Past articles have exposed the financial dangers of private equity ownership of treatment centers. Peer review doctors and shady practices have been illuminated. Unfair and fraudulent practices perpetrated by insurance benefit providers have been exposed. Sexual predators in the field have been identified.

The disconnect between research doctors and clinicians has been explored. The “pay for play” evolution of the EDCoalition and its resulting loss of integrity and moral advocacy has been highlighted

Dysfunctionality aplenty. Dysfunctionality for all. And yet, there is more. And mores’ the pity.

And so we will address our therapists. To begin with, this article is not an indictment of all counselors or even a majority of them. Many therapists give life saving treatment and save lives. To those life savers, thank you.

Our counselors and therapists,  those “soldiers in the trenches,”  hopefully utilizing the best “evidence-based” therapies in the industry, have direct, hands on interaction with our loved ones, those who are afflicted with this deadly disease. They are the ones we entrust with our most precious love. We often come to them in our greatest hour of need, when our despair and fear are at their highest. They have a sacred duty. And they do not have the luxury of treating our loved ones like guinea pigs or science experiments for their own spurious, off the wall theories.

Counselors need to research and stay abreast of the latest break throughs, if any, regarding treatment regiments. They must be able to discern which therapies are supported by authentic, objective, and scientific or evidence based research. And which therapies are little more than snake oil pipe dreams perpetuated by quacks and charlatans.

Of critical importance is that the therapist must not and cannot treat therapy as if it is their own counseling session. Their personal biases, experiences, afflictions and past struggles they may have had with eating disorders, yes in part defines who they are. But those same attributes CANNOT be allowed to form the fundamental basis of the counseling sessions. For if they do, the patients, the persons suffering from this insidious disease will suffer the greatest. Counselors … therapists … It is not about you or whatever social agenda you wish to pursue. And if you make it about you or your “social engineering project,” you fail those whose lives have been entrusted to you.

“Rich Little White Girl’s Disease.”

That term, or words to that effect have been used far too frequently. The perception that eating disorders only impact skinny, teen-aged white girls. That perception, in part, has resulted in this disease not being taken seriously be mainstream society.

“White privilege.” There also appears to be a movement among some counselors and advocates that their own self-perceived bias or “privilege,” must be addressed before they can more adequately render therapy. Counselors parading self-aggrandizing terms like, “I must first discover my own [more often than not, white] privilege so I can be a better counselor” are misguided, self-serving and just flat out wrong.

I am still searching for that first authoritative, independent research study indicating that therapists must first discover their own “white privilege” to properly treat this disease. Similar research regarding the specific manner in which the concept of “white privilege” impacts the biological aspects of the brain as they pertain to eating disorders seems to be missing.

Does white privilege impact the manner in which micro biomes in the gastro-intestinal tract process the complex messages it receives and sends the brain? Does white privilege impact the manner in which on-going genetic research is beginning to discover the way in which this insidious disease could be passed through generations? Does white privilege impact the manner in which certain “high risk” genes in the brain regulate oxytocin levels?

Recently invented terminology like “micro-aggression, macro-aggression, Trauma with a ‘Big T,’ trauma with a ‘little t,’ and ‘eating disorders are disorders of systemic oppression’,” are being bandied about by some as if they had just discovered the cure for cancer. Unfounded speculation that social injustice, “white privilege,” and latent racism in society [all of which undeniably exist and need to be fully addressed in other venues] are the direct cause or grossly exacerbate the severity of eating disorders is not supported by any ethical, independent research studies.

Counselors and therapists, you do not have the right to impose your own personal views of society’s ills upon your patients. And yet, studies are showing that this is precisely what is happening. We are speaking of Countertransference.

An article written by Trish O’Donnell, of EDCare, states:

“Transference is the unconscious tendency of our clients to shift their emotional interest toward new persons or objects in the hopes of re-experiencing old persons or objects, often with the subconscious hope of succeeding where formerly they feel they have failed. For example, a 23-year-old bulimic female arrives for therapy under the influence of marijuana. She is vaguely aware that she wishes the therapist to be irritated with her, angry enough to set limits on her behavior and control her. This is soon revealed to be a repetition of her adolescent behavior, which was designed to get a response from a remote and distracted mother. Rather than the client’s remembering, she presents the memory by transference. Transference may be adaptive to the extent that it reflects the urge to master the past and provides repeated opportunity to do so.

In the strictest sense, countertransference is the therapist’s counterpart to the transference of the client. It is not simply the multitude of varied reactions we have to stories and behaviors presented by our clients. It is the unconscious tendency of the therapist to shift his or her emotional interest from persons and experiences of the past onto the client. [emphasis added] It may be damaging to the therapeutic process when there is resistance to conscious awareness, and therefore an acting-out on the part of the therapist. For example, a therapist who has unresolved adolescent rebellion issues may have difficulty in setting limits for the multi-impulsive eating disordered client.”

Research doctors conducted an extensive study of Countertransference. Their findings were published in the International Eating Disorder Journal in 2015[1]. In this study, six patterns of reactions were identified: Angry/Frustrated, Warm/Competent, Aggressive/Sexual, Failing/Incompetent, Bored/Angry at Parents and Overinvested/Worried feelings. The factors showed meaningful relationships across clinician demographics, patient characteristics, and treatment techniques.

This study then concluded that overall, clinician’s reactions were most frequently associated with the clinician’s gender, patients’ level of functioning and improvement during treatment, and patient personality style.

Counseling sessions are not your opportunity to address your views on society’s ills. You are not there to rectify the many wrongs of society. You are there for one reason and one reason alone, that is, with all of your abilities, to help the struggling, perhaps even dying soul sitting in front of you.

So, do you want to be a better counselor? A more evolved therapist? Review the latest research regarding the latest biological aspects of this disease. Exhaustively research the brain, the gastro-intestinal system and the manner in which these aspects of the human body are inextricably intertwined. Research the genetic components of this disease. Read scientific journals on eating disorders. Absorb case studies. Make appointments to speak with local scientists and research doctors. I guarantee they would embrace the opportunity to speak with you. Get up to speed on the latest evidence based treatment regiments. Stay current on the latest thoughts on Family Based Therapy and Cognitive Behavioral Therapy. Yes, review the charlatan based therapies. Not to implement them but to dissect them and reason why they are not appropriate. Arm yourself.

Your calling is not merely a business. It is not merely a job. This is your career. This is your life’s calling. This needs to be your passion. Lives depend on you. Parents, living with terror, depend on you. You must be bigger, stronger, smarter, more insightful than you could ever possibly imagine.

And if you refuse … if you cannot, we parents will not abide. Our loved ones lives depend on you. Our most precious commodity is entrusted to you. This sacred duty is not for the faint nor the weak of heart. And we parents, the families suffering from this disease will not abide “crackpot ideas being thrown against the wall to see what sticks” when our loved one’s lives hang in the balance.

It is your sacred duty. It is our life and the lives of our children.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4485383/

“Vexilla Regis Prodeunt Inferni.”

            Dante Alighieri, The Divine Comedy, Canto XXXIV

“How are the mighty fallen, and the weapons of war perished.”

            2 Samuel 1:27 (King James Version)

The FREED Act of 2009

In 2009, the EDCoalition supported and helped introduce the Federal Response to Eliminate Eating Disorders Act (2009 FREED Act). Representative Patrick Kennedy of Rhode Island introduced this bill. It counted 51 co-sponsors comprised of Congress persons from both major parties.

The 2009 FREED Act was a mighty bill. An ambitious bill. It addressed priorities.

After the preamble, the 2009 FREED Act first addressed and required the National Institutes of Health (“NIH”) to:

1. Compile statistics on the economic cost of eating disorders;
2. Identify total expenditures by the NIH and related agencies on eating disorders;
3. Consult with eating disorder researchers to implement a comprehensive long term plan for research on eating disorders;
4. Annually submit to Congress a scientifically justified budget on eating disorders research;
5. Establish a task force to assist researchers in applying for grants, create a list of priorities for eating disorders research;
6. Establish “Centers of Excellence” among non-profit private and public institutions in which research, and training researchers was to be conducted;
7. The purpose of the research was to improve understanding of the etiology, early identification, prevention, best treatment, medical and psychological sequelae of and recovery from eating disorders;
8. Oversee collaboration and coordination of information among centers of excellence;
9. Establish a central repository in which the research could be reviewed and shared;
10. Collaborate with other agencies within the NIH to share information;
11. Establish a Center of Eating Disorder Epidemiology to collect and analyze information on mortality and causes of eating disorders, economic analysis of the costs of treating eating disorders and evaluate the impact of eating disorders on quality of life;
12. Establish a clearinghouse at the Center for Disease Control and Prevention.

A copy of the Bill is attached here:

2009 FREED Act

But, this bill was submitted just 6 weeks after the Mental Health Parity Act of 2008 had been signed into law. The 2009 FREED Act never made it out of the various committees.

In 2008 – 2009, private equity firms were unknown in the eating disorder industry. The Residential Eating Disorder Consortium (“REDC”) was not in existence. The EDCoalition counted amongst its officers respected research doctors. And the universal understanding was that research into this insidious disease was the key to making breakthroughs in treatment and recovery.

The FREED Act of 2011

In 2011, the EDCoalition supported and helped introduce the Federal Response to Eliminate Eating Disorders Act (2011 FREED Act). Senator Tom Harkin of Iowa introduced this bill. It counted 9 co-sponsors comprised of senators from the Democratic Party.

After the preamble, the 2011 FREED Act first addressed and required the National Institutes of Health (“NIH”) to:

1. Award grants to public or private entities to pay all or part of the cost of planning, establishing, improving, and providing basic operating support for such entities to establish consortia in eating disorder research;
2. Have the Director of NIH— provide for the coordination of information among consortia and ensure regular communication between members of the various consortia;
3. Require each consortium receiving a grant to conduct basic, clinical, epidemiological, population-based, or translational research regarding eating disorders, which may include research related to—

(A) the identification and classification of eating disorders and disordered eating;

(B) the causes, diagnosis, and early detection of eating disorders;

(C) the treatment of eating disorders, including the development and evaluation of new treatments and best practices;

(D) the conditions or diseases related to, or arising from, an eating disorder; and

(E) the evaluation of existing prevention programs and the development of reliable prevention and screening programs.

4. The HHS Secretary to identify other federal agencies to which collaboration and dissemination of research information;
5. Establish an Interagency Eating Disorders Coordinating Council within the Department of Health and Human Services which would be responsible for annually updating a summary of advances in eating disorder research concerning causes of, prevention of, early screening for, treatment and access to services related to, and supports for individuals affected by, eating disorders; monitor Federal activities with respect to eating disorders; develop and annually update a strategic plan for the conduct of, and support for, eating disorder research, including proposed budgetary recommendations;
6. The HHS Secretary, acting through the Director of the Centers for Disease Control and Prevention, award grants or cooperative agreements to eligible entities for the purpose of improving the collection, analysis and reporting of State epidemiological data on eating disorders;
7. The National Center for Health Statistics of the Centers for Disease Control and Prevention and the National Center for Education Statistics of the Department of Education shall conduct a joint study, or enter into a contract to have a study conducted, on the impact eating disorders have on educational advancement and achievement beginning in elementary schools.

A copy of the Bill is attached here:

2011 FREED Act

This bill was introduced approximately one year after the Affordable Care Act had been signed into law and was being challenged in various courts. The 2011 FREED Act never made it out of committee.

In 2011, private equity firms were beginning to become involved in the eating disorder industry. But, their growth was slow. The  REDC did not come into existence until December 2011. Industry professionals understood that research into this insidious disease was the key to breakthroughs in treatment and recovery. Collaboration was embraced.

Review the provisions of the 2009 and 2011 FREED Acts. Now, imagine how much further along we would be down the path of enlightenment and understanding of this disease had we continued down this path.

The FREED Act of 2013

In 2013, the EDCoalition supported and helped introduce the Federal Response to Eliminate Eating Disorders Act (2013 FREED Act). Representative Theodore Deutch of Florida introduced this bill. It counted 39 co-sponsors comprised of Congress persons from the Democratic Party. The 2013 FREED Act never made it out of committee.

After the preamble, the 2013 FREED Act first addressed and required the National Institutes of Health (“NIH”) to:

1. Compile statistics on the economic cost of eating disorders;
2. Identify total expenditures by the NIH and related agencies on eating disorders;
3. Consult with eating disorder researchers to implement a comprehensive long term plan for research on eating disorders;
4. Annually submit to Congress a scientifically justified budget on eating disorders research;
5. Establish a task force to assist researchers in applying for grants, create a list of priorities for eating disorders research;
6. Establish “Centers of Excellence” among non-profit private and public institutions in which research, and training researchers was to be conducted;
7. The purpose of the research was to improve understanding of the etiology, early identification, prevention, best treatment, medical and psychological sequelae of and recovery from eating disorders;
8. Oversee collaboration and coordination of information among centers of excellence;
9. Establish a central repository in which the research could be reviewed and shared;
10. Collaborate with other agencies within the NIH to share information;
11. Establish a Center of Eating Disorder Epidemiology to collect and analyze information on mortality and causes of eating disorders, economic analysis of the costs of treating eating disorders and evaluate the impact of eating disorders on quality of life;
12. Establish a clearinghouse at the Center for Disease Control and Prevention.

A copy of the Bill is attached here:

2013 FREED Act

This bill was submitted approximately 9 months after the US Supreme Court, in a narrow 5 – 4 decision upheld provisions of the Affordable Care Act. The 2013 FREED Act never made it out of the various committees.

By 2013, private equity firms were permeating the eating disorder industry. The Mental Health Care “Gold Rush” was on. The REDC consisting of those PE owned treatment centers was stretching its influence into the EDCoalition.

Further, after 8 years of toil and collaboration among industry professionals, the greatest hope for standardized guidelines, the  “Working Draft of the Clinical Recommendations for Residential and Inpatient Eating Disorder Programs,” one of the most comprehensive works on treating eating disorders spearheaded by the Academy for Eating Disorders was abandoned by the REDC and its members without explanation.

The EDCoalition under the growing financial influence of the REDC, was shifting its priorities from focusing on research about the biological and genetic origins of the disease and their impact on patients and their families, to treatment alone. Treatment not supported by scientific research. Treatment supported only by anecdotal evidence and confirmation bias. Treatment that would result in the greatest financial return to the private equity firms which had invested billions of dollars into residential treatment centers.

And 2013 marked the death of research related bills. 2013 marked the death of collaboration. 2013 marked the death of the possibilities of “Centers of Excellence.” 2013 marked the death of priorities.

2015 Legislation

The 2015 Legislation submitted by the EDCoalition was designated, “The Anna Westin Act bill.” It was designated H.R. 2515 and was introduced in the House of Representatives on May 21, 2015. This Legislation never made it out of committee. And yet curiously, the EDCoalition still advertises this bill as its “flagship legislation.”

As introduced, its goals did not include one mention of research, or Centers of Excellence, or collaboration with other federal agencies. However, one provision it did include was to have clarifying language that if a group health plan or health insurance issuer included coverage for eating disorder benefits, then residential treatment for eating disorders should also be covered in accordance with the Mental Health Parity Act of 2008. And that is curious.

Residential treatment was already covered under the Mental Health Parity Act of 2008. So, why was this provision even necessary? And who would financially benefit the most by having this provision included? And why was research and funding for research completely omitted from 2015 and forward? And why is this provision included in the one page dedicated to eating disorders of the 355 pages of the 21^st Century Care Act?

Attached is the 2015 bill:

2015 Act

What Changed?

So, in the ten years between 2009 when the first FREED Act was submitted to today, what changed?

In 2009, the industry understood and embraced the reality that research and collaboration constituted our greatest hope. Collaboration amongst professionals pursued devising and disseminating treatment standards and criteria for residential care. Emphasis was directed toward a greater understanding of this disease so that effective treatment could be rendered.

This was also reflected in 2011 before the REDC was born. This thinking carried forward for the last time in 2013 before private equity had the eating disorder industry in its cold, icy grip.

At one time, the eating disorder industry was led by intellectual giants. And that is reflected in the 2009 FREED Act. The REDC was not in existence. Private equity firms were not involved in the eating disorder industry. The EDCoalition was not a bought and paid for shill for those private equity firms.

The impact? Studies and analysis now exist indicating that eating disorders are worsening and are much more prevalent than previously thought. Attempting to treat this disease without a thorough understanding of the biological and genetic causes is like playing a game of three dimensional chess without knowing the rules.

And all the while, the leaders of the REDC and EDCoalition proceed secure in the knowledge that their little fiefdoms are protected by the money players. The eating disorder industry has been bought. And the price we pay is measured in the lives taken by this disease every hour of every day.

Vexilla Regis Prodeunt Inferni … “Forth go the Banners of the King of Hell.”

“No man’s life, liberty or property is safe while the legislature is in session.”

            Mark Twain

Mental Health Care in Texas

The non-profit group, Mental Health Group of America annually ranks all 50 states and the District of Columbia with regard to the prevalence of mental illness and access to care. It uses 15 different measures to compile a composite score. It then also breaks down categories according to adult rankings, youth rankings, prevalence of mental illness and access to care. Except for the prevalence category, the higher your score (on a scale of 1 – 51) the rate of access to care worsens.

So, let’s take a look at how the Great State of Texas faired:

1. Overall Ranking – 43
2. Adult Ranking – 25
3. Youth Ranking – 46
4. Prevalence of Mental Illness – 4
5. Access to Care Ranking – 50

With the exception of the prevalence of mental illness in the State of Texas, the other rankings are appalling. But even that does not tell the complete story.

The Kaiser Family Foundation is a non-profit foundation focusing on health policy research, polling and analysis. In 2018, with regard to spending per capita on mental health care to its residents, Texas ranks second to last among ranked U.S. states and territories.

Surpassed only by California, Texas also has the most Mental Health Care Professional Shortage Areas. This issue is exacerbated when you consider that two-thirds of licensed clinical psychologists practice in the five most populous counties in the state, leaving the remaining 249 counties with inadequate care. Many counties are without a single licensed clinical psychologist.

With the lack of mental health care continuing to be in the spotlight, one could naturally assume that our politicians would be able to put their differences aside and work together to implement a system that provides greater access to mental health care for its citizens. [At this point, I will refrain from using the tired, contrived saying about “ass/u/me.”]

And so let us examine the Texas Legislature and mental health care bills and issues.

The Texas Legislature

The Texas Legislature meets every other year during odd numbered years. The session begins on the second Tuesday in January and in accordance with the Texas Constitution, is limited to 140 days.

Texas has 31 state senators and 150 representatives in the House.

Getting a bill introduced and passed and then placed on the governor’s desk for signature was intentionally made difficult. Bills passed by both the Senate and House require similar language, must pass through committees in each body and are subject to parliamentary procedures which could effectively kill a bill at the last moment. Texans historically have been in favor of limited government and self-reliance. The state’s political system reflects that reality.

In the most recent legislative session, which concluded on May 27, 2019, 10,877 bills and joint resolutions were introduced. Approximately 1400 bills were passed and await signature or veto by the governor. The numbers alone indicate that if you are proposing a bill in the State of Texas, expect about a 90% rejection rate.

With the dreadful mental health care statistics being a reality, let us review how the legislature did on mental health care issues. 

Mental Health Care Bills

Senate Bill 10

The primary mental health bill considered by the Legislature was Senate Bill 10 establishing the Mental Health Care Consortium. This bill would create an executive board to ensure that state agencies coordinate and cooperate to improve mental heath care services in Texas especially to children.

SB 10 was designed to create comprehensive child psychiatry centers (“hubs”) at state medical schools and other health-related institutes of higher education. These hubs would provide mental health consultation services from on-call mental health professionals, via telemedicine, to pediatricians and family physicians.

The hubs would also use remote services to conduct behavioral health assessments for at-risk students. It would authorize these students to have two consultations via telehealth services with social workers or other mental health care professionals, and then determine if a referral for additional treatment is called for.

$99 million for funding of the program was allocated from the general budget of the State. With all 31 Senators co-sponsoring this bill, it sailed through the Senate and approval in the House looked to be assured.

Granted, there were a few, fringe groups which opposed SB 10. The reasons usually included: it increased the size of state government; it established bureaucracy without accountability to taxpayers; the bill allowed meetings and activities without parental involvement; there was a mandate to use “evidence based tools” [when all such tools were not defined] and as such, that made them dangerously vague.

But alas, every village needs its idiot. And so steppeth to the plate, Representative Jonathan Stickland. On the last night that the House could advance a bill first proposed in the Senate (like SB 10), Rep. Stickland raised a “point of order” objection to the bill claiming that an analysis of the bill provide to lawmakers contained an inaccuracy.

Never mind the fact that SB 10 was received by the House on March 6, 2019. Never mind the fact that it was read on the floor of the House for the first time on March 28, 2019. Rep. Stickland had to attempt to indulge in gamesmanship which would have cost millions of Texans access to much needed mental health care. Further, it appeared as if his ploy was going to be successful. Unfortunately and after due consideration, the parliamentarian of the House was forced to agree that an inaccuracy did exist and the bill was returned to the House committee where it would die at the stroke of midnight that night. In a telephone interview that day, Rep. Stickland attempted to justify his conduct by stating: “I think it was a well-intentioned bill that had some very bad unintended consequences. I think it could have been stronger on parental rights to make sure our constitutional rights are protected in the bill.”

The Village Idiot had from March 6, 2019 to raise these concerns. But, he chose not to do so until the 11^th hour.

But, the game was afoot. A few hours later, the major provisions of SB 10 were attached as a rider amending SB 11. SB 11 was a sweeping school safety bill that had been passed by the House earlier in the evening.

Over Rep. Stickland’s new objections and request not to reconsider SB 11 with SB 10 attached, the House passed the new SB 11 and the major provisions of the Texas Mental Health Care Consortium were born.

The implementation of the Texas Mental Health Care Consortium could be slow and cumbersome. But, it has started. Undoubtedly, Rep. Stickland will be a future beneficiary of some of the provisions of this Bill.

SB 1145

SB 1145 was an eating disorder bill written and supported by the Elisa Project, an eating disorder foundation in Dallas, Texas. Its executive director is Kimberly Martinez, whom I count as a friend.

SB 1145 required the Department of State Health Services to collaborate with the Health and Human Services Commission and prepare a report on the prevalence of eating disorders and eating disorder-related deaths in Texas.  The report was to include:

             (1)  statewide and regional statistics regarding the prevalence of eating disorders and eating disorder-related deaths in Texas;

             (2)  an overview of national trends in eating disorders; and

             (3)  an overview of state-funded behavioral health treatment options available to persons with eating disorders.

The requisite financial analysis indicated that additional state funds would not have to be allocated for this bill.

It was filed in the Senate on February 26, 2019. It jumped through the required hoops in the Senate, was passed and referred for consideration to the House on May 10, 2019. In the House, it was reported favorably without amendment and assigned to another committee to be scheduled for House debate. And there, it died.

The only issues with SB 1145 were that it was not filed expeditiously enough to warrant consideration in both chambers and it could have been supported by additional background material to both senators and representatives.

With some work in the next two years, I am confident that this bill will pass and this much needed study will be undertaken.

SB 1511

This bill also pertains to eating disorders. And yet, please let this legislation die. This bill is biennially proposed by the venerable Representative Garnet Coleman of Houston. It is a poorly written bill, does not reflect the latest research and thinking in the eating disorder industry and is vigorously opposed by the powerful insurance lobby in Texas.

I wrote an analysis of this bill two years ago when it was proposed and attach it here:

Prior Bill Analysis

It may surprise some that I am not in favor of this bill. However, I tend to support only those bills which have a realistic chance of passing, reflect the current scientific research on this disease and can be supported by the academicians and treatment professionals alike.

Conclusions

Amongst the over 10,000 bills submitted, there were a few other bills which were tangentially involved with mental health. Like most bills in Texas, they never made it to the governor’s desk for final approval or veto.

The access to care for mental health in the State of Texas unquestionably is lacking. Some of that is due to mental health care not having previously been a priority. Some of that is due to the lack of wisdom or insight of certain politicians. Some is due to the fact that Texas is a very large state and both medical and mental health care in the vast rural areas of the state are lacking.

But, with the passage of bills like Senate Bill 10 and with the passage in two years of the bill proposed by the Elisa Project, there is a glimmer of hope for the future. The road continues to be long and arduous. But, because of the work and passion of many advocates and professionals, the voices of those who suffer from mental health issues now have a chance to be heard.

“[Fast Track to Health Study] has become a touchpoint for overinflated concerns.”

“I’m perplexed as to why we’ve been singled out…”

“It’s not as if we’re recommending all young people should have this.”

Professor Louise Baur, Leading pediatrician, Fast Track to Health Study

“The HREC recognises that there is a risk for a young person to develop an eating disorder with exposure to restrictive diets, and in particular very restrictive diets.”

“ the risk of children developing an eating disorder is justified because of the potential for the participants to lose weight.”

Ms. Asra Gholami, Executive Officer of Research Ethics, Sydney Children’s Hospitals Network

In April of 2019, after worldwide criticism and condemnation of the Fast Track to Health Study in Australia, the Study’s lead researcher, Louise Baer made the inexplicable decision to throw gasoline on an already hotly burning fire. In a brief interview given to the publication, “ausdoc.com,” Ms. Baer expressed being perplexed as to why this study was being singled out. Some of her remarks are set forth above.

In response, in the United States there are a few colloquial phrases which immediately come to mind: “low hanging fruit; piece of cake; easy as falling off a log; shooting fish in a barrel; teeing it up.”

Ms. Baur, Socrates is credited with saying, “The only true wisdom is in knowing you know nothing.” More recently, in the HBO’s hit series, “Game of Thrones,” the mantra, “You know nothing Jon Snow,” was repeatedly uttered. So, let us help escort you down the path of enlightenment and give you some possible answers as to the reasons why you, your feckless colleague Ms. Gholami and your hair-brained study are being “singled out.”

First, for some reason Ms. Gholami, your Executive Officer over Research Ethics opined that the risk of children developing an eating disorder, a deadly, misunderstood, widely misdiagnosed disease, was justified because of the potential of weight loss. Really? And yet, we will come back to that issue.

The following are just some of the reasons why “you are being singled out for criticism:”

1. You acknowledged the risks and limitations of the study in correspondence with health professionals, but you were not going to pass on this information to the parents when signing their child up for the study (That is called failure to disclose a known risk);
2. Twenty-nine (29) health experts from Australia and the United States initially expressed concern that your study was not safe nor effective for children; 
3. Subsequently, additional medical experts and counselors issued a report condemning your study. Their report included the statement: “The “Fast Track” trial induces participants to behave in a way that mimics Anorexia Nervosa (AN) (severe restriction of calories), placing them in considerable risk of going on to develop AN, Bulimia Nervosa (hyperphagia with or without purging), or Binge Eating Disorder (hyperphagia);”
4. The Australia & New Zealand Academy for Eating Disorders issued a statement stating that it did not support your study;
5. A world wide petition condemning your study was signed by over 21,000 people;
6. The international eating disorder parent support group, F.E.A.S.T. condemned your study on a number of grounds;
7. Two (2) ethical complaints have been filed against your study;
8. The advocacy group, Eating Disorders Families Australia released a statement condemning the study and requesting that it be stopped;
9. HAES(“Health at Every Size”) Australia endorsed the ethics complaints, condemned the study and issued its statement of condemnation;
10. The Academy for Eating Disorders, the world’s largest eating disorder organization issued a statement not supporting the study and requesting that it be stopped; 
11. Your study cannot and will not ever be duplicated anywhere else in the world because of the inherent risks to the children and the fact that this study is not being conducted under laboratory conditions, utilizing control groups under the daily supervision of medical and treatment professionals; 
12. Your “mitigation strategies” initially did not even include a clinical psychologist to review “the young people.”

To further help place things in perspective, this site identifies issues with the study, the concerns of professionals and other persons and details the risks.

What You Need to know

A criminal lack of disclosure, lack of adequate supervision over the children in the study, lack of supervision over the testing process, world-wide condemnation, lack of the ability to duplicate the study’s processes, failure to identify all medical personnel who approved this study, concealing the identities of the so-called experts who knowingly participated in the initial decision not to inform the parents of all known risks and finally, exposing children to a known and dangerous disease.

And if these are not good enough reasons supporting condemnation, then let us address another reason.

“The risk of children developing an eating disorder is justified.”

Your Executive Officer over Research Ethics obviously requires enlightenment as to the deadly nature of eating disorders. And so, let us commence.

Eating disorders do not kill quickly nor mercifully. Only after years of having your bodily organs compromised and wracked with damage does the spectre of death finally appear at your bedside. Only after years of isolation from friends and family, years of taking you off of your life’s journey, years of physical, mental and emotional pain do eating disorders finally and almost reluctantly give way to the harbinger of death.

The disease has taken away the luster of your hair, your body emaciated to the point where you resemble a World War II concentration camp survivor, the shining light reflected in your eyes being taken away and replaced with a dull lens. And one by one, your body’s precious organs begin to shut down.

You lay back in your hospital bed, in physical agony, as the hospital staff wonders if you are “playing up your pain” because of your perceived dependence on pain medication. Your stomach, screaming in agony. Your compromised heart trying to beat its life giving blood to your permanently damaged organs. The synapses in your brain impinged and faulty. Your parents can only sit by helplessly, praying for a miracle and fearing that at long last, the end has come for their beloved child.

The parent then hears the two words that chill them to their very core, “Code Blue!” goes screaming over the public address system in the hospital as doctors and nurses run to your beloved child’s room. Your child is dead. The medical personnel frantically perform resuscitation on your child. Each passing second that your beloved child is “medically dead” seems like a lifetime. And if you are lucky, those medical professionals bring back to life, your beloved child.

You are then wheeled to the Intensive Care Unit. And even as the icy-cold fingers of overwhelming fear grips your throat, as a parent, a small spark of hope lingers in your heart. Until, two additional times, you are forced to endure hell on earth as two more “Code Blues” scream out over the hospital P.A. system. Bells screeching in alarm. Each time, for your beloved child. The lead doctor over the ICU wing then comes to you and says each time it is more difficult, after your child is brought back, each time her bodily responses become more faint, that her brain activity is stopping. Each time, more damage is being done to her body. That the end is near. With your child’s life signs all but extinguished, you make the most difficult decision of your life.

And you sit in a lonely room in agony, holding your beloved child’s hand, kissing her brow. Waiting. Praying. This time when your beloved child’s heart stops, there are no bells. There are no screeching alarms, no doctors nor nurses running frantically into the room. The doctor monitoring her heart beat and brain activity finally, mournfully looks at you and very quietly says the two words that complete a parent’s descent into total darkness … “She’s gone.” And life as you have known it, will never be the same.

If and when your study results in even one child contracting an eating disorder, that is the possible hell to which you will be sentencing them. So tell me, Ms. Baer and Ms. Gholami, under any circumstance, is that justified?

Better yet Ms. Baur and Ms. Gholami, you and those cowardly medical professionals who approved this study can tell me in person in June 2020 in Sydney, Australia at the International Conference held by the Academy for Eating Disorders. All you need do is find the booth in the Exhibit Hall hosted by the Morgan Foundation. Look for a logo that stands out like no other. You will be able to read some of the journals she wrote. You can see the photos of her life. You can tell me how the risk of eating disorders is justified for the potential of losing weight.

And if you dare, you can look me in the eyes and try to convince me that Morgan was simply one more broken egg needed to make your weight loss omelette.

“I am a soul. I know well that what I shall render up to the grave is not myself. That which is myself will go elsewhere. Earth, thou art not my abyss!”

Victor Hugo

“The most beautiful thing we can experience is the mysterious. It is the source of all true art and science.”

Albert Einstein

Over the course of the past two plus years after I have given a presentation, or assisted in getting a person back into treatment, or in general, just remaining open to a greater journey no person is meant to understand, a number of people have approached me and said words to the effect of, “Morgan is smiling right now,” or “Morgan is looking down upon you and is happy.”

After reflection, my response now is perhaps not what you may think. Now, my response is, “I hope not.” More often than not, this response surprises or confuses most people. Don’t I believe Morgan is at peace now? Is her soul “happy?”

I believe the universe, as part of Creation, is an incredible, too vast to comprehend adventure which is meant to be explored. I hope Morgan is exploring. I hope her soul is free from pain, from the chains of our existence. Her soul … Her soul.

This raises the very question, what is the nature of the soul? Is it an incorporeal, indefinable essence of some greater power within us? A light that can never be extinguished. Has it always been in existence and in this instance, just manifests itself in our frail bodies?

Certainly there are some who believe no such essence exists. That upon drawing our last breath, our bodies degenerate into corruption and the earth becomes our final abyss. Others believe in the concept espoused by some organized religions wherein there is a grand and glorious heaven and eternal damnation awaiting in hell. Choirs of angels. Armies of demons.

But more often than not, the fundamental question, “what is the soul” is not addressed.

For that matter, what is spirituality? Is it a belief in some power, being or essence greater than us?  Is spirituality a “thing,” an “object,” some substance beyond our comprehension giving a greater meaning or purpose to our existence?  Maybe it is something that cannot be analyzed or dissected in a logical manner.  Perhaps it is something as simple as the dimensions of existence which have no boundaries.   However one wishes to define, believe or not believe in spirituality or the existence of our soul, our history is replete with inexplicable, unexplainable powerful events which defy rhyme or reason and yet which fill us with … hope, with faith. And sometimes with fear.

“Spirituality” for the most part, is not included as an important consideration in programs offered by most eating disorder centers, hospitals and professionals. There are exceptions. Timberline Knolls has begun to advertise “The Grace Program.” It states, “This program was created to treat women and girls struggling with co-occurring disorders, eating disorders, trauma, mood disorders and substance use disorders in order to reconnect them with their Faith.” The Selah House in Indiana advertises itself as a “Christ centered eating disorder treatment center. The Renfrew Center offers a non-denominational optional, Christian based programming. Canopy Cove in Florida advertises that it offers Christian based programming. Undoubtedly, a few other programs offer “faith based” services as part of their programming.

And yet, there are no “evidence-based” studies indicating the effectiveness of spirituality in eating disorder treatment programs. Nor can there ever be. After all, spirituality is not based upon logic or logic based assumptions. Spirituality and the soul are not based upon hard and fast scientific research. Spirituality, by its very essence, is not based upon demonstrable facts. It is based upon Faith. 

You cannot see Faith. You cannot test Faith in a laboratory. Facts do not define Faith. Faith stands upon its own. And sometimes, when all else Fails, Faith comes to us in our greatest hour of need and it strengthens us.

I could go on about Faith, the soul, and spirituality. Instead, absorb it from the brain, the heart … the soul of a person who struggled mightily from eating disorders and yet during her greatest struggles, she found … Faith. And perhaps her Soul Found her.

On March 5, 2019, a federal district judge in San Francisco issued a sweeping judgment holding that United Behavioral Healthcare/Optum (“UBH”) on a class wide basis, violated its fiduciary duties and improperly denied payment for treatment. The ramifications and remedies for this bad faith conduct were yet to be determined.

On Friday, May 3, 2019, the plaintiffs in the Wit v. United Behavioral Healthcare case filed their Motion for Remedies. In lay person’s language, the plaintiffs are asking the Court to assess the following remedies against UBH for its bad faith conduct:

1. All class members (believed to be in excess of 50,000) will receive a notice detailing their rights and remedies;
2. Any adverse determination made by UBH against the class members will be thrown out and reprocessed using new guidelines;
3. The following three standards will be utilized to review and process the claims;

A.     For adults with a primary diagnosis of substance abuse disorder, the American Society of Addiction Medicine Criteria 2013 edition (“ASAM”);

B.     For adults with a primary diagnosis of a mental health condition, the Level of Care Utilization System, 2010 edition (“LOCUS”);

C.     For children and adolescents, the Child and Adolescent Service Intensity Instrument, 2014 edition (“CASII”).

4. UBH is prohibited from retaliating against class members, i.e, denying reasserted claims on any additional basis or alleging financial offsets;
5. Prejudgment and post-judgment interest will be paid to class members in accordance with their claims;
6. UBH is prohibited from utilizing their prior guidelines;
7. A Special Master will be appointed by the Court to develop and implement a program to train UBH’s employees, peer review doctors, external clinical consultants and any other personnel making coverage decisions;
8. This Special Master will also train all of the above mentioned employees and consultants, and all senior and executive management on ERISA;
9. This Special Master will design firewalls and other procedures such that no employee in the finance, accounting or affordability departments will serve on any committee implementing or having any input into clinical coverage criteria;
10. UBH must disclose to all Plan Administrators, each state insurance regulator and the US Department of Labor that UBH was found liable for breaches of fiduciary duties and improper denial of benefits;
11. This Special Master will serve as an independent monitor to insure that UBH complies with the Court’s orders;
12. Attorneys’ fees to be awarded.

What is missing?

In reviewing the motion and brief filed by the plaintiffs, no request was made for hundreds of millions in damages for the class members. This is because under ERISA, compensatory and punitive damages are not available for class members. In general, the class is entitled to receive the benefits they would have received had their claims been processed properly with interest. Attorneys’ fees are available as well.

Since there will be no large, monetary award, this incredibly important case will not get the attention it deserves from the leering press, the teeming masses or the great unwashed. More’s the pity. Especially since this case, if confirmed on appeal, will change the rules.

Ramifications if Granted

UBH will have an opportunity to respond to the plaintiffs’ request. However, if the Court grants the plaintiffs’ request, the blow to UBH will be significant and far reaching. UBH has money. Its profit margins are shockingly large. Even if a large monetary award could have been assessed against it, reinsurance and/or a Lloyd’s policy would have picked up the lion’s share of a monetary award and UBH  would then go back to “business as usual.”

Instead, the relief requested impacts UBH in a potentially much more significant manner. If granted, the Court will be taking away UBH’s ability to conduct business as usual. UBH will be forced to have guidelines created and imposed upon it which comply with the appropriate standards of care. UBH will be forced to comply with those standards of care. Its employees involved in the claims process, from the lowest claims reviewer, to its management staff to its outside peer review doctors will all be required to be retrained by a Special Master about the guidelines, ERISA and bad faith refusal to comply with ERISA. Its accounting and finance departments will be banned from having any input. This Special Master will oversee the claims process and the guidelines. And UBH will be prohibited from utilizing its former, unfair and biased guidelines.

The rules will be changed. Fairness and equity will be mandated. And the class members, the people insured by UBH will finally receive what they have been paying for, fair, objective insurance benefits.

So, what is still missing?

Great news indeed. But, what is still missing from the equation?  

There will be literally hundreds, if not thousands of eating disorder claims resubmitted by the 50,000 plus class members. (Recall the daughter of one of the named plaintiffs suffers from eating disorders and was denied admission to Monte Nido) And so, what guidelines, what criteria will be utilized when these claims are resubmitted?

The general guidelines set forth in LOCUS and CASII. There are no specific, eating disorder guidelines generated by the eating disorder industry which were looked upon as being authoritative enough to establish an applicable standard of care.

The accepted statistics relied upon by the eating disorder industry indicate that at least 30 million people in the United States will suffer from eating disorders. The highest mortality rate. One person dying every 62 minutes as a direct result of this disease.

And the eating disorder industry in the United States has not been able to collaborate and come up with reliable, authoritative guidelines. Guidelines which establish generally accepted standards of care. Guidelines that could have been utilized in the Wit case. Guidelines that could have been imposed upon the largest provider of behavioral healthcare benefits in the United States. Guidelines that could have been utilized to battle insurance providers and to contradict their “toady” peer review doctors who unfairly deny requests for coverage. Guidelines that could have saved lives.

There are other cases pending in the United States in which insurance providers’ baseless guidelines are at issue. If the eating disorder industry does not find a way to create and implement generally accepted criteria and guidelines for treating this deadly disease, then arguably, aren’t they just as liable as the insurance providers for perpetuating this insidious disease?

The clock is ticking.

The time for bold action is passing us by.

And the cost for this inaction is being paid once every sixty-two (62) minutes.

“Transparency is critical in public health and epidemics; laypeople become either effective force-multipliers or stubborn walls.”

            – T.K. Naliaka, Author

“The overarching purpose of access to information … is to facilitate democracy. It does so in two related ways. It helps to ensure first, that citizens have the information required to participate meaningfully in the democratic process, and secondly, that politicians and bureaucrats remain accountable to the citizenry.”

            – Gerard LaForest, Justice, Supreme Court of Canada (1997)

Once again, the EDC Capitol Hill Advocacy Day is upon us, this year scheduled for May 7, 2019. For $30 and if you can afford to pay your own transportation, lodging, and travel expenses to Washington, D.C., you have the opportunity to participate in this day. So, what exactly does that day consist of and what is the agenda being pursued? Therein lies the question … and the conundrum.

Ostensibly, The Eating Disorder Coalition (“EDC”) is the lobbying arm of the eating disorder industry and acts as a liaison with politicians. The EDC lists some of its goals as promoting federal support for improved access to care, increase funding and support for scientific research on etiology, prevention and treatment of eating disorders and mobilizing concerned citizens on behalf of people with eating disorders, their families and professionals in the field.

The current president of the EDC is Chase Bannister. At an eating disorder organization event this past weekend, Mr. Bannister was the co-presenter on a session entitled “We the People: The Practice & Ethics of Eating Disorders Advocacy.” This organization noted, “In this keynote session, participants will learn how clinicians, individuals in recovery, and loved ones join forces to help influence public awareness and public policy as it relates to early-intervention, access to care, and treatment of eating disorders. Participants will learn a history of advocacy in the field of eating disorders, the ethical imperative for advocacy by clinical providers, and forward-looking pathways to engagement, including: • Connecting with local, regional, and national coalitions missioned to increase public awareness of eating disorders illnesses • Participating in state and federal lobbying efforts by writing to and meeting with legislators, policy makers, and federal agencies, with the intent to educate public officials on the severity of eating disorders illness, the impoverished research environment, and the importance of increased treatment and early-intervention resources and • Collaborating with other clinicians and the recovery community to use personal experience as fuel for fundamental grassroots change.”

All very noble and worthwhile goals and policy statements on what the EDC does or purports to do. And now, what an incredible opportunity Mr. Bannister has to put into action, words he very likely used at that conference. Especially since at no other time has the mandate for transparency been more crucial and necessary than now.

The Affordable Care Act is on life support and is unlikely to survive. It has been systematically stripped of some of its important provisions through Executive Orders,  court decisions, and people leaving the program. The Mental Health Parity Act of 2008 has been exposed as more fraud than friend. The Wit decision showcased the manner in which insurance providers sacrifice lives for profiteering. And finally, the feckless politicians in our Nation’s Capitol are solely concerned about increasing the power of their own party at the expense of the needs of the Republic.

This years EDC Capitol Hill Advocacy Day provides the EDC with the opportunity to demonstrate the manner in which it intends to adapt to this ever changing landscape, to specifically advise those it purports to represent, i.e., families about the specific bills it intends to pursue in the future and the reasons supporting those decisions. And just as importantly, to identify its large, financial backers and the amounts contributed by those shadowy figures.

The Healthcare System in the US is Shattered

Saying the healthcare system in the United States is broken does not adequately describe the existing chaos. The system is shattered. The problems are legion. Many of the issues in the system today are new and constantly evolving. Some of the issues were brought about by past incompetence and/or lack of vision. Shaking our fists at the clouds as we loudly chant the mantra of, “Mental Health Parity” or “Affordable Care Act” or “You children get off my lawn!” does not address nor provide solutions to the current issues.

The Affordable Care Act was an inartfully drafted, constitutionally infirm yet well-intentioned law designed to address some of the on-going problems in the healthcare industry. Some of the more well-known provisions included abolishing pre-existing conditions and allowing children to stay on their parent’s health insurance until age 26. It was also designed to slow the rise of health care costs, and required all insurance plans to cover ten (10) essential health benefits, including mental health, addictions and chronic diseases. And yet, no matter how well intentioned a law is, we are first and foremost, a nation of laws with the United States Constitution as the cornerstone of our Democratic Republic form of government. And an unconstitutional law, no matter how well intentioned cannot stand.

The Affordable Care Act barely survived its first constitutionally based challenge culminating in a narrow 5 – 4 decision from the US Supreme Court in 2012. The Court was fragmented on most of the major issues. But, the key issue, the issue that allowed the Affordable Care Act to survive, was that the individual mandate (requiring citizens to pay a penalty if they did not have insurance) constituted a valid exercise of Congressional authority under its right to levy taxes. Without that finding, the US Supreme Court in all likelihood would have found the Affordable Care Act unconstitutional in 2012. The Court certainly found other aspects of the Act were unconstitutional and cast them aside.

But, the die was cast. The Tax Reform Act of 2017 removed the individual mandate from the Act. This resulted in litigation being filed in a federal district court in Texas. Relying upon the legal reasoning and language used by the Supreme Court in 2012, the Texas court struck down the Affordable Care Act in its entirety in December 2018. The case is currently on appeal before the 5^th Circuit Court of Appeals before it winds up again before the US Supreme Court. The narrow thread which previously saved it was severed by Congress and the end result is readily predictable.

There is no Parity in Mental Health Parity

To exacerbate the current climate, mental health parity has been exposed for what it really is. On its face, the Mental Health Parity Act was designed to prevent group health insurance plans and health insurance companies whose policies provide mental health benefits from imposing less favorable benefit limitations on mental health benefits than on medical/surgical benefits. In 2017, two studies indicated that mental health parity exists mostly in name only. One industrial official stated, “In the wake of these two reports, it is clear that we simply do not have mental health and addiction parity in this country as our law and policy dictate we should.” He later said, “These analyses show a pattern of insurers avoiding their obligations and then unfairly blaming mental health and addiction treatment providers for the problem of lack of care delivery.”

The Wit case revealed the manner in which insurance companies evade their duties and responsibilities under the Parity Act. As long as insurance companies have the sole and absolute privilege of drafting and implementing their own guidelines in insurance policies there will be no parity. And there are only two ways to change that reality … through the court system or through legislative action.

The Clown Show in D.C.

The health, safety and welfare of it citizenry is a noble trust possessed by federal and state governments. And yet, wise collaborative legislation designed to help people first attain and then keep that status is seemingly beyond the imagination of those pale shadows currently occupying the highest echelons of political office.

The lust for increasing the power of their own party predominates. Ignoring the healthcare crisis and refusing to explore any new legislation until after the next election is just as insidious as proposing ridiculous healthcare plans which violate the very basis of the foundation of our Republic, which are financially impossible to achieve and which were mere publicity stunts.

And like two children playing in the sand box who end up throwing mud pies at each other, both Republicans and Democrats alike are ignoring the reality that our cemeteries are being needlessly filled by those whose lives were taken because they could not afford potentially life saving care.

This is the current situation facing lobbyists in our Nation’s Capitol. This is the current situation facing EDC.

Where is EDC going?

Because of these, and many other reasons, the people who are spending their time and money to come to Washington for Advocacy Day should be apprised of the specific bills EDC has handsomely paid a lobbyist to pursue in the past and the manner in which EDC’s outlook is necessarily evolving with the changing times.

Now, I have the ability to locate and interpret the Quarterly Lobby Reporting Forms, (or LD-2 Reports) that the lobbyist employed by EDC is required to file as a matter of public record. But, hopefully Mr. Bannister will embrace the opportunity to educate the people coming to D.C. for EDC’s Advocacy Day before they arrive so they will have a chance to conduct their own research into the specific bills. I am equally confident that EDC will widely publish this information across various social media outlets. After all, Mr. Bannister just spoke about ethics in advocacy on April 13.

Along these lines, we welcome Mr. Bannister to identify the large financial contributors to EDC who make it possible for EDC to pay a lobbyist in excess of $100,000 annually. The EDC is a 501(c)(4) organization. As a 501(c)(4) organization, EDC can spend an unlimited amount of money on politics without having to disclose its donations. And yet, it is axiomatic that entities will only contribute large amounts of money for political purposes if their own agendas are being pursued.

This is certainly in keeping with transparency and ethics in advocacy. Qualities that Mr. Bannister surely embraces. So for the benefit of those who at their own expense are coming to EDC Advocacy Day, for the benefit of those families who are so impacted by this disease, for the benefit of the eating disorder industry and community, request is made that EDC and Mr. Bannister educate all of those groups with the information respectfully requested … before Advocacy Day.

As a final aside, on March 26, in a press release the EDC stated the following: “It is unconscionable that the Trump Administration would not only fail to support a law that provides health coverage for millions of American families, but also not have an alternative plan in place,” said EDC Board President Chase Bannister. “On May 7th, advocates from across the United States will arrive in Washington, D.C. for the EDC Capitol Hill Advocacy Day, and there is no question this will be on our legislative agenda—voicing our support for the ACA and its importance for those in our community.” “Despite the efforts of the Trump Administration to undermine the health care of Americans …”

If the EDC’s agenda consists of supporting a law that is on life support and which has been steadily eroded since its inception and in antagonizing the White House and the party which controls the US Senate, which in turn, controls the federal court system, the EDC may wish to rethink its agenda, its purpose and the people it claims to represent. Unless of course, that agenda is solely set by the big money entities which keep the EDC alive.

We eagerly await the EDC informing us as to the bills, the reasons those bills are being pursued and information regarding its financial structure.

“In their vanity men focus on what they wish to hear and miss the hidden meaning, the lurking threat.” 

― David Hewson, Macbeth (Adaptation)

I have recently written a few articles on the Wit v. United Behavioral Healthcare/Optum decision. We analyzed the decision and speculated as to how practitioners can start to utilize the findings of the Court. And yet, we must be mindful of the peril that lurks within the language of the Court’s decision and yet remains unspoken.

Many people believe that law schools are designed to teach its students “the law.” Those people are mistaken. The law school curriculum is designed to “retrain a person’s brain.” It seeks to have you unlearn what you have learned and to give you new tools with which you can see the world through varying and infinite shades of gray. And so, attorneys learn to read a court decision not just for the specific findings, but to also discover what was not said by the court … but is nonetheless applicable.

The daughter of one of the named plaintiffs in the Wit case, in fact, “the” named plaintiff in the case, was denied treatment at one of the Monte Nido facilities. As such, eating disorders should have been front and center with regard to the issues in the case. In determining the generally accepted standards of care, the court in Wit relied upon the following criteria:

1) The American Society of Addiction Medicine Criteria (“ASAM Criteria”);

2) The American Association of Community Psychiatrist’s (“AACP”) Level of Care Utilization System (“LOCUS”);

3) The Child and Adolescent Level of Care Utilization System (“CALOCUS”) developed by AACP and the American Academy of Child and Adolescent Psychiatry (“AACAP”), and the Child and Adolescent Service Intensity Instrument (“CASII”), which was developed by AACAP in 2001 as a refinement of CALOCUS, and;

4) The Medicare benefit policy manual issued by the Centers for Medicare and Medicaid Services (“CMS Manual”).

The Court also relied upon these criteria when it determined the generally accepted standards of care:

1) The APA Practice Guidelines for the Treatment of Patients with Substance Use Disorders, Second Edition;

2) The APA Practice Guidelines for the Treatment of Patients with Major Depressive Disorder, and;

3) AACAP’s Principles of Care for Treatment of Children and Adolescents with Mental Illnesses in Residential Treatment Centers.

All of these resources are recognized as being authoritative and reputable. But, what is missing from this list?

Despite the fact that eating disorders were the core health issue for the named plaintiff’s daughter, there is no reliance, in fact there is no reference at all to any eating disorder specific practice guidelines, principles of care, or criteria utilization. Zero. Nada. Zilch.

This despite the fact that in the last 7 years, the eating disorder industry has issued the following guidelines for the treatment of eating disorders:

1. In 2018, The Residential Eating Disorder Consortium issued its Standards of Excellence Project;
2. In 2017, The British National Institute for Care Excellence issued its Eating Disorders: Recognition and Treatment Guidelines;
3. In 2016, The Joint Commission issued its Eating Disorder Standards;
4. In 2015, The American Academy of Child and Adolescent Psychiatry issued its Practice Parameter for the Assessment and Treatment of Children and Adolescents With Eating Disorders;
5. In 2014, The Royal Australia and New Zealand College of Psychiatry issued its clinical practice for the treatment of eating disorders;
6. In 2013, The American Psychiatric Association issued its revised Diagnostic and Statistical Manual for Mental Illnesses Fifth Edition (DSM-V)(revising the manner in which eating disorders were defined and classified);
7. In 2012, The Academy of Eating Disorders, in conjunction with the National Eating Disorder Association and the International Association of Eating Disorder Professionals issued the final Working Draft of its Credentialing Guidelines.

Seven years. Seven different standards and guidelines. Seven different organizations. It’s as if the Marx Brothers along with the Three Stooges, Benny Hill, Lucille Ball, Laurel & Hardy and Abbott & Costello were tasked to collaborate and come up with the formula for solving one of the 7 Millennium Prize Puzzles.

And the clock is ticking.

The Next Steps in the Wit Case

The next steps in the Wit case are to frame the remedies to be awarded or assessed to rectify the wrongs that were perpetrated by UBH/Optum.

The plaintiffs’ motion for requested remedies is due no later than May 3, 2019. UBH/Optum has until June 14, 2019 to file its response and objections. The plaintiffs can then file their reply to UBH/Optum’s response no later than July 10, 2019. Anytime after July 10, 2019, the Court can issue an order regarding the requested remedies. It may be a matter of weeks, maybe even months. But, because the case now has a certain momentum, the delay in addressing the remedies is not likely to be extended.

In Wit, the Court found that UBH’s guidelines did not meet generally accepted standards of care in almost every conceivable manner. The class members in Wit are expected to number possibly as many as 70,000. To address the harm done to class members, the Court may order that an objective, blue ribbon panel be convened to draft new guidelines which meet the generally accepted standards of care for the mental illnesses (including eating disorders) involved in the case. For all of these mental illnesses at issue, the criteria for applying the generally accepted standards of care are located in the resources identified by the Court. Therefore, it will be a matter of taking the guidelines in those resources and applying them to reasonable insurance business practices which are then fairly and objectively applied to the claims.

As for eating disorders? Which of the 7 various standards will the Court apply? For that matter, will it apply any of them? It very well could be that the Court, or the panel it appoints may take the position since the eating disorder industry could not get its collective act together, it will devise its own standards and guidelines for eating disorders and enforce those.

And if that happens, and those guidelines are drafted and adopted by the Court, the ramifications for the eating disorders industry could be extreme. Assuming that fact scenario comes to fruition and the case survives the inevitable appeals including through the United States Supreme Court, the eating disorder industry would then be facing with the reality that the generally accepted standards of care were drafted and implemented without input from some of the greatest minds in the eating disorder industry.

And yet, because they survived judicial challenge and were enforced against the largest behavioral health insurer in the United States, the treatment centers, doctors, counselors, and organizations will in essence be forced to adopt those same guidelines. Failure to do so could result in accusations that the generally accepted standards of care are not being followed and as a result, malpractice claims will spike and centers which do not comply will be looked upon as “rogue” clinics placing their own confirmation bias above the needs of the patients as defined by the generally accepted standards of care.

This particular failure of the eating disorder industry is likely to be brought into the harsh light of public scrutiny. This scenario becomes very probable since the Court is likely to order UBH/Optum to establish a common monetary fund. This fund would be responsible for paying resubmitted claims of the class members or alternatively, perhaps a lump sum payment to members. Because of the size of the class and the harm suffered by them, this common fund could number in the hundreds of millions of dollars. Especially since UBH/Optum has net revenue of approximately $696,000,000 each and every day. At this point, the leering press is likely to wake up and notice that a case of significant importance which will impact healthcare nationwide is concluding. They will notice the criteria and resources cited by the Court and may also notice that guidelines for the treatment of eating disorders are conspicuous by their absence. And inquiries will begin. Uncomfortable questions will be asked.

Immediate Action is Necessary … or Forever Hold Your Peace

The clock is ticking.

The silo mentality resulting in 7 different guideline standards in 7 consecutive years from 7 different sources has come home to roost. And as a result, there is a reasonable probability that the eating disorder industry will be left with only one guideline. And that guideline will be dictated by a panel they did not appoint and cannot control and enforced by a federal district court.

A possible solution?

Collaboration on a never before seen basis resulting in expedited, standards of care which will hold up to challenges and scrutiny. A consortium of AED, the REDC, representatives from the non-profit/university based hospitals, representatives from independent treatment centers, scientists exploring the biological and genetic aspects of this disease. The collective minds in the eating disorder industry must come together now, review the reams of research conducted over the course of the past ten (10) years, include the most recent findings and studies on the biological aspects of the disease, agree on objective, standard guidelines and be prepared to inform the Wit court that these guidelines are the best, greatest hope of recovery for those suffering from eating disorders.

And it must begin now, for it may already be too late. Not this summer. Not this autumn. Not this winter. Now.

Certainly, the Wit case was a great victory for insureds and patients. And yet, it too was also a warning call to action. The stakes have been raised and have never been higher. Treatment for the many people who suffer from this disease hangs in the balance. It is past time to stand up and be counted … or forever remain in the shadows of inaction and ineptitude.

Over the course of the past few years, I have had the privilege of meeting some of the most influential people in the mental health/eating disorder industry. Research scientists whose brilliance and insight into the biological and genetic aspects of this disease awe and overwhelm me. Leaders of global organizations whose heart and compassion bring light and faith into the lives of everyone they meet.

Doctors whom I admire because they have started mighty networks of treatment centers, which if successful in the long term will save countless thousands of lives.

Parent advocates whose passion and drive to help others provide a safe refuge for parents overcome by fear because their loved ones are in the deadly grip of this disease. Counselors and therapists on the front lines, fighting this disease every day.

Becoming learned about the growing national issues of private equity ownership, insurance guidelines being challenged in courtrooms, mental health parity debates, controversial research studies in far distant corners of the earth and the reality that eating disorders are “big business,” but are not being treated as such.

As a result, sometimes we may not recognize when an opportunity arises to meet one of the “Points of Light” for whom we are fighting. When we find ourselves caught up in the immensity of the struggle, it may take just one, solitary young woman caught up in the horrible grip of this deadly disease to bring home the reality of what this is all about. Our soul has a way of reminding us why we have no choice. That we must continue the fight. And in the most unlikely of ways, we may encounter a young woman who epitomizes the heartfulness … and the heartache of this insidious disease. And we are emboldened anew.

Recently, I had the privilege of playing a very small role in helping a young woman get admitted into a treatment center for much needed, life-saving therapy. Fortunately, the medical director of this facility is a strong, powerful presence and has a dedicated, experienced staff. Within an hour after I contacted this doctor, her staff had set up an appointment and the process began.

I drafted a Medical Power of Attorney, which in Texas unfortunately, is easily revoked. Nonetheless, I met the mother and young woman. And my first impression was that the Demon had this young woman fully under its power. I saw such pain, such fear. And I feared that we were too late.

Then, on the next business day, after her evaluation and check in, I received the very good news that this young woman had been accepted into the program and would be getting the help she so desperately needed. And I prayed that we were not too late.

A few days went by and I went to see the young woman. She was on a feeding tube, but looked like she had more life within her. We played banana grams, laughed, and she asked me a bit more about Morgan. At the end of visiting hours, she walked up to me, gave me an emotion-filled hug and thanked me. There was no way for her to understand at that time, that I should be the one thanking her.

I visited her the next week. This time, I brought her a tiger lily in a pot. She was allowed to see it but of course, it could not be brought back on to the floor. By this time, she was off the feeding tube and she had even more energy. “Back in the day” we would call it that she had more bounce in her step.

We walked into the visitor’s room where she guided us to a corner of the room and proceeded to sit down on the floor. With a smile on my face, I plopped down on the floor directly across from her and we started a game of double solitaire. The cards were flying, we were laughing, talking about anything and everything … except topics like “how she was doing,” or  “what happens next for her treatment.” One of the many lessons my daughter taught me about this disease was that she was “so tired of being treated like a patient, the little sick girl. She wanted to be treated like a person.” We made good natured fun of the medical director and life in general. Then as time went by, I began to notice the two other parent groups in the room with their children, occasionally looking over at us and I could see what appeared to be puzzlement on their faces.

We spoke of her dogs, what her tattoos meant, why she likes the state in which she lives, we spoke of flowers and the hour flew by. As we were walking out, again, I got a huge smile from her, this heartfelt hug and thanks from her again. This time, I could not let the opportunity pass. So, I looked her in the eyes and told her that I needed to thank her. She looked puzzled. But, I briefly explained that she had given me the chance to see hope again, to see life again, and is there any bigger present than that? One day, I hope she comes to fully understand what that present truly means.

On the elevator on the way down to the lobby, one of the moms visiting her daughter told me she could see how incredibly close I was with my daughter. I smiled at her and told her, yes we were. But, this young lady was not my daughter. I explained to her that this young lady was someone who was brought into my life for a specific reason at just the right time. 

We spoke for about 30 minutes about her daughter, who Morgan was, some of the work I have done, the eating disorder industry in general and asked her to never give up. As long as her daughter draws breath, there is hope. She contacted me the next day via email and I sent some material to her. I urged her to stay actively involved in her daughter’s recovery no matter how difficult the fight becomes.

Whenever I think of that night, of being able to just sit on the floor, I wonder how it is that certain people are brought into our lives at just the right time. I see her smiling face and remember sensing a positive hope beginning to re-enter her life. The heart felt emotional hugs.

The task before us in the eating disorder industry is daunting. The problems are even greater. Many of us undoubtedly will continue to disagree and fight. We appear before legislative bodies and large organizations. The immensity of some of the problems in the industry seem overwhelming, too big to conquer.

But, for one night, one glorious night filled with laughter and light and happiness, those overwhelming issues were put on the back burner. All that while simply sitting on the floor with one of those  “Points of Light.”

Sometimes, you just gotta sit on the floor.