APA at A Glance - Missouri Psychiatric Association
Transcription
APA at A Glance - Missouri Psychiatric Association
Vol 36 No 1 1st Quarter, 2010 Eastern n hiatric Missouri Psychiatry Newsletter of the Eastern Missouri Psychiatric Society (EMPS) * * * A District Branch of the American Psychiatric Association * * * District Branch of the ty AAssembly Reorganization Means Changes for Missouri American Association By Psychiatric Garry M. Vickar MD, FRCPC, DLFAPA and Jo-Ellyn M. Ryall MD, DFAPA T he year 2009 was difficult for APA, especially after the Board of Trustees mandated a $200,000+ reduction to the Assembly’s 2010 budget. Deciding what to cut and by how much fell to the representatives and deputy representatives. It was the “big elephant in the room” during the Nov. 20-22 Assembly meeting, in Washington, D.C. Because of the need, in fact, demand, to slash expenses, numerous debates occurred in Area Council meetings and, ultimately, on the Assembly floor. The biggest issue dealt with representation in smaller areas. After hearing all the resolutions and amendments, the Assembly voted to reorganize by changing the formula for representation to one based on membership size per state, not district branch. Effective January 1 (with the new budget year), the Assembly will apportion Area Council representatives on a sliding basis of 450 members for the first rep and 400 members thereafter for subsequent reps. In addition, states with one rep will have a deputy rep and states with more than one rep will have no deputy reps attending the Assembly. The Assembly will apply the formula across the board, with the changes to occur at the May meeting. The 13 district branches in New York and five in California took a beating, as did the three DBs in Missouri. With a combined state membership of approximately 550 members, the bottom line is that Missouri loses one of its three reps and all of its three deputy reps. We—all three District Branches—have been proactive on this issue since it first arose several months ago. Arshad Husain MD (CMPS) and David Hunter MD from Central Missouri, Sherman Cole MD and Bob Batterson MD from Western Missouri, and Garry Vickar MD and Larry Kuhn MD from EMPS, reps and dep reps respectively, have participated in conference calls with the state’s DB presidents and executive staff. The discussions have focused on how to select two reps for the entire state— where no state structure exists, and whether to unite our independent district branches into a single state association. Regardless of the discussions, one thing is clear: Missouri will lose more with its current fragmented organizational structure. In its zeal for continued downsizing, APA decided to award future grants only to states, not individual DBs. This will have a serious economic impact at the district branch level because APA grants are an important supplemental funding source that enables DBs like EMPS to support special projects, advocacy initiatives, litigation, and infrastructure expenses. For example, in 2009, we received funds to support a membership recruitment and retention campaign. We would not have been able to initiate the project without the APA grant. The decision of the three DB presidents is to conduct a simultaneous election by the entire Missouri membership to determine which two representatives to send to the Assembly. As for whether or not to merge the district branches, that decision is for members, as well. “Whether or not I am the rep who will continue to serve,” Dr. Vickar said recently, “I want to express my gratitude for the opportunity of having been able to serve [EMPS] for these many years. It has been an honor and a privilege to represent my colleagues with the dignity and respect that their positions have demanded on the floor of the Assembly.” We invite the entire Missouri membership to join us Saturday, March 27, 2-4 p.m., during the Missouri State Medical Association convention at Renaissance St. Louis Hotel Airport on Natural Bridge Road. The membership meeting will immediately follow a special luncheon program on psychiatry at 11:30 a.m.–1:30 p.m., when Jothika N. Manepalli MD will present “Geriatric Mood and Anxiety as Comorbid Problems in Primary Care Settings: Evaluation and Management.” The details are in the works. Dr. Garry M. Vickar has served as the EMPS Representative to the APA Area 4 Council since 2005. Dr. Jo-Ellyn M. Ryall is Chair of the Area 4 Council. Both also serve on the EMPS Executive Council. Content President’s Column.........................2 MO Psychiatrists Advocate.............3 Legislative Report...........................4 CME: Life After Residency...............4 The Lawsuit Psychosis......................5 Roth Conversion...............................6 APA at a Glance..............................8 Visiting Africa................................13 The Great Russian Escapade..........14 Membership Update......................16 Obituaries......................................18 Committees...................................19 Member Notes................................19 Upcoming Events..........................20 Eastern Missouri Psychiatry g{x cÜxá|wxÇàËá VÉÄâÅÇ 1st Quarter, 2010 1321 Montevale Court Fenton MO 63026-3016 (636) 343-8555 [email protected] www.emopsych.org Forming the Missouri Psychiatric Association Daniel Mamah, MD, MPE EMPS President EXECUTIVE COUNCIL OFFICERS 2008-2010 President Daniel T. Mamah MD, MPE President-Elect Jack L. Croughan MD Secretary/Treasurer Susan A. Minchin MD, PhD APA Assembly Representative Garry M. Vickar MD A Deputy APA Assembly Representative F. Kuhn MD merican Psychiatric Association which involved sharingLawrenceresources and Immediate Past President (APA)—a powerful advocate publishing a statewide newsletter, failed; Jack L. Croughan MD for psychiatry—works in close the DBs eventually abandoned the effort in COMMITTEE CHAIRS Bylaws collaboration with its 74 district branches in 2004. Jo-Ellyn M. Ryall MD the U.S., Canada and Puerto Rico. A unified This year, the need to revisit thePsychiatry “merger” Child & Adolescent Judith H. McKelvey MD organizational structure and geographically issue takes on greater emphasis. Merger is Community & Public Psychiatry Christopher Loynd DO diverse membership with representation on now a more viable option for several reasons. Education Arturo C. Taca Jr. MD various components enables APA to consider First, the recent Assembly reorganization Ethics Lawrence F. Kuhn MD issues that affect all reduced Missouri’s number Forensic Psychiatry psychiatrists and, thus, of representatives Jose Mathews MD from three Legislative Affairs speak with a strong voice to two and eliminated the Paul B. Simon DO for the profession. three deputy representatives. Membership Jo-Ellyn M. Ryall MD A similar need for Second, Members-in-Training APA and the Tabe Ambilichu MD unification at the state AssemblyMoses recognize Ben W.will Holt MD Newsletter level could apply. For our three Daniel DBs collectively, T. Mamah MD, MPE example, Missouri joins i.e., only Public asAffairsa Psychiatry state entity, Collins E. Lewis MD California and New York regardless of whether a state EXECUTIVE DIRECTOR as the only states with more entity exists (see page 3). Rebecca DeFilippo MBA, CMP GOVERNMENTAL CONSULTANT than one independently Beyond Assembly Richard “Mo” McCullough run APA district branch reorganization, the reality (DB). The difference is that merger makes sense is that New York and financially and politically. California have umbrellaIn a depressed economy, like state associations that it is essential to conserve coordinate legislative and operational resources advocacy activities within otherwise duplicated by their borders. Missouri three separate organizations does not. The three district doing essentially the same branches of EMPS, Central thing. In addition, APA will Missouri Psychiatric Working MPA Logo: The logo award any future grants for Society and Western depicts a modified medical caduceus. special projects, advocacy, Missouri Psychiatric The “White Hawthorne Bossom” litigation and infrastructure Society comprise the most is the Missouri State flower, and to states, not DBs within the fragmented psychiatric represents general mental and same state. organizational structure in physical health. Three filaments per Our advocacy efforts petal symbolize the three comprising APA. would also benefit from psychiatric societies. The thorny stem Discussions about merger. Forming the is a representation of psychiatric merging Missouri’s DBs distress. Missouri Psychiatric into one organization have Physicians Political Action occurred for years. The lack of a cohesive Committee, or MoPPPAC, a little more than a statewide entity is most apparent in the year ago, was an important first step. Formally legislative arena, where activities to influence joining operations to speak on behalf of the Legislature require financial resource the approximately 550 APA members in sharing and an engaged grassroots advocacy Missouri would further strengthen our voice effort. Previous attempts in the early 2000s, Continued on page 11 2 Eastern Missouri sychiatric PSociety A District Branch of the American Psychiatric Association 1321 Montevale Court Fenton MO 63026-3016 (636) 343-8555 [email protected] www.emopsych.org EXECUTIVE COUNCIL OFFICERS 2008-2010 President Daniel T. Mamah MD, MPE President-Elect Jack L. Croughan MD Secretary/Treasurer Susan A. Minchin MD, PhD APA Assembly Representative Garry M. Vickar MD APA Assembly Deputy Representative Lawrence F. Kuhn MD Immediate Past President Jack L. Croughan MD COMMITTEE CHAIRS Bylaws Jo-Ellyn M. Ryall MD Child & Adolescent Psychiatry Judith H. McKelvey MD Community & Public Psychiatry Christopher Loynd DO Education Arturo C. Taca Jr. MD Ethics Lawrence F. Kuhn MD Forensic Psychiatry Jose Mathews MD Legislative Aff airs Paul B. Simon DO Membership Jo-Ellyn M. Ryall MD Members-in-Training Moses Tabe Ambilichu MD Ben W. Holt MD Newsletter Daniel T. Mamah MD, MPE Public Aff airs Psychiatry Collins E. Lewis MD EXECUTIVE DIRECTOR Rebecca DeFilippo MBA, CMP NEWSLETTER EDITORIAL DIRECTOR Jessica Simon GOVERNMENTAL CONSULTANT Richard “Mo” McCullough Eastern Missouri Psychiatry 1st Quarter, 2010 Missouri Psychiatrists Advocate to Increase Community Mental Health Services By Rebecca DeFilippo CMP, CMMM I nclement weather did not deter psychiatrists representing Missouri Psychiatric Association from attending an early morning legislative breakfast reception Jan. 21, in Jefferson City. Missouri Psychiatric Association (MPA), an informal organization comprised of Central Missouri Psychiatric Society, Western Missouri Psychiatric Society and EMPS, sponsored the event. MPA members from St. Louis and Kansas City met with more than 60 state legislators and their staff during the third annual Legislative Breakfast and Mental Health Advocacy Day at the State Capitol. Joining WMPS president Subbu Sarma MD, EMPS president Daniel Mamah MD, EMPS members Jo-Ellyn M. Ryall MD, Paul Simon DO and David Berland MD and the author were MPA lobbyist Mo McCullough, his McCullough Schlosser Consulting partners, Nick McCullough and Lynne Schlosser, and Missouri State Medical Association Government Relations Director Tom Holloway and Legal Affairs Director Jeffrey Howell. Missouri Gov. Jay Nixon has stated plans to “rein in . . . overused Medicaid services” by targeting “heavy users of . . . psychotropic drugs.” He projects saving $121 million in fiscal 2011, starting July 1, by reducing outpatient services provided through the Department of Mental Health and limiting the availability of some community based mental health services to participants of Missouri HealthNet, the Medicaid-funded health care program for the poor. During talks with state lawmakers, psychiatrists discussed the impact proposed service cuts would have on individuals with mental illness. “Approximately 20 percent of Missourians has a psychiatric condition and half of those have severe illness,” Dr. Mamah told legislators. “A large number do not receive adequate psychiatric care.” Many patients lack access to vital community services and programs. “When people need help, they often go to hospital emergency rooms—the most expensive level of care,” Dr. Ryall said. “This only adds a heavier burden to already limited Medicaid dollars for law enforcement, corrections and state hospitals. No one wins with these budget cuts.” Dr. Ryall cited the dramatic changes that can occur when mental health centers such as St. Louis-based Places for People provide patients with Assertive Community Treatment. “It makes a big difference in outcomes when patients get the care they need before they crash and burn.” The psychiatrists also discussed two proposals outlined in the MPA 2010 Legislative Agenda. The first proposal encourages the Legislature to develop an integrated delivery system of psychiatric care to ensure accessible and safe treatment in Missouri’s underserved areas. The fourpronged approach includes expanding the current network of telepsychiatry services, enhancing the education of primary care physicians in psychiatric care, recruiting psychiatrists to practice in underserved areas, and improving coverage of psychiatric services provided by MO HealthNet. The second proposal would create a state advisory council on psychiatric care to study and develop ways to implement an integrated delivery system. MPA members also urged lawmakers to reject bills to expand the scope of practice for healthcare professionals beyond their level of education and training. As of Feb. 5, there is no Missouri bill to allow psychologists to prescribe medications (RxP). “We may have short circuited the RxP bill already this session,” lobbyist Mo McCullough said. “So far, no one wants to sponsor it this year.” March 1 is the last day to file a bill in the Senate and April 1 in the House. “Anything could happen,” he cautioned, before the Legislature adjourns May 14 at 6 p.m. District 87 Rep. John Diehl, R-Town and Country, discussed with MPA members how the state allocates monies; education and state-funded Medicaid consume the largest share of resources. “Given the severe budget deficit in Missouri, it is unlikely the Legislature will support program growth,” said Rep. Diehl, who represents the cities of Brentwood, Creve Coeur, Crystal Lake Park, Des Peres, Frontenac, Huntleigh, Ladue, Rock Hill, Town and Country, WMPS President Subbu Sarma MD and EMPS President Daniel Mamah MD with Rep. Kevin Wilson, R-Neosho (center), at the Jan. 21 legislative breakfast in Jefferson City. EMPS Executive Director Rebecca DeFilippo and EMPS member David I. Berland from St. Louis with Rep. Stacey Newman, D-St. Louis County (center), outside the Missouri House of Representatives chamber Jan. 21. EMPS members Jo-Ellyn M. Ryall MD and David I. Berland MD from St. Louis with Rep. Dwight Scharnhorst, R-Valley Park (center), Jan. 21 at the State Capitol Building in Jefferson City. Continued on page 9 3 Eastern Missouri Psychiatry 1st Quarter, 2010 2010 Missouri Legislative Report By Richard “Mo” McCullough T he 2010 legislative session in Missouri began at noon on Wednesday, January 6. This should be a wild one. Once again, the main issue will be the state budget and, if you think last year was tough, this year will be worse. With an estimated 10% to 12% decrease over last year’s revenues, everything will be on the chopping block; nothing will be safe. Because 2010 is an election year with major turnover coming due to term limits, state legislators are going to be walking a tight rope between raising taxes and cutting expenses. Nothing is certain and nothing is off the table. Other issues likely to draw attention this year will be economic development and ethics reform. The General Assembly will spend a great deal of time on both, with an emphasis on job creation and economic development in an attempt to increase state revenues. Obviously, other things will be going on as witnessed by the more than 400 bills prefiled in December. As of February 5, there was nothing on psychologist prescribing but I expect a bill or two to come out soon. We will be ready with strategic lobbying, educational information for legislators, and proactive access legislation of our own. We will need everyone’s help in fighting this onerous legislation, so be prepared to contact your legislator when asked to do so. Also, now is when we need to grow our membership numbers in the Eastern, Central and Western Missouri Psychiatric Societies and our political action committee, MoPPPAC. So, please join, bring in a colleague and get active. By working together, we succeed. Richard “Mo” McCullough, a registered lobbyist in the State of Missouri, represents psychiatric physicians, their patients and the profession before the Missouri General Assembly. He is a frequent contributor to Eastern Missouri Psychiatry. Free Suicide Risk Training DVD Available By Rebecca DeFilippo, MS, MBA, CMP, CMMM I n 2009, the American Association of Suicidology (AAS) developed a training DVD to educate psychiatrists about suicide risk and its formulation, with a goal to help psychiatrists better recognize and treat those at risk for suicide. “Suicide Risk Formulation: A Guide for Psychiatrists” was funded by a grant from Noven Therapeutics LLC. For 42 years, AAS has led the nation in the advancement of scientific and programmatic efforts in suicide prevention through research, education and training, the development of standards and resources, and survivor support services. EMPS has a limited supply of the DVD available for free distribution. If you would like to receive a complimentary copy, please contact EMPS at (636) 343-8555 or [email protected]. Recap of CME Program on Life After Residency By Ben Holt MD, PGY 3 Psychiatry Resident, Washington University in St. Louis S t. Louis is fortunate to be home to two excellent medical schools. Annually, nearly 70 psychiatry residents and fellows along with a significant number of medical students with a strong interest in psychiatry train at these two sites. Although the programs do a fantastic job preparing the next generation of psychiatrists, it is often difficult to appreciate the breadth of psychiatric practice opportunities while engrossed in an academic milieu. In an effort to reach out to medical students and residents alike, Eastern Missouri Psychiatric Society hosted a CME dinner program entitled “Life After Residency: Options for Psychiatric Practice” on October 20. The program brought together a panel of eight outstanding psychiatrists working in eastern Missouri to showcase different practice opportunities available after the completion of residency. Jaron Asher MD began the program by outlining his experience working with 4 the underserved in St. Louis at a federally funded community health center. Robert Brady MD talked about his experience as a Child and Adolescent psychiatrist, helping his patients during the most influential years of their lives. James Cannon MD, Acting Lead Psychiatrist for the St. Louis VA Hospital, related the challenges and rewards of working with our nation’s veterans. John Crane MD, of Washington, Mo., recounted leaving the big city behind and his experience living and working in a rural community for the past several decades. Jothika Manepalli MD, Geriatric fellowship director at St. Louis University, shared her passion for working with older patients. Dehra Glueck MD described how she turned a dream of working from home into a successful telepsychiatry service, providing much needed care to rural areas from the comfort of her home office. Jose Mathews MD spoke about forensics and its importance in the practice of psychiatry. Arturo Taca Jr. MD, with many years of treating chemical dependency issues, discussed the treatment of patients with substance use disorders. The program was well received by the 64 health care professionals in attendance. The panel did a great job presenting on their psychiatric specialties and providing insight to medical students and fellows about various practice options after residency. The program also highlighted the talent of local psychiatrists and their diversity of interests. The EMPS hopes to offer more programs like this along with other resources to help foster mentorship of Members-in-Training by established psychiatrists throughout the district branch. Dr. Ben Holt co-chairs the Members-inTraining Committee on the EMPS Executive Council. He is a frequent contributor to Eastern Missouri Psychiatry. Eastern Missouri Psychiatry 1st Quarter, 2010 The Lawsuit Psychosis By Moses Tabe Ambilichu MD, PGY 2 Psychiatry Resident, St. Louis University P hysicians across all specialties spend a tremendous amount of time and investment to coronate the rigorous, tortuous and complicated training required to earn a license as a competent medical professional. This process requires discipline, assiduity, endurance and, ultimately, sacrifice. As top priority, adequately seasoned health care professionals strive to deliver good quality treatment to their patients at all times. This is the reason for enduring so much sacrifice, both in financial as well as time commitments, in the steep climb towards becoming a health care provider. Owing to the litigious atmosphere surrounding the practice of medicine, however, there lingers in the back of most physicians’ minds a persistent and significantly distress-provoking fear, even paranoia. As they execute their mission of patient care, they anticipate that an unfortunate event might occur leading to them or a colleague being cited in a malpractice case. This fear can be enormous and, at times, overwhelming. It can reflexively lead physicians to adopt maladaptive and defensive patterns of practice detrimental to the same patient they are trying to help. This situation negatively impacts the health care system, by wasting resources in a desperate effort to do everything that will make a hypothetical malpractice case defensible. This is a serious issue, which I have termed “Lawsuit Psychosis.” I recall talking with a patient from Illinois who confessed that she and her family seek health care in the St. Louis area or Missouri, at large, because most of the physicians near them have left the area or are ostracized by the heavy burden of an extremely hostile legal climate. As a result, she said wait times to see a consultant could be several months. This underscores how a physician-unfriendly environment is causing a dangerous hemorrhage of health care professionals out of this community, leading to extreme hardship for the same patients it was intended to protect. This scenario is easily replicated in many areas of the country. Take, for example, an ER doctor who assesses a patient with symptoms suggestive of a common migraine headache. The patient reports a past medical history of migraines; there are no alarming signs with this presentation. In spite of all this, the physician focuses his microscope on the possibility of a lawsuit and fails to find comfort in the pure science of the matter. His mind is pandemonium; within it an intense fear rages as a perturbing voice keeps up a running commentary: “What if I miss something and get sued? I would rather get a Neurology consult and a CT scan of the head just to cover my...” The head CT is normal and the Neurology resident confirms that the patient has a common migraine headache. This kind of approach to patient care negatively impacts both the patient (higher copay, unnecessary exposure to ionizing radiation, waste of time...) and the health care system (increased deficit). This is one of many scenarios in which ordering multiple, irrelevant diagnostic tests is not done to improve the quality of care rendered to a patient but to defend oneself against a lawsuit. A recent lecture I attended focused on malpractice lawsuits and how to avoid them. One of several ways to do this is to document objectively, accurately, completely, thoroughly and, above all, defensibly. My observation is that there is a huge discrepancy between how much time is actually dedicated to direct patient care versus that allotted to documentation. In this sea of troubles, a hostile legal atmosphere has generated gigantic negative waves that have steered the boat of the sailing physician towards the port of documentation, away from an interactive and priceless doctor-patient relationship— the gold standard of medical practice. On the average, if a doctor has an outpatient appointment of 30min with a client, he or she may spend, at most, 10 minutes talking to the patient and the rest on documentation. The rule of thumb is that it is better to spend most of the time on documentation, rather than on the patient, because it is the key tool that may be helpful in extricating oneself in case a lawsuit ensues in the future. This is defensive practice and precarious patient care. In conclusion, it is critical to appreciate the effect that “lawsuit psychosis” has on individual patient care as well as the health care system at large. Physicians will often order an excessive number of tests or obtain supplementary consults just to be sure their actions are defensible. Furthermore, the exaggerated use of consults even for minor issues severely undermines the need for residents and physicians to exercise minimal proficiency in areas of medicine other than their specialty. Defensive medicine has a huge impact on the health care crisis. Therefore, any health care reform that does not seek to overhaul malpractice laws is defective and below expectations. Tort reform may be a cure for “lawsuit psychosis.” Dr. Moses Tabe Ambilichu co-chairs the Members-in-Training Committee on the EMPS Executive Council. He is a frequent contributor to Eastern Missouri Psychiatry. Do We Have Your E-mail? Have you missed receiving late-breaking news from EMPS? Send your e-mail address to [email protected] and hear quickly about upcoming events and news that affects you, your patients and the profession. EMPS will never share your address. 5 Eastern Missouri Psychiatry 1st Quarter, 2010 Roth Conversion Season Begins; Income Limits Lifted January 1 A s of January 1, high net worth individuals can convert a traditional IRA to a Roth IRA. Income limits that once prohibited individuals with income in excess of $100,000 from converting to a Roth have been eliminated (as part of the Tax Increase Prevention and Reconciliation Act of 2005). In theory, everyone can now convert his or her traditional IRA to a Roth. But in reality, it is not as simple. Time to Explore the Possibilities Just because a medication is reclassified from a prescription to over-the-counter doesn’t mean everyone starts taking it once it arrives on store shelves. The question individuals should ask first: Is this right for me? While there are no strings attached with the elimination of the income limits, there is a resulting tax bill. In general, an individual should only convert if it is possible to pay the taxes generated from the Roth conversion with outside dollars, not from inside the Roth. One of Many Silver Linings One of the “silver linings” associated with Roth conversions is the ability for individuals to reverse a conversion. Noted Roth IRA expert Robert S. Keebler, CPA, MST, AEP explained the unwind feature in a December 2009 article in Taxes—The Tax Magazine. “It appears right now, because of current volatility in the stock market, that the most important reason why a taxpayer may want to consider converting to a Roth IRA is the ability for him/her to ‘recharacterize’ a prior Roth conversion,” Keebler said. Why would someone want to recharacterize? If an investor converts a traditional IRA to a Roth and then experiences a drop in the account’s value, it may make sense to recharacterize the account, then convert at a later date and pay less tax. With questions galore, investors have been connecting with their tax advisors. The specifics of Roth conversions can be complicated, so having some basic 6 By Aaron Vickar information can be useful. Following are some basics on Roth conversions. Five Questions on Roth Conversions 1. Which IRAs qualify? Will qualified plans such as 401(k)s and 403(b)s qualify? Investors’ personal IRAs and IRAs inherited from spouses are eligible for conversion. Other inherited IRAs are not eligible. Qualified plans such as 401(k)s and 403(b) s also qualify. 2. Does this mean that anyone can open a Roth IRA? The rules for opening a Roth are different from the rules for converting a traditional IRA to a Roth. Investors who are over the income limits cannot open a Roth. If these investors want to contribute to a Roth each year, they would have to do so by contributing to and converting a traditional IRA. 3. Can nondeductible contributions to an Continued on page 7 Focused on individual needs with a foundation built from scientic research. Our process exactly. Buckingham is proud to be a network provider for the Eastern Missouri Psychiatric Society. Buckingham supports EMPS and its goal to remain patient focused. Eastern Missouri Psychiatry 1st Quarter, 2010 EMPS Offered 10 CME Hours in 2009 By Rebecca DeFilippo, MS, MBA, CMP, CMMM E EMPS sponsored five Continuing Medical Education dinner programs in 2009, each of which offered attendees a maximum of 2.0 Category 1 CME credit hours. The programs are available free to members, non-member psychiatry residents and fellows, and medical students interested in psychiatry. Non-member but eligible psychiatrists are able to attend up to two programs at no charge before being asked to join the APA. The 2009 programs included “The Assessment of Dangerousness in Clinical Practice” with Angeline Stanislaus MD on April 7, “Ethnicity and Psychopharmacology: Recent Clinical Advances” with former APA President Pedro Ruiz MD June 4, “Preventive Health Care, A Psychiatric Perspective: The Role of Fitness in Mental and Physical Health” with ”Edwin D. Wolfgram MD on September 22, and “Life after Residency: Options for Psychiatric Practice” with a panel of eight psychiatrists on October 20. The panel included Jaron Asher MD, Robert Brady MD, James Cannon MD, John Crane MD, Dehra Glueck MD, Jothika Manepalli MD, Jose Mathews MD and Art Taca Jr. MD. Ben Holt MD and Moses Tabe Ambilichu MD emceed the program. (See “Recap of CME Program on Life After Residency” on page 4) Roth Conversion as income. If the total of the IRA accounts would increase earnings enough to move an individual into a higher tax bracket, partial conversions may be more sensible. Continued from Page 6 IRA made on an after-tax basis be converted (thus avoiding taxes)? For investors who own both deductible and nondeductible IRAs, the taxable portion of the IRA or portion of the IRA they convert will be determined based on the proportion of taxable money in all IRAs combined. The IRS does not allow taxpayers to designate that their conversions derive strictly from nondeductible contributions. 4. Do I have to convert the entire balance of my traditional IRA? No. In some cases, even if someone is a good candidate for a conversion, there may be reasons that make it impossible or impractical to convert all of his or her IRA funds. A partial conversion may make more sense if an individual does not have money to comfortably pay the taxes, as partial conversions over a set time period would soften the tax impact. Even if an individual has sufficient assets to pay the taxes, it still may not make sense to convert all at once. When money converts from a traditional IRA to a Roth, it counts Expect the Unexpected April 2009 had the highest return for the S&P 500 Index in a single month since March 2000. March 2000 ~ 9.78 percent April 2009 ~ 9.57 percent 5. How much time is given to pay the tax bill resulting from a conversion? Only for 2010, investors converting their IRAs during this year have the option to stretch the tax on the amount converted (all pretax contributions and earnings) over two years — paying half on their 2011 tax return (due by April 15, 2012) and the other half on their 2012 tax return (due by April 15, 2013). Any conversions occurring after 2010 will see the resulting amount owed in the same tax year. This information is meant to raise awareness on the topic addressed and should not be considered tax advice. Please consult a tax planner before engaging in actions that may have tax consequences. ________ This column is the first in a series on investment management provided as a new membership benefit to EMPS members by Buckingham Asset Management. Buckingham offers feeonly investment management for individuals, businesses, trusts, not-for-profits and retirement plans. Members now have access to complimentary portfolio analysis and other planning tools as well as the ability to work with a Registered Investment Advisory firm at a reduced rate. For more information on Buckingham, please visit www.investmentadvisornow.com or call 800-711-2027 X 241 for more information. Aaron Vickar is an investment advisor with the St. Louis-based company. The final educational activity of the year occurred December 8 when EMPS sponsored “A Science-Based Medicine Approach to the Treatment of Refractory Depression” with Chris D. Bojrab MD. Thirty-eight healthcare professionals attended the program including 28 Physicians, five Medical Students, one Pharmacist, and one other healthcare professional. Pamlab LLC provided an unrestricted educational grant in partial support of the program. Exhibitors also included AstraZeneca, Bristol-Myers Squibb, Janssen, Jazz Pharmaceuticals, Lilly USA, and Merck. At press time, EMPS will sponsor its first CME program in 2010 on Saturday, March 27, during the 152nd Annual Missouri State Medical Association Convention at the Renaissance St. Louis Hotel Airport, 9801 Natural Bridge Road, St. Louis, MO 63110. The luncheon program, to be held from 11:30am to 1:30pm, will feature Jothika Manepalli MD on “Geriatric Mood and Anxiety as Comorbid Problems in Primary Care Settings: Evaluation and Management.” Dr. Manepalli is a Professor in the Department of Neurology and Psychiatry at St. Louis University School of Medicine, where she also is residency director of the Geriatric Psychiatry Fellowship Program, and medical director of the Inpatient Geriatric Psychiatry Unit and Electroconvulsive Therapy Services. There is no fee to participate in MSMA’s annual convention, but attendees must register because many convention events, including access to the exhibit hall, require badges. Contact MSMA at 800-869-6762, register online at http://www.msma.org/ mx/hm.asp?id=conferencesignup, or visit the Web site at http://www.msma.org/mx/ hm.asp?id=AnnualConvention. EMPS also will post information about this program on its Web site at http://www.emopsych.org/ upcomingprograms.php. We encourage members to suggest future CME topics and/or speakers. In addition, if you attended a program in 2009 and submitted an evaluation form but did not receive a CME certificate, please telephone EMPS at (636) 343-8555 or e-mail [email protected]. 7 Eastern Missouri Psychiatry 1st Quarter, 2010 APA at A Glance By Rebecca DeFilippo CMP G o paperless with APA Feb. 5 was the last day to vote in the APA 2010 election. Members who would like to receive an electronic ballot in future elections and forego the clutter of receiving a paper ballot should log in to <www.psych.org/ options> and opt-in to only receive an electronic ballot. Members can also go online to choose the information they want to receive from APA by e-mail. Visit <www.psych.org/optinoptout.Default. aspx>, log in as an APA member, confirm or update your contact information, and then, under “E-mail options,” choose the e-mail newsletter, offers and updates you would like to receive. Meeting in New Orleans. Those DBs will each win a prize of three free member registrations to the 2011 Annual Meeting in Honolulu, Hawaii. The winning DBs will decide how to award the registrations. EMPS members will be competing for the registration prizes against the 13 other district branches in Area 4, which includes Central Missouri Psychiatric Society, Western Missouri Psychiatric Society, and the 11 mid-western states of Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Nebraska, North Dakota, Ohio, South Dakota and Wisconsin. Head to New Orleans this May for a terrific scientific program, huge exhibit hall and networking It’s not too late to renew your membership for 2009 The 2009 dues payment deadline was October 31, but if you missed the deadline and pay your dues immediately, APA will reinstate your membership. Call (888) 3577924 to provide your payment information or to learn how to pay your dues in monthly installments with automatic charges to your credit card. Call today to continue to receive full member benefits. Register online for 2010 annual meeting in New Orleans APA members can now register and make hotel reservations for the 2010 annual meeting in New Orleans, May 22-26. APA will no longer mail the annual meeting advance registration packet. Instead, it will post information about registration, housing, the preliminary program, courses, and other topics online at <www.psych.org/ MainMenu/EducationCareerDevelopment/ Meetings/AnnualMeeting.aspx>. For more information, contact Vernetta Copeland at (703) 907-7382 or [email protected]. 7 DBs will win free registrations to the 2011 Annual Meeting in Hawaii If thoughts of leis, luaus and sandy beaches come to mind, EMPS may be able to help. APA will sponsor a contest among District Branches to determine the DB in each Area with the highest percentage of members attending the 2010 Annual 8 opportunities with your colleagues. Enjoy some seafood gumbo and fresh oysters along the way. APA moves DSM-5 publication date to May 2013 APA has revised the timeline for publishing the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, moving the anticipated release date to May 2013. Draft changes to the DSM were to be posted on the DSM-5 Web site in January. Comments will be accepted for two months and reviewed by the relevant DSM-5 Work Groups in each diagnostic category. Field trials for testing proposed changes will be conducted in three phases. Information about the revision process is available online at <www.DSM5.org>. EHR incentives for physicians APA has posted important information regarding physician adoption of electronic health records (EHR) on its Web site at <www.psych.org/ehrincentive>. Physicians who treat outpatient Medicare patients and demonstrate that they are using a “certified” EHR in a “meaningful” way will be eligible for incentive payments distributed through Medicare for up to $44,000 per physician over five years. Details of the incentive program will be established through regulations that started in December. Discriminatory copay begins phase out Effective January 1, Medicare began reimbursing providers for outpatient psychiatric services at 55 percent, while the patient copay dropped to 45 percent from the 50 percent copay. Mandated by the Medicare Improvements for Patients and Providers Act of 2008, the new rates are the first step in the gradual elimination of the discriminatory copayment rate for outpatient mental health treatment. In 2012, the reimbursement rate to providers will increase to 60 percent; in 2013, it will be 65 percent; and in 2014, it will be 80 percent—the same as for all other medical services. The Lifers want you! APA Lifers are seeking new members. Lifers are APA members who have achieved Life, Life Fellow or Distinguished Life Fellow status. Annual dues are $50 and provide membership benefits that include events at APA’s annual meeting in May, a chance to have their voices heard by APA leadership, representation at the APA Assembly, volunteer opportunities at the Lifers display at the annual meeting, and a subscription to LifersLine newsletter. The Executive Committee would be pleased to hear from other Lifers with ideas for projects, programs and ways that Lifers can continue to be of assistance to and impact APA. Membership information is available from Captane Thomson MD at cpthomson@ comcast.net or (530) 753-7223. Eastern Missouri Psychiatry MO Psychiatrists Advocate Continued from Page 3 Warson Woods, Webster Groves and Westwood in St. Louis County. Rep. Rick Stream, R-Kirkwood, has sponsored House Bill 1733, to require health insurance coverage for eating disorders. “There is no support whatsoever to raise taxes,” said Rep. Stream of District 94, which includes Kirkwood and Des Peres in St. Louis County. District 93 Rep. Dwight Scharnhorst, R-Valley Park, said there is bipartisan support for this year’s autism bills; four in the House and two in the Senate at press time. He has filed HB1311 to require health insurance coverage for the diagnosis and treatment of autism, which he said is “close to my heart.” He represents part of St. Louis County and chairs the House Interim Committee on Autism Spectrum 1st Quarter, 2010 Disorders. There are 34 state senators and 163 representatives this session. To read the full text of a Senate or House bill and track its progress through the Legislature, visit <http://www.senate.mo.gov/> and use the Search for a Bill tab at the left. Postscript: Just before press time, Rep. David Sater, R-Cassville, filed HB1918, which opponents allege targets “heavy users of . . . psychotropic drugs.” The bill would establish a psychotropic medication review subcommittee of the MO HealthNet Drug Prior Authorization Committee in an attempt to further reduce access to atypical antipsychotic monotherapy for individuals with schizophrenia, bipolar disorder or psychosis associated with severe depression. One psychiatrist and one pediatrician or child psychiatrist would sit on the 8-member subcommittee. The House Health Care Policy Committee, of which Rep. Sater is a member, will hear the bill. (L-R): EMPS Legislative Affairs Chair Paul Simon DO, EMPS President Daniel Mamah MD, Sen. Yvonne Wilson, D-Kansas City, Rep. Tom McDonald, D-Independence, and WMPS President Subbu Sarma MD at the Jan. 21 legislative breakfast in Jefferson City. 9 Eastern Missouri Psychiatry 10 1st Quarter, 2010 Eastern Missouri Psychiatry 1st Quarter, 2010 Missouri Psychiatric Association 7 District Branches Will Win Free Registrations to the 2011 Annual Meeting in Hawaii Continued from Page 2 and visibility in Jefferson City, especially on legislative issues that affect our patients and the profession. After much discussion between Missouri’s Assembly reps, dep reps, presidents and executive staff, we decided to bring merger to the membership. On January 19 and 20, each of the state’s three DBs mailed an election ballot to their eligible voting members. The ballot offers members a voice on three key items: (1) Elect two candidates to represent Missouri in the APA Assembly, (2) Whether to form a unified, statewide district branch known as the Missouri Psychiatric Association, and (3) Whether to accept a draft constitution and bylaws for a new statewide district branch, if formed. A geographically diverse psychiatric physician membership would guide the Missouri Psychiatric Association (MPA). A new statewide executive council would seat members from the three former district branches and ensure an equal voice at the table regardless of membership size. Finally, cooperation and a sense of combined mission would help ensure that the two newly elected representatives to the Assembly would share psychiatric issues affecting the entire state. Merger would maintain the identity of the existing district branches and allow them to focus on regional CME programs and other events; MPA would facilitate statewide educational and networking events. A newsletter and Web site would inform members of statewide and regional psychiatric news, as well as employment and research opportunities. We encourage your participation in this election. If you have returned your ballot, thank you. If you haven’t, please complete and sign the ballot and return it in the self addressed stamped envelope included with the mailing. Ballots must be postmarked by March 12. T he APA will sponsor a contest among district branches to determine the district branches in each Area with the highest percentage of members attending the 2010 Annual Meeting in New Orleans. Those district branches will each win a prize of THREE FREE MEMBER REGISTRATIONS to the 2011 Annual Meeting in Hawaii. The winning district branches may decide how to award the registrations. Do!you!have!a!Sixth!Sense!and!are!you!Shy? A!study!at!Washington!University,!conducted!by! Dr.!Daniel!Mamah,!seeks!people!who: • • • Are!between!18"30!years!old Believe!they!have!ESP,!telepathy,!or!a!“sixth!sense” • Often!mistake!noises!for!voices • Sense!the!presence!of!others!when!alone Have!extreme!social!anxiety!(or!discomfort)!in!social! situations!involving!unfamiliar!people • Have!(very)!few!friends The goal of the study is to use computerized imaging methods to evaluate gray and white matter structure in the brain Participation will involve a no cost MRI scan, plus 3-6 hours of interviews and cognitive testing. Every participant will be compensated for their time. Earn up to $150 Call!Melissa!at!(314)!286"1707 or [email protected] 11 Eastern Missouri Psychiatry Lakeland Regional Hospital 440 S. Market Springfield, Mo. 65806 800-432-1210 www.lakeland-hospital.com CHILD AND ADOLESCENT BEHAVIORAL HEALTH SERVICES RESIDENTIAL 24-HOUR ASSESSMENT AND REFERRAL 1st Quarter, 2010 As the premier child and adolescent psychiatric hospital in southwest Missouri, we currently have openings for Staff Psychiatrists and are seeking candidates who wish to establish both a short and long-term relationship with the hospital. Reporting to the Medical Director, physicians are responsible for providing psychiatric care on an inpatient and residential basis, primarily in the Acute Hospital setting. Broad areas of responsibility include medical management, treatment planning, providing on-going treatment of patients, communicating with parents and/or guardian, timely response to patient and hospital needs. With an established patient base, our facility operates a 60 bed acute psychiatric program, a 60 bed adolescent residential program and offers on-site school services. Located in the beautiful Ozarks Region, Springfield offers a quality of life environment, with public, private or parochial schooling options, several universities and colleges, a cost of living below national average, a variety of the four seasons recreational experiences for the entire family including some of the best hunting and fishing in the Midwest, outstanding shopping, excellent churches, and a St. Louis Cardinal minor league AA team. We offer a competitive benefits package including medical, dental, vision, life insurance, long-term disability, vacation, holidays, sick-days and 401K. CALL 800-432-1210 DRUG FREE WORKPLACE/BACKGROUND SCREENING/EOE 12 Eastern Missouri Psychiatry 1st Quarter, 2010 Visiting Africa for a WPA Meeting Daniel Mamah, MD, MPE A buja, the capital city of the West African country Nigeria, was the venue of the World Psychiatric Association (WPA) Regional meeting held October 22-24, 2009. Attending the meeting and visiting Africa was an exciting and memorable experience. I had spent a large part of my youth living between my father’s homeland Nigeria and my mother’s native Hungary, but hadn’t been back to Africa for 12 years. It was particularly humbling to be able to return in some professional capacity, and I had hoped to learn about the state of psychiatry in the continent with the potential of contributing to its advancement. Nigeria, Africa’s most populous nation with over a 150 million people, has only about 130 practicing psychiatrists (in contrast, the U.S. has 137 psychiatrists per million people). As is the case in many developing countries, mental health services are very limited and largely underdeveloped. The stigma of mental illness is pervasive, and traditional healing approaches are often utilized by those with mental distress. The WPA meeting attracted 286 visitors from 19 countries. Held in collaboration with the African Association of Psychiatrists and Allied Professionals (AAPAP) and the World Health Organization (WHO) and hosted by the Association of Psychiatrists in Nigeria (APN), the theme of the meeting, “Scaling up and reaching down – addressing unmet need for service”, was chosen to reflect a major focus of current attention among stakeholders in global mental health, including both the WHO and the WPA. Dr. Oye Gureje, the meeting convener, set the meeting in the context of several decades of growth of academic psychiatry in Nigeria. He reminded participants that the first formal meeting of psychiatrists from across the world to be held in Sub-Saharan Africa was convened in Nigeria by the late Professor Adeoye Lambo in November 1961. The meeting had a full complement of scientific programs including plenary lectures, key lectures, symposia and free papers reporting new research. Specific attention was given to several components of the WPA Action Plan 2008 – 2011. These included a symposium on successful experiences in our field, with examples of mental health reform (Uganda), cultural therapy (Jamaica), and a mental health/HIV initiative (in several African countries); and a forum discussion focusing on the roles of professional societies in health care reforms. Two special workshops were held during the meeting: one on communicating with children and adults with intellectual disabilities and the other on the United Nations Interagency Standing Committee Guidelines on responding to conflicts and disasters. A formal change of leadership of the AAPAP was also witnessed at the dinner when Dr Frank Njenga, the out-going President, handed over the ceremonial chain of office to Professor Oye Gureje as the new President. It was inspiring to hear from those continuing to be involved in mental health care and psychiatric research in a continent were these could easily be discouraged by poor funding and other challenges. Social networking during the WPA meeting has provided opportunities to collaborate with psychiatrists and researchers in Africa. Fortunately, I have since been awarded startup research funds through a generous donor in the U.S. to study prodromal symptoms of psychotic disorders in Nairobi, Kenya. Hopefully this will herald more exciting and productive visits to Africa in future years. Dr. Mamah with friends at the opening soccer game of the FIFA under-17 World Cup tournament, hosted in Abuja Dr. Mamah with AAPAP Presidents incoming (left; Dr. Oye Gureje) and outoing (right; Dr. Frank Njenga) Ceremonial handing over of the AAPAP Presidency Social event at the British High Commission in Abuja. From left: Dr. Jeffrey Geller (APA Vice President), Dr. Norman Sartorius, Dr. Darrel Regier (APA), Dr. Jay Scully (APA CEO and Medical Director), Dr. Daniel Mamah, and Peter West (Acting British High Commmissioner) 13 Eastern Missouri Psychiatry 1st Quarter, 2010 The Great Russian Escapade T he “great escapade” began when Nada Stotland MD, Immediate Past President of the American Psychiatric Association, invited me to join her husband and her on a People to People Ambassador trip to Russia last August. It took me a second to sign up and check that my passport was still valid. The hardest part was sending in my passport to get a visa, but all returned in plenty of time. The following entries are condensed from my trip diary. Thursday, August 20, 2009: I fly to Washington, D.C., and then to New York’s JFK Airport, where I meet two women from Texas who are part of the trip. We get our seats on Lufthansa to Frankfurt, and then on to Moscow. The flights are long; of course, two toddlers sit in the row behind me and kick my seat for much of the overseas trip. Shortly before my departure, I broke my collarbone in a bike accident and had to travel with my left arm in a sling. I get lots of help in airports. Friday, August 21: We arrive in Moscow on a gray day, mid-afternoon their time, about 3 AM St. Louis time. Several of us are stuck in a slow moving passport control line. Finally, I claim my baggage. Several travelers are not so lucky; their baggage is lost and doesn’t arrive until Monday. We meet our fellow travelers and our guide, People to People Ambassador interpreter Alla Levitina and Dr. Jo-Ellyn Ryall attend a farewell dinner in St. Petersburg, Russia. All photos courtesy of Jo-Ellyn M. Ryall MD. 14 By Jo-Ellyn M. Ryall MD Alla Levitina, without whom we could not negotiate Russia. The bus arrives and takes us to the Marriott Tverskaya Hotel in downtown Moscow. That evening we have an introduction to our trip and our first dinner. This gives us a chance to meet the 28 members of our group, which includes three psychiatrists from Australia, two from Canada and one spouse, and 18 from the U.S. with three spouses. Saturday, August 22: We tour the Kremlin, Red Square and GUM, the big state department store that was famous in Soviet times for its long bread lines. Now, GUM (pronounced goom) is a high-end shopping mall similar to Rodeo Drive or Plaza Frontenac. We see Lenin’s tomb but do not enter because of long lines. Lunch at a floating restaurant called the Viking is a typical Russian meal, with salad, soup, Beef Stroganoff, and dessert. Tourist stops include the State Tretyakov Gallery, a view of the city from the overlook at Sparrow Heights, and the stadium from the 1980 Olympics. Then we pass the Novodevichy Convent, where the Tsars sent their first wives when they wanted to marry other women. In the convent park, we see a bronze sculpture of Momma duck and eight ducklings, which was presented in 1991 by then U.S. First Lady Barbara Bush to Russian First Lady Raisa Gorbachev. After the bus tour, we are on our own. Some shop; I sleep. Sunday, August 23: We tour the Kremlin Armoury Museum and view the treasures of the Tsars, including Fabergé eggs, Russian Imperial regalia, gowns of the Tsarinas, suits of armor, and silver and gold gifts from other nations. We also visit the Kremlin’s Cathedral Square, where the centerpiece is the magnificent gilt-domed Uspensky (Assumption) Cathedral. It is the home of the Russian Orthodox Church and formerly was the place of the coronation of all the Tsars until the last one in 1918. We enjoy a great lunch at Dymov #1 Restaurant. In the afternoon, we tour the Moscow Metro stations, constructed from 1930 to 1950 and considered works of art. Each station is decorated differently, some with huge bronze statues or with colorful icons of Ukrainian dancers and the harvest festival. Other stations feature marble floors with geometric designs or paintings and mosaics on the walls and ceilings. In the evening, we attend the ballet and see two magnificent pieces, Chopiniana and Scheherazade. Monday, August 24: We have our first professional meeting, with Dr. Peter Krasnov at the Moscow Research Institute of Psychiatry. He is also involved with the Russian Society of Psychiatrists, which dates to 1887. With the help of an interpreter, we listen as Dr. Krasnov describes inpatient care and the role of psychotherapy in the treatment of psychiatric patients. After a break for coffee, tea and chocolates, we tour the day program for patients recently released from inpatient care. Dr. Stotland presents Dr. Krasnov with framed certificates and several books from the APPI press. Several other doctors in our group also give gifts including Dr. Igor Petroff, who brought macadamia nuts from his farm in Australia. In the afternoon, we have free time; several doctors retrieve their lost luggage. Many of us venture to the Pushkin Café, a lovely restaurant near Pushkin Square. The food is delicious, if not expensive, but you only go to Moscow once. Tuesday, August 25: We tour Moscow Municipal Psychiatric Hospital #1, opened in 1894 due to a vast fundraising campaign. The hospital now accommodates over 2800 patients. Dr. Vladimir Kozyrev, who has served as Chief Physician of the hospital Continued on page 15 A patient discusses his artwork at Municipal Hospital #1 in Moscow, Russia. Eastern Missouri Psychiatry Russia Continued from Page 14 since 1987, is also the Chief Psychiatrist of Moscow and a distinguished member of the Moscow Medical Academy faculty. There are administrative districts for general psychiatric patients (similar to catchment areas), specialized services including forensic and alcohol abuse (mainly detox and stabilization), and a geriatric unit. Patients are voluntary, court ordered or forensic for evaluation. Students at the Russian State Medical University and the Russian Medical Academy of Postgraduate Education complete their residency here. The patients and families publish a newspaper. One of the reporters joins our group and plans to feature our visit in the next issue. (Once back home, I donate my copies to St. Louis psychiatrist Dr. Tamara Frishberg, who can read Russian.) We tour the hospital and return to the main room where we are given coffee and tea, and medallions commemorating the 100-year anniversary. Dr. Stotland again presents books and plaques. We dine at Taras Bulba Restaurant, which serves Ukrainian food. I know my Grandma Paraszczuk has come back! Then we are off to the Sheremetyevo Airport for our flight to St. Petersburg. We walk to the bus, ride to the plane, and climb the steps to board. The seats are very close together and the poor fellow in front of me suffers my knees in his back. The flight attendants serve sandwiches and juice. We meet our St. Petersburg guide and go by bus to the Novotel Hotel. That evening, we go to the bar and sample vodka and caviar. You only live once. Wednesday, August 26: We tour the Dr. Jo-Ellyn Ryall with a Russian health minister during a visit in Moscow. 1st Quarter, 2010 Catherine Palace at Tsarskoye Selo, now called Pushkin after the famous poet. We see the completely restored Amber Room. When I visited in 1996, the Amber Room was only partially restored and the road had potholes big enough to swallow buses. All is better now and the Russians welcome tourists. In the afternoon, we visit the Bekhterev Psychoneurological Institute, founded in 1907 by V. M. Bekhterev. Institute Director Dr. Nikolay G. Neznanov and several other staff meet with us. The institute works with the World Psychiatric Association. It covers the entire spectrum of medical education including treatment of adults, children, adolescents, geriatric, narcology (addictions), neurosurgery, psychology, and experimental methods. It has some grants to study electronic medical records, and pharmaceutical company grants to study safety and efficacy of medications. It also works with NIH and NIDA on several international projects. The Institute on the Human Brain has PET and also uses EEG and polysomnographs. There is a lot of teamwork and cross-fertilization between specialties. Chemical dependency, especially alcoholism, is a major problem in Russia. Once they detoxify a patient, there is little treatment. The 12-step program does not work because the patients do not share. Instead, clinicians use stress psychotherapy, i.e., “If you drink another drop, you will die.” Sometimes it works. Doctors are cautious in treating children under 10 years old with medications. They believe in long-term psychotherapy for the neurosis, and “Borderline” means less psychotic. Sleep disorders and seasonal affective disorder are hard to treat or even determine the frequency since patients tend to self-medicate until the end. Unfortunately, they do not have a veterans service like in the U.S., so they cannot measure depression or PTSD in veterans. Thursday, August 27: We visit the Childhood Psychiatric Rehabilitation Center. Dr. Dimitry Shigahov and his associates discuss how they treat children for epilepsy, psychosis, and acute conditions. The center has three wards for boys and one for girls, a school for 100 children, inpatient and outpatient wards, a separate 60-bed ward for retarded children or those with severe psychosis, and a unit for very young children. There is no charge or insurance. A social program for parents provides peer support on how to handle their children. The program for autistic children tries to prepare them for regular classrooms. Our hosts treat us to a morning snack of coffee, vodka, and caviar and salmon on rye bread. Delicious! Then we drive to the new hospital, which is being renovated from a building built before the 1917 Revolution. They keep the original architecture but modernize the buildings. The grounds are beautiful. We stop for lunch and shop before our final tour of the Hermitage. This is a marvelous group of buildings of art and culture that includes the Winter Palace and several other buildings. We race through the rooms, just sampling the art and magnificent decorations. In the evening, we have a farewell dinner and recap our experiences. Following a 2:30 AM wake-up call, we go to St. Petersburg (Pulkovo-2) Airport for our 6 AM flight to Frankfurt, and then the flight to JFK and home. The trip gave me new perspectives on the state of psychiatry in Russia. They are very aware of patients’ rights and trying hard to erase the horrors of psychiatry under the Soviets. The doctors were welcoming and eager to share. I would recommend a People to People tour to all our members. The People to People Ambassador Program, based in Spokane, Wash., organizes and promotes global, educational travel opportunities to bridge cultural and political borders through education and exchange. For information, call (509) 568-7000 or toll free (866) 794-8309, or visit the Web site at <http://www. ambassadorsgroup.com>. Several Russia tour members enjoy a typical ethnic dinner (clockwise from left): Jeffrey Bennett MD, Jo-Ellyn M. Ryall MD, Harold Stotland, tour leader Nada Stotland MD, Lauren Wagner MD, and Christine Bennett. 15 Eastern Missouri Psychiatry 1st Quarter, 2010 EMPS Membership Update By Rebecca DeFilippo, MS, MBA, CMP. CMMM New General Member (1) In October, Asad Qalbani MD joined APA as a General Member. He is a staff psychiatrist in the emergency room at John Cochran VA Medical Center in St. Louis. He graduated from University of MissouriKansas City School of Medicine (1997) and completed a psychiatry residency at University of Illinois-Chicago (2008). New Members-in-Training (4) EMPS welcomes four new MITs from St. Louis University. Psychiatry resident Sharmistha Barai MD completed a MBBS degree (medical degree equivalent) at Lady Hardings Medical College, in New Delhi, India (2002). Psychiatry resident Subhash Bashyal MD completed a MBBS degree at BP Koirala Institute of Health Sciences in Dharan, Nepal (2007). Psychiatry resident Sumera Salamat MD completed a MBBS degree at Jinnah Medical and Dental College, Karachi, Pakistan (2005). Pooja Sharma MD graduated with a medical degree from Terna Medical College in Navi Mumbai, India (1999) and completed a general psychiatry residency at Lokmanya Tilak Municipal Medical College in Mumbai, India (2002). Dr. Sharma began a fellowship in geriatric psychiatry at St. Louis University in July 2008. Reinstatements (1) In August, General Member Miggie L. Greenberg MD reinstated her APA membership. She is the Residency Program Training Director at St. Louis University. She graduated from medical school at Case Western Reserve University (1990) and completed a psychiatry residency at the Institute of Pennsylvania Hospital at the University of Pennsylvania (1994). Transfers In (7) EMPS welcomes seven General Members as transfers from other APA District Branches. Zinia S. Thomas MD resides in St. Louis, Mo. She received her medical degree from American University of the Caribbean School of Medicine (1999) in Montserrat. She served a general psychiatry residency at New Jersey Medical School and a child psychiatry residency at Yale UniversityNew Haven Medical Center. She has been an APA member since 2000 and previously was a member of the Connecticut Psychiatric Society. Vivek Agnihotri MD resides in St. Louis, Mo. He completed a general psychiatry residency at New Jersey Medical School (2003) and a residency in addiction medicine at Yale University New Haven Medical Center (2004). He has been an APA member since 2001 and previously was a member of the Connecticut Psychiatric Society. Katarzyna Derlukiewicz MD resides in Hannibal, Mo. She graduated from Medical University of Gdansk, in Gdansk, Poland (1996). She completed a general psychiatry residency (2005) and a two-year fellowship in child psychiatry (2007) at SUNY Health Science Center. She also completed a one-year residency in consultation at Albert Einstein College of Medicine (2008). She joined APA in 2002 and was a former member of the Greater Long Island Psychiatric Society. Justin A. Esses MD works in the Department of Psychiatry at Jefferson Barracks VA Medical Center in St. Louis. He joined APA in 2004 and was a former member of the Massachusetts Psychiatric Society. He received his medical degree from Vanderbilt University School of Medicine (2003). He completed a general psychiatry residency at Boston University Medical Center and a psychiatry fellowship at Massachusetts General Hospital/McLean Hospital. Lara Rymarquis Fuchs MD is an emergency room attending physician at Metropolitan Psychiatric Center and a staff physician for outpatient services at BJC Behavioral Health. “The balance between the ER work and the long-term relationships with patients is a nice one,” Dr. Fuchs said. She has been an APA member for nine years and was a former member of the New York County District Branch. She graduated from Washington University in St. Louis School of Medicine (2001) and completed a psychiatry residency at New York University School of Medicine (2006). “My husband and I met here at a concert at the old Mississippi Nights, and we both loved the area so much that we wanted to come back,” she said. “It just feels like home to us.” Tracy D. Gunter MD is an Associate Professor of Psychiatry at St. Louis University School of Medicine in the Department of Neurology and Psychiatry. She has a secondary appointment as an associate professor in the Center for Health Law Studies of the SLU School of Law. She also participates in the education of trainees and conducts research in forensic populations. She joined APA 18 years ago and was a former member of the Iowa Psychiatric Society. She received her medical degree from University of South Carolina School of Medicine (1990) and completed a psychiatry residency at Palmetto Health Alliance/USC School of Medicine (1995). She is board certified in general and forensic psychiatry. Raymund R. Tan MD resides in Cape Girardeau, Mo. He completed a psychiatry residency at University of South Dakota. He has been an APA member for two years and is a former member of the South Dakota Psychiatric Association. Transfers Out (2) Member-in-Training Rangsun Sitthichai MD moved to Boston, where he is a fellow in the Child and Adolescent Psychiatry program at Children’s Hospital, part of Harvard Medical School. He received his medical degree at Chulalongkorn University (1999), in Bangkok, Thailand, and completed three years of residency at St. Louis University School of Medicine. He has been an APA member since July 2006 and is now with the Massachusetts Psychiatric Society. General Member Ramasubba R. Tatini MD has relocated to Garden City (Boise), Idaho, following completion of a one-year geriatric psychiatry fellowship at Continued on page 17 16 Eastern Missouri Psychiatry 1st Quarter, 2010 Member Update Continued from Page 16 St. Louis University School of Medicine. He is now a member of the Idaho Psychiatric Association. Advancements (5) In December, the APA Board of Trustees approved for advancement five new Fellows from EMPS. They are Bun Tee Co MD, Abhilash K. Desai MD, Linda Sue Horne MD, Kimberli Etta McCallum MD, and Thomas F. Richardson MD. Drops (21) As of Jan. 31, APA dropped 21 EMPS members for nonpayment of 2009 dues. They include Mina Charepoo MD, Marcie B. Epstein MD, Lauren E. Flynn MD, Luis A. Giuffra MD, Rakhshanda B. Hassan MD, Delaina M. Jewkes MD, Julie E. Lafferty MD, Philip J. LeFevre MD, Phillip McDaniel DO, Sudha Mogali MD, Bharat Raj Nakra MD, Rashmi Nakra MD, Vasileios Panagopoulos MD, Cynthia E. Rogers MD, Luzviminda R. Santos MD, Marcie L. Shea (Orlowski) MD, Hiten P. Soni MD, Emel Aktan Sumer MD, Nazmul K. Talukdar MD, Ying-Ying Grace Wu MD and Layla Ziaee MD. Deaths (4) EMPS reports the following deaths: Donald F. Bandle MD, Dec. 27, 2009; Silvana Y. Menendez MD, Dec. 18, 2009; Terry A. Fuller MD, Oct. 5, 2009; and Robert B. Reynolds MD, Nov. 4, 2006 (death reported to EMPS in August 2009). See Obituaries on page XX. TOTAL MEMBERS: 345 (includes 17 permanent Inactive members) Local AACAP Chapter Reorganizes By David I. Berland MD T he Greater St. Louis Council of Child and Adolescent Psychiatry has reorganized under new bylaws. The council elected new officers last spring. David I. Berland MD is president, Mini Tandon DO is vice president and Assembly representative, Ginger Nicol MD is secretary, and Suzanne L’Ecuyer MD is treasurer. Renuka N. Patel MD, Scott Trail MD and Cristiana Teodorescu MD serve as directors on the council. Consistent with the priorities of the American Academy of Child and Adolescent Psychiatry, the council is working to improve access to psychiatric care for children, adolescents and their families. Currently, the council is exploring working with St. Louis Children’s Hospital and Cardinal Glennon Children’s Hospital. The next meeting will be held January 26 at 6:30 pm. All area AACAP members or eligible members are invited. Please contact Dr. Ginger Nicol at [email protected] for further information and to be added to the e-mail list. Membership Form Please type or print clearly. —————————————————————————— Name* —————————————————————————— Employer* —————————————————————————— Street* —————————————————————————— City* State* ZIP* —————————————————————————— Phone Fax —————————————————————————— E-Mail * State law requires that we use our best efforts to collectand report the name, mailing address and employer of individuals who contribute to MoPPPAC. Enclosed is my check or money order for: $250 Capitol Club $365 Dollar-a-Day Club $500 Speaker’s Club $1,000 Senator’s Club $2,500 Congress Club $5,000 President’s Club Other $_______ MoPPPAC Club The amounts recommended are suggestions only. An individual or medical practice may donate more or less than the suggested amount. The amount donated by a contributor, or the refusal to donate, will not benefit or disadvantage you. Only U.S. Citizens or Green Card holders may contribute. Contributions to the PAC are not tax deductible. Make checks payable to: MoPPPAC Return to: 1321 Montevale Court, Fenton, MO 63026 17 Eastern Missouri Psychiatry 1st Quarter, 2010 OBITUARIES Donald Francis Bandle MD, 89, of Shawneetown (Gallatin County), Ill., died December 27, 2009, at the Oakview Heights Center in Mt. Carmel, Ill. He was born September 29, 1920, in St. Louis, Mo. In 1970, he married Thomasine Logsdon, who preceded him in death in 2004. His daughter, Thomasina Jon White and Eric Turpin of Mt. Carmel, Ill, and a brother survive him. His parents; a wife, Betty Bandle; and his son, Gary Bandle, preceded him in death. During World War II, Dr. Bandle was a first lieutenant in the Navy, where his duties included being captain of a sub chaser in the South Pacific. After the war, he resumed his college studies, receiving a master’s degree in clinical psychology from Washington University in 1948 and a medical degree from St. Louis University in 1953. He served a one-year rotating internship at Evangelical Deaconess Hospital in St. Louis and a psychiatry residency at the former St. Louis State Hospital, where he later served on the medical staff for nine years. He later engaged in private practice for fifty years in St. Louis. He was a 54-year member of the American Psychiatric Association, which recognized him as a Distinguished Life Fellow of Psychiatry. He was also a member of the American Medical Association. Dr. Bandle was a consummate sportsman, and played on the football, basketball and baseball teams in high school and college. He also owned and raced thoroughbred racehorses for forty years. Burial was at Westwood Cemetery with military rites by Ridgway American Legion Post #596. Memorials in Dr. Bandle’s memory may be made to the new project with Wabash County Animal Shelter Buddies (WCASB), 11336 North 1550 Boulevard, Mt. Carmel, IL 62863; telephone (618) 262-7109; Web site at [email protected]. Go to http://www.vickeryfuneralchapel.com to make Internet condolences. Silvana Yolanda Menendez MD (nee Lee) died December 18, 2009, in Chesterfield, Mo. She was the wife of the late Manuel F. Menendez MD, mother of Manuel J. (Michele) Menendez DDS, Yolanda M. Menendez, Michael F. (Marcia) Menendez and Robert Lee Menendez; and grandmother of three grandchildren. 18 held December 22. Contributions may be made to the American Heart Association or Behavioral Healthcare, c/o Friends of St. Elizabeth Hospital, 11 South Third Street, Belleville, IL 62220. Silvana Yolanda Menendez MD Dr. Menendez was born in Cuba, and completed medical school at Universidad de la Habana, in Havana, Cuba. She served a rotating internship at Christian Hospital of St. Louis and a psychiatry residency at the Child Guidance Clinic of Jewish Hospital and at the former St. Louis State Hospital (now, St. Louis Psychiatric Rehabilitation Center), where she later worked as a staff psychiatrist. She was a member of the American Psychiatric Association for 46 years, having joined as an Associate Member in 1963. She advanced to Distinguished Life Fellow in 1996. “I always admired Yolanda as a person, mother and professional. She loved her career and her family,” reminisced Dr. Ofelia E. Gallardo, who worked with Dr. Menendez at State Hospital. “She was a source of pride among her fellow Cubans here in St. Louis.” Dr. Menendez also was the first woman president of Memorial Hospital in Belleville, Ill., first woman president of St. Clair County (Ill.) Medical Society and second vice president of the Illinois State Medical Society. Dr. Menendez was a staff psychiatrist at Belleville Memorial Hospital and St. Elizabeth Hospital in Belleville, Ill. The funeral service was Terry A. Fuller MD Terry A. Fuller MD died October 5, 2009. Dr. Fuller graduated from Washington University School of Medicine in 1974 and completed his residency in psychiatry in 1977. Dr. Fuller was a trainee in pathology through the National Institute of Environmental Health Sciences and a research scientist development awardee through the National Institutes of Mental Health. He received his board certification in psychiatry and neurology in 1979. After conducting research for many years, he began private practice in 1987. He was a member of the American Academy of Organizational and Occupational Psychiatry, and the Society for Neuroscience. He also was a former General Member of the American Psychiatric Association. Dr. Fuller was an assistant professor of psychiatry at Washington University and was on staff at Barnes-Jewish Hospital until his death. Donations may be made in memory of Dr. Fuller to Youth in Need, Attention: Development Office, 1815 Boone’s Lick Road, St. Charles, MO 63301, or to Washington University in St. Louis, Attention: Medical Alumni and Development Program, 7425 Forsyth Blvd., Suite 2100, Campus Box 1247, St Louis, MO 63105-2161. Robert B. Reynolds MD died November 4, 2006, in Glenwood Springs, Colorado. He was born November 8, 1922, in China. He completed his pre-medical education at Carleton College in Northfield, Minnesota in 1944, and graduated with a medical degree from Harvard Medical School in 1947. He served a one-year general hospital internship at the University of Chicago Clinics and residencies in psychiatry at St. Louis City Hospital (Malcolm Bliss) and the Veterans Administration Hospital at Jefferson Barracks in St. Louis. He joined the American Psychiatric Association in 1951 and was named a Life Fellow in 1985. He achieved 50-Year Life Fellow status in 2001. Eastern Missouri Psychiatry 1st Quarter, 2010 EMPS Committee Membership BYLAWS Jo-Ellyn M Ryall MD (chair) EDUCATION Arturo C. Taca Jr. MD (chair) CHILD and ADOLESCENT PSYCHIATRY Judith McKelvey MD (chair) Meg Corrigan MD David Duesenberg MD Dehra Glueck MD Adelita Segovia MD Duru Sakhrani MD Moisy Shopper MD Natasha Marrus MD ETHICS Lawrence Kuhn MD (chair) Aviva Raskas MD Moisy Shopper MD COMMUNITY and PUBLIC PSYCHIATRY Chris Loynd DO (chair) Malik Ahmed MD Jay Engelhart MD Asif Habib MD Duru Sakhrani MD Melissa West MD Member Notes Compiled by Rebecca DeFilippo CMP, CMMM Abhilash Desai MD, George T. Grossberg MD and Jothika N. Manepalli MD will present a continuing medical education course on “Pain and Palliative Care in Psychogeriatrics” on May 24, during the APA Annual Meeting in New Orleans. Drs. Grossberg and Desai also will present on “Psychiatric Consultation in Long-term Care: Advanced Course.” Parkland Health Center, a part of BJC HealthCare in Farmington, Mo., has appointed Vikrant Mittal MD, MHS director of geriatric psychiatry. Dr. Mittal authored two chapters in Clinical Assessments in Psychiatry: Mastering Skills and Passing Exams, edited by Rajesh Tampi MD, due out this year from Lippincott, and published articles in Psychiatric Services and Case Reports in Medicine in 2009. He will serve a teaching assistantship at Johns Hopkins University, in Baltimore, Md., for their online Health Information Management Systems course. He plans to pursue a fellowship in health services administration with the American College of Healthcare Executives (ACHE). Garry M. Vickar MD will present FORENSIC PSYCHIATRY Jose Mathews MD (chair) Angeline Stanislaus MD LEGISLATIVE AFFAIRS Paul Simon DO (chair) Jack L. Croughan MD Alan Felthous MD Asif Habib MD Azfar Malik MD Jay Meyer MD “How to Help Your Patients: Adding Vitamins and Minerals” at the Nevada Psychiatric Association’s 15th Annual Psychopharmacology Update, Feb. 11-13, at South Point Hotel & Casino, Las Vegas, Nev. Collins E. Lewis MD has a role in Casualties of the State, a feature-length film from Corner Film Productions, directed by St. Louis independent filmmaker Jeremy Cropf and slated for release in 2011. Dr. Lewis plays FBI Deputy Director Robert MEMBERS-IN-TRAINING Ben Holt MD (co-chair) Moses Tabe Ambilichu MD (co-chair) Ujjwal Ramtekkar MD, MPE Paul Simon DO MEMBERSHIP Jo-Ellyn M Ryall MD (chair) Bharat Nakra MD Edwin D. Wolfgram MD NEWSLETTER Daniel Mamah MD, MPE (chair) Azfar Malik MD Ujjwal Ramtekkar MD, MPE PUBLIC AFFAIRS Collins Lewis MD (chair) David Duesenberg MD Herb Rosenbaum MD Angeline Stanislaus MD Radhika Rao MD Abrams in a thriller about the mysterious deaths of high-level, federal officials who are profiting from a war between the U.S. and a Middle Eastern country. Filming took place in St. Louis and included Kirkwood City Hall and the Old Post Office Building. Dr. Lewis’s previous acting credits include Seamstress of St. Francis Street (2008) and Room at the Inn (2008) for First Run Theatre and An Evening with Harold Pinter (2007) and The Rimers of Eldritch (2006) for Soundstage Productions. Two EMPS members traveled abroad this year and agreed to write about their experiences for Eastern Missouri Psychiatry. Jo-Ellyn M. Ryall MD penned “Great Russian Escapade” (page 15) during a People to People Ambassador trip when she visited psychiatric hospitals in Moscow and St. Petersburg. Daniel T. Mamah MD, MPE recollects his memorable trip to Nigeria to attend a regional meeting of the World Psychiatric Association in “Visiting Africa” on page 13. Dr. Collins E. Lewis (right) as FBI Deputy Director Richard Abrams with Neal McCluggage as Assistant Director Neal Geller in Casualties of the State, scheduled for release in 2011. EMPS encourages members to share news about their professional accomplishments in “Member Notes.” Please submit entries to <[email protected]> or mail to EMPS Newsletter, 1321 Montevale Court, Fenton MO 63026 19 Eastern Missouri sychiatric PSociety A District Branch of the American Psychiatric Association PRESORTED FIRST-CLASS MAIL U.S. POSTAGE PAID ST. LOUIS, MO PERMIT #4400 1321 Montevale Court Fenton, MO 63026-3016 RETURN SERVICE REQUESTED Upcoming Events Friday, March 26 – Sunday, March 28 152nd Annual Missouri State Medical Association Convention Renaissance St. Louis Hotel Airport There is no fee to participate, but attendees must register. Contact MSMA at 800-869-6762 or visit www.msma.org Saturday, March 27, 11:30am – 1:30pm (buffet lunch will be served) EMPS Specialty Session on Psychiatry: “Geriatric Mood and Anxiety as Comorbid Problems in Primary Care Settings: Evaluation and Management,” Jothika N. Manepalli MD Renaissance St. Louis Hotel Airport EMPS has requested 2 Category 1 CME credits for this activity. There is no fee to participate in MSMA’s Annual Convention, but attendees must register. Contact MSMA at 800-869-6762, register online at www.msma.org Saturday, March 27, 2-4pm EMPS Organizational Meeting, Renaissance St. Louis Hotel Airport There is no fee to participate in this meeting and no CME credit is available. To register, please contact EMPS at [email protected] or 636-343-8555. Register online at www.emopsych.org Saturday, May 22 – Wednesday, May 26 APA 163rd Annual Meeting, “Pride & Promise: Toward a New Psychiatry,” New Orleans, La. For registration information, go to www.psych.org We strive to make content in future issues of Eastern Missouri Psychiatry representative of our membership and encourage our members’ participation in its creation. For communications regarding the newsletter, or to include articles, events or advertisements in future publications contact: Daniel Mamah, MD, MPE Editor, Eastern Missouri Psychiatry Dept. of Psychiatry, Washington University 660 South Euclid Avenue St. Louis, Missouri 63110 or [email protected] Copyright © 2010 by Eastern Missouri Psychiatric Society. All rights reserved. No part of this document may be reproduced or used in any form or by any means, electronic, mechanical, or otherwise, including photocopy, recording, or by an information or retrieval system, without the prior written permission of the publisher.
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