While APA Assembly members deliberated a variety of issues at their
November meeting in Washington, D.C., the future of organized psychiatry in
Texas was the topic of much discussion during the plenary sessions as well as
during Area Council meetings and informal
Richard Kaye, D.O., wins the APA Assembly's 2004 Profile of Courage
Award for his fight against Virginia's plan to close inpatient beds at state
psychiatric facilities. Kaye feared the plan would leave many indigent
patients without access to treatment for serious mental illness and increase
the number of people with mental illness who end up in jails and prisons."
I never thought that patient advocacy would become a major part of my
practice," Kaye said.
Assembly Speaker James Nininger, M.D., set aside an hour after the first
plenary session ended to provide a forum in which members could quiz the Texas
representatives about the details and impact of a controversial restructuring
for organized psychiatry in that state that has drawn substantial opposition
from both the Board and Assembly (Psychiatric News, November 19).
Later in the three-day meeting, the Assembly voted to ask the Board of
Trustees, which meets later this month, to hire an independent mediator, at an
estimated cost of $12,000 to $15,000, to see whether Texas district branch and
APA leaders can reach some agreement that would satisfy both sides of the
dispute. The Assembly chose that option over doing nothing, supporting the
Texas "experiment," or allowing the Board of Trustees to"
de-link" the Texas district branch from APA and replacing it with
a new district branch.
The Assembly also passed several action papers concerning patient-care
The members voted, for example, to support federal legislation or
regulatory efforts to eliminate a 30-patient limit on the number of
opioid-dependent patients that can be treated with buprenorphine in an
outpatient practice. The representatives were not persuaded by arguments that
removing the limit could lead to the establishment of "prescribing
mills" by physicians who passed the mandatory buprenorphine-prescribing
course but had little other addiction treatment experience.
They also backed a proposal that urges APA to "develop and regularly
update procedures to apply the principles of medical necessity to the practice
of psychiatry." The action paper states that the motivation underlying
the proposal is the belief by some members that APA is not adequately
monitoring how managed care companies are defining medical necessity and
applying their definitions to coverage decisions. This calls on APA to take a
more "proactive" role and meet more often with insurers about
their medical necessity principles and with district branches about their
efforts to deal with insurers in setting medical necessity standards for
Nininger also devoted one plenary session to workforce issues in
psychiatry. The presentations will be described in the next issue of
In other actions, the Assembly voted to
A summary of the Assembly's actions is posted in the "Members
Corner" section of APA's Web site at<www.psych.org/members/gov/assembly/maynovmtg/nov04final.cfm>.▪