Commentary: Why Missouri's doctors and lawyers hide burnout until it breaks

By Martha Fernandez 

Missouri Independent

Burnout among Missouri’s doctors, lawyers and executives rarely announces itself. It shows up as a surgeon in Kansas City who stops sleeping through the night, a litigator in Clayton who adds a second drink most evenings, a hospital administrator in Springfield who snaps at a staff meeting and spends the drive home replaying it. Their work stays excellent. That is exactly the problem.

I am a licensed clinical social worker, and the people I see most often in this situation are not short on money, insurance or information. They are short on one thing: a way to get help that nobody at work will ever hear about.

The research on attorneys makes that point more clearly than anything else I know. The largest study of lawyer mental health, published in the Journal of Addiction Medicine in 2016, screened 12,825 licensed, employed attorneys. When the authors asked why people had not sought help, the two most common answers were not wanting others to find out and concerns about privacy or confidentiality. Among attorneys who had been in treatment, about half named the first reason.

That finding has held up. A 2026 research paper by my firm, CEREVITY, works through the decade of studies that followed and notes that the headline numbers vary with the method used. The fear of exposure is the one finding that shows up every time someone asks the question, in attorneys and in law students alike.

Doctors and senior executives carry the same calculation. A physician wonders who at the hospital will see the claim. A chief financial officer pictures the board hearing about it. A partner thinks about origination credit and what the firm did the last time someone admitted they were struggling. Each person decides, usually quickly and usually alone, that the safer move is to wait.

Here is what that waiting looks like in practice, in a composite drawn from common patterns rather than any one person. A Kansas City executive notices in January that she is lying awake at 3 a.m. By spring she is canceling lunches and rereading emails four times before sending them. By late summer a colleague asks if she is OK, and she says she is just busy. She finally calls someone in the fall, after a panic attack in a parking garage. The care she gets then is harder and slower than it would have been in January.

Missouri already has a piece of the answer, and it deserves more attention. The Missouri Bar’s lawyers’ assistance program offers counseling and referrals to every lawyer and judge in the state at no cost, and the Bar states plainly that its services are confidential and that reaching out does not affect a lawyer’s license. That last sentence matters more than any brochure. It answers the exact question that keeps people away.

Three changes would extend that logic beyond the bar.

First, employers should say the confidentiality promise out loud, in writing and from the top. A benefit nobody trusts is a benefit nobody uses. If a hospital system, law firm or company in St. Louis or Kansas City offers counseling, its leaders should spell out who can see what, and who cannot.

Second, boards and managing partners should stop treating a request for help as a performance signal. The people most likely to hide strain are the ones whose standing depends on looking unshakable. If the first person to admit difficulty gets quietly passed over, everyone else learns the lesson.

Third, professionals themselves should stop waiting for a crisis to make the decision for them. Early signs are ordinary: broken sleep, short temper, more alcohol, less patience with family. Help works best at that stage, before the panic attack in the parking garage. Confidential options exist, including burnout therapy for leaders delivered by video, and many people never need to tell their employer anything at all.

Missouri asks a lot of the people who run its hospitals, courtrooms and companies. The least the state’s institutions can do is make sure the help they offer is help those people will actually use. That starts with taking the fear of being found out as seriously as the people feeling it do.

Martha Fernandez is a licensed clinical social worker and co-founder of CEREVITY, a private-pay concierge network of independent licensed clinicians built for high achievers: executives, founders, physicians, attorneys and finance leaders. Her clinical work focuses on burnout, anxiety and depression in high-demand careers. She is the author of Wired to Burn: A Therapist's Guide for High Achievers Running on Fumes.

Missouri Independent is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Missouri Independent maintains editorial independence. Contact Editor Jason Hancock for questions: info@missouriindependent.com.

Nancy Hughes: When my closet smelled

  “I have hidden your word in my heart that I might not sin against you.”

Psalm 119:11 (NIV)

There’s an old pair of tennis shoes that I only wear outside when I mow or work in the yard. You may have a pair like them: shoe laces broken and tied together, grass stains accented with rips, one or two tiny pebbles caught in the tread (what’s left of the tread), along with remnants of “gifts” shared by the neighborhood cat.

One day, my grandkids decided to help me straighten up my house, and somehow those “outside only” tennis shoes got tossed inside my closet without my knowledge. The next morning, when I opened the closet door, the stench that hit me in the face nearly knocked me over.

It permeated the whole closet, including my clean clothes and the other shoes. I only needed a matter of seconds to pinpoint the source of the smell and throw the offending shoes out on the deck. However, even though the shoes were gone from the closet, the horrible smell remained.

I aired out the closet for a whole day and then hung an air freshener in it. The thing was, even though the tennis shoes had been removed for hours, they still left an odor that required me to put another and another and another air freshener in the closet until it was completely gone.

The horrible odor had to continually be replaced with the clean fragrance of the air fresheners. Thankfully, it eventually worked! It occurred to me while I repeatedly changed air fresheners in my bedroom closet that I also needed to allow the Lord to clean out those smelly tennis shoes from the closet in my heart. Let me explain.

When the tennis shoe smell says, “God doesn’t even know I exist,” Psalm 139:17-18 says, “How precious to me are your thoughts, O God! How vast is the sum of them! Were I to count them, they would outnumber the grains of sand. When I awake, I am still with you.”

When the stench hints that “God doesn’t care about my life and what I do,” Jeremiah 29:11 says, “For I know the plans I have for you,” declares the Lord, “plans to prosper you and not to harm you, plans to give you hope and a future.”

The horrible odor whispers, “She should never have said that about you. You have a right to be angry and to hold it against her.” But we read in Matthew 18:22 that Jesus answers Peter’s question if seven times is enough to forgive someone with “I tell you, not seven times, but seventy-seven times.”

Don’t let Satan’s lies hang around in the closet of your heart. Replace his stench with God’s truth and love. And remember, too, that the “air freshener” you hang up only works so long without needing to be renewed.

In other words, praying once or twice about negative thoughts and then thinking you don’t have to bother with them anymore is not true, because Satan doesn’t stop attacking. You have to constantly be in the Word to stand strong against him.

Dig through the closet of your heart, find all those stinky shoes, and give them a toss! Don’t forget to replace them with the sweet fragrance of God’s words of love and encouragement.

Father, so many times I allow the liar to creep into my thoughts and speak untruths to my heart. Help me to focus on you and your truth. In Jesus’ Name. Amen.

R.A.P. it up . . .

Reflect

Why do you think you allow Satan to attack you with lies?

Do you have Scripture memorized to stand against the attacks?

Apply

Journal each “stinky shoe” that you struggle with in your heart.

Beside each entry, journal a Scripture that shares God’s promise for that struggle.

Power

Psalm 119:11 (NIV) “I have hidden your word in my heart that I might not sin against you.”

II Corinthians 2:15 (NIV) “For we are to God the aroma of Christ among those who are being saved and those who are perishing.”

Proverbs 4:23 (NIV) “Above all else, guard your heart, for it is the wellspring of life.”

For more of Nancy Hughes' writing, check out her blog, Encouragement from the War Room.)

25 years ago today- Diamond R-4 superintendent missing, Bank of Diamond robbed

Twenty-five years ago today, two events occurred that shook the city of Diamond.

I was in my third year of teaching creative writing at Diamond Middle School when Principal Mark Mayo came to the trailer where I was teaching and said there would be an assembly in the gymnasium seventh hour, giving me no details as to what the topic would be.

When we gathered the next hour, we were told that Dr. Greg Smith, Diamond R-4 superintendent, had disappeared and that the bank had been robbed. Children who normally walked home were told to take a different route if they passed the bank since the area was still cordoned off. 

At first, media reports seemed to link the two events, though later it turned out there was no connection at all. 

Dr. Smith's body was found 11 days later in his car at the bottom of a pond just outside the Diamond city limits. Newton County Coroner Mark Bridges eventually ruled that Dr. Smith, 49, committed suicide and deliberately drove into the pond.

The investigation into Smith's death showed he was between $500,000 and $700,000 in debt and had taken out $3 million in life insurance in the six months before his death.

A search of Smith's computer revealed he had been researching insurance fraud and methods of committing suicide.

As for the bank robbery that occurred the same day Smith disappeared, a man carrying a fake bomb robbed $5,000. After the robbery, with the bomb still in the bank, authorities evacuated the facility and the surrounding block and brought in the bomb squad, which determined it was a fake. The fake bomb forced Diamond school officials to cancel the annual parade of elementary student in their Halloween costumes.

Smith was eliminated as a suspect in the bank robbery when surveillance video and eyewitness descriptions simply did not match him and the $5,000 wouldn't have made a dent in his debt. Plus, the investigation that Smith's vehicle and his final movements did not put him anywhere near the bank when the robbery took place.

As far as I can determine, no one was ever arrested for the bank robbery despite an extensive investigation by the FBI and local authorities.

Three establishments fail Joplin Health Department inspections

Three establishments failed Joplin Health Department inspections this week, according to information posted on the department website.

Receiving failing marks were Braum's, 3501 N. Range Line Road; Pho Saigon Vietnamese Noodle & Grill, 2640 E. 32nd Street; and MSSU Mayes Cafeteria, 3950 E. Newman Road.

Braum's

 Braum's received five priority violations and four core violations.

Priority violation were noted for the following reasons:

-An employee beverage was stored on a shelf in the walk-in cooler above food.

-Cut tomatoes and lettuce at the dressing station maintained at room temperature and were not provided with written times to discard.

-Shake spindles had heavy residue accumulation.

-A sewage drain line beneath the three-compartment sink is leaking.

-A chemical spray bottle was stored over food equipment on the cooking line.

The core violations can be found at this link.

Pho Saigon Vietnamese Noodle & Grill

Pho Saigon Vietnamese Noodle & Grill received a priority violation for having live cockroaches in the kitchen area and an administrative violation for not having an up-to-date health permit posted.

One of the restaurant's nine core violations was for having numerous dead insects and insect parts in hard to reach areas on the floor throughout the kitchen and beverage area.

Other core violations can be found at this link.

MSSU Mayes Cafeteria

MSSU Mayes Cafeteria received a priority violation for having mouse droppings beneath the soda dispenser boxes in the kitchen.

Among the four core violations was for dead insects near the south rear exit door and in hard to reach areas in the kitchen. The other violations can be found at this link.

The inspection report included an additional comment:

A complaint was received on 10/23 at the MSSU Mayes Cafeteria. The complainant reported finding hair in food, observing roaches on the countertops adjacent to the drink dispenser, and being served food that appeared pale in color and was reportedly undercooked.

During the inspection, observations were made regarding food handling practices, the reported presence of hair in food, potential pest activity on the countertops near the drink dispenser, and food preparation procedures. Staff were observed wearing hair coverings. Food cooking temperatures were evaluated to assess compliance with proper cooking and food safety requirements.

***

The following establishments passed their inspections:

McDonalds' 1531 W. 7th Street

Walmart Neighborhood Market Deli/Bakery, 2426 S. Maiden Lane

McKinley Elementary School, 610 S. Forest Avenue

Sleep Inn Breakfast, 4100 S. 43 Highwayt

Recovery Outreach Community Center, 1402 S. Main Street (re-inspection)

Blackstone Gastropub, 1521 E. Broadway Street

Stop N' Shop, 1930 S. Schifferdecker Avenue

Lafayette House, 1809 S. Connor Avenue

Nothing Bundt Cake, 2401 E. 32nd Street

Bamboo, 2316 S. Maiden Lane

Dollar General, 2630 W. 32nd Street

Hardee's, 4013 S. 43 Highway

Stop N' Shop, 1832 S. Maiden Lane

Wings N More, 1318 E. 7th Street

Tiger's Taqueria, 1515 W 10th Street

Thomas Jefferson Independent Day School, 3401 E. Newman Road

IHOP, 2117 S. Range Line Road (re-inspection)

Manuela's Mexican Restaurant and Cantina (re-inspection)

Nationally recognized medical trauma expert to speak at Willcoxon Summit at MSSU

(From Missouri Southern State University)

Missouri Southern State University (MSSU) will welcome Sacha A. McBain, PhD, clinical psychologist and associate professor in the Department of Psychiatry and Behavioral Sciences at Rush University System for Health, as the keynote speaker for the fourth annual 2027 Willcoxon Innovation in Health Sciences Summit, on March 12, 2027. This year’s summit will focus on “Innovating Health Sciences for a Better Tomorrow.”

McBain’s keynote, titled “At the Crossroads: Understanding Medical Trauma, Reimagining Care,” will explore the psychological impact of traumatic medical experiences and the importance of integrating behavioral health into healthcare.

As a clinical psychologist with expertise in early intervention, medical trauma, post-traumatic stress disorder (PTSD), adjustment to illness and injury, and integrated healthcare, McBain brings extensive clinical, research and educational experience to the summit. McBain is also a nationally recognized expert and trainer in medical traumatic stress and has contributed to national efforts to establish best practices for mental health and substance use screening among patients experiencing acute trauma.

In addition to the keynote, McBain will participate in an afternoon roundtable discussion, “Caring Deeply for Our Communities: Integrating Behavioral Health with Healthcare,” alongside regional healthcare professionals. The discussion will explore opportunities to strengthen collaboration between behavioral health and medical providers and improve care for individuals and communities.

The Willcoxon Innovation in Health Sciences Summit brings together healthcare professionals, educators, students and community members to examine emerging research, innovative technologies and trends shaping the future of health and life sciences. 

The event features expert presentations, opportunities for discussion and networking, and presentations by Willcoxon Scholars showcasing undergraduate research.

Registration is open for the 2027 Willcoxon Innovation in Health Sciences Summit. Participants are encouraged to register in advance and join MSSU for a day of learning, collaboration and forward-thinking conversations about the future of healthcare. Register today at https://www.mssu.edu/willcoxon-health-summit/willcoxon-summit-registration.php.

Hear from Dr. McBain about the upcoming summit at https://www.youtube.com/watch?v=XEhzbKy2zzY.

Joplin man arrested after allegedly murdering his 82-year-old mother

(From the Joplin Police Department)

A Joplin woman has died, and her son has been arrested as a result of the ongoing homicide investigation being conducted by the Joplin Police Department.

On October 30, 2026, around 8:52 a.m., the Joplin Emergency Communications Center received a 911 call about a physical assault in progress in the parking lot of 1715 S Rex Avenue. 

Additional information was provided indicating that one female appeared to be suffering injuries. Joplin Police, Fire, and M.E.T.S. Ambulance were dispatched.

Upon officers’ arrival, they located a female victim identified as Karol Betzel, 82, of Joplin, who was
suffering from life-threatening injuries in the parking lot. Karol Betzel was transported to a local
hospital. 

The suspect was identified as Anthony Betzel, 47, of Joplin. He was located a short distance away inside an apartment. Anthony was detained a short time later without incident.

During a preliminary investigation, it was determined that a physical confrontation occurred between Karol and Anthony while on the parking lot of 1715 S Rex Avenue. Karol was identified as
Anthony’s mother. 

During the physical confrontation, Karol sustained life-threatening injuries. At this time, no weapons were believed to be used during the altercation.

After being transported to a local hospital, Karol was pronounced deceased.

Anthony was arrested and transported to the Joplin City Jail. Charges for Second Degree Murder are
being submitted to the Jasper County Prosecuting Attorney’s Office for consideration.

At this time, this incident is considered isolated, and JPD investigators do not believe there is any
ongoing threat to the public. Next of kin have been notified.

If anyone has any information regarding this incident, they are encouraged to contact Detective
Sergeant Andy Blair at 417-623-3131 ext. 1602.

2027 health insurance rates released for Missouri

(From the Missouri Department of Commerce and Insurance)

Today, the Missouri Department of Commerce and Insurance (DCI) announced the release of final health insurance rates for Missouri’s 2027 individual and small group markets.

“As we head into a new plan year, I want to reassure Missourians that our state’s health insurance market remains structurally strong, and there are still many good options available when it comes to health coverage,” DCI Director Angela Nelson said. “We know Missouri families are struggling right now, and with rates increasing again this year, DCI is committed to supporting consumers and providing clear, accessible information and resources to help them make informed choices.”

For 2027, every county in Missouri will continue to have at least two carriers offering individual health insurance plans, with most counties offering four or more carriers and a variety of plan options from each. Carriers in the small group market (businesses with two to 50 employees) also continue to offer a range of choices for employers and their employees.

Consumers can find more information about the rate review process and review rate information on DCI’s website at insurance.mo.gov/health-insurance. To see which carriers are offering coverage in the individual market in your county, visit DCI’s online health insurance market map.

The department urges Missourians to take a close look at their 2027 coverage as rates increase and networks change for many plans.

“We know Missouri families and small business owners are facing significant economic pressures and limited household budgets,” Director Nelson said. “When everyday expenses rise, paying for health insurance can feel like an overwhelming burden – but foregoing coverage entirely leaves you vulnerable to devastating financial hardship if an unexpected illness, accident or medical emergency occurs tomorrow.”

“Having some level of coverage, even if it is just for catastrophic health events, is always better than having none at all,” Director Nelson added. “We strongly encourage all Missourians to shop the market, compare all available options, and identify the coverage structure that best protects their health and budget.”

Annual open enrollment for health insurance coverage in 2027 begins Nov. 1, 2026. For coverage to start Jan. 1, 2027, consumers must enroll or change their plan by Dec. 15, 2026. Consumers who miss the Dec. 15 deadline have until Jan. 15, 2027, to enroll, but coverage will not begin until Feb. 1, 2027.

Consumer Tips for Open Enrollment

DCI’s Health Insurance Shopping Tool is a valuable resource to help consumers compare plans and understand key terms and considerations. The department also recommends keeping the following in mind when shopping for a plan:

Compare total costs: Review and compare the costs associated with each health plan, including all out-of-pocket costs – premiums, deductibles, co-pays and co-insurance amounts – to determine the most cost-effective choice. 

Understand your plan: Consider more than just cost when choosing a health plan. It’s important to understand what services the policy will cover, the costs you’ll be responsible for, and your current and potential future health care needs. 

Review plan changes annually: Health insurance policies can change from year to year. Even if you remain with the same carrier, benefits premiums, covered medications and provider networks may change. 

Confirm provider networks: With recent attention to in-network providers, always verify whether your preferred physicians, pediatricians, clinics and regional hospitals remain in a plan’s network. Talking with both your health care providers and insurance carrier can help you to stay up to date about current and future participation in a particular plan’s network.

Review the plan’s prescription drug formulary: If you routinely take medications, make sure you are reviewing the plan’s formulary to see if your prescribed medications are included – and at what level of coverage. If any of your medications are not on the formulary – or are on a tier with higher cost-sharing, now is the time to also talk to your physician about whether there are suitable generics or other alternatives that may be more affordable. 

 
Explore Health Savings Accounts: A health savings account (HSA) is a personal, tax-advantaged savings account that you can use to pay for qualified out-of-pocket medical expenses, like deductibles, coinsurance, copayments, prescriptions, and other eligible health products. Under federal rules, all ACA Bronze and Catastrophic plans are HSA-compatible. Funds roll over from year to year, helping consumers build an emergency reserve and giving them more options to help cover their share of health care costs.

For more specific information about policies and coverage, talk with a trusted insurance agent or other assister (like a navigator or a certified application counselor). Free, unbiased assistance and education, including application assistance and plan comparisons, is available to all consumers seeking health coverage.

The Cover Missouri Coalition, a project of the Missouri Foundation for Health, is a network of partners – including Certified Application Counselors and Navigators – who assist individuals seeking coverage through the Marketplace and Medicaid. The Centers for Medicare and Medicaid Services (CMS) has awarded Navigator grants to the Missouri Association of Area Agencies on Aging (MA4) and the Missouri Primary Care Association for statewide assistance in 2027.

You can find free assistance in your area by visiting FindLocalHelp.CoverMissouri.org or calling 1-800-466-3213.

Clarification on Marketplace Oversight and Network Negotiations

In light of recent public concern and confusion regarding Children’s Mercy Hospital’s network status, the department reminds Missourians of the legal framework governing health insurance regulation:State vs. federal regulatory authority: Not all health plans fall under DCI’s jurisdiction. DCI has jurisdiction over “fully insured” health plans only. If “fully insured” or “fully funded” is printed on your health insurance card, this means it falls under the department’s authority. Missouri law does not grant DCI statutory authority to review, approve, or enforce network adequacy standards for individual health plans sold on the ACA Marketplace. Network adequacy standards for Marketplace plans are enforced at the federal level. 

State network authority: State law limits DCI’s network adequacy authority strictly to Health Maintenance Organizations (HMOs). HMO plans currently insure fewer than 14,000 individuals statewide, and no HMO plans are offered on Missouri’s individual ACA marketplace. 

Private contract negotiations: DCI has no legal authority to arbitrate or intervene in private contract negotiations between health care systems and insurance companies.

Missourians with questions about health coverage, policy terms or disputes, or any other insurance topics call DCI’s Insurance Consumer Hotline at 800-726-7390 or visit insurance.mo.gov/consumers/.

DCI is charged with protecting Missouri consumers through oversight of the insurance industry, banks, credit unions, utilities and various professional licensees operating in the state. For more information about the department, please visit our website at dci.mo.gov.

Three members of Joplin family to stand trial on child abuse charges

Three of the four members of a Joplin family who allegedly kept an autistic 12-year-old girl locked in a kennel every night for two years waived their preliminary hearings today on two charges of child abuse.

Trial court arraignments for Shane Ross, 50, and Hannah Ross, 25, are scheduled for November 30, with the arraignment for Crystal Ross, 46, set for November 24.

The preliminary hearing for the fourth family member, Megan Ross, 19, is scheduled for 8:30 a.m. November 25.

Probable cause: Four family members forced autistic chlid to sleep in dog kennel

Search warrant execution at Dade County home leads to arrest for statutory sodomy, child molestation

(From the Dade County Sheriff's Office)

On Thursday, October 29, 2026, deputies with the Dade County Sheriff's Office, working in cooperation with the Barton County Sheriff's Office, successfully executed a search warrant at a residence in Dade County, Missouri, resulting in the apprehension of a wanted felony suspect.

Freddy Tiznado Diaz was located at the residence and taken into custody on an active Dade County arrest warrant.

Diaz was wanted in connection with the following felony charges:

Statutory Sodomy or Attempted Statutory Sodomy – Deviate Sexual Intercourse – Person Less Than 12 Years of Age — Unclassified Felony

Child Molestation – Second Degree – Child Less Than 12 Years of Age — Class B Felony

Diaz was taken into custody and is being held on the Dade County warrant without bond.

This operation highlights the importance of cooperation and coordination between neighboring law enforcement agencies in locating and apprehending individuals wanted for serious felony offenses.
Sheriff Ryan Robison stated:

"Our office takes allegations involving crimes against children extremely seriously. Individuals wanted for these types of offenses should understand that we will continue to pursue them and use every lawful resource available to bring them before the courts.

"I want to personally thank the Barton County Sheriff's Office and the deputies who assisted us with this operation. Their professionalism, dedication, and willingness to work alongside our deputies were instrumental in the successful apprehension of this individual.

"Law enforcement is most effective when agencies work together. Our partnerships with surrounding counties are invaluable, and today's operation is another example of what can be accomplished through teamwork and a shared commitment to protecting our communities."

The Dade County Sheriff's Office will continue working diligently to locate wanted individuals, protect victims, and ensure those accused of serious crimes are brought before the judicial system.
All subjects are innocent until proven guilty in a court of law.

Barry County woman charged with statutory rape, statutory sodomy

The Barry County Prosecuting Attorney's office filed statutory rape and statutory sodomy charges against an Exeter woman who allegedly committed the crimes with a boy less than 17 years old.

The arraignment for Brandi Ranae Thomas (DOB 1999) is scheduled for 9 a.m. November 12 in Barry County Circuit Court.

From the probable cause statement:

On September 14, 2026, I, Detective Jeremy Berner began investigating a sexual assault report made to the Barry County Sheriff's Office involving Brandi Thomas having sexual intercourse with a male
juvenile.

On September 21, 2026 Brandi met me at the Barry County Sheriff's Office for an interview. She
was read her Miranda Rights and made the following statement.

Brandi admitted V1 had stayed the night at her residence on the night of September 4, 5, 2026.

While V1 was staying the night at Brandi's residence she had touched V1 penis in an inappropriate gratification way. She described it as "jerking V1 off".

Brandi then stated on the night of September 10, 2026 she went to V1 residence and had sexual intercourse with V1.

Brandi stated this was consensual and it was her idea.