who must pay attention to the ethics of various fields.

"Just as a medical school would be permitted to bar a student who refused to administer blood transfusions for religious reasons from participating in clinical rotations, so ASU may prohibit Keeton from participating in its clinical practicum if she refuses to administer the treatment it has deemed appropriate," says the decision.

"Every profession has its own ethical codes and dictates. When someone voluntarily chooses to enter a profession, he or she must comply with its rules and ethical requirements. Lawyers must present legal arguments on behalf of their clients, notwithstanding their personal views.... So too, counselors must refrain from imposing their moral and religious views on their clients."

Read more here.

Thanks to Ken Pope for this article.

Friday, December 30, 2011

Supreme Court hears case involving medical record disclosure

An HIV-positive pilot claims the government is liable for releasing his medical history during a joint-agency investigation.

By Alicia Gallegos, amednews staff. 
Originally posted Dec. 26, 2011.

The U.S. Supreme Court has heard oral arguments in a case centering on whether the government is liable for disclosing to another agency the medical history of an HIV-positive patient.

The Social Security Administration admits that it violated federal law when it shared a pilot's medical records with the Federal Aviation Administration. But government attorneys say the federal Privacy Act allows recovery for economic damages only, not for emotional distress.

The case emphasizes the importance of adhering to national privacy laws, such as the Health Insurance Portability and Accountability Act, said Alexander Wohl, a law professor at the Washington College of Law and a contributor to the Supreme Court's blog.

"It reinforces the impact of those laws. Doctors have their own legal standards," but they still need to be careful not to violate their patients' privacy, he said.


Case at a glance

Is the government liable for noneconomic damages for disclosing a person's medical records to another agency?

A federal court said no. The court ruled that the government violated the Privacy Act but is not responsible for noneconomic damages. The 9th U.S. Circuit Court of Appeals disagreed. It ruled that when a federal agency intentionally or willfully fails to uphold its record-keeping obligations under the law, Congress intended that the plaintiff be entitled to recover both pecuniary and nonpecuniary damages. The case is before the U.S. Supreme Court, which heard arguments Nov. 30.

Impact: Attorneys for the plaintiff say a ruling for the government would significantly limit recoveries for people whose privacy is violated by government agencies. In addition, whistle-blowers, including doctors, who report instances of fraud and abuse would face greater disincentives to expose misconduct. A ruling for the plaintiff would lead to more lawsuits against the government for overly broad claims related to the Privacy Act, government attorneys say. A decision is expected in 2012.

The entire story can be read here.

Digital Data on Patients Raises Risk of Breaches

By Nicole Perlroth
Published 12/18/11
The New York Times: Technology

One afternoon last spring, Micky Tripathi received a panicked call from an employee. Someone had broken into his car and stolen his briefcase and company laptop along with it.

So began a nightmare that cost Mr. Tripathi’s small nonprofit health consultancy nearly $300,000 in legal, private investigation, credit monitoring and media consultancy fees. Not to mention 600 hours dealing with the fallout and the intangible cost of repairing the reputational damage that followed.

Mr. Tripathi’s nonprofit, the Massachusetts eHealth Collaborative in Waltham, Mass., works with doctors and hospitals to help digitize their patient records. His employee’s stolen laptop contained unencrypted records for some 13,687 patients — each record containing some combination of a patient’s name, Social Security number, birth date, contact information and insurance information — an identity theft gold mine.

His experience was hardly uncommon. As part of the 2009 stimulus bill, the federal government provides incentive payments to doctors and hospitals to adopt electronic health records. Some 57 percent of office-based physicians now use electronic health records, a 12 percent jump from last year, according to the Centers for Disease Control.

An unintended consequence is that as patient records have been digitized, health data breaches have surged. The number of reported breaches is up 32 percent this year from last year, according to the Ponemon Institute, a security research group. Those breaches cost the industry an estimated $6.5 billion last year. In almost half the cases, a lost or stolen phone or personal computer was responsible.

The entire story can be read here.

Thursday, December 29, 2011

LV teacher gets state prison for sex with student

By MCT Information Services
The Pocono Record
Originally published December 20, 2011

A former Allen High School teacher wept in anguish Tuesday as a Lehigh County judge shocked the woman and her supporters by sending her to state prison for having sex with a 17-year-old student on prom weekend.

Ms. Marvelli
Gabrielle Suzanne Marvelli, 39, of Quakertown looked stunned as Judge Maria L. Dantos sentenced her to nine months to five years in state prison. About 15 friends and family members cried and shook their heads as Marvelli, who had been free on bail, was led off to prison. Marvelli wept loudly.

"You violated everything that a teacher is supposed to be," Dantos told Marvelli moments before issuing the sentence.

Marvelli had been seeking probation. Instead she got the maximum sentence under the law.


The student, a senior who Marvelli had previously taught, was a week shy of his 18th birthday and Marvelli was on the staff at Allen when the tryst occurred.

The entire story is here.

Former Utah teacher gets prison for sex with student

By Roxana Orellana
The Salt Lake Tribune
Originally published December 16, 2011

Former drama teacher Jeremy Flygare delivered a tearful apology for having a sexual relationship with a 17-year-old student. But the girl’s mother called Flygare’s statements just another performance from an actor who has manipulated others and lied.
Jeremy Flygare
"Your honor, please send him to prison. He has no fear for the law. Has no respect for kids," the victim’s mother said in court. "This is going to be on our family for life, not for like a year."
On Friday, Judge Thomas Kay sentenced Flygare to prison for up to 15 years.
Flygare, 33, was charged in 2nd District Court with three counts of first-degree felony rape, which is punishable by up to life in prison.
The story is here.

Patrick Lott, Middle School Principal, Arrested For Allegedly Recording Boys Showering

By Laura Hibbard
The Huffington Post

Patrick Lott, 54
Patrick Lott, Bernardsville Middle School assistant principal, has been arrested for allegedly recording boys showering at Immaculata High School in Somerset County, N.J., where he was a volunteer, the NewJersey Journal reports.

Lott was arrested last week after authorities used a Superior Court search warrant to find videos of the nude teenagers in his home.

The whole story can be found here.

Wednesday, December 28, 2011

Mentally Ill flood ERs as States Cut Services

By Julie Steenhuysen and Jilian Mincer
Originally published December 26, 2011

On a recent shift at a Chicago emergency department, Dr. William Sullivan treated a newly homeless patient who was threatening to kill himself.

"He had been homeless for about two weeks. He hadn't showered or eaten a lot. He asked if we had a meal tray," said Sullivan, a physician at the University of Illinois Medical Center at Chicago and a past president of the Illinois College of Emergency Physicians.

Sullivan said the man kept repeating that he wanted to kill himself. "It seemed almost as if he was interested in being admitted."

Across the country, doctors like Sullivan are facing a spike in psychiatric emergencies - attempted suicide, severe depression, psychosis - as states slash mental health services and the country's worst economic crisis since the Great Depression takes its toll.

This trend is taxing emergency rooms already overburdened by uninsured patients who wait until ailments become acute before seeking treatment.

"These are people without a previous psychiatric history who are coming in and telling us they've lost their jobs, they've lost sometimes their homes, they can't provide for their families, and they are becoming severely depressed," said Dr. Felicia Smith, director of the acute psychiatric service at Massachusetts General Hospital in Boston.

Visits to the hospital's psychiatric emergency department have climbed 20 percent in the past three years.

The entire story is here.

Sybil in Her Own Words

By Patrick Suraci
The HuffingtonPost.com

I always wondered why universities deemed it necessary to teach Ethics courses. Wasn't this something you learned from your parents and childhood, as your superego, in Freudian terms, developed? Now I have learned the need to teach many people without values, especially narcissists, the ethical impact of their behavior towards other people.

This was made clear when I recently published Sybil In Her Own Words: The Untold Story of Shirley Mason, Her Multiple Personalities and Paintings. It is a follow-up to the case of a woman who had 16 personalities, then called Multiple Personality Disorder. Flora Schreiber wrote this story titled Sybil. The therapist, Dr. Cornelia Wilbur used unorthodox, but not unethical, treatment for ten years, such as, psychoanalysis, hypnosis and Sodium Pentothal which resulted in the complete integration of the 16 personalities. Sybil was the pseudonym for Shirley Mason who was born on January 25, 1923, in Dodge Center, Minnesota. She was an artistically gifted and shy only child. Her family was well known in this little town; therefore, her mother's bizarre behavior was overlooked. During Shirley's treatment the alternate personalities emerged and told of the abuse by her mother. Whenever her mother committed an atrocious attack on Shirley, she would split and development another personality to cope with the trauma.

Attacking the veracity of Sybil published in 1973 did not begin until April 24,1997, when Dr. Herbert Spiegel gave an interview to the New York Review of Books. He stated that Sybil was not a multiple, but rather an hysteric. He claimed to have hypnotized her, performed regression studies and filmed her for the class he taught at Columbia University, thus, discovering that Sybil's therapist, Dr. Cornelia Wilbur, had been: "helping her (Sybil) identifying aspects of her life, or perspectives, that she then called by name. By naming them this way she was reifying a memory of some kind and converting it into a 'personality'..." In fact, he accused Dr. Wilbur of implanting false memories, giving credence to this developing fanatical movement.

There entire article is here.

Another post on this topic can be found here.

Tuesday, December 27, 2011

APA's Guidelines on Multiculturalism

Multicultural Guideline

Diversity Based Psychology: What Practitioners and Trainers Need to Know

Diversity Based

This document was found in the public domain here.

Monday, December 26, 2011

Dr. Robert Gordon's Comment on DSM

Recently, Dr. Robert Gordon posted a comment on the Pennsylvania Psychological Association's listserv about the upcoming DSM-5 revision.

I have been writing to the DSM 5 committee my suggestions and concerns. However, I do not like the DSM. I use a combination of the ICD and PDM. The DSM is American psychiatry's political motive to put mental health care under their umbrella.

As I commonly state in court, "The DSM is a product of a particular guild and it has no legal or scientific authority. My diagnostic opinion is based on the best available research."

 Yet, in over 100 years, the American Psychological Association has not been able to do better. We argue a lot among ourselves, but we have failed to produce a diagnostic system that is better than the DSM.

The international psychodynamic community produced the excellent Psychodynamic Diagnostic Manual (PDM 2006).


Robert Gordon, PhD ABPP
The Psychodynamic Diagnostic Manual (PDM Task Force, 2006) is the first psychological diagnostic classification system that considers the whole person in various stages of development. A task force of five major psychoanalytic organizations and leading researchers, under the guidance of Stanley I. Greenspan, Nancy McWilliams, and Robert Wallerstein came together to develop the PDM. The resulting nosology goes from the deep structural foundation of personality to the surface symptoms that include the integration of behavioral, emotional, cognitive, and social functioning.

The PDM improves on the existing diagnostic systems by considering the full range of mental functioning. In addition to culling years of psychoanalytic studies of etiology and pathogenesis, the PDM relies on research in neuroscience, treatment outcome, infant and child development, and personality assessment.

The PDM does not look at symptom patterns described in isolation, as do the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM). Research on brain development and the maturation of mental processes suggests that patterns of behavioral, emotional, cognitive, and social functioning involve many areas working together rather than in isolation. Although it is based on psychodynamic theory and supporting research, the PDM is not doctrinaire in its presentation. It may be used in conjunction with the ICD or DSM. The PDM Task Force made an effort to use language that is accessible to all the schools of psychology. It was developed to be particularly useful in case formulation that could improve the effectiveness of any psychological intervention.

The PDM has received very favorable reviews from mostly the psychoanalytic community (Clemens, 2007; Ekstrom, 2007; Migone, 2006; and Silvio, 2007).  However, even non-psychodynamic psychologists that were introduced to the PDM as part of MMPI-2 and ethics/risk management workshops had a positive reaction to the new diagnostic system.  Ninety percent of 192 psychologists surveyed (65 Psychodynamic, 76 CBT and 51 Family Systems, Humanistic/Existential, Eclectic with no primary preference) rated the PDM as favorable to very favorable (Gordon, 2008).

The entire article is here.

Sunday, December 25, 2011

Integrating Spirituality and Psychotherapy: Ethical Issues and Principles to Consider

Ethics Psy Spirit

This commentary can be found in the public domain here.

Saturday, December 24, 2011

Patient Participation in Medical and Social Decisions in Alzheimer's Disease

By Johannes Hamann, MD; Katharina Bronner; Julia Margull; Rosmarie Mendel, PhD; Janine Diehl-Schmid, MD; Markus Bühner, PhD; Reinhold Klein, MD; Antonius Schneider, MD; Alexander Kurz, MD; Robert Perneczky, MD

From Journal of the American Geriatrics Society

The participation of patients in healthcare-related decisions is an ethical imperative that patient organizations and treatment guidelines promote. The mental health guidelines for most major psychiatric disorders, such as depression or schizophrenia, strongly recommend the inclusion of patients in all healthcare decisions,[1, 2] but Alzheimer's disease (AD) is an exception in this regard; although guidelines emphasize the disclosure of diagnosis and stress patient independence as a major aim, they consider impaired decisional capacity to be a limiting factor for patient participation at the same time.[3] Although AD is characterized by a cognitive decline that impairs the participation in medical decision-making,[4, 5] decisional capacity for important medical and social decisions might still be intact in patients in the early clinical stages of AD.[6] Important medical and social decisions that need to be made in these early stages are the introduction of an advance directive, a decision about driving, the initiation of antidementia treatment, and participation in clinical trials. Preventing patients from participating in these decisions not only reduces patient autonomy, but also risks ignoring the patients' will while they are still capable of making decisions, which might result in postponed decisions until decisional capacity has been lost.

The entire study can be found here.  In order to access the study, the reader needs to be registered with Medscape.  Registration is free.

Friday, December 23, 2011

Facebook aims to help prevent suicide

The Associated Press

A program launching Tuesday (December 13, 2011) enables users to instantly connect with a crisis counselor through Facebook's "chat" messaging system.

The service is the latest tool from Facebook aimed at improving safety on its site, which has more than 800 million users. Earlier this year, Facebook announced changes to how users report bullying, offensive content and fake profiles.

"One of the big goals here is to get the person in distress into the right help as soon as possible," Fred Wolens, public policy manager at Facebook, told The Associated Press.
Google and Yahoo have long provided the phone number to the National Suicide Prevention Lifeline as the first result when someone searches for "suicide" using their sites. Through email, Facebook also directed users to the hotline or encouraged friends to call law enforcement if they perceived someone was about to do harm.

The new service goes a step further by enabling an instant chat session that experts say can make all the difference with someone seeking help.

"The science shows that people experience reductions in suicidal thinking when there is quick intervention," said Lidia Bernik, associate project director of Lifeline. "We've heard from many people who say they want to talk to someone but don't want to call. Instant message is perfect for that."

How the service works is if a friend spots a suicidal thought on someone's page, he can report it to Facebook by clicking a link next to the comment. Facebook then sends an email to the person who posted the suicidal comment encouraging them to call the hotline or click on a link to begin a confidential chat.

Facebook on its own doesn't troll the site for suicidal expressions, Wolens said. Logistically it would be far too difficult with so many users and so many comments that could be misinterpreted by a computer algorithm.

"The only people who will have a really good idea of what's going on is your friends so we're encouraging them to speak up and giving them an easy and quick way to get help," Wolens said.

The entire story can be found here.

Greek woes drive up suicide rate to highest in Europe

By Helena Smith
The Guardian

Homeless man begs for money
The suicide rate in Greece has reached a pan-European record high, with experts attributing the rise to the country's economic crisis.

Painful austerity measures and a seemingly endless economic drama is exacting a deadly toll on the nation. Statistics released by the Greek ministry of health show a 40% rise in those taking their own lives between January and May this year compared to the same period in 2010.

Before the financial crisis first began to bite three years ago, Greece had the lowest suicide rate in Europe at 2.8 per 100,000 inhabitants. It now has almost double that number, the highest on the continent, despite the stigma in a nation where the Orthodox church refuses funeral rights for those who take their lives. Attempted suicides have also increased.

"It's never just one thing, but almost always debts, joblessness, the fear of being fired are cited when people phone in to say they are contemplating ending their lives," said Eleni Beikari, a psychiatrist at the non-governmental organisation, Klimaka, which runs a 24-hour suicide hotline.

Klimaka received around 10 calls a day before the crisis; it now gets more than 100 in any 24-hour period.

"Most come from women aged between 30 and 50 and men between 40 and 45 despairing over economic problems," said Beikari. "In my experience it's the men, suffering from hurt dignity and lost pride, who are most serious."

The entire story is here.

Thursday, December 22, 2011

Responding to Research Wrongdoing: A User-Friendly Guide

We have added a link to our "Ethics Resources, Guides, and Guidelines" page. 

The entire guide can be found here as well.  In 2010, this guide won an award for Innovation from the Health Improvement Institute for Excellence in Human Research Protection.

The Foreword is posted to give an idea of what is in the guide.


Every once in awhile a product comes along that is destined to make a difference. This Guide is such a product. Informed by data generated through surveys and interviews involving more than 2,000 scientists, the Guide gives voice to those researchers willing, some with eagerness and others with relief, to share their stories publicly in their own words. There are stories from scientists who want to do the right thing, but are unsure how to go about it or concerned about negative consequences for them or their junior colleagues. There are accounts from researchers who took action, and are keen to share their successful strategies with others. On the flip side, there are those who hesitated and now lament not having guidance that might have altered the course of past events.

In response to these compelling stories, the Guide adopts a problem-solving approach that looks for ways to preempt wrongdoing in research, to create options for scientists faced with suspicions or evidence of irresponsible science, and to assist researchers in working through those options in a manner that reinforces the integrity of the science without risking career or friendships. The Guide pulls no punches. While it is intended to help researchers achieve a successful resolution of what are often very messy matters, it recognizes that this may not always be possible. It is this honest assessment that will appeal to scientists looking for fair-minded and useful guidance, not pious prescriptions that bear no resemblance to the real world.

Perhaps the most encouraging aspect of the research reported in the Guide is that scientists included in the study proclaimed "overwhelming support for the concept of a researcher’s individual responsibility to intervene when suspecting wrongdoing, especially if it rises to the level of a ‘serious nature’ (94%)." Surely, there is no argument that reporting research wrongdoing and preserving the integrity of the research record will depend largely on the willingness of individuals to intervene. Recognition of one’s professional responsibility to act is a necessary step in that direction, but it is not enough. What is also needed is a good compass that points in the right direction, warns of hazardous terrain ahead, locates where support is available, and helps people assess and reason through their choices. Just as the compass greatly improved the safety and efficiency of travel dating back to the 11th century, so too will this Guide greatly help scientists navigate the challenges they encounter when taking the moral high ground.

Mark S. Frankel
Director, Scientific Freedom, Responsibility and Law Program
American Association for the Advancement of Science

Dr. Frankel served as a consultant to the authors of the Guide.

Virtue Ethics and Social Psychology

From a lecture at Ohio State University in November 2003 at the Merson Center.

The paper is available in the public domain here.

Virtue Ethics and Social Psychology

Wednesday, December 21, 2011

My psychoanalyst’s twisted final session

Once a legend in his field, he was clearly losing his grip. Still, why did he have such a hold on me?

Published by Salon.com

It was with some trepidation that I called Dr. M.

I had read his articles in various psychoanalytic journals and heard his name tossed around at conferences and institutes. He was one of the princes of psychoanalysis and supervision, a member of the old school. He knew people who had been analyzed by Freud and was a colleague of some of the last century’s bad/good boys of psychoanalysis – Hyman Spotnitz, Lou Ormont, Ethel Clevans, Phyllis Meadow.

Nineteen years I had been with a previous analyst and supervisor with whom I had an irreparable break. Nineteen years may sound like a long time for most people, but in the rarefied world of New York psychoanalysis, 19 years is merely a beginning.

Finally, I had made the phone call. And now I was at Dr. M’s Upper West Side office for my interview. I had built a practice that was already sizable, but would I rate for his famous supervision group?

I had arrived about 10 minutes early and expected to read in the waiting room until the appointed hour. By tradition, an analyst will open his door precisely at the right time, neither early nor late.
To my surprise, he came out 10 minutes before our appointment time. Anticipating a silent rebuke I quickly said, “I apologize for coming early.”

“I apologize for seeing you early,” he said. “Come in.”

He had a shock of white hair. He was handsome. Looking at him in that dimly lit hallway in the late spring of 2009, I was taken aback. Why, he must be 90 years old, at least. (He was 89.) His body sent my body a message: I am dying. But at the very same time the vigor in his booming voice said something else entirely. It took hold of me. I was confused: While on the one hand he looked as though he might be nearing the end of his life — the office was dusty, his pants were hiked up too high, subtle but telltale signs of a man losing touch — his voice said, “Beginnings!” New life.

He talked, I talked. I talked, he talked. We had a rhythm. He seemed to be building an enthusiastic lather about having me as his newborn as though he were a man of 30 being given a baby to hold outside the delivery room. There was, you could say, a kind of love in the air.
And it made me somewhat uneasy. In fact, I was quite certain that I had made a mistake. I wanted to run away fast. I did not want to be in this man’s group. Perhaps I feared that I would have to face his death and my own here. I wanted to go to a group that promised me everlasting life. I did not want a dying analyst. I was looking for potency, vitality, virility. I had quite a bit myself, but sought it in others too.

As if magically sensing my turmoil, he stood up. “Enough for today,” he barked. “I would like you to join my group, but say in about nine months. Not before.”

I was astonished. Was he a master, I thought, one of these wonder-worker analysts who can read the mind and even ride like a bronco, two wildly opposing winds of thought in a man? Such things were possible in my world. I had great faith in analysts and their mad magic, their alchemy, their abilities to turn lead into gold and ambivalence and even death into life.

The rest of this interesting story is here.

Tuesday, December 20, 2011

House Republicans Reject Senate Compromise for the "Doc Fix"

House Republicans rejected a Senate compromise bill that would have extended the 2 percent payroll tax break for two months along with the "doc fix", voting 229 to 193.  In a convoluted motion, House Republicans voted to send the measure to a conference committee, which will not occur in the near future. 

Basically, House Republicans killed a bill that would have prevented a 27 percent cut to Medicare payments, generically known as the "doc fix" provision. 

As of January 1, 2012, Medicare reimbursements will be cut by 27%.

Legislative Concerns at the Current Moment

Hi Blog Followers!!

Just to let folks know, I called my Republican Representative, Todd Platts, to express my extreme displeasure that the Speaker of the House, Mr. Boehner, will not run an up or down vote on the current Senate bill that will extend Medicare payments for 2 months (as well given the middle class tax relief).  The Senate bill had 90% of the votes in favor of this bill.  In other words, it is truly bipartisan.

For psychologists who participate in Medicare, they will receive a 32% cut in reimbursement as of January 1, 2012 if this bill is not voted on or if this bill is defeated.

The reimbursement cut is part of both PPA's and APA's agenda.

The best that we can hope for is that the current bill is passed.  My Representative's health liaison aide indicated that they are aware of the problem for ALL Medicare recipients, not just those with mental health issues.  She also indicated that she does not know if the Speaker can be swayed.

If you have a Republican Representative, my suggestion is to contact him or her to encourage speaker Boehner to run the bill.  Time is of the essence.

Here is a reminder of the Legislative Action Alert sent on November 30, 2011.

John Gavazzi, PsyD ABPP
Concerned Psychologist
Ethics is more than a code.  Ethical behavior extends beyond treating our patients to advocating on behalf of our patients.

Even if you do not work with Medicare patients, many insurance companies base reimbursement schedules on Medicare rates.

TO:   All Psychologists 
RE:    Three Weeks to Stop Medicare Cuts

Legislative leaders have begun to discuss options to address critical, time-sensitive issues by the end of the year, including the expiration of unemployment benefits, the Alternative Minimum Tax patch, tax extenders and Medicare extenders.

Now is the time for psychologists to make their voices heard and remind Congress that their patients and practices will soon face a 5% cut to psychotherapy payments in addition to a 27.4% Sustainable Growth Rate (SGR) cut to all services scheduled for 2012 if they fail to act. 

Congress has blocked the SGR cut 12 times since 2001 and the APA Practice Organization has successfully secured the psychotherapy restoration 3 times since 2008, but practitioners face a tougher climate this time around in light of the unprecedented focus on deficit reduction and the broadening divide between legislative leaders.

Your profession needs you to take action NOW to ensure legislators are attentive to these critical priorities.

Take Action Now!

Click here to urge your Senators and your US Representative to halt Medicare cuts to psychological services.

Please TAKE ACTION by Tuesday December 6.

Feel free to leave a comment on this blog so that other psychologists know how easy and simple the process really is......as well as the importance of this advocacy effort!


 My patients and practice are only a few weeks away from major reimbursement cuts that will impact patient access and put my small business at risk.  As a psychologist and constituent, I urge you to extend the Medicare mental health add-on through 2012.

 Congress has repeatedly found extension of the 5% psychotherapy payment restoration necessary to address the unintended impact of CMS's last Five-Year Review on access to Medicare mental health services.  An extension is necessary until completion of the current Five-Year Review of psychotherapy codes, which has been delayed into 2012.

 As Congress works toward end-of-year action on several pressing priorities, please make my patients and the mental health extender a priority, as well as halting the 27.4% Sustainable Growth Rate (SGR) cut.  Thank you for your time and consideration.

 Additional Background:


To ensure the viability of the Medicare outpatient mental health benefit, Congress should extend through 2012 the restoration of cuts to Part B mental health services made in 2007.

Mental Health Extender.  Congress restored payments temporarily but they now need to be extended.  Through the Medicare Improvements for Patients and Providers Act of 2008, Congress partially restored the cuts made by the Centers for Medicare & Medicaid Services (CMS) "Five-Year Review" through 2009. Subsequent laws then extended the restoration through December 2011. The valuation of psychotherapy codes in the 2011 Five-Year Review has been delayed into 2012.  Congress should pass new legislation to extend payments through 2012, until the Five-Year Review is completed.

Effect on Beneficiaries. Extending psychologist payments cut by the Five-Year Review is crucial to protecting access to Medicare mental health services.  Psychologists and social workers provide almost all of the Medicare psychotherapy and testing services, but many have indicated that they may have to reduce their caseloads or leave Medicare if they are faced with these reimbursement cuts. The cost of protecting mental health services is very low, increasing costs by only $30 million per year.

Cut By MEI Rebasing.  A CMS technical advisory panel will be asked to examine the effect of a 4% cut to Medicare part B reimbursement for psychologists in January 2011 due to "rebasing" of the Medicare Economic Index (MEI).  In the 2011 fee schedule, CMS used more recent survey data that showed practice expense and malpractice became a larger share of the payment formula while provider's time became smaller. This increased payments for some services, particularly of professionals who utilize expensive technology.  Due to budget neutrality requirements, CMS reduced other reimbursement work values, which hit services of psychologists and social workers the hardest because they are typically provided at lower cost and lower overhead.
These cuts are not related to the Sustainable Growth Rate.  Psychologists were saved from a second and even more devastating reduction when Congressional action halted the projected 25% SGR cut through December 31, 2011.  Ultimately Congress must replace the flawed SGR formula with one that responsibly and permanently addresses provider payments.

Psychologists will leave Medicare.  In a 2008 survey, 11% of psychologists reported that they have dropped out of Medicare participation and a primary reason cited was low reimbursement rates.

Abortion 'does not raise' mental health risk

By Jane Dreaper, 
Health correspondent, BBC News
Abortion does not raise the risk of a woman suffering mental health problems, a major review by experts concludes.
Data from 44 studies showed women with an unwanted pregnancy have a higher incidence of mental health problems in general.
This is not affected by whether or not they have an abortion or give birth.
But anti-abortion campaigners said the review sought to "minimise" the psychological effect of terminating a pregnancy.
Experts from the National Collaborating Centre for Mental Health (NCCMH) used the same research methods they use to assess evidence on other mental health issues for NICE.
The work - funded by the Department of Health - came after concerns that abortion may adversely affect a woman's mental health.
Usually, a woman's risk of suffering common disorders such as anxiety or depression would be around 11-12%.
But the researchers said this rate was around three times higher in women with unwanted pregnancies.
'Equal risks'
The director of NCCMH, Prof Tim Kendall, said: "It could be that these women have a mental health problem before the pregnancy.
Whether these women have abortions or give birth, their risk of mental health problems will not increase”
"On the other hand, it could be the unwanted pregnancy that's causing the problem.
"Or both explanations could be true. We can't be absolutely sure from the studies whether that's the case - but common sense would say it's quite likely to be both.
"The evidence shows though that whether these women have abortions - or go on to give birth - their risk of having mental health problems will not increase.
"They carry roughly equal risks.
"We believe this is the most comprehensive and detailed review of the mental health outcomes of abortion to date worldwide."
The whole story is here.

Monday, December 19, 2011

Board suspends license of accused prison psychologist

By Cathy Locke
clocke@sacbee.com The Sacramento Bee

The California Board of Psychology announced that it has suspended the license of Laurie Ann Martinez, a psychologist employed by the state Department of Corrections and Rehabilitation who is accused of falsely telling police that she was sexually assaulted.

The entire story is here.

California Prison Psychologist Charged With Faking Rape

The Associated Press
Originally Published December 9, 2011

Laurie Ann Martinez
She split her own lip with a pin, scraped her knuckles with sandpaper and had her friend punch her in the face. Investigators say she even ripped open her blouse, then wet her pants to give the appearance she had been knocked unconscious.

But it was all part of what authorities said Friday was an elaborate hoax by the woman to convince her husband she was raped so they could move to a safer neighborhood.

Charges filed by the Sacramento County district attorney allege Laurie Ann Martinez, a prison psychologist, conspired with the friend to create the appearance that she was beaten, robbed and raped by a stranger in April in her Sacramento home.

Martinez, her friend and two co-workers eventually told police the whole thing was a setup to convince Martinez's husband that they needed to move from a blighted, high-crime area three miles north of the state Capitol.

It didn't work. Instead, the couple filed for divorce six weeks after the April 10 incident, according to court records.

"If all you wanted to do is move, there's other ways than staging a burglary and rape," said Sacramento police Sgt. Andrew Pettit. "She went to great lengths to make this appear real."

Martinez, 36, a psychologist for the California Department of Corrections and Rehabilitation, reported she had come home that day to find a stranger in her kitchen, authorities said.

"As she tried to run away, the suspect grabbed her and hit her in the face," court records say in describing what she told police. "She lost consciousness and then when she awoke she found her pants and underwear pulled down to her ankles."

Missing from her home were two laptop computers, Martinez's purse, an Xbox video game console, a camera and numerous credit cards that Martinez said the stranger had stolen.

In reality, the items were all at the home of her friend, Nicole April Snyder, authorities allege. Investigators say Martinez had Snyder punch her in the face with boxing gloves they bought for that purpose.

The entire story is here.

Sunday, December 18, 2011

The Psychology of Moral Reasoning

Moral Reasoning

This article is found in the public domain here.

Saturday, December 17, 2011

Breach concerns rise for health care firms

By Judy Greenwald
Business Insurance
Originally published on November 27, 2011

Hospitals increasingly need a new kind of specialist on call: data security experts.

Health care institutions are particularly vulnerable to data breaches because of factors that include stringent federal and state regulations, widespread dissemination of patient data and a growing black market for patient medical information.
At CNA Financial Corp., for instance, health care represents about 25% of the data breach insurance business written but 60% of all claims, said Mark Silvestri, Quincy, Mass.-based vp of product development and director of CNA's NetProtect.
There are steps health care firms can take to minimize breach risks (see related story on best practices).
Despite the data security challenges they face, health care institutions generally perform well, experts say.
“By and large, I think they do a good job, some better than others,” said Nicholas Economidis, an underwriter of professional liability and specialty lines at Beazley Group P.L.C. in Philadelphia. However, information that “exists in multiple forms throughout an organization,” as it does in health care institutions, is a “very difficult exposure to control,” he said.
The dispersal of that data is an issue as well. While banks tend to keep information internally, health care data is handled by many more organizations, said Tom Srail, Cleveland-based senior vp with Willis North America Inc. “The nature of the health care business requires the sharing of that same information,” he said (see related story on third-party providers).
Patrick Moylan, New York-based senior associate with Dubraski & Associates Insurance Services L.L.C., said health care institutions are increasing their Internet activity with partners that include physicians, health plans and pharmacies.
Having “more people in the line of that chain that have the potential to handle sensitive data simply increases the risk that data will be accessed by accident, or by a third party,” with the potential that it could be used fraudulently, he said.
The sheer breadth of personal information that health care institutions hold complicates the issue.
The entire story is here.

Friday, December 16, 2011

APA/ASPPB/APAIT Joint Task Force - Telepsychology- Summary Statement 2


Thursday, December 15, 2011

See No Evil: When We Overlook Other People‘s Unethical Behavior

See No Evil

This paper is part of the public domain and can be found here.

Wednesday, December 14, 2011

Judgment before principle

Engagement of the frontoparietal control network in condemning harms of omission

Social, Cognitive, and Affective Neuroscience

Correspondence should be addressed to: Fiery_Cushman@brown.edu


Ordinary people make moral judgments that are consistent with philosophical and legal principles. Do those judgments derive from the controlled application of principles, or do the principles derive from automatic judgments? As a case study, we explore the tendency to judge harmful actions morally worse than harmful omissions (the ‘omission effect’) using fMRI. Because ordinary people readily and spontaneously articulate this moral distinction it has been suggested that principled reasoning may drive subsequent judgments. If so, people who exhibit the largest omission effect should exhibit the greatest activation in regions associated with controlled cognition. Yet, we observed the opposite relationship: activation in the frontoparietal control network was associated with condemning harmful omissions—that is, with overriding the omission effect. These data suggest that the omission effect arises automatically, without the application of controlled cognition. However, controlled cognition is apparently used to overcome automatic judgment processes in order to condemn harmful omissions.