APA Boosts Advocacy Efforts In Courts, State Houses

The APA Board of Trustees ratcheted up the Association’s advocacy efforts on behalf of psychiatrists and their patients significantly when it voted at its meeting last month to participate in or contribute financially to several lawsuits impacting psychiatric care.

The Board also agreed to make substantial contributions to two APA district branches to help them prepare for impending battles in their state legislatures over granting psychologists the authority to prescribe psychoactive medications.

On the litigation front, the Board heard reports of decisions made earlier by the APA Executive Committee to file friend-of-the-court briefs in two cases. One of the cases, Kansas v. Michael T. Crane, which is awaiting a hearing by the U.S. Supreme Court, arose from the notorious Hendricks case in Kansas (Psychiatric News, July 18, 1997).

That case established the precedent that states could involuntarily confine in psychiatric hospitals sexual predators who are to be released from prison after completing their sentences. The court’s majority in that case was not swayed by arguments that sexual predators are not necessarily suffering from a treatable psychiatric disorder and thus would not benefit from interventions that psychiatrists and other professionals in those facilities can provide.

In the new case the court is being asked to rule that Hendricks was a narrowly focused decision based on the special facts of that case, namely that Hendricks admitted that he would be unable to stop himself from committing additional sexual offenses once released. Such a ruling from the court in the current case, as APA argues in its amicus brief, would counter the interpretation that its Hendricks decision was a validation of state sexual predator laws allowing indefinite psychiatric confinement in lieu of stronger punishments in the criminal justice system.

APA is backing Crane’s contention that indefinite psychiatric confinement based on potential for future violence violates his constitutional liberty rights. If the state believes it needs to confine him, it should do so by incorporating an appropriate punishment into the criminal justice system, APA maintains.

The other case, United States v. Gomes, involves involuntarily medicating a criminal defendant who has been found incompetent to stand trial. While the arguments are similar to those recently made in the case United States v. Russell Weston (Psychiatric News, April 6 and September 7), the charges here involve weapons violations, and thus the death penalty is not at issue, though Gomes does face the prospect of recidivism penalties adding significantly to a possible sentence.

A federal appeals court asked APA and the American Psychological Association to provide their views on the issue of involuntary medication of psychotic arrestees. In backing the government’s desire to medicate Gomes forcibly, APA’s brief will emphasize the much-improved side-effect profiles of antipsychotics and the harm likely to ensue from leaving a psychotic individual unmedicated.

Support for ECT Case

The Trustees also approved a recommendation from the Commission on Judicial Action that APA contribute $4,000 to the New York State Psychiatric Association (NYSPA) to help it defray the costs of preparing an amicus brief in the appeal of a case involving ECT. In the case known as In the matter of Paul Henri T., the patient had been declared incompetent to consent to ECT, which physicians maintain will help the patient, but family members would not allow the procedure. The NYSPA brief, which is based on the “APA Task Force Report on the Practice of Electroconvulsive Therapy,” explains the recent literature on ECT and counters the family’s depiction of the procedure.

The commission and the NYSPA believe that the brief could serve as a “template” that can be used in future cases involving the use of ECT. In early October, however, the patient was released from the hospital before the court could decide on his appeal of the original order allowing ECT to proceed. At press time attorneys for both sides were working on an agreement to end the suit and the appeal.

Two DBs Get Funds

On the legislative front, the Board of Trustees endorsed a recommendation from the Commission on Public Policy, Litigation, and Advocacy that APA provide $30,000 each to the district branches in Hawaii and Virginia to help them respond to scope-of-practice issues on the agendas of their state legislatures. In both states psychologists are working to have lawmakers grant them the right to prescribe psychoactive medications without a requirement that they attend medical school first.

Other Actions

In other actions the Trustees voted to

• change the charge of the APA Committee on Psychiatric Dimensions of Disasters to add a concern about the psychiatric sequelae of terrorism-related disasters. This proposal had been submitted prior to the September 11 attacks on the United States.

• establish a 15-month project on patient safety to be conducted by a new task force that will be funded through an unrestricted grant from Astra-Zeneca. The project’s goal is to improve patient safety in the mental health care system and reduce adverse events such as medication errors and suicides by examining and making recommendations about the roles of psychiatrists and other key personnel, and the health systems in which care is provided;

• support the candidacy of APA Secretary Pedro Ruiz, M.D., for the position of secretary of meetings of the World Psychiatric Association;

• increase the advance registration fee for international members attending the APA annual meeting from $135 to $450 and the on-site registration fee from $185 to $500. This change is to remedy complaints of unfairness by some U.S. and Canadian members that while they have been paying the same registration fees as international members, some of them also pay approximately $1,000 in combined annual dues to APA and their district branch, while international members pay dues of only $150. For international members it was thus cheaper to join APA to get the lower registration fee, and many then dropped out.

• combine APA’s two committees for members-in-training—the Committee of Residents and Fellows and the Assembly Committee of Area Member-in-Training Representatives. The Trustees charged the two committees with developing a plan to facilitate this merger and urged them to use the model the two committees of early career psychiatrists used last year to accomplish the same task.

• approve a change to the procedure for amending APA’s bylaws when such a change is initiated by the Board of Trustees. Under this proposal, on which members will be asked to vote on the 2002 APA election ballot, any amendments that the Board makes to the bylaws must be brought before the Assembly. The Assembly must ratify it by a two-thirds vote by strength. (A vote by strength means that the vote cast by each district branch represents the number of voting members in that branch.) If action is required before the next Assembly meeting, two-thirds of the Assembly Executive Committee participating in a meeting at which a quorum is present can vote on the bylaw change. However, if the amendment is not ratified by the Assembly at the next Assembly meeting, it will not be effective.

• participate in a survey by the Council of Medical Specialty Societies (CMSS) designed to gather data on the personal and professional consequences on physicians of being involved in a malpractice suit. The Board agreed to facilitate the participation of a small, random sample of APA members after the CMSS asked each medical specialty society to provide such a membership sample of physicians, who will be identified by a numeric identifier and not their names. Only aggregate data will be reported. Psychiatrist Sara Charles, M.D., is the principal investigator.

In addition, APA President Richard Harding, M.D., announced at the meeting that the Board and Medical Director Steven Mirin, M.D., had agreed on the terms of a three-year extension of Mirin’s current contract, which expires June 2002.

The court cases are Kansas v. Michael T. Crane, U.S. Supreme Court, No. 00-957; U.S. v. Aaron Gomes, U.S. Court of Appeals for the 2nd Circuit, No. 00-1435; and In the matter of Paul Henri T., Supreme Court of the State of New York, Appellate Division, 2nd department.

The task force report on ECT cited in the NYSPA amicus brief is posted on APA’s Web site at www.psych.org under the heading “Clinical Resources.” ▪