On Its Golden Anniversary, Assembly Tackles Diverse Agenda

In elections held during a three-day meeting in San Francisco in May, members of the APA Assembly elected James Nininger, M.D., the Assembly’s recorder, to be their next speaker-elect and Area 1 Deputy Representative Joseph Rubin, M.D., to replace Nininger as recorder.

Nininger, a private-practice psychiatrist in New York City and clinical associate professor at Cornell University Medical College, defeated Jo-Ellyn Ryall, M.D., of St. Louis, who was the Area 4 deputy representative.

The race to succeed Nininger as Assembly recorder saw Rubin, who is in private practice in Portland, Maine, outpoll opponent Louis Moench, M.D., of Salt Lake City, Utah. Moench was the representative for Area 7.

The Assembly speaker does not reveal the vote totals, and ballots are destroyed after the results are announced.

The May meeting marked the 50th anniversary of the Assembly’s founding, and perhaps fittingly, the members spent a substantial portion of their time debating the Assembly’s appropriate size and representation mix.

The Assembly was presented with a report from an ad hoc task force chaired by former Assembly speaker Al Herzog, M.D., that recommended increasing the number of district branch members that each representative would represent. After heated debate, substantial opposition, and several votes on amended versions, the Assembly decided to send the matter to its Committee on Planning for further review. The task force was appointed by Speaker Al Gaw, M.D., and Speaker-elect Prakash Desai, M.D.

In other actions, the Assembly voted to

• have APA back a policy that encourages the federal government “to oversee the establishment and funding of universal health care access.” Such a program would have no rules that discriminate against people seeking mental health or substance abuse care. This was the modification of a proposal the Assembly was unwilling to back to have APA go on record endorsing universal, government-sponsored health care insurance.

• call on APA to urge the AMA to “work with all the nation’s pharmaceutical firms to [develop] a single form they would use to determine eligibility for their medication benefit programs.” This is an attempt to reduce the paperwork burden on psychiatrists faced with multiple forms their patients need filled out for these programs.

• ask APA to establish a task force on universal access that would advocate for nondiscriminatory universal health insurance for mental health care for all Americans.

• defeat a proposal to have APA evaluate whether it should continue its membership in the World Psychiatric Association (WPA). The proposal maintained that the WPA is a “figurehead organization” that brings little benefit to American psychiatry and took the WPA to task for not investigating charges of misuse of psychiatry in China.

• institute a one-year trial of having Assembly materials available online and by CD-ROM. This would replace mailing the group’s voluminous reports and background material to Assembly members.

• request that the Board of Trustees electronically record all its votes.

• request that APA add a member benefit in the form of offering free CME. Members could receive 50 or more Category 1 credits each year.

• endorse a proposal to have APA “clarify that an evaluation of a capital offender by a psychiatrist expert for mental retardation is not unethical.” The proposal argued that in light of the Supreme Court’s ruling banning execution of mentally retarded individuals, a psychiatrist’s refusal “to evaluate a capital offender for possible mental retardation, when failure to diagnose may lead to the offender’s execution, could be considered unethical.”

• defeat a proposal calling on the AMA to amend an opinion by its Council on Ethical and Judicial Affairs to add that “on no account should a physician give any opinion that states that a person sentenced to death is mentally competent for execution” or “agree to state, after treatment, that a prisoner is fit for execution.”

• urge APA to adopt a position supporting somatic nuclear cell transfer research, including its being federally funded, and opposing laws that aim to ban such research.

• Ask APA to institute a grant program through which district branches could receive funds to hire public relations consultants who would advise them on developing local public education programs about mental illness and its treatment. The costs of this proposal were estimated to be “high.”

• refer to the Committee on Advocacy and Litigation Funding a proposal that APA join other psychiatric organizations, including the American Psychoanalytic Association, in a lawsuit challenging the legality of the HIPAA regulation that substitutes “regulatory permission” for a patient’s right to consent to the release of his or her electronic medical records. The suit against the U.S. Department of Health and Human Services contends that allowing release of these records to insurance companies and other interested businesses without the patient’s express permission is a violation of physician-patient confidentiality.

In addition, the Assembly applauded the presentation of several Speaker’s Awards by Gaw. He presented awards to California Assembly member Darrell Steinberg for sponsoring a state law funding mental health services for the homeless (see box); Lydia Lewis, president of the Depression and Bipolar Support Alliance; and former APA Government Relations Director Jay Cutler, J.D. (see Original article: page 2).

The Assembly also heard an update on the President’s New Freedom Commission on Mental Health from its chair, Michael Hogan, Ph.D. Hogan said he could talk only in generalities because, while the report is complete, it has not yet been made public, so he did not want “to scoop the president.”

He did point out that the commission focused on “serious mental illness” and that its goal was not to keep people out of hospitals, but to identify ways to help them “work, learn, and live in the community.”

Among the national goals that he said would be included in the report are establishing an understanding that mental health is essential to health; that to provide “consumer- and family-centered care,” health care systems and bureaucracies will have to recognize that they must develop one plan for a person’s care; that eliminating race- and place-based disparities in mental health care is “tremendously complicated”; that scientific investigations need to focus on “what’s relevant” to clinical care; and that the nation needs to “improve and expand the mental health workforce.”

The draft summary of the Assembly’s actions will be posted in “Members Corner” section of APA’s Web site at www.psych.org/members/index.cfm under “Assembly.” The Assembly’s next meeting will be held November 14 to 16 at the J.W. Marriott in Washington, D.C. ▪