Fwd: transparency and disclosure

[Guest guest]

Unfortunately this message did not make it onto a single list serve, though I posted directly to them. Censorship and subject fatigue are alive and well. Please, all of you, do your best to keep these issues in the public eye. The silence on list serves since late last year is deafening, and the will to move forward on ISNR's agendas have not been quelled in the least. In fact, our governance organizations have enlisted a new professional with ample lobbying experience. At the very least, send this to as many colleagues as possible. Have courage! To the extent we do not collude with letting this get swept under the rug is the extent we maintain our rights to practice in sovereign peace, without spending mountains of money to keep our rights intact.

Sajeela ---------- Forwarded message ----------From: Sajeela Ramsey <drsajeela@...>

Date: Sun, Feb 12, 2012 at 5:24 PMSubject: transparency and disclosureNeurofeedback Colleagues, and BCIA, ISNR and AAPB Board Members, 

An unfinished debate regarding industrial principles and policies will, from time to time, be updated for the scrutiny of all. The interdisciplinary nature of neurofeedback practice will most certainly ultimately preclude it from being defined and regulated under any traditional peripheral disciplines that may have existed before kitty-cats were deemed to be emanating SMR purrs that ensured protection from the toxic effects of rocket fumes. Quite honestly, I would like to find as excellent a panacea for our industries' sometimes toxic debates and turf wars. That said, trial by fire is sometimes the only way the human spirit and its practices are forged --- and I would hope this tempering would take place without losing our souls in the process. 

At the end of 2011, I e-mailed a letter (below) to board members of AAPB, ISNR and BCIA asking a series of very specific questions. I recently received cursory replies (below) from only two of the organizations (AAPB and BCIA) that did not answer any of my specific inquiries. I am still seeking much more clarification and hope in resubmitting my letter I will get responses that better inform my understanding, since the responses I received were not from any board member, but rather, from the CEO of two " separate " governing organizations ---- a CEO who actually happens to be the same individual. I have never received any reply what so ever from ISNR, as did not my associate (who is a member, and who forwarded my letter and his own letter asking many of the same questions). 

My letter addressed conflicts of interest between all three organizations and their members and certificants. To elaborate, as I understand it, all industrial certifying agencies are required by law to maintain very clear boundaries and clear separations between their agency and any non-profit membership associations within the same industry. Yet BCIA and AAPB share the same CEO, and also appear to be located in close proximity on a single property. Likewise, BCIA and ISNR also share inter-relationships where lines of required separation appear blurred. Many board members of all three organizations rotate positions in all three organizations, year after year. Would I be the only person to object to such clear ethical conflicts of interest? 

My letter also addressed concerns about a lack of transparency and disclosure in all three organizations, and especially in ISNR, with regard to activities by official members of the standards committee; activities that pose ethical breaches in the form of attempting to influence state medical boards, lawmakers, and even the FDA with as-yet incorrectly vetted and prematurely publicized and published industry standards. In addition, these same committee members have been directly implicated in malicious prosecutions and apparent fair market trade violations against any number of individual providers and manufacturers in any number of states, dating back at least four years. Am I the only professional who thinks these activities must be brought to an end because they raise the scepter of systemically inappropriate ethical and legal overreach?

ISNR's president and BCIA's director of admissions did reply to an inquiry by a colleague, essentially inviting that colleague to share their opinions with any inquiring minds. Their responses (below) promulgate several unofficial official notions, namely, that: 1) licensed professionals are the superior professionals of choice for the industry ( though in the same sentence the president of ISNR, despite evidence to the contrary, maintains  " there is no push by ISNR to endorse one licensure group over another " , and 2) those who have been maliciously prosecuted are apparently whiners who must be ethically and professionally incompetent and apparently deserved what they got. These positions are clearly leveraged from behind the perceived safety of state regulations, erroneous and fallible as these might be. One has only to study  FTC and DOJ regulations that ensure fair market practices across all industries in order to start questioning BCIA, ISNR and AAPBs current alignments with established medical disciplines and associated regulations that by default lower the status (and earning power) of all unlicensed professionals.   

As an industry that espouses a desire to regulate practice based on sound science, I would hope our governance organizations would be able to produce impervious and scientifically sound data that backs up mere opinions that might exclude new industry entrants and current members from practice when backed by existing erroneous statutes or the writing of any new erroneous laws. Otherwise it might be construed we have a credibility problem with the very individuals who are charged with administering ethical oversight of neurofeedback practice. Along the same vein, regardless of any disavowal of knowledge by ISNR's president (or any of our governance organizations) of possible illicit or unethical activities, by law, all trade associations and non-profit membership organizations remain responsible for all of the actions of their staff and any official committee members. 

Sajeela M. Ramsey, MS, PhD OMC-EEG, BCN-EEG, CBS, CNIApplied Behavioral ScientistNeurofeedback Center of Virginia803 W. Broad Street Suite 620

Falls Church, Virginia 22046Telephone: (703) 536-2690 www.NeurofeedbackCenterVa.com

drsajeela@...

_______________________________

WOW…. Rumors….crazy stuff sometimes.

Here’s what I know AND believe to be true. I would be so happy if you can spread the word.  The truth is so much easier than the rumors and you will most likely give yourself that mental head slap that says – oh yea, duh… that makes sense.

There are already laws that regulate the treatment of disease and disorder.  This is done at the state level through licensing boards.  It is illegal in all 50 states to INDEPENDENTLY treat a medical or psychological disorder without a license.  If you are unlicensed,  you may certainly work under appropriate supervision when treating a med/psych disorder.  Additionally one must work within their scope of practice – in other words a dentist should probably not treat urinary incontinence, even if he knows how.  

OR - If one is working with a golfer to help him focus, that is not a med/psych disorder and therefore states do not regulate that work through licensure.  BCIA does NOT require a license for certification.  We require a university-based health care degree for certification AND license for independent treatment of disease and disorder, in accordance with state law.  Certification teaches you about the modality and how to employ it and license is a state regulation of health care.

This is not specific to the modality so if you are using puppy therapy, smoke therapy, string therapy, or neurofeedback – it does not matter. NOW from my recent personal experience in speaking with state health care investigators from both Utah and CA, state health care boards are realizing that they are dreadfully behind the times and are not quite exactly sure what to do with some of the new modalities (like neurofeedback ).  They have both shared that their states should undertake a complete review to have a better understanding.  In both states it is considered illegal to independently treat – but with no specific mention of bf/nf.  CA calls it a felony to practice medicine without a license and there are 2 criteria:  the unlicensed person must provide both a diagnose and treatment plan to be found guilty.  There is jail time attached so they take it very seriously!  

The licensed psychologist rumor has a little more traction but not much.  I KNOW that in both states, other licensed professionals are legally able to use nf BUT I think there may be some gray areas.  Now this is where the education part comes in.  These regulatory agencies don’t realize that bf/nf can be used for things OUTSIDE the scope of a psychologist and so therefore this would not be an appropriate way to regulate.  There was a case a few years ago where somebody in UT was in big trouble for using nf and he was actually crying when he called me and he blamed all his woes on 1 prominent person.  We discussed his case and I patiently explained the rules and regs and that it has nothing to do with “psychs only” as he stated.  He said he was a chiropractor.  So I said did you show them your license and explain your scope of practice – he said “uh well um er blah ….. oh I don’t have a valid license to practice in UT.”  So was the story really about those naughty psychs but about HIM not having any license to practice no matter what modality he used?

So what does this sound like to you?  Reasonable I hope.  I hear this so often and we’ve even written about it several times.  So please try to help  people better understand.

Thanks – take care,

Judy

_____________________________

I have been following the discussions that you refer to on the neuroguide listserve.   I heard about this with during a discussion of ISNR business with Siegfried Othmer and then the email you listed on the NG listserve.   Siegfried mentioned the Utah issue but not the other states.  I saw Corey’s statement about Utah and believe that to be the case, that it should be for licensed health practitioners not just psychologists.  I have not heard that there is any such activity going on in Texas and I am very much on top of things in this State.  Also, Texas is a practice act state which means that the services you are allowed to provide have to be written into the practice act of the of the specific discipline.  I am a Master’s level LPC and it is stated in my practice act that I can do biofeedback.  Therefore, until that is changed by the legislature, they can’t take that away from me.   I don’t know what the other states actions are.

I want to correct something you said about BCIA.  You don’t have to be licensed to be certified, just have a degree in a health care field.  I believe even a bachelors degree will suffice.  I do know of  a situation where someone with a MBA was certified because they were in a Master’s Counseling program and got certified during their class work but then dropped out and never completed their degree work but remained certified.  Regarding ISNR’s position, you can look at the recently released Standard’s paper to see where we stand.  My experience with the Board over the last 6 years has been that they try take a neutral stance to licensure but this is starting to change due to some of the people that have started doing neurofeedback and their lack of education, professional experience, and ethics. This becomes a balancing act given the diverse group of practitioners and the requirements of the different geographic areas we represent.  You ask about providing the Standard’s paper to state boards and this has been done but not byISNR.  Corey took it upon himself to do this, however, ISNR was not knowledgeable of this action, nor did we support it at this time.  We wanted to have a final Standard’s paper before anything like this was done.   I guess the best thing to say about ISNR (which is my opinion) is that the organization wants to support credible, competent, and ethical practice of neurofeedback.   ISNRcertainly supports licensed professionals as perhaps the first choice but realizes the interdisciplinary field.  Also, there is no push by ISNR to endorse one licensure group over another.

Hopefully, this has answered your questions.  Let me know if you hear more about what is going on so I can be knowledgeable and can help inform ISNR in case action needs to be taken.

Best of the Holidays…

____________________

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Judy Crawford

<jcrawford@...>

date

Fri, Jan 13, 2012 at 5:43 PM

subject

RE: A Letter of Concern

Important mainly because

you often read messages with this label.

 

hide details Jan 13

 

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Dear Sajeela,

 

I am writing to you in my capacity as

executive director of BCIA. Thank you so much for your letter. Please be

assured that BCIA’s Professional Standards and Ethical Principals of

Biofeedback are in concert with and fully support those of state licensing

boards.

 

Again, we appreciate your comments.

 

Sincerely,

 L. Stumph, IOM, CAE

Executive Director

Biofeedback Certification International Alliance

formerly Biofeedback Certification Institute of America

10200 W. 44th Street,

Suite 304

Wheat Ridge, CO 80033

(303) 420-2902

dstumph@...

www.bcia.org

 

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Sajeela Ramsey

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" Monta

A. Greenfield " <MGreenfield@...>

date

Sun, Jan 15, 2012 at 5:29 PM

subject

FW: A Letter of Concern

Important mainly because

you often read messages with this label.

 

hide details Jan 15 (13 days ago)

 

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Dear Sajeela,

 

I am writing to you in my capacity as

executive director of AAPB. Thank you so much for your letter. Please be assured

that AAPB’s Ethical Principles are in concert with those of BCIA’sProfessional Standards and Ethical Principles of

Biofeedback and those

of state licensing boards.

 

Again, we appreciate your comments.

 

Sincerely,

 

Dave

 

 L. Stumph, IOM, CAE

Executive Director

Association for Applied Psychophysiology & Biofeedback

10200 W. 44th Street,

Suite 304

Wheat Ridge, CO 80033

(303) 422-8436

dstumph@...

www.aapb.org

_______________________________________

 December 30, 2011

All BCIA, AAPB, and ISNR Members of the Board

Subject: Neurofeedback Practice Standards 

 You may be aware that a Neurofeedback provider in Utah received confrontational anonymous posts to his blog in April of this year, followed by a similar anonymous phone call to him at his practice. In October 2011 the same provider received a letter of reprimand from a Utah licensing board, based on anonymous complaints alleging he was practicing outside his licensed limitations. The provider in question is a masters prepared licensed mental health counselor who, like me, also holds a PhD in the Applied Behavioral Sciences, and, like me, uses Cygnet. Like me, he also was named in complaints submitted to state boards. And like me, at least one member of ISNR's committee for standards of practice for Neurofeedback was implicated in those complaints. 

 

I am writing to all of you because of ethical concerns I have about the proposed standards for Neurofeedback practice. These proposed standards are marred by involvement of some members of the committee with both open and cloaked hostilities that have been acted out in various ways over at least four years. In at least four cases, apparently, complaints were lodged with state licensing boards, with at least some level of involvement from one or more members of the standards committee. In at least three cases those targeted were Cygnet or NeuroCare Pro users.  These activities might be construed as endorsements for the restriction of Neurofeedback trade in a field where, for fifty years, diverse and innovative platforms and applications have flourished. 

 

In every case I am aware of, letters of complaint included copies of at least one article by Cory Hammond; allegorical articles that have appeared in ISNR publications, and that imply " harm " to the public by specific platforms or approaches. In my own case, a letter of complaint directly implicated platforms we were using at the time as having " caused harm " to an individual. This allegation was ultimately not sustainable. The same platforms we used at the time were also used by at least one of the complainants, and the same platform is apparently used by a standards committee member who previously condemned it. Post-acceptance of said platform is the remaining claim that in the hands of an unlicensed and unsupervised provider these platforms and any others are " dangerous " .

 

Official silence by any organization that governs or represents any profession, where board and staff members of those organizations knowingly overlook the involvement of any official committee member in systematic profiling, intimidating and attacking of select colleagues, in coordinated efforts, across state lines, using electronic means of organizing, in conjunction with legal action taken in order to prematurely enforce un-vetted and unofficial standards of practice, and where committee members who, by virtue of positions of status and power, have never received official reprimand or been held accountable for their covert and hostile actions against undeserving others, poses a serious set of infractions. Official silence from nepotistic organizations in such a case might be construed as a kind of endorsement of unethical and unlawful practices by those who have authored standards that, by design, selectively narrow or even criminalize whole market sectors out of hand. Such official silence in the face of punitive and injunctive actions against any professional should be scrutinized.

 

In August or September of 2008, defamatory and personalized complaints against me and the platforms we used at the time were submitted to the Attorney General of Virginia, and to various state medical boards, apparently by Deb Stokes and five other local licensed Neurofeedback competitors. Their unfounded charges caused me and my associate immeasurable personal and financial hardship. I spent approximately ten thousand dollars out of pocket before my case was officially closed, with no official judgment made against me. For almost two years I lived in fear, not knowing if offices leased against our home would be forcibly closed. Was Deb Stokes thinking at that time about " First Do No Harm " to her professional colleagues? Apparently not --- nor were our governing organizations, who were appraised of the case against me. I know of no formal ethical reprimand what so ever to anyone of those whose actions caused me individual harm.  Exactly how many similar cases to mine exist (beyond the four I am familiar with) is somewhat unclear. [since writing this letter I've heard details of a fifth case]. But there can be no doubt about significant legal, psychological and financial hardships foisted upon otherwise apparently upstanding providers. Even one single case where a professional is targeted, harassed and intimidated by those who purport to set ethical standards for us all is simply indefensible. 

 

If universal standards for and comprehensive education of all providers is the actual business at hand, then surely BCIA, ISNR and AAPB should only be in the business of endorsing ethical, civil, fair, mutually respectful, fair-market and critical-thinking values and behaviors in the shaping of professional standards. This has not been the case, and there is much evidence to support this. Standardized rules of practice and truly uniform training and mentoring for all providers are something that ultimately could benefit public and provider alike. But so long as governance unfairly selects who authors our standards of practice, who delivers our standardized education and the contents thereof, and what platforms for delivery will be included, there will be no scientific or democratic means for reasonable practice standards.

 

Outstanding issues must be fairly vetted and resolved before we try to regulate Biofeedback/Neurofeedback:

 1) Neurofeedback definitions --- are we or are we not engaging in operant conditioning, and therefore are we or are we not involved in an educational process of training the brain? Are we going to contradict official underpinnings of Neurofeedback process by claiming licensed professionals may " treat " medical conditions, rather then employing educational means for the same outcomes?

 

2) FDA limited uses --- Neurofeedback equipment is not approved for treatment of any medical condition. Are we to assume that state regulations trump federal ones, such that professionals may improperly represent off-label uses for Neurofeedback by virtue of their licensure alone? 

 

3) Restriction of trade --- Should select platforms and approaches commonly used throughout the world today be criminalized, with no rigorous scientific proof what so ever that these platforms are indeed " dangerous " ?

 

4) Who can and can not competently provide Biofeedback and Neurofeedback --- Exactly which state-regulated disciplines apply most or least to the practice of Neurofeedback? Exactly who is to be constitutionally excluded from their right to work, or severely financially limited in their ability to compete, despite respectable credentials and/or equal or greater amounts of professional training?

 

5) Regulation going forward --- Will the definitions and standards of practice be managed democratically and scientifically, in a truly fair referendum before the entire Neurofeedback community? Or will these be enforced via the agendas of a few people on a single committee? Shall we ultimately relinquish all Neurofeedback practice to the co-enabling interests of Licensed Providers, Medical Boards, Insurance Companies, Universities, Pharmaceutical Industries, and Medical Doctors (who always have the final say on all matters medical)? Shall these biased interests lay claim to 50 years of brilliantly unfettered competition with no evidence found of lasting or irreversible harm in Neurofeedback practice? Shall corporate and regulatory interests be awarded authority over the practice of personal self-regulation? Is not self-regulation a matter of fundamental and constitutional personal choice?

 

6) Biases for " clinical " Neurofeedback applications --- What is the basis by which ISNR, AAPB and BCIA endorse " clinical " over " non-clinical "  Neurofeedback practice? Is there an inherent conflict of interest embedded in the preference for " clinical " applications in order to pave the way to insurance parity? 

 

7) " Documented " harm done --- Should we not demand complete transparency in the un-official gathering of data that has been and still is being used to intimidate select Neurofeedback providers in " stings " by apparently the same committee members seeking to legislate all Neurofeedback practice? On what basis are committee members entitled to arbitrarily exercise campaigns of unfair discrimination against select platforms and providers? What legal right do a few individuals have in selectively presenting data in order to apparently further their own unscientific claims of so-called danger to the public? 

 

8) Improperly vetted standards of practice --- What is the legitimate basis of adding many complicated layers by way of at least ten licensed medical specializations that might regulate Neurofeedback practice, even as the enactment of such would, by default, end sovereignty of all unlicensed competitors? Does apparent selective and systematic intimidation before and leading up to the establishment of standards of practice discourage participation in the discussion by those who stand to lose the most? 

 

9) Publishing standards in advance of official ratification and fair vetting, and distributing these to regulating authorities --- On what basis has ISNR posted [and worse, published] as yet unofficial and as yet un-vetted standards of practice for consumption by the public and regulatory officials, who might easily assume these are correctly endorsed and fairly representative in the case of their use in complaints to states where unlicensed and even some licensed providers are selectively targeted by any member of any official committee? 

 

Please take my concerns seriously and put a stop to unfettered injustices against many by a few.

 Sajeela Ramsey

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