My bona fides are that I was on the search committees that hired the MPS Executive, the Baltimore County Medical Assn. Executive, the Baltimore/Washington Psychoanalytic Society Executive and the MedChi Executive. I have a good idea about what that person should do. I initiated the weekly meetings of the MPS Executive Committee with the Executive Director, which continue to this day. I feel that the failures of the organization are the responsibility of the Board of Trustees. The buck stops with them. They have a responsibility to communicate to staff clearly and unambiguously what they want done on behalf of the membership, that their votes should be recorded, and they should stand for election or reelection based on that.

I know the APA structure and functions quite well. Over the last 30 years, I have served in more than 30 APA components. For instance, I have Chaired two Councils (National and International Affairs) and two Scientific Programs Committees (Annual Meeting and Institute). Additionally, I have been Vice Chair of three Departments of Psychiatry (Einstein, Baylor and U.T. Houston) and have directed several major and complex psychiatric programs. The blending of these two related sets of organizational experiences puts me in an ideal position to make the APA more efficient and effective.

It has been my good fortune to have had a very broad professional experience. I was trained in general and child psychiatry and in psychoanalysis. Though office based now, I have worked in long and short term hospitals, a community mental health center, nursing homes and even as a consultant to a residential home for the retarded. In the USPHS I was employed as a prison psychiatrist. I enjoy teaching and supervision opportunities. I have experience with the kinds of problems that psychiatrists face in a variety of settings. Through organizational work in the MPS and APA and the medical society I have also learned more about the special problems faced by IMGs, young psychiatrists, minorities, women and others and I think because of that I can represent their needs well and effectively. And I am always willing to listen.

Over the years, I have moved through the APA ranks and got exposed to all APA membership sectors: national and international affairs, psychiatric services and APA journal editorial boards, several training fellowships, joint reference committee, membership committee, scientific programs, etc. Professionally, I have worked in the public and private sector, in academia and in the clinical arena, and I am an IMG and an ethnic minority psychiatrist. Definitely, I have the exposure and sensitivity needed to represent well all APA members.

I am a long-term member of the MPS and MedChi legislative committees. It was during my term as President of MedChi that we were able to get the Grievance and Appeals bill through the legislature. Not only was that bill useful for patients and doctors, but it also increased the interest of the Attorney General’s office and the Maryland Insurance Commissioner in HMOs including the special problems that the mental health carve outs have been causing. Several HMO’s have been fined because of violations of Maryland laws or regulations including a large fine against Magellan. Maryland has most of the elements of the federal Patients Bill of Rights with the exception of the ability to sue the insurer. On the whole we have done very well but of course there is still more to do.

In the Texas Society of Psychiatric Physicians (TSPP) and The Houston Psychiatric Society (HPS) I have been, all along, deeply involved in advocating and in confronting many of the abuses and profiteering of the managed care companies. Actually, our Texas District Branch (TSPP) have developed a "Psychiatric Utilization Review Compliant Service", which we utilize to fight back inappropriate and unjustified denials of psychiatric services by managed care companies. During my tenure as President of the Houston Psychiatric Society (HPS) and as a member of the Texas District Branch's Public Affairs Committee, I have all along been at the forefront of these advocacy efforts.

As a long time member of the legislative committee of the MPS and MedChi, I have opposed expansion of prescribing privileges. But a warning is in order. It is unlikely that the MPS (or any specialty society) can long succeed in keeping their finger in the dike against expanding privileges from any groups if it were not for an umbrella organization like MedChi. MPS members need to support MedChi with their dues dollars because if it doesn’t survive all physicians including psychiatrists will be the losers.

In Houston and Texas, the Houston Psychiatric Society and the Texas Society of Psychiatric Physicians (TSPP) have been quite active in influencing the legislators in blocking the attempts from non-physicians professionals to increase their scope of practice. So far, we have been quite successful in this regard. At the present time, we are again deeply involved in blocking an attempt on the part of the psychologist to have prescription privileges in Texas. My deep involvement with patients and patient's relatives organizations have been most productive in these efforts.

The MPS has raised important issues.

As this question implies, APA’s inefficiency and ineffectiveness must be addressed. Within the APA’s 40 million dollar budget, the Board has a generous annual authorization for itself of over half a million dollars, yet it is going to overrun that authorization this year by two hundred thousand! Over-runs are common within the APA. In my career, I have been responsible for budgets for about 25 years, some budgets over $100 million. Never once did I spend a penny over my authorization. If elected Area III Trustee, I will bring a voice of fiscal discipline the Board obviously needs.

As to effectiveness, I have made a number of proposals that would streamline the APA’s governance and eliminate some of its 160 committees. For over a dozen years I have advocated a closer relationship with other major psychiatric organizations. The APA is slowly moving in that direction. A closer relationship with organizations like the American Academy of Child and Adolescent Psychiatry, American Academy of Psychiatry and the Law, and so forth will increase the effectiveness of the APA.

Since 1975, I have been representing all of the members of the Washington Psychiatric Society in the Assembly. Again and again, I have initiated Actions in the Assembly that ultimately passed the Assembly and the Board of Trustees. This record is the result of being in tune with American psychiatrists. {Over the past decade, incidentally, Marylanders [Larry Kline, Tom Allen, Bruce Hershfield, Larry Sack, and I] have led the way in Assembly approved actions -- more than any other state representatives in the Assembly.}

I am prepared to make APA representative of all its members. I have worked with allied psychiatric organizations, MITs and early career psychiatrists to bring them into active participation in the Assembly. While I was in the Assembly I was also a Board Member of Association of Community Psychiatrists; I introduced their guidelines for psychiatrist practice in CMHCs to the Assembly and assured that this document became an official APA policy. These guidelines also provide standards for psychiatrist practice in other organized care settings, including managed care, and have been successfully used in many settings to establish appropriate job descriptions and clinical responsibility for psychiatrists and medical directors.

The experience has been within the APA and in my practice. I was among the minority that questioned managed care in the 1980s when it was being practiced by the APA. Throughout the 1990s, I was party to many of the initiatives that the APA adopted in its challenges of managed care. I was one of the early supporters of Harold Eist’s APA presidential campaigns that included the proviso that forces that deprive the psychiatrically ill of the care and treatment the ill need are evil.

Of the many initiatives that came out of the Washington Psychiatric Society in the 1980s and 1990s and eventually became APA policy, one that I championed most frequently was that the concept that managed care’s interpretive guidelines should not be secret. I condemned the secrecy of the APA’s interpretive guidelines in the 1980s. In my clinical work now, it is a pleasure to note that I have the interpretive guidelines the reviewer has.

Working at the front lines in a general hospital, I see many patients whose treatment has been delayed or compromised by the artificial requirements of managed care. When they seek help for severe, disabling conditions, even suicidal depression, they typically must wait several days to see a psychiatrist in the community. Approval for this needed specialty care is withheld or given grudgingly after hours of discussion and delay.

In the District of Columbia, there was an effort made in the public sector to have psychologists have an admission role in the public’s mental health emergency room that evaluates more than 2,000 patients a year. For a number of years in the 1980s and early 1990s, I had a major role in blocking that effort.

In my daily clinical work teaching and teaching in emergency departments and general hospital services, I can demonstrate to medical colleagues the expertise psychiatrists can bring to patient care. They can see the other abilities of social workers and nurses, and see quickly that psychiatrists offer a comprehensive fund of knowledge in assessing and treating patients. I will work for the future of psychiatry as well as for better patient care now.