Assembly Sets Out to Improve DB, Member Relations
Issues concerning how APA and its district branches function and relate to each other were prominent on the agenda of the APA Assembly last month during its three-day meeting in Washington, D.C.
Assembly representatives voted to respond to calls from desperate district branches, usually those in small states, whose financial resources do not allow them to hire an executive director—at least part time—to carry out "basic or core association activities" or respond adequately to state legislative proposals that threaten psychiatric practice or patient care. The Assembly endorsed a proposal from representatives of the North Carolina Psychiatric Association to have APA "evaluate the needs and cost for DBs that request support for those functions and resources essential to further the mission and goals of APA and the DBs." The proposal was forwarded to the Board of Trustees.
Members also agreed to have APA explore whether district branches could begin purchasing the benefits package offered to APA central office staff, thus making it available to district branch staff as well. This would include health, disability, and life insurance benefits and retirement plans. The Assembly asked for a report back by its May meeting after complex issues of cost, legal considerations, and insurance company requirements are explored.
Another action paper the Assembly supported that touches on the relationship between APA and its district branches calls on APA to develop a mechanism through which APA would share with its district branches and state psychiatric associations revenue from sources other than member dues. Introduced by representatives from the New York County and New York Capital district branches, the proposal points out that the revenue-sharing plan should be "based in part on the number of members and in part on need such as for legislative advocacy, public affairs campaigns, and other issues of national significance."
In an effort to make APA and district branch membership more attractive to psychiatrists working in state hospitals, of whom only a minority are APA members, the Assembly supported a proposal asking all district branches to establish the Committee on the Care and Treatment of the Severely and Persistently Psychiatrically Ill. The proposal urges the district branches to appoint state hospital and other public sector psychiatrists to a majority of the positions on the new committees. The proposal was developed by the APA Caucus of State Hospital Psychiatrists.
A far more contentious issue for Assembly members was whether to support a referendum that would limit Assembly representatives to 10-year terms.
The initiative received strong backing from the Assembly’s early career psychiatrist and member-in-training representatives, among others, but several members cautioned against imposing a new rule on territory that is the prerogative of district branches. Fewer than 20 district branches have imposed term limits, and those limits vary considerably. Proponents of the change were distressed, however, that some representatives from district branches without term limits have sat in the Assembly for 20 years or more, shutting out younger members who want to serve.
Term-limit advocates proposed a ballot referendum to decide the issue, and the Assembly backed the idea by a vote of 99 to 54. The authors withdrew the action the next day, however, when they realized the wording of the proposed referendum neglected to address several legal questions about the referendum and Assembly governance process. It will come back before the Assembly at its May meeting in Chicago.
Assembly members also voted to have the APA Ethics Committee study the issue of "whether it is within the ethical guidelines to inform patients about issues that would affect their care," and if not, whether APA should begin the process of changing its ethics guidelines to permit this. This action paper noted that several times in recent years, legislation on topics such as managed care, medical-record privacy, parity, and nonphysician prescribing has been on the agendas of state and federal legislatures. While many psychiatrists believe patients should be alerted to potential laws that will affect their care, they have "felt hampered by the perception that it would be unethical to ask a patient to support any cause that is of interest to the psychiatrist and APA, even if such a cause would directly and mostly benefit the patient," the proposal suggests.
The Assembly also agreed to have the Program Committee of the APA Institute on Psychiatric Services sponsor a debate each October between candidates for "major APA offices." This action, which now goes to the Board for approval, was introduced by the two candidates for APA president-elect, Richard Harding, M.D., and Roger Peele, M.D.
The largest block of the Assembly’s meeting time was devoted to a discussion of substantial cuts that the Board of Trustees has identified for the Assembly. Members debated, often passionately, whether the cuts would interfere with their ability to represent their constituents and whether the Board was acting properly in planning to impose cuts of about $200,000 if the Assembly did not do so on its own. The Assembly wanted more information about the Board’s suggested cuts and more time to evaluate options, so it voted to have its Executive Committee develop preliminary recommendations by January 28, which would then be forwarded to the seven Area Councils for response. The Assembly would then decide on a list of cuts at its May meeting. The money saved would be used primarily to assist district branches with critical legislative and educational initiatives.