WHAT IF ?

Eating disorder therapists are the valued “foot soldiers” in the community. They are on the front lines. They have the most interaction with those suffering from this illness. They are exposed to the ugliest aspects of this insidious illness. What an incredibly difficult career path.

And yet families should not just expect, but demand, that therapists always place their patient’s needs first and foremost. Therapists have the duty of good faith with their patients. Their patient’s needs must always come first. A patient’s recovery is the paramount goal.

The therapist’s job is maddeningly difficult. It requires intelligence, creativity, empathy, compassion, wisdom, strength, resiliency. It requires the therapist to not just listen, but to understand the complex relationship between their patient’s pain, the therapist’s seasoned experiences and knowledge of the latest technologies and evidence-based treatments.

Therapists have the ability to take a patient by the hand and walk with them on a perilous journey which hopefully leads to a future life filled with happiness and love. To accurately assess progress on this journey, a therapist must take and keep session notes. These notes constitute not just a foundational reference to rely upon for future sessions but also illustrate a path of recovery for those loved ones entrusted to their care.

However, what if a therapist fails in her duties?

What if that therapist for an extended number of years does not take any treatment notes for a patient?

What if that therapist then creates a dual relationship and employs that patient at the same time that person is receiving therapy from the therapist?

What if that therapist then misclassifies the patient as an independent contractor instead of an employee in an attempt to avoid taxes?

What if that therapist then also utilizes her patient to organize, edit and publish that therapist’s podcasts without even publicly recognizing that patient’s work?

What if that therapist then fires the patient from her employment position?

What if, as soon as that patient is fired by that therapist, the therapist’s podcasts were discontinued?

What if that therapist also abandons the patient by stopping her much needed therapy?

What if that therapist then admits to that patient’s subsequent therapist that she may have crossed the line?

What if that therapist also admits to that patient’s subsequent therapist she had not taken any session notes for that patient?

What if a failure to take notes is an obvious and blatant violation of Massachusetts’ statutes and code of ethics for therapists?

What if that therapist then attempts to draft session notes and a summary of therapy years after those sessions had taken place?

What if that therapist then transmits those falsified documents to the patient’s subsequent therapist?

What if that therapist then has the attorney assigned to her by her D&O insurance carrier transmit those “therapy notes and summary” to the attorney representing her former patient?

What if those “therapy notes” show the therapist submitted notes for only 54 sessions and invoices for 216 sessions?

What if those therapy notes were supposed to be representative of weekly sessions for over a ten-year time period and as such, were completely inadequate and deficient?

What if the aggrieved patient, pushed to the limit by her therapist’s wrongful conduct, then has to resort to litigation because of that therapist’s wrongful conduct, violations of Massachusetts tax laws and misclassification as an independent contractor?

What if that patient’s subsequent therapist deemed that therapist’s conduct so egregious that she files an ethics complaint with the Massachusetts licensing board?

What if that patient justifiably is in the process of filing a separate ethics complaint against her former therapist?

What if that therapist’s conduct exacerbated the patient’s mental health condition instead of improving it?

What if that therapist’s ego was such that despite not being a medical doctor nor psychiatrist, she named her practice which purportedly specializes in eating disorder care using her own name?

That is certainly a lot of “what ifs.”

So much so that one may wonder about and question the authenticity of those “what ifs.” And yet, those “what ifs” are true. Review the many “what ifs.” They are not speculation nor subject to vague interpretation. They are based upon a therapist’s past conduct and statements of fact.

As such, why would any family entrust their greatest treasure, their child or loved one, to that therapist? For that matter, how would families even learn about that therapist’s conduct? Conduct that is critical and is a crucial consideration for any family allowing them to make an informed, intelligent decision.

And so that therapist is now facing not just one, but two ethics complaints with the Massachusetts Bureau of Health Professions Licensure Agency.

But the troubles for that therapist do not end there.

Ethics complaints will also be filed with iaedp, MEDA and any other organization to which that therapist belongs.

Since significant tax issues are involved, complaints will be filed with the Massachusetts Department of Revenue and the IRS.

Although justifiably detrimental to that therapists, consequences for intentional wrongful conduct should have the ultimate impact of strengthening the eating disorder community. Certainly, families deserve so much more from therapists.

Oh, this therapist?

Karin Lewis and the Karin Lewis Eating Disorder Center.

Are things getting worse?

In a Facebook group I occasionally darken, a question was asked: 

“From my research, it appears that the recovery rate for EDs is not much better than it was 20 years ago. What are we missing?? I would love hearing your experiences & theories.”

Many of the responses were erudite, thought provoking and compelling. Studied contributions from true professionals. Some responses were less so. And as per usual, the “Clown Show” segment of the eating disorder community appeared and spewed forth their litany of “isms” to the exclusion of anything resembling accountability, reason, facts or logic.

In response to the question posed, the reality is … the problems in the care and treatment of eating disorders are legion and significant.

Private Equity

First, there are the PE owned treatment centers which purportedly provide a higher level of care. These treatment centers are profit driven. And the investors behind the PE firms demand that their investment be paid back… with contractual profits. The best way to achieve this monetary reality is by slashing expenses. The highest expense? Employee costs. The highest paid employees? Medical doctors.

So, we have seen medical doctors terminated or forced into retirement as full-time employees. Some may be brought back as part time independent contractors. But this obvious problem is growing.

Further, it appears as if the PE firms and their investors (who can, and do, operate with impunity) will start to turn these treatment centers into “addiction type treatment model” centers. That is, hiring more, lower paid, and lesser experienced therapists. Fewer doctors. Increase the number of lower-level employees. We are already seeing that. We will also see the ramifications and consequences from this failed treatment model.

A treatment model which is utilized to attempt to address the two mental illnesses with the highest mortality rates … opioid addiction and eating disorders.

And yet, nothing says appalling failure like overseeing and worsening the two highest mortality rates.

Insurance

Even as a growing number of therapists are turning away from accepting health insurance and only accept private pay, health insurance companies remain the engine driving the care and treatment of eating disorders.

They create and implement their own treatment guidelines. They run their guidelines through their finance and accounting departments to determine how much treatment they will agree to pay before the claim becomes financially unfeasible.

They utilize outdated and/or ineffective standards of “health determination” in deciding to terminate coverage.

And finally in many cases, an insured must show the insurance company’s decision was arbitrary and capricious in order to have that decision reversed. It is the perfect storm of avarice and lack of accountability.

Research Funding

Grants and funding for research are woefully inadequate. The EDCoalition has stopped introducing and/or pursuing legislative bills which provide collaborative funding for our research-based doctors.  At one time, they did. But that stopped about 10 years ago. Just about the time when the REDC was formed and PE firms took over.

Now, those PE owned treatment centers and their toadies pay the costs of their lobbyists. As such, they get to dictate the terms of the lobbyists’ engagement. To pursue a legislative agenda that does not include grants for research funding.

Research and university-based professionals seemingly only know of one well to approach. Most do not have the contacts nor desire to explore private funding.

Research is being ignored.

No Generally Accepted Standards of Care

There are no generally accepted standards of care for the treatment of eating disorders. Imagine the care and treatment of a potentially deadly and serious mental health illness which does not have generally accepted standards of care.

That leaves us with erratic, inconsistent and ineffective treatment therapies. For example, today it appears as if therapy has gone from “trauma informed” to “trauma entrenched.” Every small verbal slight is looked upon as a macro-aggression or “trauma with a little t.”

Concepts like resiliency, strength, self-determination and resolve have been replaced by precious fragility, hypersensitivity and expectations of being “owed something” by society. Yes, words have meaning. Absolutely. But to allow yourself to become mentally and emotionally paralyzed because of what a stranger, or third person may say to you?

Therapists

There are some incredible therapists providing insightful care who literally save the lives of many. Therapists who inspire. Therapists who have put aside their ego and go about their profession with intelligence and grace.

However, the flip side is that there are far too many inexperienced, incompetent therapists attempting to treat eating disorders.

These therapists don’t deeply study medical research. They do not understand the genetic and biological aspects of this illness. Some are still in their own recovery. Some try to bring their own social justice and political views into therapy rooms. Some have little self-awareness. Some do not wish to deal with, nor have the life skills to be able to reach those whose views on life, politics or society differ from their own.

They run from controversies which challenge their views of the world. Some have been shaped by their tribal views. And that detrimentally impacts the quality of the therapy they attempt to give.

Societal Issues

There is no doubt that societal demands impact a number of people suffering from eating disorders.  Certainly, no rational person can argue against the fact that medical and mental health services must become more available and more affordable to the African American, Hispanic, LBGTQ and other minority communities. Not just a worthy goal but an absolute necessity.

Access to care, whatever kind there may be, is out of reach for many. Stigma. Polarization. Discrimination. These issues must be addressed thoroughly and intelligently so that we may explore workable, rational solutions.

However, for the most part, eating disorder advocates are far too reductive and far too simplistic in addressing those views. They excoriate the diet and wellness industry, the food industry, the pharmaceutical industry, the medical industry and do not seek any type of understanding nor collaboration. They are mere shills who complain and criticize but provide no realistic nor practical solutions.

Instead of looking upon eating disorders through the lens of a “triage basis” supported by evidence based medical research, some advocates are more concerned with centering those whose social justice or political causes align with their misguided views.

For the sake of their own myopic beliefs, they would let the eating disorder community burn if they could be Queen of the Ashes.

Random Thoughts

If the statistics are to be believed, eating disorder mortality rates have worsened under the current “leadership.” More people are being diagnosed with eating disorders. More families in pain. The community is splintered. And still there is no call for change in leadership. No grabbing of burning torches and pitchforks.

Conferences where professionals were brought together to attempt collaboration have been sabotaged by advocates caught up in their own ignorance and self-loathing.

The mortality rate for anorexia is almost 4 times the rate of all other eating disorders. If we do not emphasize the needs of the sickest first, if we shirk our non-delegable duty to save as many lives as possible, if we choose to turn our backs on the sickest, what does that say about us as a just and compassionate society. Other than, it proves that we are the antithesis of that society.

The troubling issues are many. Recommendations on practical solutions are far too few.

We must recognize the way of doing business in the past has failed.  Not to revel in the failure of others, or like petulant children, point an accusing finger at others and repeat, “I told you so!”

But to perhaps come to the realization that instead of viewing past failed treatment regiments and community activism as being completely wrong, we view them simply as a lesson in how NOT to proceed. We actually gained productive insight and knowledge and can keep moving forward.

And with this knowledge, we can more boldly, more intelligently stride ahead into a better future. With a more open heart and mind and soul.

Death Cannot be a “Default Option”

“There’s nothing more we can do for you. It’s never gonna get any better…“

—        Some Idiot Dutch psychiatrist

States considering legalizing Medical Aid in Dying for terminal illnesses do not exclude mental health illnesses from those very same laws.  Further, the 10 states and District of Columbia which have approved MAiD have not excluded mental health illnesses.

As such, we are now getting a clearer picture of the ramifications for this lack of vision.

Protestant Theological University healthcare ethics professor Theo Boerin served on a euthanasia review board in the Netherlands from 2005 until 2014. During this time, he told The Free Press, he observed Dutch euthanasia “evolve from death being a last resort to death being a default option.”

We see that observation playing out in the media.  Following are just three stories involving physician assisted suicide in which the patient’s mental health is the primary health issue.

https://www.bbc.com/news/stories-45117163

https://www.dailymail.co.uk/news/article-13272847/Depressed-Dutch-woman-borderline-personality-disorder-euthanasia.html

https://www.bbc.com/news/world-europe-48541233

Some observations from those articles include:

“How could I know – how could anybody know – that her death wish was not a sign of her psychiatric disease? The fact that one can rationalise about it, does not mean it’s not a sign of the disease,” says psychiatrist Dr Frank Koerselman, one of the Netherlands’ most outspoken critics of euthanasia in cases of mental illness.

“My whole career I worked with suicidal patients – none of them was terminal. Of course I had patients who committed suicide, but as a matter of fact these were always cases when you didn’t expect it.”

But people can and do live for decades with psychiatric disorders. “They’re not treatable like an infection, they’re like diabetes – you’ve got the disease, you will have it the rest of your life, but we, as doctors, are going to make it possible for you to live with it,” argues Frank Koerselman.

Ter Beek decided she wanted to die after a psychiatrist told her ‘there’s nothing more we can do for you’ and that ‘it’s never gonna get any better’, The Free Press reported. [emphasis added] [As an aside, perhaps another definition of “grooming” should be, “A process used by a mental health predator to make a child or vulnerable adult an easier victim.”]

“Now, after doctors have reportedly said they cannot do anything else to help improve her mental health, she has decided she is tired of living.”

‘I see the phenomenon especially in people with psychiatric diseases, and especially young people with psychiatric disorders, where the healthcare professional seems to give up on them more easily than before,’ Groenewoud said. [emphasis added]

Debates surrounding MAiD and mental health focus on the rights of the individual versus the rights of a compassionate society. Or the cognitive capacity of an individual to make the most important decision he/she will ever make. In the United States, debate on this topic inevitably includes our insipid politicians, their room temperature IQs and their tribal mentality.

However, regarding MAiD laws, we do not discuss evolving new technologies which are meant to address the brain and its capacity to heal itself. Or how the upcoming snowflake generation seemingly characterizes every slight as an aggression or traumatic event which paralyzes them and contributes to their lack of development.

Another great concern is that the debate on Medical Aid in Dying rarely focuses on calling into question the competency of those medical and mental health professionals. Look at just a few quotes from the articles posted …

“… especially young people with psychiatric disorders, where the healthcare professional seems to give up on them more easily than before…”

“… Ter Beek decided she wanted to die after a psychiatrist told her ‘there’s nothing more we can do for you’ and that ‘it’s never gonna get any better’…”

“Now, after doctors have reportedly said they cannot do anything else to help improve her mental health, she has decided she is tired of living.”

Patients deciding they are tired of living after being told there is nothing more to be done. That their condition is not going to get any better.

We must start to address the competency of mental health providers who are involved in physician assisted suicide. Especially regarding eating disorders. Because that is the elephant in the room and the potential for an appalling rise in mental health “grooming” is very real.

In June 2023, a dissertation entitled, “A Systematic Review of Training Programs for Mental Health Professionals Who are Treating Eating Disorders” was submitted by a PsyD candidate, Shir Zion. The statistics, resource material, findings and notations included in this dissertation are alarming. The dissertation can be found here:

https://digitalcommons.pepperdine.edu/cgi/viewcontent.cgi?article=2327&context=etd

This dissertation found:

“Previous researchers have noted that psychologists historically have not used treatments that have been empirically validated due to having received minimal training and because those treatments did not address ways to mitigate concerns and comorbid conditions that people with EDs typically display (Haas & Clopton, 2003).”

“Only 6%-35% of clinicians who treat EDs report utilizing evidence-based guidelines (Waller, 2016). In fact, practicing psychologists tend to not use treatments that have been empirically validated due to having received minimal training and because these treatments do not address effective ways to mitigate general concerns and comorbid conditions that individuals with EDs frequently report having (Haas & Clopton, 2003).”

“Despite reviewing 665 articles, 14 were included in this review, suggesting that there is a dearth of quantitative research in this area. This is important, particularly for the mental health field, to note because there is a general lack of training opportunities available across settings (universities, practicum sites, and internships) for those who wish to treat one of the most enduring, complicated, and debilitating psychiatric illnesses in the field.”

“According to Kazdin et al. (2016), therapist competence may be linked to treatment outcome, and given the seriousness of EDs and the exceptionally vulnerable client groups who seek treatment, the need for increased professional competence in this area is greater than ever (Williams & Haverkamp, 2010).”

“According to Williams and Haverkamp (2010), despite having the knowledge that there is a lack of competence related to the management of EDs (e.g., Gurney & Halmi, 2001; Rosenvinge et al., 2003), there remains insufficient training as well as a lack of competency and overall confidence for professionals who are working with individuals who have EDs (Jones & Larner, 2004). For example, graduate school training opportunities for those interested in treating EDs are likely “insufficient and inadequate” (Wilson et al., 2007, p. 207).”

This dissertation, with its cited resources, confirms what many in the eating disorder industry already know and have been whispering about for quite some time.  And that for some eating disorder professionals, their characteristics include:

Insufficient training.

Lack of overall competency.

Lack of training opportunities.

Lack of confidence.

Grad school training which is sporadic and inadequate.

Only 6%-35% of clinicians who treat EDs report utilizing evidence-based guidelines.

The inescapable conclusion is that many medical and mental health professionals are incompetent because they do not have adequate training nor experience treating the unique challenges presented by eating disorders. Let alone to participate in life and death decisions regarding eating disorders and end of life options.

Make no mistake. I have met some incredibly intelligent, insightful, involved clinicians and research professionals.  Persons whose wisdom, experience and compassion far exceed anything I would ever hope to accomplish. Those people inspire me and give some hope for the future. But there are many, many others who do not.

To participate in the ending of another sentient being’s life, a medical or mental health provider must epitomize the absolute best in not just their chosen profession but, as a human being.

Intellectually, they must be elite. They must have experience gained only through years of exposure to and treating persons suffering from mental health conditions. They must be at the very forefront of understanding human anatomy and the brain. They must be inquisitive and seek to understand evolving treatments and state of the art biological interventions.

They must have a limitless supply of compassion which is honed by setting aside their own ego, listening and absorbing the subtle messaging which exists in the manner in which humans communicate. They must be spiritually evolved and have a vast understanding of the manner in which different religious beliefs, or the lack of any beliefs, impact the body, the mind and the soul. They must be transparent and open to talking/collaborating with all persons with a stake in the topic.

Only after mastering all of these qualities should a medical/mental health professional think about participating in the end of another human being. And they absolutely cannot be a passive witness enslaved to the demands of their patient who wishes to take their own life.

Our medical schools are not providing a working, rudimentary training and understanding of eating disorders. We know there are no generally accepted standards of care for treating eating disorders. Treatment centers and providers bandy around the term “gold standard” such that it has lost all meaning. Health insurance companies are utilizing their own treatment guidelines, guidelines they ran through their finance and accounting departments. Charlatans are peddling new therapy milieu devoid of any scientific or medical background or support.

And yet we expect our medical/mental health professionals to have the insight, intuition, intelligence and integrity to discern whether a person has the cognitive ability to make the decision to take their own life?

To rise above all controversies as well as the flaws, mistakes, inadequacies and incompetence in the eating disorders field? And then to administer or supply the very substances by which a person will take their own life?

What a mad, mad, mad, mad world in which we live.

The Winds of Change

In the past few weeks, iaedp’s “Board” released an announcement advising its members that changes were coming and that the Board was launching a new initiative and strategic plan for the organization.

When I first read this, I equated this “major announcement” with the “major award” won by Old Man Parker in one of the best Christmas movies ever released, “A Christmas Story.” Visions of a fishnet stockinged leg lamp danced in my head.

However, the announcement, when it comes, will end up being quite significant, if not different than what the Board initially intended. Although iaedp has not yet issued its official announcement, the subject has become known in certain circles of the eating disorder community. And that is …

Bonnie Harken, iaedp’s Managing Director is … “retiring.” 

It is unknown whether she will also be stepping down as Chairperson of the Boards of Directors of all the “independent” corporate chapters. It is logical to presume that these positions will be included in her retirement.

Most people in the community know that I have significant issues with Ms. Harken and that we are in an adversarial capacity. But that should not diminish the accomplishments Ms. Harken achieved in the past.

According to her LinkedIn profile, Ms. Harken has been in the eating disorders treatment field since 1987. She states she was a founding officer of Remuda Ranch Centers serving as its Vice President until February 2002. Since February 2002 until two days ago, she served as the Managing Director of The International Association of Eating Disorders Professionals Foundation (iaedp). Certainly, twenty-one (21) years far exceeds the reign of any other leader of all other eating disorder organizations. Ms. Harken stated that she served many major eating disorders treatment facilities as a consultant.

In the past, she had a vision for eating disorder board certification. Under her leadership, this certification program was built. For that she should certainly be commended. She was instrumental in helping to bring information about eating disorders to the mental health community. 

However. 

After issues were brought to the attention of Ms. Harken and before the lawsuit was filed, Ms. Harken and iaedp’s attorneys attempted to deflect attention away from iaedp’s issues and stated their belief that the Morgan Foundation was operating illegally. This is generally known as a “straw man fallacy or argument.”

A straw man fallacy is the fallacious practice of attempting to refute an argument different from the one under discussion, while not recognizing or acknowledging the distinction. Ms. Harken failed to consider that in early 2020, I intentionally let the Foundation lapse.

Through my investigation and research, I found that there were people in the eating disorder community who instead of helping families, were hurting families suffering from this disease. I knew that to expose their conduct and get them out, I had to be aggressive and utilize social media and the court system. I had to become almost hated. I did not want my daughter’s name sullied with that which had to be done.

So, the Morgan Foundation does not, and has not solicited donations, accepted donations or co-sponsored any events since it closed. I regarded Ms. Harken’s attempt to use this to deflect attention away from her own alleged questionable conduct as a sin that cannot be forgiven.

To me, there are very few things/people beneath contempt. But, in attempting to take issue with, and besmirch the memory of my daughter is beyond all decency.

My daughter died after fighting eating disorders for seven (7) years. She possessed more courage, resolve and heart than people like Ms. Harken could possibly envision. However, Ms. Harken crossed the Rubicon of decency. For that, there can be no forgiveness. And that knowledge, that reality, hurts my heart.

Before the current situation, I was on a cordial basis with Ms. Harken. In fact, in one email she wrote:

“I have read Morgan’s journal entries several times.  I feel very honored that you shared those pages with me because I imagine the contents of her journal are so very precious to you.

My mother left me a diary that journaled her health issues for over a year before her sudden death.  She did not share the issues she was having with me or my brothers.  She did not seek medical help which I believe was due to the fact that my father had died four years prior and she didn’t want to go on.  Her diary was both a comfort and –sometimes– an agony for me.  So many feelings…  I am not comparing my experience for any other reason than to share that I know how precious those words on paper are and am so deeply touched that you shared them with me as someone you do not know.

I can’t even begin to fathom what feelings Morgan’s words stir in your father’s heart.

I have no context for her thoughts in terms of when she wrote them or how close it was to her death or the pages that precede or follow those you shared.  I do not need to know because the pages I read spoke to me of her journey from a “higher power” to the revelation that our Savior is real and a comforter who loved and cared about her even if she didn’t understand her own circumstances or feelings.

I read the pages repeatedly and thought about my own journey to Jesus and all I have learned since I began my imperfect journey nearly 40 years ago with a Savior who is real and present daily in my life.  I asked Him to guide my words to you.

My prayer is that my words comfort you. 

I do know this with certainty:  When Morgan closed her eyes here on earth, she opened them in the presence and love of Jesus.   Heaven is beautiful with colors beyond our imagination.  She is with God in perfect peace. 

God loves you and I believe He has a call on your life and your journey.”

One statement in that message is particularly poignant. “I can’t even begin to fathom what feelings Morgan’s words stir in your father’s heart.” No, Ms. Harken, you can’t. Consider yourself lucky that you can’t.

I wonder what happened to that person. The person who crafted those words. The person who crafted that message. It is that person I want to remember. That person who at one time strove to help others.  That person who made a difference. And yet, I fear that person no longer exists.

That person who could have remained an icon in the community … instead of an outcast.

iaedp’s crucible

“Life’s most persistent and urgent question is, what are you doing for others?” 

— Martin Luther King, Jr.

“We make a living by what we get, but we make a life by what we give.” 

— Winston Churchill

Iaedp’s Symposium 2024 has begun. As per its custom, this year it is being held in Orlando, Florida. To say the Symposium is completely engulfed by controversy and discord is an understatement.

Some BIPOC iaedp members chose to boycott the Symposium because of the Florida Board of Education changing the state’s standards on African American history in July 2023.

The iaedp petition calling for Ms. Harken’s resignation and revising the certification process, which was started by concerned iaedp members in December 2023, has reached 277 signatures. Until very recently, a reasonable inquiry would have been whether Symposium attendees would exceed the number of signatures on the petition. Purportedly, the numbers are close.

The on-going lawsuit. Complaints filed with state and federal administrative agencies and taxing authorities.

Iaedp corporate chapters demanding dissolution. Ms. Harken demanding that those chapters pay over to iaedp national, any monies those chapters may have in their meager bank accounts. Demands for the resignation of Bonnie Harken.

Iaedp’s Board of Directors have no members with any business or legal experience and did not even place Ms. Harken on Administrative Leave while they conducted an investigation. For that matter, did the Board conduct ANY independent investigation?

There is no doubt that iaedp is under increasing pressure from many different sources. It finds itself in a fiery crucible where irrelevancies and subterfuge are burned away thereby exposing questionable conduct and the flaws of human nature.

And above all, we as a community, cannot and should not be looking upon the inevitable dismantling of this organization and Ms. Harken with any satisfaction or pleasure. Schadenfreude should be so remote from our conscious thoughts or feelings as to be non-existent. 

Whether you agree or disagree with the lawsuit. Whether you have positive or negative thoughts or feelings directed toward me for pursuing this matter. Whether you believe or not believe that iaedp and the certification process needs substantial revamping … the sparsely attended 2024 Symposium should serve as a stark example of what could happen when we, as a community drift away from the sacred trust placed with our medical and mental health providers who treat eating disorders.

When NEDA was sued in December 2020, I pushed for an early mediation. My sincere hope was that improvements and positive changes could be made and that NEDA, yes would go through some difficult times, but would emerge more vibrant and stronger than before. In addition to the attorneys appointed by the Directors & Officers insurance company, NEDA also had an experienced, wise attorney who had been involved with NEDA for a number of years. That attorney understood the importance of an early resolution. And in less than six (6) months after filing, the NEDA case was settled. NEDA served and serves a purpose.

In past writings, I mentioned the great Chinese General, Sun Tzu. He believed that when you have your foe surrounded and their defeat is inevitable, you should offer that foe an honorable exit. And so it was.

With iaedp, an early resolution will not happen. Settlement offers have been made, the latest as recently as last week. Each offer has been met with silence. Iaedp also does not have an experienced attorney independent from the insurance providers to lend wisdom and knowledge of eating disorders. NEDA had and still has experienced business people on its board. Iaedp does not. NEDA had a semblance of oversight over its officers by its board, oversight which resulted in its former CEO and the person who mainly caused the damage to be let go. Iaedp does not.

Brantley is Whitfield. Whitfield is Brantley. Iaedp is Ms. Harken. Ms. Harken is iaedp.

I do not believe iaedp can, nor will, survive the investigations which may be conducted by state and federal authorities.

In this matter, a road to redemption was offered. And was not accepted.

The consequences for that lack of vision will inevitably lead to the conclusion from which Ms. Harken and iaedp are desperately running.

In litigation as in war, you achieve victory by engaging in a relentless, aggressive, well-orchestrated and carefully designed plan to obtain victory and deprive your opponent of the initiative. You make your opponent pay a price higher than it expected for choosing the path of war. In litigation, an attorney has the power of the legal system at his/her beck and call. Issuing subpoenas for relevant documents not just from the named parties but also from third parties and witnesses. Deposing people who may have information of relevant facts. Uncovering lies. Exposing fear, arrogance, greed and collusion. Discovering facts which support long held suppositions. Where necessary, including third parties as possible liable parties. Hundreds of hours spent on the process. The uncertainty.  The unexpected. For example, did United Behavioral Healthcare dare to consider that in the Wit case, it would lose its ability to control its own claims process and possibly must pay attorneys’ fees exceeding $3o million dollars?

The greatest truth to embrace, the truth that keeps one focused through this mighty process is the reality that people who suffer from eating disorders will undoubtedly benefit from this challenge. Families who suffer from this disease may find comfort and greater opportunities to heal. Fraud, and those who perpetrate it will at long last be exposed.

We must continually be looking forward, always forward. We must place our families who suffer from eating disorders first and foremost. As a community, our nondelegable duty must be to help those who are suffering. Somewhere on the path, iaedp lost that vision. It lost its way. And those who are supposed to be overseeing iaedp have lost iaedp’s mission… if not its very soul.

THAT is what the iaedp lawsuit is about. Trying to salvage a broken system so that more lives can be helped. To burn away the falsehoods and nonsense in the crucible.

That is the absolute reality which keeps one focused, which guides one through the turbulent days, weeks, months and years which lie ahead. Saving lives.

And so, as I previously plagiarized from Willie Bob Shakespeare, “Once more unto the breach dear friends, once more …”

Take Dead Aim

In the past few months, Physician Assisted Suicide (“PAS”) or Medical Aid in Dying (“MAiD”) has been a frequently discussed or considered issue both domestically and internationally.

Canada delayed until 2027, implementation of PAS for people whose primary diagnosis is a mental illness.

Colorado is seeking to expand its existing MAiD law to allow anyone in the United States to benefit (?) from its proposed, expanded MAiD law wherein life-ending medication can be prescribed by an “Advanced Practice Registered Nurse” and a “consulting provider” only needs to be qualified by specialty or experience to make a professional diagnosis and prognosis regarding a terminally ill individual’s illness.

According to the Death with Dignity organization, there are 19 states either considering, or opposing implementation of PAS or MAiD legislation. These states and bills can be found here:

Bills We are Tracking

“Fer it … or Agin’ it.” That seems to be our current society. Our world has devolved into black or white. Right or wrong. Coke or Pepsi. Republican or Democrat. Far Right Religious Loon or Far Left, Extremist Socialist Loon. Your choice has been made easy. Press this button or that button.

So too, with PAS/MAiD. You must either support those bills. Or you must oppose those bills. After all, topics as simple as our very existence, whether we have a soul, what constitutes a sentient being can readily be pigeon-holed into one of two choices.

“Fer it … or Agin’ it.”

In general, people who oppose PAS/MAiD bills show up during subcommittee hearings, present arguments opposing the proposed bill and seek to have the entire bill defeated. The politician’s aide then contacts the money people behind the politician and asks them how they want the politician to vote. The money people make their views known and the politician dances to that tune.

But what if there was another way?

Instead of supporting or opposing PAS/MAiD legislation, what if a specific carve out excluding eating disorders from these bills were proposed as a rider. Therefore, the position would be regardless of whether that legislative bill passes or expires, eating disorders must be excluded. And that is because we simply do not have enough medical and mental health information and knowledge about this illness.

When does Anorexia Nervosa become terminal? Does the medical community even have a remotely accurate understanding of the way eating disorders impact the brain? And if so, why haven’t effective, biologically based treatments been researched, studied and implemented?

We also know there are no generally accepted standards of care. The “experts” in the community cannot even agree about the most effective medical and mental health interventions to treat this deadly mental health illness. For that matter, should anorexia even be classified primarily as a mental health illness?

We know there is no effective collaboration with any other medical or mental health community.

Private equity companies dictate residential “standards of care” and the way this mental health illness is treated. Emphasizing profits over patient safety. Running treatment guidelines through their finance department. Even a former CEO of a residential treatment center is now admitting to this reality.

There are no pharmaceutical drugs which have been specifically researched, trialed and then approved to treat eating disorders. The drugs being used today were all designed to be used for other mental health and medical issues.

What criteria and protocol would be utilized to establish that which constitutes the highest level of treatment care before patients can utilize PAS/MAiD?  

How many years would a patient have to be afflicted with Severe and Enduring Anorexia before a death protocol is appropriate for them? For that matter, can any mental health or medical doctor, within all reasonable medical probability, opine that death will come within six months?

How often has this legion of information been presented to politicians when PAS/MAiD legislation is being considered?

Envision testifying before a legislative subcommittee and instead of making “Coke or Pepsi” arguments before the politicians (arguments they have heard numerous times), an advocate presents the above information and statistics plus much more. Advocates present compelling information, facts, reasons and logic why eating disorders must be excluded from the legislation.

And the law of unintended consequences may result in, while the discussion of PAS/MAiD is going on, we educate those politicians and society about the dangers of eating disorders. The high mortality rate. The dysfunctionalities and lack of understanding of this illness.

We must start to aim for the specific target before us instead of the zip code sized area of discussion and dispute on this topic which is currently raging.

Harvey Penick, the late, great golf coach and instructor had a famous saying, “Take Dead Aim.” This saying is more about a technique for focusing than a philosophy on how to play. By narrowing down to a very specific target you end up focusing in better on what needs to be done.

With regard to PAS/MAiD, we need to “Take Dead Aim.”

When Not Awkward Becomes …

On January 8, 2024, I had the pleasure of appearing on the “Making it Awkward” podcast hosted by Jessica Wilson, MS, RD, and Whitney Trotter, DNP.

As I stated in a prior article, there is no doubt that on some issues, our views are very different… at times even opposite. However on that day, I thought there was a feeling of respect, of professionalism, of courtesy. I certainly extended those qualities to the two hosts. However, it would appear that those feelings of respect and professionalism on the part of the esteemed hosts may have ended that day, if they existed at all.

After my appearance on the podcast and before it was disseminated, I contacted Ms. Wilson and Ms. Trotter, thanked them for the opportunity and on two occasions discussed iaedp’s certification process and how the BIPOC community could get involved at the earliest level. The exact language I used was:

(The First email)

“Also, I will be sending to you in the next few days an email talking about iaedp’s certification process. The BIPOC Committee at iaedp, and the BIPOC community as a whole, have an incredible opportunity to be on the ground floor in helping come up with new certification guidelines. More to follow.”

(The Second email)

“Regarding the “certification program,” we are facing a unique challenge. In one of two ways, the eating disorder certification program is going to change, to grow, to evolve in the next few years.  First, the Court may very well take away the certification program from iaedp and assign it to an established board specializing in overseeing certification programs.  Or two, Ms. Harken will decide she has had enough and will step away. These are inevitabilities.”

“And the BIPOC Committee of iaedp as well as BIPOC advocates have the opportunity to have their voices heard, to be part of the process which changes certification, to have the certification program become much more fair and available to all. However, this requires that the BIPOC community come together, to reach agreement on how best the certification process can be changed to meet the needs of the BIPOC community and to speak with one, mighty, united voice.”

“But, that voice has to be clear. That voice has to provide real life, workable, reasonable solutions which can be implemented.

I believe you two are in a place where you can be the harbingers of this change, this voice. But, this must be organized expeditiously and wisely. I also have no doubt that the obstacles are many and the way forward is difficult. Then again, what great thing was ever accomplished without hardship?”

So, what was their response?

Ms. Trotter responded with:

“Thanks so much for the feedback. We’ve heard positive reviews as well- which has been encouraging. There are several folks on the IADEP BIPOC subcommittee who I’m sure would be interested in helping with the certification process. It’s not a task that I can undertake but I appreciate you reaching out and asking.” 

Ms. Wilson responded with:

“I cannot take on the full task of improving the certification, but I’m happy to provide paid consultation to those who are interested in my experience.”

Interesting. It appears as if their collective response was tantamount to, “We cannot be bothered to undertake such a momentous task knowing that progress and obtaining results which could help the BIPOC community is beyond us. And in Ms. Wilson’s case, “unless of course, you pay me to participate.”

To be on the ground floor of building a foundation that would inevitably help the BIPOC community. What an incredible opportunity. But Ms. Wilson and Ms. Trotter chose to not participate. To not be influencers. To not engage in bettering the community in this manner.

Ms. Wilson and Ms. Trotter then conducted Part 2 of the discussion and invited Meghan Cichy to appear. A majority of that podcast was dedicated to, “Steven Dunn is a loon, he has it all wrong, let’s run down him and his views, read his mind and epitomize the name of their podcast, ‘Making it Awkward.’”

After listening to Part 2 of the Podcast, and its many inherent flaws, it would have been so very easy to go on the attack, pick apart Part 2 of the Podcast, pointing out the many inaccuracies, inconsistencies and false narratives. But, to what end? What would be accomplished other than causing a few more rifts in the community? Of hurting others for their views no matter how misguided.

Instead, I reached out to Ms. Wilson and Ms. Trotter.  My email stated the following:

“I had the chance to listen to your Litigation Podcast 2. I can tell you I do enjoy the different points of views you bring out from different guests. And what a learning experience it is hearing other’s opinions. So, thank you!

There were a number of points that could use clarification but, it is what it is.

Again, I appreciate the opportunity to be on the podcast and would welcome any future interaction.

Oh… and I am SOOOO sending you both Christmas cards!”

To date, Ms. Trotter and Ms. Wilson have not responded to that email.

There comes a point where the hand we extend in friendship cannot be turned into a fist. A point where we continue to seek understanding and compassion even if those around us do not. Someone must show compassion and understanding for those who are in such internal turmoil and pain.

In this matter, damage was done and opportunities lost. Why compound it? An opportunity to collaborate, to bring together people of divergent viewpoints and opinions for the betterment of those suffering from eating disorders was not recognized and was lost. Perhaps grace, acceptance of other people’s viewpoints, respecting them even if you disagree with them are foreign concepts to some.

As I reflect upon my interaction with Ms. Trotter and Ms. Wilson, I have no doubt I gained some insight especially on sensitive issues and topics which have the potential to be incredibly awkward. Respecting the person, treating them with courtesy, with respect, with civility is the best weapon to diffuse awkward topics and issues. To turn awkward issues into issues upon which we can work together even as we maintain divergent points of view. That is a special gift. That is the essence of making awkward not awkward.

Because undoubtedly, our end goal is the same. That is, saving as many lives as humanly possible. Helping as many people in pain and suffering as we possibly can. Aren’t we all working toward that same, end goal?

The Power of the Message CANNOT be lost because of the false narrative that the Image of the Messenger is far more important. When the focus is on the messenger and not the message, the message is lost, the end goal is pushed further away and we as a community suffer.

Which results in more pain, more harm, more loss endured by families suffering from eating disorders. And when that happens … we all lose.

Ohhhhhhhh Colorado

A few weeks ago, I wrote of Canada’s decision to delay until 2027, implementation of Physician Assisted Suicide (“PAS”) for people whose primary diagnosis is a mental illness.

Reasons given included: Canada’s healthcare system was not ready to handle the increase in requests for PAS from patients with mental health issues; the expansion of PAS could undermine efforts to prevent suicide; politicians casting blame on the opposing party; and the risk of medical practitioners recommending assisted suicide as a cost-cutting measure to alleviate strain on Canada’s health care system.

And so reasonable, hopefully rational studies will be funded addressing the issue of PAS for patients with mental health issues.

Brava Canada!

In opposition to this reasoned, rational, logical approach, we have ‘Murica … specifically the State of Colorado.

In 2006, the movie, “Idiocracy” had a limited release in the U.S. It was directed by Mike Judge and co-written by Mr. Judge and Etan Cohen. Mr. Judge was the creator (or co-creator) of Beavis and Butthead, King of the Hill and Office Space.

The plot of Idiocracy follows U.S. Army librarian Joe Bauers, (played by Luke Wilson) who wakes up five hundred years in the future after a botched government hibernation experiment. He finds himself in a dystopian society run by corporations, where evolution has made humanity stupid because the benefits of technology made it unnecessary for people to be intelligent and physically fit to survive. Idiocracy serves as social satire that touches on issues including anti-intellectualism, commercialism, consumerism, dysgenics and overpopulation.

Colorado already has in place an overly liberal (or accommodating depending on your viewpoint) law on PAS. But then, certain Colorado politicians embraced some of the over the top aspects of the Idiocracy movie and are seeking to expand Colorado’s PAS law.

This is the proposed bill:

Click to access 2024a_068_01.pdf

The Colorado bill could have been drafted by Mike Judge as a script for an Idiocracy sequel entitled, “Idiocracy: How to Die in Colorado Without Really Trying.”  And yet, to date, there is no registered opposition to the bill in Colorado’s lobbying database.

So, let’s review some of the key provisions of this Idiocracy bill.

First, we know how busy Colorado medical doctors are. Overworked. Underpai.. well, overworked. So, let’s take some of the burden off them by allowing “Advanced Practice Registered Nurses” to make the determination that a patient qualifies for PAS. We also want to take even more burden off physicians so let’s allow Advanced Practice Registered Nurses to also serve as “consulting providers.”

Of course, this “consulting provider” must be qualified by specialty or experience to make a professional diagnosis and prognosis regarding a terminally ill individual’s illness. [emphasis added] Qualified by experience? That certainly gives an entirely new meaning to the phrase, “Expert by Experience.”

Naturally, with Colorado being an enlightened, beneficent land of opportunity, they surely cannot restrict their expanded PAS to residents of Colorado alone. When the bill is passed, ANY ADULT is eligible to apply for PAS. Even those who reside outside the State of Colorado. The bill does not restrict its implementation and activities to the State of Colorado. Which brings up a number of intriguing and troubling issues.

With the expansion and proliferation of the Interstate Medical Licensure Compact Act and the use of tele-health, the bill does not address whether a provider can make his/her diagnosis via telehealth and whether the opinion of the consulting provider may be provided via telehealth. If the attending provider has the requisite DEA certificate and complies with any applicable administrative rules, that provider can send the poison cocktail medications directly to the patient.

Then there is the current mandatory waiting period for PAS in Colorado which is 15 days. Presumably, that is far too long to consider and contemplate the end of one’s existence. So, let’s shorten that puppy up to 48 hours! After all, one can squeeze a lot of living in 48 hours … champagne, five-star dining, complaining about the latest Taylor Swift conspiracy. What more does one need? However, if the attending provider believes that death will come within that 48-hour window, even that waiting period can be waived.

But, what to do about those pesky life insurance companies which have exclusions in their policies for insureds who commit suicide? The Colorado bill thought of that too. The bill provides that a life insurance company doing business in Colorado cannot deny nor alter benefits otherwise available to its insured who chooses to undergo the Colorado PAS process.

At this point, we should also ask if this is merely a tempest in a teapot.  How prevalent is PAS in Colorado?

Since 2017, [when Colorado’s medical-aid-in-dying law went into effect] and 2022, according to data gathered by state health officials more than 1,090 patients were prescribed life-ending medication. Of those, 838 picked up the medication. [This information can be read by clicking on the link underlined in the prior sentence.] It’s unknown how many people used the medication to end their lives.

Over that six-year period, aid-in-dying prescriptions were provided by 219 Colorado doctors.

Interestingly, a survey was published in January 2022 of 583 physicians in Colorado carrying for potential medical-aid-in-dying patients. This survey can be found here:

https://link.springer.com/article/10.1007/s11606-021-07300-8

This survey provides some fascinating insight into those providers who are involved in medical-aid-in-dying for their patients.

The survey’s general conclusions were, “Many physicians in our sample are both willing and prepared to discuss MAiD with patients and to provide MAiD referrals. Fewer are prepared and willing to serve as an attending or consultant and fewer have provided these services. MAID consultants and attendings largely report the experience to be emotionally fulfilling and professionally rewarding, but all respondents reported multiple barriers to participation.”

The survey was transparent about the ethical concerns which included: “Ethical concerns include, but are not limited to, issues of equity and justice, patient autonomy, the nature of human suffering, slippery slope arguments, the proper roles of physicians, and the potential for devaluing human life. Religious beliefs have led some religiously affiliated hospitals to prohibit employed physicians from providing MAiD.”

For diseases like cancer, the availability and applicability of MAiD is much more compelling. Medical knowledge has shown the human body constantly produces new cells. Normal cells follow a typical cycle: They grow, divide and die. Cancer cells, on the other hand, don’t follow this cycle. Instead of dying, they multiply out of control and continue to reproduce other abnormal cells. These cells invade body parts, such as the breast, liver, lungs and pancreas. They may also flow through the blood and lymphatic system and spread to other parts of the body. Within a reasonable medical likelihood, death can be estimated.

But PAS for mental illnesses? For Anorexia Nervosa? Without having any objective medical criteria to determine a person’s capacity to make a life-or-death decision? Not even requiring a licensed psychiatrist or physician to be involved? Our wisdom and knowledge have not expanded to address mental health issues and PAS. To believe otherwise is clearly Idiocracy material.

One day, will our understanding of the human body, the brain, the complexities of our psyche reach a level which turns Physician Assisted Suicide into Medical-Aid-in-Dying for mental health issues? Perhaps so. But that day is certainly not today. Today, we are subjected to Idiocracy bills like Colorado’s law, short on wisdom and long on pedantic naivete.

Without the need of a physician to oversee the process, opening the process to everyone, and shortening the mandatory wait period to 48 hours, Colorado could become a mecca for PAS tourism.

Imagine Colorado’s new state slogan:

QUESTIONS AND WEBS OF SUBTERFUGE

The iaedp Annual Symposium is about four weeks away. All the while, iaedp finds itself in an expanding web of trouble, legal issues, and membership rebellion. And learning the hard way that subterfuge and non-transparency is a pathway to failure.

Dark, lightning-laced storm clouds on the horizon evince a tempestuous future which may very well spell doom for iaedp, the certification process and Bonnie Harken. And not because of the lawsuit.

Alarming issues have been raised regarding iaedp and Bonnie Harken. One can’t help but wonder whether iaedp members and corporate chapters are receiving direct, honest answers to questions which should be asked. Or instead, are they receiving subterfuge in the guise of finger pointing and failed attempts to blame the messenger in a vainglorious attempt to play the misdirection game, the shell game … the con game?

With the belief that iaedp members and chapters may not be receiving direct answers about questions and issues regarding iaedp, let’s attempt to address them here. Let us put out those questions in an open, free forum. Then, it will be up to iaedp members and chapters to demand open, transparent, honest answers … if that is what they choose.

Petition

The online petition calling for the resignation of Ms. Harken is only two (2) months old.  And yet, it already has 258 signatures!

258 persons who demand to see the eating disorder field improve and evolve.

258 people who believe that iaedp is not serving this mission.

For those interested in this petition, some of your questions may be:

Q:       Ms. Harken, have you met with the people who started the petition, respectfully listened to their concerns, and then brought these concerns to the iaedp Board of Directors?  If not, why not?

Q:       At the upcoming Annual Symposium, will you commit to having an open forum about this petition and iaedp in general and open that forum to all interested persons? Again, if not, why not?

Q:       What do you plan to do about the very alarming issues raised in the Petition?

Corporate Chapters

We know at least six (6) chapters who wish to dissolve/disband. They are Baltimore, St. Louis, Phoenix, Denver, Los Angeles and Central Coast. The reasons given by the Baltimore chapter are very alarming.

For those interested in this topic, some of your questions may be:

Q:       Why aren’t iaedp and its Board of Directors concerned about chapters closing and what are iaedp and its Board doing to talk to those chapters trying to keep them in the fold?

Q:       Is it true that Ms. Harken is intentionally dragging her feet and not dissolving those chapters hoping she can find other people in that area who will agree to take over those chapters?

Q:       Is it true that the iaedp national Board of Directors supports that conduct? What discussion was had about that topic? [And be very careful … there may be documents which prove the facts in that question.]

Q:       Is it true that Ms. Harken is demanding that any money left over in those dissolving chapters be paid over to iaedp national? That even though those funds were raised by local people from people in their community who intended their donations to be used in the local community, Ms. Harken is making demand for those amounts? [And be very careful … there may be documents which prove the facts in that question.]

But those are not the only issues surrounding the corporate chapters. According to the Illinois Secretary of State website, the following thirteen (13) chapter are listed as being, “Not in Good Standing:”

Alabama

Baltimore

Central Coast

Denver

Greater Philadelphia

Hawaii

Lubbock

New Haven

Orange County

San Diego

South Florida

St. Louis

West Philadelphia

Additional questions may be:

Q:       Ms. Harken had the duty to maintain the records for those chapters. How could she let so many chapters go into the status of being “Not in Good Standing.”

Q:       When a chapter is listed as not being in good standing, what does that mean in terms of the ability to raise funds … and possible liability?

Ms. Harken’s Employment Status with iaedp

Ms. Harken has been adamant that she, and/or her dissolved (since 2016) corporation, Crossroads Programs, have always been “independent contractors” of iaedp. Her reasons for this flight of fantasy are obvious.

When workers are classified as independent contractors, organizations avoid paying the benefits that most employees are entitled to such as health insurance, paid time off, and the employer’s side of payroll taxes. In some instances, employers deliberately misclassify employees to avoid paying those employee benefits and taxes.

When an employee is misclassified, federal and local government lose out on tax and payroll revenue. Employers may be responsible for paying state and federal payroll taxes as well as Social Security and Medicare taxes for all employees found to be classified incorrectly. Penalties can also be imposed for failing to timely deposit payroll taxes.

If the IRS believes an organization has intentionally misclassified workers, there is also the possibility of criminal and civil penalties and sanctions. Additional penalties and fines can be applied depending on the severity of the misclassification.

So, what is an independent contractor? In essence, you hire independent contractors for very specific jobs. A plumber. An electrician. Your bookkeeper. Your accountant. Your attorney. Your PR person.

But the only person who oversees all aspects of your organization’s operations, including financial matters? The only person on a full-time basis? That person is clearly an employee.

Regarding Ms. Harken and iaedp, she recently filed an affidavit in federal court in Dallas, Texas. In this affidavit, Ms. Harken admitted the following:

  1. She is “very actively involved in the iaedp, particularly with regard to its annual symposium”;
  2. “My duties have included, among other things …”
  3. “to lead the organizations according to the decisions made and strategies developed with the board of directors” [not BY the board of directors];
  4. “protect and grow the organization’s financial health”;
  5. “plan for upcoming initiatives and leadership of the initiatives”;
  6. “mentor new leadership”;
  7. “create policies that ensure new strategies align with the organization’s mission are put into action.”

In that affidavit, Ms. Harken also admitted that she supervises people under her, that “she operates iaedp from my home in Pekin, Illinois;” that she has custody and control over all physical and electronic records of iaedp.

We also know she is not only on the Board of Directors of iaedp national but is Chairman of the Board of Directors for all corporate chapters.

This overwhelming Mt. Everest sized stack of evidence establishes one inescapable conclusion … Ms. Harken is more a Dictator than an independent contractor.

I am confident the IRS, the Department of Labor and the California Franchise Tax Board will agree.  And those three (3) agencies have now been informed of the iaedp situation and evidence forwarded to them.

As such, the questions which could be asked of Ms. Harken could include:

Q:       From 2017 – 2021, why did you falsely state that Crossroad Programs, Inc. was an active corporation on iaedp’s Form 990 tax filings and that iaedp had a contractual relationship with this non-existent entity?

Q:       Couldn’t that be tax fraud?

Q:       Do you plan to plead the Fifth Amendment to any questions asked about your leadership of iaedp?

Q:       Despite the overwhelming amount of evidence, why do you still believe you are an independent contractor?

Q:       If any of those agencies find back taxes, interest and penalties are due, how will iaedp pay those?

Q:       Have you asked for, or received any legal opinions evidencing that you are NOT an independent contractor? If so, why did you ignore them?

Q:       Do you understand that if iaedp financially collapses because of your malfeasance, the certification process could also collapse and that could result in families being hurt?

Final Questions

Lawsuits are filed for different reasons. Uncovering the fundamental truth ranks at the top of the list.

They can also be filed to uncover evidence, evidence that state and federal agencies can utilize to prosecute administrative actions and lawsuits against people and organizations who run afoul of the law.

Evidence like … sworn affidavits. Affidavits which contain crucial information. Information which can be utilized in administrative actions against those people.

Perhaps a few final questions should be …

Q:       How has it come to this?

Q:       How did an entire community fail to come together and replace so called leadership who demonstrates the qualities of narcissism, ego and avarice?

For those who have shown the courage to stand up and be counted, you inspire us all. You dared to be mighty. You are facing slings and arrows but you know, you absolutely know, that through your deeds, you are making a positive difference. You are in the arena. You are the light of hope in a dark room.

And finally, one last question I have …

Q:       For those treatment providers who refuse to ask those questions of iaedp and Ms. Harken, for those treatment providers who have no interest in discovering the truth, for those treatment providers who stand on naïve, blind loyalty instead of pushing for the truth, for those treatment providers who do not dedicate themselves to improving the care and treatment of eating disorders but instead, choose to bury their heads in the sand …

Why should any family trust you to care for their beloved children?

Medical Aid in Dying or Physician Assisted Suicide?

Words matter. Words are one of the strongest ways in which we communicate. We use words to express every human emotion. When words are used passionately and honestly, they can inspire us to greatness. Motivate us to dare mighty deeds. To, in the name of humankind, be open to exploring the greatest mystery facing us, that is, our very existence.

Close your eyes. Now, embrace the rapture you feel when the most special person in your life holds you in his/her arms, looks you in your eyes and says, “I love you.” Revel not just in those words, but the feelings and emotions they evoke.

Contrarily, words can also be used to inflict the deepest, darkest scars on a person’s soul. Words can cause such pain, such rage … such defeat, that they can push us prematurely closer to our graves.

Again, close your eyes. And try to imagine how you may feel when the most special person in your life looks you in the eyes and says, “I do NOT love you.” One word. One small word. One word changes everything. It changes feelings, emotions. That one small word changes … life.

Recently, end of life issues in the mental health community have come to the public’s attention, not just domestically, but internationally. Are physicians in the Netherlands prescribing death-inducing medications for autism? Is the UK government allowing life support measures to be removed from a child against a parent’s and their doctor’s wishes? Canada’s recent decision to delay until 2027, end of life measures for persons whose primary diagnosis is a mental health issue. And of course, here in the U.S., end of life options for persons suffering from severe and enduring anorexia.

And yet for these great emotional debates and issues, we cannot even agree which term of art to use … Medical-Aid-in-Dying (MAiD) or Physician Assisted Suicide (PAS). Each phrase engenders very different thoughts and feelings. Granted, this was not much of a debate when MAiD was first being considered for biologically based diseases for which the medical community did not have viable cures. It is now.

Dr. Matthew Wynia, director of the University of Colorado’s Center for Bioethics and Humanities, states: “There is a significant, a meaningful difference between someone seeking to end their life because they have a mental illness, and someone seeking to end their life who is going to die in the very near future anyway.”

As Lee Corso, a college football pundit and legend is fond of saying, “Not so fast my friend!”

Now, a once relatively clear line is being blurred.

In the United States, ten states and the District of Columbia allow patients to receive life ending medication. However, among these states, I could locate no provision specifically including, or excluding mental health issues. 

Instead, the statutory language focuses on the requirement of a “competent, terminally ill patient.” A vague, ambiguous term. When a person’s life hangs in the balance, there are few things as egregious as including terms which are vague, subjective to numerous interpretations and which are not readily definable.

So, what is the difference, if any, between MAiD and PAS?

Some health advocates and medical professionals insist that a terminally ill patient with a recognized, biologically based, somatic disease taking medication to hasten the end of their life is doing something fundamentally different than suicide. The term “medical aid in dying,” they say, is meant to emphasize that someone with a terminal diagnosis is not choosing whether to die, but how to die. Their death is immediate and inevitable.

Anita Hannig, an anthropologist at Brandeis University and author of the book, “The Day I Die: The Untold Story of Assisted Dying in America,” stated, “A phrase like “medical aid in dying” would reassure patients that they were taking part in a process that was regulated and medically sanctioned. Medicine has that legitimating power, like it or not, that really removes a lot of the stigma.”

Now, look at the language used by Ms. Hannig.

A process that was regulated.

A process that was medically sanctioned.

I would add, a process focused on a biologically based, somatic diseases, thoroughly researched and studied. Diseases in which relatively objective findings, treatment regiments and outcomes had been thoroughly vetted and are considered reliable. A disease, which in an advanced state, medical science cannot effectively combat nor cure.

For this, yes, Medical Aid in Dying may very well be accurate, understandable and compassionate.

But for circumstances in which a mental health issue is the primary diagnosis? Particularly, Severe and Enduring Anorexia? A legion of questions abound.

When did Anorexia become terminal? Does the medical community even have a remotely accurate understanding of the manner in which eating disorders impact the brain? And if so, why haven’t effective, biologically based treatments been researched, studied and implemented?

For that matter, regarding eating disorders, we also know the following:

There are no generally accepted standards of care. The “experts” in the community cannot even agree about the most effective medical and mental health interventions to treat this deadly mental health illness. For that matter, should anorexia even be classified primarily as a mental health illness?

There is no effective collaboration with any other medical or mental health community.

Private equity companies have been allowed to dictate residential “standards of care” and the way this mental health illness is treated. Emphasizing profits over patient safety. Even a former CEO of a residential treatment center is now admitting to this reality.

There are no pharmaceutical drugs which have been specifically researched, trialed and then approved to treat eating disorders. The drugs being used today were all designed to be used for other mental health and medical issues.

If the statistics can be believed, the mortality rate for eating disorders is worsening.

It is with this background, despite these harsh facts, that some people are attempting to legitimize end of life options for Severe and Enduring Anorexia.

Seriously. What criteria and protocol would be utilized to establish that which constitutes the highest level of treatment care before patients are welcomed into the warm embrace of death? Some pro PAS professionals may even look upon death as not being a failure or even a bad outcome.

How many years would a patient have to be afflicted with Severe and Enduring Anorexia before a death protocol is appropriate for them?

What objective testing exists to determine brain atrophy? Testing which would give more objective evidence showing that a patient either has or does not have the capacity to make life and death decisions?

As it is, no state has set forth any minimum, objective biological standards which must be met before a death protocol is made available for patients suffering from mental health issues.

With many biological based, somatic diseases such as cancer, objective testing and decades of research support a medical finding that death is inevitable. And as a compassionate society, Medical Aid in Dying, with effective oversight and clear protocols, very well may be in humanity’s best interest.

However, with Physician Assisted Suicide for mental health issues, because of the dearth of medically objective criteria, the diagnosis of “terminal” is based not so much on whether a patient will die, but how they will die.  

That patient’s death may not be pending, may not occur soon and may not be inevitable. That is the heart of Physician Assisted Suicide. Besides subjective criteria experienced by some mental health providers, there appears to be no medically recognized protocols or standards supporting those person’s views.  That is not and should not be acceptable.

For the treatment of Severe and Enduring Anorexia, the brightest and the best medical and mental health doctors cannot collaborate and come up with treatment standards utilizing the latest technological and science-based knowledge and innovation. There are no protocols to preserve life.

When the community cannot come up with and implement a legitimate, generally accepted protocol for life, how can anyone seriously consider a protocol for death?