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

Friday, August 31, 2012

The Widespread Problem of Doctor Burnout

By Pauline Chen
The New York Times
Originally published August 23, 2012

Here is an excerpt:

Research over the last 10 years has shown that burnout – the particular constellation of emotional exhaustion, detachment and a low sense of accomplishment – is widespread among medical students and doctors-in-training. Nearly half of these aspiring doctors end up becoming burned out over the course of their schooling, quickly losing their sense of empathy for others and succumbing to unprofessional behavior like lying and cheating.

Now, in what is the first study of burnout among fully trained doctors from a wide range of specialties, it appears that the young are not the only ones who are vulnerable. Doctors who have been practicing anywhere from a year to several decades are just as susceptible to becoming burned out as students and trainees. And the implications of their burnout — unlike that of their younger counterparts, who are often under supervision — may be more devastating and immediate.

Analyzing questionnaires sent to more than 7,000 doctors, researchers found that almost half complained of being emotionally exhausted, feeling detached from their patients and work or suffering from a low sense of accomplishment. The researchers then compared the doctors’ responses with those of nearly 3,500 people working in other fields and found that even after adjusting for variables like gender, age, number of hours worked and amount of education, the doctors were still more likely to suffer from burnout.

Thursday, August 30, 2012

Psychologist pleads guilty to $1M fraud

Rhett E. McCarty admitted filing bogus Medicare, Medicaid claims since 2008

The Lebanon Daily Record
Originally published August 21, 2012

A psychologist who practiced in the Lebanon area pleaded guilty in federal court last week to engaging in a $1 million scheme to defraud Medicare and Medicaid.

Rhett E. McCarty, 67, of Lake Ozark, pleaded guilty before U.S. District Judge Howard F. Sachs to health care fraud and to forgery, according to a media release from David M. Ketchmark, acting U.S. Attorney for the Western District of Missouri.

McCarty is a licensed psychologist and private practitioner who provided psychotherapy services to recipients of both Medicare and Medicaid in their homes in the Lebanon area.

The entire story is here.

Wednesday, August 29, 2012

Rationing Health Care More Fairly

By Eduardo Portor
New York Times - Business Day
Originally published August 24, 2012

Older adults are understandably anxious about the political sniping over the future financing of Medicare. That is precisely the intention of the presidential campaigns.

Yet the cross-fire over who will cut Medicare by how much sidesteps a critical issue about the future of our medical care: If we must ration our care to hold down costs in the future, how can we do it in a fair, efficient and transparent way?

Mitt Romney’s campaign was brazenly misleading in its charge that the president’s health plan would cut medical services to older adults by reducing Medicare spending by $716 billion. The president’s savings will come mostly from smaller payments to managed care companies, which provide the same services as Medicare at a higher cost, and from slower growth in reimbursement rates to health care providers.

But the response of President Obama’s campaign also aimed to stoke voters’ fears. It stressed — rightly — that the plan to curb Medicare costs proposed last year by Representative Paul D. Ryan, Mr. Romney’s vice-presidential running mate, would add thousands of dollars to older Americans’ out-of-pocket expenditures. Yet it ignored Mr. Ryan’s recent efforts to soften the plan.


Rationing is inevitable in a world with finite resources. We do it in this country, too, and it is still one of the least fair and most inefficient rationing systems in the world. You get care if you have the money to pay for it; if not, you probably won’t.

The wealthiest 30 percent of the population accounts for nearly 89 percent of health care expenditures, according to a government study. Tens of millions of Americans — those whose employers don’t provide health insurance, who are too poor to pay for it themselves and yet are too rich to use Medicaid — get the least health care of all.

Tuesday, August 28, 2012

Psychopaths Get A Break From Biology: Judges Reduce Sentences If Genetics, Neurobiology Are Blamed

Medical News Today
Originally published August 21, 2012

A University of Utah survey of judges in 19 states found that if a convicted criminal is a psychopath, judges consider it an aggravating factor in sentencing, but if judges also hear biological explanations for the disorder, they reduce the sentence by about a year on average.

The new study, published in the Aug. 17, 2012, issue of the journal Science, illustrates the "double-edged sword" faced by judges when they are given a "biomechanical" explanation for a criminal's mental disorder:

If a criminal's behavior has a biological basis, is that reason to reduce the sentence because defective genes or brain function leave the criminal with less self-control and ability to tell right from wrong? Or is it reason for a harsher sentence because the criminal likely will reoffend?

"In a nationwide sample of judges, we found that expert testimony concerning the biological causes of psychopathy significantly reduced sentencing of the psychopath" from almost 14 years to less than 13 years, says study coauthor James Tabery, an assistant professor of philosophy at the University of Utah.

However, the hypothetical psychopath in the study got a longer sentence than the average nine-year sentence judges usually impose for the same crime - aggravated battery - and there were state-to-state differences in whether judges reduced or increased the sentence when given information on the biological causes of psychopathy.

The entire story is here.


We tested whether expert testimony concerning a biomechanism of psychopathy increases or decreases punishment. In a nationwide experiment, U.S. state trial judges (N = 181) read a hypothetical case (based on an actual case) where the convict was diagnosed with psychopathy. Evidence presented at sentencing in support of a biomechanical cause of the convict's psychopathy significantly reduced the extent to which psychopathy was rated as aggravating and significantly reduced sentencing (from 13.93 years to 12.83 years). Content analysis of judges' reasoning indicated that even though the majority of judges listed aggravating factors (86.7%), the biomechanical evidence increased the proportion of judges listing mitigating factors (from 29.7 to 47.8%). Our results contribute to the literature on how biological explanations of behavior figure into theories of culpability and punishment.

Monday, August 27, 2012

FTC decision jeopardizes authority of medical boards, doctors say

By Alicia Gallegos
Originally published August 20, 2012

Physicians are urging a U.S. appeals court to overturn a Federal Trade Commission ruling that doctors say strips medical boards of their right to regulate medicine.

The appeal comes after a North Carolina dental board was found to have violated federal antitrust regulations by attempting to stop nondentists from operating teeth-whitening centers. The FTC said the board is not exempt from antitrust scrutiny because its members are private professionals who compete with others in the marketplace.

If the FTC decision stands, the ruling would significantly imperil state regulation of medicine and put the public’s health at risk, doctors said.

“It would be disruptive to the proper regulation of medicine nationwide,” said Stephen Keene, general counsel for the North Carolina Medical Society. “The notion of having government agency bureaucrats regulate a learned profession is not good for the public. There would be no meaningful oversight of practitioners to deliver safe medicine.”

The entire story is here.

Sunday, August 26, 2012

'Gay Cure' Ban Heads For Vote In California

By Lila Shapiro
The Huffington Post
Originally posted August 19, 2012

Here is an except:

Two months ago, Guay testified at a hearing on a new bill in the California State Legislature that would ban the "gay cure," as this type of therapy is known. The bill is the first of its kind in the U.S., and observers expect it to pass by the end of August. If Gov. Jerry Brown (D) signs it, licensed therapists who try to change the sexual orientation of minors will run the risk of losing their licenses.

"I wanted parents to understand that this therapy is crazy," said Sen. Ted Lieu, the California Democrat who authored the bill.

The passage of SB 1172 would be the latest in a series of recent actions signaling a widespread condemnation of the practice. Almost all mainstream mental health organizations, from the American Psychiatric Association to the American Psychological Association, have renounced it. The World Health Organization has released a statement saying that such methods "lack medical justification and represent a serious threat to the health and well-being" of patients. Robert L. Spitzer, a psychiatrist who published a widely cited study supporting the "gay cure" practice in 2003, recently apologized for his work in the journal where the original paper appeared.

The entire post is here.

Saturday, August 25, 2012

Haidt on Colbert

Social psychologist Jonathan Haidt discusses his book "The Righteous Mind: Why Good People are Divided by Politics and Religion".

Friday, August 24, 2012

Preventing Suicides in US Service Members and Veterans: Concerns After a Decade of War

By Charles W. Hoge, MD, & Carl A. Castro, PhD
JAMA. 2012;308(7):671-672. doi:10.1001/jama.2012.9955

Before the wars in Iraq and Afghanistan, the incidence of suicide in active duty US service members was consistently 25% lower than that in civilians, attributable to "healthy-worker" effects from career selection factors and universal access to health care.

Between 2005 and 2009, the incidence of suicide in Army and Marine personnel nearly doubled.
From 2009 through the first half of 2012, the incidence of suicide among Army soldiers remained elevated (22 per 100 000 per year), with the number dying of suicide each year exceeding the number killed in action.

High rates of suicide have also been reported for US veterans, although incidence studies in veteran populations have drawn conflicting conclusions.


"Examining communication strategies is also critical. Stigmatizing attitudes may be unwittingly reflected in cliches, such as 'zero tolerance' or 'one suicide is one too many,' expressed by well-intentioned VA or military leaders.  These slogans convey an implicit message: suicides are different from any other medical condition, the result of a bad 'choice' by the individual or negligence by peers or leaders.  These types of communications would not be used to describe attitudes toward depression, PTSD, or cancer."

The entire article is here.

Thanks to Ken Pope for this information.

U.S. Army suicides reached record monthly high in July

By Collen Jenkins
Originally published August 17, 2012

Twenty-six active-duty soldiers are believed to have committed suicide in July, more than double the number reported for June and the most suicides ever recorded in a month since the U.S. Army began tracking detailed statistics on such deaths.

During the first seven months of this year, there were 116 suspected suicides among active-duty soldiers, compared to 165 suicides for all of last year, the Army said. The military branch reported 12 likely suicides during June.


"Suicide is the toughest enemy I have faced in my 37 years in the Army," General Lloyd J. Austin III, vice chief of staff of the Army, said in the report released on Thursday.

"To combat it effectively will require sophisticated solutions aimed at helping individuals to build resiliency and strengthen their life coping skills," he said.

The entire story is here.

Thursday, August 23, 2012

EHRs could mean fewer malpractice claims

By Mike Milard
IT Health News
Originally published August 3, 2012

A study by Harvard Medical School-affiliated researchers, published in June in the Archives of Internal Medicine, showed that Massachusetts physicians who used electronic health records saw a reduction in malpractice claims.

Correlation does not imply causation, of course. But the report's authors say their findings suggest, "implementation of EHRs may reduce malpractice claims and, at the least, appears not to increase claims as providers adapt to using EHRs."


"We found that the rate of malpractice claims when EHRs were used was about one-sixth the rate when EHRs were not used," the researchers write. "This study adds to the literature suggesting that EHRs have the potential to improve patient safety and supports the conclusions of our prior work, which showed a lower risk of paid claims among physicians using EHRs. By examining all closed claims, rather than only those for which a payment was made, our findings suggest that a reduction in errors is likely responsible for at least a component of this association, since the absolute rate of claims was lower post-EHR adoption."

Wednesday, August 22, 2012

Sexual Assault In The Military

The Huffington Post Live
Originally posted August 15, 2012

Actress Jennifer Beals joined a HuffPost community discussion Wednesday afternoon on sexual assault in the military. Beals sat down with HuffPost Live host Janet Varney, former Staff Sgt. Sandra Lee, and president of the organization Protect Our Defenders, Nancy Parrish, who blogged on HuffPost in late July on the topic.

Here is the third segment:

Tuesday, August 21, 2012

‘Economic suicides’ shake Europe

By Arianna Eunjung Cha
The Washington Post - Business
Originally published August 14, 2012

Here is part of the article.

So many people have been killing themselves and leaving behind notes citing financial hardship that European media outlets have a special name for them: “economic suicides.” Surveys are also showing increasing signs of mental stress: a jump in the use of antidepressants and illicit drugs, a rise in depression and anxiety among workers worried about salary cuts or being laid off, and an increase in the use of sick leave due to psychological problems.

“People are more and more uncertain about their future, which is leading to a sharp rise in mental health problems,” said Maria Nyman, director of Brussels-based Mental Health Europe, a multinational coalition of mental health organizations and educational institutions.

In recent years, researchers in the United States and elsewhere have repeatedly identified a correlation between suicides and unemployment or other economic distress. The U.S. Centers for Disease Control and Prevention reported last year that suicides increased during periods of economic stress, including the Great Depression, the oil crisis of the 1970s and the double-dip recession of the 1980s. Other studies have estimated that people with employment difficulties are two to three times as likely to commit suicide than the population as whole.

The entire story is here.

More than 14K affected in Oregon hospital breach

By Beth Walsh
Originally published August 6, 2012

Yet another hospital has suffered a data breach. The administration at Oregon Health & Science University Hospital (OHSU) in Portland is sending letters to the families of 702 pediatric patients after a USB drive containing some of their patient information was stolen. In total, data for more than 14,000 patients was stored on the drive, along with information for about 200 OHSU employees.

The entire story is here.

Editorial note: It is advisable to not take patient data home, whether it is stored on a laptop or in some type of portable storage device such as a jump drive.

Monday, August 20, 2012

How to Train Graduate Students in Research Ethics: Lessons From 6 Universities

What do graduate students consider ethical research conduct? It depends on their adviser, says a new report from the Council of Graduate Schools.

According to the report, which is being released today, graduate students overly rely on their advisers, rather than university resources, for guidance on thorny issues such as spotting self-plagiarism, identifying research misconduct, or understanding conflicts of interest.

The findings come three years after the National Science Foundation said that it's up to universities to make sure researchers receive ethics training required by the federal government.

Graduate students who were surveyed as part of the council's Project for Scholarly Integrity felt they had a good grasp of research ethics, said Daniel Denecke, associate vice president for programs and best practices at the Council of Graduate Schools. But "when we really drill down," he said, "we see a real need on the part of students to know how to handle perceived misconduct."

The report, "Research and Scholarly Integrity in Graduate Education: A Comprehensive Approach," outlines the findings from the project, which began in 2008 and is financed by the federal Office of Research Integrity.

The entire story is here.

Integrating Integrity

By Kaustuv Basu
Inside Higher Ed
Originally published August 14, 2012

Graduate schools need to do a better job teaching their students about responsible and ethical research, according to a report being released today by the Council on Graduate Schools.

If they do, they will have more success preventing research misconduct, the report states.
The report, Research and Scholarly Integrity in Graduate Education: A Comprehensive Approach, suggests that university administrators should work with faculty members and graduate students across disciplines to boost research integrity. For example, a successful workshop offered in one discipline can be adapted for another discipline or a course in research ethics taught intermittently by one professor could be taught by other faculty members.

The entire article is here.

Sunday, August 19, 2012

War Wounds

By Nicholas D. Kristof
The New York Times - Sunday Review
Originally published on August 10, 2012

IT would be so much easier, Maj. Ben Richards says, if he had just lost a leg in Iraq.

Instead, he finds himself losing his mind, or at least a part of it. And if you want to understand how America is failing its soldiers and veterans, honoring them with lip service and ceremonies but breaking faith with them on all that matters most, listen to the story of Major Richards.

For starters, he’s brilliant. (Or at least he was.) He speaks Chinese and taught at West Point, and his medical evaluations suggest that until his recent problems he had an I.Q. of about 148. After he graduated from West Point, in 2000, he received glowing reviews.


Military suicides are the starkest gauge of our nation’s failure to care adequately for those who served in uniform. With America’s wars winding down, the United States is now losing more soldiers to suicide than to the enemy. Include veterans, and the tragedy is even more sweeping. For every soldier killed in war this year, about 25 veterans now take their own lives.

President Obama said recently that it was an “outrage” that some service members and veterans sought help but couldn’t get it: “We’ve got to do better. This has to be all hands on deck.” Admirable words, but so far they’ve neither made much impact nor offered consolation to those who call the suicide prevention hot line and end up on hold.

The military’s problems with mental health services go far beyond suicide or the occasional murders committed by soldiers and veterans. Far more common are people like Richards, who does not contemplate violence of any kind but is still profoundly disabled.

Psychologist Has License Suspended

By Robert Cook
PortsmouthPatch - Public Safety
Originally published August 14, 2012

An Exeter psychologist charged with running a prostitution operation out of his Portsmouth apartment has had his license temporarily suspended by the New Hampshire Board of Mental Health.

Alexander Marino, 38, of 565 Sagamore Ave., in Portsmouth is currently free on bail following his arrest for allowing his apartment in Sagamore Court to be used for prostitution. But until Monday, he was free to keep treating patients.

Peggy Lynch, the board's administrative assistant, said the board has scheduled a review hearing with Marino at Merrimack County Superior Court in Concord on Aug. 27 to determine if his license to practice psychiatry in New Hampshire will remain suspended or be re-instated as his criminal case proceeds through the court system.

The entire article is here.

Saturday, August 18, 2012

In Ill Doctor, a Surprise Reflection of Who Picks Assisted Suicide

by Katie Hafner
The New York Times
Originally published on August 11, 2012

Dr. Richard Wesley has amyotrophic lateral sclerosis, the incurable disease that lays waste to muscles while leaving the mind intact. He lives with the knowledge that an untimely death is chasing him down, but takes solace in knowing that he can decide exactly when, where and how he will die.

Under Washington State’s Death With Dignity Act, his physician has given him a prescription for a lethal dose of barbiturates. He would prefer to die naturally, but if dying becomes protracted and difficult, he plans to take the drugs and die peacefully within minutes.

“It’s like the definition of pornography,” Dr. Wesley, 67, said at his home here in Seattle, with Mount Rainier in the distance. “I’ll know it’s time to go when I see it.”

Washington followed Oregon in allowing terminally ill patients to get a prescription for drugs that will hasten death. Critics of such laws feared that poor people would be pressured to kill themselves because they or their families could not afford end-of-life care. But the demographics of patients who have gotten the prescriptions are surprisingly different than expected, according to data collected by Oregon and Washington through 2011.

Dr. Wesley is emblematic of those who have taken advantage of the law. They are overwhelmingly white, well educated and financially comfortable. And they are making the choice not because they are in pain but because they want to have the same control over their deaths that they have had over their lives.


Dr. Linda Ganzini, a professor of psychiatry at Oregon Health and Science University, published a study in 2009 of 56 Oregonians who were in the process of requesting physician-aided dying.
“Everybody thought this was going to be about pain,” Dr. Ganzini said. “It turns out pain is kind of irrelevant.”

By far the most common reasons, Dr. Ganzini’s study found, were the desire to be in control, to remain autonomous and to die at home. “It turns out that for this group of people, dying is less about physical symptoms than personal values,” she said.

Psychologist Christopher M. Allen surrenders license under investigation for sex with client

PsychCrimes Database
Originally published on August 11, 2012

On May 2, 2012, psychologist Christopher M. Allen surrendered his license to the Oregon Board of Psychologist Examiners while under investigation. According to the Board’s stipulated order, Allen provided psychotherapist to a female client (Client A) who was referred to Allen by her boyfriend (Client B). During therapy with Client A, Allen made inappropriate self-disclosures to her and displayed poor judgment by continuing to see Client A during a time when he reported feeling strong attraction toward her.

The entire story is here.

Friday, August 17, 2012

Campus Threat-Assessment Teams Face Complex Task of Judging Risk

By Beth Mole
The Chronicle of Higher Education
Originally published August 10, 2012

In science-fiction movies like Minority Report,psychics could identify future murderers before they ever picked up a weapon. But the task of predicting the future and thwarting violence by identifying students who are likely to do harm is, in reality, complex, difficult, and full of pitfalls.

Many American colleges set up teams after the 2007 shootings at Virginia Tech to monitor campus incidents and, they hope, intervene before a potentially violent member of the community snaps. But those entities - which go by such names as threat-assessment teams, behavioral-intervention teams, or caring teams - face many challenges. Mental-health disorders often develop among young people in the traditional college-age years, but it can be difficult if not impossible to assess the extent of a person's illness early on.


Many campuses lack ready access to mental-health experts who can authoritatively assess the risk of violence, and some experts say the assessment teams rely too little on those authorities.

At the University of Colorado at Denver, a threat-assessment team reportedly was alerted to a university psychiatrist's concerns about James E. Holmes, a former graduate student there. Mr. Holmes, who withdrew in June from a Ph.D. program in neurosciences at the university's medical campus, in neighboring Aurora, is accused of killing 12 people and injuring 58 others in a movie theater there last month.

News reports have said that the threat-assessment team did not meet to discuss Mr. Holmes because he had announced his intent to withdraw from the university.

The entire story is here.

Thanks to Ken Pope for this information.

Doctors target gun violence as a social disease

By Marilynn Marchione
Seattle Post-Intelligencer
Originally published on August 13, 2012

Is a gun like a virus, a car, tobacco or alcohol? Yes say public health experts, who in the wake of recent mass shootings are calling for a fresh look at gun violence as a social disease.

What we need, they say, is a public health approach to the problem, like the highway safety measures, product changes and driving laws that slashed deaths from car crashes decades ago, even as the number of vehicles on the road rose.

One example: Guardrails are now curved to the ground instead of having sharp metal ends that stick out and pose a hazard in a crash.

"People used to spear themselves and we blamed the drivers for that," said Dr. Garen Wintemute, an emergency medicine professor who directs the Violence Prevention Research Program at the University of California, Davis.

It wasn't enough back then to curb deaths just by trying to make people better drivers, and it isn't enough now to tackle gun violence by focusing solely on the people doing the shooting, he and other doctors say.

They want a science-based, pragmatic approach based on the reality of a society saturated with guns and seek better ways of preventing harm from them.

Thursday, August 16, 2012

Life in a Mental Hospital

"Erasing the Past at the Ghost Hospital"
By Lawrence Downes
The New York Times
Originally published on August 4, 2012

Engineers and earth movers have now joined nature and vandals in the slow dismantling of the Kings Park Psychiatric Center, an all-but-abandoned city of the sick on the North Shore of Long Island, on thickly wooded bluffs above Long Island Sound.
Kings Park was one of the island’s four giant state mental institutions — part farm, part warehouse — that treated hundreds of thousands of patients from New York City. It began in the 1880s and kept growing into the 1960s and ’70s until, like its counterparts on the island and across the country, it was made obsolete by new drug therapies and a new understanding of the rights of the mentally ill.


New York State has largely abandoned its comprehensive commitment to caring for the mentally ill and disabled. When the hospitals emptied out, patients were sent to group homes to be better cared for; many were forsaken there, too. A recent series of articles in The Times found that abuse and neglect plague the mental-health system to this day. It would be wonderful if someday profitable redevelopment of Kings Park led to a surge in financing for care of the mentally ill. I’m not counting on it.

This article is here.


A Letter to the Editor by Lucy Winer about this story is here.

I was committed to Kings Park Psychiatric Center on Long Island as a teenager in the 1960s after a series of suicide attempts. Having experienced the abuses of institutional life, I expected to rejoice at news of the hospital’s bulldozing. Instead, I feel grief.


State hospitals were closed to save money. The promise was that savings would be invested in community mental health care. This never happened, and we are living with the fallout from this broken social contract.

New Orleans psychologist who made racist remarks resigns

PsychCrime Database
Originally published August 11, 2012

On May 23, 2012, the Jefferson Parish Public School System reported that Louisiana school psychologist Mark A. Traina resigned.

Traina had come under scrutiny the by the Parish due to the numerous racially inflammatory remarks he posted on his Twitter feed.

A week earlier, the Southern Poverty Law Center (SPLC) filed a complaint with the United States Department of Education Office of Civil Rights against the Jefferson Parish Public School System and the Jefferson Parish School Board on behalf of students of the parish, for discrimination on the basis of race and disability. The complaint specifically alleged that the district’s alternative school policies have resulted in black students making up 78 percent of all alternative school referrals even though they are only 46 percent of the district’s student population.

The entire story is here.

Wednesday, August 15, 2012

Psychiatry’s Legitimacy Crisis

All We Have to Fear: Psychiatry's Transformation of Natural Anxieties into Mental Disorders
by Allan V. Horwitz and Jerome C. Wakefield

Book Review by Andrew Scull
The Los Angeles Book Review
Originally published on August 8, 2012

ABOUT 40 YEARS AGO, American psychiatry faced an escalating crisis of legitimacy. All sorts of evidence suggested that, when confronted with a particular patient, psychiatrists could not reliably agree as to what, if anything, was wrong. To be sure, the diagnostic process in all areas of medicine is far more murky and prone to error than we like to think, but in psychiatry the situation was — and indeed still is — a great deal more fraught, and the murkiness more visible. It didn’t help that psychiatry’s most prominent members purported to treat illness with talk therapy and stressed the central importance of early childhood sexuality for adult psychopathology. In this already less-than-tidy context, the basic uncertainty regarding how to diagnose what was wrong with a patient was potentially explosively destabilizing.

The modern psychopharmacological revolution began in 1954 with the introduction of Thorazine, hailed as the first “anti-psychotic.” It was followed in short order by so-called “minor tranquilizers:” Miltown, and then drugs like Valium and Librium. The Rolling Stones famously sang of “mother’s little helper,” which enabled the bored housewife to get through to her “busy dying day.” Mother’s helper had a huge potential market. Drug companies, however, were faced with a problem. As each company sought its own magic potion, it encountered a roadblock of sorts: its psychiatric consultants were unable to deliver homogeneous populations of test subjects suffering from the same diagnosed illness in the same way. Without breaking the amorphous catchall of “mental disturbance” into defensible sub-sets, the drug companies could not develop the data they needed to acquire licenses to market the new drugs.

The entire story is here.

California psychology board issues sex misconduct charge against Peter J. Murphy

PsychCrime Database
Originally published August 11, 2012

On February 7, 2012, the California Board of Psychology issued and Accusation against Peter J. Murphy, Ph.D., alleging sexual misconduct and unprofessional conduct.


From March 2009 through at least December 2010, Murphy engaged in a sexual relationship with the intern, whom he first met when he provided group therapy to her young son, who was diagnosed with Asperger’s Syndrome.

The entire story is here.

Tuesday, August 14, 2012

“Hired guns,” “charlatans,” and their “voodoo psychobabble”: Case law references to various forms of perceived bias among mental health expert witnesses.

By Edens, John F.; Smith, Shannon Toney; Magyar, Melissa S.; Mullen, Kacy; Pitta, Amy; and Petrila, John
Psychological Services, Vol 9(3), Aug 2012, 259-271.


Although in principle the legal system expects and professional ethics demand that expert witnesses be unbiased and objective in their forensic evaluations, anecdotal evidence suggests that accusations of financial bias, partisanship, and other forms of nonobjectivity are common. This descriptive survey of published legal cases expands on an earlier case law review (Mossman, 1999) attempting to encapsulate and summarize key issues concerning perceptions or allegations of bias in mental health expert witness testimony. Using a series of search terms reflecting various potential forms of accusatory bias, a total of 160 published civil and criminal court cases were identified in which 185 individuals (e.g., attorneys, trial and appellate judges, other witnesses) made one or more references to clinicians' alleged lack of neutrality. Allegations most typically involved describing the expert as having an opinion that was “for sale,” or as a partisan or advocate for one side, although aspersions also were made concerning “junk science” testimony and comparing mental health experts to mystics and sorcerers. Our results indicate that diverse forms of bias that go beyond financial motives are alleged against mental health experts by various players in the legal system. Means are discussed by which experts can attempt to reduce the impact of such allegations.

Here are two excerpts:
It should not be surprising that wholesale acceptance of mental health expertise as accurate and neutral is hardly the norm.

Clearly, some judges, attorneys, academics, and jurors view at least some mental health experts-if not the entire field-with a considerable degree of suspicion (Fradella, Fogarty, & O'Neill, 2003), if not overt distain and/or hostility.
In terms of putative sources of examiner bias, several forms have been suggested as potentially undermining examiner objectivity (e.g., Saks, 1990).

Perhaps the most pernicious is that opinions are for sale. It is commonly alleged that monetary incentives primarily (or completely) motivate the testimony offered by witnesses characterized as "'hired guns,' 'whores,' and 'prostitutes'" (Mossman, 1999, p. 414).

Although being for sale is frequently lodged as a criticism of expert testimony, allegations of other forms of bias may spring from perceptions that the expert has a particular personal, political, or scientific "ax to grind" in relation to a specific legal issue.

Evidence of advocacy for one's pet cause(s)--whether it is championing a particular examinee's case, the rights of fathers in child custody disputes, or a novel or controversial psychological syndrome (to name but a few possibilities)--may be justifiable grounds for questioning an examiner's objectivity and fairness as well.
For reprint requests, comments, or questions: John F. Edens, Department of Psychology, Texas A&M University, 4235 TAMU, College Station, TX 77843; Contact johnedens@tamu.edu

Thanks to Ken Pope for this information.

Psychologist Lynda Harris-Boscaino surrenders license on felony

PsychCrime Database
Originally published August 11, 2012

On April 24, 2012, the New York State Education Department Office of the Professions reported that psychologist Lynda Harris-Boscaino of Spring Valley, New York surrendered her license. Harris-Boscaino was convicted of felony Grand Larceny.

The entire story is here.

Monday, August 13, 2012

6 Practice Recommendations for Reducing Premature Termination in Therapy

Practice recommendations for reducing premature termination in therapy.
Swift, Joshua K.; Greenberg, Roger P.; Whipple, Jason L.; Kominiak, Nina
Professional Psychology: Research and Practice, Vol 43(4), Aug 2012, 379-387.
Premature termination from therapy is a significant problem frequently encountered by practicing clinicians of all types. In fact, a recent meta-analytic review (J. K. Swift & R. P. Greenberg, 2012, Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology. doi:10.1037/a0028226) of 669 studies found that approximately 20% of all clients drop out of treatment prematurely, with higher rates among some types of clients and in some settings. Although this dropout rate is lower than previously estimated, a significant number of clients are still prematurely terminating, and thus further research toward a solution is warranted. Here we present a conceptualization of premature termination based on perceived and anticipated costs and benefits and review 6 practice strategies for reducing premature termination in therapy. These strategies include providing education about duration and patterns of change, providing role induction, incorporating client preferences, strengthening early hope, fostering the therapeutic alliance, and assessing and discussing treatment progress.
1. Help clients develop realistic expectations of treatment duration and recovery expectations at the beginning of treatment.
2. Utilize role induction prior to starting an intervention.
3. Pay attention to patient preferences, such as active versus passive therapist or whether homework will be assigned.
4. Instill a sense of hope that treatment will work
5. Foster the therapeutic alliance
6. Routinely monitor treatment outcomes.
Thanks to Ken Pope for this information.

Psychologist Carrie E. Schaffer suspended over sex with former patient

PsychCrime Database
Originally published August 11, 2012

On April 11, 2012, the Virginia Board of Psychology indefinitely suspended Carrie E. Schaffer, Ph.D.

According to the Board’s findings of fact, As of April 2011, Dr. Schaffer continued to be involved in an intimate and sexual relationship with a former client, which was the subject of an August 2010 Board Consent Order.

The entire information is here.

Sunday, August 12, 2012

New generation of virtual humans helping to train psychologists

American Psychological Association Press Release
Originally published August 3, 2012

New technology has led to the creation of virtual humans who can interact with therapists via a computer screen and realistically mimic the symptoms of a patient with clinical psychological disorders, according to new research presented at the American Psychological Association’s 120th Annual Convention.

“As this technology continues to improve, it will have a significant impact on how clinical training is conducted in psychology and medicine,” said psychologist and virtual reality technology expert Albert “Skip” Rizzo, PhD, who demonstrated recent advancements in virtual reality for use in psychology.

Virtual humans can now be highly interactive, artificially intelligent and capable of carrying on a conversation with real humans, according to Rizzo, a research scientist at the University of Southern California Institute for Creative Technologies. “This has set the stage for the ‘birth’ of intelligent virtual humans to be used in clinical training settings,” he said.

Rizzo showed videos of clinical psychiatry trainees engaging with virtual patients called “Justin” and “Justina.” Justin is a 16-year-old with a conduct disorder who is being forced by his family to participate in therapy. Justina, the second and more advanced iteration of this technology, is a sexual assault victim who was designed to have symptoms of post-traumatic stress disorder.

The entire press release is here.

Saturday, August 11, 2012

Psychologist pimped hookers, police allege

By Elizabeth Dinan
Originally posted August 5, 2012

A clinical psychologist, with a private practice in Exeter, is wanted by police on a warrant alleging he operated a prostitution business out of a Portsmouth apartment.

Police announced Saturday that Alexander Marino, 38, of 565 #4 Sagamore Ave., Portsmouth, is wanted for a misdemeanor count of prostitution that alleges he knowingly allowed his apartment to be used for prostitution, and that he benefited financially from the sale of sex.

Thanks to Ken Pope for this story.

N.C. psychologist admits to $63 million Medicare, Medicaid fraud

By Jaime L. Brockway
Originally published on July 24, 2012

An Asheville, N.C., psychologist pleaded guilty earlier this month in Miami district court to submitting more than $63 million in fraudulent claims to Medicare and Medicaid in Miami, Fla., and Hendersonville, N.C.

Serena Joslin, 31, admitted to participating in a fraud scheme operated through Health Care Solutions Network (HCSN), which operated partial hospitalization programs (PHPs), or intensive mental health treatments for severe mental illness, in Miami and Hendersonville.

Friday, August 10, 2012

Violence risk instruments overpredicting danger

By Karen Franklin
forensic psychologistblogspot.com
Originally posted August 2, 2012

Here is an excerpt:

Bottom line: Risk assessment instruments are fairly good at identifying low risk individuals, but their high rates of false positives -- people falsely flagged as recidivists -- make them inappropriate “as sole determinants of detention, sentencing, and release.”

In all, about four out of ten of those individuals judged to be at moderate to high risk of future violence went on to violently offend. Prediction of sexual reoffense was even poorer, with less than one out of four of those judged to be at moderate to high risk going on to sexually offend. In samples with lower base rates, the researchers pointed out, predictive accuracy will be even poorer.

The entire story is here.

Thanks to Gary Schoener for this information.

Pfizer Settles U.S. Charges of Bribing Doctors Abroad

By Katie Thomas
The New York Times
Originally published August 7, 2012

The Securities and Exchange Commission announced on Tuesday that it had reached a $45 million settlement with Pfizer to resolve charges that subsidiaries of Pfizer and Wyeth, which it acquired in 2009, bribed overseas doctors and other health care workers to increase sales of their drugs.

At the same time, the Justice Department announced that another subsidiary, Pfizer H.C.P. Corporation, had agreed to pay a $15 million penalty to settle similar charges.

The allegations, which date to 2001 and in the case of Wyeth are said to have continued after Pfizer’s acquisition of the company, involve violations of the Foreign Corrupt Practices Act, which forbids paying bribes to government officials. In many countries, doctors are government employees.

Thursday, August 9, 2012

Guidelines for the Practice of Telepsychology


(Draft – Released for public comment on July 27, 2012)

Definition of Telepsychology
Operational Definitions
Need for the Guidelines
Development of the Guidelines
Guideline 1: Competence of the Psychologist
Guideline 2: Standards of Care in the Delivery of Telepsychology Services
Guideline 3: Informed Consent
Guideline 4: Confidentiality of Data and Information
Guideline 5: Security and Transmission of Data and Information
Guideline 6: Disposal of Data and Information and Technologies
Guideline 7: Testing and Assessment
Guideline 8: Interjurisdictional Practice

These guidelines are designed to address the developing area of psychological service provision
commonly known as telepsychology. Telepsychology is defined, for the purpose of these
guidelines, as the provision of psychological services using telecommunication technologies as
expounded in the “Definition of Telepsychology.” The expanding role of technology in the
provision of psychological services and the continuous development of new technologies that
may be useful in the practice of psychology present unique opportunities, considerations and
challenges to practice. With the advancement of technology and the increased number of
psychologists using technology in their practices, these guidelines have been prepared to educate
and guide those who engage in the practice of telepsychology.

The proposed Guidelines are here.

In order to comment on these proposed guidelines, click here.

Technological Imperative

By Pat DeLeon
Posted with permission

One direct consequence of the advent and steadily increasing presence of technology within the health care arena will be the need for psychology to finally seriously address the issue of licensure mobility. The Department of Veterans Affairs (VA) recently announced its plan to increase veterans’ access to mental health care by conducting more than 200,000 clinic-based, telemental health consultations by mental health specialties this fiscal year. Earlier the VA indicated that it would no longer charge a copayment when veterans receive care in their homes from VA health professionals using video conferencing. The Secretary: “Telemental health provides Veterans quicker and more efficient access to the types of care they seek. We are leveraging technology to reduce the distance they have to travel, increase the flexibility of the system they use, and improve their overall quality of life. We are expanding the reach of our mental health services beyond our major medical centers and treating Veterans closer to their homes.” Since the start of the VA Telemental Health Program, VA has conducted over 550,000 patient encounters.

The Fiscal Year 2013 budget request for the Office of Rural Health Policy, which is located within the Health Resources and Services Administration (HRSA) of the Department of Health and Human Services, notes that there has been a significant Departmental focus on rural activities for over two decades. Historically, rural communities have struggled with issues related to access to care, recruitment and retention of health care providers, and maintaining the economic viability of hospitals and other health care providers in isolated rural communities. There are nearly 50 million people living in rural America who face ongoing challenges in accessing rural health care. Rural residents have higher rates of age-adjusted mortality, disability, and chronic disease than their urban counterparts. Rural areas also continue to suffer from a shortage of diverse providers for their communities’ health care needs and face workforce shortages at a greater rate than their urban counterparts. Of the 2,052 rural counties in the nation, 77 percent are primary care health professional shortage areas (HPSAs), where APA’s Nina Levitt reports that psychologists are eligible for the National Health Service Corps Loan Repayment Program which places health professionals in underserved rural communities. 

HRSA’s Telehealth Grants initiative is designed to expand the use of telecommunications technologies within rural areas, seeking to link rural health practitioners with specialists in urban areas, thereby increasing access and the quality of healthcare provided. Telehealth offers important opportunities to improve the coordination of care in rural communities by linking its providers with specialists and other experts not available locally. The strengthening of a viable rural health infrastructure is viewed as critical for long-term success, including facilitating distance education experiences. The budget request for the office of rural health office once again proposed $11.5 million, which has subsequently been approved by the Senate Appropriation Committee, and thus allows the continuation of the Licensure Portability Grant initiative, in order to assist states in improving clinical licensure coordination across state lines. This particular initiative builds on HRSA’s 2011 Report to Congress indicating: “Licensure portability is seen as one element in the panoply of strategies needed to improve access to quality health care services through the deployment of telehealth and other electronic practice services (e-care or e-health services) in this country…. Overcoming unnecessary licensure barriers to cross-state practice is seen as part of a general strategy to expedite the mobility of health professionals in order to address workforce needs and improve access to health care services, particularly in light of increasing shortages of health professionals. ” 

For some colleagues, and particularly for those who are not comfortable with fundamental change, the relationship between telemental health and licensure mobility might seem to be a tenuous one. And yet, we would suggest that they are intimately linked. The public policy rationale for professional licensure is to protect the public from untrained and/or unethical practitioners, not to enhance the status or economic well-being of the profession. Historically, and we would expect for the foreseeable future, licensure decisions and qualification criteria have been made at the individual state level, where each of the professions plays a major role in determining its requirements for membership and its scope of practice, albeit through the political process. Within the federal system the governing statutes and implementing regulations generally require licensure in at least one state (regardless of practitioner geographical location) and facility approval (i.e., being credentialed). As improvements in technology allow for increasingly higher quality utilization, the congressional committees with jurisdiction have been systematically “cleaning up” potential lingering statutory restrictions. And, at both the state and federal level, expanding reimbursement paradigms are evolving. APA estimates that 13 states now require private sector insurance companies to pay for telehealth services. Over the years, we have not been aware of any objective evidence which suggests that the quality of care being provided via telehealth is in any way compromised. To the contrary, as the VA, the Department of Defense (DoD), and the federal criminal justice system are demonstrating, access has been significantly enhanced and new state-of-the-art clinical protocols have been developed and implemented. 

A First Hand View -- From Tripler Army Medical Center: “I joined the Telebehavioral and Surge Support (TBHSS) Clinic in February, 2011 during its infancy. At that time, the program was fully staffed with providers and support staff, making us 24 strong. TBHSS provides healthcare access by connecting eligible beneficiaries to providers who are able to indentify and treat their clinical needs. These services are provided through secured video technology which allows accessibility from remote locations worldwide. I was very excited to have the opportunity to work in a clinic that has the ability to reach out to those off island, typically in areas where the demand for services is far greater than that of the availability. To date, the clinic has been able to support Alaska, Texas, Korea, Japan, Okinawa, and American Samoa, as well as various sites on the island of Oahu and in the Continental United States. As a provider, it was refreshing to be able to provide multiple services such as therapy, consultation, administrative evaluations, and both neuropsychological and psychological assessments. In addition, we provided surge support during different points within the ARFORGEN cycle whenever there was a need for augmented behavioral health resources. In February, 2012 I was fortunate to be commissioned in the USPHS as a Lieutenant (0-3) and detailed to Tripler. As a clinical psychologist, I was able to utilize all the skills within the Department of Psychology that I acquired from my time at TBHSS. Recently, I had the honor to be promoted to the position of Clinical Director of TBHSS. Returning back to my roots has been exciting as I get to work with individuals who have a passion and commitment to serve service members and their families. My journey as a clinical psychologist civilian contractor to active duty clinical director has just begun and I am looking forward to the ongoing relationships that the TBHSS team forges with the different regions” [Sherry Gracey, Lt. USPHS]. 

ASPPB: We were very pleased to learn from Steve DeMers that the Association of State and Provincial Psychology Boards (ASPPB) was successful in its application this year for one of the licensure portability grants issued by HRSA. ASPPB will receive approximately $1 million over the next three years to provide support for state psychology licensing boards addressing statutory and regulatory barriers to telehealth, focusing upon continuing the development and implementation of its Psychology Licensure Universal System (PLUS) initiative. As an integral means of addressing the present barriers associated with telepsychology, ASPPB has developed an on-line application system, the PLUS, that can be used by any applicant who is seeking licensure, certification, or registration in any state, province, or territory in the United States or Canada that participates in the PLUS program. This also enables concurrent application for the ASPPB Certificate of Professional Qualification in Psychology (CPQ) which is currently accepted by 44 jurisdictions and the ASPPB Interjurisdictional Practice Certificate (IPC). All information collected by the PLUS is deposited and saved in the ASPPB Credentials Bank, a Credentials Verification & Storage Program (The Bank). This information can then be subsequently shared with various licensure boards and other relevant organizations. Therefore, streamlining future licensing processes. 

ASPPB is an active participant in the APA/ASPPB/APAIT Joint Task Force for the Development of Telepsychology Guidelines for Psychologists, established by former APA President Melba Vasquez and co-chaired by Linda Campbell (APA) and Fred Millan (ASPPB). The members have backgrounds, knowledge, and experience reflecting expertise in the broad issues that practitioners must address each day in the use of technology -- ethical considerations, mobility, and scope of practice. Several of the meta-issues discussed to date center on the need to reflect broadness of concepts when incorporating telecommunications technologies and to provide guidance on confidentiality and maintaining security of data and information. In addition, a number of meta-issues focus on the critical issue of interjurisdictional practice. The underlying intent behind the proposed guidelines is to offer the best guidance to psychologists when they incorporate telecommunication technologies in the provision of psychological services, rather than be prescriptive. The Task Force met twice in 2011, June of 2012, and plans to meet once more this Fall. Feedback on their recommendations will be sought at the Orlando convention, throughout the APA governance, and continuously from the membership at large. Their goal is to have the guidelines adopted by APA as policy and approved by ASPPB and APAIT sometime in 2013. 

The U.S. Supreme Court: As we all must be aware, this summer the U.S. Supreme Court upheld the underlying constitutionality of the President’s landmark Patient Protection and Affordable Care Act of 2010 (ACA), including it’s far reaching individual mandate provision, by a 5-4 vote. For legal scholars, the most critical issue was probably the Court’s deliberations regarding the federal government’s power to regulate Commerce vs. its power to raise Taxes, as a government of limited and enumerated powers. “We do not consider whether the Act embodies sound policies. That judgment is entrusted to the Nation’s elected leaders. We ask only whether Congress has the power under the Constitution to enact the challenged provisions. 

For health policy experts and practitioners, the Court’s musings on our nation’s health care system makes for particularly intriguing reading. * “Everyone will eventually need health care at a time and to an extent they cannot predict, but if they do not have insurance, they often will not be able to pay for it. Because state and federal laws nonetheless require hospitals to provide a certain degree of care to individuals without regard to their ability to pay, hospitals end up receiving compensation for only a portion of the services they provide. To recoup the losses, hospitals pass on the cost to insurers through higher rates, and insurers, in turn, pass on the cost to policy holders in the form of higher premiums. Congress estimated that the cost of uncompensated care raises family health insurance premiums, on average, by over $1,000 per year.” * “Indeed, the Government’s logic would justify a mandatory purchase to solve almost any problem…. (M)any Americans do not eat a balanced diet. That group makes up a larger percentage of the total population than those without health insurance. The failure of that group to have a healthy diet increases health care costs, to a greater extent than the failure of the uninsured to purchase insurance…. (T)he annual medical burden of obesity has risen to almost 10 percent of all medical spending and could amount to $147 billion per year in 2008. Those increased costs are born in part by other Americans who must pay more, just as the uninsured shift costs to the insured.” * “In enacting [ACA], Congress comprehensively reformed the national market for health-care products and services. By any measure, that market is immense. Collectively, Americans spent $2.5 trillion on health care in 2009, accounting for 17.6% of our Nation’s economy. Within the next decade, it is anticipated, spending on health care will nearly double. The health-care market’s size is not its only distinctive feature. Unlike the market for almost any other product or services, the market for medical care is one in which all individuals inevitably participate.” * “Not all U.S. residents, however, have health insurance. In 2009, approximately 50 million people were uninsured, either by choice or, more likely, because they could not afford private insurance and did not qualify for government aid.” 

Bringing Psychology To The Table – State Leadership In Health Care Reform: At this year’s impressive State Leadership conference, Katherine Nordal exhorted our state association leaders to appreciate that: “We’re facing uncharted territory with proposed new models of care delivery. New financing mechanisms that we’re going to have to understand and appreciate, and the ways that they are going to impact practice, whether it’s private practice or institutional practice. We know that the states are in the drivers’ seat, and most of what happens about health care reform is going to happen back home. We know that we can’t do it alone. Our advocacy depends on effective collaborations and effective partnerships. We have to be ready to claim our place at the table. We need to be involved at the ground level. You’ve got to get involved in coalitions. If we don’t participate, then we abdicate our responsibility there and we let other people – physicians, nurses, social workers, MFTs, whoever – define what our future is going to be as a profession. And that’s just not an option for us. If we’re not at the table, it’s because we’re on the menu…. When you get home and you turn your focus to health care reform, I want you to remember that other groups don’t automatically think about psychology and invite us to the table when they’re having these discussions. We have to identify health care reform initiatives that impact psychological practice and our patients and get involved in those in a proactive way. If you wait….” Aloha,

Wednesday, August 8, 2012

Psychologist pleads guilty to $1.5M fraud scheme

KUSI News Release
San Diego, California
Originally published on August 3, 2012

A clinical psychologist from National City admitted in federal court Thursday to immigration and Social Security fraud in connection with a scheme to falsify medical certifications to the federal government.

Roberto J. Velasquez, 55, pleaded guilty to two criminal counts during a hearing before Magistrate Judge William McCurine Jr. in San Diego.

Velasquez admitted to falsely certifying that dozens of patients were disabled and therefore eligible for disability benefits or exemptions from immigration requirements, according to the U.S. Attorney's Office.

The entire story is here.

Thanks to Ken Pope for this story.

5% of Americans Spend 50% of Health Care Dollars

By Merrill Goozner
The Fiscal Times
Originally published July 31, 2012

The key argument in favor of the individual health insurance mandate, which was upheld last month by the Supreme Court in a 5-4 vote, was that everyone uses health care eventually. Therefore, it is only fair that everyone pays into the insurance pool. Without a mandate, when access to affordable coverage becomes guaranteed in 2014, some people will simply wait until they get sick before buying a plan.


A new issue brief from the National Institute of Health Care Management adds grist to the mill of those who rebelled against the universal insurance mandate. The study showed that in 2009 half the population – fully 150 million people – spent an average of just $236 per person on health care. That was a paltry $36 billion for the entire group out of $1.3 trillion in personal health care expenditures.

On the other side of the use spectrum, however, just five percent of the population – about 15 million people – spent a whopping $623 billion or about half of all personal health care expenditures. That came to nearly $41,000 per patient.

The entire story is here.

Tuesday, August 7, 2012

Did Your Brain Make You Do It?

By John Monterosso and Barry Schwartz
The New York Times Sunday Review
Originally published on July 27, 2012

Are you responsible for your behavior if your brain “made you do it”?

Often we think not. For example, research now suggests that the brain’s frontal lobes, which are crucial for self-control, are not yet mature in adolescents. This finding has helped shape attitudes about whether young people are fully responsible for their actions. In 2005, when the Supreme Court ruled that the death penalty for juveniles was unconstitutional, its decision explicitly took into consideration that “parts of the brain involved in behavior control continue to mature through late adolescence.”

Similar reasoning is often applied to behavior arising from chemical imbalances in the brain. It is possible, when the facts emerge, that the case of James E. Holmes, the suspect in the Colorado shootings, will spark debate about neurotransmitters and culpability.

Jared Loughner to plead guilty in Tucson shooting, sources say

Mental health officials reportedly believe he is now competent to understand the charges in the killing of six people and wounding of Rep. Gabrielle Giffords and 12 others in Tucson last year.

By Richard A. Serrano
The Los Angeles Times
Originally published August 4, 2012

Jared Lee Loughner is set to plead guilty Tuesday in the shooting attack that severely wounded Rep. Gabrielle Giffords, according to knowledgeable sources, as mental health officials believe he is now competent to understand the charges against him in the assault, which killed six people and injured 13 at a gathering with the congresswoman’s constituents in Tucson.

At the hearing Tuesday morning in U.S. District Court in Tucson, psychiatric experts who have examined Loughner, 23, are scheduled to testify that they have concluded that despite wide swings in his mental capacity, at this time he comprehends what happened and acknowledges the gravity of the charges, according to two sources who spoke on condition of anonymity because the case was still unfolding.

The entire story is here.

Monday, August 6, 2012

Vignette 16: Money Matters

A psychologist receives a call from an attorney wishing to seek services for depression, anxiety and substance abuse.  The psychologist screens the potential patient and she believes that she can help him.  When she asks about insurance, he indicates that he will use cash payments.  The psychologist explains the fee structure for the initial appointment as well as ongoing psychotherapy sessions.  The lawyer-patient comments that this seems low.  The psychologist ignores the comment and finishes by setting their initial appointment.

The psychologist and the attorney-patient meet for the initial session.  At the end of the session, the psychologist asks for the requisite fee as stated on the phone.  The attorney-patient indicates that he earns about 2.5 times what the psychologist asked.  He indicates that, in order for him to benefit from the treatment, he feels a need to pay what he makes an hour.  He also states that if she does not accept what he is offering, he will lose respect for her as a professional and probably not return for treatment.

Not knowing what to do, the psychologist takes the cash and sets up another appointment.  At the end of the day, the psychologist reflects on the interaction between she and her new lawyer-patient.  She does not feel right taking a fee larger than her usual and customary rate.  She is struggling that the situation is not right and feels very uneasy about the arrangement that the lawyer-patient foisted upon her.

Uncertain, she calls you for an ethics consultation.

What are the ethical issues, if any, involved in this case?

What would be your emotional response to this situation?

What factors make this situation potentially difficult for you as a psychologist?

What factors make this situation potentially easy for you as a psychologist?

What do you believe is the best course of action?

Sunday, August 5, 2012

Official Rescinds Punishment of Psychologist on Reservation

By Timothy Williams
The New York Times
Originally published August 2, 2012

A government psychologist who was officially reprimanded for alerting his superiors to widespread child abuse on a North Dakota Indian reservation has had his punishment rescinded, the Department of Health and Human Services announced Thursday.

The psychologist, Michael R. Tilus, director of behavioral health at the Spirit Lake Health Center on the Spirit Lake Reservation, said he had been acting as a whistle-blower when he e-mailed letters to senior federal health officials, law enforcement agents and North Dakota’s United States senators about what he described as an “epidemic” of child abuse at Spirit Lake and the lack of effort by the tribe’s leaders to address the problem.

The entire article is here.

The original story on this blog about Michael R. Tilus is here.

Telephone therapy technique brings more Iraq and Afghanistan veterans into mental health treatment

Originally published July 26, 2012

A brief therapeutic intervention called motivational interviewing, administered over the telephone, was significantly more effective than a simple "check-in" call in getting Iraq and Afghanistan war veterans with mental health diagnoses to begin treatment for their conditions, in a study led by a physician at the San Francisco VA Medical Center and the University of California, San Francisco.

Participants receiving telephone motivational interviewing also were significantly more likely to stay in therapy, and reported reductions in marijuana use and a decreased sense of stigma associated with mental health treatment.

The study was published electronically recently in General Hospital Psychiatry (May 25, 2012).

Lead author Karen Seal, MD, MPH, director of the Clinic at SFVAMC and an associate professor of medicine and psychiatry at UCSF, noted that 52 percent of the approximately half-million Iraq and Afghanistan veterans currently being seen by the VA have one or more mental health diagnoses, including post-traumatic stress disorder, depression, anxiety or other related conditions.

The entire story is here.

Saturday, August 4, 2012

Colorado Shooting Suspect Was Getting Psychiatric Care

By Dan Frosch
The New York Times
Originally published July 27, 2012

James E. Holmes, the Colorado man accused of gunning down 12 people at an Aurora movie theater last week, was being treated by a psychiatrist whose research interests include psychotherapy and the neurobiology of schizophrenia, according to court papers filed by Mr. Holmes’s lawyers on Thursday, the first documented glimpse into his mental health condition.


According to the court papers, Mr. Holmes had sent a package to Dr. Fenton, which was ultimately seized by the police after a search warrant was executed on Monday.


In September 2004, Dr. Fenton received an admonition from Colorado’s board of medical examiners for prescribing medications — including the allergy medication Claritin, the sleeping pill Ambien, two tranquilizers and the narcotic painkiller Vicodin — for a few colleagues and her husband on several occasions, and failing to keep proper documentation of the prescriptions. The board noted in its admonition letter that Dr. Fenton was no longer writing prescriptions for people who were not her patients.

The entire story is here.

Psychologist's death blamed on sex case worries

BBC News
Originally published July 23, 2012

A clinical psychologist who blamed herself for a decision to release a known sex offender was "visibly upset" before her death, an inquest has heard.

Lisa Derriscott, 33, of Long Eaton, Derbyshire, was found dead in a burned out car near her home on 3 August 2011.

She worked on a Nottinghamshire mental health team that sanctioned the release of sex offender Shaun Tudor, 44, who went on to reoffend.

In a narrative verdict, the Derby coroner said she took her own life.

The entire story is here.

Thanks to Ken Pope for this information.

Friday, August 3, 2012

Sex with patients the biggest no-no for doctors

By Melissa Davey
Health Reporter - The Age
Originally published July 26, 2012

HAVING a sexual relationship with a patient is more likely to see a doctor banned from practising than if they give a patient the wrong operation, miss a diagnosis or breach patient confidentiality, according to new research.


Of the 79 cases where doctors were guilty of a sexual relationship with a patient, 64 were removed from practice. Although it was far more common for doctors to be found guilty of inappropriate or inadequate treatment, writing inappropriate medical certificates and records, and illegal and unethical prescribing, they were much less likely to be removed.

The entire story is here.

Thanks to Gary Schoener for this article.

When I Kissed the Teacher

Student-Doctor Relationships Can Be Problematic When It Comes to a Teaching Environment

By Guy Rughani
From Student BMJ
Medscape Today News
Originally posted on July 17, 2012

Here is one excerpt:

From the beginning of medical school we are told that doctors should never date their patients. Accusations of preying on the vulnerable, abusing a position of trust, and eroding professional integrity are all persuasive reasons against such relationships. Indeed, in the United Kingdom, the General Medical Council has extensive guidance on the topic, requiring doctors to “maintain a professional boundary between themselves and their patients.” Although some guidance exists for staff about relationships in the workplace (see box), why do we never hear warnings against student-doctor/teacher relationships?

Jonathan Coe is the director of the Clinic for Boundaries Studies, an organisation which supports the victims of professional boundary violations and educates professionals in improving their approaches to prevention. “When we [patients] go to a doctor, we bring with us a level of vulnerability to the relationship,” says Mr Coe. “Implicitly, we are seeking assistance with issues whose solution is outside our knowledge and ability to respond effectively. There is a clear power differential and it is this that means that senior practitioners need to be careful before entering into any kind of personal involvement.”

Mr Coe argues that the guiding ethical principles that underpin the doctor-patient relationship are also relevant in the context of doctor-student matches. “There is a general ethical responsibility to avoid harm [non-maleficence/beneficence] and to respect autonomy,” he says, “both of which are at risk if an intimate relationship [among doctors and students] is started.”

The entire story is here.

Thursday, August 2, 2012

Psychology and Social Justice: Why We Do What We Do

By Vasquez, Melba J. T.
American Psychologist, Vol 67(5), Jul-Aug 2012, 337-346. 

Much of psychological science and knowledge is significantly relevant to social justice, defined here as the goal to decrease human suffering and to promote human values of equality and justice. A commitment to social justice has evolved as a more important value in the last few decades for psychology, including for the American Psychological Association (APA). The mission, vision, goals, Ethics Code, and strategic plan of APA all provide a rationale for psychologists' involvement in systematic and visible ways of applying our knowledge to social issues. Although psychology has not been immune to the application of psychological knowledge in destructive ways, overall, psychology, many psychologists, and APA have demonstrated a commitment to social justice. This article provides a brief review of the key proponents, debates, and controversies involved in applying psychological science and knowledge to complex societal problems. Psychologists often find themselves in conflict and honest disagreement when the association addresses complex and controversial issues. An important goal is that we continue to find ways to agree or disagree in a respectful manner regardless of where each of us stands on the various positions that APA takes.