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By: Mary Mavromatis, MD

As I discussed last month, we have had many changes to adapt to in the last few months and even more to come in the next few months. We have, of course, switched over to the new CPT codes, but there are numerous reports of insurance companies that have denied patient claims despite the coding changes put in place to insure parity. The New York State Psychiatric Association (NYSPA) has joined a class action suit against United Health Group for alleged violations (such as limiting outpatient psychotherapy for patients who were suicidal!). The APA is also investigating abusive and illegal practices and is requesting its members to document any abuse or failure on the part of insurance companies in providing appropriate reimbursement to patients or physicians. At the end of this letter you will find directions and a website for reporting and documenting your experiences (even if they are positive). I encourage you to do so. We will also receive more instruction and updates on the new CPT coding from Seth Stein at our dinner meeting on April 19th. Mr. Stein will also take questions on other medico-legal issues that have been of immediate concern to our members such as the NY SAFE Act and how it affects us.

The major upcoming change is of course the introduction of the DSM V at the APA meeting.  APA is sponsoring 2 of our branch members, Dr. Nigel Bark and Dr. Russell Tobe (our president-elect), to take a course in DSM V designed to train them to return to our membership and train us. By the way, if you receive any solicitations for courses that will be given before the official debut of the DSM V at the APA meeting, the APA asks that you notify them about this.  We are hoping to bring this information and training to our membership as an additional educational program, hopefully sometime in June. We are exploring whether this could be done as a lunch program(s) for those of you who are unable to attend our dinner meetings. We are also exploring whether there would be any interest in presenting this program in a location other than Rockland County. Please let us know if there is any interest out there!

I am very pleased to announce recent honors awarded to our members. Congratulations to Dr. Richard Brand on his advancement to Life Member status, Dr. Mukesh Jhaveri on attaining Life Fellow status, and Dr. Lawrence Levitt on being entered on a special list of 50 Year Distinguished Life Fellows and Life Members! Dr. Jhaveri and Dr. Levitt will be honored at the 2013 Convocation of Distinguished Fellows at the APA Annual Meeting in San Francisco on Saturday, May 18th.

This will be my last letter to the membership as WHPS president. My term will be officially up at the start of the APA meeting in San Francisco. Our new nominated president, Dr. Russell Tobe, will be officially elected at our dinner meeting on April 19th and will represent us at the APA meeting as district branch president. I am very excited about his leading our branch for the next term. I will be introducing him at the dinner meeting and also in our next issue of esynapse.  I feel it has been a privilege and a pleasure serving our membership over the last 2 years. It was more personally rewarding than I could have imagined. It has given me the opportunity to form friendships and relationships that I hope to continue. We are fortunate to have so many bright, talented, innovative, dedicated, and forward thinking members on our executive board. My special thanks to them for having made my job so easy-Dom Ferro, Lois, Kroplick, Jim Flax, Raj Mehta, Nigel Bark, Russ Tobe, Marc Tarle, Jane Kelman, Mona Begum, and last but certainly not least, Liz Burnich, our executive director. My thanks also to past members of the board-Diane DiGiacomo and Susan Hoerter-who pitched in to help when it was needed.

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By: Russell Tobe, M.D.

Dear West Hudson Psychiatric Society (WHPS) membership, colleagues, and friends:

There are numerous events on the horizon. Firstly, our fall educational forum will take place November 1st at La Terrazza. Dr. Bennett Leventhal is Deputy Director at the Nathan Kline Institute and a world-renowned expert in Autism Spectrum Disorders. His broad title of “Autism Spectrum Disorders: What is New and What is Not” should not deceive us. It speaks to his varied expertise in this field, not only as a clinician but as a tenacious researcher. He has been involved in studies of epidemiology, natural history, evaluation, genetics, biologic treatment, and psychotherapy treatment of Autism Spectrum Disorders. He is also a charismatic and superb speaker. I am confident it will be a wonderful opportunity for the membership.

Secondly, the Mental Health Coalition Breaking the Silence Symposium will be this Wednesday 10/16.  Historically it is a widely attended event with a broad audience of consumers, providers, students, families, and advocates. Because of this, it is a forum for education but also remaining connected to our community, both professionally and more broadly. The topic this year is Major Depressive Disorder with the physician speaker (Dr. James Murrough), an expert in treatment resistant depression including use of ketamine. Visit for more information.

Finally, keep posted for further DSM meetings; the next being scheduled for February 7th. We continue to be open to ideas for areas of DSM discussion. Please contact with suggestions and requests.

Next, I want to again congratulate and thank our team of representatives who spent yesterday in the overcast and chilled weather reaching out to our community at the Nyack Street Fair offering depression screening. Though I have not yet had the opportunity for updates from Dr. Mavromatis and others who were involved, I am sure the effort continued to produce ongoing psychoeducation and linkage to care in our community as it has done for so many years to date. Thank you again to all who volunteered.

Finally, I wanted to highlight a recent trip to Orange Regional Medical Center (ORMC), which is objectively by any measure a beautiful medical center. One challenge for WHPS is our broad geographic area (four counties) with the vast majority of members located in Rockland (the smallest county in New York). It reminds me of the famous View of the World from 9th Avenue cover in the New Yorker. However, as with the cover, it is irrational and illogical. It was simply wonderful to meet with a growing and robust department of psychiatry at ORMC. Most ORMC department members are also WHPS members including several early-career psychiatrists. The meeting was useful in exploring both ways in which WHPS can better service our entire regional area and members farther away can continue to have representation in our district branch. We are most grateful to Dr. Carlos Rueda for facilitating the gathering and his ongoing collaboration.

So we will leave this column short and sweet. Please remember to stay involved and reach out with suggestions and requests. I am looking forward to seeing you all at the educational forum.  Please make sure to register as soon as possible.

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By:  Russell Tobe, M.D.


Dear West Hudson Psychiatric Society (WHPS) membership, colleagues, and friends:

With respect to our expansion and growth as a district branch, current times are exciting for
WHPS for two primary reasons. First, we have allocated significant effort (in no small order
from our Executive Director) to increase funding through grants in infrastructure and educational
support. This has positioned us as one of the more financially sound district branches regionally
and amongst the most sound (if not so) in our history. Second, we have revitalized our efforts to
reach all members across the district.

These efforts have reestablished longtime professional relationships while developing new
collaborations. Our fall educational forum was an exemplar of this positive advance. The
meeting was superbly attended, without an empty seat, and, sadly, with a need to turn people
away due to space limitations. The audience included new faces, many of whom are energetic
younger psychiatrists looking to forge professional contacts while contributing to and benefitting
from APA initiatives including education, advocacy, and mentorship. This has now spilled over
into our Executive Council meetings bringing fresh perspectives and desire for involvement.
Senior colleagues have also been responsive and generous in advising and guidance. In a year
where the APA is scheduled to be in New York City, the opportunity for further expansion and
adaptation of our branch is ripe.

So for all of you out there who may be on the sidelines after years of prior involvement or for
those of you who have never had an active part within the branch, there will be no better time (in
my estimation) than now to become involved. The next Council meeting is January 17th and all
members or prospective members are welcome to attend.

Now down to business. Please note that though details including DSM 5 topic and venue are still
in the works, we will be hosting a DSM 5 educational meeting with dinner on February 7, 2014.
Because this dinner is supported by grants obtained by and allocated to the branch, there will be
no financial cost to members. But there is no such thing as a free dinner. In this case, the cost is
suggestion of DSM topics by December 9, 2013 through emailing If topics are not suggested, Dr. Bark and I may be forced to talk
at length about the difference between DSM 5’s “Other Specified Schizophrenia Spectrum and
Other Psychotic Disorder: Delusional Symptoms in Partner of Individual with Delusional
Disorder” and DSM-IV’s “Shared Psychotic Disorder.”

With respect to the educational forum, those who attended were generally quite pleased. Dr.
Leventhal deftly navigated Autism Spectrum Disorders, from epidemiology through
neurobiology into treatment. The lecture was entertaining, interactive, and highly educational.
Dr. Leventhal was incredibly gracious, staying late into the night to answer specific research and
clinical questions. For those who missed, we have included a synopsis, kindly reviewed and
approved by Dr. Leventhal, that outlines the main points of the lecture. So, as usual, we will
leave this column short and sweet. Please remember to stay involved and reach out with
suggestions and requests. I am looking forward to seeing you all at the DSM 5 dinner.

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By:  Russell Tobe, M.D.


Dear West Hudson Psychiatric Society (WHPS) membership, colleagues, and friends:

As is often the case, winter time has been quiet for the West Hudson Psychiatric Society. I
sincerely hope everyone, their friends, and families have had a pleasant holiday season and a
Happy New Year. The holiday season was particularly happy for me as we had our baby boy in
December. So, in anticipation of preparing this Presidential column, please forgive gross
spelling and grammatical errors readily attributable to sleep deprivation.
Nonetheless, though WHPS has been in a state of hibernation, we have certainly been breathing
and very much alive. Some recent events have been exciting.

First, given the increasing needs from members and growth of the branch, Scott Wiener has
joined with Dom Ferro to jointly guide membership outreach and coordination. For those of you
who have not met Scott, he is an energetic early-career psychiatrist who recently started practice
in Pomona. With Scott on board, we anticipate a significant boost in membership outreach
coupled to a cultivation of fresh ideas. Welcome, Scott!

Second, Lois Kroplick has been exploring the possibility of educational opportunities in disaster
psychiatry training through the Red Cross or other avenues for interested members in the branch.
Third, our website is still very much a work in progress, please continue to send feedback and
suggestions. (

With respect to educational programming, the DSM 5 meeting initially scheduled for Feb 7, will
be tabled for the time-being due to logistical issues that arose. Nigel Bark and I are coordinating
another meeting date (likely the end of February or early March). This will still be a free event
to all members. For those members in Orange, Delaware and Sullivan Counties, please stay
particularly posted as we are hoping to make this meeting more accessible to you. An
announcement should be out in the coming days.

Also, I wanted to thank Nigel for coordinating with Dr. Ann Sullivan to conduct our Spring
Educational Forum speaker. Dr. Sullivan is now Commissioner of the New York State Office of
Mental Health. She has an exceptional service record in public psychiatry within New York
State. Accordingly, she is incredibly knowledgeable and experienced. It should prove to be a
wonderful forum. We are also actively in the process of organizing our fall symposium. If you
have suggestions for speakers, please forward them to me.

So we will wrap up here. Please stay tuned for our DSM 5 training announcement. As always,
forward suggestions and comments to make our branch more efficient and helpful for the
membership to me.


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By:  Russell Tobe, M.D.


Dear West Hudson Psychiatric Society (WHPS) membership, colleagues, and friends:

After a terrible winter, it seems (perhaps) signs of relief and thaw are coming into focus. With
this have come a series of significant policy decisions to which the APA and West Hudson
Psychiatric Society have contributed.

First, APA strongly supported legislation to permanently repeal the flawed sustainable growth
rate (SGR) formula through introduction of the SGR Repeal and Medicare Provider Payment
Modernization Act of 2014 (H.R. 4015). This bipartisan legislation brought with it the promise
of improved physician payment (in the looming context of 24% payment cut on 4/1) and patient
access to care while eliminating the need for SGR patches (totaling, to date, 157 billion dollars).
Ultimately passed by a vote of 237 to 182 in the U.S. House of Representatives, sadly a policy to
delay the Affordable Care Act’s individual mandate for five years was attached by Republican
lawmakers in an attempt to offset the budget required to implement H.R. 4015. This, of course,
prevents mandates developed to encourage all citizens to obtain health care coverage.
Accordingly, APA does not support this and suggests lawmakers should go back to the table in a
bi-partisan fashion. If not resolved, the ongoing need for SGR patches will remain and the 24%
payment cut on 4/1 continues to loom. Accordingly, APA is still advocating for sensible
immediate legislation.

Second, APA supported action against a Center for Medicare and Medicaid Services (CMS) rule
to eliminate antidepressant and antipsychotic medication from protected coverage status. This
action by CMS would have limited beneficiary access to “all or substantially all” medications in
those classes. On 3/11, it was reported that CMS agreed to withdraw the proposal to eliminate
antidepressant and antipsychotic medications from protected coverage status.

With respect to other activities, WHPS recently completed another DSM training dinner in
Central Valley. This made an opportunity for Orange, Sullivan and Delaware county members
to join and participate. While I was able to fumble through the talk without the luxury of my
DSM-partner-in-crime (Dr. Nigel Bark), it was a fun occasion with a bit more time for casual
conversation and collegial discussion than our more intensive educational dinners. Speaking of
which, our next educational dinner will be April 25th, with Dr. Ann Sullivan, who is the new
Commissioner for NYS OMH. It should prove to be an interesting lecture from a very gracious,
knowledgeable, and kind speaker. The fall speaker is still being arranged. So please forward
requests and suggestions.

Finally, I want to invite everyone to our next Executive Council Meeting on April 4th. We will
be spending a significant amount of effort critically appraising the website for WHPS. We
would love to have as much feedback as possible as this is still very much a work in progress. If
you are unable to attend, please send suggestions for improvements. As always, forward
suggestions and comments to make our branch more efficient and helpful for the membership.


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BY: Mona Begum, M.D. (

Dear West Hudson psychiatric society members, colleagues and friends:

I know many Psychiatrists including myself are disturbed by the denial of prescription
drugs for our patients by insurance companies. It is time consuming to obtain
authorization and therefore at times even inhibit us from prescribing newer drugs.
Recently, I was denied generic Geodon for an adolescent patient I have been treating in a
residential treatment center due to his insurance company’s policy “quantity limit
recommendations.” He has been receiving Geodon 60mg, 3 caps/day for one year and
they want me to lower the number of pills from 3 to 2, obviously to reduce the cost. My
reaction is one of annoyance and then retrospection. How did we as a society got to this
place that our health care system and the cost of medicine is so profit oriented? I looked
into this and one answer is GREED.

Many of you read the recent news about Martin Shkreli, who gained notoriety earlier this
year when his company, Turing Pharmaceuticals, increased the price of a drug used to
treat AIDS patients from around $13.50 to $750. Mr. Shkreli has emerged as a symbol of
pharmaceutical greed for acquiring a decades old drug and, overnight, raising the price

Turing’s price increase is not an isolated example. While most of the attention on
pharmaceutical prices has been on new drugs for diseases like cancer, Hepatitis C and
high cholesterol, there is also growing concern about huge price increases on older drugs,
some of them generic that have long been mainstays of treatment.

Prescription drug spending is the third most expensive cost in our health care system.
And spending seems to grow larger every year. Just last year, the average American got
12 prescriptions a year, as compared with 1992, when Americans got an average of seven
prescriptions. In a decade and a half, the use of prescription medication went up 71
percent. This has added about $180 billion to our medical spending.

While there are more medicines on the market today than in 1992, researchers estimate
that around 20 percent of the $180 billion increase has absolutely nothing to do with the
number of medications available, or increases in the cost of that medication. To
understand this change, one place to look is:

“An Advertising Revolution”
It used to work like this: Doctors decided what to prescribe. Drug companies — through
medical advertisers — tried to influence doctors. Patients did what they were told.

The only problem, was that the system wasn’t working out for the drug companies. For
them, the system was much too slow.

And so a large medical advertising company came up with a solution: They would
advertise directly to the patient. They’d get the patient to go in and ask the doctor for the

There was only one small problem with this solution: It was almost impossible to do due
to FDA regulations requiring that drug ads include both the name of a drug and its
purpose, as well as information about all the side effects. But side-effect information
often took two or three magazine pages of mouse print to catalog, and this wouldn’t do
for a major television campaign.

But then, in 1986, while designing an ad for a new allergy medication called Seldane, the
medical advertising company hit on a way around the fine print.

They didn’t give the drug’s name, Seldane, all they said was: ‘Your doctor now has
treatment which won’t make you drowsy. See your doctor.’ ”

This was one of the very first national direct-to-consumer television ad campaigns. The
results were nothing short of astounding. Before the ads, Seldane made about $34
million in sales a year, which at the time was considered pretty good. Their goal was
maybe to get this drug up to $100 million in sales but eventually it went to $800

Pharmaceutical companies took note.

Today, drug companies spend $4 billion a year on ads to consumers. The Nielsen Co.
estimates that there’s an average of 80 drug ads every hour of every day on American
television. And those ads clearly produce results:

“Something like a third of consumers who’ve seen a drug ad have talked to their doctor
about it,” says Julie Donohue, a professor of public health at the University of Pittsburgh
who is considered a leading expert on this subject.

“About two-thirds of those have asked for a prescription. And the majority of people who
ask for a prescription have that request honored.”

By taking their case to patients instead of doctors, drug companies increased the amount
of money we spend on medicine in America.

The good news is the AMA calls for a ban on advertising directed at consumers. The vote
reflects concerns among physicians about the negative impact of commercially driven
promotions and the role that marketing costs play in fueling escalating drug prices. I
believe APA also should join in since the cost of medicine affects the quality of treatment
of our vulnerable patient populaton.

I welcome your ideas and exchanges. Our next meeting is on February 12, at 12:30 pm in
Il Fresco restaurant in Orangeburg. I wish you happy New Year.