ARIZONA PSYCHIATRIC SOCIETY NEWSLETTER
Spring Newsletter 2014, Volume 5, Issue 1
IN THIS ISSUE...
The DSM-5 Workshops repeated in Tucson and Phoenix enjoyed great reviews and attendance.  Phoenix presenter, Dr. McLoone (center), is joined here by Dr. Mark Harp and Dr. Amanda Cattelino.

Dr. Brian Espinoza (APS Representative to the ArMA House of Delegates in June) attended the Phoenix Winter Social and CME with his wife Stephanie.

Dr. Matthew Goldenberg (nominated for Co- Resident-Fellow Member Rep) and Dr. Monica Faria attended the Winter Social and CME Event.


Spring Greetings
Robin Reesal, MD, Newsletter Chair     April 2014

Welcome to the APS Spring Newsletter, which should foster neuronal growth and increase dopamine activity. This edition marks the end of Dr. Joanna Kowalik's term as APS President. Her conscientiousness, enthusiasm, and thoughtfulness has increased member involvement and spurred resident participation to new heights. Thank you Dr. Kowalik for all of your time and efforts!

 

Congratulations to all the new Fellows.  Of note is Dr. Wagman's achievement of Distinguished Fellow status.  Special appreciation and gratitude goes out to Dr. Edward Gelardin and Dr. Edward Wolpert who became 50-year Members with Life status in January of this year.

 

We start the Newsletter articles with a transcultural psychiatry theme. Dr. Hammerschlag, an accomplished book author, writes a wonderful article on transgenerational resilience of Native Americans. His knowledge and insights about this topic are thought provoking. Dr. Daniel Conrad shares his colorful life experiences about his meaningful work among children and adolescence of the Navajo Nation. He discusses some of the ethical issues and treatment barriers. Last, I have written a brief article on Rwanda, which will be my home for the next year.  Dr. Taylor-Desir, who has been a regular contributor to our Newsletter, has kindly agreed to take over my role. No doubt she will do an outstanding job.

 

In our Meet Your Fellow APS Member feature, we learn of Dr. Jasleen Chhatwal and her developing medical career.  She is forging a path to be an outstanding psychiatrist.  Her sincere and honest writing style allows all to see her love of people and enthusiasm for psychiatry.

 

Our next three articles are on Arizona politics and mental health. Mental Health America allowed us to reprint a succinct and informative summary of the final RHBA transition in Maricopa County. We thank them for their collaboration. Charles Arnold, a mental health attorney in Phoenix, the primary named-Plaintiff in the class action lawsuit known as Arnold vs. Sarn graciously agreed to write his thoughts on years of hard work and perseverance on this matter. Our APS Lobbyist, Joseph Abate, who has served us well through our psychologist prescription matters, summarizes the ongoing Legislative Session and highlights concerns with the Sunrise process.

 

The last part of the Newsletter offers various topics. There is information on the maintenance of certification program requirements for the ABPN, news on the recent resident Spring mixer in Tucson, and an awards recognition page.  We close with a set of reminders about educational events.

 

Thanks to our readers, contributors, Executive Director, President and the Newsletter Committee, the APS Newsletter received the APA Member Communications Award, the e-Newsletter category, for 2013.

 

On behalf of the APS, the Newsletter committee and the incoming editor Dr. Taylor-Desire enjoy your read.   

The Winter Social and CME Event offered great interactive education, food, and peer connections. Photographed here Drs. Sonia Godbole, Gurjot Marwah (APS Treasurer), Shubha Kumar, and Anita Karnik.

 

President's Message
Dr. Kowalik speaking to Residents from the University of Arizona Psychiatric Residency Programs. Our thanks to Drs. Herron and Kaempf and their staff for the gracious welcome.
Joanna Kowalik, MD, MPH, President
Arizona Psychiatric Society

I hope everyone is doing well and getting ready to attend the 2014 Annual Meeting of the Arizona Psychiatric Society.  The theme for the incoming meeting is: "Changing the Practice and Perception of Psychiatry: Delivering Optimal Care in an Integrated Settings".   We are looking forward to seeing you on Saturday, April 12, 2014, at the Wild Horse Pass Hotel, which is a gorgeous establishment with great meeting facilities and also opportunities for fun and entertainment before and after the meeting.  Our agenda include lectures and discussions by distinguished speakers who will focus on integrated care in the field of general and geriatric psychiatry, addiction, administration, child psychiatry and many other interesting areas.

 

We are hoping that all of our members will also join us at the Social and Networking Event on Friday, April 11, 2014, at the Wild Horse Pass Casino and Hotel.  This is the first year we will offer a peer poster presentation opportunity, and we are hoping you will use the opportunity to share your research with us.  We will also be recognizing achievements of our members with the new Career Achievement in Psychiatry and Resident Recognition Awards.   

Drs. Ole Thienhaus, Carol Olson, and Bennett Blum also spoke to the residents about the value of APS and advocating for their profession and patient care.

 

  About a year ago, I shared with you my gratitude and excitement to serve my term as the President of the Arizona Psychiatric Society.  It's truly hard to believe that the  year of my term is almost over.  This has been a very interesting,  busy, and productive year for me  as the President and for the  Arizona Psychiatric Society.

 

 We are facing changes and  challenges in our professional and  personal life. The past year  brought in many changes and opportunities to learn, analyze, and adjust our practice.  The new and innovative DSM-5 was released in May 2013.  Arizona Psychiatric Society, striving to prepare our profession and to provide the real time information, provided DSM-5 workshops to members, as well as other mental health professionals.  Our professional leaders and distinguished colleagues, Drs. James McLoone and Ole Thienhaus, presented "DSM 5: What You Need to Know to Transition from DSM-IV".  Those DSM-5 workshops in Phoenix, Tucson and Flagstaff were very well attended and received.

 

We realize the importance of professional connections and networking.  We were pleased to offer Fall and Winter Social Events, to our members in Phoenix and Tucson.  We are delighted to see so many of you attending and participating.

 

We are so proud to have distinguished members such as Dr. Martin Kassell who has been hosting monthly Kaffe Klatch discussions and providing all APS members with an opportunity to discuss various psychiatric topics.

 

Last year I mentioned to you that we recognize that we need to continue to build upon the transparency of Arizona Psychiatric Society so that members better understand what the Executive Council and the organization are doing.  We hope that your active participation in workshops, meetings and social events organized by Arizona Psychiatric Society provided more real-time and relevant education and information.  Dr. Robin Reesal, The Chief Editor of our quarterly APS Newsletter provided us with a plethora of innovative topics in psychiatry throughout the year.  We are pleased to announce that his editorial work has created an award winning publication, recognized as the best by American Psychiatric Association.

 

Arizona Psychiatric Society is a professional organization of Psychiatrists in Arizona and we strive to reflect that in all we do.  It has been an honor and a wonderful professional experience to serve as the President of APS.  I'm planning on staying involved and active in our professional organization.  I hope you will also stay engaged in what is happening by attending APS events, volunteering to serve on committees and reaching out to us.  Once again, I invite you to partner with us as we endeavor to advance the value and strength of our profession and to advance mental health care in our state.

Gary Grove, MD, DFAPA
Medical Office Space for Lease (Available June 1, 2014)

Located in the beautiful Ironwood Square development near Scottsdale Healthcare Shea, an ideal office is available with a long established psychiatric practice for a mental health professional, whether a psychiatrist, psychologist or psychotherapist.  

 

The office includes a shared waiting room, records/workroom, secretarial/reception area, break room; utilities and janitorial included.  The office is spacious and well-appointed, and the rent is negotiable.   

 

For more information please call 480-948-3361 or email to info@garygrovemd.com 


APS Annual Meeting on April 12, 2014 
 
Haven't registered yet for the APS Annual Meeting on Saturday, April 12, 2014 at Wild Horse Pass Casino, just off I-10 at Wild Horse Pass Boulevard, in Chandler, Arizona?
Through 5:00 pm on April 10, 2014, you can register online at https://aps-annual-041214.eventbrite.com or by faxing or e-mailing the registration brochure to Teri (teri@azmed.org, 602-288-5103 fax).   After 5:00 pm on April 10, 2014, you are still welcome to walk-in register at the event.  We have a great day planned and hope to see you there!  
 
APS members are welcome to attend the Friday Social, whether or not they are registered for the Annual Meeting.  If you wish to attend the Friday Social, hosted by American Professional Agency, Inc. (www.americanprofessional.com), the APA-endorsed malpractice carrier, from 6:30 to 8:30 pm, in the Ocotillo Room at Wild Horse Pass Casino (appetizers, beer and wine hosted, with cash bar available), please call or e-mail Teri (602-347-6903, teri@azmed.org). 
Native Americans: A Story of Transgenerational Resilience

By Carl A. Hammerschlag, MD

Dr. Hammerschlag is an internationally recognized transcultural psychiatrist and author of four critically acclaimed books that tell his transformative journey from doctor to healer. He is a faculty member at the University of Arizona School of Medicine, and Chief of Community Mental Health, Gesundheit! Institute. From 1974-1986 he was Chief of Psychiatry at the Phoenix Indian Medical Center.

 

I appreciate the invitation to address my Arizona colleagues on the psychiatric care of Native Americans. Generally, when we hear the words psychiatric care and Native Americans, it immediately conjures up a symptomatic population rife with substance abuse, domestic violence, high suicide rates among the young, and educational underachievement; because the literature focuses on these aberrations. The underlying psychological explanations for these problems are attributed to internalized anger, and the powerlessness resulting from their subjugation and political disenfranchisement. These ongoing symptomatic manifestations are attributed to the transgenerational transmission of their historical trauma.

 

There is not much in the literature about the transgenerational transmission of resilience among Native Americans; how did some tribes survive the assaults on their culture while others fade away? I have spent much of my professional life working with Native Americans, and would like to tell you their story from that perspective. The tribes who thrived were the ones who maintained a connection to the values and cultural systems (language, myths, rituals and ceremonies) handed down from generation to generation. Resilience is rooted in the nurturing soil of knowing who you are in the world. If you have a sense of yourself as unique in a positive way when you are young you greet the world as equal when you become an adult.

 

First, a brief history of how I came to work in Indian Country. It was the mid-60's, and I didn't want to go to Viet Nam; so after completing my internship I served my military obligation in the Indian Health Service. I thought it would be a 2-year experience but it turned into more than 20. Shortly after my arrival at the Santa Fe Indian Hospital in 1965 I was introduced to an old man on morning rounds who would be my patient because I provided the aftercare in his village. He was admitted in acute congestive heart failure, and was resting comfortably since he'd been digitalized, given a diuretic and oxygen.  I introduced myself, and then he asked me "where did you learn how to heal?" I assumed he was asking for my academic credentials so I tell him where I went to medical school and completed my internship, and when I finished he looked at me smilingly and asked "do you know how to dance?"

 

I was touched by his whimsy, thought I'd humor him, and said I knew how to dance and shuffled my feet at his bedside. The old man laughed, so I asked him if he knew how to dance, not knowing at the time he was a renowned medicine man. So he got out of bed the oxygen running and did the steps to a Corn Dance at the bedside, When he got back into bed he said to me "you must be able to dance if you are going to heal people" so I asked him if he would teach me those steps and he said "I can teach you my steps, but you have to hear your own music".

 

I learned from Native healers that there were many ways to do the healing dance and what it meant to be healthy. Health was never defined in medical school, other than if you weren't sick then you were healthy). And I learned about how many ways there were for people to get sick and how many ways to do the healing dance.

 

Most of us in Western medicine (especially in psychiatry), learn to do our healing dance one way; we become proficient in whatever our preferred methodology (psychopharmacology, neurobiology, psychotherapy, behavioral therapy, cognitive therapies, psychoanalysis), and then spend most of our professional lives refining the steps to that familiar tune.

 

The Navajo word for health is HOZHO... the same word also means harmony, truth, beauty, balance and the Great Spirit. Being healthy is when what you say with your lips, is the same story you're telling by your actions, and what you truly believe in your heart; that's when you are in balance, in truth. In the language of modern medicine this is the science of psychoneuroimmunology.

 

From Native healers I learned the importance of rituals, ceremonies, and sacred objects in setting the stage in opening ones heart, which is critical in healing; and that people heal better in community because the more people you have helping you/pulling for you, the more likely you'll have a positive outcome. I was also awakened to many ways of altering human consciousness, and helping people see the familiar with new eyes that included the use of powerful psychoactivating substances has been used to heal the mind/body/spirit for thousands of years. The current explorations in the use of psilocybin mushrooms, and the Schedule III drug Ketamine for use in depression and end-of-life anxiety have been part of the indigenous therapeutic armamentarium for millennia.

 

I learned that no matter how much we know about the brain (its neurobiology and chemistry), that it will always have a mind of its own and some phenomena can't be satisfactorily explained.

 

Those Native people who maintained a credible connection to their psychohistory, to the wisdom stories and ceremonial practices of their tribes, survived the vagaries of assimilation psychically intact, because that's how we learn who we are in the world. It turns out that our survival as a species is not transmitted through our DNA, but through our stories. The road to resilience is in rediscovering old wisdom...stay connected in community, trust the truth of your heart, and keep your mind open to new ways of seeing, hearing, and doing the healing dance.

 

References

Hammerschlag, Carl A. The Dancing Healers, Harper/Collins, San Francisco, 1988

Hammerschlag, Carl A. The Theft of the Spirit, Simon and Schuster, New York, 1993

Hammerschlag, Carl A. and Howard Silverman. Healing Ceremonies, Putnam/Perigee, New York, 1998

Hammerschlag, Carl A. Kindling Spirit: Healing From Within, Turtle Island Press, 2013

Reflections on Child and Adolescent Psychiatry in the Navajo Nation
   
By Daniel J. Conrad, MD
Daniel J. Conrad, MD is a psychiatrist, currently working with IHS in Chinle, Arizona, who holds ABPN Certifications in Psychiatry and Child and Adolescent Psychiatry, and he offers here his personal insights from over 25 years of providing care on the Navajo Nation.

Seated in the dining car of the Southwest Chief, returning to Flagstaff from a visit with my daughter in Los Angeles, I found myself recently with three strangers.  Our conversation turned to the plight of Native Americans in the United States.  "Given the money from natural resources and gambling," stated one companion, "there is no excuse for poverty on the Reservation these days, is there?"

 

I squirmed a bit, wondering where to start.  Of course, nothing could be farther from the truth.  On the Navajo Nation, where I have worked on and off for the last 28 years, poverty in its many forms is widespread, part of a historical trajectory widely acknowledged.

 

My work among Navajo people began from my perspective as a family physician, first at Rough Rock, and then in Ganado, but for the last 19 years has continued as a child psychiatrist.  For 12 of those years I worked in Flagstaff in Community Psychiatry, employed at The Guidance Center, a regional provider for NARBHA.  For the last five years I have worked for IHS, first at Ft Defiance, and since 2010 at Chinle.  While living in Flagstaff, I learned that my interest and experience in working with American Indians were shared by many of my colleagues and acquaintances.

 

In many ways my work in Chinle is similar to my work in community psychiatry in Flagstaff.  Many children are referred to see me by schools or the court, because of learning or behavior problems, or due to self-injury or depression.  A possible difference in the two settings is the widespread prevalence of trauma in its many forms in the lives of the children I see here.  This has led me to seek additional skills in trauma-focused therapies.  Immersing myself as much as I practically can in Navajo worldview and culture has also helped me to be more effective in my work.

 

A unique problem my colleagues here and I have experienced has been in the realm of involuntary hospitalization.  Effective treatment of serious mental illness presents many challenges in any culture, but perhaps the most vexing here has been seeking effective care for individuals who represent a significant risk to themselves and others.  Legal structures do not function efficiently in this setting to meet this need, often presenting difficult ethical and liability concerns.  This has required that we work carefully with our local authorities to plan and to try to find ways to meet the barriers we have encountered.  In addition the Navajo Nation provides no inpatient treatment facilities and only limited outpatient follow-up.  Furthermore facilities off the Navajo Nation are poorly equipped to provide appropriate treatment, considering the complex social environment to which the individual will return.

 

Poverty, trauma, ordinary treatment episodes, learning to know members of another culture, and the challenges of serious mental illness: these represents a part of the multifaceted experience of work here.  

Are You a Psychiatrist Who is Not Ready to Call it Quits?

 

Park Center, an Indiana-based community mental health care center and hospital, located in Fort Wayne, is looking for a quality psychiatrist who would like to explore options for park-time work, either taking calls in the evening and/or providing care through telepsychiatry. The appropriate candidate will need to obtain their Indiana license. Please contact Paul Wilson, CEO Park Center Inc. to discuss options, 260-481-2721, or  pwilson@parkcenter.org.

Meet Fellow APS Member and Co Resident-Fellow Rep Nominee: Jasleen Chhatwal, MD
Dr. Jasleen Chhatwal (on the right) with Dr. Jason Curry (her fiance).

By Jasleen Chhatwal, MD

Resident Physician

University of Arizona, Department of Psychiatry

 

Jasleen Chhatwal, MD, is currently a PGY-3 resident with the Department of Psychiatry at the University of Arizona. Born and raised in Northwest India, she attended medical school at Bharati Vidyapeeth University. She graduated in 2009, after completing a one-year rotatory internship at the Government Multi-Specialty Hospital. She worked as a Medical Officer with the Punjab Civil Medical Service for the next 2 years, serving an underserved population. She served multiple roles there, starting in Obstetrics-Gynecology, and later spending most of her time in the Emergency Room.

 

Working in this unique setting apprised her of the enormous burden of undiagnosed mental illness within the community. She found herself struggling to refer patients to the small handful of psychiatrists in the community. At times finding the greater limitation was the strong resistance from patients and families alike to pursue mental health treatment. This was the face of stigma in India, the ever present, culturally pervasive entity. Seeing the same patients who presented almost weekly to the ER complaining of a multitude of vague physical ailments brought her attention to psychosomatic illness, and the dilemma often faced by physicians who deal with such patients- to treat the symptoms or the patient? These cases piqued her interest in psychiatry.

 

Realizing the limitations of the field within her own country, she sought clinical rotations in the U.S. to familiarize herself with the field that had so intrigued her. Working with a psychiatrist at California and then pursuing a 4-month elective at the University of Louisville in Kentucky, she had found herself more motivated to pursue the field. She joined the University of Arizona's Department of Psychiatry in July 2011 as an intern. She has taken an active role in her learning throughout residency, and she was recognized for her outstanding performance, receiving the department's Junior Resident Award in 2013.  She credits her mother Dr. Manpreet Chhatwal's loving support and her late father Mr. A. S. Chhatwal's inspirational spirit for successes achieved thus far.

 

Jasleen is passionate about mental health education, both for healthcare providers and the population at large. She is keen on pursuing a career in academic psychiatry after residency to further this passion. She enjoys the growing popularity of integrative healthcare and increasing frequency of collaborations between medical and mental health providers. Her clinical interest remains firmly rooted in psychosomatic medicine, especially integrated care. She continues to be fascinated by the developmental considerations in psychiatric disorders with research interest in prevention and early intervention. Especially, intervention programs as they relate to global mental health. She is presently arranging for an international rotation in India for the next academic year and wishes to better her understanding of the WHO mental health Gap Action Program (mhGAP) [or similar ventures that aim to close the mental health gap in low and middle income populations or nations].

 

On a personal front, Jasleen continues to avidly pursue her interests in physical training and adventure sports. She uses her time away from residency to travel with her fiancÚ, Dr. Jason Curry. She hopes to continue traveling within and outside of the country to attend more psychiatric conferences and pursue integrative healthcare opportunities.

Rwanda Moving Forward

By Robin Reesal, MD

Dr. Robin Reesal has been the Newsletter Committee Chair since 2012.  He and his wife, Helen Ewing, RN, DHSc, will be leaving for Rwanda shortly to work with Rwandans and their Healthcare system.  Dr. Reesal will be contributing articles on their experiences in Rwanda in the months ahead. Stay tuned.

This is an introductory article about Rwanda and its people. Rwanda is a landlocked African country with a population of about 12 million as of August 2012. It is known as "the land of a thousand hills" due to its scenic topography. Kigali is the capital and Paul Kagame is the President of this small and rapidly improving central African country.  The Republic of Rwanda provides further information at the website http://www.gov.rw.  

 

Culturally, there are three languages spoken in Rwanda; Kinyarwanda, English and French. 

The United Nations website, 

https://www.un.org/en/preventgenocide/rwanda/education/rwandagenocide.shtml, states Rwanda has had three ethnic groups; Hutu 85%, Tutsi 14% and Twa 1%. Rwanda now focuses on unity and emphasizes the commonality of its people versus past secular divisions.   

Rwanda was under German rule in 1899 prior to Belgian oversight in 1919. The country gained independence in 1962. Over the years there have been ongoing clashes among its people, with April 7, 2014 marking the 20th anniversary of the well-known "genocide".

 

How does a country fix a broken past? No one knows. However, Rwandan President Paul Kagame has had success with his Vision 2020 initiative. This plan emphasizes moving forward, self-reliance, reconciliation and unity. Three pillars of this plan include compulsory education, universal health care and a knowledge-based economy. In their book Rwanda Inc. authors Patricia Crisafulli and Andrea Redmond, based on Rwandan Government statistics, state that poverty has been reduced by about 1 million people since 2006.  

 

As written in Rwanda Inc., President Bill Clinton stated, Rwanda, "created an exceptional blueprint for other developing countries." Mrs. Clinton, in June 2011, as Secretary of State before the African Union Commission in Addis Ababa praised Rwanda for, "strong successes with their approaches to development."

 

Dr. Helen Ewing, the former Chair of the Doctor of Health Science Program at A.T. Still University, will serve as distance and e-learning programs advisor in Rwanda. We thank the Clinton Foundation and the University of Maryland, for the opportunity to work with the Rwandan people and their health system over the next 16 months. I hope to submit future articles on our health care observations in Rwanda in the coming year.   

American Professional June 2013
Case Concludes; New RBHA in Maricopa County
MHA America (Arizona) Report on Arnold v. Sarn Settlement and Mercy Maricopa Integrated Care

With the consent of Mental Health America (Arizona), the following article is reprinted from the Mental Health America (Arizona) March 2014 Newsletter

 

 On Thursday, February 27th, Governor Jan Brewer was one of the speakers at the fairness hearing that brought the Arnold v Sarn lawsuit to end after 33 years.  "I am pleased Judge Bassett acted so quickly to approve the stipulation, which helps us maintain our momentum implementing a behavioral health system worthy of the people of Arizona," said Governor Brewer. "The Court's decision is a true testament to the collaborative and good-faith efforts of the state, plaintiffs and other stakeholders who have worked diligently to bring about this long-awaited accomplishment. I thank those involved for their hard work and commitment, and I commend the Court for its swift support of our mission."

 

Now it's on to the work of actually implementing and monitoring the terms of the agreement described in the January issue of the newsletter.  In brief, the elements include:  1) Eight Assertive Community Treatment (ACT) teams are to be available around the clock providing a wide range of flexible services, to help stabilize an individual in the community; 2) Supported Housing provided at scattered-sites and is permanent for the individual for 1,200 new people; 3) Supported Employment services to serve up to 750 individuals; and, 4) Peer and Family Support Services to serve 1,500 peers and their families. 

 

New RBHA in Maricopa County:

Mercy Maricopa Integrated Care (MMIC) is scheduled to officially become [became] the Regional Behavioral Health Authority (RBHA) for Maricopa County on April 1st.  MMIC is a not-for-profit locally owned and operated health plan sponsored by Mercy Care Plan and Maricopa Integrated Health System.  MMIC will provide an integrated health plan for AHCCCS-eligible SMI members by meeting both behavioral and physical health care needs for this population.  MMIC has a toll-free line (866-796-5598) and staff dedicated to answer your questions.  You can also go to their website to get more information. 

 

SMI members who are not enrolled in AHCCCS will continue to receive the same behavioral health services.  For non-AHCCCS individuals receiving general mental health or substance abuse services, MMIC will be their RBHA for those services.  Physical health care services will not be integrated or bundled for non-AHCCCS SMI, substance abuse or general mental health care individuals.

 

For children who receive AHCCCS coverage, their behavioral health will be provided by MMIC and their physical health needs met by the child's current AHCCCS health plan.  Children who are not enrolled in AHCCCS will receive only their behavioral health from MMIC.

 

There are a few remaining community forums where you can go to get answers to your questions:

  • April 16 - 3 to 6 p.m., Partners in Recovery, 5625 W. Bell Road, Phoenix
  • April 23 - 3 to 6 p.m., Mountain Health and Wellness, 625 N. Plaza Drive, Apache Junction 
Arnold v. Sarn Resolved After 33 Years

 

By Charles Arnold, Esq.

 

Charles (Chick) Arnold is a mental health attorney in Phoenix, and was the primary named-Plaintiff in the class action lawsuit known as Arnold vs. Sarn.

            

Way back in 1980, local mental health experts, including psychiatrists 

Dr. William Bonfield and Dr. Glenn Lippman, came together to draft what became known as Senate Bill 1057, a proposed statute to create a community-based system for persons with serious mental illness.  Our community, like many others around the country, was being forced to deal with a failed "de-hospitalization" process, and so, this Bill sought to address the problem by fixing and defining the State's responsibility to create a full continuum of community-based care for persons with serious mental illness.

 

The Bill was passed, led by the efforts of the then Senate Majority Leader, Robert Usdane, thus creating the foundation upon which rested the class action lawsuit known as Arnold v. Sarn.

 

Over the 33 year life of this lawsuit, class members and the Court have gently, and sometimes, not so gently, nudged the State of Arizona and Maricopa County into providing a responsive and accessible person-centered behavioral health system, as contemplated and required by our state law.  There were some notable successes spurred on by the lawsuit, such as enrolling in the Federal Title 19 program to provide federal reimbursement for many of the required services, and significant enhancement of peer support and consumer run services.  But, for the most part, the defendants were unable to live up to the commitments made to the Court, to fix deficiencies, and comply with regular corrective action plans.

 

On February 27, 2014, the Maricopa County Superior Court approved a settlement agreement in this case, which creates an enforceable contract, expressly structured to hold the State of Arizona accountable to provide additional services called for in this agreement.  This settlement agreement affirms the State's underlying responsibility to follow the mandate of our statute and provides an opportunity for great optimism among those in Arizona's mental health community.

 

The new agreement requires the State of Arizona Department of Health Services to adopt national quality standards set forth by the Substance Abuse and Mental Health Administration (SAMHSA).  As well, the agreement provides for an annual Quality Service Review to be conducted through an independent contractor, adds additional supported housing services capable of serving 1200 class members, adds additional supported employment services capable of serving 750 class members, adds an additional eight Assertive Community Treatment teams, as well as provides support for consumer operated and peer support services capable of serving 1500 class members.

 

And, that this settlement agreement coincides with a new Regional Behavioral Health Authority taking over the system in Maricopa County, emphasizing integrated care, helps our system become more responsive and accessible.

 

The opportunity for the settlement was synchronistic, coming as a result of the "perfect storm" created by Arizona's enactment of the Governor's Medicaid Restoration Plan, the passage of the Federal Affordable Care Act, and the increased national attention on mental health issues and the accompanying failure of public mental health systems around the country.

 

The settlement and resolution of this case is a big deal.  As many members recognize, the ability of the Court to enforce its Orders seeking to actualize the vision of our statute is limited.  Such has been demonstrated over the years as a result of regular and continuing audits performed by the Court Monitor, which consistently showed failures on the part of the State to meet the commitments it regularly made to the Court and to the citizens of Arizona.  The Court process worked...until it didn't.  The authority of the Court is limited.  Now, it was time for the defendants to make the Court Orders theirs, and by doing so, remove the issue of enforcement by the Court.

 

Thus, the embracing by the State of Arizona of the tenets of the Orders of the Court will go a long way toward actualizing the vision of our statutes, and toward helping to assure that Arizona's community mental health system properly serves its members.

MHA-AZ and MHG 50/60 Birthday Bash

THOSE WERE THE DAYS TICKETS ON SALE NOW! 

$100 per person ($75 Per Person Early Bird Discount Ends April 15, 2014)

 

Dining, Dancing & Live Entertainment

Friday, May 2, 2014 - 5:30 to 10:30 pm

Arizona Country Club, 5668 E Orange Blossom Lane, Phoenix, AZ 85018

CLICK HERE TO BUY TICKETS!

 

Or mail checks to MHA/MHG Fundraiser, R. L. Peterson, 7928 E. Sage Dr., Scottsdale AZ 85250

Sponsorships available, contact Cheryl Collier at CollierCL@mac.com

 

The Mental Health Guild (MHG) and Mental Health America of Arizona (MHA-AZ) are celebrating the anniversary of their formation in 1954 and 1964.  MHA-AZ has been an advocacy voice for mental health issues in Arizona throughout its history.  MHG is dedicated to improving the quality of life of the seriously mentally ill in Maricopa County.  

Have fun, mingle with friends and make new friends while you help these two organizations celebrate this birthday anniversary.

The evening includes a DJ playing favorite tunes from the 1950s and 1960s, a silent auction, exhibits, dinner, a concert featuring William Florian, former lead singer with New Christy Minstrels, and dancing under the stars. 


Legislative Update

HEALTH CARE LEGISLATION REPORT FOR 51st LEGISLATURE

2ND REGULAR SESSION - 2014

By Joseph F. Abate, Esq., APS Lobbyist

 

The Second Regular Session of the 51st Legislative Session, which commenced January 2014, looks to still be recovering from the embattled prior session and Medicaid expansion.  The carry-over strife will make it difficult to introduce new legislation or move forward on somewhat split support topics like GME funding.  One development of note is that probably for the first time since the Sunrise process was established in 1985, a piece of health care legislation was passed without coming out of the Sunrise Committee.  It was an optometrist scope of practice bill that was heard in Sunrise but withdrawn and not voted upon.  At the time of this writing, the Bill is close to passage (introduced as S1362, now H2380 striker).  This leaves Arizona with some real concerns for the Sunrise process. 

 

For your reference and information, summaries of the Bills introduced in this session with the largest impact to health care providers are provided (CLICK HERE TO REVIEW).  If you would like any additional information, please contact the APS Lobbyist, Joe Abate, at 602-393-1700.  If you are interested in being a part of the Legislative Committee of APS, co-chaired by Dr. Jack Potts and Dr. Carol Olson, please contact teri@azmed.org.  (51st Legislature - 2nd Regular Session, 2014, Bill summaries and histories copyright 2014 Arizona Capitol Reports, L.L.C.)

MOC Requirements: Phase-in Schedule
As part of a year-long leadership project involving Early Career Physicians, a summary of Maintenance of Certification Requirements for Diplomates Certified or Recertified in 2004 through 2011 has been compiled,together with requirements for Diplomates Certificates or Recertified in 2012 or Later.  

 

Beginning in 2012, diplomates will enter the Continuous Pathway to Lifelong Learning.  Diplomates prior to 2012 may elect to participate.  Instead of paying a single fee at the time of the MOC exam, you will pay an annual fee that covers participation in the ABPN Physician Folio and the "cognitive examination" (AKA recertification exam) at the end of the 10 year period (the annual fee does not cover any modules).  You will open a "ABPN Physician Folio" on the ABPN website where you will log your activities and keep track of your status and progress in MOC.   There will be 3 stages, with 3 years/stage.  Passing subspecialty board certification can take the place of the requirements for one stage beginning 2012.  CME, SA, and PIP activities can count towards multiple certificates if the diplomate has multiple ABPN certifications.   (Other specialty boards may have different rules governing "double dipping," consult your other Board's MOC  to be sure.) Diplomates in child and adolescent psychiatry do not need to maintain certification in general psychiatry to maintain certification in child, but all other subspecialties much maintain their general psychiatry certification to remain eligible for their subspecialty certification.

 

There will be 4 components:

--professional standing (maintenance of an unrestricted license, continuously)

--self-assessment and CME * (avg. 8 hours of CME/year/stage involving SA; avg 30 hours/year of CME relevant to the specialty of certification)

-- cognitive expertise (board recertification exam)

--performance in practice* (1 practice improvement activity every 3 years, including chart review and patient/peer external review;  may take up to 24 months to complete!)


CLICK HERE for the MOC Summary including APA Resources available to you.  An important note:  Annual Meeting on Demand offers 64 hours of additional CME with over 300 hours of educational content from the APA annual meeting. (Discounts vary around the time of the Annual Meeting); and Practice Guideline Courses offer up to 8 CME credits per course, 9 courses available ($50 for APA members, $100 for non-members).
Resident-Fellow News:  Photo Highlights of Tucson Spring Mixer
Thanks to the cooperative planning efforts of Drs. Jasleen Chhatwal and Jason Curry from the Tucson residency programs and Drs. Koster and Goldenberg from the Phoenix residency programs, the Tucson and Phoenix residents gathered together at Bodega Kitchen & Wine in Tucson on March 22, 2014 for an afternoon of relaxation and collegial connection!  

L-R: Jesse Reinking, DO (PGY2),
Karnika Patel, MD (PGY1), Jenni Treusch, MD (PGY3), Matt Atienza, MD (PGY2)

L-R: Aris Mosley, MD, Nancy Yan, DO,
Jason Curry, DO (PGY4),
Alan Wolfson, MD (PGY3)

L-R: David Bentz, MD (PGY1), Jason Curry, DO (PGY4), C. Kit Gesmundo, MD (PGY3)

L-R: Aris Mosley, MD (PGY1),
Nancy Yan, DO (PGY1), Jasleen Chhatwal, MD (PGY3), Claire Sollars, MD (PGY3),
Felicitas Koster, DO (PGY3)

Fellow definition
Distinguished Fellow and Fellows Congratulations
Please join us in congratulating APS Member, Sheldon P. Wagman, DO, DLFAPA, who will be recognized at the 2014 APA Annual Meeting as being selected to the status of Distinguished Life Fellow of the APA.

Please further join us in congratulating the following APS Members who will be recognized at the 2014 APA Annual Meeting as being selected to the status of Fellow of the APA:

Aaron V. Riley, MD, FAPA
Aktar  S. Hamidi, MD, FAPA
Lance Franklin Rouse, MD, FAPA
Len Douglas Balke, MD, FAPA
Mehmud Ahmed, MD, FAPA
Payam M. Sadr, MD, FAPA
R. Kaan Ozbayrak MD, MBA, CPE, FAPA
Rodgers McKinley Wilson, MD, FAPA
Shabnam Sood, MD, FAPA

If you would like to know more about the requirements for Fellowship or Distinguished Fellow status in the APA, please visit http://www.psychiatry.org/join-participate/member-benefits/becoming-a-fellow or contact Teri (teri@azmed.org).  Distinguished Fellow applications must be submitted by the District Branch and are due on or before July 1st each year.  Fellowship applications may be submitted directly to the APA and are due on or before September 1st of each year.
Life Member and 50-Year Life Member Thanks and Recognition
Please join us in recognizing the following members of the Arizona Psychiatric Society for their outstanding contributions to behavioral health in our community and to their advocacy for the psychiatric profession, having reached Life Member status in the APA as of January 2014:

Allen Kayser, MD, DLFAPA
Sylvia Simpson, MD, DLFAPA
Richard Bradley, MD, LFAPA
Marcelle Leet, MD, LFAPA
Richard Spiegel, MD, LFAPA
Alvin Burstein, MD
Pamela Frazier, MD
Jack Potts, MD
Gail Schwartz, MD

Of special note, we recognize the following members who achieved the pinnacle of 50-Year Members with Life status in the APA as of January 2014:

Edward S. Gelardin, MD, DLFAPA
Edward A. Wolpert, MD, PhD, DLFAPA

These member will be acknowledged in the Convocation at the 2014 APA Annual Meeting in New York.

If you are a Life Member of the APA, you qualify for membership in the Senior Psychiatrists, Inc.  Dues are only $50 per year.  Join now at http://www.seniorpsych.org 

Upcoming CME: Tucson WMH and More

The Women's Mental Health Symposium provides high quality continuing education.  Featuring keynote speaker Charles Raison, MD, Associate Professor of Integrated Mental Health at the University of Arizona presenting "Coming to Our Senses:  Rethinking Depression in Women and Children."  His visionary work focuses on harnessing scientific understanding of the mind and body to enable us to enjoy happiness and health.  A series of diverse breakout lectures follows.  Dr. Raison kicks off a new track in 2014 with "Integrating a Pediatric Focus."  This optional track covers mental health concerns of children, focused on adolescent girls, and integrated medicine options.  Register online today at www.wmh.arizona.edu.    Banner
Banner Grand Rounds take place on Fridays from 12:00 pm to 1:00 pm in the Medical Education Amphitheatre at Banner Good Samartian Medical Center.  There will be no Grand Rounds on April 11, 2014.  On April 18, 2014,  Matthew Markis, DO, PGY-2, presents on "Post-Traumatic Stress Disorder," and on April 25, 2013, George Journas, MS, Clinical Faculty, presents on "EMDR: Protocols for Trauma and Addictions."  As a preview for May 2014, Banner will offer resident presentations on May 2, 16, and 23, and a Grand Rounds presentation by medical toxicologist Dr. Aaron Skolnik on May 9.  The presentation on May 23, 2014 will be the final Grand Rounds for this academic year.  CME credit is available commensurate with physician participation in the activity.
FREE APA free education highlightwebinar sessions of the Providers' Clinical Support System for Medication Assisted Treatment in cooperation with the APA are held monthly and CME and Certificates of Participation are available.  In May, the webinar is on May 13, 2014, "Managing Pain in Patients with Addiction History," Janice F. Kauffman, RN, MPH, LADC, CAS, Vice President, Addiction Treatment Services, North Charles Foundation, Assistant Professor of Psychiatry, Harvard Medical School. Sign-up at http://www2.gotomeeting.com/register/566690482  
SAVE THE DATE for Southwest Community Preparedness Conference 2014:  Lessons Learned on October 16, 2014 at Westin Kierland Resort in Scottsdale.  The purpose of this conference is to provide participants with information to improve emergency operations plans.  For registration and additional information, please visit www.coyotecampaign.org.     
APA Resources:  Understanding ICD-10 and DSM-5
On October 1, 2015, the entire health care system in the US is scheduled to change its diagnostic codes from ICD-9-CM to ICD-10-CM.  Everyone is now using ICD-9-CM codes; mental health practitioners know these codes from using DSM-IV-TR (they are also included in DSM-5).  In response to misinformation that DSM-5 does not provide HIPAA-compliant code sets and may not be used in HIPAA standard transactions, the APA has issued a statement correcting those claims.  For information concerning DSM-5 and ICD codes, see "Understanding ICD-10-CM and DSM-5: A Quick Guide for Psychiatrists and Other Mental Health Clinicians."

Community Connect on Chronic Pain Management
You Johnson & Johnson Logoare cordially invited to participate in Community Connect, a meeting of local prescribers and pharmacists to provide perspectives about shared responsibilities in prescribing and dispensing opioid pain medications.  The meeting will feature a panel of thought leaders on chronic pain management, outcomes and policy, and U.S. Drug Enforcement Administration (DEA) regulations.  CLICK HERE for the full flyer, including the registration link for this event, which will be held on Thursday, April 24, 2014, from 5:30 to 6:00 p.m. registration, 6:00 to 7:00 p.m. Panel Discussion, followed by a networking reception and buffet, at the Hilton Scottsdale, 6333 North Scottsdale Road, Scottsdale, Arizona.  This is a non-CME/CE event, with program content developed by the American Academy of Pain Management and Janssen Pharmaceuticals, Inc.  Physician Payment Sunshine Act reporting may apply.  
Share Your Big Apple Adventure

Are you attending the APA Annual Meeting, May3-7, 2014 in New York, NY?  When you return, please share your highlights of the meeting and/or your visit to New York by submitting your story or photograph (selfie or otherwise) to teri@azmed.org.  We would like to share these highlights and special moments with our members in teh Summer Newsletter.  

The Spring Newsletter photo is a night blooming cactus.  If you have a seasonal Arizona photograph that you would like to submit for the Newsletter banner, if you are interested in contributing an article or have a theme you would like addressed in a future Newsletter, or if your e-mail or mailing address have recently changed, please contact Teri (teri@azmed.org, 602-347-6903).

APS Newsletter Committee:  Robin Reesal, MD, Chair (Outgoing); Monica Taylor-Desir, MD, MPH, Chair (Incoming); Elizabeth Kohlhepp, MD, DFAPA; and Gretchen Alexander, MD.