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How Have Things Changed

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“How Have Things Changed?” Psychologists Share Their Experiences in Dealing with the Coronavirus Pandemic

We asked a group of psychologists, “How have things changed for you in the shut-down and how are you doing at this point?” About half replied back in time for this issue. In this feature we report on how colleagues are managing the changes, mostly verbatim with some edited for length.

Dr. Gail Gillespie has been in private practice in New Orleans since 1996, specializing in evaluating and treating school-aged children and their families. “Existence in the time of a pandemic Gillespie said. “Because about 80% of my practice is face-to-face assessment, 80% of my business came to an abrupt halt. Thankfully I qualified for the Paycheck Protection Program and I am very grateful for the two months of income that will be replaced and forgiven. In the interim, I am catching up on my to-do list that I never thought I would have time to get to. This tech dinosaur has also learned how to do teletherapy and Zoom meetings, and I have finally created a weekly Zoom meeting demonstrating Emotional Freedom Technique which I am offering for free to front-line healthcare workers, gig workers, service industry folks, anyone who has lost their income, and anyone who has experienced the death or severe illness of a loved one due to Covid-19,” she said.

“In this time in which the entire earth has taken a pause – a once-in-a-lifetime opportunity of forced stillness – I am afforded the opportunity to re-assess my priorities. Living in the French Quarter, I am finally able to truly appreciate the amazing architectural beauty and history in which I am surrounded. For the first time I look forward to walking down Bourbon Street – because it is clean and completely empty! I am now more cognizant of what is truly important: quality human connection, stillness and self-reflection, exuberant experiences and adventure to be created, an appreciation for nature, and prioritizing activities that boost my immune system and reduce stress! I have gained clarity in what activities in my practice feed my soul and what activities that I am ready to release. I have honestly enjoyed this pause but am looking forward to manifesting a more quality, exciting and adventurous life!”

Clinical Neuropsychologist, Dr. Matthew Holcomb, is also in private practice in the New Orleans area. “The shut-down has been hard on a professional and personal level,” Dr. Holcomb said. “Professionally I was just starting to ‘hit my stride’ and my identity as a professional was starting to finally solidify. The momentum that I had built feels like it has stalled out. It’s also been a time for reflection, in that I have been solidly career focused for the last few years and COVID-19 has forced me to stop and take stock of where I am in life and the choices I’ve been making,” he said.

“Personally, its been an adjustment having so much free time on my hands. The first few weeks was wrapping up patient evaluations. Then some time getting caught up on some manuscript writing, but after that its been rough figuring out how to ‘fill my day.’ I routinely talk to some of my elderly patients about ‘having a plan’ for their retirement. Not being sedentary and making plans. I’ve realized how important that is at all ages and stages in life. Making a plan each night of things to do around the house (no matter how small) or goals to accomplish for the next day, or in the near term have been so helpful in getting me through the shutdown,” he said.

“Finally, I have spent a lot of time reconnecting with family. Happy Hour and game nights over zoom have created some treasured memories.”

Dr. Thompson Davis III, Professor of Psychology at LSU Baton Rouge and Director of the Laboratory for Anxiety, Phobia, & Internalizing Disorder Studies has revamped his desks.

“My new ‘mobile workstation’ at the kitchen table composed of my iPad linked to my laptop via Duet for use as a seamless second monitor so I can use my laptop while I zoom/team/etc. while I also have one of my children’s room monitors on hand to be sure things aren’t getting too wild! Confidential video meetings are of course done in a separate room,” Dr. Davis said.

“I think one of the biggest changes is that my work day and work week have extended and bled together (i.e., the day is longer and I’m working even more on weekends than before) as I and my wife trade off roles as telecommuters, preschool/kindergarten teachers, parents, spouses, etc.”

Dr. Alan Coulter, a licensed psychologist in practice now for his 51st year, maintained a small number of clients as a school psychologist providing organizational development consultation, before the COVID19 sequestration.

“My work was largely face-to-face involving travel,” he said. “In this new, temporary period, I have maintained those clients at about 75% of the previous activity level. Some of past work is ‘on hold’ until schools return to typical locations. Predictably, some new work with these clients has emerged focused on adapting to closed school buildings and physical distancing. Maintaining social emotional connections with clients has become a more deliberate task as everyone learns to ‘zoom’ as a way of routine communication. I expect this new form of doing my work to continue for six to twelve months. I agree with others, ‘We’ll get through this.’ And we’ll all learn new skills that will make us more effective and helpful to our communities.”

Dr. Bill McCown is Coordinator of the Psychology Program at University of Louisiana at Monroe and Associate Dean for Research, College of Business and Social Sciences, as well as a Licensed Clinical Psychologist.

“We are working our butts off! It is just nonstop. We are not in the front line but darn, it is incredible. Most college professors are keeping unbelievable hours. From what I’ve seen in every department, all are working nonstop in ways they could not have imagined a few months ago,” Dr. McCown said.

“We do everything we did previously: we prepare lectures, grade assignments, advise students, write letters of recommendation, conduct research. But we also have to find innovative ways to teach and reach students, many of whom are stressed and vulnerable.

“Today’s highlights: ‘My grandmother died. My father tested positive last week. Can I be late on assignment five?’ and (from an Intro Psych student) ‘Do you really think this virus stuff is real or is it made up? My parents are having an argument and I have to ask someone I can trust.’

“Each student and class is different and has unique needs. Fortunately, our deans, administration, and Supervising Boards realize the need for local solutions,” he said. The key has been that we have been given the freedom to respond locally. Academics are generally pretty creative people and their heart is in their work. Like psychologists, they can usually find really good solutions if given the chance.

“There is no manual for this sudden transition, no guru, no roadmap. Faculty creativity has been exceptional. So has student commitment and effort. I’m struck by the number of students who now have unexpected obligations. Some are taking care of siblings, others of sick family members. Many have stepped up to volunteer to help their communities in any way they can. Some are also working jobsany jobs they can find- to help support their families. It’s hard for these students to maintain the academic focus they had in March. But they are really trying,” he said.

“Many students turn to Psychology faculty for objective information. They trust us and ask all kinds of questions! They know our profession is evidence-based. We answer lots of questions. We help them read data and understand the risks and models. What we don’t know we look up or refer to someone who does.

“Other students, frankly want counseling or therapy from us now, probably for similar reasons. They know us and that we are believable. We are evidence-based. What we say makes more sense to them than what they hear on social media. Psychology faculty have to be especially careful to avoid any dual relationships. But what I’ve seen they’re doing a great job in being helpful to these students while also being mindful of ethical issues. We listen and make lots of careful referrals.

“Perhaps just as importantly, we convey a sense of optimism and reasonableness. This helps combat the gut feeling that everything is out of control. Life will get better.”

Dr. Katherine Robison practices in Metairie and works evaluating youngsters. “How have things changed in the shut down? I’m a school psychologist in private practice in the New Orleans area. With regard to my practice, I’m basically shut down since I can’t test kids ‘virtually.’ I am utilizing online or ‘remote administration’ rating scales, but this is a small part of the evaluation. I have used Zoom for a few tele therapy sessions, but it’s ‘not the same’ as an in-person session since I see children. I am happy to have finally caught up on reports!,” she said.

“On a personal level, I really miss being around people! But the shut-down has been good for me in some ways. I’m spending time outdoors and enjoying bike rides through City Park.”

Dr. Charles Burchell is a licensed Clinical Psychologist who has had a largely independent practice for over 35 years, and lived and practiced in Baton Rouge, New Orleans, and Texas. “I suppose my life mirrors that of many others that you know. Back in March, on the advice of my primary care physician, I changed to working from home at one parttime position; and my consulting practice is now one-hundred percent online. Professionally, I conduct business through a combination of mostly emails and HIPPAcompliant TeleHealth services. I’ve been attending more webinars and am planning to virtually attend a Forensic Psychology conference,” he said. Dr. Kim VanGeffen is in solo private practice in New Orleans. “COVID-19 has required adapting to many changes and a lot of flexibility, neither of which are my strong suit. I have switched to doing tele psychology and phone sessions although my billed hours have drastically dropped. Before the stay-at-home orders, I did a large amount of psychological testing which is not possible now. I look forward to seeing people in my office again as I find that I prefer face-to-face work over tele psychology. I am trying to maintain my natural optimism and to find as many of the silver linings in these clouds as I can. I am using the extra free time to catch up on office paper work which had been neglected for the past several months. I am also on the Board of Directors of LPA and our Board is spending a lot of time trying to provide services to our members during these trying times. Keeping busy and productive keeps me sane. I am also keeping in touch with family, friends and colleagues by email, on line gatherings and telephone chats which is very important when we are so isolated.”

Dr. Charles Burchell is a licensed Clinical Psychologist who has had a largely independent practice for over 35 years, and lived and practiced in Baton Rouge, New Orleans, and Texas.

“I suppose my life mirrors that of many others that you know. Back in

March, on the advice of my primary care physician, I changed to working from home at one parttime position; and my consulting practice is now one-hundred percent online. Professionally, I conduct business through a combination of mostly emails and HIPPAcompliant TeleHealth services. I’ve been attending more webinars and am planning to virtually attend a Forensic Psychology conference,” he said.

“On a personal note, I stopped attending religious services even before modifications in ritual and eventual cessation of public gatherings had been announced. I stopped going into WWOZ, the community supported FM radio station in New Orleans (online at wwoz.org) for my weekly Friday show, ‘Jazz From The French Market.’ Instead, like some others, I record the shows at home instead of a live presentation. I didn’t have a problem with feeling safe at ‘OZ; I just was, and am, obeying the ‘stay at home’ government recommendations. Going to the radio station would have been a weekly 180- mile trip.

“Of course socializing in person is nonexistent, so I call, text, FaceTime, IG, Facebook, tweet, and use Messenger to maintain that very human contact. This is especially useful for staying in touch with close friends (one whom I have known since age three) and my two adult children (one who currently lives in Rome, Italy).

“Days are filled with professional tasks, and watching all kinds of TV (including participating with a small group of friends for Netflix parties who used to meet up to see movies in theaters), more reading, and cleaning (no positive correlation here between motivation for housework and increased time availability). I’m more motivated to learn Italian on my Duolingo app; before the pandemic I might have time to use it two or three times a week or lessnow I’m up to 73 days straight!”

Dr. Traci Olivier is a pediatric neuropsychologist at Our Lady of the Lake Children’s Health Development & Therapy Center. She has a part-time practice at the Neuropsychology Center of Louisiana and serves as a local expert advisor for Cogstate cognitive science research company.

“As a pediatric neuropsychologist, my practice is primarily focused on neuropsychological evaluations.,” she said. “There has been much discussion in professional circles about the feasibility, validity, and ethical considerations of using telemedicine for psychological and neuropsychological testing. After much research and contemplation about using tele-testing, I decided not to pursue this avenue of service delivery. Therefore, my time has been dedicated to completing current evaluations (e.g., providing feedback, finalizing reports) and seeing new patients for initial visits – all via telemedicine, or video visits. The use of telemedicine platforms and the quietness around the office are perhaps two of the most significant changes that I have noticed. My practicum students are on hiatus for now, which is also a change. Interestingly, this time has been a welcome period of rest and refreshing – a time to catch up, contemplate priorities, and plan for the future. I realize that there are those who have become incredibly busy over the past several weeks, and for many, this is a time of significant stress. My heart goes out to those people. I am so blessed, however, to be able to use this time to plan and invest.

Dr. Jamie Landry, is married with two, energetic, fun-loving boys. She is in the Covington, Mandeville area and notes that she loves camping and the outdoors.

“With a part time practice focused on assessment, most of my work has been put on hold during the stay at home order. Like many others, I’ve been spending more of my time with my family, keeping my kids engaged in some educational activities and having some good old fashioned family fun. I’m doing well but look forward to achieving a sense of normalcy again.

Dr. Randee Booksh is a licensed clinical and neuropsychologist. “My small private practice is split between neuropsychological/psychological evaluations and therapy patients. I work with two other neuropsychologists who do the same and we share many resources, including a testing assistant, office space, and testing materials, etc.” Dr. Booksh said.

“So what has changed? I only go to the office to pick up supplies or mail. I see patients via telemedicine, which I had never done before, except an occasional emergency phone session. Now I see my established therapy patients and a handful of new patients and conduct some brief psychological evaluations when I feel I can answer the referral question via tools I can use during a video session. I cannot conduct neuropsychological evaluations this way. I’m working much fewer paid hours, but the work is harder. Everything I do at home takes longer than if I was at the office,” she said.

“The telemedicine curve has been steep for me. I find it requires more preparation, a different kind of attention, and use of different tools. At the same time, I’m immensely grateful that it’s available and I know that I will continue to do some telemedicine indefinitely. Patients are significantly more distressed, with so many in crisis. Established patients with anxiety and trauma related disorders are really struggling and finding it difficult to maintain gains made in therapy, previously. I’m experiencing increased stress, anxiety, and fatigue too. I’m finding I need greater self-care to be prepared and able to meet the changing needs of the patients I see.

“Focus on the shared practice has shifted to when and how we will (eventually) reopen and what that will look like. We’ve developed a strategy to start low and go slow. We’ve written a safety plan, posted important safety guidelines on the wall, and removed chairs from the waiting room. We are staggering times and using alternate entrances, so patients don’t come in contact with each other. We’ve purchased lots of hand sanitizer, face shields, acrylic desk partitions, masks, Lysol wipes, etc. I cannot imagine trying to figure this out or implement it by myself. My colleagues and coworkers made it possible.

“As far as my home life, the biggest change is I spend a lot, and I mean a whole lot, of time with my husband. He’s an audiovisual technician, labor coordinator for conventions, and musician, so all of his work has cancelled for the remainder of the year. Luckily, we get along really well. Again, hooray for technology, but I’m sure getting tired of virtual family visits. I get dizzy when the grandkids run with the phone during Facetime and I can’t wait to put my hands on the bellies of my two pregnant daughters. Overall, I think I’m adapting very well. I’m extremely fortunate with many resources and it can still get overwhelming. I can’t imagine trying to do this alone.

Dr. Melissa Dufrene has worked full-time in private practice at her office in the Algiers neighborhood of New Orleans for the last 6 years. She primarily provides individual therapy, but also completes 1-2 testing cases per work. She is married with two young boys (ages 2 and almost 5).

“Since quarantine,” Dr. Dufrene said, “I have been seeing my clients via a telehealth platform (doxy.me). Fortunately, I had been using this platform as needed for several years. In that way, the transition was easy. However, I am now only working 20 hours/week because my two kids obviously are staying at home. This has required managing a strict schedule and coordination with my husband’s work, who works in an essential field,” she said. “For me, one of the greatest struggles has been the immediate shift between caring for the boys and diving right into my therapy appointments, then right back into parenting. This last week I took two days off because I felt I needed a respite from clients. I have also had to decline new clients and requests for other types of work. At the same time, I’m thankful for the strict scheduling that has been needed because it is keeping me very busy. I am also extremely thankful for the lovely weather that Louisiana has bestowed upon us in recent months. Clinically, this has been an interesting experience. My client’s responses to the current situation range from, “Nothing is going on. I’m bored and have nothing to talk about.” to significant emotional turmoil. My main points of emphasis with everyone has been empathetic support and normalization. I believe these approaches have provided immediate relief from the self-judgment that many people are battling. Quite frankly, I think one of the most important, and mutually beneficial aspects of therapy has been socialization.”

Dr. James (Pat) Thompson, is a clinical psychologist in Houston, but attended Tulane University his freshman year and maintains such a close connection to New Orleans that he is also licensed in Louisiana and is an active member of the Louisiana Psychological Association.

“These are indeed sad, weird, and frightening times for everybody and that includes psychologists. The COVID-19 crisis has changed everybody’s life,” Dr. Thompson said. “If someone had told me six months ago that I would be doing psychotherapy sessions entirely by telehealth, I would have thought they were schizophrenic.

If someone had told me six months ago that I would be frightened and wearing a mask every time I go to the grocery store, I would have thought they stopped taking their medication. If someone had told me six months ago that I would be instructing patients to avoid in vivo meetings with friends and family, I would have thought they were taking some bad drugs. If someone had told me six months ago that I would be telling patients to not attend Easter services in person, I would have thought they were off their rocker. If someone had told me six months ago that I would not be able to eat inside my favorite restaurants in Houston and/or New Orleans, I would have wondered if there was something in the water they were drinking,” he said.

“I visited my favorite place in the world, New Orleans, the weekend after Mardi Gras this year. When I arrived in New Orleans, there were no COVID-19 cases in Louisiana. On the day of my departure, while I was waiting for my plane at the Louis Armstrong Airport, the Times Picayune reported one case in Jefferson Parish which was subsequently transferred to the Southeastern Louisiana VA Medical Center. We all know what happened from there. If someone had told me six months ago that I would not be able to visit New Orleans, I would have laughed in their face.

“While I was in New Orleans in early March, I attended two public performances. I had a great time at both events. The first one was at the Fillmore and I saw the bands Sweet Crude and Rebirth Brass Band. I just learned today (4/30/2020) from an article in the Times Picayune that two of the band members of Sweet Crude were positive for COVID19. Today I also learned that rashes and blisters on the fingertips are some of the symptoms of COVID-19. About two weeks after I visited New Orleans, I developed these symptoms along with diarrhea and muscle pain. I went to my PCP and it was early in the crisis and they did not do a test for the virus. I am wondering if I was exposed and if I have antibodies. I called my PCP and she told me that tests for antibodies are not readily available.

“I have two patients who are positive for COVID-19. They are learning from me and I am learning from them.

“I am already missing New Orleans. I will miss attending the LPA convention and most likely the workshop in the fall. I missed attending the French Quarter Festival and am missing attending plays at Le Petite Theater. I will most likely miss the Tulane homecoming game and the Tulane Psychiatry conferences that I have been attending for the last few years. I cannot imagine what a season without the Astros, LSU Tigers, Tulane Green Wave, University of Houston Cougars and the Saints will be like,” he said.

“I remember the morning that Katrina was approaching New Orleans. I was gripped with fear and anticipation as I thought about what the storm might do to my favorite city. This crisis has the same feeling, but it is on a global scale.

“It is strange and awkward working with patients by telehealth. Sometimes it is difficult to hear what they are saying. Sometimes it is difficult for them to hear what I am saying. I am finding that some patients who suffer from severe problems communicating with other humans are very happy to be forced to stay at home and have no human contact. Other patients who have intact social skills are suffering deeply and report feeling like they are in prison in their own home.

“The impact on the African-American community and their rich culture, music and history in Houston and New Orleans makes me cry.

“This is a time for everyone to muddle through this crisis the best we can and to remain adaptable and cooperative. It is important to extend our help to others and reach out for help when we need it ourselves. I have opposed telehealth as a means of conducting psychotherapy for years. I am seeing its merits now and realize it has possibilities for the future after the virus has subsided. My motto now is to bend with the prevailing winds like a birch tree. We can get through this catastrophe together. United we will stand. Divided we will fall.”

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Malpractice Lawsuit in Terrebonne Parish Goes Against Lafayette Psychologist

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In a lawsuit filed in 2017 against psychologist Dr. Eric Cerwonka, a Terrebonne Parish jury awarded $1,150,000 to a 35-year-old Houma man. The plaintiff said he suffered emotional abuse from Cerwonka, according to the news article in a March issue of The Houma Courier.

The plaintiff’s case was tried by Jerri and Maxwell Smitko of the Smitko Law firm, in Houma, Louisiana.

According to the Courier, Jerri Smitko said that some of Dr. Cerwonka’s mental abuse included forms of brainwashing.

“He wrongfully attempted to convince my client that he had been abused by family members,” Smitko told the Courier reporter, Dan Copp.

Copp reported that the legal complaint alleged that the plaintiff had been in therapy with Dr. Cerwonka in early 2017, during the time that the defendant’s license to practice had been suspended.

However, other sources indicate that while Dr. Cerwonka‘s license had been suspended following a January 2017 hearing held by the Louisiana State Board of Examiners of Psychologists, he retained his license because he immediately appealed the decision. According to state records, Cerwonka‘s license is currently in effect in both Louisiana and New York.

The Courier report notes that the Houma man’s legal complaint included the following:

• “Dr. Cerwonka‘s advice during this time reflected the obvious tumult in his practice, as he advised plaintiff to live in his car and fight his father.”

• “When plaintiff learned of Dr. Cerwonka‘s suspension he reached out to him for clarification. In retaliation, Dr. Cerwonka threatened to have the plaintiffs subject to a civil commitment.“

Dr. Cerwonka has been involved in legal matters since 2017, when the psychology board decided to remove his license. He immediately filed an appeal and alleged several due process violations.

In August 2017, he also filed a lawsuit in the United States District Court Western District of Louisiana Lafayette division. In his complaint, Cerwonka and his attorneys allege that the board acted on an interim basis before any hearing had taken place, that Cerwonka was denied a proper opportunity to defend himself against specific charges, that an emergency action was taken because he exercised his right to free speech, and that evidence was manipulated and obtained illegally.

Among these and other violations of his rights, he and his attorneys also allege that because the prosecuting attorney for the board had previously represented Cerwonka in a hotly contested custody battle, and that the attorney had information that was, allegedly, used in the prosecution, the attorney should have been removed.

The due process lawsuit is scheduled for next month and based on an unopposed motion by Ms. Jaime Monic and her attorneys, was changed from a bench trial to a jury trial.

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Legislature Could Dump 66% of Bills

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Legislators are slowly finding their way back to the 2020 legislative session after they suspended activities the second week in March due to the coronavirus cases in the region.

Required to adjourn on June 1, lawmakers will have less than 30 days to create a budget for the state, approve 300 or so appointees, and restructure state agencies that are scheduled for sunset. Only about a third of the bills previously filed will be addressed, reports Mark Ballard of the Advocate.

Only about a third of the bills previously filed will be addressed, reports Mark Ballard of the Advocate.

Ballard noted, “Senate President Page Cortez, R-Lafayette, and House Speaker Clay Schexnayder, R-Gonzalez, asked members to prioritize the legislation each had filed for what was supposed to be an 85-day session beginning March 9. About a third of the legislation will be heard with emphasis on measures dealing with COVID-19 responses, the economy and the budget. About a third of the proposed legislation will get a hearing, Cortez and Schexnayder said.”

The lawmakers have met very little during the interim and mostly to start the process of new bills that would be focused on combating the coronavirus and other problems related to the states economy and sinking oil prices.

Senate Bill 458, the ambitious set of changes to the psychology practice law initiated by the Louisiana State Board of Examiners of Psychologists (LSBEP) is not currently on the schedule. The measure is on hold after officers from the Louisiana Psychological Association (LPA) raised objections. A task force was established to develop a consensus regarding the measure and is still deliberating.

If passed SB 458 would make sweeping changes to the psychology law including a new set of regulations and fees for assistants, expanding the charter of the board, removing certain qualifications for serving, authorizing the board to conduct continuing education, exempting the board from Open Meetings Law for investigatory meetings, and formally establishing the position and duties of the Executive Director.

Some of the bills that have made it to the calendar include:

HB 243, by Rep. Lyons, exempts persons with disabilities from fees associated with obtaining medical records.

HB 473, by Rep. Duplessis, eliminates the 12-month mandatory minimum supervision period for defendants who elect to undergo treatment while participating in a drug division probation program.

HB 498, by Rep. Emerson, requires licensing boards to waive fees to applicants who meet certain criteria and to offer payment plans. Those applicants will qualify if they are receiving public assistance and earning less than 200 percent of the federal poverty guidelines.

HB 449, by Rep. Echols, provides relative to behavioral health services delivered via telehealth and regulation of such services by the La. Department of Health. Present law, the Louisiana Telehealth Access Act (R.S. 40:1223.1 et seq.), defines “telehealth”, in pertinent part, as a mode of delivering healthcare services that utilizes information and communication technologies to enable the diagnosis, consultation, treatment, education, care management, and self-management of patients at a distance from healthcare providers. Proposed law amends this definition to provide that healthcare services delivered via telehealth include behavioral health services. Present law, the Behavioral Health Services Provider Licensing Law (R.S. 40:2151 et seq.), requires the La. Department of Health to promulgate rules and regulations for behavioral health services providers. Proposed law provides that such rules and regulations address the delivery of behavioral health services through telehealth.

Other measures that may or may not be heard include:

HB 45, HB 48, both by Rep. Miller, provides a deadline for Title 37 licensing boards reports to be submitted and shifts the receipt of reports and complaints to the legislative auditor instead of the House and Senate governmental affairs committees. HB 48 removes provisions requiring Title 37 licensing boards and commissions to give notice that complaints about actions or procedures of the boards may be submitted to the board or commission or to the House and Senate governmental affairs committees.

HB 138, by Rep. Wright, requires the use of video cameras in classrooms where special education services are provided to certain students with exceptionalities.

HB 195, by Rep. D. Miller, removes the requirement to submit proof of active hospital privileges for a new healthcare provider in a group practice who bills an insurer using the group practice’s identification number prior to credentialing.

HB 158 by Rep. Marino, authorizes the recommendation of medical marijuana to patients by physicians for treating several neurodegenerative diseases and conditions.

HB 338, by Rep. Duplessis, requires the reporting of certain physical and mental health information of an offender appearing before the committee on parole for a parole hearing. Proposed law retains present law and adds information regarding the physical, mental, or psychiatric condition of the offender, when available, to the list of information included in the report secured by the department.

HB 485, by Rep. D. Miller, provides admitting privileges to psychiatric mental health nurse practitioners for preparing and executing orders for the admission of patients to licensed psychiatric treatment facilities. Proposed law retains present law and adds psychiatric mental health nurse practitioners may admit persons with mental illness or suffering from a substance-related or addictive disorder pursuant to present law.

HB 505, by Rep. Bishop. Proposed law establishes the licensed profession of art therapist in La. Provides for licensure of art therapists by the La. State Board of Medical Examiners.

HB 663, by Rep. Hughes revises school discipline laws. Present law provides relative to student discipline. Proposed law provides a comprehensive revision of present law, applicable to all public schools, including charter schools.

SB 128, by Sen. Barrow, requires certain assessments of a student prior to suspension from school. Proposed law requires the principal, prior to suspending a student, to ensure that the student is assessed using an instrument, such as the Adverse Childhood Experiences Assessment developed by the Centers for Disease Control, that is designed to determine if the student has experienced trauma, and whether the student’s behavior may be better addressed in a manner other than through suspension.

SB 170, by Sen. F. Mills, provides relative to health care emergency visit alternative treatment reimbursement. Proposed law establishes an enhanced Medicaid reimbursement rate for hospitals that triage nonemergency Medicaid recipients presenting at the hospital emergency department to a hospital primary care clinic when such transition is appropriate.

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Trump Administration and CMS Expand Telehealth During COVID-19 Pandemic

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In an April 30 press release, the Centers for Medicare & Medicaid Services (CMS) announced that at President Trump’s direction, and building on its recent efforts to help the U.S. healthcare system manage the COVID-19 pandemic, CMS has issued another round of regulatory waivers and rule changes to deliver expanded care to the nation’s seniors and provide flexibility to the healthcare system. These changes include continuing CMS’s efforts to further expand beneficiaries’ access to telehealth services.

CMS is taking action to ensure states and localities have the flexibilities they need to ramp up diagnostic testing and access to medical care, key precursors to ensuring a phased, safe, and gradual reopening of America, said the authors.

CMS’s goals during the pandemic are to 1) expand the healthcare workforce by removing barriers for physicians, nurses, and other clinicians to be readily hired from the local community or other states; 2) ensure that local hospitals and health systems have the capacity to handle COVID-19 patients through temporary expansion sites (also known as the CMS Hospital Without Walls initiative); 3) increase access to telehealth for Medicare patients so they can get care from their physicians and other clinicians while staying safely at home; 4) expand at-home and community-based testing to minimize transmission of COVID-19 among Medicare and Medicaid beneficiaries; and 5) put patients over paperwork by giving providers, healthcare facilities, Medicare Advantage and Part D plans, and states temporary relief from many reporting and audit requirements so they can focus on patient care.

According to the announcement, for the duration of the COVID-19 emergency, CMS is waiving limitations on the types of clinical practitioners that can furnish Medicare telehealth services. Prior to this change, only doctors, nurse practitioners, physician assistants, and certain others could deliver telehealth services. Now, other practitioners are able to provide telehealth services, including physical therapists, occupational therapists, and speech language pathologists.

Also, CMS previously announced that Medicare would pay for certain services conducted by audio-only telephone between beneficiaries and their doctors and other clinicians. Now, CMS is broadening that list to include many behavioral health and patient education services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14- $41 to about $46-$110. The payments are retroactive to March 1, 2020.

In a May 1 press release, the American Psychological Association applauded the Administration and CMS for expanding Medicare coverage for audio-only phone services during the coronavirus pandemic, including psychotherapy, health behavior assessment and intervention services, and other behavioral health services.

Previously, Medicare recipients who wanted to take advantage of psychotherapy through telehealth could do so only via videoconferencing. This was a significant limitation for people without access or capability to use those technologies

“To curb the spread of the coronavirus and help our communities heal, we cannot leave any of our neighbors behind,” said Arthur C. Evans Jr., PhD, CEO of the American Psychological Association. “The American Psychological Association is grateful to our members and congressional leaders on both sides of the aisle for tirelessly advocating for these needed phone services.”

“Psychologists can now use their specialty skills to improve the health of ALL the communities we serve, including older adults, people with lower income or education, individuals with disabilities and people in rural areas,” he added. “Yesterday, some of the most vulnerable people in our country did not have access to psychological care. Today, they do.”

For additional background information on the waivers and rule changes, go to: https://www.cms.gov/newsroom/factsheets/additional-backgroundsweepingregulatory-changes-help-us-healthcare-systemaddress-covid-19-patient

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Freud

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A Review

by Alvin G. Burstein

Growing up in the 1930’s, going to the movies was a special treat. Summers in Omaha, on the banks of the Missouri river could be hot, and the marquees would promise “20 degrees cooler inside.” The Italianate architecture of the Paramount theatre induced a sense of luxury, and stars studded the velvet dark of the ceiling.

In later Chicago days, the surroundings could be on the dingy side, and it was years before I learned I didn’t have to stay for the whole triple feature. But there was always popcorn. The wheel turns, and now I favor the movie tavern, with reclining seats, cocktails and food, albeit microwaved.

But, given Covid 19 and social distancing, the movie tavern is off-limits, so I decided to binge watch eight hours of the NetFlix Freud.

It is quite a confection, a mashup of biopic, gross-out horror, social commentary, murder mystery and skin flick. Something, as it were, for everyone. Its ties to Freud’s theories and to his life are deep, detailed and elaborately fictionalized.

Robert Finster plays a hunky, coked-up, grandiosely ambitious, but highly unsuccessful young Jewish neurologist in racist Vienna. We watch him interacting with his mentor, Breuer, played by Merab Ninitze, and his boss, Meynert, played by Rainer Bock. These are real people in Freud’s life, though the details of their relationship to him and each other are freely tweaked. Young Freud gets entangled with a Hungarian couple, Count and Countess Szápáry and their protogé, Fleur Salomé. Fleur, it turns out, has a dual identity—a classic, if creaky, dual personality. She is, at times, a táltos.

These are figures in Magyar folk lore. Children born with six fingers, patent teeth, or a caul that are supposed to have mystical powers. The script writer(s) seem familiar with this material, because at one climactic moment an adult Fleur/táltos emerges from an amniotic casing, and as the series draws to its close, she meets Freud wearing a veil, a caul, over her face.

There is a noble Hungarian Szápáry family, but the Count and Countess in the film appear fictions. Their role in exploiting the 19th century political complexities of the AustroHungarian empire is a Cliff’s Notes view of an interesting place and time.

Fleur, too, would appear to be fictional. She may be intended as a teasing reference to Lou Andreas-Salomé, a woman prominent in the European intelligentsia of the time who became a member of Freud’s later psychoanalytic circle. But in the film Fleur Salomé is one of Freud’s first patients, one with whom he becomes sexually involved.

So we are presented with an account of the dangerous potential of counter-transference, a theme pounded home in the 2011 film, A Dangerous Method, describing Jung’s first psychoanalytic case. Aside from the misinformed implication that the therapeutic transference is positive and sexual, as opposed to multi-faceted and often productively negative, this film commits a second theoretical blunder. It confounds the repression central to the psychoanalytic view of hysteria with the so-called vertical splitting that occurs in identity disorders, arguably now more common, or at least more often diagnosed than the hysterias.

There are some genuinely well-acted and very engaging characters in the film that made the eight hours bearable if not gratifying. Inspector Kiss, played by Georg Freidric; Poschacher, his sidekick, played by Christoph Krutzler; and Lenore, Freud’s housekeeper, played by Brigette Kren, stand out.

A final trigger warning: full frontal male nudity, graphic sadism.

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Stress Solutions

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The Tapping Solution To Release Stress and Find Balance

Years ago when working with very anxious infants and toddlers, I discovered a good calming technique was to pat or tap the child’s back gently in a continuous pattern. The child would calm and finally go to sleep. Actually, moms have been doing that for centuries. I taught clients with high anxiety little children to do that as a means of calming the child. It always worked but I never thought of it as a technique that could be used with older children and even adults.

Recently, an old friend who had become highly anxious after a head injury attended a seminar on the Tapping Solution and referred me to it. I am excited to learn about it and that there is a theory behind how it works to balance the nervous system. And, to make it even more available, Nick Ortner and his siblings developed an App called Tapping Solution App. During this superstressful period of Covid-19 they have been offering a special for the healthcare workers, including mental health care workers, and first responders. The special is a 6-month free access to the premium version of their Tapping Solution App. The basic app and a few of the tapping meditations are free.

An example of a basic tapping meditation works like this. You download the app on your smart phone. You start the anxiety tapping meditation which begins with music and a way of measuring your anxiety before starting the tapping. The meditation is 9+ minutes long and begins with a nice deep breath in. The phone shows you where to start tapping on your body (side of hand). The app guides you with a positive statement to repeat to yourself as you tap.

The app tells you where to shift to the next place to tap. Each place of tapping is done for a few seconds before moving to the next spot. The places to tap are lit up with a blinking star. There are approximately 10 or more places on your hand, face, head, collar bone, under the arm to tap. As the app continues, you are asked to think about what makes you anxious or stressed as you tap. If you are in a group or more public place, earphones will make you unobtrusive as you use the app.

There are over 100 tapping meditations on a wide variety of topics to choose from. Basic topics include Releasing Stress, Releasing Anxiety, Releasing Fear, and Releasing Grief. Now, they have added specific tapping meditations for Covid 19. There is a really valuable one entitled Quiet My Racing Mind, which is a major cause of anxiety. Some of the meditations are in Spanish as well

There are over 100 tapping meditations on a wide variety of topics to choose from. Basic topics include Releasing Stress, Releasing Anxiety, Releasing Fear, and Releasing Grief. Now, they have added specific tapping meditations for Covid 19. There is a really valuable one entitled Quiet My Racing Mind, which is a major cause of anxiety. Some of the meditations are in Spanish as well

Normally, the use of the app costs about $50 a year, paid monthly or annually. However, the current offer of 6 months free for healthcare workers is a great deal. To explore further, you can order Nick Ortner’s book, The Tapping Solution, at Amazon.

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For Now, Behavior is the Key

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“There’s no magic bullet. There’s no magic vaccine or therapy. It’s just behaviors”, said Dr. Deborah Brix of the White House Coronavirus Task Force. “Each of our behaviors, translating into something that changes the course of this viral pandemic, over the next 30 days.”

The current crisis brings into sharp focus the limitations our health systems in fighting any new, stealth, and lethal virus. Behavioral intervention is not one of traditional medicine’s strengths––reflected in Medscape authors’ use of the term “non-pharmaceutical intervention” to describe social distancing.

While pharmaceutical treatments are being developed, the “behavioral immune system” and lifestyle interventions that support natural immunity are the key

The new virus is highly contagious, transmitted through the air, from those who are asymptomatic––estimated to be up to 50%. Since the virus may avoid our usual pathogen detection, efforts have been to raise our conscious awareness. Heightening this behavioral immune system–so we learn to automatically wash our hands, resist touching our eyes, or take three steps back from another–is becoming the new normal.

A second avenue of behavioral intervention is to support the innate immune system for individuals. Evidence is also mounting that the new virus might somehow bypass the innate immune defenses in some, or suppress immunity, an especially dangerous issue for older people and those younger people with deficiencies.

Self-care behaviors for natural immunity involve many lifestyle factors. One example is food choice. The immune system needs adequate vitamins A, B, C, K, Zinc and sunshine for D. Too much sugar, alcohol or caffeine is detrimental to the immune system, as is any amount smoking at all. Exercise boosts growth hormone and that enhances immunity. Lowering emotional stress supports immune functions. One of best and cheapest behavioral interventions for everyone is a simple and pleasant behavior–sleep. Yet, many in the U.S. don’t get their needed dose.

We have a myriad of ideas and methods for supporting the behavioral immune system and behaviors that increase the innate immune defenses. Even a 10% change in some aspect or another might be the difference between a person going to the hospital or staying out. For this special issue we cover topics for sleep, stress, and music, ideas for dealing with the pandemic and how psychology can help.

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Lullaby Blessings: Help for Families Stuck at Home

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Susie Marie, PhD

Musical Messages® – April 1, 2020

As infants, when we felt irritable and fussy, or were unable to relax and fall asleep, our mothers would wrap their arms around us, hold us close, and sing lullabies to us. These softly sung rhyming words, with their slow, steady, repetitive patterns of simple melodies, delivered with high pitched, deep emotional expression, in swaying triple meter, were the medicine we needed to drift into peaceful slumber.

The mother’s voice, la voix maternelle, has unmatched power to influence the growth and development of her young. Even before birth babies can recognize their mother’s voices, and as infants they prefer the voices of their mothers above all others. Mothers across the centuries and around the globe have used the power of their voices to influence their children through lullabies.

Lullabies are the vehicles through which mothers first teach their children important family stories and traditions, and share timeless cultural knowledge and values. Mothers also express their own troubles and worries, reassuring themselves and their little ones, through lullabies.

Gregor Roy MacGregor of Clan Gregor fought for years to reclaim family land that Robert the Bruce, King of Scotland, had granted to the chief of the Clan Campbell. When he was captured and killed in 1570, his widow composed and sang the lullaby Ba Mo Leanabh to her son. You can listen to her mournful tale here. https://www.youtube.com/watch?v=P7dW 1FtfS9Q

She sang of her plight while comforting her child, “On hush-a-bye, my little baby. Hush, my little baby, hush. Oh hush-abye, my little baby. My own little baby will go to sleep. Though I am without a flock of sheep, And the others all have sheep, Though I am without a flock of sheep, You, little baby, can go to sleep.”

She also sang of the strength of her devotion as she relayed the tragic truth of her child’s father’s fate, “Darling, of the people of the great world, They spilt your blood yesterday, They put your head on an oaken post. A little way from your corpse I breathlessly climbed the great mountain, I climbed and I descended. I would put the hair of my head under your feet, and the skin of my two hands.”

No matter what the circumstances of her life, a mother can establish a secure bond with her child through lullabies, which provide stabilizing comfort by modulating arousal and regulating behavior. Research on premature infants provides some of the most compelling evidence of the benefits of lullabies. Their breathing and heart rates improve, feeding and sleeping increase, they get better faster, and they are discharged sooner than babies deprived of “live” lullabies.

The electronic delivery of lullabies lacks impact for babies in hospitals and in homes. Babies want real, live females to sing their lullabies. One of the beautiful features of lullabies is that the lyrics are customized, adding special endearments and unique details, sometimes with silly words and intonations, that express love and affection, and the worth of each individual child. Babies need the intimate, personal interaction of traditional lullabies that mothers through-out the world have provided for centuries.

Screened presentations of lullabies, such as those available through Apps and YouTube, are generically produced, lack understanding of children’s social and developmental needs, and are promoted by unscientific testimonials. These productions have corrupted the classic definition of lullabies. They use male voices and instruments, and instead of lulling a baby to sleep, they function primarily as ways to settle a baby by signaling a specific family routine.

Children whose mothers sing lullabies to them through-out the first year of life have significant advantages over children deprived of such a rich musical heritage. Lullabied babies show greater growth across multiple developmental realms. Music activates many parts of the brain simultaneously, and establishes strong foundations for speech and language, mathematical and spatial skills, sensory and creative development. Dr. Nina Kraus of the Auditory Neuroscience Laboratory of Northwestern University aptly describes music as the “quitessential multimodal activity.”

The Polish composer Frederic Chopin gave the world a new musical form in 1844 when he completed his, a cradle song. (Le berceau is French for cradle.) He is thought to have been inspired by Louisetta, the child of his musician friend Pauline Viardot, and by a song from his childhood, “The moon now has risen, the dogs are asleep.”

German composer Johannes Brahms gave us his berceuse, Wiegenlied, a lied (art song) for piano and voice in 1868, which is best known as “Brahms Cradle Song,” one of his most popular works. He too was inspired by a friend who was a mother, Bertha Faber, when she gave birth to her second son. In 1877 Brahms incorporated this melody as the second theme of the first movement of his second symphony. The second theme begins at bar 82 and continues through-out the movement. You can hear that first movement here. https://www.youtube.com/watch ?v=uJ3AOeNfWy4

Brahms original lyrics were, “Good evening, good night, With roses covered, with cloves adorned, Tomorrow morning, if God wills, you will wake again. Good evening, good night, By angels watched, who show you in your dream, the Christ-child’s tree. Sleep now blissfully and sweetly, see the paradise in your dreams.” These words express Brahms’ appreciation of the ultimate security a mother provides, by protecting her child even beyond death through faith.

Today we know this piece, so popular in music boxes, as “Brahms Lullaby,” that begins “Lullaby, and good night” and continues “Lay thee down now and rest. May thy slumber be blest.” Twentieth century American lyricist William Engvick created new, simpler words for the melody, giving us “Close Your Eyes.” You can enjoy Rosemary Clooney’s version here. https://www.youtube.com/watch ?v=MOLOFTFatgc&feature=yo utu.be

In contrast to the peace and joy of the lullaby is the lament. A lament, as a passionate expression of grief that is prominent in Biblical texts, is an appeal to God for help. The initial wailing complaint is transformed through the process in which the petitioner addresses God, describes the suffering, pleads for divine assistance, expresses trust, and offers thanksgiving and gratitude, in anticipating of receiving relief.

Music therapists have developed “lullaments,” which combine both lullabies and laments, to help hospitalized children and their parents, and adult cancer patients in palliative care. Lullabies, which focus on attachment, nurturance, and growth, used together with laments, which emphasize detachment, sorrow, and loss, can help patients cope with uncertainty and fear of death. As our nation contends with the crises and tragedies of the coronavirus pandemic, lullaments can be an important resource to help ease suffering.

Lullabies, however, capture the blessings and fundamental freedom of a strong maternal bond. Perhaps we all need to envision ourselves embraced in a loving mother’s arms, lulled into peaceful sleep by the sounds of her sweet lullabies. Though the link below takes you to a lessthan-ideal digital format where I share a childhood memory and sing a lullaby inspired by roses, I hope that my Musical Messages® will help bring us emotionally close as we remain physically distant for the health of country.

Musical Messages®

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Sleep’s Gift to Immunity – Monocytes, Macrophages, and Natural Killer Cells

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“Sleep has been shown to be an important modulator of the immune response,” said Dr. Denise Sharon, MD, PhD, and Diplomate in Sleep Medicine. “Lack of sleep increases susceptibility to infection by decreasing immunity.” Dr. Sharon is a psychologist and physician and she now serves as Independent Consultant at Pomona Valley Medical Center’s Adult and Children Sleep Disorders Clinic.

Dr. Sharon previously served as Associate Professor of Medicine, Sleep Medicine Fellowship Faculty, and Assistant Clinical Professor of Pediatrics at the Tulane University School of Medicine in New Orleans, and also as director of the Comprehensive Sleep Medicine Center of the Gulf Coast.

“Sleep is a behavior,” Dr. Sharon explained, “and it is an important one for health.” Pointing to research by Besedovsky and others, “Sleep and immune function” in Pflugers Arch European Journal of Physiology, Dr. Sharon says, “Sleep supports the immune system through the initiation of an adaptive immune response.”

“There are two major types of immune response: innate and adaptive. Innate immunity is the first line of defense, the immediate generalized response to pathogens,” explained Dr. Sharon. “Adaptive or acquired immunity is an antigen-specific response and develops over time. The innate immune system cell types include monocytes, macrophages and dendritic cells. During sleep these undifferentiated immune cells peak in the peripheral blood and lymph nodes.”

“Growth hormone and prolactin are released during the same period of sleep and both enhance the proliferation and differentiation of the T cells, which are active in innate immunity. Natural killer cells–NK cells–are also affected by sleep,” she said, citing the research by Reis and others. “NK cells are part of the immune complement system whose activation is increased by sleep.”

“Sleep and immunity have a bidirectional relationship. The stimulation of the immune system triggers an inflammatory response that can induce an increase in sleep duration and intensity, but also sleep disruption. The enhanced sleep potentiates the immune system resulting in improved infection outcomes,” she said.

“Contrarily, sleep deprivation can lead to susceptibility to infections and if chronic to systemic low-grade inflammation,” she explained pointing to a 2019 study by Besedovsky and Lange, “The Sleep-Immune Crosstalk in Health and Disease” in Physiol Rev.

“There are huge numbers of people who are sleep deprived,” she said. “And it is a state in which negative emotion tends to prevail, like other strong need deprivation states.”

Clinical psychologist Dr. William Waters, long-time expert in the area of sleep would agree. “The whole country is sleep deprived,” he said in a previous interview. “You can’t do sleep deprivation research without feeling a little scared about traveling on the highway at night or early in the morning.”

Dr. Waters developed his interest in sleep during his years as Clinical Director at Louisiana State University throughout the 80s. An ABPP in clinical psychology with a strong psychophysiological background, Dr. Waters trained psychologists in sleep research and sleep medicine while Director and Full Professor at LSU. His first publication in the area of sleep was also in the 80s. He continues his interest at the Sleep Disorders Center at Ochsner Clinic in Baton Rouge.

“It’s not just sleep deprivation,” he said, “but the quality of sleep is very poor for many of those who actually do get enough sleep. For example, sleep apnea produces fragmented and light sleep that is not restorative, and causes the same functional decrements that are caused by sleep deprivation, including negative affect.”

Dr. Waters has worked in several areas of neuroscience research at the University of Missouri School of Medicine, LSU and the Pennington Biomedical Research Center. He holds fellowship positions in the American Academy of Sleep Medicine and he sits on the Board of Directors of the Louisiana Academy of Sleep Medicine. He is a Diplomate of the American Board of Sleep Medicine and the American Board of Professional Psychology.

Researchers have found that poor sleep patterns appear connected with a number of chronic illnesses, high stress hormones, hypertension, or a greater risk of diabetes and body mass.

“…And increased morbidity and increased mortality,” noted Dr. Sharon. “If we add intermittent hypoxemia, even mild, to the mix, the result is an inflammatory response that challenges the autoimmune system and contributes to plaque build-up.”

“Look for a middle-aged, overweight male or female,” said Dr. Waters, “and you are likely to find a problem with quality of sleep because they are likely to have sleep apnea. For psychologists, it is worth noting that sleep apnea will look a lot like depression,” he said.

As important as a full night of quality sleep is, the National Sleep Foundation’s data has revealed that 33.7 percent of responders said they did not get the amount of sleep they needed. And only 40 percent said they get a good night’s sleep every night or almost every night.

“The one thing that will reliably destroy sleep is stress,” Dr. Waters said. “No matter what the psychiatrists say, it is all continuous. If you want to take a point on the continuum and call it a disease you can. But stress–the psychophysiological responses–are aimed at getting you to deal with threat,” he said. “And then how likely are you to go to sleep?”

“Keep in mind that negative emotion is a stress response,” he said, “and therefore predictably disrupts sleep, delaying its onset, and making it light and interruptible. In other words, non-restorative.”

Helping a person get the rest and quality night sleep he or she needs was one of the first things that Dr. Sharon enjoyed in this specialty area. “Coming from psychiatry,” she said, “the first thing I liked about sleep medicine was instant gratification. The majority of our patients [obstructive sleep apnea, narcolepsy, restless leg syndrome] improve immediately after diagnosis and correct treatment with minimal if any side effects.”

“Sleep is the kind of area that clinical psychologists should be doing, it is just made for us,” Dr. Waters said. “We have a whole scientific discipline at our fingertips that is applicable.” He explained that the basic principles of behavior, applied to the treatment of sleep, is a perfect fit.

“Sleep hygiene and stimulus-control therapies are nothing more than applying what we know about sleep related behavior to make the person more likely to sleep,” he said. “Relaxation therapy is what we do to tone down activation. And remember that it is activation, particularly emotional activation, that causes insomnia and reduces the quality of sleep.”

Walter C. Buboltz, Jr. PhD, Professor, Director of Training Counseling Psychology, and his team of researchers at Louisiana Tech have worked to help unravel some of the complex issues in the area of sleep, for college students.

“Basically what we’re finding is people that have poor sleep quality tend to consume more food and weigh more over time,” said Dr. Buboltz, “Our hope eventually is to give them interventions or strategies to sleep better which would keep them healthier and decrease their weight.”

Dr. Janelle McDaniel, currently at University of Louisiana Monroe, and previously Assistant Professor and part of the team at Louisiana Tech, said, “It’s important to consider the interaction between different factors such as sleep and eating habits when thinking about wellness globally because treating one particular factor may not address underlying conditions.”

Dr. Buboltz and his team developed an intervention program for college students called the Step Program. “It’s basically training students to learn appropriate sleep habits, sleep hygiene and sleep education.”

Sleep hygiene, explained Dr. Buboltz, is “Doing things that promote sleep, like not drinking coffee past five, not working out at midnight or eating a lot of food before bed, but relaxing before going to sleep.”

Dr. Buboltz noted that their goal for these types of studies was learning about what’s appropriate. “Most people don’t know you’re supposed to sleep eight to nine hours a night. Most people don’t know about the amount of caffeine in food. Chocolate is actually worse for caffeine content than Coke! Colleges are bad about having intramural sports events at nine and ten o’clock at night and that prevents them from going to sleep.”

“We’re mainly focused on its effect on health,” Dr. Buboltz said.

With the overlap between major areas of psychology, psychophysiology, attention, emotion, Dr. William Waters finds this area to be perfect for those in psychology and the health promotion of patients. “The best clinician you can have is one with an integrated perspective,” he said.

Current research suggests that seven to nine hours of uninterrupted per night is necessary for the immune system to function optimally.

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Gov. Edwards Establishes COVID-19 Help Desk for Louisiana Businesses

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Gov. John Bel Edwards and Secretary Don Pierson of Louisiana Economic Development announced the opening of an LED help desk that provides email and hotline support for Louisiana businesses impacted by COVID-19.

For COVID-19 business questions, LED may be reached at LEDbiz@la.gov or via the toll-free hotline, (833) 457-0531. The COVID-19 hotline is staffed from 8 a.m. to 8 p.m. Monday through Friday.

“Louisiana has experienced the fastest rate of increase for confirmed COVID-19 cases in the world, and it is imperative that everyone in our state take part in the efforts to slow the spread of this disease,” Gov. Edwards said.

“Businesses are making tremendous sacrifices to slow the spread, and resources are available to help businesses navigate this crisis. If your business has questions, please make use of the resources that Louisiana Economic Development has made available to you.”

“This LED help desk is the latest of our efforts to serve Louisiana businesses and to help them sustain operations through the challenges presented by COVID-19,” Secretary Pierson said.

LED is working with all levels of government and the private sector to support Louisiana businesses and their employees during the COVID-19 pandemic. At the LED website — OpportunityLouisiana.com/covid19 — businesses may find workplace guidance from the Governor’s Stay At Home Order and other proclamations; COVID-19 public health recommendations; sources of COVID-19 financial aid; regional resources across the state.

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Psych Board’s Ambitious SB 458 Filed in March

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A 23–page document, Senate Bill 458, outlining an ambitious set of changes to the psychology practice law was introduced on March 31. The legislative effort was initiated by the Louisiana State Board of Examiners of Psychologists (LSBEP) and is authored by Senator Jay Luneau from Alexandria.

If passed SB 458 will make sweeping changes to the psychology law including a new set of regulations for assistants, additions to the charter of the board, changing qualifications for serving, authorizing the board to conduct continuing education, exempting the board from Open Meetings Law for investigatory meetings, and formally establishing the position and duties of the Executive Director.

The measure is on hold after officers from the Louisiana Psychological Association (LPA) For Now, Behavior is the Key attended the public meeting of the board, held on Zoom, Friday, April 3, and raised objections. Attendees included current President Alan Coulter, President-Elect Erin Reuther, and Chair for Professional Affairs, Kim VanGeffen.

Following discussion on several matters regarding both how the bill was initiated and the content of the specific changes, Dr. Greg Gormanous, Chair of Legislative Affairs for LSBEP, put forth a motion to establish an Ad Hoc Legislative Collaborative Committee composed of members from LPA, the Louisiana School Psychological Association, and the Louisiana Academy of Medical Psychologists.

After discussion with LPA Pres. Alan Coulter, Dr. Gormanous also put forth a second motion to agree that SB 458 would not proceed forward unless and until participants in the Collaborative Committee arrived at a consensus, through good faith efforts.

The Times asked Dr. Gormanous, if the board had contacted any citizen in or citizen groups, for initiating legislation. He replied no. The Times also asked if the board had conducted a formal vote about filing legislation to which Dr. Gormanous also answered no.

SB 458 covers a variety of changes to the practice act. One of the significant areas a new category of “Registered Assistant to Psychologist.” This is to be, “§2356.4. Assistants to psychologists; registration, supervision, renewal, lapse, termination, reinstatement, and scope of practice.”

New language includes the following: “B. Upon employment of an assistant to psychologists, but prior to performance of psychological duties by the assistant to psychologists, the psychologist of record who is licensed under the provisions of this Chapter shall submit a complete application for registration, the registration fee, and other information as may be required by the board. The application fee for registration of an assistant to psychologist shall not exceed one hundred dollars.”

The board’s criteria for issuing a certificate of registration as an assistant to psychologist includes

“(5) Possess minimum qualifications commensurate with the services to be provided by the registrant as defined in the rules and regulations of the board.

“(6) Has supervised training commensurate with the services to be performed by the registrant as defined in the rules and regulations of the board.

“E. (1) The services and duties of a person registered under this Section as an assistant to psychologists is limited to psychological services authorized by the board, that are commensurate with their education and training, and under the direct and continuous supervision of the psychologist of record who is licensed under this Chapter.

“J. (1) The board may deny or revoke a registration that is in the best interest of public, health, safety, and welfare for any unethical, unlawful or other unprofessional conduct brought to the attention of the board under the jurisdiction of this Chapter. […]

“L. (1) The psychologist of record shall, during the month of July of each year, beginning in the year immediately subsequent to the initial registration of the assistant to psychologist, submit to the board a renewal application as prescribed by the board and renewal fee. The renewal fee shall be determined annually by the board and shall not exceed seventy-five dollars.

“N. The provisions of this Section shall not apply to medical psychologists utilizing assistants under the provisions of R.S. 37:1360.61 under jurisdiction of the Louisiana State Board of Medical Examiners.”

The new legislation would also make additions and changes to “Practice of psychology,” including:

“(a) Psychological research…

“(b) Psychological research and test development.

“(h) Provision of direct services to individuals or groups for the purpose of enhancing individual and organizational effectiveness.

“(i) Using psychological principles, methods and procedures to assess and evaluate individuals for the purpose of rendering an expert opinion and diagnosis in a legal setting.

“(j) Using psychological principles, methods, and procedures to assess and evaluate an individuals’ personal characteristics for individual development or behavior change or for making decisions about the individual.

“(k) Supervision and consultation related to any of the services described in this Chapter. […]

“Psychological services may be offered in a variety of settings including, but not limited to private and public clinics, hospitals, schools, universities, legal settings, that include civil, criminal and family court, and prison systems, government organizations and departments.”

The LSBEP also proposes to change the qualifications for board members, and remove the wording for board members to have practiced “for at least five years.” Then they seek to add the following: (b) No more than two early career psychologists shall hold a seat on the board at any given time.

Also under §2353, regarding organization, the proposal would make formal the position of executive director.

“(3) The board shall appoint an executive director who shall be an unclassified employee of the state. The executive director shall receive a salary determined by the board along with reimbursement for the actual and reasonable expenses approved by the board, in connection with the performance of official duties […].”

A listing of the duties includes: the daily operations of the board and implementation of board policy, the supervision and direction of all employees of the board, and the performance of complaint investigations.

Also under the section on organization, the board seeks to expand its charter. Some of the new duties are:

. “(8) Administer oaths, in the taking of testimony at any hearing before the board or appoint a designee by resolution or contract to administer oaths upon any matters relative to the duties of the board or violation of this Chapter.

“(9) Issue subpoena or appoint a designee by resolution, to require attendance, testimony, and the production of documents to enforce the laws and rules relative to the practice of psychology and to secure evidence of violations thereof.

“(10) Take emergency action in accordance with the provisions of R.S. 49:961: (a) If the board finds that the public health, safety, and welfare require emergency action and incorporates a finding to that effect in its order, a summary suspension, revocation or other action. […] (b) The board may delegate by resolution to the executive committee, the authority to issue an order of summary suspension when it is determined that the public health, safety and welfare requires emergency action. […]

“(13) Establish an executive committee with authority to establish through formal action to execute certain tasks and duties of the board, including but not limited to issuing subpoena and summary suspension authority, and utilized to facilitate the proper functioning of the board.

“(15) Provide education to licensees and to the public relating to the purpose of the board, applicable laws and rules, and public health, safety, and welfare as it pertains to the practice of psychology.”

SB 458 also lists numerous changes in authority to collect fees and to exempt meetings of the investigatory process from Open Meetings Law. The new language would be, “All proceedings in connection with any investigation by the board shall be conducted in closed session, and are exempt from the provisions of the Public Meetings Law pursuant to R.S. 42:17(A)(4).”

SB 458 can be found at https://legis.la.gov/legis/ViewDocument.aspx? d=1168057

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The Call of the Wild

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A Review

by Alvin G. Burstein

For decades, H. L. Mencken adorned the public sphere as an acerbic social, political critic and literary critic. Said to have coined the term Booboisie, he opined, “On some great and glorious day the plain folks of the land will reach their heart’s desire at last, and the White House will be adorned by a downright moron.”

When he wasn’t spearing the electorate, he harpooned literary icon Henry Adams thusly, “Take any considerable sentence…and examine its architecture. Isn’t it wobbly with qualifying clauses….Doesn’t it wriggle and stumble and stagger and flounder?”

Clearly, he wasn’t a man given to formulaic praise. That gives his evaluation of Jack London’s The Call of the Wild special weight: “No other popular writer of his time did any better writing than you will find in The Call of the Wild. Here, indeed, are all the elements of sound fiction.”

I had read the book as a young boy, remembering mostly the emotional scene when his owner, having staked his all on the ability of his sled dog to pull a load of a thousand pounds, pleads with the animal, “As you love me, Buck.” And Buck rises to the occasion. The dog lover in me still feels misty about it.

Before seeing the 2019 film, I re-read the book. The focus of this review will be on their differences.

The film’s visuals capture the majesty of the north land in a spectacular way. But the novel’s focus on Buck’s transition from favored status to forced servitude, to dedicated but savage sled dog, to mystical lupine master are trivialized and blurred in the cinematic version. Buck is an almost cartoonish, a clown, in the film’s opening scenes turning his being beaten into obedience into a different kind of humiliation.

The novel captures the harsh physical demands of sled dogs’ lives and their desperate, urgent need for food of any kind in ways that the film glosses over. The book also highlights the compelling force of habitual accommodation—what William James called the great flywheel of behavior—that eventuates into Buck’s dedication to his role as leader of the dog team.

The most striking divergence between the two accounts has to do with the fate of John Thornton, the object of Buck’s love. In the book, Thornton is killed by Indian savages, upon whom Buck wreaks murderous revenge. In what is a nod to current convention, in the film Thornton is shot by one of Buck’s early Alaskan exploiters, and dies while Buck attempts to comfort him.

Plot-wise, the manner of Thornton’s death distracts from one of the book’s central foci, the deep ancestral call that draws Buck away from what most would call civilization into a savage and primitive state, one with its own stark beauty.

And on a personal note, the dog lover in me wanted to see Buck’s response to Thornton’s “as you love me.” That scene, alas, is omitted in the film.

I can’t imagine what H. L. Mencken would have to say about the movie. What I say is, “Read the book.”

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Stress Solutions

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A Map for Dealing with the Uncertainly, Chaos, and Change

More trying times than this one is hard to imagine. Most of us remember Katrina. The last pandemic was the Spanish Flu in 1918 and none of us remember that. It is cited as the most devastating epidemic in recorded world history killing between 20 and 40 million people in about 2 years, more people than were killed in WWI or in 4 years of the Bubonic Plague. We were not helpless then and we did survive it. It did come to an end. And, we know so much more now than we did then. We have more tools with which to fight now

A key ingredient in this bitter stew we are all in is Uncertainty. Uncertainty is the Mother of Fear. And, fear gives birth to anxiety. The rules for how we are supposed to live and conduct business change daily. We are frankly being bludgeoned 24 hours a day with fear producing information over the TV and internet. Friends, family, colleagues, patients and clients are calling, texting, emailing to express their fears about the Unknown. No rules govern this global crisis, least of all how long it will last. Or, who will survive?

Everything about our way of life is threatened. People are afraid of dying should they test positive for Covid-19 – or maybe people they love will die. People are afraid they might not be able to pay their bills, might lose their home, or lose their job. They fear a shortage of provisions that they need to survive. The isolation, loneliness, is even harder to manage for many.

Over fifty percent of the American population are estimated to have significant worry and anxiety and most everyone would agree that they are stressed. We face a distinct danger of not staying emotionally healthy if we are unable to manage our fears and Cont next pg stress. There is danger to our immune system if the stress and anxiety are allowed to blossom and grow unchecked. In a nutshell, stress weakens your immune system. This new virus is particularly dangerous to those with a weakened immune system because of a reduced ability of the system to fight off antigens. And, cortisol suppresses the production of both Tlymphocytes and antibodies, which leaves body more vulnerable.

Of course, it is important during this period to use all the stress reduction techniques you have in your toolbox. On a daily basis, get good sleep, eat more natural foods, monitor your thoughts, take time for things like meditation and exercise. However, the epic scale of this coronavirus calls for more. Major chaos calls for significant and conscious change. Reducing the impact of the Covid-19 requires a new map, one that plumbs the depth of what matters to us. All over the world, people are being asked to shelter at home or to quarantine yourself if you have been exposed. Use this time as an opportunity to pause, push in the clutch, and reevaluate how you are living your life. Think about more deep questions, like what matters most to you. During your shelter at home days, consider taking one or two days to completely disrupt your schedule and routine, like doing a retreat in your own living space.

What would that look like? Take off your professional psychologist’s hat and clear your schedule or list of your usual routine. Maybe you do this with a significant other who is socially isolating with you. This is a time to dream about what changes you would like to see in the world. Possibly the coronavirus pandemic is presenting us with an opportunity to make major change. Maybe you do your dreaming and pondering alone and later connect by phone or internet with a small support group to discuss your thoughts and share your dreams and visions with others.

Consider what this virus might mean, might symbolize about our world. Many of our philosophers have commented on how compassion is growing more and more absent in the world. Oh, not everyone lacks compassion, but it is in short supply. Turf wars still light up the skies with new and better ways to kill each other. We notice the turbulence, but in this busy world, we rarely stop to feel compassion for those who are involved. So many people who are in pain need our compassion. We all have patients or clients that are more anxious and fearful than ever.

How might Covid-19 change our world? Don’t just focus on the negatives and the fears when considering this question. Of course, the negatives will come up first. Write them down and then look beyond. What good things might come from Covid-19? A friend sent a copy of a letter from Dr. Jean Houston to me, which is currently trending on the internet. Jean Houston earned Ph.D.’s in both psychology and religion. She is a writer, lecturer, a leader in the Human Potential movement, and was a close friend of Margaret Mead. Her letter beautifully describes one future that possibly is growing out from the Covid-19 chaos. That change could be increased compassion among the peoples in the world. Dr. Houston wrote: “All of my life I have been dedicated to encouraging the potential that every person carries within them. I’ve taught about our innate depths, our possibilities, and our purpose. Now, however, it’s time to live out the promise that we all carry, to become noble, kind and compassionate people. This week on television, I witnessed the best and most fearful sides of our natures. On the one hand, I saw violent videos of shoppers fighting over toilet paper, and also experienced indiscriminate generosity while shopping at my local Costco.”

Dr. Houston is not alone in what she reported. We have all witnessed firsthand or heard on the news of the juxtaposition of the best and the most feared sides of human nature coming out in this crisis. The fights over toilet paper are in direct contrast to the kindness and caring shared by people waiting in line. Restaurants turning into soup kitchens and being willing to feed hungry people in the area is happening in urban areas. Generous donations by famous people, like Drew Breese for food for those who have lost their livelihood during this crisis.

In the past, I have personally witnessed an entire bus load of 5 o’clock commuters in NYC yelling at the driver to wait and to reopen the bus door to let in one person so that they could escape the foul weather. Is it possible that Covid-19 will bring more of that kindness and compassion to the world? I believe that if we spend some of our retreat time contemplating how we can each show more compassion in our own communities, that our own burdens will become lighter.

So, what else could you think about when you take time to retreat? Spend time contemplating what really matters to you. We are all different and there is no “correct” list. But, maybe try to write down things that really matter to you and then try to pick out those that are most important to your growth and well-being.

Another important thing you can do is to spend some time thinking about your beliefs. Too many people are falling into the trap of believing all the negative things that are on the news. Make it a point to monitor and limit the amount of time you spend watching network news or searching the internet. Search out your destructive and negative beliefs. Change them to include the positive information that is less publicized. For example, here is some positive information. Most cases are not that serious and now there are over 100,000 full recoveries worldwide. China and South Korea are reporting a huge drop in new cases as a result of their tough restrictions. The Covid-19 death rate is actually lower than WHO estimated. Research and experimentation to find drugs and treatment for this new virus is making good progress and that should reduce the number of deaths. This would help bring back sanity. Apple stores are reopening in China; other stores are expected to follow. Cleveland’s MetroHealth Medical Center has developed a test that can give results in 2 hours, not days. A pharmaceutical giant announced a test that will take 7 minutes and the FDA gave permission for it to be mass produced and distributed.

Along the same lines, take control of your thoughts. Practice some of what we all preach: Cognitive Behavioral Therapy – we know how to argue and challenge the logic of our fears. Monitor your thinking so that you can stop worrying about things over which you have no control and no voice. Stop worrying and change what you are thinking about. If you cannot do that without help, then pick up a funny or exciting book, or watch a Disney movie, or experiment with the magic of your imagination. Decide upon a project that is long been on your list and start working on it. This is an opportunity to make new choices and find new directions. Activate your imagination, dream and explore those dreams and visions in your mind. Consider these next weeks like an unexpected vacation and use it to work on things you have on your “to do list.” Or, take this time to play and make sure you keep humor in your thoughts. Watch cat videos on YouTube; they are guaranteed to make you laugh.

Have you ever pondered this mystery? “Somehow things always seem to work out.” Look back in your own life and find a time when you were sure things would end badly but they magically seemed to work out. Or, recall similar stories from your clients. I remember one client who was sure they were going to lose their home after Katrina. But, in the end, they wound up with an even better one.

I know we are all feeling the pain of disrupted work and career, the drama of possible critical supply shortages, the boredom of staying home and socially distant from others. Keep in your mind that it is what you think about and what you do that determines your mental and emotional health. Recently a friend met me for coffee wearing a tshirt that read: “If you can be anything, be kind.”

Jean Houston closed her letter with these words:

“Take all the precautions that are recommended and at the same time, be bold in your love, and constant in your faith that together we will pass through this challenging time. On the other side of it, we will look back and realize that we were part of an epic time in history when caring triumphed over fear, and goodness prevailed!”

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Dr. Buckner Named for Research Excellence

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Louisiana State University Professor Dr. Julie Buckner has been named the G. Alan Marlatt Mid-Career Research Award winner for 2020, announced at this year’s annual meeting of the Association for Behavioral and Cognitive Therapies (ABCT) Addictive Behaviors & Anxiety Disorders Special Interest Group.

Julia Buckner is a Professor and Director of Clinical Training in the Department of Psychology at Louisiana State University and the Director of LSU’s Anxiety and Addictive Behaviors Laboratory & Clinic. She is also a Clinical Associate Professor in the Department of Psychiatry at LSUHealth Sciences Center and a Visiting Professor at the London South Bank University School of Applied Sciences. She is also a licensed clinical psychologist.

The awards committee said, “Among the multiple renown and highly-productive researchers who were nominated this year, you were the unanimous choice of the award selection committee. The praised her “pioneering work on the role of anxiety in substance use and related problems as well as her commitment to the development of innovative treatments for addictive behaviors, her research with historically underrepresented groups, her work to disseminate evidence-based practice to Baton Rouge (a high need area), and her outstanding mentorship and commitment to teaching…”

Dr. Buckner said, “I am honored to have received this award. Alan Marlatt was committed to both research aimed at understanding substance misuse as well as the translation of evidence-based findings to help improve treatment outcomes. Receiving this award highlights my research on the impact of psychosocial vulnerability factors such as anxiety on the etiology and maintenance of substance use disorders and research on ways to best treat dually diagnosed patients.” She explained that these patients, such as those with comorbid anxiety and substance use disorders tend to have poorer treatment outcomes.

Dr. Buckner’s program of research primarily focuses on: (1) delineation of causal and maintaining factors implicated in substance use disorders, especially the role of affect-related vulnerability factors; and (2) development and evaluation of empirically-informed treatment and prevention protocols for substance use disorders, including treatment for cooccurring anxiety-substance use disorders.

Dr. Buckner has had over 150 publications and has been involved in several NIH grants. She is currently Primary Investigator on a graduate education training grant from the US Department of Health & Human Services’ HRSA to integrate clinical graduate students into Our Lady of the Lake Hospital in Baton Rouge to bring evidence-based psychotherapy for substance use disorders, with a particular focus on treatment for opioid misuse. She has also received awards from organizations such as the American Psychological Association, College on Problems of Drug Dependence, Anxiety Disorders Association of America.

The award is in honor of Dr. G. Alan Marlatt for his distinguished career as a pioneer and innovator in cognitivebehavioral therapy and research on addictive behaviors.

Dr. Buckner said, “This award is unique in that it also highlights our work that more directly impacts the lives of individuals in Baton Rouge who are suffering from these conditions, including our efforts to bring MET-CBT for substance use disorders (including those with dual diagnoses) to several locations throughout Baton Rouge, including the 19th JDC Adult Drug Treatment Court Program, Our Lady of the Lake’s outpatient clinic Center for Psychiatric Services, and thanks to a recent HRSA grant we received from the US Dept of Health & Human Services, to several units in OLOL Hospital.”

Also at this year’s conference Kayce Hopper was awarded the Outstanding Student Poster award for her poster, “Dual electronic and combustible smokers use of cannabis in relation to pain and hazardous drinking.”

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DOJ Asks Judge for More Time to Answer Dr. Hesson’s 2255 Petition

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On February 12, prosecutors at the Department of Justice asked for a second extension to respond to a 2255 Petition by Dr. Rodney Hesson, who was at the center of the 2015 high profile Medicare fraud case that resulted in convictions of two other well-respected psychologists in the community, Dr. Beverly Stubblefield and Dr. John Teal.

Dr. Hesson filed 829-pages of documents and exhibits with the United States District Court, Eastern District of Louisiana on November 1, 2019, alleging violation of his Constitutional rights to a fair trial due to inadequate representation.

A 2255 petition is a motion under 28 United States Constitution §2255 to vacate, set-aside, or correct sentences for a person in federal custody.

Among other assertions, Hesson alleges that his rights were violated when his defense attorney failed to “move the court” to issue a jury instruction which would have identified the governing Medicare rules and regulations that Hesson relied upon in his clinical and billing practices. In contrast, prosecutors focused on CPT codes. The failure to explain Medicare regulations caused numerous “prejudicial consequences which were overwhelming…” Hesson writes.

Representing himself in the Petition, Hesson argues that the jury was not given instructions as to how to understand critical Medicare regulations and rules, and if they had, their understanding would have been the basis of a “complete defense.”

“In the end, not even one governing Medicare regulation was presented in the court’s instructions to jurors,” he writes, “leaving jurors unable to determine that the billing procedures were based on Medicare regulations, CPT codes being only a part of the more complex Medicare guidelines, and that Hesson relied on these regulations in good faith.”

If jurors had been made to fully understand, he explains, that Hesson’s company, Nursing Home Psychology Services (NHPS) passed a 2011 Medicare audit and review of its procedures for billing, and also that in 2012 he voluntarily asked Civil-DOJ to review NHPS billing procedures, then jurors would have concluded that he did not have any intent to do fraud or make false statements, he writes.

In the fact-filled 2255 Petition, Hesson argues that the jury was not instructed nor allowed to understand the official regulations, which would have successfully countered the prosecutors’ theory of fraud, and more importantly, their “theory of conspiracy.”

In response to the November 8 Petition, Judge Carl Barbier ordered that the US attorneys file a response to Hesson’s arguments by January 7. In December the prosecutors filed a motion for additional time and then again in February prosecutors asked for more time. Judge Barbier granted both extensions. The US response is now due on April 6, 2020.

Hesson’s company, Nursing Home Psychological Services (NHPS) consulted with and served up to 72 nursing facilities and employed between 23 and 26 psychologists and between 18 and 20 clinical coordinators. Hesson designed a service that paired each psychologist with a clinical assistant, and the total units/hours billed was a sum of both the psychologist’s and the supervised assistant’s procedures. Consulting with the staff at the nursing home and working from physician referrals were part of the program for diagnostic testing of patients.

Three main NHPS practices formed the basis of the charges against Hesson: use of clinical assistants, medical necessity, and “locum tenens” billing, of one psychologist under the agency Medicare number of another.

In the Petition, Hesson argues that each of these business practices would have been shown to be legal and valid, or a good faith reliance upon them at the least, if the jury would have been caused to fully understand the Medicare regulations and rules. And, his company’s willingness to undergo voluntary reviews by Civil-DOJ would have countered any conclusion of “conspiracy.”

The 2015-2016 charges against all defendants were elevated to “conspiracy,” which carries some of the harshest legal treatment that Government prosecutors can bring to bear on defendants, through laws that allow pre-trial and pre-conviction seizing of assets and property.

“Conspiracy” laws originate from prosecution of individuals in organized crime and terrorists. “Federal prosecutors can, and should, use civil forfeiture to enhance criminal cases and further the Department of Justice’s (Department) goal of effective law enforcement,” writes Craig Gaumer in the U.S. Attorney’s Bulletin, “A Prosecutor’s Secret Weapon: Federal Civil Forfeiture Law.

Even the Judge, notes Hesson, commented on the unusual circumstances of the case. Before the trial began, Judge Barbier said, “You know, in many criminal cases, the defense is: I didn’t do it. I didn’t commit the act you said I committed. I didn’t have a gun, I did not do whatever it is. But in this case, as I understand it, the defendants are saying: we did what we did, but we didn’t believe it was illegal to do what we did.”

And, the transcript confirms that confusion. The Judge acknowledged that he had not reviewed the regulations and stated, “I have seen references to them in all the pleadings, all the memoranda that have been filed. They said these are very complex regulations, does it pretty much say in black and white under 101 and 102 what you can do and not do?“

Prosecutor’s Kanellis response was misleading at best, writes Hesson: “The CPT codes are very short. What [the defense] want[s] to do is they want to muddle the picture by saying here’s a way you interpret these codes, why don’t we consider this ….”

Hesson writes that when prosecutor Kanellis reinforced his point that any interpretations about the governing law is “the Judge’s function,“ the following conversation occurred:

The Court: You’re going to propose or suggests legal instructions on that, right?

Prosecutor Kanellis: Yeah. If there’s a reason —

The Court: is there case law on this that’s relevant, on how to instruct the jury on these types of regulations?

Prosecutor Kanellis: There are cases that discuss the issue in general. I have not seen a case where they discuss the specific instructions in that regard. That’s certainly something, your honor – – I mean, the easiest thing to do is for the court to say, this is what CPT code 96101 says,” and it’s a sentence, or a few sentences. Here is what CPT code 96102 says.”

Jurors never received these instructions, Hesson writes, and so could not determine whether he and his employees reasonably complied in good faith with civil law.

Hesson and his mother, Gertrude Parker, owned and operated regional companies, Nursing Home Psychological Service and Psychological Care Services. They marketed to nursing homes in Louisiana, Mississippi, Alabama and Florida. At the trial, Hesson said that his company was “…inundated with referrals.” He said that at times the company had to cap how many people could be seen.

Physicians ordered the assessments and nursing homes appeared to need them, based in part in changing attitudes around the country and the increasing awareness about overmedication of senior citizens in nursing home care. Many sources note the under utilization of psychological services in senior care facilities. Hessen and his company, classified as a small-business based on yearly revenues, became a top biller of Medicare services.

Dr. Hesson was found guilty and sentenced to 120 months, and restitution of $13,800,553 with at least $200 per month after release, paid to Medicare.

Gertrude Parker was sentenced to 84 months, restitution of $7,313,379, and $200 per month.

Dr. John Teal was sentenced to serve 24 months, restitution of $3,505,137, and $200 per month. He has completed his sentence.

Dr. Beverly Stubblefield was sentenced to serve 30 months, restitution of $2,181,378, and $200 per month. She is home in Ecru, Mississippi. Stubblefield worked contract for the Hesson companies, part-time for about five years. She was paid roughly $89,000 per year.

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