Suspended Nova Scotia doctor may get licence back

CBC News.
Former patient blames doctor for suicide

A Nova Scotia doctor who used a patient to get a narcotic drug for her personal use will be allowed to return to the practice of medicine if she fulfils several conditions imposed by the College of Physicians and Surgeons of Nova Scotia.

Dr. Violet Hawes of Middle Musquodoboit had her licence suspended in November 2009 after the allegations surfaced.

The following month, one of her former patients committed suicide and left a note blaming her.
Doug Carpenter, 49, took his life in the parking lot of the Musquodoboit Valley Memorial Hospital in December 2009.

He left a note for his family saying "Dr. Hawes did this to me."

According to Carpenter's medical records, Hawes prescribed him Hydromorph Contin — a narcotic — for the first time in January 2008.

Carpenter's mother, Phyllis, said her son had described an arrangement with his doctor when she prescribed the drug.

"She would have a prescription ready for him when he went in there for his drug. He would fill it and give it to her," Carpenter told CBC News last December.

The entire CBCNews-Canada story can be here.

There was a similar case in central Pennsylvania in which a physician used numerous patients to obtain narcotics for himself.  In the Pennsylvania case, the physician's patient did not commit suicide, but he apparently told patients the drugs were for a dying parent.  Physicians using patient to obtain narcotics occurs.

Some of that information can be found here.

Petitioner was charged with five misdemeanor counts of unlawful procurement of prescription drugs in violation of 63 P.S. � 390-8(13) - however, the misdemeanor conviction is not at issue in this proceeding. Both the felony and misdemeanor charges involved Hydrocodone (Lortab) a Schedule III controlled substance. I.G. Ex. 8, at 1.

Antisocial Personality Traits Predict Utilitarian Responses To Moral Dilemmas

By Daniel M. Bartels and David A. Pizarro

The Mismeaure of Morals:
Anitsocial Personality Traint Predict Utilitarian Responses to Moral Dilemmas
Cognition, Volume 121, Issue 1, October 2011, pages 154-161


Abstract

Researchers have recently argued that utilitarianism is the appropriate framework by which to evaluate moral judgment, and that individuals who endorse non-utilitarian solutions to moral dilemmas (involving active vs. passive harm) are committing an error. We report a study in which participants responded to a battery of personality assessments and a set of dilemmas that pit utilitarian and non-utilitarian options against each other. Participants who indicated greater endorsement of utilitarian solutions had higher scores on measures of Psychopathy, machiavellianism, and life meaninglessness. These results question the widely-used methods by which lay moral judgments are evaluated, as these approaches lead to the counterintuitive conclusion that those individuals who are least prone to moral errors also possess a set of psychological characteristics that many would consider prototypically immoral.

The first two pages of the article can be found here

Bartels, Pizarro

Facebook refuses to shut rape page run by schoolboy

theage.com.au
By Philip Sherwell in New York

Nobody knows better than MJ Stephens that rape is no laughing matter. So as the victim of a sexual assault, she was horrified when she encountered the contents of a Facebook page full of jokes about rape and violence towards women.

But worse was to come when the young American tried to argue with people who had attached comments to a page called: "You know shes [sic] playing hard to get when your [sic] chasing her down an alleyway" - most of them teenagers and young adults from Australia and Britain.

In sickeningly explicit terms, several of them threatened her and expressed the wish that she be raped again.

Such pages, full of ugliness, aggression and pornographic language are multiplying on Facebook, drawing lucrative user traffic to the social networking site.

Now it has emerged that one of the "administrators" of the page - users with the right to edit its content - is believed to be a British schoolboy linked to a network of hackers in Australia, Britain and America who have set up Facebook pages featuring offensive sexual and violent content.

Micheal O'Brien, a Canadian computer systems engineer who co-founded the Rape Is No Joke (RINJ) campaign to pressure Facebook to delete "rape pages" via petitions and boycotts, has tracked the activity on several such pages and contacted participants online.

He told London's The Sunday Telegraph that associates of 4chan, a loose-knit collection of international "cyber-anarchists" who champion absolute online freedom, including the right to share pornography, have founded and administer several of the pages.

 

The entire story can be found here.

Thanks to Gary Schoener for the link to this article.

Apple FaceTime May Be HIPAA Secure

By Ken Terry InformationWeek

The FaceTime video chat feature of Apple's iPhone 4 and iPad 2 has the potential to be a game changer for doctor-patient communications, health IT experts tell InformationWeek Healthcare, but only if it's secure enough to satisfy federal privacy regulations.

InformationWeek asked Apple about reports that FaceTime can be configured so that it meets the requirements of Health Insurance Portability and Accountability Act (HIPAA). In response, Apple said that only HIPAA-covered entities, not software applications, can be HIPAA-compliant. But the company also stated, "Our [iPad 2 and iPhone 4] products can be used by HIPAA-compliant organizations."

For FaceTime communications to be highly secure, Apple told a contributor to ZDnet, an iPad2 user would have to configure the device's security settings so that it uses WPA2 Enterprise to access an enterprise wireless network. WPA2 Enterprise has 128-bit AES encryption. Moreover, each video chat is encrypted with unique session keys, and each participant receives a unique ID number, Apple said.

The entire article can be found here.

W.Va. board withdraws autism rule after lawsuit

By Lawrence Messina
Associated Press
Published September 27, 2011

The West Virginia board that regulates psychologists voted Tuesday to withdraw an emergency rule that claimed jurisdiction over specialists who treat children with autism, after the new policy spurred a lawsuit and an outcry among parents of these children and their supporters.

The rule issued in July by the state Board of Examiners of Psychologists has been misinterpreted and misunderstood, board Executive Director Jeffrey Harlow said in a statement emailed to the media late Tuesday.

"The parents are calling the board and expressing fear and anger," the statement said, adding that "The last thing the Board would want to do is obstruct the provision of vitally needed services to these vulnerable children."

The rule had barred applied behavioral analysis, a therapy considered crucial for many children diagnosed with an autism spectrum disorder, unless a licensed psychologist supervised the ABA analyst. When it applied for the rule, the board called the providing of this therapy outside its jurisdiction "an immediate threat to public safety."

"There is a relatively small, but most likely soon to increase, group of individuals engaging in the practice of psychology who are not licensed and who do not meet the minimum education and training requirements for licensure," the board wrote when it sought the rule. "They are not prepared to practice independently, lack oversight and constitute a serious and immediate concern to public safety."

A certified ABA analyst, Jill Scarbro-McLaury, sued the board last week, asking a judge to scuttle the rule. Her Kanawha Circuit lawsuit alleged that ABA therapy is separate and distinct from psychology, and has been practiced in West Virginia for years without the board's interference.

"We are encouraged that the board recognized that the rule should be pulled since it was in violation of the law, and we hope no more road blocks are placed in front of our families who just want to help their children," Scarbro-McLaury said in an email.

The board pursued the rule over a new law that will eventually require both public and private insurers to cover ABA therapy. Parents of children with these neurological ailments and their supporters had lobbied the Legislature for several years for the measure. Acting Gov. Earl Ray Tomblin signed the regular session bill into law in April.

The entire story can be read here.

The Ethics Of Gallows Humor In Medicine

By Katie Watson
The Hastings Center

Medical professionals regularly joke about their patients’ problems. Some of these jokes are clearly wrong, but are all jokes wrong?

It was 3:00 am and three tired emergency room residents were wondering why the pizza they’d ordered hadn’t come yet. A nurse interrupted their pizza complaints with a shout: “GSW Trauma One—no pulse, no blood pressure.”

The residents rushed to meet the gurney and immediately recognized the unconscious shooting victim: he was the teenage delivery boy from their favorite all-night restaurant, and he’d been mugged bringing their dinner.

That made them work even harder. A surgeon cracked the kid’s rib cage and exposed his heart, but the bullet had torn it open and they couldn’t even stabilize him for the OR. After forty minutes of resuscitation they called it: time of death, 4:00 a.m.

The young doctors shuffled into the temporarily empty waiting area. They sat in silence. Then David said what all three were thinking.

“What happened to our pizza?”

Joe found their pizza box where the delivery boy dropped it before he ran from his attackers. It was face up, a few steps away from the ER’s sliding doors. Joe set it on the table. They stared at it. Then one of the residents made a joke.

“How much you think we ought to tip him?”

The residents laughed. Then they ate the pizza.

Gallows humor is humor that treats serious, frightening, or painful subject matter in a light or satirical way. Joking about death fits the term most literally, but making fun of life-threatening, disastrous, or terrifying situations fits the category as well. There is a fair amount of literature on humor in medicine generally, most of which is focused on humor in clinician-patient interactions or humor’s benefit to patients. There is relatively little specifically addressing the topic of this article: gallows humor in medicine, which usually occurs in interactions between health care providers.

Gallows humor is not a feel-good, Patch Adams kind of humor, but it is not synonymous with all cruel humor, either. As one physician put it, the difference between gallows humor and derogatory humor is like “the difference between whistling as you go through the graveyard and kicking over the gravestones.” Many health care providers witness or participate in gallows humor at some point. After reviewing over forty medical memoirs, Suzanne Poirier reports that “Anger and gallows humor are generally accepted forms of expression among undergraduate and graduate medical students . . . but expressions of serious self-doubt or grief are usually kept private or shared with only a trusted few.”

David’s question intrigued me as a bioethicist because it is about moral distress, power imbalances between doctors and patients, and good people making surprising choices. But it also piqued my interest as someone who enjoys joking around—when not teaching bioethics, I teach improv and sketch writing at Second City, where I’m an adjunct faculty member. But David didn’t ask me if the tip joke was funny. He asked about it in ethics’ normative terms of right and wrong.

David told me this story fifteen years after he finished his residency, but the urgency with which he told it made it seem like it happened last night. “You’re the ethicist,” he said. “Was it wrong to make a joke?”


The rest of the story can be read here.  In order to access the entire article, you may have to register with The Hastings Center.

Confidentiality, Seinfeld Style

If you are a Seinfeld fan, then you likely remember this scene.

If you are not a Seinfeld fan, then you need to know the following.

George is in bed with Susan, his fiance.  George has been experiencing "cold feet" about their upcoming nuptuals.  He confides some of his ambivalence to Elaine.  Elaine and George have a prickly social relationship.

Enjoy the scene.

Richard F. Small: PPA's 2011 Ethics Educator of the Year

Richard F. Small, PhD ABPP

Ethics Educator of the Year

Pennsylvania is fortunate to have Dr. Richard F. Small as a practicing psychologist and ethics educator.

A survey by Ken Pope showed that psychologists were more often likely to turn to peers as a source of ethical information than published articles, ethics codes, or other sources. Here at PPA, we are pleased that the ethics educators’ award not only goes to academic psychologists but also goes to practicing psychologists (such as Don Jennings, Don McAleer, and Eve Orlowe) who have a substantial impact and credibility in supporting their professional colleagues.

Part of Dr. Small’s success as a thinker or presenter on ethical issues stems from  real life experience, as a psychotherapist, a marriage therapist, a practice owner, a supervisor, an evaluator, and a teacher.  This wide ranging experience gives him credibility and familiarity with the ethical issues that psychologists face on an average, everyday basis.

In everything he does, whether as a practicing psychologist, a consultant on insurance and practice issues, or a volunteer for PPA, Rick is guided by overarching ethical principles. For example, his writings on insurance and practice management always kept patient well-being at the forefront. He gave special attention to multiculturalism and diversity while PPA President, and, through the Pennsylvania Psychological Foundation, he has focused on developing book awards for graduate students in psychology.

Dr. Small presented on ethics for a number of organizations, including the American Psychological Association, the Pennsylvania Psychological Association, various private organizations (such as The American Health Care Institute), and non-profits.  In fact, Rick and Sam Knapp first used the term “positive ethics” in a workshop they gave 15 years ago entitled, “Ethics is more than a code.”  Dr. Small has also authored or co-authored a number of articles for The Pennsylvania Psychologist.  He has been a member of our Ethics Committee for years.  He remains committed to multiculturalism and diversity as well.

As you will see this afternoon, Rick is an excellent presenter.  Using the Acculturation model as a guide, Dr. Small balances the legal aspects of ethics with the personal values and emotional qualities of a seasoned psychologist to provide a truly integrated approach to teaching ethics.

For all his work with ethics education at the state and national level, I am pleased to present Dr. Richard F. Small as this year’s the Ethics Educator of the Year.

New Jersey Psychologists Fight to End Unlawful Practices of Major Health Insurance Plans

Press Release
The New Jersey Psychological Association
October 13, 2011

NJPA Sues Horizon and Magellan for Violating Patient Privacy and Breaking Contractual Obligations

The New Jersey Psychological Association (NJPA), which represents approximately 2,000 psychologists throughout the state, has filed a lawsuit in conjunction with two patient co-plaintiffs against Horizon Healthcare Services, Inc. and Magellan Health Services. The suit seeks a declaration that Horizon and Magellan have violated patient confidentiality rights and breached the terms of their plan documents by systematically and wrongfully requiring psychologists to disclose confidential patient information to secure authorization for payment for mental health treatment.

The suit alleges that defendants' practices not only contradict the plan documents of the State Health Benefits Plan, the largest insurance plan in the state, but also violate state and federal laws protecting patient privacy. NJPA filed the suit to preserve and protect the rights of its members and its members' patients, who are directly affected by Horizon's and Magellan's actions.

"The skill and support of my psychologist were crucial when I was dealing with a deeply personal and challenging time in my life," said Steven Sargese, a retired law enforcement officer in Essex County and a co-plaintiff in the lawsuit. "Unfortunately, my health plan repeatedly denied the full course of treatment recommended by my psychologist. I'm determined to stand up for people who need mental health services and cannot stand up for themselves."

The entire story can be read here.

The New Jersey Psychological Association website is here.