April, May, June 2014 | Vol. 30 No. 2
Current ISSUES PRESIDENT’S MESSAGE
President’s message 1
An exciting past year by David Conant-Norville, MD
Legislative report 3 Executive Council highlights 4 Winter conference 6 APA accolades 12
This is my last President’s Column for the newsletter and a chance to reflect on the past year for our organization. To say that this year was a period of transition is an understatement. Perhaps the biggest change is re-naming our professional organization to Oregon Psychiatric Physicians Association. We are now awaiting name ratification from the APA to make our new name official. As we change our name we must also meet the changing needs of our membership and community. We are an organization of psychiatric physicians; now our organization clarifies that fact. What that will mean in the future will be determined by our leadership in reshaping our state’s mental health system and workforce development. Our first challenge this year was bringing in a new professional management team. They have now been on the job for a year. I hope you have taken time to get to know our new Executive Director, Patrick Sieng. Patrick has done a phenomenal job in his first year, learning about our organization, and leading the way back into financial viability. Patrick has reviewed boxes of old organization records and is digitalizing our records. He reviewed our bank accounts, consolidated our banking, reduced bank fees, and
brought us into the age of internet banking. We are working to decrease costs of paper (mailing, copying, and printing) and working to becoming a more paperless organization. Patrick worked to establish clear financial practices that are transparent. Perhaps you may have noticed that we are cutting back on mailing notices and printing CME conference books. We are transitioning our communication to e-mail and website. Patrick also organized unified billing of APA and OPA dues, again to save OPA funds. I want to thank Patrick for his high energy, enthusiasm, innovative ideas, attention to details, and organizational leadership. Our new legislative lobbyist, Amy Goodall, had a rough start last year as she came on as new Executive Director and Lobbyist, joining the OPA during the 2013 legislative session. Last year was a frustrating legislative year for the OPA. After the legislative session Amy and Patrick clarified their new roles that highlight their respective skills. Amy has built a strong presence in Salem representing the OPA, and supporting our legislative committee. Amy, thanks for taking the risk to join the OPA, for bringing your expertise and energy to guide our presence in Salem. Our effort to study and revise our
bylaws and to change our association name was spearheaded by immediate past president, Chris Lockey, MD. Chris did a great job making strong case for this identity change that he initiated during his year as president. Both Chris and former OPA president Tom Hansen, MD have joined me three times to present our CME program, Transitioning to DSM 5, as a benefit to OPA members and a fund raiser for the OPA. Like many OPA members, we donate our time for the benefit of our organization and colleagues. We will take this program on the road for members and other mental health professionals around the state. Chris and Tom, thank you for your creativity, generosity, and dedication to OPA. Our professional organization cannot function without our committees and the leadership from our committee chairs. The highest profile committee is the program committee, with responsibility for organizing and presenting our two big CME programs every year. Lee Shershow, MD has served this year as our program committee chair. This is a demanding job but comes with the great privilege of working with a fabulous committee. Lee and his committee have put on two successful (Continued on page 2)
OPPA Execut ive Council President David Conant-Norville, MD President–Elect Annette Matthews, MD Secretary Vacant Treasurer April Sweeney, MD Past Presidents Chris Lockey, MD Satya Chandragiri, MD John Lipkin, MD APA Representative Annette Matthews, MD APA Deputy Representative Amela Blekic, MD Councilors Sally Behel, MD Daniel Dick, MD Stephanie Lopez, MD At Large Councilors Denise Dion, MD Norwood Knight-Richardson, MD Child Psychiatry Representative Kirk Wolfe, MD Newsletter Editor Scott Reichlin, MD Lane County Chapter President Victor Richenstein, MD Psychiatric Residents’ Representatives Kelly Cleaves, DO Jennifer Lindley, DO
Commit t ee Chair per sons CME Scott Reichlin, MD Ethics Victor Richenstein, MD Legislative Daniel Dick, MD Member Assistance Program Henry Grass, MD Membership George Keepers, MD Program Lee Shershow, MD Public Information & Education Daniel Bristow, MD
OPPA Staff Executive Director Patrick Sieng Government Relations Director Amy Goodall Program Committee Coordinator Patti Legarda OPPA Contact: phone/fax: 503-406-2526 info@oregonpsychiatric.org
President’s message (Continued from page 1)
programs this year while attending to our organization’s financial challenges. Lee and the committee, thank you for your fantastic and committed efforts to our organization’s educational mission to our members and colleagues around the state. Our legislative committee has a new chairman, Daniel Dick, MD. Daniel and the legislative committee just finished a short session without any adverse legislative actions that affect our members. Daniel, Mike Franz, MD, Kathy Flegel, MD, and I will be testifying to the Governor’s Task Force to study HB 2902, last year’s legislation that temporarily requires insurance companies to pay primary care and psychiatric nurse practitioners at the same rate as physicians. Daniel and his committee are beginning to prepare for next year’s legislative session. The legislative committee needs a strong political action fund. We raised $4500 for the OPA political action committee at the winter conference. Thanks to all of you who contributed, and I urge those of you who have not yet made a contribution to the PAC to do so soon. Daniel and the legislative committee, thank you for past efforts and your work to anticipate challenges and prepare for the next legislative session. We have revived the OPA membership committee under the chairmanship of George Keepers, MD. George created a committee to reflect the many facets of our membership, with the goal to retain and build membership by reaching out to all psychiatrists in Oregon and determining what our members and would be members believe is the value in membership. I want to thank George and the new membership team for stepping forward to help understand and serve the OPA members. Any OPA member with five or more years of membership may be eligible for election as a fellow of the APA. Members can gather information about APA fellowship from the APA website or by contacting Patrick Sieng at the OPA office. 2
I wish to provide a special thank you to April Sweeney, MD, our OPA treasurer, for carefully managing our funds and working hard to establish a sound and workable budget for 2014. And finally I want to acknowledge Scott Reichlin, MD, our newsletter editor, official photographer, CME chairman, program committee member, and keeper of the history at OPA executive committee meetings. It has been my honor and privilege to serve as OPA president this year and I am certain that our next president, Annette Mathews, MD is well prepared to take on this leadership role in May. I hope that members appreciate how professional medical specialty organizations advocate for and serve members. This last year some of our members began to complain about treatment by Optum, the behavior health contractor for the Providence Health Plan. The OPA gathered information from members and began conversations with Providence Health Plan, OMA, APA, and eventually the leadership of Optum, first locally and then nationally. Our concerns were heard because we brought forth our concerns as the professional organization representing Oregon psychiatrists. We heard from both Providence Health Plan and Optum that they believe that they made errors in communicating with psychiatrists, and that they are correcting their mistakes, to rebuilt trust with Oregon psychiatrists. If any member is experiencing problems with Optum/ Providence Health Plan, please contact me directly at drdocn@hotmail.com and I will make sure that you are connected with Optum leadership who can address and correct the problems. Working together we always have more influence and power to improve psychiatric practice for our members and the mental health care delivery system for our state. I hope OPA (and soon OPPA) continues to be internally driven to support our member colleagues, while remaining externally focused to provide the best care for our patients.
LEGISLATIVE REPORT
Short session wrapped up by Amy Goodall The 2014 Legislative Session concluded on March 7. The OPA legislative committee followed several bills during session. OPA did not sponsor legislation or aggressively oppose any bills introduced. Below are two issues that were of interest and that we will continue to follow into the 2015 session. HB4036 – This bill would have expanded the crime of assault in the third degree to include, under certain circumstances, causing physical injury to an employee or a patient at the state mental hospital. This bill was very controversial. It was sent out of House Judiciary to the House Rules committee, essentially to die. Representative Clem made a procedural move on the House floor to remove the bill from committee to try to bring it back to life but the motion was defeated (primarily by Democrats). The opposition to the bill got the most traction by explaining that the 2013 legislature provided the Marion County District Attorney’s office with additional resources to prosecute alleged assaults by patients. Despite this extra money there is no evidence that the resources have had any positive effect, and the prudent way to proceed is to wait and determine the success of that legislation. Unfortunately, a large part of the reason for no improvement is that Marion County did not hire anyone to effect these changes until recently. It is now recommended that legislators wait to observe the impact of these changes from the 2013 legislation, if it has resulted in additional prosecutions and if these prosecutions create a greater deterrent of assaults. The bill did not pass either chamber; this will likely be an issue in 2015 that OPA could engage in. HB4124A – This bill establishes a Youth Suicide Intervention and Prevention Coordinator within Oregon Health Authority to work with mental health and addiction issues. This legislation also requires an update of the Youth Suicide Intervention and Prevention Plan once every five years. The coordinator is directed to report to Legislative Assembly regarding the first plan update by January 1, 2015. The bill was amended once to raise the upper age limit from 19 to 24. The OPA legislative committee voted to support the bill. The bill passed both chambers and was signed by the Governor on April 1. (Continued on page 4)
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Kitzhaber’s role in what Richardson reports are criminal acts related to government spending of health care dollars.
LEGISLATIVE REPORT
The primary election will be held on May 20 and the general election is on November 4.
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The filing deadline for legislative seats has passed for the 2014 election cycle. While there will be significant changes in the House, there are only a couple of Senate races that are considered in play. Senate District 8 covers Albany and Corvallis; this seat was held for several years by Frank Morse-R. Morse retired from office, mid-term, and Betsy Close-R, who had previously served in House District 15 (Albany), was appointed to complete his term. Now a formal election will be held for the first time since Morse’s retirement, and Close is being challenged by Sara Gelser-D, who currently represents House District 16 (Corvallis). The registration edge is tight in the Senate district because Albany leans Republican while Corvallis is widely Democrat.
Executive Council Highlights February 27, 2014 – Portland The Executive Council met at the DoubleTree by Hilton Hotel in Portland, site of the winter conference. The January meeting was cancelled due to budget cuts. Council Members certified the election results for a vote by members, changing the name of the organization to the Oregon Psychiatric Physicians Association. Over 76% of members who voted cast a vote in favor. The council evaluated possible logo options.
The other open Senate seat is District 13, which encompasses Keizer, St. Paul, and parts of Newberg, Wilsonville, and Sherwood. The seat is currently held by Republican Larry George. Kim Thatcher-R, who currently holds the seat representing Keizer in House District 25, is running against Democrat Ryan Howard. The district has a Republican registration edge.
The organization continues to implement policies to streamline processes and save money. At this meeting, the council approved a travel policy for staff, members, and speakers who are conducting association business. The council also reviewed a draft honorarium policy for speakers, which will be continued to the next meeting.
In the House, there are 16 open seats. Many are in districts where the registration edge skews so significantly that the races are not considered contentious, or the primary is considered the real contest. These races include districts 2, 3, 4, 7, and 58, which range across Roseburg, Central Point, Pendleton, and Grants Pass and are assumed to remain represented by Republicans. The seats that are open that are heavily Democratic include districts 12 (Eugene), 16 (Corvallis), and some in the Portland area, 34, 41, and 42.
Dr. Lee Shershow, chair of the program committee, presented a report for the winter conference. Attendance and revenue numbers both exceeded projected budgets.
March 1, 2014 – Portland The OPA held its winter semi-annual business meeting during the Saturday lunch of the conference at the DoubleTree by Hilton in Portland. Approximately 50 members attended.
The Salem-Keizer area has several open seats. Some districts have more narrow registration edges than others. House districts 19, currently Kevin Cameron, and 25, currently Kim Thatcher, are expected to remain Republican. House District 20 encompasses parts of South Salem and Monmouth and Independence, it has been held by Republican Vicki Berger for many years. She is not running for re-election so the seat is open and has an even D-R registration demographic. There is one Democrat running for the seat, Paul Evans; he is a military veteran, previous Mayor of Monmouth, and was a candidate for State Senate in 2006. The Republicans have a four-way primary. The other districts that could swing from one party to the other include District 29 (Hillsboro), District 50 (Gresham), and District 54 (Bend).
Dr. David Conant-Norville, OPA President, provided a review of the past year. He called it a huge transformation year for the association with a change in staff, business and financial practices, and new focus on membership. Chairs of committees were also present to provide a report on their respective activities. Dr. Daniel Dick, chair of the legislative committee, gave a quick update about bills being discussed at the legislature. Dr. Henry Grass, chair of the member assistance committee, sought input on the next Brian Buss lecture, which will occur at the 2014 fall conference in Ashland. Representatives from Optum and Providence Health Plan were present. They engaged in a discussion over controversial billing issues with the members present. They assured members that they are working through the issues and hope to continue a strong partnership with Oregon psychiatric physicians.
While many people are registered to run for Governor, the two candidates that are considered viable are current Governor, John Kitzhaber-D, and State Representative Dennis Richardson-R. Richardson is running largely on a platform related to the problems initiating health care reform and 4
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Brain & Beyond: 2014 Winter Conference Over 250 mental health care professionals attended the 41st annual winter continuing medical education conference. It was one of the largest conferences in the organization’s history. During the conference, attendees helped raise over $500 for the Foundation for Psychiatric Education and over $4,500 for the Oregon Psychiatrists Political Action Committee. During the Friday reception, two legislators - State Rep. Mitch Greenlick (D-Portland) and State Rep. Lew Frederick (D-Portland) stopped in to chat about the legislative session and their own experiences with mental health policy. The conference was sponsored by Providence Health Plan, Cascadia Behavioral Healthcare, and American Professional Agency.
On behalf of the Intercultural Psychiatric Program at OHSU, Amela Blekic, MD accepted one of the 2014 Access Awards from President David Conant-Norville, MD. The presentation occurred during the winter conference. Jonathan Betlinski, MD spoke about Mental Health First Aid, a training method to help non-professionals make a difference with friends and family who show the onset of mental health problems. Developed in Australia in 2001, it came to the US in 2008 and has been upgraded and expanded regularly since then.
SAVE THE DATE! 27th ANNUAL FALL CME CONFERENCE
OF THE OREGON PSYCHIATRIC PHYSICIANS ASSOCIATION SEPTEMBER 18-21, ASHLAND
Octavio Choi, MD, PhD demonstrated his vast knowledge and indefatigable enthusiasm for the field of brain imaging. Presenting twice during the conference, he focused on functional imaging techniques and how they may apply to detection of lies, a science that needs continued study before it becomes legally applicable. 6
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Winter Conference: Brain & Beyond (Continued from page 6)
Mark Frye, MD from Mayo Clinic aims to promote giving the “right drug to the right patient at the right time.” He presented a clear review of metabolic enzymes and how they can help the clinician plan medication therapy.
Eric Frombonne, MD, director of OHSUs Autism Center, moved to Portland from England, and treated the winter conference attendees to new insights into the diagnosis of autistic disorders.
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An exciting and intense speaker, Paul McHugh, MD, past department chair in Oregon and currently at Johns Hopkins, gave two presentations. In the first he described the lack of evidence for the concept of false memories and criticized how some clinicians introduce them during therapy. His second presentation was the Dickel lectureship sponsored by OHSU; he explained why DSM is no more than a “field guide” of mental illness and proposed improvement in diagnoses.
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Winter Conference: Brain & Beyond (Continued from page 8)
The winter conference turnout was extensive; the thought-provoking and engaging lectures generated many questions and much discussion.
OHSU neuroscientist Bonnie Nagel, PhD spoke about adolescent addiction. The risk of developing adolescent alcoholism can be related to: the age at first drink (especially 14 or younger), family history, a sensation-seeking personality, and having an externalizing disorder such as conduct disorder or ADHD.
Yale’s Assistant Professor Patrick Skosnik, PhD, is on top of the research on cannabis intoxication, which mimics many symptoms of schizophrenia. In his second lecture he highlighted the risks related to increased availability of synthetic cannabinoids, whose chemical structures morph so easily and quickly that legal control is difficult. Skosnik supports legalizing marijuana merely to thwart further development of these more dangerous synthetic products.
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Winter Conference: Brain & Beyond (Continued from page 11)
George Keepers, MD, Maggie Bennington-Davis, MD, and Doug Luther, MD joined in a panel for the annual Waterman luncheon lecture to teach the latest concepts in CCOs, Coordinated Care Organizations. Pondering the role of psychiatry in integrated medical care, one take home lesson is that “all health is behavioral.�
Kent Thornberg, PhD, a Professor of Medicine at OHSU and Director of the Moore Institute for Nutrition and Wellness, explained that early epigenetic factors can lead to the development of chronic illnesses in later life. Epigenetic factors such as maternal diet and social stress influence the expression of genes.
State Rep. Mitch Greenlick, PhD (D-Portland), chats with Paul McHugh, MD, (left) and David Conant-Norville, MD (right). Greenlick chairs the House Committee on Health Care.
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P.O. Box 21571 Keizer, OR 97307
Congratulations to OPPA Members!
The OPPA congratulates the following members for their new membership designations by the APA:
Distinguished Life Fellow Kathryn Zerbe, MD Scott Reichlin, MD Life Fellow Bennett Garner, MD Mary McCarthy, MD Karl Weaver, MD Fellow Hung Tran, MD Holly Hoch, MD Kathryn Flegel, MD Jennifer Coffman, MD James Hammel, MD Cecille Reuther, MD Life Member Marvin Fickle, MD Lawrence Hipshman, MD Martin Raitiere, MD Steven Tackett-Nelson, MD
New General Members Shannon Robinson, MD Eric Leong, DO Mark Brown, MD Anne Gross, MD New Resident-Fellow Members Leigh Anne Bressler, DO Johnnie Chi, DO Pari Faraji, MD Brent Frazee, MD Vanessa Katon, DO Ki Kurtz, DO Jessica Myers, DO Pia Quimson -Guevarra, DO Elizabeth Schmick, DO Paria Zarrinnegar, MD
Currency for Current Issues In accord with recent financial directives of the Executive Council, this newsletter’s editor and staff have updated procedures that will help preserve the association’s precious resources. Starting with this issue we save money by formatting the paper in the OPPA office, and after this issue, most members will receive their newsletter via email rather than in a printed version, for another substantial monetary advantage. A limited number of copies will still be printed and mailed for those OPPA members who lack adequate Internet access. If you are a member who needs to receive a paper version please contact the OPPA office as soon as possible so we can make plans for the next issue. Thank you. E-mail the OPPA office: info@oregonpsychiatric.org