As military struggles with suicides, a push for seeking help

By Adam Ashton
Tacoma News Tribune

A Washington state social worker is circulating a petition urging federal lawmakers and the military to adopt a policy declaring that service members shouldn't be punished if they seek help for behavioral health issues, such as post-traumatic stress.

Patricia Bailey, 45, believes the lack of a firm policy on whether service members could be held back in their careers for seeking counseling is one of the main obstacles keeping people in the military from pursuing treatment.

"It will give reassurance to him that if he seeks mental health counseling nothing will be in jeopardy," said Bailey, whose 13-year marriage to a Joint Base Lewis-McChord soldier ended in 2008 as stress built during his deployments to Iraq.

She's targeting a gray area in the military's evolving suicide prevention and post-traumatic stress programs. Leaders at the Pentagon and at Lewis-McChord insist service members won't face professional repercussions for seeking counseling, but it's not clear how well that message reaches down the ranks.

An April study on military suicides released by the nonprofit RAND Corporation pointed out that the Defense Department hasn't taken concrete steps to reverse a perception that service members might be retired for medical reasons or lose out on a promotion if they ask for counseling. The study received funding from the Defense Department.

Bailey got a close view of Lewis-McChord's behavioral health services both as a part-time counselor between 2002 and 2004 and as someone who later reached out for help in keeping her marriage together. She'd like to see a greater emphasis on preventive programs instead of ones that kick in after an outburst, such as an arrest.

"When my husband and I were going through everything, I asked people for help," she said. "I wasn't shy. And they said 'We can't do anything for you.' You're frustrated because you can't do anything. I didn't want my marriage to end."

She's one of many people in the South Sound who are raising their voices to draw attention to the psychological toll 10 years of warfare have taken on military families. In the past year, service clubs have organized retreats for Army couples and the United Way of Pierce County put forward a proposal to deliver more resources to military families.

The military, likewise, is looking for new approaches. Madigan Army Medical Center increased its ranks of behavioral health specialists last year. Lewis-McChord recently hired a new suicide prevention officer.
Yet the Army and the base continue to struggle with how to reach distressed service members.

The Army reported that it was investigating 32 possible suicides in July, the most in any month over the past two years. Lewis-McChord officials told Sen. Patty Murray, D-Wash., that nine soldiers took their lives this year.

Read more here.

DOD, Services Work to Prevent Suicides

By Karen Parrish
American Forces Press Service

WASHINGTON, Sept. 9, 2011 – Officials know the facts about suicide in the military services, but the causes and best means of prevention are more elusive, a senior Defense Department official said today.

In testimony before the House Armed Services committee, Dr. Jonathan Woodson, the assistant secretary of defense for health affairs and director of the TRICARE Management Activity, said DOD has invested “tremendous resources” to better understand how to identify those at risk of suicide, treat at-risk people, and prevent suicide.

“We continue to seek the best minds from both within our ranks, from academia, other federal health partners, and the private sector to further our understanding of this complex set of issues,” Woodson said.

The overall rate of suicide among service members has risen steadily for a decade, he said, and DOD and the services are taking a multidisciplinary approach in their efforts to save lives.

The Defense and Veterans Affairs Departments are developing shared clinical practice guidelines that health care providers in both agencies will use to assess suicide risk and help prevent suicide attempts, Woodson said.

DOD also is working with the Department of Health and Human Services and the Substance Abuse and Mental Health Services Administration to offer critical mental health services to National Guard and Reserve members, who often don’t live close to military medical facilities, he added.

Woodson acknowledged much work remains.

“We have identified risk factors for suicide, and factors that appear to protect an individual from suicide,” he said. “As you well understand, the interplay of these factors is very complex. Our efforts are focused on addressing solutions in a comprehensive and holistic manner.”

Defense suicide prevention research includes Army ‘STARS,’ a study to assess risk and resilience in service members, Woodson said.

“This is the largest single epidemiologic research effort ever undertaken by the Army, and is designed to examine mental health, psychological resilience, suicide risk, suicide-related behaviors and suicide deaths,” the assistant secretary said.

The study, he said, involves experts from the Uniform Services University of the Health Sciences, University of California, University of Michigan, Harvard University, and the National Institute of Mental Health.

STARS is examining past data on about 90,000 active-duty soldiers, evaluating soldiers' characteristics and experiences as they relate to subsequent psychological health issues, suicidal behavior and other relevant outcomes, he said.

DOD has added more than 200 mental health professionals from the Public Health Service to medical facilities’ staffs, and is expanding access to services in civilian communities, Woodson said.

“Within the department, we have amended medical doctrine and embedded our mental health professionals far forward … to provide care in theaters of operation,” he added.

The department also has worked to collect, analyze and share data more effectively “so that the entire care team understands the diagnosis and treatment plan,” he said.

“As important as any step, we have also made great attempts to remove stigma from seeking mental health services, a stigma that is common throughout society, and not just in the military,” Woodson continued. “This is a long-term effort, but both senior officers and enlisted leaders are speaking out with a common message.”

Defense leaders are encouraged that service members increasingly now seek professional help when it is recommended, he said.

The entire article can be found here.

Psychologist found guilty of sexual relationship with patient

By Bruce Vielmetti of the Journal Sentinel

Published September 2, 2011

An Oak Creek psychologist was found guilty Friday of starting a sexual relationship with a longtime patient in 2005.

Jeffrey Adamczak, 48, faces up to 71/2 years in prison for sexual exploitation by a therapist at his sentencing Oct. 13. Jurors deliberated about two hours before reaching the verdict after a weeklong trial.

Adamczak was charged in August 2010. The victim, with whom he carried on a yearlong affair before she broke it off in 2006, reported Adamczak to authorities in March 2010 after she became convinced that he was again having sexual contact with patients.

Milwaukee County Circuit Judge Rebecca Dallet directed that the woman not be named in news reports.

A second former patient also testified that Adamczak had sexual contact with her in 2004, and two other former patients described what they considered inappropriate sexual comments from him during therapy. Adamczak flatly denied those allegations.

His attorney, Gerald Boyle, told jurors in closing arguments that jealousy drove the woman to destroy Adamczak, and said his client's testimony and office records showed the affair didn't start until after he had closed the woman's file, ending the therapist relationship.

The woman, a 40-year-old physical therapist, had been in near weekly counseling with Adamczak for about three years when he initiated sexual contact with her at a session in February 2005, after she told him she had filed for divorce from her husband.

Timing questioned

At trial, both parties testified about a memorable tryst at a Milwaukee hotel suite, replete with candles, special music and rose petals scattered near the whirlpool tub.

But when she was interviewed earlier by police, the woman said she couldn't recall the exact date, or the hotel where she and Adamczak had the experience they referred to as "Paris."

And that, his attorney argued to jurors Friday, was a big red flag on her credibility.

"If she can't remember "Paris,' " Boyle said, jurors shouldn't believe her testimony about exactly when she first had sex with Adamczak.

The timing of the first encounters was a key question for jurors. The woman testified it was in February 2005, just after she had filed for divorce, and that her therapist initiated three sexual episodes before finally telling her she could no longer be his patient "on paper."

Adamczak testified she came on to him, in late March 2005, several weeks after he had determined she no longer needed counseling and closed her file.

The entire story can be found here.

New data spill shows risk of online health records

By Jordan Robertson

AP Technology Writer

Until recently, medical files belonging to nearly 300,000 Californians sat unsecured on the Internet for the entire world to see.

There were insurance forms, Social Security numbers and doctors' notes. Among the files were summaries that spelled out, in painstaking detail, a trucker's crushed fingers, a maintenance worker's broken ribs and one man's bout with sexual dysfunction.

At a time of mounting computer hacking threats, the incident offers an alarming glimpse at privacy risks as the nation moves steadily into an era in which every American's sensitive medical information will be digitized.

Electronic records can lower costs, cut bureaucracy and ultimately save lives. The government is offering bonuses to early adopters and threatening penalties and cuts in payments to medical providers who refuse to change.

But there are not-so-hidden costs with modernization.

"When things go wrong, they can really go wrong," says Beth Givens, director of the nonprofit Privacy Rights Clearinghouse, which tracks data breaches. "Even the most well-designed systems are not safe. ... This case is a good example of how the human element is the weakest link."

Southern California Medical-Legal Consultants, which represents doctors and hospitals seeking payment from patients receiving workers' compensation, put the records on a website that it believed only employees could use, owner Joel Hecht says.

The personal data was discovered by Aaron Titus, a researcher with Identity Finder who then alerted Hecht's firm and The Associated Press. He found it through Internet searches, a common tactic for finding private information posted on unsecured sites.

The data were "available to anyone in the world with half a brain and access to Google," Titus says.

Titus says Hecht's company failed to use two basic techniques that could have protected the data — requiring a password and instructing search engines not to index the pages. He called the breach "likely a case of felony stupidity."

One of the patients affected was Paul Thompson, who learned of the breach from Titus.

The Sugarloaf, Calif., electrician blew out his shoulder four years ago on a job wiring up a multiplex movie theater. His insurance company denied his claim, which led to a protracted dispute. He eventually settled.

Thompson says his injury has been a "long, painful road."

Unable to afford surgery in the U.S. to fix his torn rotator cuff, he paid a medical tourism company that was supposed to schedule a cheaper procedure in Costa Rica. The company went bankrupt, however, and Thompson said he lost nearly $7,300.

To have his personal information exposed on top of that was a final indignity.

"I'm totally disgusted about everything," he said, calling the breach "another kick in the stomach."

Thomson is worried that hackers may have spotted his information online and tagged him for future financial scams. He contacted his bank and set up a fraud alert with the credit reporting agencies.

He says the prospect of all health records going electronic — which federal law mandates should happen by 2014 — "scares the living hell out of me."

When mistakes occur, the fallout can be more severe than the typical breach of email addresses or credit card numbers.

The rest of the story can be read here.

Patient Data Posted Online in Major Breach of Privacy

By Kevin Sack
The New York Times

Published September 9, 2011

A medical privacy breach led to the public posting on a commercial Web site of data for 20,000 emergency room patients at Stanford Hospital in Palo Alto, Calif., including names and diagnosis codes, the hospital has confirmed. The information stayed online for nearly a year.

Since discovering the breach last month, the hospital has been investigating how a detailed spreadsheet made its way from one of its vendors, a billing contractor identified as Multi-Specialty Collection Services, to a Web site called Student of Fortune, which allows students to solicit paid assistance with their schoolwork.

Gary Migdol, a spokesman for Stanford Hospital and Clinics, said the spreadsheet first appeared on the site on Sept. 9, 2010, as an attachment to a question about how to convert the data into a bar graph.

Although medical security breaches are not uncommon, the Stanford breach was notable for the length of time that the data remained publicly available without detection.

Even as government regulators strengthen oversight by requiring public reporting of breaches and imposing heavy fines, experts on medical security said the Stanford breach spotlighted the persistent vulnerability posed by legions of outside contractors that gain access to private data.

The spreadsheet included names, diagnosis codes, account numbers, admission and discharge dates, and billing charges for patients seen at Stanford Hospital’s emergency room during a six-month period in 2009, Mr. Migdol said. It did not include Social Security numbers, birth dates, credit-card numbers or other information used to perpetrate identity theft, he said, but the hospital is offering free identity protection services to affected patients.

The breach was discovered by a patient and reported to the hospital on Aug. 22, according to a letter written four days later to affected patients by Diane Meyer, Stanford Hospital’s chief privacy officer. The hospital took “aggressive steps,” and the Web site removed the post the next day, Ms. Meyer wrote. It also notified state and federal agencies, Mr. Migdol said.

“It is clearly disturbing when this information gets public,” he said. “It is our intent 100 percent of the time to keep this information confidential and private, and we work hard every day to ensure that.”

Diane Dobson, of Santa Clara, Calif., said her “jaw dropped” on Saturday when she intercepted the letter from Ms. Meyer addressed to her 21-year-old son, who she said had received emergency psychiatric treatment at Stanford in 2009. Ms. Dobson said it could have been disastrous if her son, who lives at home, had learned that his name was linked to a mental health diagnosis.

“My son, I can tell you, is fragile and confused enough that this would have sent him over the edge,” Ms. Dobson said, saying she decided to speak publicly now because of her frustration with the breach. “Everyone with an electronic medical record is at risk, and that means everyone.”

The entire story can be read here.

Info dump yields $40K settlement

By Bryan Cohen
Legal Newsline

North Carolina Attorney General Roy Cooper announced on Wednesday that a Charlotte doctor has paid $40,000 for allegedly dumping files that contained patients' financial and medical information. 

Dr. Ervin Batchelor owns and operates the Carolina Center for Development and Rehabilitation, which is a psychological testing and treatment facility located in Charlotte. In June 2010, the facility allegedly disposed of 1,000 patient files illegally by dumping them at the West Mecklenburg Recycling Center.

The files allegedly contained health information, insurance account numbers, drivers' license numbers, Social Security numbers, dates of birth, addresses and names for 1,600 people.

"Any business you entrust with your information has a duty to keep it safe," Cooper said. "Sensitive financial and health information should never be carelessly dumped, putting customers and patients at risk of identity theft."

Under a state law Cooper pushed through the General Assembly in 2005, businesses that dispose of records containing personal identifying information must destroy or shred those records so that identity thieves can't retrieve information from discarded files that have been carelessly thrown away. Medical records also face added restrictions under federal health privacy laws.

The Carolina Center records were recovered by Mecklenburg County, N.C., officials, who contacted Cooper's office.

As part of a settlement, Batchelor paid $40,000 and agreed to abide by both federal and state laws that protect people's personal financial and health information.

The Carolina Center has already notified the patients whose information was placed at risk. State law requires businesses, as well as state and local government agencies, to notify consumers if a security breach may have put their personal information at risk. The breaches of security must also be reported to the Consumer Protection Division. Since state laws on security breaches took effect in 2005 and 2006, a total of 889 breaches involving information and more than 3.3 million state consumers have been reported.

Cooper's CPD has won settlements in multiple other document dumping cases, including against a Gastonia, N.C., movie rental store, two mortgage lenders from the Charlotte area and a Greensboro, N.C., urgent care clinic.

Providence police, hospitals at odds in medical privacy debate

By Amanda Milkovitz
Rhode Island News

A judge in a murder trial in June wanted to see the medical records of a woman whose husband was charged with killing her.

Rhode Island Hospital’s records department rejected the court order –– and answered the subsequent subpoena by saying the law allowed 20 days to respond.

A Providence detective investigating an alleged murder requested the medical records of the victim, who died at Rhode Island Hospital. In his request for the records in March 2010 — nearly two years after the death –– the detective included a copy of the victim’s death certificate, plus two signed releases from the man’s father and adult son.

Rhode Island Hospital refused.

In March, the Providence police wanted to know if a man who’d been shot was still alive, before the suspect accused of shooting him was released on bail. If the victim was dead, the suspect would be held for murder.

Rhode Island Hospital wouldn’t say whether the wounded man existed.

Providence Detective Sgt. James Marsland sighs in frustration as he tells these stories.

“We call over to the hospital to find out his condition: Is he dead or alive? That’s the only medical information I want.

“They wouldn’t tell me he was there,” Marsland said. “I know he’s there –– we brought him there.”

The federal Health Insurance Portability and Accountability Act, known as HIPAA, was designed to protect the privacy of medical databases and imposes hefty fines against those who release patients’ protected information. Even so, the federal law allows the release of some information to law enforcement, such as when the police need to identify a suspect, fugitive or material witness, or when the police are investigating whether a patient is a victim of a crime.

States have their own versions of patient privacy laws, and Rhode Island’s Health Care Confidentiality Law, written in 1978 and adapted over the years, is even more restrictive than the federal law.

The state’s law requires health-care providers to release information to law enforcement about specific kinds of cases, including those involving gunshots and abuse of children — but otherwise, providers need the consent of the patient or family to release any information. Violators may be punished by a fine of up to $5,000 or six months in prison.

Dr. John B. Murphy, senior vice president for medical affairs at Rhode Island Hospital, said in an interview that the hospital wants to work with the police, but it also must follow the law. He’s participated in meetings with the Providence police about the issue, most recently with then-Chief Dean M. Esserman a few months ago, and said the hospital has been trying to accommodate investigators.

The hospital has recently stopped concealing the identities of all people brought in with violent injuries, Murphy said. The hospital also gave police contact information for the top on-call administrator.

But there is only so much the hospital can do within the law, he said.

“If you think the law needs to be changed, then change the law,” Murphy said. “Why does the law differentiate from a grazing gunshot that just needs a Band-Aid and a life-threatening stab to the liver?”

The rest of the story can be found here.

A High Risk Situation: The Suicidal Client

Gary Schoener

From our experience, psychologists and students frequently look for excellent resources for dealing with suicidal patients.  Working with suicidal patients can become time intensive and emotionally draining.  Psychologists need to become educated and remain current with their training.  Consulting with other psychologists when dealing with at-risk patients is always recommended.



Gary Schoener, noted ethics educator, permitted our committee to post this resource when dealing with suicidal patients.

Suicide Handout

Why Therapist Directories Are A Waste Of Time

by Mike Langolis
Gamer Therapist
Psychotherapy Meets Web 2.0

This post is for all of you who have been considering or actively using listings in therapist directories.  I frequently get asked from consultees which directories they should list in.  I also frequently see colleagues debating on bulletin boards and listservs the merits and demerits of individual directories.  So I figure it’s time to offer you my perspective.  Please bear in mind that I am sharing my experience and opinions here, and if you’ve had a different one, hopefully you’ll mention it on the comments.  If you own a directory service, I hope you’ll disclose that as well.

When I started building my practice, I had a lot of time to spend filling out various online directories.  I literally spent hours filling out profiles that promised to make me visible to potential patients.  To be fair it gave me the opportunity to hone my bio and elevator speech, but other than that I now think that I was wasting my time.  But let’s talk a little about why directories may be a waste of your time, because I think it points to a larger misconception about marketing your practice online.

Billboard in a bottle.

Many therapists still approach the internet as if it was a giant Yellow Pages.  We often create static content, the equivalent of a business card, cover letter and resume, and then slap it up on a website, or a directory.  Then we sit back and wait for the phone to ring.  It’s like we imagine that we created a giant billboard and threw it into the world wide web.  But in reality, it’s more like a message in a bottle, thrown in a vast ocean.  We imagine that that will get us recognized.  It usually doesn’t, and here’s why.

If you google “find a therapist” you will literally find dozens of website directories guaranteed to help patients find the right provider.  If you’re ambitious you could spend hours and days finding all of them and entering your information.  Many of them are free, some charge money, and a few don’t let you know whether they will charge or not until you’ve entered all of your information.  One of the main problems with directories is exactly that there are so many of them.

One thing I’ve learned from starting up social networks for other companies is that you always need a critical mass of members as quickly as possible.  If you launch a site you have a few days to a week to achieve this in most cases.  Otherwise potential members will log in to your site, look around and see little activity, and leave.  So low enrollment of providers in a directory will drive little traffic to it.

On the other hand, if you take a directory like Psychology Today’s you will see that they did achieve a critical mass, and have more traffic.  But the problem here is that this is because every therapist and her maiden aunt is now listed there.  So the problem becomes how to set yourself apart from the rest.  If you are determined to spend time on listing yourself in a directory, I’d suggest that you pay for the PT one and try to distinguish yourself as best you can.  In fact, the Psychology Today site is the only directory I even try to keep current and pay for anymore.

The entire blog post can be found here.