I get many e-mails, letters and phone calls from doctors, nurses and others who have been abused by “professional health programs” (PHPs).
Most are anonymous. Afraid of being identified and punished by the PHP, very few leave comments on my blog revealing their names or potentially identifiable information.
This is understandable. By simply reporting “noncompliance” to the medical boards a state PHP can end their careers. As it was with the Inquisition this system relies above all else on silence and secrecy. Speaking out can result in “swift and certain consequences.”
They are afraid. Some are undoubtedly suffering from PTSD. Most have developed a “learned-helplessness” Many have reported abuse and even crimes to their medical societies, medical boards, law enforcement, the media and others only to have the door slammed in their faces.-myself included.. They have no advocacy or support and feel no one cares. Their locus of control, identify and self-worth have been suddenly ripped from them without recourse. There is no lifeline. Attempts at justice are often undermined by a concerted defiance of the truth by their medical boards and even the attorneys who are purportedly working for them but will not “bite the hand that feeds.”
PHPs are ostensibly Employee Assistance Programs (EAPs) for doctors in both mechanics and mentality. EAPs assist employees with substance abuse, personal problems and other issues. They do not diagnose or treat “patients” but refer to outside professionals who do. The critical difference between EAPs and PHPs is PHPs have mandated all assessment and treatment be done by their own. These “PHP-approved” facilities are economically and ideologically intertwined with the PHP. The conflicts of interest are serious and many.
PHPs also use non-FDA approved junk-science drug and alcohol testing they introduced. The procedural safeguards most EAPs use to protect the donor ( certified labs, FDA-approved validated tests, split-specimen, strict chain-of-custody, MRO review) have been reviewed. Unvalidated “personality” assessments they also introduces are being used in “disruptive” physician evaluations guaranteed to find “character defects” to justify monitoring contracts. They implement polygraphs despite the AMAs previous conclusion they are scientifically unsupportable.
It is an institutionally unjust system of coercion, control and abuse that is unregulated, opaque and protected. There is no answerability and they are accountable to no one.
But regulatory agencies have readily adopted policies not only unsupported by science and evidence-based research but outside the normative principles and practice of medicine.
Granting PHPs authority to limit assessments and treatment to their own facilities offends the fundamental rights of the individual.
Informed consent (or refusal) constitutes a basic rule of the lawfulness of medical practice according to national and state medical practice acts governing the profession. It is a basic principle of all published principles of medical ethics.
Involuntary treatment is motivated by either potential harm to others (for the good of society) or by need for treatment and/or potential self harm.
Involuntary treatment should be a confined to those gravely disabled by psychiatric disorders or substance abuse. It necessitates reflection under the ethical principles of autonomy and beneficence.
A single DUI, transient psychological issue such as grief or anxiety, and even sham peer-review can easily land a doctor into forced assessment and involuntary treatment at a “PHP-approved” facility.
Involuntary assessment and treatment involves legal, clinical ethical, and deontological consideration in its demarcation.
The economic and ideological aspects need to be considered here.
How is it this paradoxical assessment and treatment paradigm legitimized and justified within a profession that emphasizes evidenced based decision making and beneficence and autonomy as two of the basic principles of medical ethics?
To sell the “PHP Blueprint” to other EAPs it is necessary to prevent doctors from speaking the truth. Very few want their names, states or other unique identifiers published for fear of consequences and retaliation.
The letters here have only been posted after being approved by their authors. The letter below is a representative sample I received today. The concept of our colleagues having to undergo “back alley” surgery under this regime is incomprehensible to me. -MLL
I was a victim of human rights violations committed by the PHP farmed out the group called Maximus. While in the “Diversion program” with 18 month clean sober, over 130,000 invested to date, I fractured and dislocated my shoulder. When arriving in the ED I told the MD of my circumstances and requested a drug test as part of my in addition to standard radiographs. The ED MD ordered IV pain medication right away seeing my pain. I refused, until I could reach my “diversion nurse counselor”. The ED doc consulted Pain Management and Ortho given the added level of complexity. Ortho advised that they immediately give me dilaudid and place my fractured shoulder back in socket as my hand was numb and my pulses were weak., then I be admitted for surgery. When I finally reached the PHP monitor, her she told me that if I “take anything other than tylenol ( including for surgery)she would have my license” My team of 4 physicians now at this point( a hospitalist, ortho, PM and ED) all agreed that this was ill advised and I must have my shoulder placed back into socket immediately. That assuredly, this nurse knew not what she spoke and as soon as Monday morning came and they could contact the medical board….I would certainly be vindicated”post-procedure”, as even my contract read,that “medical care recommended by a reasonable licensed physician could not be prohibited” by participation in the program. I let the orthopedist, give me dilaudid and reduce my shoulder. I was admitted to the hospital for one week, while the Orthopod tried to induce me to have the surgery. Pain Management managed my acute pain, with full knowledge of my situation. All the doctors tried to contact the medical board to tell them of my unique surgery. That I should not be kicked out of the program. And, I should have the surgery I needed. The medical board took my license. Upon discharge from the hospital, the the medical board detectives came to my door to inform me, that I couldn’t work. I knew I could not even get myself dressed. When the board detectives came to take my license I had my hospital wrist band on one hand, and a wrist band circulating around our beach community of Ladera Ranch, for the little girl whom I was just featured in the newspaper and on TV for saving her life. They told me I was a danger to the public. My life fell apart. It has never been the same. I had already paid some 130-160,000 in fees to the PHP, and related expenses, even though I “had a strong case to fight the board” as one attorney said. I had no more money left. They had taken everything from me. My life was over. Suicide is something I still think about as I try to piece my life together. There were human rights violations occurring. There were anesthesiologist in Diversion forced to have “back alley” surgeries while in the program, at their friends surgery centers, using diprovan, as it wasn’t checked for. If you had a minor surgery or God forbid a situation such as mine….you were kicked out and lost everything.