Recently, the CEO of one eating disorder group stated,  … “ … we just want you to know that our commitment to anti-racism and dismantling systemic oppression in the eating disorder community is ongoing and will continue to permeate every aspect of our work.” [emphasis added] Good Lord.

More facts, tangible evidence, including scientific evidence, exists establishing that Covid-19 is a social justice virus than exists showing eating disorders are a social justice illness let alone systemically oppresses some segment of those who suffer from this deadly disease.

Dr. Anthony Stephen Fauci, an American physician and immunologist, has served as the director of the National Institute of Allergy and Infectious Diseases since 1984. He is generally regarded as the foremost authority on Covid-19. With regard to Covid-19, Dr. Fauci stated the following:

“Social inequalities are among the factors behind why the black community in the United States has “suffered disproportionately” from Covid-19.”

“African-Americans have suffered disproportionately from coronavirus disease. They’ve suffered in that their rate of infection is higher because of the nature of the economic status that many of them find themselves in where they’re outside working, being unable to physically separate.”

“And then when they do get infected, given the social determinants of health which make it for them, have a higher incidence of diseases like hypertension, obesity, diabetes.”

“They are at much greater risk of suffering the deleterious consequences including death.”

If you consider some of the initial statistics, you will see that nationally, African-American deaths from COVID-19 are nearly two times greater than would be expected based on their share of the population. In four states, the rate is three or more times greater.

In 42 states plus Washington D.C., Hispanics/Latinos make up a greater share of confirmed cases than their share of the population. In eight states, it’s more than four times greater. 

A study conducted by NPR finds that in 32 states plus Washington D.C., blacks are dying at rates higher than their proportion of the population. In 21 states, it’s substantially higher, more than 50% above what would be expected. For example, in Wisconsin, at least 141 African Americans have died, representing 27% of all deaths in a state where just 6% of the state’s population is black.

According to Dr. Marcella Nunez-Smith, the Director of the Equity Research and Innovation Center at the Yale School of Medicine, “African-Americans have higher rates of underlying conditions, including diabetes, heart disease, and lung disease, that are linked to more severe cases of COVID-19.”

Nunez-Smith also stated, “They also often have less access to quality health care, and are disproportionately represented in essential frontline jobs  that can’t be done from home, increasing their exposure to the virus.”

Latinos and Hispanics test positive for the coronavirus at rates higher than would be expected for their share of the population in all but one of the 44 jurisdictions that report Hispanic ethnicity data (42 states plus Washington D.C.). The rates are two times higher in 30 states, and over four times higher in eight states. 

The non-partisan group, American Public Media (“APM”) Research Lab recently released new figures and information under the title, “Color of Coronavirus.” This study provided further evidence of the staggering divide in the Covid-19   death rate between black Americans and the rest of the nation. That study found, “Across the country, African Americans have died at a rate of 50.3 per 100,000 people, compared with 20.7 for whites, 22.9 for Latinos and 22.7 for Asian Americans.” The study later held, “More than 20,000 African Americans – about one in 2,000 of the entire black population in the US – have died from the disease.”

Those grim numbers and statistics paint a picture illustrating the ramifications of long term societal neglect. And if “Social Justice” is defined as “Equal rights, equal opportunities and equal treatment for all,” those forbidding numbers and statistics reflect the results when true, social injustice is present. True social injustice does not exist in a vacuum. The ultimate consequence of social injustice is often a disproportionately higher mortality rate. A direct correlation between social injustice and mortality rates.

To exacerbate the reality of this situation, those persons who attempt to refute those numbers, statistics and talking points are forced to argue against the scientific evidence, facts and logic supporting those numbers. Because scientific research does not support their argument, they must find a way to attack science. And this too, is a problem.

On this issue, Dr. Fauci stated, “One of the problems we face in the United States is that unfortunately, there is a combination of an anti-science bias that people are — for reasons that sometimes are, you know, inconceivable and not understandable — they just don’t believe science and they don’t believe authority.”

He also stated, “It’s amazing sometimes the denial there is. It’s the same thing that gets people who are anti-vaxxers, who don’t want people to get vaccinated, even though the data clearly indicate the safety of vaccines.” “That’s really a problem.”

Social justice issues inextricably intertwined with a higher mortality rate. Scientific evidence supporting the correlation between the two. Some of the foremost experts in their fields linking the two together. That constitutes direct correlation between social justice issues and adverse consequences of not addressing them. And yet, in the eating disorder community?

And meanwhile, in the Eating Disorder World

In the eating disorder realm, we are facing the antithesis of this reasoning. A very small group of advocates is trying to elevate their voices to become a mighty cacophony of noise. They are attempting to elevate the alleged social injustice encountered mainly by women in larger bodies to “the” ultimate place of prominence in the eating disorder community.

Despite reams of scientific research to the contrary, they claim that eating disorders are social justice issues. It is not enough to say, “Eating disorders are complex medical and psychiatric illnesses that can have serious consequences for health, productivity and relationships. Eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder and OSFED (other specified feeding or eating disorder), are bio-psycho-social diseases.” That yes, with certain eating disorders, there is absolutely a societal component which must be included and addressed.

Because they have no scientific research supporting their position that eating disorders are social justice issues, they attempt to attack the research community and question the validity of past studies. When the highest mortality rate is shown to be as a result of anorexia nervosa (which is generally not the eating disorder impacted by societal issues), those voices simply attempt to change the narrative, the facts and statistics, hope that no one notices, and when they are called out on their inaccuracies, refuse to issue retractions. They then attempt to silence the voices who support scientific research and accurate numbers. In Dr. Fauci’s words, “ … [it is] inconceivable and not understandable — they just don’t believe science and they don’t believe authority.”

To exacerbate this reality, the eating disorder industry universally does not impose any consequences for their reprehensible conduct. There are no ramifications for behavior that is harmful or bullying. The eating disorder industry has enabled this reality and now, must live with the consequences of its own inactivity and acceptance of incompetence and misguided leadership.

Deaths in the black community from Covid-19 are the result of generations of social injustice. The mortality rate, facts, evidence, and scientific research combined demonstrate the serious ramifications of social injustice when a society is hit with a deadly virus.

In the eating disorder realm, those clamoring that eating disorders are social justice issues do not have the higher mortality rate, facts, evidence or scientific research supporting their views. They only have the ability to loudly trumpet their own unsubstantiated, uninformed, and uneducated opinions colored by their extreme political and societal views.

And all the while, the horrific death toll that anorexia nervosa enacts continues unabated.

On November 6, 2019, the Academy for Eating Disorders (“AED”) in conjunction with the Strategic Training Initiative for the Prevention of Eating Disorders: A Public Health Incubator (“STRIPED”) a research and training program based at the Harvard T.H. Chan School of Public Health and Boston Children’s Hospital, announced that they were collaborating with economic consulting giant Deloitte Access Economics to develop the most comprehensive report to date on the social and economic costs of eating disorders in the United States.

On Wednesday, June 24, 2020, the US Deloitte Report was released. A copy of the Report is embedded here:

Deloitte Report

The Deloitte Report is a ninety-one (91) page document. It is broken into seven (7) distinct sections:

1. Background
2. Prevalence
3. Case Studies
4. Financial Costs
5. Loss of Well Being
6. Best Practices
7. Conclusions

The Report includes ten (10) separate charts and forty-six (46) different tables. In short, the Report is designed to provide an extensive breakdown and analysis of the social and economic costs of eating disorders in the United States.

Because of its length, this article will attempt to succinctly highlight the important aspects of relevant sections. Note that the Report is statistic intensive and requires careful consideration and analysis.

[The language provided below under each section is largely pulled verbatim from the Report.]

Background

The Background section identifies the types of eating disorders studied. It then explained the cost analysis of eating disorders (“EDs”) were estimated from a societal perspective for the fiscal year between October 1, 2018 and 30 September 30, 2019 (referred to as “2018-19” in the report) using cost-of illness methods.

Costs were then estimated using a prevalence approach, where prevalence was estimated based on a combination of nationally representative surveys and modelling studies in the US. Costs were then primarily generated by multiplying prevalence by mean incremental costs for people with EDs across a range of cost components, which included:

• financial costs to the health system (e.g. costs of providing care in hospital and residential treatment facilities, and visits to primary care provider and other health services).
• productivity costs from reduced workforce participation and reduced productivity at work, loss of future earnings due to premature mortality, and the value of informal care (lost productive income of caregivers who provide help to people with EDs).
• other costs, which include transfer costs, and their associated efficiency losses, or reduced economic efficiency, associated with the need to levy additional taxation to fund the provision of government services.

Prevalence and Mortality

Based on current lifetime prevalence, incidence and mortality data, the Report estimated that 28.8 million Americans alive in 2018-19 will have an ED at some point during their life – either in the past, present or future.

The Report states that the overall one-year prevalence of EDs was estimated to be 5.48 million cases. Prevalence was estimated to be higher in females 4.39 million cases compared to males 1.09 million cases. (approximately 80% females, 20% males)

It was estimated that 21.0 million people in 2018-19 have had an ED at some point in their lives, of which 14.4 million cases occurred in women and 6.6 million cases occurred in men. The overall lifetime prevalence of EDs was estimated to be 8.60% among females and 4.07% among males.

Evidence cited in the Report suggests that EDs are associated with substantial excess premature mortality. An authoritative meta-analysis found that mortality rates were 5.86 times higher than the general population in people with anorexia, 1.93 for bulimia, and 1.92 for eating disorder not otherwise specified (EDNOS). When these rates were extrapolated in the Report, it was estimated that approximately 10,200 deaths (ranging between 5,500 and 22,000 deaths) were associated with EDs in 2018-19.

This equates to approximately one death every 52 minutes. And yet, it must be noted that this mortality rate is estimated and includes deaths believed to be associated with ED conditions, NOT directly caused by ED.

Financial Costs and Well Being

The total financial costs associated with EDs were estimated to be $64.7 billion in 2018-19, which equates to $11,808 per person with an ED. In addition, EDs are also associated with a substantial reduction in well being among people with EDs, which resulted in a further (non-financial) value of $326.5 billion.

Of total financial costs ($64.7 billion), health system costs made up 7.0% of the total, accounting for $4.6 billion. Of this expenditure, $363.5 million was paid by Americans in out-of-pocket costs to manage their ED.

Productivity costs make up the largest share of total financial costs (75.2%) while efficiency losses account for 7.4%. Informal care, which is care given free of charge, accounted for the remaining 10.4% of financial costs attributed to EDs in 2018-19 (measured as the caregivers’ forgone labor earnings).

It was estimated that government bore 27.5% of total financial costs, with the remaining costs shared across individuals (29.0%), employers (25.2%), society and other payers (11.0%), and family or friends (7.3%).

Cost Effectiveness of Best Practice Intervention and Prevention

Another primary focus of the Report was to summarize evidence pertaining to the cost-effectiveness of stepped care and integrated care models, which the Report asserts are recognized as best practice in the care of people with EDs.  

Stepped care is an evidence-based, staged system comprising a hierarchy of interventions, from the least to the most intensive, meaning that treatment is available to meet an individual’s needs at the point in time that they require the treatment.

Integrated care is characterized by the comprehensive delivery of health services, designed according to the multidimensional needs of the population and delivered by a coordinated multidisciplinary team of providers working across settings and levels of care.

As the Report notes, often, there is little distinction between stepped and integrated care models in the evidence base. However, stepped and integrated care have been separately discussed in the Report as they can involve different care settings – for example, stepped care for an individual may include residential care following by an intensive outpatient (IOP) program, while a program delivered solely in an outpatient setting could still be integrated care.

The Report acknowledges there is limited literature evaluating the cost-effectiveness of the stepped and integrated models of care. Outcomes have been shown to improve with stepped care treatment compared to CBT alone (although it is recognized that CBT is often delivered as a treatment within the context of stepped care), and the time burden upon caregivers diminished substantially.

The incremental cost-effectiveness ratio (ICER) was $12,146 per person who abstained from BN behaviors for stepped care and $20,317 for CBT, suggesting that stepped care may be superior to single step interventions delivered in isolation.

The integrated care model is likely to provide cost-effective treatment by better offering multiple disciplines (e.g. medicine, nutrition, psychology/social work and psychiatry) to support a patient’s individual needs and their symptoms.

Partial hospitalization programs (PHPs) may also offer significant cost savings compared to inpatient care.

Unfortunately, the Report did not address proactive, prevention strategies and the amount of revenue that would be saved or recaptured by investing in those strategies instead of paying for reactive, treatment costs on the back end. This omission is both curious and glaring since the 2012 Australian Report estimated that for every $1 spent in proactive, preventive care, it saved approximately $4 on reactive treatment care on the back end.

Necessary Research Identified

The Report identified four (4) areas of research which are crucially needed to expand our understanding of eating disorders:

Research to estimate the cost-effectiveness of stepped, integrated care models to reduce the burden of ED in the United States and this research should be undertaken as a priority;

Research to determine the long term impacts of eating disorders and the impact of co-morbidities on the costs associated with eating disorders;

Research to estimate the costs that may be prevented through early intervention and prevention of eating disorders;

Research to understand and estimate the additional costs of eating disorders that may be attributable to structural racism and other structural oppressions in the US.

it should be noted that no lobbyists or eating disorder organizations are currently pursuing any bills which would provide funding for any of these areas of research.

Application in the Industry

The Report is an expansive report and is deserving of careful analysis and research to determine what applicability, if any, it may have to medical providers, mental health providers, insurance benefit providers, large corporations and governmental entities. Potentially, its application and use in the United States could be invaluable. At the same time, some glaring omissions in the Report could undermine its usefulness.

The Report could be the foundation upon which eating disorder bills in the nation’s capital and in state capitals could be based. Long abandoned bills which once emphasized research could be resurrected since they would now be supported by objective, third party information, statistics and facts. Research exploring that aggressive, preventive, proactive measures with possible pharmacological involvement could be pursued. Or, the Report could be lost in the ocean of white noise which seems to define the eating disorder industry.

How will the Report be utilized?

During the seven season run of the television series, “The West Wing,” the fictional character, President Josiah Bartlet [played by Martin Sheen] repeatedly asked his White House staff, “What’s next?”

Bartlet explained his catchphrase’s intent during a flashback to the campaign trail. Bartlet and his team are discussing strategies for securing his nomination for the presidency. When a character belabors a proposal, Bartlet counters, “I understood the point…. When I ask ‘What’s next?’ it means I’m ready to move on to other things. So, what’s next?”

So with regard to the Report and its usage and application in the medical, mental health, legal, corporate and governmental areas, the question needs to be asked, “What’s next?”

Father’s Day 2020.

Some people with whom I have spoken expect this Father’s Day to be particularly difficult for me. 3 ½ years ago, my beloved daughter, Morgan was taken after fighting various eating disorders for over 7 years.

Last October, October 24, 2019 to be exact, just 6 days before the commemoration date of Morgan’s passing, and in the same hospital, my dad passed away.

He led a full life. Air Force fighter pilot, businessman. I was honored to be his guardian when we went with 50 other military veterans, on what is called “The Honor Flight.” The Honor Flight takes 50 or so veterans to Washington, D.C. to tour the war memorials and monuments, to experience fellowship. Respect and true thanks for their past service are not just spoken words, but shown through actions and conduct.

And so, this Father’s Day is the first that I will experience without my dad and without my daughter. And many people may assume, perhaps rightly so, that it will be a somber day of remembrance.

We do remember.

And yes, we grieve. But sometimes, that grief does not have to destroy us. Sometimes that grief does not have to define us in a negative way. Sometimes, that grief fills us with incredible strength, purpose and insight.

The journey of our soul, its path revealed just enough to keep us moving forward, always forward. Its ending is not clear. Nor does it need to be. We only need to find a way to stay on that path. And we know we do not walk that path alone.

We know we are on the right path when messages filled with hope and love continue to be revealed to us during our darkest moments.

I remember the last few days of my dad’s life not because the specter of death was nearby, but for the courage, dignity and strength my dad showed as his final hour neared. His last fatherly lesson to me was surely, “the manner in which we face death is just as important as the manner in which we face life.”

Those last few dark nights in the hospital. There were times when I sat alone contemplating life … and death. And during those times, I sometimes felt a presence around me. A calmness. I certainly did not hear, but almost “felt” a message. A message along the lines of, “Daddy, you have done this before. You have weathered far worse. You are needed. I am with you.”

And I know I am not alone. I will never be alone.

As my father’s physical life force continued to weaken, I felt drawn to the hospital nursery. Looking through the window, I saw the perfect little fingers, the perfect little toes, the pink, black and brown faces, the promise of a full and happy life ahead. And instead of feeling sorrow, I felt a feeling of hope, of renewed life. I was led there not to mourn and grieve for the life that was taken three years before and the life which would be taken in the very near future. But, to see those faces, those incredible little bodies, to feel hope and joy and love.

Enveloped by the feelings of love, on October 24, 2019, at 12:54 p.m., Dallas time, my father breathed his last. Surrounded by all 5 children, their spouses, significant others. Surrounded by love. Once again, hearing those devastating words, “He’s gone.”

Tears of grief. Tears of sorrow. And yet, a firm conviction that his energy, his soul, his Higher Self was soaring. And I felt love. I felt hope.

I desperately miss my beloved daughter. I too, miss my dad, a man who taught me so many lessons, the last one focused on strength and dignity. And the path before me has never been more clear.

A person whose path is placed in front of them, a person who is filled with resolve, inspiration and strength, a person who fears naught, can do wondrous things. Not for his or her own personal glory, but because the message is powerful, clear and universal. The energy of others fill that person with hope. Hope that sustains them.

My father’s name is Richard E. Dunn. He was known to the many friends he made throughout his life as, “Red.” His call sign when he flew the F-86 Saberjet was “Red.“

And on this Father’s Day, to my incredible dad, I choose not to mourn you, to grieve your passing, but to celebrate your life. To my beloved daughter, I know you are with me filling me with resolve, courage, strength and hopefully, wisdom. I celebrate the lessons you are still teaching me.

My Father’s Day is filled with love. My son and I embrace our relationship and we joyfully await the birth of the next generation, his daughter, my granddaughter.

I embrace hope. And in the words of Andy Dufresne, from the movie, The Shawshank Redemption, “Remember RED, hope is a good thing, maybe the best of things, and no good thing ever dies.” 

Happy Father’s Day to all dads here and to those who have gone before us.

Today the mental health community is facing two, invisible deadly  forces which threaten not just our way of  life, but perhaps our very lives as well. The first deadly force is the Covid-19 virus. Covid-19 shuttered our businesses. Brought national economies to its knees. Took the lives of loved ones. Splintered our communities. Exposed our human weaknesses. In many ways, it brought out the worst in mankind. Or so we thought. For Covid-19 was but the catalyst for something far more sinister.

The second deadly force is our own human frailty. Our fear. Our rage. Our ignorance. Our ego. Our sloth. When those conditions are combined, they inevitably lead to a perfect storm of cruelty, division, racism, and madness. Although Covid-19 has scarred us, it will eventually leave us. On the other hand, racism has been embedded into our consciousness, into our very existence. Sometimes openly and notoriously. Sometimes hidden and in the shadows. And yet always beneath the surface where we naively believe we can contain it.

However, the tenuous hold we believe we had on racism was shattered in the span of Eight Minutes and Forty-Six Seconds.

The time it takes to escalate fear and anger attendant with being isolated, sequestered in our homes, quarantined from life, and cowering before an uncertain and frightening future, into a nuclear like explosion consuming all reason, intellect and rationality.

The time it takes for the eating disorder community to hold up a mirror and recoil from the unsavory image appearing before our eyes. And so, the community responded.

Outgoing AED president, Dr. Bryn Austin responded with a passionate statement on behalf of AED.

Dr. Cynthia Bulik co-authored a statement paper vowing for growth, change and greater exclusivity. Her statement appears here:

CEED Statement

Project HEAL sent the following email:

“Dear friends & community,

As Project HEAL’s CEO, I speak on behalf of our staff, board, and volunteers when I say: The violence and systemic injustice that Black people experience in America is unacceptable. Black lives matter. We will not be silent in this long overdue conversation about race in America, and we are heeding the urgent call to action we are hearing from the Black community. We must do better, and we will.

To the Black people in the Project HEAL community: we see you, we are listening, and we are so grieved over the unrelenting pain you continue to endure. You matter to us, deeply. We are committed to being actively anti-racist, both personally and programmatically. We are committed to self-examination and accountability, especially as an organization founded by two white women who represent the dominant ED narrative, and as a majority white staff. We will continue doing the work as an organization to unlearn and learn, and to be better allies and activists, both in this moment and going forward. 

As a first step, starting now, we are offering an online Communities of HEALing support group specifically for Black, Indiginous [sic.] & People of Color (BIPOC) who are struggling with an eating disorder — click here to sign up. This group is free, as always. [bolding was by Project HEAL]

We stand with you, and we love you.”

Other eating disorder communities, persons and foundations issued similar proclamations.

On behalf of the Eating Disorder Coalition, Chase Bannister, its president issued a very heartfelt message:

EDC Message

Rebecca Steinfort, the Chief Financial Officer for the Eating Recovery Center issued a statement of hope and commitment for a greater future:

ERC Statement

No rational thinking person can refute that racism is manifest even in what most people consider, “enlightened societies.” Racism is not genetic. It is learned. It is a condition based upon fear. A condition based upon insecurity. A condition based upon ignorance. A condition based upon irrational hatred. A condition based upon the wrongful belief that I am, in some way, superior to  you.

We face a future of uncertainty. However, what is certain is that the high mortality rate of this disease indicates that research and treatment of eating disorders has largely failed and must be left in the past. Each passing death, each beloved son and daughter, husband and wife, parent or loved one who is taken by this insidious disease is a grim reminder of our failure. A gross institutional failure.

As the eating disorder community and industry express platitudes that they will work toward greater inclusivity, shouldn’t we first ask ourselves the very difficult question, “Exactly what type of quality treatment regiment are we bestowing upon the marginalized members of society? Right now, the answer can only be, “A treatment regiment that has failed.”

We have failed.

We have no generally accepted standards of care.

We have no generally accepted pharmaceutical intervention based upon collaborative research.

Research doctors, clinical doctors and treatment centers in general, do not collaborate and work together.

No legislative oversight.

No agreement on a legislative agenda that is designed to increase funding for research and lower the mortality rate.

Advocacy groups, fighting not just with other advocates but openly and notoriously attempting to harm other advocates who do not agree with their positions.

A small cadre of persons in such internal pain and anguish and who yet occupy what should be positions of leadership, attempting to derail professional summits attended by some of the brightest minds in the industry.

We have no accountability nor consequences for our failures or intentional acts of malfeasance. At a time when we had the opportunity to include the financial power that corporate giants could bring to the care and treatment of eating disorders, our egos and self-interest predominated. Those corporate giants which could have invested untold millions of dollars into the research, care, and treatment of eating disorders turned their backs on us. And the opportunity for real progress was lost. We failed. And those responsible for this horrific failure faced no consequences.

That is the reality of the eating disorder community today. That is the image we see when we look into the mirror. And yet, we have the arrogance to believe we should still reach out to the disenfranchised and marginalized and expose them to our dysfunctions? Isn’t that the very height of hubris?

Instead, perhaps the disenfranchised and marginalized people should take a look at us and ask, “Why should we subject ourselves to your incompetence, petty jealousies, failure to communicate, failure to collaborate, back-stabbing, short-sightedness, in-fighting and ridiculously high mortality rate?”

Perhaps, the disenfranchised and marginalized people should say to us, “We deserve better than what you can possibly provide. We don’t need your pandering. Get your own house in order first. Why should we possibly believe that you are capable of helping us when you can’t even help yourself? We don’t need your pity. We don’t need your white guilt. We don’t need your pandering. We do not care for your platitudes of inclusivity which you spew forth to make only yourself feel good especially since you are not offering any positions of power within your organization to implement real change!”

Perhaps they would say, “This past year, if you looked at NEDA, The Alliance for Eating Disorders Awareness, The National Association of Anorexia Nervosa and Associated Disorders, The International Association of Eating Disorder Professionals (“iaedp”), The Academy for Eating Disorders (“AED”), The Eating Disorders Coalition,  and The Multi Service Eating Disorders Association, there are forty-one (41) executive officer positions listed. How many were held by African-Americans?  The same number as are held by dead men … Zero.”

Perhaps they would also say, “What we do need is intelligent, evidence based, affordable treatment from a community which is enlightened, inclusive of all (including boys and men) and which presents a strong, united, cohesive message of hope for the future.”

Perhaps, the disenfranchised and marginalized should say to us, “Thanks but no thanks. We will forge our own path. We are united. We are, and will continue to be strong. We are one. We are what you hope to be one day. We are your goal. If you, as a collective community, ever get your act together, find a way to get the bad apples out, come up with generally accepted treatment guidelines, push legislative initiatives which actually aid in the understanding of this disease and learn not to bully, badmouth, and besmirch fellow advocates and organizations which do not agree with your narrow viewpoint, give us a call. We have faced generations of abuse, harassment and reprehensible conduct. We have faced and overcome obstacles which would destroy you. Our bond has been forged by the hottest fire. Our bond is one. YOU do not deserve US. You have failed.”

And they would be right. The “established” Old Guard will continue to set the rules, and the disenfranchised and marginalized will just have to obey and comply with them! Everyone here is equal. Some are just more equal than others.

The disenfranchised and marginalized will recognize us and our thinking for exactly what it is … Plantation Mentality.

We have failed.

How dare we expose others to our systemic failure.

In early 2020, many law enforcement officers and other first responders throughout the world contracted COVID-19 due to the requirements and demands of their jobs. We held them up as heroes. We praised them. We admired their courage. They represented what we aspire to be. And death took its merciless toll on them.

The following law enforcement officers are only some of those who died as a result of contracting Covid-19 in the line of duty.

Bedminster Township Police Department, New Jersey

• Sergeant AlTerek Patterson

Bexar County Sheriff’s Office, Texas

• Detention Deputy Timothy De La Fuente

Bloomingdale Police Department, New Jersey

• Patrolman Gary Walker

Boston Police Department, Massachusetts

• Police Officer Jose Fontanez

Broward County Sheriff’s Office, Florida

• Deputy Sheriff Shannon Bennett

Chicago Police Department, Illinois

• Police Officer Marco DiFranco
• Sergeant Clifford W. Martin, Sr.
• Police Officer Ronald Newman

Detroit Police Department, Michigan

• Captain Jonathan Parnell

District of Columbia Department of Youth Rehabilitation Services, District of Columbia

• Correctional Officer Kenneth J. Moore

Durham County Sheriff’s Office, North Carolina

• Senior Detention Officer Alexander Pettiway

El Paso County Sheriff’s Office, Colorado

• Deputy Sheriff Jeff Hopkins

Glen Ridge Police Department, New Jersey

• Sergeant Charles “Rob” Roberts, III

Kansas Department of Corrections, Kansas

• Corrections Supervisor 1 Fella A. Adebiyi
• Corrections Supervisor 1 George “Bernie” Robare

Louisiana Department of Corrections, Louisiana

• Warden Wilmot Sandlin “Sandy” McCain

Melrose Park Police Department, Illinois

• Police Officer Joseph Cappello

Montgomery County Sheriff’s Office, North Carolina

• Deputy Sheriff Sypraseuth “Bud” Phouangphrachanh

New Orleans Police Department, Louisiana

• Reserve Captain Raymond Andrew Boseman
• Senior Police Officer Mark Hall, Sr.

Palm Beach County Sheriff’s Office, Florida

• Sergeant Jose Diaz-Ayala

Puerto Rico Police Department, Puerto Rico

• Agent Miguel Martínez-Ortiz

Riverside County Sheriff’s Department, California

• Deputy Sheriff Terrell Young

Sands Point Police Department, New York

• Sergeant Joseph Spinosa

Santa Rosa Police Department, California

• Detective Marylou Armer

Texas Department of Criminal Justice, Texas

• Corrections Officer V Jesse Wayne Bolton
• Corrections Officer Coy D. Coffman, Jr.
• Corrections Officer V James D. Coleman
• Corrections Officer V Jonathon Keith Goodman
• Corrections Officer V Maria Mendez
• Chaplain II Akbar N. Shabazz
• Corrections Officer IV Kelvin D. Wilcher

Troy Police Department, New York

• Detective Sergeant Randall C. French

Union City Police Department, New Jersey

• Detective Alex Ruperto

United States Department of Defense – Naval District Washington Police Department, U.S. Government

• Corporal Lawrence Onley

United States Department of Homeland Security – Customs and Border Protection – Office of Field Operations, U.S. Government

• Officer Richard G. McCoy
• Officer Omar E. Palmer
• Officer Ching Kok “CK” Yan

Washington State Department of Corrections, Washington

• Correctional Officer Berisford Anthony Morse

We revered them. They went into places where we did not have the courage, or strength or will to go. They left behind spouses. They left behind children. They left behind parents. They knew the risks. Their dedication to duty, to society knew no bounds. And they paid the ultimate price.

And then, Eight Minutes and Forty-Six Seconds.

Eight Minutes and Forty-Six Seconds to murder a man because of the color of his skin.

Eight Minutes and Forty Six Seconds is how long it took for we as a society, to change the manner in which we look upon law enforcement officers. And in some cases, that change came about  in the most vicious, heart-breaking, reprehensible manner. How quickly we forget.

Eight Minutes and Forty-Six Seconds.

The time it takes for society to descend into a state of madness and chaos.

Eight Minutes and Forty-Six Seconds.

The time it takes for society to forget or disregard all caution about a deadly virus. [On June 2, 2020 at 7:07 p.m., a student/football player attending Oklahoma State University reported on social media that he tested positive for Covid-19 after attending a protest in Tulsa, Oklahoma]

Eight Minutes and Forty-Six Seconds.

The time it takes for society to willingly and intentionally expose their fellow citizens to a deadly virus.

Eight Minutes and Forty-Six Seconds.

The time it takes to precipitate wholesale lawlessness and insanity to grip an already crippled nation.

Eight Minutes and Forty-Six Seconds.

The time it takes for a society which so admired the courage of those first line responders to denigrate into hatred, violence and unrestrained rage.

Eight Minutes and Forty-Six Seconds.

The time it takes for society, in 96 hours to observe:

-A Las Vegas police officer was shot in the head while struggling with a rioter

-An active shooter opened fire on law enforcement at a Las Vegas courthouse

-4 St. Louis police officers were shot by an active shooter;

-A NY police officer was struck by a vehicle

-3 Buffalo law enforcement officers were struck by a vehicle in front of a police station

-3 Davenport law enforcement officers were ambushed and 1 was shot

-132 police officers were injured in Chicago during a riot

-Several police officers in Rhode Island were injured during riots

-An active shooter opened fire at the Oakland police department

-2 police officers were struck in the head by projectiles in Santa Ana

-2 Richmond police officers were shot in VA

-1 police officer was struck in the head by a brick in Albany

-4 Prince William Co police officers sustained head injuries from projectiles

-7 police officers injured in Sacramento

-Several officers were shot at and injured in Lynchburg

-3 Oakland police officers injured

-21 police officers injured in Salt Lake City

-50 Secret Service Agents injured by molotov cocktails in DC

-3 Denver police officers run over by a vehicle

-33 NYC police officers injured during riots

-6 Athens police officers injured during a protest

-2 police officers injured during a riot in Harrisburg

-12 Las Vegas police officers injured during a riot

-1 Federal Protective Service Officer shot and killed

Before those Eight Minutes and Forty-Six Seconds, the vast majority of these men and women were respected and revered. They placed their lives on the line going to work while we stayed home. They were admired. They were thanked. And then …

Eight Minutes and Forty-Six Seconds.

For a life to be taken in a cruel and reprehensible manner and for a nation to lose its soul.

And yet, those Eight Minutes and Forty-Six Seconds did not rip the souls from all law enforcement officers. Some removed their helmets, dropped their batons, kneeled, prayed and marched with the righteous George Floyd protestors.

Police With Protestors

As for those law enforcement officers who died from Covid-19, and those who have been injured, shot and killed in the lawless rioting … what direct relationship did these people have to the reprehensible murder of George Floyd? … Nothing. Other than, they agreed to place their lives on the line while the majority of us stayed home hoarding toilet paper.

Nothing can forgive the reprobates who stole the life of George Floyd.

Evil is manifest in different shapes and forms. Certainly, evil exists within those murderers who stole the life of George Floyd because of the color of his skin. And yet, what emotional scarring, pain and anguish must surely exist within those persons who are painting with a broad brush and defining all law enforcement officers as racist sub-humans.

No rational thinking person can refute that racism is manifest even in what most people consider, “enlightened societies.” Racism is not genetic. It is learned. It is a condition based upon fear. A condition based upon insecurity. A condition based upon ignorance. A condition based upon irrational hatred. A condition based upon the wrongful belief that I, in some way, am better than you.

A subgroup of people see all law enforcement officers as being racist, that they trample the rights of fellow citizens whenever the cameras are off. As with any profession, there are reprehensible people employed as law enforcement officers. Society has the absolute non-delegable duty to raise our standards, to expose those bad actors which in turn, will allow law enforcement to engage with wisdom, courage, understanding and compassion. We have no choice and if we do not fully embrace that mandate, as a nation we will continue to live without a soul.

As for that subgroup of individuals who regard all, if not the vast majority, of law enforcement officers as evil and corrupt, when it is their house being burned by rioters, when it is their business being looted, undoubtedly they will be the first one on the telephone begging law enforcement to help them, to come save them.

After all, they have their precious hoards of toilet paper to protect.

And in response … law enforcement will come.

“Life began by waking up and loving my mother’s face.”

George Eliot, Novelist

Mother’s Day 2020 was yesterday. The day upon which we openly recognize and honor that which we feel and embrace each and every day. While researching this article, I came across a blogsite which included an incredible, impactful message. That post is a conglomeration of letters and messages from moms who must bear the daily agony of having a beloved child taken from life:

“Dear Friend,

I miss my child every day. This grief of mine will never leave me, and honestly, why should it? I love my child more than I ever could have imagined, and yes, I do mean present tense “love”.  It is excruciating knowing that my child will never return to my arms. However, a mother’s love for her child doesn’t require physical presence; this can be proven by the fact that most mothers love their children well before they are even born.  I will love my child forever, and therefore, I will grieve my child forever. This is just how it goes.

I know it’s difficult for some people to understand my ongoing grief, I guess because they want me to “get better” or return to “normal.” However, I actually am normal. I’m just different now. I believe those who say they want to support me on difficult days like Mother’s Day, but part of this is accepting me as a grieving mother who will always love her deceased child. Again, this is just how it goes.

My grief is like the weather. Somedays it’s calm, quiet, maybe even a little sunny. Other days it’s a devastating storm that makes me feel angry, exhausted, raw, and empty. I wake up in the morning and wonder – “Am I even alive at all?  And if so, how am I supposed to make it through this day?”  This is why when you ask me how I feel about Mother’s Day, all I can say that it depends.  Of course, I’m going to try my best to cope with the day, but while you’re hoping that your Mother’s Day picnic doesn’t get spoiled by actual rain, I’ll be praying that the grief storms stay at bay.  

Like many things in a grieving mother’s life, Mother’s Day is bittersweet to the nth degree. On the one hand, I feel immense joy because I was blessed with my child and I feel gratitude for every moment I was given with them.  On the other hand, the pain of missing my child – my greatest happiness, my life’s purpose, and my best friend – is intense.

Bereaved mothers live with so many of these confusing contrasts. They are like undercurrents that tug at and toss about our hearts and minds.  I am the mother of a child who is not alive. Perhaps a child who you’ve never met. You can’t ask me about their school year, or how they’re liking piano lessons, or whether they’ve chosen a major in college. In my mind, I’ve imagined my child doing all these things. People don’t realize that I grieve each of my child’s milestones, knowing they didn’t get the opportunity to experience these special days. 

Most people don’t know how to validate my child’s place in the world or my ongoing role as my child’s mother. This is a difficult concept for others to grasp. Heck, sometimes even I grapple with the answers to questions like “Do you have children?” and “How many?.”  I know many bereaved mothers, like me, long for these questions to have straightforward answers.

Sadly, mothers who have experienced the death of their only child may even wonder whether they get to call themselves a mother at all in broader society. So, in addition to the pain of grief, these mothers have to cope with a sense of being left out, forgotten, and ignored.  Can you imagine how that might feel?  I think it must be like being stabbed through the heart and when you turn to others for help they say “What blood?” “What knife?”  

Then, for mothers who have surviving children, there is this gem of a comment – “Don’t forget, you’re lucky to have other children.” Please let me assure you, a mother does not forget any of her children. This mother loves each and every one of her unique and special children in unique and special ways, but one of her children has died and so her love for this child looks a little untraditional. Mothers do not have a finite amount of love to be shifted, divided, and spread around depending on the number of children they have on this Earth.  So please be careful with your comments, because it’s difficult enough for grieving mothers who often feel torn between feeling joy and happiness for their living children and grief for the child who has died.

All that said, you asked me what it’s like to grieve a child on Mother’s Day, so here’s what I have to say:

This day will forever be hard for me. I live with an emptiness that no one can fill; so I may be sad, I may be unsociable, and I may need to take a break to be by myself in a quiet place. Whatever shape my grief takes on this day, please allow me to feel the way I feel and please follow my lead.

Beyond that, acknowledge me as a mother. It makes me feel forgotten and as though my child has been forgotten when people act as though my child never existed. Also, I can sense that people feel uncomfortable talking about my child and I constantly feel like the elephant in the room, but it doesn’t have to be this way. Honestly, I find it really comforting when someone talks about my child. I love hearing their name spoken out loud!  I love hearing stories about them. Maybe you know a story I’ve never heard, or maybe I’ve heard it a hundred times before, but it really doesn’t matter to me.  Your acknowledgment alone is one of the greatest Mother’s Day gifts you could give me.

I guess while I’m offering my two cents, I also have something to say to my fellow bereaved mothers.  No one has it all figured out, but I’ve learned a few lessons along the way.  If you’re worried about Mother’s Day, you’re not alone.  Try not to get overwhelmed or wrapped up in anxiety.  You may actually find that the anticipation of the day is worse than the day itself.  You may want to plan a whole day of activities just to stay busy, or you may feel like doing nothing at all.  There is no “right” way to handle Mother’s Day – but do try to plan ahead a little. You may want to reach out to others who are struggling with the day and, if you can, it always helps to face the day with people who love and support you.

Whatever you do, believe you will make it through the day. With time, the grief storms will grow smaller and less frequent and you will find a little more balance and room to breathe.  Believe you will be okay and have hope that in the future you will find yourself in a place where you can grieve and celebrate on Mother’s Day all at the same time.

Let’s take care of each other,

M”

_____________

A mother’s grief. For many people, another person’s grief is a topic that is difficult to handle, let alone handle with grace, dignity, wisdom and insight. Especially when that grief involves a child’s death.

Nowhere is that more true than in the eating disorder community. When a child dies as a result of eating disorders, it does not just leave a gaping hole in the heart of that child’s mother, but it also represents the most obvious manifestation of the failure of the eating disorder industry and community as a whole.

This is only a very short list of those mothers whose beloved child was taken by eating disorders:

MARTHA DUNN

NANCY BURK

DEBRA SCHLESINGER

SHARON HOFSTRA HAUGEN

SHARON LOZIPONE MATHIASON

LOUISE KAISER

DEANNA SPEIR

ELLEN KITSEN BENNETT

ROXANNE SCOLARI  WRIGHT

KATHY ROHAN

SUZIE MARIE HEIM

LINDA MAZUR

LAUREN SILVERI

ALITA RITZEMA DORN

JOHANN MCGOWANS

STEPHANE GROSS

LINDA BERRY

ERICA ZENGEL

TANIA JOHNSON

CHERYL VELDMAN

TRACY WRIGHT

ELAINE STEVENSON

CHRISTA JAPEL

SANDY BACON

SARAH GEORGE

LORI SIRACUSA

LISA LANIEWSKI

MICHELLE MORALES

NANCY WEST

JEANETTE KIRBY

LEIGH CLARE

CINDY RAMBO SULTIS

LISA GOROVE

DORIS SMELTZER

BETTY NONENMACHER

SUE BARNES

CANDY MILLER

TRACY SMITH PICONNI

CAROL CROFT

JOAN RIEDERER

ROBIN SMITH

SHERRI FOWLER

KATHERINE HASS STARNER

JOAN ALLEN

DEBBIE BEGENY

KITTY WESTIN

STEPHANIE MOTSINGER

Mothers all, who until their last day, must live with a burden so onerous, that unless you share that tragic bond with them, you cannot possibly grasp the depth of the pain within them. Mothers all, who deserve so much more.

The death of our beloved child or loved one should be the first, second, third and final goal to eradicate in the treatment of eating disorders. And yet, we, the eating disorder industry and community, have failed them. With each death of another beloved child, we fail.

Even worse than failing, certain elements in the eating disorder community have lowered themselves to a level specifically designed to cause friction and fragmentation in the community.

This horrific reality, these facts which are so incredibly difficult to acknowledge, so painful to grasp, paralyze with fear some so-called leaders in the eating disorder community. This fear is so overwhelming, that those so-called leaders not only do not acknowledge those facts and let them inspire and motivate them to accomplish far greater things, but, they lash out in blind, irrational fear to conspire with like-minded sycophants and attempt to destroy anyone who does not agree 100% with their views. A reprehensible conspiracy conducted in the shadows … where only eating disorders live.

In the recent past, a so-called leader in the eating disorder community made the following public post on Facebook:

“The entire ED community is getting “upskirted” by certain men and we cannot put our own FOMO aside long enough to see it. Instead, we attend these men’s meetings and give them power to continue their gaslighting and lack of any willingness to see the intersections affecting our field. I’d love for other women to join me (and a few others) in being difficult when it comes to these people.”

This so-called leader and her shadowy cadre of like-minded sycophants have perpetrated certain deliberate conduct in support of their irrationality to stop progress in the understanding and treatment of eating disorders.

Mothers all, deserve better. We all deserve better.

In life, our beloved children, our now Warrior Angels, our honored dead, certainly deserved better.

But, our Warrior Angels know the identity of those sycophants. They know the underhanded conduct, both in the past and which is presently being perpetrated by those persons. They know.

Those so-called leaders and their sycophants know.

And … I know.

And yet, I fervently hope that those shadowy figures will fully understand how far they have diverged from a path of enlightenment. I fervently hope that those shadowy figures will grow, that wisdom, compassion and understanding will become a light of illumination. I fervently hope that they will begin to embrace those hurt and suffering Mothers with love, with compassion, with understanding. I fervently hope that they will embrace the endless possibilities which exist when we collaborate and think and work as one.

One great goal. One great purpose.  Our Warrior Angels will not remain silent. They demand a far better future. I fervently hope that those so called leaders and their followers become shining beacons demonstrating the power of love, of healing, of understanding, of compassion, of vision. 

I fervently hope.

“The way is shut. It was made by those who are Dead, and the Dead keep it, until the time comes. The Way is Shut.”

            “The Return of the King,” J.R.R. Tolkein, Author

The United States’ economic history is replete with examples of businesses whose collapse and failure caught the world by surprise. And yet, many of the more notable collapses have some common elements. These same elements are prevalent in many of the eating disorder organizations today. And with the changing economic and cultural world which will arise after the Covid-19 Apocalypse passes, these elements may doom some of those organizations to failure … unless they learn to adapt, innovate and reinvent now.

Blockbuster Video

Blockbuster became not just a video industry giant but its stores became social centers in small towns throughout the United States and abroad. Its empire was vast. It had a virtual monopoly over the video industry. Production of VHS tape recorders and then DVD players exploded as a result of Blockbuster stores. Blockbuster went public and its empire of stores exploded in growth. By 2004, Blockbuster had over 9,000 stores globally, counted 60,000 employees and had an annual revenue of $5.9 billion. But, Blockbuster’s fate had already been sealed 4 years before, in 2000.

In 2000, struggling fledgling company Netflix approached Blockbuster about being acquired. Netflix envisioned a future in which streaming videos on the internet was the wave of the future. Unfortunately, Netflix at the time did not have the financial means to fully develop this software and technology. So, they offered themselves up to Blockbuster for the relatively bargain price of $50 million. Blockbuster declined. Speculation exists to this day that Blockbuster declined in part because late fees were a substantial part of its revenue stream and the Netflix model of operation did not include these fees. In fact, at its height, Blockbuster collected annual late fees in the amount of $800 million! This was 16 times the amount for which Netflix could have been acquired.

We know that streaming video today is the goliath, as is Netflix, and Blockbuster ended up insolvent and in bankruptcy. Certainly in part it was Blockbuster’s short sightedness in not acquiring Netflix. But it was also a failure of leadership in not embracing creative innovation. Blockbuster was more interested in protecting its own business model instead of looking to the future.

Sony

In 1978, Sony invented the “Walkman.” In an industry with many competitors, for at least ten years, Sony maintained a 50% market share in the United States even though its Walkman was routinely more expensive than its competitors. This success allowed Sony to purchase CBS Records in 1987. Two years later, it purchased Columbia Records. Therefore, Sony now had the most popular portable music device and the ability to control its product distribution through the acquisition of the record label brands and their retail outlets.

Sony was in the ideal position to expand its market control through inventing the “iPod.” Instead, Sony languished allowing a computer company with no experience in the music business to brazenly jump into the market and then, to dominate the music industry. That computer company? Apple. And the invention of the iPod, followed quickly by the development of the iTunes store established Apple as an industry giant. Apple’s vision and power of innovation allowed it to evolve from a computer company into a consumer electronics company and major retailer behemoth.

So, why did Sony not make this jump? Some experts attribute Sony’s failure to “innovation dilemma.”

Innovation dilemma occurs when established companies in an industry become resistant to perceived disruptive innovation, which threatens their existing capabilities and cannibalizes their existing products. In theory, an assemblage of businesses which could be positively impacted by disruptive innovation might appear to be the best means of assembling the capabilities needed to manage proactive change. In practice, it is more often than not a means of gathering together everyone who has an incentive to resist change.

The executives of music companies, film studios and book publishers did not embrace the opportunities offered by new channels of distribution. They saw these technological developments as a threat to well established business models in which they had large personal and corporate investments. And their lack of vision was a financial and cultural time bomb waiting to explode.

This allowed Apple, with its creative innovation to introduce its vision into a completely new industry and to dominate the competition. The old ideas from old companies mired in protectionist thinking could not possibly compete.

Xerox

Thirty years ago, when an employee needed a copy of a document, more often than not, they were asked to “get a Xerox of that please.” Xerox’s control of the business copier market was so entrenched that its corporate name became synonymous with photocopies.

To sustain this monopoly, in 1970 Xerox started its research department, the Xerox Palo Alto Research Center (“Parc”). Parc was supposed to allow Xerox to look ahead and invent the technologies of the future. And at first, Parc was successful in developing inventions. The Ethernet, the graphical user interface, a commercial version of the mouse and laser printers were the work of Parc. And yet, Xerox was not able to capitalize on the market potential of its own research and development.

Then, in 1984, despite not having invented the graphical user interface or the mouse, both of these technologies were incorporated in Apple’s Macintosh. The Macbook evolved and became a dominant force in personal computing machines while Xerox market share is non-existent.

The lesson learned is that research, development and invention are not enough. In order to creatively and successfully innovate, a company must take its framework and inventions and adopt them to have commercial success. Xerox failed in part because its leaders could not connect those innovations with its core business. Innovation without sustainably profitable business models is only half the battle.

Creative Innovation

The lessons learned from these, and many other examples are many but all have similar foundational elements. Those companies which rely too heavily on protecting their own business interests and ideas (“that is the way we have always done it”) do not attract creative innovative thinkers. Better mousetraps are always being built. Those failed companies generally lack the vision to take their own product or services, incorporate developing technologies and market them successfully. In general, those failed companies cannot envision new financial or cultural possibilities. Ego and hubris dominate. Their own image is more important than the power of the message they are trying to send. And they are passed. And left in the past.

They do not understand that sometimes, that light at the end of the tunnel is an oncoming freight train.

The Eating Disorder Industry and Covid-19

On a national scale, the eating disorder industry is relatively new, is very small and has no particular significance in terms of power and prestige in our Nation’s Capital. Public funding from state and federal entities is a pittance. There is no advertising or marketing of clinical treatment centers or research breakthroughs which capture the imagination of mainstream society. Infighting in the eating disorder community is rampant. Protecting the small pieces of their pie predominate many organization’s mindsets to the exclusion of all else. And now, Covid-19 could be the death knell.

As we struggle to survive the Covid-19 Apocalypse, individuals, non-profits, organizations and corporations must come to grips with harsh new realities. The world is forever changed. Covid-19 has brought the world’s economy to the brink of disaster. Employee lay-offs are massive. Unemployment claims continue to spike to record levels. Budgets have been cut. The Federal Deficit has risen to unprecedented levels.

Those are the facts. That is the reality.

Each eating disorder organization must conduct a thorough self-evaluation and determine if they are a Netflix or a Blockbuster. Do they have the bold, creative innovative thinking and action of Apple? Or are they looking to hold on to their past like Xerox? Are they zealously holding on to their own version of the “Walkman” instead of exploring brave new avenues of funding, of messaging, of collaboration?  Do they possess the skills, experience, intellect and courage to discover the necessary new paths which lay in the future and guide the organization on this path and to a place of success? Or are they doomed to languish in anonymity and failed dreams?

The way is shut. And Covid-19 and its long term economic and cultural ramifications could be the “culling of the herd” in the eating disorder industry and community.

The way is shut.

Covid-19 has created a new reality for peer review doctors, insurance companies and even treatment guidelines. For those persons and entities which do not understand nor embrace that reality, civil and possibly criminal ramifications exist.

Issue: Your son or daughter has a severe eating disorder and is currently receiving treatment at a residential treatment center. This treatment center has implemented lock down procedures to lessen the likelihood of its patients being infected by Covid-19. The insurance company is now demanding that the patient be stepped down from residential care. If that decision is not overturned in the peer review process, the patient, your son or daughter could be forced to leave the residential program and travel home.

That means: your son or daughter could be exposed to Covid-19 in the taxi on the way to the airport; at the airport; in the airplane; at the airport in their home city; on the way home. In addition, your son or daughter could then be subject to a fourteen (14) day quarantine requirement in the (currently) twelve (12) states requiring quarantine for those who travel from outside that state. Further, governors from forty (40) states have issued stay at home executive orders.

To follow up for much needed care from your discharge treatment team at home, you will need to schedule an in-person doctor’s appointment. The doctor overseeing their treatment at home undoubtedly will want to take blood and urine tests to establish a starting baseline for the next phase of your loved one’s recovery. Isolating and physical distancing will exacerbate your loved one’s condition. Of even greater concern, if your loved one has a severe relapse episode or related serious health issue, they will need to be taken to the emergency room.

Since your loved one is receiving treatment at the residential treatment level, it is likely that their immune system has been compromised and they are at greater risk for contracting the Covid-19 virus.

And yet, a decision is made to step them down from treatment that may have been effective and which kept them as safe as possible from exposure. All because the insurance company made a financial decision which was solely in their best interest.

Fiduciary Duties and Duty of Good Faith

Most courts  recognize a common-law (or statutory) duty of good faith and fair dealing with regard to insurance companies.  Courts recognize that a special relationship exists in the insurance context due to the increased bargaining power an insurance company has in the insurance claim settlement process.  Because an insurance company has the ultimate control over the evaluation, processing, and denial of its insureds’ claims, it has the potential to unscrupulously take advantage of its position of power and treat its insureds unfairly. As such, courts hold that the insurance company has the duty to act in good faith and to deal fairly with its insureds.

An insurance company is liable for acting in bad faith if it denies or delays payment of a claim when it knows or should know coverage is reasonably clear.   If the insurance company has no reasonable basis for denying or delaying payment of your claim, and does so regardless, it is in breach of the duty of good faith and fair dealing.

Additionally, if the insurance company does not properly and thoroughly investigate your claim, the insurance company is liable for acting in bad faith.  The insurance company must adequately investigate your claim before denying it.  If the insurance company merely investigates your claim for the sole purpose of denying it, it is liable for bad faith.

For the purposes of reviewing claims for additional treatment at the residential treatment center level, focus is placed on the peer review process.

Peer Review Doctors

Your insurance benefits provider must also employ Peer Review physicians in good faith, physicians who are competent and who must hold the insured’s needs paramount. And yet, by its very nature, the Peer Review physician is occupying an adversarial position to  your treating doctor.

A peer-to-peer review is typically done as a scheduled telephone call between the Peer Review physician acting on behalf of the insurance provider, and the healthcare professional who requested the review. Ideally, the Peer Reviewer applies the health plan’s medical coverage guidelines to the clinical information, uses clinical judgment, and renders a decision. Although the Peer Reviewer is a delegate of the insurance company, allegedly the Peer Reviewer receives no financial incentive to deny or to approve a request.

In practice, the reality is different. A number of medical doctors and counselors have advised that the peer review process is woefully flawed. Stories of peer review doctors being unprepared, of not having all relevant documentation, of allowing their assistants to conduct the peer review, of having no objective, reliable treatment guidelines in place are rampant.

Last year, in the case of  David Wit, Individually and on Behalf of Others Similarly Situated, et al v. United Healthcare Insurance Co., et al, Civil Action No. 3:14-cv-02346, a federal district court in San Francisco determined that United Behavioral Healthcare, in every version of its Guidelines at every level of care placed an excessive emphasis on addressing acute symptoms and stabilizing crises while ignoring the effective treatment of members’ underlying conditions. 

This overemphasis on treatment of acute symptoms was found not only in the admission criteria of the challenged Guidelines but also in the continued service and discharge criteria that applied to all levels of care.

The Court found that the financial incentives infected the Guideline development process. In particular, instead of insulating its Guideline developers from financial pressures, UBH placed representatives of its Finance and Affordability Departments in key roles in the Guidelines development process.

In short, UBH was more concerned about increasing their revenue than the well-being of their insureds. Similar cases are pending against a Blue Cross entity in the State of Florida, against Optum in a state court in Utah and against other insurance companies in other courts throughout the United States.

At this particularly challenging time in not just the history of the United States, but global history, unscrupulous entities which do not take into account the realities of Covid-19 and the manner in which the virus impacts the delivery of medical and mental health treatment will find themselves liable under new theories of accountability. Both civilly and potentially criminally. Especially to our most vulnerable citizens.

Many People with eating disorders have compromised immune systems

A research study  published in the July 2019 issue of the Journal of Child Psychology and Psychiatry, revealed there is a strong relationship between eating disorders and autoimmune diseases, especially in women. The most prevalent autoimmune illnesses in the sample were celiac disease  (related to malabsorption and intestinal sensitivity to Gluten), type 1 diabetes (related to the body’s inability to produce sufficient insulin), and psoriasis  (a skin condition).

Analysis of the relation between eating disorders and autoimmune illnesses showed that in both men and women, previous autoimmune illness was associated with an increased risk for eating disorders. In fact, that study found women diagnosed with any eating disorder had a 114% increased risk of being diagnosed with an autoimmune illness in the following year.

Compromised immune systems are more susceptible to disease.

It has long been understood that people whose health is compromised for any reason are more likely to be susceptible to disease and can have more severe symptoms than a healthy and robust person. A person’s body ravaged by an eating disorder may be an ideal place for viruses or bacteria to take root and thrive. And then take their life.

Both small and large amounts of virus can replicate within our cells and cause severe disease in vulnerable individuals such as the immunocompromised. In healthy people, however, immune systems respond as soon as they sense a virus growing inside. Recovery or possible death depends on which wins the race: viral spread or immune activation.

Civil or possible criminal liability

And so, our current situation is:

1. Insurance companies’ enforce treatment (read, “payment”) guidelines which do not have to comply with generally accepted standards of care;
2. These insurance companies are making adverse, medical decisions refusing to pay for potentially life-saving treatment for patients;
3. The patient’s treating doctor disagrees with the insurance company’s decision and cites reasons supported by the patient’s current symptoms and status using generally accepted standards of care;
4. Ultimately, the peer review doctors almost universally agree with the insurance company’s determination;
5. The peer review doctor knows, or should know that the vast majority of times, eating disorder patient’s immune systems are compromised;
6. The insurance company and peer review doctors have actual knowledge that the insured/patient, with a compromised immune system is being released in an environment in which the Covid-19 virus is rampant and is causing widespread death;
7. The insurance company and peer review doctor know, or should know that being forced to quarantine or isolate away from human interaction in all reasonable medical probability, is going to cause a relapse of eating disorder symptoms;
8. If the insured/patient contracts Covid-19, with their compromised immune system, they are much more likely to succumb to Covid-19.

This course of conduct is ripe for litigation. The failure to evolve treatment protocol and guidelines to adapt to the reality of Covid-19 is at best negligent. At worse, it could cost a business entity millions of dollar in damages. The damages, including exposure to Covid-19 and dying from such exposure are reasonably foreseeable to the insurance company and peer review doctor. And reasonable foreseeability equates to civil liability. And possibly criminal liability.

The crime of “Culpable Negligence” is defined as a course of conduct “showing reckless disregard for human life, or for the safety of persons exposed to its dangerous effects, or . . . which shows wantonness or recklessness . . . [or] an indifference to the rights of others as is equivalent to an intentional violation of such rights.”

Under Florida law, Culpable Negligence may be classified as second degree misdemeanor (punishable by up to 60 days in jail), a first degree misdemeanor (punishable by up to 1 year in jail), or a third degree felony, punishable by up to 5 years imprisonment.

Where the culpable acts of the accused merely “expose” another to a danger without injury, the offense is a second degree misdemeanor. Where the accused’s actions actually inflict personal injury, it is a first degree misdemeanor.

For insurance companies and their peer review lackeys, liability is present. The rules have changed. Parents, treatment providers, fellow insureds, the time is now to be aggressive asserting your rights. COVID-19 is an unprecedented public health emergency – both in the rapid spread of the disease and because of the sweeping nature of some the measures States have taken in their responses to it. Fortune favors the bold. For the sake of your loved ones, for their very lives, you must be bold. It is YOUR turn now.

As we struggle to survive the Covid-19 Apocalypse, individuals, non-profits, organizations and corporations must come to grips with harsh new realities. The world is forever changed. Covid-19 has brought the world’s economy to the brink of disaster. Employee lay-offs are massive. Unemployment claims continue to spike to record levels. Budgets have been cut. The Federal Deficit has risen to unprecedented levels.

One research firm released an analysis estimating that Disney could lose as much as $3.4 billion domestically alone as a result of Covid-19.

The National Basketball Association is expecting a loss of league gate revenue of between $350 – $400 million. And that is just from the cancellation of their regular season.

Our colleges and universities are also being financially devastated by Covid-19. The University of Florida recently reported an estimated loss of $33 million for the spring and summer of 2020 alone. After the financial crisis of 2008, Harvard’s endowment lost 30% of its value. Harvard’s current endowment is the largest of all United States’ universities standing at approximately $40.9 billion. Analysts are projecting a loss equal to or exceeding that 30% as a result of Covid-19.

Both Google and Facebook are projected to lose $44 billion in advertising revenue in 2020.

Unquestionably, non-profit organizations, foundations and entities relying on public or private funding are going to be severely impacted. Many will not survive. This reality began even before Covid-19 became a global catastrophe.

Changes in the Tax Cut and Jobs Act of 2017 while not generally aimed at charitable deductions, reduced the scope of the tax benefit for charitable giving. A higher standard deduction and the limit on the deduction for state and local taxes caused more individuals to take the standard deduction, as opposed to itemizing deductions. As a result, many individuals who were able to deduct charitable contributions no longer claim this itemized deduction. Other changes exempted more estates from the estate tax thereby eliminating the benefit of deducting charitable contributions in those instances.  The Tax Policy Center estimated that overall charitable giving will decline between $12 to $20 billion annually.

And yet, people worldwide tend to embrace their charitable heart in the face of catastrophes. According to the Chronicle of Philanthropy, a Washington-based news agency that tracks institutional charities like the American Red Cross, after the terrorist attacks on 9/11, Americans donated a record-breaking $2.8 billion to help the victims of the worst terrorist attack on U.S. soil.

Americans also donated nearly $2 billion to victims of the gargantuan tsunami that slammed into Indonesia and other parts of the South Pacific in 2004, killing more than 180,000 people. 

After Hurricane Katrina devastated Louisiana, Mississippi and other states, killing 1,723 people in what the Federal Emergency Management Agency called “the single most catastrophic natural disaster in U.S. history,” Americans donated $5.3 billion to the victims of Katrina, according to the Chronicle.

In 2010, United States donors gave nearly $1.5 billion to victims of the apocalyptic earthquake that devastated Haiti, annihilating much of Port-au-Prince and killing more than 300,000 people.

But, Covid-19 is different. Covid-19 was the “perfect storm” which changed all aspects of our world. Life and Death. Financial. Humanitarian. A global epidemic. This will have a huge impact on non-profit organizations. Indeed, the manner in which non-profit organizations, foundations and entities have traditionally operated is now buried in the past.

Non-profit organizations must evolve and creatively stay ahead of this new reality. Many corporations, wealthy individuals and investors which previously invested in the non-profit sector no longer have the financial luxury or means to sustain their past levels of support. The non-profit sector must understand this reality and find alternative avenues of relevance. Or they face oblivion. And many will sink into the abyss.

In the movie, “The Godfather,” anticipating that the five (5), feuding Italian crime families would be going to war, Michael, the Don of the Corleone Family, removed Tom Hagen as the family’s consigliere (“trusted advisor.”) He knew that the Family needed a “wartime consigliere.”  A wartime consigliere is a senior advisor  with the cunning, wit and intellect needed to defeat an enemy during times of open conflict. Unconstrained by the caution and deliberation called for during regular business order, a wartime consigliere acts and plots creatively, perhaps in unorthodox and unexpected ways but understands that the rules and the world have changed. And in order to preserve what is important, he must adapt and stay ahead of the new world order.

So too, each organization must conduct a thorough self-evaluation and determine if their President, CEO or perceived leader is up to the task of leading that organization into the next decade. Do they possess the skill, experience, intellect, bravado and courage to find the new paths which lay in the future and then be able to guide the organization onto this path and to a place of success? Does your leader understand the reality that non-profit organizations can no longer simply approach financial supporters hat-in-hand and ask for donations as they did in the past?

Does your leader understand that because of these catastrophic economic times, your organization must be able to not only completely understand the vision, the mission and passion of their past financial supporters but to embrace their mission? Your leader must convince past and future supporters that they are NOT making a donation to the non-profit organization but instead, are making a sound financial investment in themselves! Your organization must have a product or a service that they can use to partner with their financial supporters to not only accomplish the goals of the non-profit organization but to help their financial supporters rebuild their financial structure. These entities will NOT be your donors but instead, will be your financial and visionary collaborators.

THAT is what a wartime consigliere will and must do for non-profit organizations. They must have vision … Daring … Courage … Intelligence … and be willing to undertake bold initiatives. They must convince their past financial supporters that by investing (NOT donating) in the non-profit, they are actually investing in themselves, their employees, their families. And through collaborating with you, they are making a sound investment.

The non-profit organizations which have that type of wartime consigliere will survive and eventually thrive. Those that do not …

I am attaching the link to an hour long discussion with Dr. John Torous, the Director of the Digital Psychiatric Division of the Beth Israel Deaconess Medical Center. 

He discusses the three major initiatives enacted by the Trump Administration pertaining to Telemedicine and discusses how virtual counseling is likely to impact mental health services in the future.

Dr. Torous on the Mental Health Moment