“Are we there yet?” The famed words of every kid trapped in the backseat of their parents’ car on another long road trip. Are we there yet. “No! A little while longer. Stop asking that question.” 

Ad: Professional Risk Management Services (PRMS) and Resources on Complying with Regulation on Information Blocking under the Cures Act (April 5, 2021 Deadline)

bookcase, behind the desk chair, captured in the frame of the computer camera during Zoom meetings. Dr. Racy’s bookcase does not hold many items, but it speaks volumes of this prolific psychiatrist.

I have known John Racy for many years. He was (and continues to be) one of my seminal teachers in the field of psychiatry. As professor in the Department of Psychiatry at the University of Arizona College of Medicine-Tucson, Dr. Racy for the past 43 years has been an inspirational guide to many medical students and physicians in training.

Educated and trained in Beirut in the 1950’s – graduate of the American University of Beirut – John has held a medical license for more than 50 years. John’s career has intersected with countless lives offering kindness, expertise, and service, particularly in the areas of psychiatric education, transcultural psychiatry, the integration of psychotherapy and pharmacotherapy, family and marital therapy, and sexual disorders.

Attempting to point through the cavalcade of achievements that is John’s career would demonstrate the deserving nature of his recent awarding of Arizona Psychiatric Society’s Lifetime Achievement Award. Yet, such a list would not illuminate the reader to John’s serene and generative nature. There are those surrounded by an aura of warmth and wisdom that draw out from others the wide-eyed curiosity of a child in play. This is what it is to engage with John Racy. It is serene and playful.

On numerous occasions, I have seen John transfix an audience. He is thoughtful in his words, deep in his listening, and always generous with his smile. I fondly recall to November 2016, seated in a lecture hall at the UofA, as John delivered a stirring Grand Rounds entitled, “Discipling Intimacy- Personal Reflections on Psychotherapy in Psychiatry.” John read aloud from a letter. His reading was steady and earth-stilling. The presentation was an admixture of his observations through 6 decades in medical practice and his reverence for psychiatrists, “conditioning their capacity for human intimacy to instill hope and meet expectations of relief.”

It was one of three times that I have seen a grand rounds or keynote lecture at any venue end in a standing ovation. On further reflection, it is the only time following our department’s Grand Rounds that I have seen a line form at the lectern with people waiting to ask more questions after the Q&A session had already completed.

Perhaps it is memories like this that cause me pause when looking at the bookcase of this revered figure. With such an expansive and illustrative career, one might assume that Dr. Racy’s bookcase is littered with his many awards or ladened with psychiatric texts or brimming with the baubles of an internationally traveled man. However, the bookcase is modest and orderly.

The top shelf has a copper framed clock whose large face is turned not to the desk but to the place that John’s patients would sit in the office. No other item is on the top shelf. It is a signal to the patient that this warm and comfortable space was designed for them, and, in the time that they have together, the patient rests at the pinnacle of John’s concern.

The next shelf below has a small collection of books. They appear at the bindings to be well-read and well-loved. The shelf is three feet wide, and the books cover only half the expanse.

Below the shelf with books is a shelf completely utilitarian. This shelf is the resting place for John’s necessary implements and information being actively studied. It is covered with small piles of neatly ordered articles, journals and readings. A place to hold a work bag. A place to reach for an extra box of tissues when the two opened boxes in the office have been exhausted.

Underneath the utilitarian shelf is a shelf with treasured items. Aside a small glass figurine, two photograph calendars from 2019 and 2020 are sitting open. Unlike the clock on the top shelf, the faces of these calendars are turned toward the desk. The photographs contained within feature John’s bright-eyed, talented grandchildren. I imagine, throughout his workday, John steals grateful glances at their smiling faces.

The bottom shelf at ground level is empty. Perhaps another utilitarian approach; perhaps it is emblematic of the importance to stay open, to make space, to welcome opportunity. The way we arrange the world around us is the way we have arranged the world within us. This is why one can sit facing Dr. John Racy’s bookcase and see how he honors his patients, how he seeks to alleviate burden through the sharing of knowledge and generous acts, and how he makes room for the needs of others.

Thank you for sharing your office with me John. Although I am tempted to pull out your APS Lifetime Achievement Award and place it firmly on the second shelf, I promise to leave the office just like I found it. Warmth, comfort and all. 

2020-2021 Corporate Sponsor

The Arizona Psychiatric Society is pleased to announce a call for nominations for the 2021 Career Achievement in Psychiatry Award. This award is presented annually to an Arizona Psychiatric Society member who best exemplifies the following award criteria.

The award recipients will meet one or more of the following American Psychiatric Association values:

•      Compassion, as evidenced by exemplary patient care and/or compassion to colleagues and in the workplace.

•      Leadership in the field of psychiatry as evidenced by holding leadership roles in individual residency programs, at the District Branch level of the APA and/or at the national level.

•      Community service on the local or national level.

•      Political action on behalf of their patients, their profession, and/or their community.

•      Clinical excellence as evidenced by exemplary patient care.

•      Research to advance the field of psychiatry.

The membership of the Arizona Psychiatric Society will be encouraged to nominate the worthiest of its members for this distinction. The nominated psychiatrist must be a member of the APA and APS and must be in licensed to practice medicine and in good standing with the Arizona Board of Medical Examiners. Members are encouraged to nominate the fellow APS member that best exemplifies the APA values.

Nominations must be e-mailed by April 10th and the nomination letter must contain information documenting the candidate's achievements as outlined in the selection criteria above. Only one candidate may be nominated by a member. Nominees must be APA members.

JOIN US for a virtual risk management webinar, “What Would You Do?,” presented by PRMS - Wednesday, March 31, 2021, 6:00 to 8:00 pm (Arizona MST)

This course is an interactive audience response lecture allowing you to engage with a risk management specialist to discuss real-life scenarios based on actual calls received by the PRMS risk management helpline. How would you deal with a law enforcement demand for patient records, a “Friend” request from a patient, pharmacist report of prescription alteration or an estranged parent demand for records? For the second part of the course, a defense attorney from PRMS panel of counsel will describe local trends in professional liability exposures. CLICK HERE for a flyer with complete CME and other event information.

Physicians are required to comply with a new regulation on information blocking under the Cures Act as of April 5th. CLICK HERE for an update from PRMS (available to policyholders and non-policyholders) to help answer your questions about this incredibly complex regulation. 

2020-2021 Corporate Sponsor

Earlier this month, the Arizona Psychiatric Society (APS) moved forward in its advocacy of reducing physician mental health stigma by engaging the Arizona Medical Board (AMB)--first by drafting a Comment and later by appearing before a Board Committee (Physician Health Program) to discuss our concerns and ideas.

Our efforts arose following the creation by the Arizona Medical Association (ArMA) of the “Virtual Doctor’s Lounge,” a peer-to-peer support network, where it came to light that many physicians feared reaching out for support due to concerns about disclosure for licensure application/renewal to the AMB. It seems fortuitous that around this time the AMB was accepting public comment on its processes, including the licensure questions regarding mental health, and with haste and APA support, we drafted a comment raising our concerns with regarding the disclosure question and related impact to physician wellness. In brief, our concern was that the language can promote a perception that a physician is required to report any mental health diagnoses or treatment over the past five years to the AMB (unless carefully reading the question and its related fine print), and this perceived scrutiny has caused many physicians to avoid or delay seeking needed treatment.

The comment letter was collaboratively agreed to by ArMA, and we reached out to all known physician specialty societies and our membership with a call to sign-on. With thanks to our members who participated, we were successful in having widespread support of our letter co-signed with ArMA and 22 additional physician associations and organizations (logos above), including the Az Academy of Family Physicians, Az Chapter of the ACP, Az College of Emergency Physicians, and others. This collaborative letter, together with supporting letters from the Az Chapter of the ACP, and the Az Chapter of the College of Cardiology, were submitted to the AMB PHP Committee and to the AMB in response to the call for comments. On March 15, 2021, Dr. Chhatwal, Teri, and I spoke to the PHP Committee on these issues, and ArMA made a companion presentation on the Virtual Doctor’s Lounge program and physician wellness. The Committee was generous in their time and candor in discussion of the topic and appeared to strongly consider our recommendations toward a change in language.

At the time of this writing, the issue has been referred to the AMB Executive Director Pat McSorley to further research the recommendations and to work with stakeholders and supportive legal regulatory staff on considering these comments. We hope that with tenacity the issue will come before the Medical Board as a whole, carrying the potential to change the mental health question or to create a “FAQ” delineating what needs (or need not) to be disclosed. Ultimately, we are excited to begin this partnership with the AMB in promoting early mental health treatment for our valued physicians and alleviate fears of punishment by the Board for obtaining this needed support.

With many thanks for the Society’s contributions,

Nick Ahrendt, MD

Disaster Response Committee

CLICK HERE or the image above for a downloadable resource developed by Janssen Neuroscience: Summary of the Journey of Adult Patients with Schizophrenia, including the clinical and economic consequences of the burden of schizophrenia and newer treatment guidelines that support long-acting injectable (LAI) antipsychotic medications in certain adult patients with schizophrenia.

2020-2021 Corporate Sponsor

The APA 100% Club was established to encourage residents throughout the United States and Canada to join the APA with fellow trainees in their programs. Thanks to the support of Program leadership, we celebrate the third consecutive year as 100% Club for the University of Arizona College of Medicine Phoenix and the inaugural year as 100% Club for the University of Arizona College of Medicine Tucson.

You are are invited to submit an abstract for poster presentation in the Yukari Kawamoto, MD Memorial Poster Session for 2021, which will be modeled after the 2020 virtual presentation format and held on Thursday, May 20, 2021. The abstract submission link is open, and the deadline to submit is April 25, 2021 pursuant to the Guidelines for Physican Peer Posters and the Guidelines for RFM and Medical Student Posters. As we have a time limit in the session on Thursday, May 20, 2021, if accepted, all abstracts will be recorded and shared to our members online through our meeting platform. If more abstracts are accepted than time permits, the Society will invite selected abstract authors to be available for broadcast of their recorded presentations followed by live Q&A on Thursday, May 20, 2021.

A newly released leadership training curriculum developed by APA for residents, fellows and early career psychiatrists provides 4 hours of CME for those needing CME and is free for all APA members.

The program was developed in collaboration with the American Academy of Psychiatric Administration and Leadership (AAPAL).

The work of the Mental Health Parity Advisory Committee ("MHPAC") continues, meeting monthly on the progress of the website resources, and other matters. The website content is available for continual feedback and updating by the Committee. There have also been preparations for the public comment on the draft rulemaking proposed by the Department of Insurance and Financial Institutions ("DIFI") (which public comment closed on March 22, 2021), and presentation to the MHPAC by Tim Clement, APA Director of Legislation, on the new federal parity compliance requirements. At the March 22, 2021 public hearing for comment on the proposed rules held by the State, Dr. Jasleen Chhatwal, President, Dr. Don Fowls, Past President and Government Affairs Chair, and Tim Clement, APA, testified, and the Arizona Psychiatric Society submitted written comment to DIFI on the draft Arizona rules. Those comments are under review by DIFI and should be posted to the public, which we believe includes some lengthy comment from health insurance industry. The Society Lobbyist Alexis Glascock is working with leadership on preparations for the next stage in rulemaking, which is a hearing with the Governor's Rules and Regulatory Review Council ("GRRC"). If there is not a second draft of rulemaking distributed for comment, the GRRC hearing could happen within the next four to six weeks.

The MHPAC meetings will continue on a bi-monthly basis after April. These are open to the public, and your comment and participation are welcome there. If you have feedback on the parity website resources, FAQs, or how to get out the message on parity, please contact Dr. Fowls at djowls@aol.com or cell 602-309-2582. The next meeting of MHPAC will be held on Friday, April 16, 2021 at Noon. If you are interested in receiving notices of the MHPAC meetings, please contact Teri.

The last few months have seen significant movement across a broad array of issues. For the latest APA Advocacy update, including an update on the Center of Excellence for Protected Health Information answering FAQs on understanding the Final Rule for 42 CFR and the APA urging CMS to Permanently Cover Audio-Only Services, and many other APA-led activities, executive branch, congressional, and state activities, CLICK HERE.

Want to receive APA advocacy updates directly? CLICK HERE to subscribe for Advocacy Alerts and Updates from the APA.

The 2021 Legislative Session had a recordbreaking number of bills to consider, with the carryforward from the interrupted session in 2020, and many new bills added in 2021, for over 1700 bills in total, only 167 of which have passed, and 67 of which have been signed into law by the Governor, signalling his strong support for the same. To date, the Governor has not vetoed any legislation.

With the week ending March 26th being the last week for bills to be heard in the Committee of the opposite chamber (excluding Appropriations), it was a long week of packed Committee Agendas and final pushes to advance legislation. Next week looks to hold a record number of striker amendments and the Society will be watching for striker amendments on any opposed legislation.

Things have slowed with respect to the budget negotiations as the Governor’s Office and Legislature wait on clarification from the federal government regarding for what purposes they can utilize the American Recovery Plan funds. States are not permitted to use the funds to supplant state budget items, such as implementing tax cuts and then replacing the revenue with the federal funds. However, there are other areas that are less clear where the state may be able to use the federal funds that would still impact the budget. This will likely mean that the budget will be delayed for several weeks to a month. In the meantime, other bills will continue to move through the process. Originally projected to sine die on or around its 100th day, the budget progress will be a main consideration of when the legislature retires.

CLICK HERE for a current report of the legislation that has been voted to support, oppose, or monitor by the Society in this 2021 Legislative Session, and CLICK HERE for a chart summarizing those Bill positions . This Report is provided weekly to the Government Affairs Committee of the Society and is available to any member who requests a copy by contacting Teri. Included within the priority legislation is HB2454 Telehealth, which would preserve the payment parity for telehealth and allow for audio coverage in stances where it is appropriate to the care and consented to by the patient, and which includes amendment to require the registration of out-of-state telehealth providers and requires meeting network adequacy for a health plan through in-state providers. The Telehealth legislation passed out of Senate Finance and is working its way to a vote on the Senate floor. Other priority legislation of the Society has made it through both Chambers and to the Governor for signature, HB2621 Prior Authorization and HB2622 Non-Retaliation Policies, both bills sponsored by Representative Dr. Shah. SB1270 Step Therapy has advanced out of Committee and coalition members are promoting messages of support to get the legislation through the House vote. CLICK HERE to read a letter of comment submitted by President Dr. Jasleen Chhatwal to the House Health & Human Services Committee in support of SB1270.

The Society joined members of the Arizona Healthcare Advocacy Coalition (AHAC) as the house of medicine stood together to support HB2545 Telehealth, SB1270 Step Therapy, SB1377 Civil Liability; Public Pandemic (protecting health care workers and others from liability relating to pandemic response), and oppose SB1457, which would criminalize physicians for providing legal reproductive care. CLICK HERE to view the AHAC letter. As a member of AHAC, the Society receives a report of all health care legislation and updates on topics of common interest to the house of medicine. CLICK HERE for the most recent AHAC Health Care Legislation Summary.

We invite interested members to join the advocacy efforts of the Government Affairs Committee. E-mail Teri if you would like to join this Committee.

The APA and APS advocate on behalf of psychiatrists to increase reimbursement and decrease administrative burdens from public and private payers, legislators, and regulatory agencies.

To ensure we are well-equipped to fight for better payment for clinical services, we need to know about our members’ experience with outpatient insurance participation. Your responses to questions regarding the nature of your outpatient practice & your experience with participating in health plan networks will help strengthen the arguments for appropriate reimbursement and advocating for you before health plan payers, legislators, and regulatory agencies.

Dr. Balfour is a national leader in quality improvement and behavioral health crisis services. She is the Chief of Quality and Clinical Innovation at Connections Health Solutions, which provides 24/7 access to mental health and substance use care throughout Arizona, and an Associate Professor of Psychiatry at the University of Arizona. Dr. Balfour was named the Doctor of the Year by the National Council for Behavioral Health for her work at the Crisis Response Center in Tucson and received the Tucson Police Department’s medal of honor for her efforts to help law enforcement better serve its citizens with mental health needs. She is a co-author of the book People with Mental Illness in the Criminal Justice System: Answering a Cry for Help and has served on the board of directors of the American Association of Community Psychiatrists, The American Association for Emergency Psychiatry, and NAMI Southern Arizona. She received a BA in Biology at Johns Hopkins University, her MD and PhD in Neuroscience from the University of Cincinnati, and completed residency and fellowship in Public Psychiatry at the University of Texas Southwestern Medical Center in Dallas.

Dr. Balfour will recognized at the APA Annual Meeting be in the 65th Convocation of Distinguished Fellows held virtual on Sunday, May 2, 2021, 10 a.m. – 11 a.m. EST. This plenary session includes the 2021 William C. Menninger Memorial Convocation Lecture from Anthony Fauci, M.D.

CLICK HERE for more information to guide if this is the right time in your career to pursue the honor of Fellow or Distinguished Fellow, which are honorary statuses that reflect your dedication to the work of the APA and signify your allegiance to the psychiatric profession. Contact Teri if the District Branch can offer you any support or guidance.

Join APA on Thursday, April 8, 2021, for a two-part webinar series that will examine strategies and opportunities to improve the mental health of African Americans during the COVID-19 pandemic, while also raising awareness and building trust on the efficacy of the COVID-19 vaccine. Prominent leaders in their respective fields will discuss the impact of the COVID-19 pandemic on the mental health of African Americans.

Register for Part 1: April 8, 2021, 7:00 to 7:45 pm EDT (Open to the General Public) and

Register for Part 2: April 8, 2021, 8:00 to 8:45 pm EDT (Member Only Event; Member Log-in Required for Registration)

Commentary, Mens Rea, Competency to Stand Trial and Guilty but Mentally Ill, Joseph D. Bloom, MD, and Scott E. Kirkorsky, MD, J Am Ac Psychiatry Law 49(23) online, 2021. DOI: 10.29158/JAAPL.200105-20

Primary Disease Prevention for Southwest American Indian Families During the COVID-109 Pandemic: Camp in a Box, Francine C. Gachupin, PhD, et al., including Noshene Ranjbar, MD, DOI: 10.3389/fsoc.2021.611972

Kim JH, Bright EE, Williamson TJ, Krull JL, Weihs KL (Karen Weihs, MD), Stanton AL. (2021). Transitions in coping profiles after breast cancer diagnosis: implications for depressive and physical symptoms." Journal of Behavioral Medicine:44 (1): 1 - 17 https://doi.org/10.1007/s10865-020-00159-w4 PMID: 32535673: PMC7736058.

Mueller D, Marshe V, Maciukiewicz M, Hauschild A, Islam F, Qin L, Tiwari A, Sibille E, Blumberger D, Karp J (Jordan Karp, MD), Flint A, Turecki G, Lam R, Milev R, Frey B, Rotzinger S, Foster J, Kennedy S, Kennedy J, Mulsant B, Reynolds, III C, Lenze E. Genome-wide analysis suggests the importance of vascular processes and neuroinflammation in late-life antidepressant response. Translational Psychiatry. Accepted for publication.

Williams K, Markwardt S, Kearney SM, Karp J (Jordan Karp, MD), Kraemer KL, Park MJ, Freund P, Watson A, Schuster J, Beckjord E. Addressing Implementation Challenges to Digital Care Delivery for Adults with Multiple Chronic Conditions: Stakeholder Feedback in a Randomized Control Trial. JMIR mHealth and uHealth. Epub, ahead of print.

On February 10, 2021, Carol Olson, MD, DFAPA, Chair of the Department of Psychiatry, Valleywise Health System and District Medical Group, Division of Psychiatry was presented the David's Hope Mental Health Criminal Justice Collaboration 2021 Community Member Award, and we are honored to share that presentation and acceptance speech from the awards.

Resharing a recent post to @AzPsychSociety Facebook and Instagram accounts, with thanks to Dr. Ramsha Rao for her work coordinating and creating content. Take a look and follow @AzPsychSociety on Facebook, Instagram, Twitter, and LinkedIn.

"As Black history month comes to an end, we would be remiss if we didn’t celebrate black history’s contribution to the field of psychiatry. Pictured here is Dr. Solomon Carter Fuller, who is widely recognized as the first black psychiatrist. Dr. Fuller faced significant discrimination from the psychiatric community at the time and his work was often undervalued. He was a pioneer in Alzheimer’s research and published what is now recognized to be the first comprehensive review of the disease. CLICK HERE for source and to read an article recognizing Dr. Fuller’s achievements. @alzassociation"