Monday, April 23, 2018

Evading the Corporate Practice of Medicine Law ... The New "Millennium Prize Puzzle"


In 2000, the Clay Mathematics Institute in Peterborough, New Hampshire set forth seven (7) Millennium Prize Puzzles. These puzzles/problems were so maddeningly convoluted, complex and incomprehensible, that a correct solution to any of the problems would result in a $1,000,000 payment being awarded to the person who discovered the solution.  To date, only one of the seven puzzles has been solved.

The Corporate Practice of Medicine doctrine ("CPOM") is on the surface simple. And yet, its application is a mysterious puzzle with each layer increasing its complexity. Even its very name is a misnomer. States that have adopted this doctrine through statute, Attorney General opinion or via caselaw should more accurately entitle the provision “The Corporate Non-Practice of Medicine” doctrine. The simple version of this doctrine holds that corporations comprised in whole or in part of non-physicians cannot own or operate a medical practice. Simple. Concise. Easy to understand… and in application, perhaps the 8th Millennium Prize Puzzle.

The Premise Behind and An Example of CPOM Language

So, what is the premise and reasoning supporting the CPOM doctrine?  Its purpose is to ensure that only licensed professionals deliver medical care to their patients and that unlicensed persons and entities do not influence treatment decisions. The needs of the patient predominate over everything and patients must always be protected from potential conflicts of interest. 

In a true capitalist democracy, for-profit corporations exist for one reason… to make a profit. That fundamental truth is irrefutable. That is the very essence of capitalism. However, when a corporation practices medicine or employs a physician it has the potential to commercialize and potentially debase the medical profession. The thirst and demand for profits has the potential to 
undermine the physician-patient relationship by placing the needs of the corporation over the needs of the patient. The pressure to generate profits also has the potential to override the physician’s exercise of independent medical judgment which has to be focused on the sole interest of the patient. Finally, the general intrusion into the practice of medicine by non-medical, unlicensed corporate entities results in those entities not being subject to the same exacting professional standards or regulatory control as licensed entities and resulting in an unbalanced playing field.

Let’s examine the State of Colorado’s Corporate Practice of Medicine statute. The Colorado statute, Co.Rev.Stat. §12-36-134 (2016) states in material part:

(1) Persons licensed to practice medicine by the board may form professional service corporations for such persons' practice of medicine under the "Colorado Business Corporation Act", articles 101 to 117 of title 7, C.R.S., if such corporations are organized and operated in accordance with the provisions of this section. The articles of incorporation of such corporations shall contain provisions complying with the following requirements:

(a) The name of the corporation shall contain the words "professional company" or "professional corporation" or abbreviations thereof.

(b) The corporation is organized solely for the purpose of permitting individuals to conduct the practice of medicine through a corporate entity, so long as all the individuals are actively licensed physicians or physician assistants in the state of Colorado.

(c) The corporation may exercise the powers and privileges conferred upon corporations by the laws of Colorado only in furtherance of and subject to its corporate purpose.

(d) (I) Except as specified in subparagraph (II) of this paragraph (d), all shareholders of the corporation are persons licensed by the board to practice medicine in the state of Colorado who at all times own their shares in their own right; except that one or more persons licensed by the board as a physician assistant may be a shareholder of the corporation as long as the physician shareholders maintain majority ownership of the corporation. The shareholders shall be individuals who, except for illness, accident, time spent in the armed services, on vacations, and on leaves of absence not to exceed one year, are actively engaged in the practice of medicine or as a physician assistant in the offices of the corporation. [emphasis added]

(7) (a) Corporations shall not practice medicine. Nothing in this section shall be construed to abrogate a cause of action against a professional corporation for its independent acts of negligence. [emphasis added]

And yet we know that a residential treatment program based in Denver, Colorado has had three separate private equity firms acquire a minority or majority ownership interest in it since 2008 when the Mental Health Parity and Addiction Equity Act was signed into law. None of the three private equity firms, Trinity Hunt, Lee Equity nor the current overlord, CCMP Capital Advisors is licensed to practice medicine in the State of Colorado. Nonetheless, these transactions resulted in the rapid expansion of this facility into seven different states while at the same time, exponentially increasing its debt structure into the hundreds of millions of dollars. All the while, neither the State of Colorado nor the applicable federal government agencies investigated any of the transactions to determine the legality of complying with the letter and "the spirit" of the CPOM.

The CPOM Millennium Prize Puzzle

Private equity firms routinely do not employ Dewey, Cheatum & Howe, shyster "street attorneys" as their legal counsel. Knowing that billions of dollars hang in the balance, they employ and pay for the most reputable, highest paid, elite law firms possible. Hourly rates for senior partners exceed $1,000.00. These law firms are not hired to tell their client that they cannot do something. They are hired to tell a client how they can get around legislation or case precedent which tells them they should not be able to do something.

So, let's speculate.

Since the CPOM doctrine ordinarily stipulates that an entity providing medical services be provider-owned, physician owned practices typically are structured as professional corporations or limited liability companies (these physician owned entities will be jointly referred to as “PC”) which own all of the assets of the medical practice.

To acquire a medical practice owning an eating disorder residential treatment center, a private equity firm either acquires or establishes a new Management Services Organization ("MSO").  For tax reasons, the MSO is often incorporated in the State of Delaware, Nevada or Texas. The infusion of investment funds into the MSO allows it to acquire all purported "unregulated assets" of the medical practice.  These assets could include the real estate owned by the PC, unlicensed staff, equipment, furniture, supplies, and account receivables.

The PC and MSO then enter into a “Managed Services Agreement,” whereby the PC pays fees to the MSO to manage the purported non-medical assets. The services provided by the MSO typically comprise all nonclinical services involved in the operation of a medical practice such as providing office space, overseeing nonclinical personnel, and handling business, office and administrative services, such as managed care contracting, recordkeeping, support services, marketing and public relations, accounting and legal services, billing and collections, financial planning and expansion goals and decisions.
Note that there is the possibility that at least one further level of “ownership” is instituted to further convolute the manner in which the entities operate with an additional holding company being formed (for example, a “Topco Holdings, LLC) which initially is wholly owned by the PC.  The MSO then buys ownership interest in that holding company purporting to represent its interest in the non-medical assets set forth in the MSA.
The physicians comprising the PC often have an incentive package with the MSO which was negotiated on their behalf by merger and acquisition specialists and which typically include very large payments to the physicians in the event additional expansion is successful or via capturing a greater share of the industry market. These incentive packages often greatly exceed the amount of revenue received by the physician from his/her actual practice of healing. On very rare occasions, the incentive package could include active participation in ground-breaking research resulting in new treatment regiments for an industry such as novel, microbiome-based interventions which benefit patients with severe eating disorders. However, without a direct connection to a research university, more often than not the PC physicians are in a position of merely saying “Me as well” as they build on the work and research performed by academicians and scientists.
With regard to private equity firms participating as MSOs, a number of states have opined on the role of a MSO vis-à-vis payors, providers and medical practices. The Attorney General for the State of California issued an opinion on July 27, 2000, expressing concern about the difficulty of separating business and medical decision-making by the MSO. “Where those two functions merge, there is the prospect that the MSO could be viewed as engaging in the unlawful practice of medicine.”
So, is this worthy of Millennium Prize Puzzle consideration? To the general public and most physicians, perhaps so. But, other issues exist which further complicate these transactions. 
Issues and Controversies with Acquisitions

The potential pitfalls and problems with private equity firms acquiring medical practices are many and complex. This is where the $1000 per hour law partner earns his/her payday.
The first and most obvious issue (besides the obvious violation of CPOM doctrine) is the issue of “fee-splitting.” Fee-splitting is broadly defined as, “any arrangement pursuant to which unlicensed individuals or business entities share in a medical provider’s professional fee income.” The prohibition on fee-splitting may be based on a state’s CPOM statute, another state statute, a federal statute or case law. These fees could include referral fees, office leases with “triple-net” payment restrictions, rental payments tied to a percentage of practice revenue, or an MSA contract fee based in whole or in part, which is a percentage of practice revenue, or other fee-sharing arrangements.
Any competent, cautious attorney will advise that an arrangement providing for a payment based, in whole or in part, upon a percentage of a health care provider’s revenues must be carefully analyzed under the applicable state fee-splitting statutes and regulations, and under the applicable CPOM laws because fee-splitting may be indicative of an impermissible ownership interest.

Federal courts have negatively opined upon the MSO “fee-splitting arrangement.”   In the case of  Virgiliu Necula, M.D. v. Martin J. Conroy et al., 2000 U.S. Dist. Lexis 8928 (S.D.N.Y. 2000) a physician established a radiology practice as a provider under the New York Medicaid program. In that case, the federal court was required to construe and apply New York’s fee-splitting statute, and ruled against the physician. Under review were contracts at different times that the physician had with two MSOs for management services. Those agreements specified that the MSO would provide facilities, x-ray and other medical equipment as well as non-physician staff and management of the finances for the radiology practice. The physician agreed to pay the MSOs a fixed percentage of his receipts for billing services and a fixed dollar amount for each procedure performed. During the period of these management services agreements, the physician received payments from the New York’s Medicaid program. The State audited Medicaid payments made to the physician, and a determination was made that the physician engaged in unlawful fee-splitting under the MSO arrangements. The court held the physicians violated the fee-splitting provision, required the physician to return Medicaid payments which had been received and excluded the physician from the state Medicaid program.

At this point, with the MSO and PC being inextricably intertwined, with fees being shared, and with courts sanctioning physicians for such conduct, private equity firms involvement in the medical industry “is looking like a duck, is walking like a duck and is beginning to learn how to sound like a duck.”

A far greater issue potentially arises if the PC receives any revenue from federal health care programs, i.e., Medicare, Medicaid or Tricare. The arrangement should be analyzed for compliance with the federal fraud and abuse laws, in particular the Anti-Kickback Statute. If there is an incentive package pertaining to the PC and the physicians and any revenue from the federal health care programs are going to the MSO, criminal sanctions and claims of Medicare Fraud would be a spectre lingering over the entire transaction.
Finally the greatest issue for physicians and private equity firms when the physician’s medical practice is based in Colorado is the express language of the Colorado Revised Statutes pertaining to the practice of medicine. Colo.Rev.Stat. § 12-36-106 states in material part:

(1)For the purpose of this article, “practice of medicine” means:

(a) …

(b) …

(c)The maintenance of an office or other place for the purpose of examining or treating persons afflicted with disease, injury, or defect of body or mind; [emphasis added]

(2)If a person who does not possess and has not filed a license to practice medicine, practice as a physician assistant, or practice as an anesthesiologist assistant in this state, as provided in this article, and who is not exempted from the licensing requirements under this article, performs any of the acts that constitute the practice of medicine as defined in this section, the person shall be deemed to be practicing medicine, practicing as a physician assistant, or practicing as an anesthesiologist assistant in violation of this article.

The express language of the Colorado statute, Colo.Rev.Stat. §12-36-134(7)(a) states, “Corporations shall not practice medicine.” [emphasis added]

By defining the practice of medicine to include maintaining an office, that the Colorado legislature has taken away the “non-medical asset” loophole through which private equity firms “snuck the camel’s nose into the tent.” The term “maintenance of an office or other place,” is a very broad phrase and is furtherance of the legislative mandate that corporations, and non-physicians shall not practice medicine with the practice of medicine being defined in very broad terms.

Ramifications for violating the CPOM Doctrine

At least in Colorado, the legislature set forth one possible remedy as follows:

(g)
Pursuant to § 12-36-129(6), the board may apply for an injunction to enjoin any person from performing delegated medical acts that are in violation of this section or of any rules promulgated by the board.

In layman’s language, the State Attorney General has the legislative mandate of closing any medical practice violating the CPOM doctrine. Physicians who violate the doctrine are subject to civil and criminal liability, loss of medical privileges and removal from state and federal Medicaid programs.

Ordinarily, the state’s attorney general is tasked with enforcing the CPOM doctrine. But, if there is possible Medicaid or Medicare fraud involved, a private citizen can file a “qui tam” action on behalf of the state and not only would the offending physician or entity be subject to prosecution in this manner, but the prevailing qui tam plaintiff potentially could recover as much as thirty percent (30%) of the amount the state or federal governments were defrauded through the actions of the offending entities.

The Faustian Bargain between private equity firms and eating disorder residential treatment programs continues unabated … for the time being. But, the words of Dr. Faustus ring true today:

I do promise him in return that, when I be fully sated of that which I desire of him, twenty-four years also being past, ended and expired, he may at such a time and in whatever manner or wise pleaseth him order, ordain, reign, rule and possess all that may be mine: body, property, flesh, blood, etc., herewith duly bound over in eternity and surrendered by covenant in mine own hand by authority and power of these presents, as well as of my mind, brain, intent, blood and will.
I do now defy all living beings, all the Heavenly Host and all mankind, and this must be.

In confirmation and contract whereof I have drawn out mine own blood for certification in lieu of a seal.

Doctor Faustus, Adept in the Elementa and in Church Doctrine.

The winds of litigation war continue to stir.




Monday, April 16, 2018

Residential Treatment Centers and Private Equity Firms ... A Faustian Bargain


Faustian Bargain (def) - A pact whereby a person trades something of supreme moral or spiritual importance such as personal values or the soul in exchange for some worldly or material benefit such as knowledge, power or riches.

Residential Treatment Centers

Residential Treatment Centers ("RTC") provide treatment for eating disorders throughout the United States and abroad. There are currently in excess of 75  residential programs in the United States. This number is significantly up from a mere 22 in 2006. Some attribute this growth to the Mental Health Parity Act of 2008 and the Affordable Care Act two years later.  But, whereas those legislative changes may have been an initial catalyst, private investors, specifically large, private equity firms and venture capitalists determined that the probability of a large financial return on an initial investment existed in providing care and treatment to behavioral health problems.  As a result, RTCs have proliferated and have become inextricably intertwined with their investor-owners.

Certainly, an RTC can provide a needed service.  A number of eating disorder experts agree that some patients, particularly those with eating disorders that have been active for a number of years, can benefit from increased supervision and services available at many RTCs. But, legitimate, third party objective studies showing the effectiveness of RTC programs are non-existent and the few studies which do exist have been roundly criticized as being biased and flawed, if not outright misrepresentative. 

Further, a division between academic based treatment programs and the "for profit" RTC programs is widening as academic based programs generally utilize practices which are more "evidence-based" but struggle financially, while RTCs expand and financially prosper. This article explores the basis behind the growth of RTCs and its impact on the eating disorder industry.

A Case Study on ERC

The Eating Recovery Center ("ERC") based in Denver, Colorado is the most obvious example of the proliferation and growth of residential treatment programs in the United States.  In 2006, ERC operated one, small facility in Denver, Colorado.  Currently, ERC has 26 facilities in 7 different states and markets itself as the preeminent eating disorder residential facility in the United States. Let's study how ERC reached this lofty height. 

In May 2010, the Dallas based private equity firm, Trinity Hunt Partners purchased a minority interest in ERC and the expansion race began in earnest. In two years under the tutelage of Trinity Hunt, ERC grew from its one facility to three additional, new treatment facility developments and two strategic West Coast facility affiliations. Their employee numbers increased from approximately 90 to more than 300. The resulting financial return on Trinity Hunt’s initial investment was such that it did what any aggressive private equity firm would do. After tripling ERC's revenue, it sold the asset for a profit.
  
Trinity Hunt then sold its interest to Lee Equity Partners in 2012. Lee Equity invested in ERC out of a private loan fund in which it was participating.  In addition, Lee Equity was able to obtain a majority ownership interest in ERC.  This influx of capital resulted in rapid expansion for ERC.  In five years, ERC grew to 26 facilities in 7 states.  And yet, questions began to be asked about transparency of the financial investment and its impact on quality of care.

In the late spring of 2017, Lee Equity announced that it was divesting itself of ERC and was going to hold an auction for the sale of its ownership interest.  Welsh Carson, FFL and Apax, all private equity firms, were participants in the auction but CCMP Capital Advisors prevailed with a deal which produced a 4X financial return for Lee Equity.  CCMP’s leveraged buyout was estimated to be worth $550 million, with Antares Capital, LP and Golub Capital Markets, LLC providing the financing for the transaction.  Antares Capital disclosed that it invested $250,000,000 as a first lien credit facility on the transaction.

ERC was represented by Jamieson Corporate Finance in the transaction. Jamieson announced that as part of the transaction, ERC and its management team entered into a new “incentive plan” with CCMP Capital.  Dr. Ken Weiner, the CEO of ERC was quoted as being on board with “CCMP’s mission.” And yet, CCMP’s mission, as with most private equity firms is to participate in the acquisition of a corporation or asset, drive up its growth cycle  and then divest for a profit.  

As for the "incentive plan," one can question whether the incentive plan pertains to break through discoveries of state-of-the-art, evidence-based medical treatment of eating disorders which would dramatically reduce the death rate of this disease and give hope to the millions who suffer. Or does the incentive plan pertain to financial growth and expansion of ERC facilities. The probable answer comes from the realization that ERC has no formal affiliation  or partnership with an academic, medical institution, let alone any such medical institution conducting research into the biological aspects of the disease.

With regard to the acquisition of ERC, Bloomberg reported, “Our stable rating outlook reflects our expectation that ERC will deliver strong revenue growth and margin improvement in the new few years supported by stable reimbursement from commercial payors and consistent capacity increases.” [emphasis added].  Bloomberg also reported, “We could consider raising the rating if the company could grow and sustainably produce positive free cash flow of around $20 million per year.” 

Subsequent to the CCMP transaction, Moody’s Investor Services for the first time issued a rating for ERC.   Moody’s reported that ERC has a $30 million senior secured revolving credit facility expiring in 2022;  a $190 million senior secured first lien term loan due in 2024, and; a $30 million senior secured delayed draw term loan due in 2024.  Moody’s rating outlook for ERC is stable. Moody’s states that it, “… believes ERC will continue to expand aggressively through growth of existing facilities, new facility openings and acquisitions.” It later reported, “The company has no exposure to direct government reimbursement and maintains in-network contracts with most large insurers.  However, given the high daily cost of treatment, there is the risk that payors will pressure length of stay or steer patients to lower cost settings.”  Moody also reported, “The ratings could be upgraded if ERC materially increases its size and scale. Revenues were approximately $152 million for the last twelve months ended June 30, 2017.”

To start to accommodate this demand for growth, ERC announced in March 2018 that Rebecca Steinfort had been appointed to the newly-created position of Chief Operating and Business Development Officer. The press release noted that, “Ms. Steinfort has extensive experience leading mission-driven healthcare companies with significant growth potential.” One may wonder as to the reasons why this position had not been previously created until one realizes that the position was created not by the medical professionals at ERC to improve the quality of medical services provided to patients, but instead by CCMP to further their mission of growth, expansion, profit and divestiture.

From this dizzying array of multi-million dollar transactions and statistics, we know the following:

(1). ERC has a multi-milllion dollar debt ceiling;
(2). ERC’s credit and improved business ratings depend on aggressive expansion;
(3).  Until CCPM divests itself of ERC, as the majority owner, it will dictate the terms of any such expansion;
(4). ERC’s operating revenue depends upon insurance entities and individual families continuing to pay for extended lengths of treatment so that lines of credit and revolving credit lines do not need to be repeatedly drawn against to meet daily financial demands.

The logical conclusions drawn from these facts are that ERC’s current on-going operating revenues are controlled by insurance entities and banking institutions, ERC’s expected future aggressive expansion is being dictated by a private equity firm and its secured lenders, employment of high ranking officers is controlled by CCMP and $220 million in loans mature in less than 6 years after a $30 million senior secured revolving credit facility expires in 2022. 

One cannot automatically assume that just because an RTC is owned and controlled by a private equity firm, that the RTC cannot provide reputable treatment and assist in the healing process. In fact, the in-pouring of capital and expansion of facilities arguably makes access to treatment centers more readily available to those who previously did not have access.  However, when a private equity firm controls an RTC and financial success depends on rapid expansion, that RTC's business and financial structure makes it susceptible to practices that maximize revenue generation rather than prioritizing evidence-based practices and optimal treatment outcomes for its patients. 

The ultimate conclusion that can be drawn is that eating disorder sufferers and their families are potentially being treated as mere commodities instead of patients fighting for their lives.

Evidence Based Treatment

"Evidence-based treatments" are generally defined as interventions, (therapies) that are supported by reputable, published research demonstrating some type of effectiveness.  And yet, there are no specific therapeutic modalities which have emerged as a definitive “evidence-based treatment”  for adults suffering from anorexia nervosa. In general, enhanced Cognitive Behavioral Therapy is regarded as the most effective treatment for adults suffering from eating disorders.  Family based therapy is generally regarded as being more effective for children and adolescents suffering from anorexia and bulimia.  

Whereas many RTCs represent that they include CBT as part of their therapy model, eating disorder experts generally agree that the least restrictive setting whenever possible, is the best environment for treating eating disorders.  And that treatment module runs contrary to the RTC profit and expansion model.  

So, how effective are RTCs in treating eating disorders?  That is the multi-billion dollar question. And it is a question which remains largely unanswered.

With regard to ERC, as with most RTCs, they do not publish their recidivism rates.  In fact, industry experts cannot even agree as to the manner in which to define recidivism.  ERC does not release the percentage or number of its patients who are released AMA … Against Medical Advice.  Being released AMA generally occurs when the insurance provider stops paying for treatment.

Further, the paucity of information released by ERC, does not include reporting systematically collected objective data, such as weight change data for patients with anorexia nervosa.  In fact, most published treatment descriptions and weight gain data are from hospital programs affiliated with academic centers.  This objective, outcome related data is crucially important in evaluating the effectiveness of a treatment facility since weight restoration is the single strongest indicator of recovery for treating anorexia nervosa.

Without objective standards being published by RTCs, families and patients are left in the shadows as to the effectiveness of a program and instead are subjected to puffery, vague statements regarding a program's success and the purported accolades of its medical staff and programs.  And all the while, the deadly disease continues unabated.

Other Residential Treatment Centers

The focus of this article has been on ERC and CCMP.  However, many of the other major residential treatment centers also have private equity firms as their owners and overseers.

Trinity Hunt purchased Castlewood Treatment Center in July 2008. In January 2017, it announced the sale of Castlewood to The Riverside Company, which markets itself as recapitalization and leveraged buy out specialists.

Coker Capital Advisors represented McCallum Group, Inc. d/b/a McCallum Place when it was acquired by Acadia Healthcare Company, Inc. in September 2014.  Acadia operates a network of 76 behavioral healthcare facilities.  McCallum represents that it provides innovative, evidence-based treatment.

In 2015, Levine, Leichtman Capital Partners acquired Monte Nido Holdings, LLC d/b/a/ Monte Nido from Centre Partners.  Centre Partners "invested" in Monte Nido in December 2012.

In September 2012, Acadia Healthcare paid approximately $90 million for Timberline Knolls.

In August 2015, Vestar Capital Partners purchased a majority ownership interest in Veritas Collaborative, LLC.

Kohlberg & Company, LLC acquired Meadow Behavioral Healthcare in 2016.  They operate Remuda Ranch at the Meadows.

This list is not meant to be exhaustive.  However, it is illustrative of the current state of financial affairs in the eating disorder industry as private equity firms gear up to do battle and start to move the pieces on the chess board. The possible reward?  Control over a multi-billion dollar industry.  The cost? One little commodity ... one precious life every 62 minutes with no improvement in sight. 

But then some commodities are meant to be exploited ... and then discarded. 





Sunday, April 15, 2018

The Power of the Message ... and the Image of the Messenger

Eating disorders come into our lives in different ways, through different means, in different and varying disguises. This disease knows all too well the weaknesses in the human heart and soul and it preys upon them.  Ego, anger, insecurity, greed, ignorance and especially fear. This disease sows hate-filled seeds of self-destruction within us and then waters them, tending them carefully knowing that our weaknesses need so little to have them flourish and grow into a monster which consumes and ultimately destroys us. And it happens with all aspects of this disease and with all people who are caught in its insidious web.

There are a number of both "open" and "closed" groups on Facebook and other social media which are designed to provide "peer-to-peer" support for parents needing help and advice when they, or their loved ones are fighting this disease. A closed group is a group in which a person must first request consent from a Moderator to be included. The purpose of this ostensibly, is to protect the confidentiality of its members and to protect the integrity of the information being disclosed. Good, sound advice has been given and assistance has been obtained in these groups.

For example, a few months ago, I was contacted by an advocate based in Kansas who knew of a mother in Houston whose son was suffering and who was not receiving effective treatment. She asked me about treatment facilities in the Dallas area. I put her in touch with a good friend who was then the marketing person for the eating disorder program at Texas Health Presbyterian. She contacted her counterpart at Children’s Medical Center in Plano (a suburb in Dallas). Within days, the mother’s son had been checked into Children’s and was receiving the life-saving treatment he needed. That is an example of how these groups can and should operate.

Ironically at about the same time, one of the leading parent support “closed groups” on Facebook went through an acrimonious “divorce,” as moderators were abruptly removed and excluded, a new group with the same name was opened and ego, anger, threats and recrimination were played out on a public stage which was supposed to be reserved for providing sound advice and support for parents who are in the grip of fear, of suffering the greatest heartache and pain a parent can feel … the death of their beloved child. In response to this public disgrace within the group, I posted the following:

“I watched the ridiculous eyeball scratching, pillow fight yesterday with at first, mostly amusement, which then turned to pity which then turned to muted anger.

Yesterday, and the split into two groups, was not about a division of professional ideas and a collegial disagreement on how best to treat this insidious disease.  It was not about how best to help those parents whose souls are in agonizing pain. It was not about love, or faith, or hope. If that was indeed the case, then an orderly and mutually beneficial split could have been obtained with the clear messages of each group being delivered to those who so desperately need a candle in their darkness.

The Message.  The Message. The Message.

Going back as far as Biblical times (or for those of you who do not believe in God), then going back as far as at least 2000 years, the maxim, “It is the power of the message and not the image of the messenger” rings just as strongly today.

And yesterday, the Message was completely obliterated. Yesterday was about ego, and self-importance, and insecurities and inadequacies.  And so called “leaders” on both sides dragged this insipid ugliness into the clear light of day and paraded it around without regard to the pain, the suffering of the parents and their loved ones whose souls are compromised.

And to give it even greater clarity, in the four plus hours that the ugliest of the pissing match was going on, FOUR MORE SOULS WERE CLAIMED BY THIS DAMNABLE DISEASE!  And as to all the so-called “leaders,” not one remembered… not one gave the slightest indication that they gave a damn.  They were too caught up in feeling snubbed, or making demands or having their little feelings hurt or caught up in an emotional scrap heap.  FOUR MORE SOULS WERE TAKEN!  While everyone was scrambling for scraps from the table, and pointing fingers and being in every way, the very worst example of a self-absorbed, self-important close-minded reprobates … FOUR MORE LIVES WERE TAKEN!

To those who would say, “you don’t know everything that went on behind the scenes,” know this for an absolute fact… whatever you believe was so important about “what went on behind the scenes,” speaks to the image of the messenger, and is NOT about the POWER OF THE MESSAGE.

The two, mirror EDSP groups epitomize EVERYTHING that is wrong, everything that is bad in the eating disorder industry today. The silo-mentality, the isolationism, the self-importance, the self-absorption, the close-mindedness, the inability and unwillingness to listen.  And this begs the very real question… if you cannot even resolve your differences in a professional, calm transparent manner, why should any parent remotely believe that you are capable of offering advice or resources that is based on any type of objective standard instead of emotionalism and self-interest? Two mirror groups with the same message HURT those persons who need help the most.

Now, you want to ban me for an hour, or for good and delete this post because it is speaking some very hard truths? Buh-Bye.  I have helped a number of people on here behind the scenes, my child is dead so I am not getting any help on here and I am one of perhaps… two men who post on here.

And I do know another thing for an absolute certainty, the pissing match and subsequent split in the group grossly insulted the memory of my beloved daughter, Morgan, it insulted the memory of Maggie, it insulted each and every Warrior Angel this damnable disease has ripped from this earth.  And if the so-called leaders do NOT find a way to repair the rift and present a unified, transparent, open-minded front to supply a larger, greater, stronger, combined resource group for those parents and loved ones who are in agony, if the so-called leaders cannot find a way to get past the pettiness, then you are not part of the solution… you are part of the problem.  And when you become part of the problem, you will be treated accordingly.

Eating disorders, and the evil it instills in the brain, the heart and the soul it represents are my sworn, permanent and hated enemy. I will not stop.  I will chase this Demon.  I will chase it round Good Hope, and round the horn, and round Norway’s maelstrom and round perdition’s flames before I give him up. And if you are part of the problem, pray that you do not cross my journey.

Put your egos aside, remember the POWER of the message. The solution is simple.  The implementation of the solution is very simple.  The only complex thing is the ego… and if the message is important… that then is not complex.”

The impact of this message was exactly … zero. The two groups are still and will forever remain, split. Acrimony has been directed at the owner/moderator of another closed group accusing her of taking the material in the group and using it as the subject matter of a book. (which she vehemently denies). In the “new” closed group, when a moderator demanded its members adhere to a strict code of confidentiality I questioned how that could be widely and universally applied across the board since if any new, break through counseling techniques, counselors or centers were opened, that should be shared with everyone and also reminded people that courts had subpoena power over any “closed group.” As I pushed the points and asked for discourse, one of the moderators dismissively stated that she could “mansplain” it to me. I was not surprised that she was not called out for the use of such demeaning terminology directed toward an individual.

What these closed group moderators/admins fail to grasp, as their egos continue to run rampant, as they are blindly guided by their political views and agenda, the cracks in the “closed groups” are ever widening and “their closed groups” are beginning to be defined, not by their strengths but by their weaknesses. They do not understand that the “closed groups” do not belong to them at all. They belong to the parents who constitute the members. The moderators are merely stewards of the groups and should “their” members leave, they will have exactly what they have now … nothing. And all the while, the chilling laughter of the Demon lingers in the background.

These groups are losing, or have lost, the Power of the Message. These groups are underestimating the dark strength of this disease. These groups, instead of proliferating, are weakening. Our loved ones continue to die at an alarming rate. And all the while, the chilling laughter of the Demon lingers in the background.


There are millions of parents worldwide who are experiencing anxiety, crippling fear and hopelessness as their beloved child or spouse withers. An asset which could provide hope and shared strength for those parents is intent on burning itself to the ground. And the moderators, who are so concerned about lording themselves over their groups to the exclusion of everyone else may find themselves nothing but “Queen of the Ashes.” And all the while, the chilling laughter of the Demon lingers. 

As a final reminder of what the disease is about of the incredible harm it does to its victims and families, I will leave you with this: 

https://vimeo.com/218511446 

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