President Bob Pyles opened the last meeting of the century of the Executive Council on December 16, 1999, by stating that the day's agenda addressed matters of the greatest importance, including regulations on privacy from the Department of Health and Human Services and the Surgeon General.
Secretary Jon Meyer announced the results of the fall election in which Newell Fischer was chosen President-elect and Ruth Fischer and Robert Glick were elected councilors-at-large. The Council held an election to fill the two-year unfinished treasurer's term of Newell Fischer. The three nominees were Allan Compton, Mary Scharold, and Jonah Schein. Compton was elected treasurer.
Warren Procci, chair of the Committee on Government Relations and Insurance, reported that the time frame in Washington is very different from psychoanalytic time; things can happen very rapidly in Washington. A strength of the proposed HHS regulations is that for the first time strong protection for psychotherapy notes could be coded into the regulations. The American can take considerable credit for this development. Psychoanalysis is the only service afforded this special protection in the proposed regulations. In practice, the regulations appear not to recognize the right of privacy. Regulatory protections would be substituted for an individual's authorization for access to information.
Procci summarized the various categories of regulations. The first category would require neither patient authorization for disclosure (psychotherapy notes excepted) nor patient notification of the disclosure. In this category are broadly defined treatment, payment, and health care operations. Treatment would include such areas as health care management via risk assessment. Payment would include utilization review activities. Health care operations would include review of the competence of health care professionals. In the second category, patients' authorization would not be required for disclosures, but the patient would have to be sent notice of the disclosure. Government health data systems and facility patient directories are included in this category. Disclosures in the third category would require both authorization and notification, thus offering some protection.
James Pyles, of Powers, Pyles, Sutter & Verville, the APsaA's Washington legislative law firm, joined the discussion. He stated that 1999 was a great year legislatively for the American, which has done more to protect patient health information privacy than any association in the country. The American has been featured on the front pages of major newspapers across the country regarding this issue.
Photo by Mervin S. Stewart
The American was instrumental in Vice-President Albert Gore's decision to intervene in blocking regulations that would have compelled disclosure of mental health information for Medicare patients receiving home care. The Association made it clear to HCFA that patient-therapist privilege was delineated by the Supreme Court in Jaffee vs. Redmond. HCFA agreed in principle to abide by “Charting Psychoanalysis,” the American's practice guideline for psychoanalysis conducted under Medicare.
However, Pyles said, the Association must not get complacent. The American is on the side of the public, against a great deal of private money. It needs to find ways to educate the public about what industry-influenced bills would do to them. Pyles emphasized that we need strong advocates in Congress.
Bob Pyles then spoke about the new Joint Ad Hoc Task Force on Education and Membership. Discussions about giving non-certified members full membership rights led to the creation of both a Council task force and a corresponding committee of BOPS. The groups had differing views. The Council task force proposed that all members should be able to vote on everything except educationally related by-laws and that there should be a de-linkage between certification and the right to be a councilor or to run for office (except in BOPS). The BOPS committee emphasized its concern that there was a structural problem in the organization between the areas of membership and education; it proposed a referendum that would define the position of the Board.
The joint task force grew out of discussions of these views. Its mandate is to develop proposals that would give universal membership rights while protecting the Board from political pressures that would unduly affect education. A preliminary committee report is due in May.
Michael Gundle made a motion for favoring universal voting rights while still protecting the functions of BOPS. The purpose was to promote discussion of the issue to determine how the Executive Council is thinking. In full, the motion read:
It is the sense of the Executive Council that the by-laws of the Association should be amended to provide for the following: 1.) All active members of the Association may vote on all issues which require membership votes; 2.) All active members of the Association are eligible to run for and hold all elective offices in the Association except those on BOPS. These by-law changes should be made within a framework which fully recognizes and accounts for the autonomy of the Board on Professional Standards in setting and regulating educational standards for the institutes of the American.
This Sense of Council passed with thirty-six votes for, ten against, and four abstentions.
Susan Vaughan, chair of the Joint Committee on Issues of Homosexuality, announced that there have been major revisions in understanding the treatment of homosexual patients. Because of this, the committee developed a position statement against anti-homosexual bias in their treatment. The previous day, BOPS passed the statement along with an accompanying statement, requesting that the joint committee, together with the Executive Committee, integrate them.
The Council passed both statements and allowed the Committee on Homosexuality and the Executive Committee to work out the final wording. (The final statement appears on page 5.)
The Committee on External Credentialing was represented by co-chairs Leon Hoffman and Calvern Narcisi. Through very hard debate the APsaA thought it had come to an understanding with its Psychoanalytic Consortium partners. But some organizations differed markedly with the American on the frequency of training analyses and supervised analyses, as well as the training analyst system. They felt that the concepts of minimum and recommended number of sessions per week would be perceived as demeaning their work. The APsaA representatives were very direct about the unacceptability of these wishes to unravel previous agreements. The committee has a strong sense that the American should stay with the negotiations. Narcisi emphasized that what is important involves APsaA relations with the public in terms of what psychoanalysis is and what a psychoanalyst is. Even though the last meeting was difficult, there was not the acrimonious lack of trust that had marred some earlier meetings.
The Budget and Finance Committee, chaired by Newell Fischer, presented the budget for the year 2000. The Association will be in the black for 1999, thanks to the outreach to enroll new members, increased income from JAPA subscriptions, and the profits from Washington meeting in May 1999. However, there is very little leeway for unexpected expenses.
Meyer indicated further that the APsaA graduates about eighty-two new members a year, of whom on average sixty-nine join the American. Through deaths, suspensions, and resignations, about seventy-two members are lost per year. This makes it very important to make the American relevant to new graduates so as to replenish the membership. Efforts are now being made to help new graduates to feel a part of the American [see page 11].
Otto Kernberg, President of the IPA, addressed Council. The most important matter was the Structure and Mission II (SAM II) proposal for the reorganization of the IPA administration. It is an effort to make the IPA leaner, more representative, more democratic, less expensive, and more effective. The proposal contemplates condensing the Executive Council and House of Delegates into one body. It will comprise representatives of the general membership, representatives of regions, and direct representatives of presidents of component societies. The SAM II proposal will be circulated and will include pros and cons, and a minority report.
The IPA plans to invest more efforts and financial support inter-regionally to take up challenges to psychoanalysis all over the world. A decision has been made to upgrade the position of executive director to the position of director general. [See page 19.] The next congress of the IPA will take place in Nice, France, in 2001. It will focus on the psychoanalytic method and its applications, with a particular emphasis on the application of psychoanalytic technique to modified psychoanalytic psychotherapy.
Jon Meyer, a member of the IPA's Structure and Mission task force, spoke about SAM. This year he chairs the IPA House of Delegates. Between the House of Delegates and the Executive Council of the IPA, there are about fifty people centrally involved in its governance of the IPA. The SAM II proposal would reduce that number to eighteen. The proposed IPA change from a bicameral system to a unicameral one raised Meyer's concern that problems could occur with so few people at the center and no system of checks and balances. An APsaA committee has been appointed to examine the APsaA's relationship with the IPA.
The American has six committee sections of Council and joint committees: Governance, coordinated by Judy Chertoff; Membership and Membership Services, by Prudy Leib; Psychoanalytic Practice, by Glen Gabbard; Psychoanalytic Science, by Allan Compton; Public Outreach and Information, by Leon Hoffman; and Professional Outreach and Liaison, by Marvin Margolis.
Judy Chertoff, heading the Committee on Council, announced that the Briefing Book has been completed for members of Council. There is a section on fiduciary responsibility of councilors, a section on the structure and lines of communication within the American, and descriptions of the by-laws. The Briefing Book was accepted by Council.
Ralph Engle, chair of the Ethics Committee, reported that the committee is presenting its first major revision in ethics since 1974. The document was provisionally accepted by the Board. This was Engle's last appearance as chair of the committee. He will be succeeded by Marvin Margolis.
Glen Gabbard reported for the Committee on Confidentiality that more than two years of work has produced a document based on ethical principles. The last item is that the patient's treatment record will not be considered or used as a commodity in the marketplace and should not be made available for purchase or sale by any individual or entity. The committee's report was accepted unanimously.
Nancy Brehm reported for the Affiliate Council. She announced that seventy-eight out of 104 new candidates have become affiliate members. About 79 percent of all candidates are affiliate members.
Richard Fox, president-elect, spoke for the Joint Ad Hoc Committee on Graduate Education, chaired by Stevie Smith. The Council approved converting the committee from an ad hoc to a standing committee of Board and Council.
Jon Meyer addressed the Proposal for Invited Participation by presidents of two Mexican societies (Mexico City and Monterey) and the Canadian and Independent Psychoanalytic Societies. They want participation in scientific, clinical, and political activities. A proposal to make them non-voting members of the Council was initiated by the Mexican analysts, who want a closer, bilateral relationship with the APsaA. It was felt to be premature to vote, and this matter will be re-introduced at the next meeting.
Robert Cummings, for the Committee on Peer Review, spoke about the problem of informed consent. The committee has developed a guideline that will be helpful to members, elaborating on informed consent. A vote was held in regard to publishing this guideline, in order to make it available to members and others. The vote passed.
Donald Meyers reported for the Committee on Honorary Membership. Paul Gray was nominated for distinguished contributions to psychoanalytic education, and Joseph Masling was nominated for honorary membership. Both nominations were unanimously approved.
Harvey Rich reported for the American Psychoanalytic Foundation. The foundation continues to thrive, with a very substantial sum in the bank now. The money being given to approved projects seems to be advancing psychoanalytic education and services. One dissonant note is that there have not been as many requests for money as previously, and so the foundation will be distributing about $10,000 less this year.