Regulation of the Medical Profession: The Influence of Special Interest Groups and “Bent” Science

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In  Bending Science: How Special Interests Corrupt Public Health Research 1  Thomas McGarity and Wendy Wagner describe how special interest groups scheme to advance their own economic or ideological goals by using distorted or “bent” science to influence legal, regulatory and public health policy.

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The authors describe a “separatist view” of science and policy that assumes scientific research is sufficiently reliable for public policy deliberations and legal proceedings when it reaches them.  This is illustrated as a pipeline in which it is presumed  the scientific community has properly vetted the information flow through rigorous peer-review and professional oversight.  The final product that exits the pipeline is understood to be unbiased and produced in accordance with the professional norms and procedures of science.   The reliability, integrity and validity of the final product is indubitably accepted.The separatist  view does not consider the possibility that the scientific work exiting the pipeline could be intentionally shaped and contaminated by biasing influences as it flows through the pipeline.  When this occurs the final product exiting the pipeline is distorted or “bent” and bent science can result in bad decision making and bad policy.

Bent science starts with a pre-determined outcome and works backward from a desired result. It is not true science. Those orchestrating the deception (“benders”) use a variety of tactics and strategies to shape, package and spin science to support their own hidden agenda and suppress opposing science.

Benders attempt to hide, dismiss and debunk contrarian research and unsupportive science.  Benders will attack and harass the science and scientists that pose a threat to their interests. Using carefully crafted studies designed to confirm a desired outcome, the pre-determined conclusions are subsequently promoted and publicized to the relevant stakeholders who are often unable ( or sometimes unwilling) to discern real science from junk-science.

Misinformation, propaganda, and deception are disseminated in a variety of venues. Public relations firms are used to manipulate public perception and freelance writers are hired  brandish favorable consensus statements.  Authoritative reviews and critiques are ghostwritten under the names of  “outside experts” who profit both monetarily and by adding a high-profile publication to their resume.

Opinion is paraded as fact and with a dearth of professional oversight the charade usually goes unnoticed and unopposed.

Data-dredging, cherry picking, confirmatory bias, confirmatory distortion, fabrication, falsification, exaggeration, and a whole host of deceptive tactics are used to work backward from an already determined result.

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Any information that contradicts the answer is manipulated, undermined, suppressed or downplayed; even if it is the result of real science and evidence-based research; even if it is the truth.  Professional procedure, protocol and ethics are off the table.  It is an underhanded free-for-all. Bare knuckle boxing. Trash your opponents work and label it junk-science. Undermine the integrity of your opponents.  Use ad hominem attacks to question the opponents motives. Claim the scientists are hacks on the take.  Start rumors about them.Loudly claim you are the one who is evidence based. Proclaim professionalism and authority.  Quibble. Move the goalpost.   Nit-pick and split hairs.  Proclaim over and over and over again you are the one who is evidence based.

And the problem is it usually works.  It is an unfair playing field.  When no meaningful barriers are in place to detect cheating and identify cheaters they usually win.

Bending science can have serious and sometimes horrific consequences and multiple examples including the Tobacco and pharmaceutical industry are given in the book.

Calling for immediate action  to reduce the role that bent science plays in regulatory and judicial decision making, the authors emphasize the assistance of the scientific community is necessary in designing and implementing reform.

“Shedding even a little light on how advocates bend policy -relevant science could go a long way toward remedying these problems.  Indeed, precisely because the advocates have overtaken the law in this area, heightened attention to the social costs of bending science could itself precipitate significant change.”

But there are difficulties in challenging bent science including a general lack of recognition of the problem. With an absence of counter-studies to oppose deliberately manufactured ends-oriented research this would be expected.

Bent science involves the deliberate manufacturing of a pool of  information designed to promote a specific agenda.  A level playing field would require a pool of opposing research specifically addressing that agenda.  In reality this requires both the incentive and the power to do so–an unlikely scenario short of an equally well funded competitor or sufficient public concern about the problem.

In fact counter-forces are often nonexistent. Investigatory techniques developed and promoted by the FBI crime lab (such as firearms identification and intoxication testing) is one example described in the book.  These techniques evolved with little meaningful oversight from the larger scientific community and could be badly bent but there is no meaningful pool of information to disprove them.  The authors aptly state that   “defendants in most criminal cases lack resources to mount effective challenges, much less undertake their own counter-research.”

And part of the “art” of bending involves swaying public opinion and the mainstream media is typically aligned with the benders so opposing viewpoints seldom make the headlines.

Additionally, there is no meaningful oversight or avenue to pursue accountability. No systems exist to prevent, catch and publicly expose bent-science or those who bend science.

The influence of special interest groups on the practice of medicine is unknown.  No one has examined the role of bent science in the rules, regulations, policies and decisions made by those who are in charge of the standards of medical practice and professional behavior of doctors but as a regulated profession governed by the  decisions and policies of regulators it is certainly possible.

Regulation of the Medical Profession

Alexis de Toqueville once observed that a key feature of American government was the decentralized character of administration. “Written laws exist in America,” he wrote, “and one sees the daily execution of them; but although everything moves regularly, the mover can nowhere be discovered. The hand which directs the social machine is invisible.”2

Administrative law is the body of law that allows for the creation of public regulatory agencies and contains all of the statutes, judicial decisions and regulations that govern them. Administrative agencies implement their powers in the form of rules, regulations, orders and decisions.   State medical boards are the regulatory agencies responsible for the licensure and discipline of physicians. They grant the right to practice medicine in the form of a medical license and each state has Medical Practice Act that governs and defines the practice of medicine. The medical board is empowered to take action against a doctor for substandard care, unprofessional behavior and other violations as defined by the state Medical Practice Act.

Administrative Code governs the licensure and disciplinary process and the State Administrative Procedure Act governs the legal process (due process, discovery, etc.). Regulatory changes are enacted through procedural, interpretive and legislative rules.

Both medical practice acts and administrative procedure acts are subject to change.  Changes in medical practice acts can redefine what is acceptable practice and what constitutes professional behavior. This can increase the power and control these agencies have over doctors both professionally and socially.

Changes in Administrative practice acts can decrease what rights a doctor has if this power and control is abused.  Changes in the wording of administrative code and administrative practice acts can have profound implications in these rights including due-process, timeliness of being heard, rights to appeal decisions and time-constraints for judicial review.

And when these changes occur they do so silently.  The hand that directs the machine is indeed invisible.  The consequences, however, are not.  These changes not only impact those touched by the hand but can have a systemic impact on the entire profession.

State medical practice acts as well as administrative practice acts and code are susceptible to change and therefore susceptible to the influence of special interest groups benefitting from such change.  Regulation of the medical profession is thus susceptible to bent science.

Bent Science and the Medical Profession

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The impact of bent science on the regulation of the medical profession has not been studied. As a profession governed by regulatory agencies medicine is certainly not immune to the influence of special interest groups who could in turn influence public policy and regulatory decisions, rules and regulations to benefit their own interests.

Making sound decisions about regulation calls for an understanding of the problem it is intended to solve. This demands methodologically sound science and evidence-based facts arrived at through rigorous peer review and professional oversight. The science on which policy decisions are made must be reliable and unbiased. Legitimate policy must be based on recognized and legitimate institutions and experts.

If the information regulatory agencies rely on to discipline doctors and protect the public is unreliable then serious consequences can occur.

It would be beneficial to look for changes in public policy, guidelines, rules and regulations involving the medical profession and examine the reasons behind them. When did the problem present? Who presented it? Was it based on methodologically sound and accurate data?  What organizations do the problem presenters represent?  What organizations or individuals aligned or associated with the presenters might benefit?  What are the consequences?  Who is harmed?

Howard Becker describes the role of “moral entrepreneurs,” who crusade for making and enforcing rules that benefit their own interests by bringing them to the attention of the public and those in positions of power and authority under the guise of righting a society evil.8   

The mechanics and mentality is similar to the science benders and, as discussed below,  they use some of the same techniques.

Moral entrepreneurs take the lead in labeling a particular behavior deviant and spreading this label throughout society.  They associate the behavior of some group with a society evil, affix an easily recognizable label to it and then express the conviction that the evil must be combated.  Labeled as being outside the central core values of consensual society, the deviants in the designated group are perceived as posing a threat to both the values of society and society itself.

Activities can rise to the level of ‘social problems” when harm or danger is attributed to those activities and governmental powers are called upon to put an end to those harms. Bent science requires convincing others of a viewpoint and the likelihood of this occurring increases when the activity that is identified as a problem resonates with underlying societal concerns and anxieties.  The problem is then endorsed by experts who give legitimacy to such claims.3,4 This legitimacy results attracts media attention which further enforces support from both the public and policy makers.5,6  

As a result any bent science directed at regulatory and public policy decision making should be clearly visible.

The sociologist Stanley Cohen used the term ”moral panic” to characterize the amplification of deviance by the media, the public, and agents of social control.7 According to cultural theorist Stuart Hall, the media obtain their information from the primary definers of social reality in authoritative positions and amplify the perceived threat to the existing social order. The authorities then act to eliminate the threat.9 The dominant ideas or ideologies are reproduced by relying on the opinions of the defining authority and then spread through the media.

An internet search of what labels have been affixed to doctors in association with a threat to society there are three.  A google search of “impaired physician” yields 20, 600 results; “disruptive physician” yields 17, 400 results; and “aging physician” yields 27, 800 results. A large number of these articles, opinion pieces and reviews associate impaired, disruptive and aging physicians with patient death and other adverse events, medical error, and malpractice.   The labels affixed to these physicians have been characterized as a major threat to public health and the rhetorical tools used in many of these articles seems aimed at increasing public anxiety.

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A PubMed search yields 154 results for the “impaired physician”; 47 results for the “disruptive physician”; and 19 results for the “aging physician.”  Many of these are opinion pieces written by the same group of physicians and aimed at hospital administrators, regulators and those involved in the legal or business aspects of medicine.

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There is, in fact, no evidence based research that associates the impaired, disruptive or aging physician with any adverse events. The “impaired,” “disruptive” and “aging” physician labels  as evinced by a quick google search seem escalated far beyond the level warranted by the existing evidence.

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The “impaired” and “disruptive” labels have taken on the status of moral panic and the “aging” label, which is being associated with cognitive impairment, seems to be heading in that direction. The number of articles being published and lectures being given on the dangers of cognitively impaired doctors is increasing.  It has not yet reached the level of public awareness the impaired and disruptive have.

To acknowledge that the current level of concern about these labels is exaggerated is not to suggest they do not exist. They do.  But the disparity between the evidence-base, or lack thereof, and the level of concern warrants further investigation.

To be clear,  doctors who are impaired by drug and alcohol abuse need to be removed from practice to protect the public and receive treatment;  doctors who are abusive to others or engage in behavior that threatens patient care need to be held accountable for their actions; and doctors who are cognitively impaired due to dementia need to be removed from practice and evaluated by the proper specialists.  If a diagnosis of dementia is confirmed then they need to be removed from practice.

What is the motivation behind the “impaired,” “disruptive” and “aging” physician labels and the multiple articles linking these labels to patient harm and medical error?  There is no data driven evidence so where does it come from?   Could moral entrepreneurs be behind it?  If so then there should be evidence  of bent science and to examine this we must look for evidence that these labels have been used to influence regulatory decisions, rules, regulations and policy.

And with the recently archived Journal of Medical Regulation this task can be easily accomplished.

The Journal of Medical Regulation as Timeline and Framework for Policy Evaluation

The Federation of State Medical Boards (FSMB) is a national not-for profit organization that gives guidance to state medical boards through public policy development and recommendations on issues pertinent to medical regulation. Shortly after its founding in 1912, the Federation of State Medical Boards began publishing a quarterly journal addressing issues relating to medical licensing and regulation of doctors. First published in 1913 as the Quarterly of the Federation of State Boards of the United States, the publication has undergone several name changes and publication schedules. From1921 to 1999 it was published monthly as the Federation Bulletin. In 1999 it was changed to the quarterly Journal of Medical Licensure and Discipline and in 2010 was revised to the Journal of Medical Regulation The Journal of Medical Regulation is in the process of archiving all issues dating back to 1913.

Presently every paper dating back to 1967 is available online and the archival organization and availability of full articles published sequentially over the past half-century is historically invaluable.   As the official journal of the national organization involved in the medical licensing and regulation of doctors, this archival organization allows for an unskewed and impartial examination in both historical and cultural context. We can identify when particular issues and problems were presented, who presented them and how.

The Journal of Medical Regulation archives provides a structured context to examine these issues in their historical and cultural context.  This facilitates a retrospective analysis.  As a timeline it allows identification of when the issues were presented.  It also allows us to look at the events preceding the problem, who benefited from them, and the consequences. Could these factors be involved in influencing the regulation of medicine and shaping the medical profession? Could bent science have been involved in regulatory and administrative changes that have significantly impacted the rights and well-being of doctors and how the profession of medicine is defined?  Could some of the current problems such as the marked increase in physician suicide, sham-peer review, and physician burnout be the result of bent science?  If bent science is contributing to bad policy and bad decision making then it need to be exposed and addressed.  Bent science is bad medicine and if it exists then we need to urgently shine a light on it.

  1. McGarity TO, Wagner WE. Bending Science: How Special Interests Corrupt Public Health Research. Cambridge, MA: Harvard University Press; 2008.
  2. de Toqueville A. Democracy in America. New York: Penguin Books; 1984.
  3. Blumer H. Social Problems as Collective Behavior. Social Problems. 1971;18:298-306.
  4. Stone DA. Causal Stories and the formation of policy agendas. Political Science Quarterly. 1989;104:280-300.
  5. Best J. Threatened Children, Rhetoric and Concern about Child Victims. Chicago University of Chicago Press; 1990.
  1. Gerbner G, Gross L. The scarey World of TV’s heavy viewer. Psychology Today. 1976;9(89):41-45.
  2. Cohen S. Folk Devils and Moral Panics: The Creation of the Mods and Rockers (New Edition).Oxford, U.K.: Martin Robertson; 1980.
  3. Becker H. Outsiders: Studies in the Sociology of Deviance. New York: Free Press; 1963.
  4. Hall SC, Critcher C, Jefferson T, Clark J, Roberts B. Policing the Crisis: Mugging, the State, and Law and Order. London: Macmillan; 1978.
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Doctors fear controversial program made to help them

 

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Many say a controversial program designed to help doctors with mental health issues is out of control, destroying careers and causing some doctors to commit suicide.

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Author: Investigative Reporter: PJ Randhawa, Erin Richey

Dr. Gary Hammen admits that he was tired on the job.
In 2017, he had a newborn at home and a packed schedule as an anesthesiology resident, on top of a sleep disorder stemming from an injury he got serving our country as a soldier overseas.

But to him, the questions his supervisors asked crossed a line.

“They asked me, is this a drug problem? Are you sure you’re not using drugs?” he recalled. “I was floored.”

The questions came after months of exhaustion for Hammen.

Hammen says repeated, 24-hour shifts were taking their toll on his mental and physical health. Most weeks, he worked more than ninety hours and slept no more than four hours a night.

More than a year earlier, he met with his supervisors to tell them about his sleep disability, and offer them schedule recommendations from his sleep doctor.

He says supervisors promised, but failed to make any accommodation to his schedule or his sleep disability.

Weeks after his supervisors asked him about drugs, he got a call that made him think they didn’t believe him.

An organization called a Missouri Physician’s Health Program wanted him to fly to an addiction recovery center in another state, to be checked out.

Hammen couldn’t believe what was happening. “I had a bad feeling about it,” he said. “The whole thing just felt wrong.”

But he had no choice; colleagues warned him that if he didn’t follow the PHP’s requirements, he could lose his license and his career.

PHPs, or Physician’s Health Programs, are meant to help doctors with addiction or other psychological problems. But some, including Hammen, claim that doctors are sometimes falsely accused and getting help that they don’t need. They say the result drains their savings, endangers their licenses, and has even led some young doctors to take their own lives.

Nearly every state has a PHP. Some states have more than one. They started in the 1980s, often with closeties to the state’s medical boards or hospital associations. Medical industry professionals told 5 On Your Side’s I-Team that now big money is involved, and the lack of regulation turned a well-meaning measure into something that doctors fear even when they need help.

Dr. Wes Boyd of Harvard University is one of the skeptics. He used to work for a state PHP. Now he and others have raised concerns about these programs in the American Medical Association’s Journal of Ethics and in other respected publications.

“The physician is basically at the mercy of the PHP,” said Boyd. “There is no one outside the program looking at them, monitoring their practices and making sure that they’re really acting in a benevolent way.”

Boyd told us that when a PHP gets a tip about a supposed problem doctor, there is usually no way for the physician to appeal or dispute it. Instead, he or she must go to a “preferred” treatment center for evaluation. That center has complete authority to decide which doctors need treatment and how much.

Hammen made the flight to a treatment center, where evaluators made an unusual diagnosis. They said he had “provisional alcohol disorder,” something Hammen never heard of before.

“They hadn’t even talked to my wife to see if I drink. Most people wouldn’t make that sort of diagnosis without talking to some sort of outside person beside the patient,” said Hammen.

That diagnosis, Hammen thought, came from the fact that he told evaluators he and his wife shared a bottle of wine over the course of several dinners that week. It’s the only thing listed in the part of his evaluation describing his alcohol use.

Many of the treatment centers that PHPs refer doctors to are for-profit and specialize in addiction, even though doctors enter PHP monitoring because of stress and depression as well.

The I Team found many of the “preferred” treatment centers also donate money to the PHP trade organization: the Federation of State Physician Health Programs (FSPHP). Newsletters on the FSPHP website show several treatment centers are donors and exhibitors at FSPHP events.

Boyd told the I-Team that the bottom line motivates the centers to push doctors into treatment regardless of whether it’s really needed.

“Even in cases where there was no substance dependence, these centers come back and say, ‘You need to stay for 30 or 90 days of treatment,’” he said. “It is very hard not to think that financial motivations were behind the misdiagnoses.”

That can mean weeks of being unable to work, attending a treatment center that might not even offer services that doctors really need, with no way to get a second opinion or to choose their own care.

Even doctors who need help find the system difficult to navigate, with a high price to them and their community. Karen Miday once hoped that her son would get to help the community as a Cancer Specialist, but now he’ll never get that chance.

The words he left behind in a suicide note are so painful that she never took it out of the police department’s evidence envelope. But she read them to KSDK’s PJ Randhawa to show what he was feeling at the end of his life.

“That ‘I love you’ line stays with me,” she said.

“This is just the end of the line for my particular train,” Dr. Greg Miday wrote. “Earth wasn’t a great place for me.”

Dr. Greg Miday was 29 years old when he finished his residency in St. Louis in 2012. Friends and colleagues described him as bright, talented, and gentle. Under the surface, he also battled a drinking problem.

Miday’s last phone call was to the Missouri PHP. Karen Miday believes they had a chance to help him.

“I think all they needed to do was say, get yourself to a place of safety, you know, we’re behind you. That was all they needed to do,” she said.

Dr. Miday had been to one of the program’s approved out-of-state treatment centers before, where he followed the PHP’s requirements exactly. Then, just as he was about to start a new fellowship, he had a relapse.

Karen told the I-Team that he knew he needed help, but he also didn’t want to lose his new job. He suggested to the PHP that he could go to the outpatient program at a recovery center in St. Louis. This would let him keep his job and get treatment.

When Dr. Miday called the Missouri PHP, they said he must go to one of their “preferred” centers outside of the state. If he didn’t, the organization said, they would report Dr. Miday to the medical board.

“I think he thought there was no way out,” Karen said. “They have dual agency. It’s like being a policeman and a therapist at the same time.”

The list of approved facilities for Missouri physicians to get treatment includes just one in the state of Missouri. The nearest out-of-state option is in Lawrence, Kan.

“There’s no legitimate reason why they should have that handful of centers around the country that they prefer to use,” said Boyd.

“You start thinking after a while if there’s some diagnosing for dollars going on because now it’s not just substance use disorders, but now the “disruptive physician” and they’re talking about aging physicians,” said Miday.

Many doctors told the I-Team that the same lack of options that Dr. Miday felt is the reason that they fear contacting their local PHP when they really need help. That could put you at risk.

“If they’re afraid to ask for help, the chance that you’re going to get a doctor who shouldn’t be taking care of patients that day, goes up.  And you won’t even be able to know what the chances that that’ll happen. Because nobody will say anything,” said Hammen.

The I-Team reached out to the Missouri Physician’s Health Program with questions, and even went to the home of program director Bob Bondurant, RN, to ask them. He declined to talk about the doctors’ concerns, as did the Missouri Medical Association, and the Missouri Board of Healing Arts.

The National Federation of State PHPs declined to answer any of our specific questions about how their programs work. Instead, they issued this statement:

“Physician Health Programs (PHPs) across the United States and Canada provide physicians and other health care professionals a resource to ensure they are healthy, can practice their craft and at the same time ensure public safety. Today’s physicians often suffer from stress and burnout. A smaller number develop substance use disorders and depression. We are a ready resource to physicians with such untreated conditions who would otherwise be at risk to the public an/or face loss of licensure by their state medical board. PHPs lessen the significant barriers that stand in the way of physicians asking for help. 

Treatment is necessarily different for those in safety-sensitive professions, such as pilots and physicians; PHPs help physicians access care specifically designed to their needs. Our goal is to restore physicians’ lives and safely return them to patient care. Research as shown that the PHP care model has unmatched long-term consequences for substance use disorders. Additional research demonstrates successful graduates of PHP’s have a lower risk of malpractice.”

“There’s no legitimate reason why they should have that handful of centers around the country that they prefer to use,” said Boyd.

“You start thinking after a while if there’s some diagnosing for dollars going on because now it’s not just substance use disorders, but now the “disruptive physician” and they’re talking about aging physicians,” said Miday.

Many doctors told the I-Team that the same lack of options that Dr. Miday felt is the reason that they fear contacting their local PHP when they really need help. That could put you at risk.

“If they’re afraid to ask for help, the chance that you’re going to get a doctor who shouldn’t be taking care of patients that day, goes up.  And you won’t even be able to know what the chances that that’ll happen. Because nobody will say anything,” said Hammen.

The I-Team reached out to the Missouri Physician’s Health Program with questions, and even went to the home of program director Bob Bondurant, RN, to ask them. He declined to talk about the doctors’ concerns, as did the Missouri Medical Association, and the Missouri Board of Healing Arts.

The National Federation of State PHPs declined to answer any of our specific questions about how their programs work. Instead, they issued this statement:

“Physician Health Programs (PHPs) across the United States and Canada provide physicians and other health care professionals a resource to ensure they are healthy, can practice their craft and at the same time ensure public safety. Today’s physicians often suffer from stress and burnout. A smaller number develop substance use disorders and depression. We are a ready resource to physicians with such untreated conditions who would otherwise be at risk to the public an/or face loss of licensure by their state medical board. PHPs lessen the significant barriers that stand in the way of physicians asking for help. 

Treatment is necessarily different for those in safety-sensitive professions, such as pilots and physicians; PHPs help physicians access care specifically designed to their needs. Our goal is to restore physicians’ lives and safely return them to patient care. Research as shown that the PHP care model has unmatched long-term consequences for substance use disorders. Additional research demonstrates successful graduates of PHP’s have a lower risk of malpractice.”

 

Emergency Physician with Depression Chronicles Her 10-Year Fight to Keep Her License – ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.
— Read on www.acepnow.com/article/emergency-physician-with-depression-chronicles-her-10-year-fight-to-keep-her-license/

Systematic Abuse and Misuse of Psychiatry in Physicians’ Health Programs Discussed in the Journal of American Physicians and Surgeons

TUCSON, Ariz., Dec. 7, 2018 /PRNewswire/ — Physicians’ Health Programs (PHPs) are part of the medical regulatory-therapeutic complex intended to protect the…
— Read on www.prnewswire.com/news-releases/systematic-abuse-and-misuse-of-psychiatry-in-physicians-health-programs-discussed-in-the-journal-of-american-physicians-and-surgeons-300761899.html

“There are risks and costs to action. But they are far less than the long range risks of comfortable inaction”- John F. Kennedy

via “There are risks and costs to action. But they are far less than the long range risks of comfortable inaction”- John F. Kennedy

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“There are risks and costs to action. But they are far less than the long range risks of comfortable inaction”- John F. Kennedy

Born – May 29, 1917
Brookline, Massachusetts,
Died- November 22, 1963
Dallas, Texas, aged 46

“A man does what he must–in spite of personal consequences, in spite of obstacles and dangers and pressures–and that is the basis of all human morality.”–JFK

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https://www.gofundme.com/PHPReform

Thanksgiving Day Proclamation 1963-JFK

“As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them.”– Thanksgiving Day Proclamation 1963—John F. Kennedy.

IMG_1072Let us therefore proclaim our gratitude to Providence for manifold blessings–let us be humbly thankful for inherited ideals–and let us resolve to share those blessings and those ideals with our fellow human beings throughout the world.

On that(this) day let us gather in sanctuaries dedicated to worship and in homes blessed by family affection to express our gratitude for the glorious gifts of God; and let us earnestly and humbly pray that He will continue to guide and sustain us in the great unfinished tasks of achieving peace, justice, and understanding among all men and nations and of ending misery and suffering wherever they exist.

–Thanksgiving Day, 1963

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https://www.gofundme.com/PHPReform

New Center for Physician Rights Helps Protect, Guide Doctors (Article Published in Medscape Medical News November 9, 2018)

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New article by Pauline Anderson published in Medscape Medical News.

Please follow link and comment.


News > Medscape Medical News > Psychiatry News

New Center for Physician Rights Helps Protect, Guide Doctors

Pauline Anderson

November 09, 2018

 

Physicians who believe they have been subjected to unfair treatment and/or discipline by a state medical board, physician health program (PHP), or other regulatory body now have a place to turn for information, advice, and support.

Screen Shot 2018-11-10 at 5.51.01 PM.pngThe newly launched Center for Physician Rights (CPR) “will aggressively pursue necessary changes in the administrative legal arena to ensure fairness, prevent abuse of power and, where indicated, promote ethical and compassionate treatment,” according to the organization’s website.  Propelled by his own career-ending experience with the North Carolina Medical Board (NCMB) and that state’s PHP, CPR founder Kernan Manion, MD, told Medscape Medical News the new organization will, among other things, offer physicians “pointers” on how to deal with PHPs.

 

“We will tell them, here’s what you need to look out for; here are the warning signs of a sham peer review; here are some methods to approach this; here is why you need to have a lawyer who specializes in this and not a generic lawyer,” he said.  A practicing psychiatrist for some 30 years who had no previous disciplinary problems with any licensing body, Manion said he was put on the defensive when an anonymous source raised concerns about his mental health, which resulted in an investigation by the NCMB.

Although an independent, comprehensive psychological evaluation determined he had no mental disorder or other psychological impairment, an assessment by the NCMB concluded otherwise, and he was forced to deactivate his medical license.

In 2016, he launched a lawsuit against the North Carolina PHP and the NCMB, which was ultimately unsuccessful on appeal because it exceeded the time limit for filing a petition. As reported by Medscape Medical News at that time, Manion blamed the board and the PHP for using stall tactics to delay the legal process.

In the midst of his struggles, Manion organized a physician advocacy study group whose members were experts in this area or “who had been traumatized” by firsthand experiencwith a state medical board or PHP, he said.

Subsequently, the group began reaching out to the physician community and gradually became more visible, he said. As it did so, individual physicians, some of them “desperate” in the face of a PHP accusation, began reaching out for help.

One-Stop Shop

Now, with the official launch of the CPR, said Manion, these physicians have a one-stop access point for assistance.

Many of these cases, he said, have devastating psychological effects on the accused, including suicidality.

Another of the CPR’s key players is Louise B. Andrew, MD, JD, an emergency physician, internist, and lawyer. Andrew has a keen interest in physician suicide prevention. Her interest in this began when a number of such deaths occurred during her medical training and while on faculty at Duke University in Durham, North Carolina, and Johns Hopkins Medical School in Baltimore, Maryland.

While chairing the Well-being Committee of the American College of Emergency Physicians (ACEP), she was contacted by members who claimed to have been treated inappropriately by PHPs.

“Some had depression and were being forced into drug treatment programs that bankrupted them and in some cases ran them out of medicine and, in at least one case, caused a suicide. That disturbed me a great deal, and I’m continuing to see more of the same,” she told Medscape Medical News.

Andrew was licensed for a number of years in her home state of North Carolina. She said she was “appalled” when, in 2008, she received the standard license renewal application requesting all prior medical records for “vetting by the PHP as to the need for intervention and monitoring.”

As a lawyer, as well as a physicians, and having represented the ACEP for years at the Federation of State Medical Boards (FSMB), she knew the request was unorthodox, she said.

Since the North Carolina license was superfluous because she was no longer living in the state, she deactivated it in protest.

“I had learned at the FSMB that there was competition among state medical licensure boards to increase their disciplinary statistics, so I began monitoring the issue,” she said.

“Critical” New Resource

The CPR, said Andrew, will be a “critical” resource for physicians, who, when they become involved in an investigation, “are often induced to relinquish their basic rights, believing that they have nothing to hide and that these organizations exist to protect them.”

These physicians “are tacitly or even actively discouraged from seeking legal counsel,” said Andrew.

“They often find themselves railroaded into treatment that is unjustified and held hostage by the threat of licensure action; and because if they have signed away rights, are not even able to fight the injustice legally.”

In addition to the free “curbside” advice, the CPR offers a fee-based coaching program. Fundraising efforts should help those who can’t pay “because their resources have already been depleted,” said Manion.

Manion plans to apply for nonprofit status to make the CPR a charitable organization. Andrew is pitching in to help with this process.

She has experience setting up nonprofit organizations designed to help physicians. One of them, the Coalition and Center for Ethical Medical Testimony, provides education for those involved in medical malpractice cases.

Manion’s group is also pulling together a book of personal essays and advice columns, tentatively entitled Disrupted Doc, to help raise funds.

A contributor to that book, Anne Phelan-Adams, MD, is an original member of the advocacy work group. Like Manion, her personal story prompted her to become active.

About 3 years ago, Phelan-Adams, who had been practicing medicine for more than 35 years, experienced a personal crisis that “devastated” her but from which she completely recovered. Nevertheless, the Ohio state medical board launched an investigation into her personal circumstances.

After she refused to agree to a 3-month stint in residential treatment, she allowed the board to revoke her medical license.

“I was unwilling to spend 90 days in an alcohol and drug treatment center because I didn’t have either alcoholism or addiction,” she told Medscape Medical News.

Civil Rights Violation?

After talking to other healthcare professionals in similar circumstances and doing some additional research, she discovered that her story is far from unique.

“It’s clear that the basic civil rights of countless healthcare professionals have been flagrantly violated by state licensing boards,” she alleges.

Many medical boards, she said, have “devolved into quasi-judicial, extra-legal agencies that are rife with civil rights violations, hidden agendas, and financial conflicts of interest.”

As for PHPs, these “have degenerated into pseudo-medical, state sanctioned profit centers that have dubious financial relationships with the expensive rehabilitation facilities and psychiatric hospitals” into which they funnel their “impaired” physicians, she said.

A key element of the CPR is peer support and talking to someone who has been through the experience. A physician who asked to remain anonymous because he’s still practicing and is concerned about professional repercussions will be stepping into this peer support role.

As a result of one conviction for driving under the influence almost 4 years ago, the physician completed a “very rigorous, long, and intense court-ordered” treatment program.

During that program, the Washington state medical board “issued a press release saying my medical license had been suspended for noncompliance with treatment for alcohol abuse, which was totally unfounded,” he told Medscape Medical News. He only learned of his license suspension through the media.

“I know from experience that this can do a total number on someone emotionally, psychologically, spiritually, and every which way; it’s extremely traumatic,” he said.

“Doctors have invested enormous amounts of time, energy, and money on years of education and training, and in most cases, they are respected in the community and provide good-quality care. So this experience completely and totally pulls the rug from underneath someone, personally and professionally,” said the physician.

A Sense of Hope

He wants to offer physicians a “sense of hope.” His medical license was reinstated – albeit after almost a year and at a cost of thousands of dollars in legal fees, he said. Nevertheless, he describes himself as “one of the fortunate ones.”

He also envisions “being a kind of voice of reality” to those facing this kind of situation.

Manion’s plan also includes educating legal groups.

“We want to serve as knowledge experts about what really goes on in the medical community, because lawyers haven’t got a clue, for the most part,” said Manion.

Another important role of the CPR is advocacy.

“This is not just about helping the individual physician; it’s about taking a legislative stance and making changes,” said Manion.

Many areas require reform, he said. He pointed to the North Carolina PHP that “went behind the scenes” and lobbied the state legislature to change the wording of the law governing what it’s allowed to do.

“Believe it or not, the law gave the PHP basically the equivalent of a medical license – to evaluate and refer,” he said

Auditor Report Follow-up?

He wants to know what happened to the 2014 North Carolina auditor’s report that raised the possibility that some physicians “were deprived of legally required due process.”

The auditor was supposed to follow-up within 18 months, but nothing came of it, said Manion.

“We have the feeling [the auditor] may have been pressured into making this go away. But we’re saying that this is not going away; physicians are being harmed,” he said.

In the wake of allegations of financial conflicts of interest and inadequate treatment options for nonaddictive illness against the North Carolina PHP, a work group of the American Psychiatric Association (APA) Council on Psychiatry and Law was tasked with looking into standards and practices of PHPs across the board.

Last year, the work group issued a report that said it “does not confirm or deny the veracity of those allegations.”

However, the report did include several recommendations on appropriately dealing with physicians who have a mental health or substance use problem.

One recommendation is that in addition to the traditional chemical dependency treatment track, “there should be treatment tracks designed specifically for the management of psychiatric disorders or other medical disorders that do not require traditional substance abuse program elements.”

Wherever possible, the report notes, physician evaluations should occur within the boundaries of his or her locale and the medical board’s own jurisdiction.

No Place for Financial Gain

It’s noteworthy that the report outlined explicit policies to discourage financial conflicts of interest.

“PHPs should not operate for the purpose of making a profit,” the authors note.

The document was posted on the APA website and is available to all APA district branches.

But it’s simply a road map. According to the APA, it has no authority to intervene on behalf of individual physicians who complain about treatment by a PHP.

As a “private collection of doctors” and not a government agency, it has no investigative authority and can’t subpoena documents or records.

Class Action Lawsuit

But the courts do. A class action lawsuit is being pursued in the state of Michigan.

The case began more than 3 years ago, when lawyers filed a suit against the Michigan Health Professional Recovery Program, which is that state’s equivalent of a PHP, on behalf of three nurses and a physician assistant.

Since then, several hurdles have been cleared, said Ronald W. Chapman II, Esq, LLM, whose legal firm, Chapman Law Group, in Troy, Michigan, is handling the case.

“We have survived two rounds of motions to dismiss by the PHP and the state, and the judge ruled that we have viable claims,” Chapman told Medscape Medical News.

Another success, said Chapman, has been securing “a significant amount of discovery.”

What he and his colleague uncovered, he said, was that if there was any indication that a healthcare provider might be impaired, they were sent to a PHP.

If the provider refused to contact the PHP or didn’t accept its request to be monitored, the state would “automatically” suspend their license.

In addition, if they accept monitoring, “we found that the PHP was applying broad-based treatment decisions and protocols and were unfairly recommending monitoring for people who didn’t have an indication of a diagnosis,” said Chapman.

Currently, he and his team are awaiting class certification.

“We have oral arguments before a federal judge next month to deal with the issue of class certification,” he said.

Once that’s in hand, the road to a trial should be much smoother. However, he added, a settlement is also possible.

“They might see that they are going to be on the hook for damages to a large swathe of the Michigan health professional population,” he said.

The current focus of the CPR is on physicians, but Manion plans to expand this to include all healthcare providers – nurses, dentists, veterinarians, and pharmacists. “We have seen them all harmed,” he said.

AMA Weighs In

Medscape Medical News contacted the FSMB, the NCMB, and the Federation of State Physician Health Programs (FSPHP) for their take on the CPR. The FSMB and the NCMB both declined to comment. The FSPHP had not responded at press time.

Medscape Medical News also contacted the American Medical Association (AMA) to determine whether there has been an uptick in member complaints about unfair treatment at the hands of PHPs or state medical boards.

“The AMA can’t corroborate that there’s a trend in physicians being subjected to unjustified or unfair medical board investigations,” Robert J. Mills, the AMA’s media relations manager, told Medscape Medical News.

“The regulation of medicine is a state-run process governed by the laws and statutes of the local state legislature. On matters of state law and regulation, the AMA defers to local state medical associations as the primary authorities.

“The state medical associations are best positioned to monitor the state medical boards and take investigative action if there are causes for concern,” he added.

 

Comments on Medscape (as of November 24, 2018)

Dr. Patrick Bradley|  Family Medicine 

The dilemma facing doctors in an emotional crisis is illustrated by an article this monthin the Sydney Morning Herald by Professor Steve Robson, president of Royal Australian and New Zealand College of Obstetricians and Gynaecologists, entitled  THE KNOCK ON THE DOOR THAT STOPPED MY SUICIDE …….”. He said that he “ found medical school difficult – I was not a natural academic……Halfway through 1988, I felt overwhelmed with inadequacy. I had a patient die and I felt responsible. My consultants ….were not exactly glowing in their feedback……I had an all pervasive sense of failure….I could see no way out…So one night I made careful plans to kill myself…..I stole some supplies from the wards…..Incredibly , a work colleague arrived unexpectedly and began knocking on the door…That impromptu visit saved my life….I made an appointment with a GP ( Family Medicine Practitioner)in the town. To this day I remember this GP’s advice: Under no circumstances tell anybody or see a psychiatrist…..If I had a record of suicidality or mental illness, I would never be able to income-protection insurance and I would probably never get a good job….I tried antidepressant treatment but I remember it being very unpleasant ……The GP warned me that if anyone found out about prescriptions for antidepressants I might be in trouble with the Queensland Medical Board, perhaps struck off until I could prove myself….. Today, I am president of my college. I have had a good career. There was light at the end of the long, dark tunnel. I just couldn’t see it at the time……Today I am not ashamed of how I felt or what I did 30 years ago. I am ashamed that I have not used my position to advocate more strongly for colleagues in difficult emotional circumstances. …. When trainees of the college of which I am president took their own lives , I stayed silent. When a junior doctor took his own life while working at the same hospital where I tried the same thing I stayed silent. Enough silence……If you feel the way I did 30 years ago , seek help. Who knows where you might end up.”

Ayanya Toldstory|  Psychologist 

@Dr. Patrick Bradley Thank you for sharing your story, Dr. Bradley. Space is very limited here. I believe Dr. Manion stated he was planning to write a book based on the stories of physicians and other healthcare professionals who’ve been abused by their boards. In your story, a GP was telling you to NEVER go to a psychiatrist and she told you an Rx for anti-depressants could cause you trouble given the nature of boards and their associates. Then you stated that things have changed and you are now doing well and you feel you took the right action so many years ago. I feel as if I missed the middle rel in the film. I would love to somehow know more about the B between the A and C.

Dr. Kernan Manion|  Psychiatry/Mental Health 

In the US, the primary issue is not shame in having an episode of “mental illness” per se (a poor term itself), it’s being corralled into a state-sponsored diagnosis and treatment racket and then having your career ruined. The very intervention causes mental illness! Finally, due to the efforts of diverse groups, state medical boards have been cautioned about asking invasive questions on license applications and renewals about one’s personal history of such illness.

Even there, the primary issue wasn’t about the asking of the questions, it was what happened after one answered in the affirmative about a current (and in treatment) or past episode of a “mental illness” like an episode of depression or anxiety. One would then be sent to what amounts to a pseudo-psychiatric RICO and then have one’s life ruined by a supposedly benevolent agency acting on behalf of the state to “protect the public.”

Part of this horrific scenario has to do with these agencies’ play on the taboos around the term “mental illness.” Having an episode of a readily treatable emotion-centric illness which has somatic representations, i.e. depression or anxiety, takes on an entirely different meaning under the term “mental illness.” Thus, all situational episodes of such an illness get classed under this term which has too many taboo associations which evoke images of zombie-like people walking around Frankenstein-like with frontal lobectomies.

It’s a compound problem that can’t be fully addressed here. Suffice it to say that 1) having an episode of a mental-based illness which is treatable is not the same as being “mentally ill;” and 2) such is nevertheless rightfully in the domain of one’s utmost protected health information and should never be revealed to a licensing entity without solidly established cause and protection from harm. And I would add an additional caveat: given the horror stories from states across the country pertaining to abuses of psychiatry by state-sponsored physician health programs (PHPs), no physician in their right mind should participate in one without thorough research into its integrity, sensitivity and mechanism of grievance. PHPs’ own trade association FSPHP refuses to intervene in cases of reported abuse by its members and refuses to allow institution of a nationally standardized external audit. What are they afraid of?

Dr. cathryn wield|  Emergency Medicine 

Why is the general press not aware of what is going on?  It seems that there is a consensus of opinion here – physicians prepared to go ‘on the record’.  What has been said in this article is surely a national scandal! I am British (although living in Colorado) and have elsewhere on Medscape commented on our own Doctors Support Network, run by doctors for doctors. We are a small nation and comparable in size to ‘one state’ in many ways, so I realize that comparisons are not valid.

The British physician regulatory body the GMC (General Medical Council) has been brought to task, because of the seriously high rate of suicide of doctors who are ‘referred’ to them for ‘investigation’. It is a worldwide problem.

Doctors are patients too. They require the same degree of high quality, confidential advice and treatment as anyone else – more so when mental health is concerned. When this is not in place, fear prevents timely help and treatment – we all know that – it is obvious. I wrote something similar to this as a letter to the ‘GMC News’ in 2004, three years after my complete  recovery and return to work from a prolonged and severe depression.

However the reality is that until doctors start speaking out about their mental health, the successful treatment and recovery, as well as the horror stories, this will not change.

Thank you to those who have done this already. We need more to come forward. The shroud of secrecy needs to be broken. We cannot tell our patients that there is no shame in being mentally ill if we do not believe this ourselves.

Dr. Kathryn Kennedy|  Psychiatry/Mental Health 

We have needed this for so long now!

Dr. David Ostrow|  Psychiatry/Mental Health 

I don’t think that I have ever seen a MedScape article on such a controversial subject that received unanimous support from so many commentators and from many extremely prominent senior physicians whom I respect for their ethical and common sense approach to difficult issues. My heart goes out to the woman who lost her son due to the over-reaching and inappropriate actions of a State PHP, and to all the practitioners who described the Kafka-esque treatment they received. And if the AMA and other National Medical Associations won’t investigate and put an end to these abuses, where are our State Medical Boards in sorting out this mess? Surely they aren’t all run by persons with COIs that are personally profiting at the expense of the physicians (and their patients) being destroyed by unsubstantiated allegations and diagnoses! Obviously, the takeover of US healthcare by for-profit companies has done more harm than lining the pockets of health corporation executives and insurance companies with the resources that should be going into service delivery.

Ayanya Toldstory|  Psychologist 

@Dr. David Ostrow  Please don’t call me Shirley. : ) Seriously though, It is not simply wishful thinking to believe that not ALL State Medical Boards could be thick with the Conflicts of Interest (COI) you mention. There is logic to the proposition. However, we must remember that there are centralized “unifying” players who in the name of “standardization,” wield great influence. I won’t go into the natural dynamics here, but there is a Federation of State Medical Boards. As they lean, likely the others in the Federation lean. Personally, I have not heard any tales of “Great Debates” or splits within the Federation (FSMB). That’s not good.
Dr. Kernan Manion|  Psychiatry/Mental Health 

@Dr. David Ostrow

Unfortunately, neither AMA nor APA appear to be particularly concerned about the gross abuse of psychiatry by boards, PHPs and so called peer review committees. Nor aboutthe ensuing irreparable harm to physicians and to THEIR patients, not to mention to their already overworked colleagues who are saddened and burdened by their regulatory ensnarement but feel helpless to intervene.

Make no mistake, there ARE just medical boards and compassionate and ethical PHPs. Likewise can be said for the legal system where there are non-power abusing prosecutors and fair judges. But that doesn’t mean that there can’t be rot in the judicial system that results in a horrible miscarriage of justice. Sadly, the same for boards, PHPs and peer review entities. And with neither governmental oversight nor medico-legal accountability, and operating with virtually iron-clad immunity from suit, the means of confronting and correcting these administrative prosecutorial abuses is essentially non-existent.

I’m hopeful that both AMA and APA will soon come to their senses, if only due to demand by their newly aware members confronting them with these horrors. But if they don’t, when these abuses are made visible which they inevitably will be (one only recall the Catholic Church and Penn State pedophilia scandals), it’s hard to imagine physicians keeping their memberships in organizations that permit such abuse of their members.

Then again, and I dread to conceive it, it’s possible that membership “has its privileges” and the abuse so tyrannically dispensed is disproportionately weighted towards those not protected by such membership and inner circle connectedness. After all, multiple medical societies proudly exclaim their parental role in creating their states’ PHPs. It’s not inconceivable that they have amongst their membership directors of some of these PHPs as well as those having financial ties with the “preferred programs.” It is well known that one or more PHP directors are esteemed members of their national societies.

This would be troubling indeed, but could certainly account for AMA’s and APA’s apathetic response.

Meanwhile, what to do? Caveat doctor. Consider carefully where you want to practice. If medical boards, PHPs and peer review committees can irreparably harm physicians’ hard earned careers and do so with impunity and with no legal recourse for the physician, why risk practicing in such a state? Perhaps it’s only when a state cannot recruit top medical talent and is seen as a 3rd rate medical system that its governor and legislators will finally choose to act.

Dr. M S|  Internal Medicine 

Rise up-fight the Power!

Ayanya Toldstory|  Psychologist 

@Dr. M S  Cheers to that! Except for the fact that I don’t like to fight. Sigh. Hopefully fighting now will lead to reforming and replacing the present powers with sensible and fair powers, bringing about a return to sanity. But now? Yes, we MUST fight. It WILL be worth it. One of the things we must do is to dispell the idea that there are magic “others” among us who will do the fighting while the rest stand back and await the outcome. There are no magic “others.” Whether you are drafting demands in your own state or assisting someone who is doing this, you must expect that if YOU aren’t fighting, fighting isn’t happening.

Dr. Patrick Bradley|  Family Medicine 

Dr Kernan Manion is to be congratulated for founding the Centre for Physicians Rights after his own shocking treatment by the Medical Board and its Physician Health Program.

We had the same problem in Australia until a spate of young doctor suicides forced authorities to look again at this entire process including the Mandatory Reporting Laws concerning health professionals. Such secretive processes are open to abuse and are now being reviewed.

The most high profile case was that of Dr Chloe Abbott , a 29 year old doctor in training , and a former national representative swimmer. She was a tireless advocate for doctors in training and a representative on AMA and national health bodies negotiating with political leaders.

When a close friend, also a doctor in training , committed suicide Chloe became depressed. Her registration was suspended and she was committed to a psychiatric hospital for two months. After her discharge she also took her own life. Her family were appalled at the way she was treated. Her sister Micaela Abbott summed up the way Chloe had been treated , “ eaten alive by the medical profession.” Her mother Leonie Eagles said she would advise all parents not to let their children study medicine.

These Physician Health Programs seem to have more in common with totalitarian government’s “re-education” camps than the humane therapeutic programs that Dr Karl Menninger would have provided.

One has to wonder whether enforced psychiatric treatment is more harmful than no treatment at all.

When one also considers the high rate of burn out and suicide in the medical profession and that many doctors regret that they chose medicine and would not advise their own children to study medicine then something is surely wrong.

Once again thank you Dr Kernan Manion for your well needed and courageous initiative.

Dr. Kernan Manion|  Psychiatry/Mental Health 

@Dr. Patrick Bradley Deeply appreciative of your comment and sharing Dr. Abbott’s story. I and my colleagues at CPR have received a deluge of mail detailing horror stories of their own or of a colleague’s abusive treatment. We’re compiling a book of stories of physicians’ Kafkaesque experiences in this dystopian medical regulatory nexus. We also anticipate upcoming articles expanding the traditional definition of abuse of psychiatry to encompass this shadowy and thoroughly unregulated nexus. We know we have a growing base of physicians, lawyers, legislators and association leaders who are eager to confront this menace to physician wellbeing but thus far have had no means of doing so. While extraordinarily lackadaisical (if not professionally negligent), we anticipate that AMA and APA will come to their senses when physicians – some of whom are their members – publicly share their stories of abuse. Currently, neither the Federation of State Medical Boards nor the Federation of State Physician Health Programs has shown one iota of concern or need for self-examination. This is indeed regrettable.

We’d welcome your submitting Dr. Abbott’s story for the book and invite all physicians and significant others to submit their stories for consideration of inclusion. We can be reached via the website linked in the Medscape article.

Dr. Louise Andrew|  Emergency Medicine 

@Dr. Patrick Bradley Chloe Abbott’s story is truly a travesty.  Reprehensible that it took shaming of the agencies involved regarding two senseless suicides of promising young physicians to force needed change in your country’s system.

I’m sure similar tragedies have happened in the US and in Canada, and it simply has not yet come to national attention because of the stigma and probably disbelief on the part of reporters that such could happen in a country supposedly governed by rule of law, and at the hands of fellow physicians, whose entire profession is founded on relief of suffering and disease, and whose oath after all, is first, to Do No Harm.

Physicians have allowed this to happen, by ignoring the problem, by labeling sufferers as “impaired” and in need of “rehabilitation” which just happens to be available at considerable cost and extraordinary length of stay because of unholy alliances between those who provide such expensive “rehabilitation” and those who diagnose the need for such using unscientific methods and ignoring accepted medical criteria—based upon a profit motive.

Only physicians ourselves can begin to address the problem.  We can’t depend on organized medicine however, because largely the same individuals are in power in organized as in regulatory medicine.

No, it will require grass roots effort, by those who acknowledge the potential impact of Niemoller’s vignette upon physicians ourselves.  Thus, the critical need for CPR.

Dr. John DeBanto|  Gastroenterology 

I am happy to see that such an organization exists.  Too often physicians are vilified for relatively minor indiscretions.  There does not appear to be an alternative to help physicians who may want it or need it.  Rather, their admission is penalized so  many suffer in silence as they are afraid to come forward.  Furthermore, those that submit anonymous accusations are not held accountable if they are wrong.  By then, the physicians reputation and status is ruined.

Dr. Michael Langan|  Internal Medicine 

The AMA’s “not my department” response is unacceptable.  It is the same tinkering with the laws and statutes of the local state legislature that has allowed this to occur. The fundamental freedoms and rudimentary rights of health care practitioners have been removed all under the banner of “protecting the public.”  They are not protecting the public and many are being harmed. Silence, deflection and anonymity in response to a nationwide and serious problem is unacceptable. DisruptedPhysician,com/blog

Michael Rosenblatt|  Other Healthcare Provider 

Regulation is seen by some law-makers as a  way to protect the public. But it also has a dark side, one that is experienced by any doctor who has been or is a victim of sham peer review. Regulation can be “molded” by people who are in power to use successfully against their adversaries for a variety of reasons, almost none having to do with protecting the public.

One example is practice committees, which are used by hospitals to get rid of doctors who may challenge their ruling class. In almost any specialty it is easy to find certain practices that are “controversial.” These can be cherry picked to push the balance against any physician who takes on difficult cases. Before they know it, they have a Board action against them. Perhaps it was authored by a colleague who has a reduced patient volume since you got into town? Did you speak brusquely to a hospital employee or nurse? Did you accidentally snub a colleague and insult them? Do you have an open political difference or have been politically active against legalized abortion?

The National Data Bank was established to protect the public against “bad” doctors jumping from state to state. Now it has be weaponized against largely innocent physicians to prevent lawsuits by them against hospitals.

I don’t want this note to be political. But  when discussing sham peer review it is inescapable. In the US, states are largely and historically defined  for controlling healthcare and practitioners, NOT Federal Government.  Some wish to reverse that metric.

Fortunately there are other people interested in helping physicians deal with sham peer review. The Center for Peer Review Justice is another. Perhaps surprisingly, it is run by a podiatrist who has garnered over 16 years of successful battles in this arena for his mostly MD clients. Because you essentially have NO Constitutional right to practice medicine, lawyers have few options. If you dare instigate a lawsuit, you can and will expect to be Data Banked in retribution.

Sham peer review has led to the suicides of caring doctors. I caution all physicians to recognize that not every US political party believes in “control by regulation.” Whom you vote for counts.

Michael M. Rosenblatt, DPM

Ayanya Toldstory|  Psychologist 

@Michael Rosenblatt Thank you, Dr. Rosenblatt. Well stated. More than more exposé, you are helping to reveal the mechanics of this “machine.” It is in fact time for us to begin turning in this direction. It is extremely important to have urgent individual resources available to us when we find ourselves injured but we also need to neutralize the injurers.

Dr. Kernan Manion|  Psychiatry/Mental Health 

Over the five year course of our Physician Advocacy Study Group, we – about a dozen physicians of various specialties – have spoken or corresponded with literally hundreds of physicians around the country who have shared horror stories about their abuse at the hands of medical boards, physician health programs (“professional assistance” type programs) and dishonest (sham) peer review committees.

Some in the group are themselves survivors of this abuse; others are deeply impassioned ethical physicians who have consulted on and treated falsely diagnosed or falsely framed physicians.

Our inquiry began with a belief that this was a travesty of justice for just a few unfortunate physicians caught up in an unregulated system. But as we compared notes, and then commented in articles just like this one, and received emails and phone cals from other physicians and lawyers around the country, we realized this was much larger than just a few docs wrongfully apprehended in a disciplinary roundup.

As @Dr. Jesse Cavenar & @ Dr. Anne Phelan-Adams noted in their Niemoeller quote, there’s a natural tendency to avoid involvement with issues like this. For one, the administrative injustice and the accompanying psychological abuse is so mind-boggling as to be unbelievable – as in “that just can’t be.” For another, there’s fear of retaliation. And another, the comforting belief that there MUST be justice available for these docs, or that surely they MUST’VE done something wrong.

I and our study group can assure you – this abuse is real and its breadth and severity jaw-dropping. And it shows no signs of letting up. Because there is no government oversight of these regulatory entities and no legal accountability. Boards can make whatever accusations they want and legally overpower you and drive you to bankruptcy. PHPs can make up whatever diagnosis they want, order you to their “ referred” programs and essentially brand you as mentally ill for life. And there is utterly NO INTEREST by the professional societies which should protect physicians’ rights in investigating this. One must wonder why.

And physicians must begin demanding answers.

Check out the website: http://www.physicianrights.net. We’re going to be publishing a book very soon featuring physicians’ stories and practical advice. Sign up on the website to stay informed and join us in making positive change to protect physicians’ – and patients’ – rights.

Dr. Danielle Cherdak|  Neurology 

I am heartened to see this article and to know that these amazing people are doing something I have only dreamed about doing myself.

Dr. Jim Behan|  Psychiatry/Mental Health

I wish this group success. ‘What is potent for good’ (the protection of the public) ‘is powerful for evil’ by an unregulated and unchecked abuse of power which oppresses good doctors. How is that in the public interest? The ghost of Kafka still shuffles its faltering way through the rack employed by unethical abuse of power and lack of due process.

Dr Jim Behan Psychiatrist

Ayanya Toldstory|  Psychologist 

It appears that this article has come to the attention of a Facebook group called Patient Safety Action Network (PSAN) Community. It seems as if the group is made up of some sincere good people who have had difficulties with Medical and other Healthcare Regulatory Boards from the patients’ end. From what I can gather, many of them have complained to the Medical Boards in their states and have been brushed off. It seems as if they have found it next to impossible to get any real action. One contributor suggested their contributors write comments on this article. Please feel free to differ, but I think it would be wonderful for them to write in and give us an opportunity to create an alliance. Imagine their concern. They (as patients and patient advocates) have NO way to feel confident in their providers. I would like to validate this concern and validate their very legitimate fears. We (healthcare providers) believe it or not, are patient advocates too. Unfortunately, I am acutely aware that not healthcare providers are patient advocates. Not all healthcare providers are ethical. Not all healthcare providers are competent. Real protection of the public and of patients is going to come when we as a society can RELIABLY tell the difference. Healthcare Regulatory Boards (not all, but unfortunately most, I believe) have betrayed us – as have the State governments which house them. They DO NOT protect the public. Because of the way they are structured GOOD, ethical and competent, and indeed, some of the BEST providers are attacked and destroyed while truly dangerous, unethical, self-serving, “well-connected” providers are allowed to slide when complaints are made against them, and they are allowed to remain in circulation. Whether it be the Patient Safety Action Network or any other person or group concerned FIRST about patient safety, we are on your side. Please join us in finding a path to transparency, justice, and safety we can ALL have confidence in.

The Healthcare Alliance for Regulatory Board Reform (HARBR) supports the Center for Physician Rights (CPR) for the sake of patients and the GOOD providers who put them first.

Dr. Anne Phelan-Adams|  Family Medicine 

@Ayanya Toldstory Hello Ayanya.  Thank you so much for letting us know about these organizations.  The more individuals and groups are involved, the harder it is for us to be written off as a bunch of “poor me; sour grapes looneys”    You have articulated an important point that MLB are failing to protect the public and, in fact, are doing harm by eliminating these “good, ethical and competent” HCP’s. Imagine a test that gave false positives 80% of the time.  We would scrap that test!  But, when it comes to the MLB system, their diagnosis and treatment are wrong 80% of the time.  The entire system needs to be scrapped and rewritten to include due process for the individual under investigation.  Again, thanks for this.

Anne Phelan-Adams, MD

Dr. Michael Langan|  Internal Medicine 

Yes the majority of those I have heard from over the past few years ( now an average of 4 per week) do not meet the diagnostic criteria for a SUD ( or any of the other diagnoses they are being given by the out-of-state “PHP-approved” assessment and treatment centers they are being referred to by the PHPs ( and mandated under threat of summary suspension by the state MLBs). The majority of those caught in this maw of sham adjudicatory proceedings have obtained 2nd, 3rd and even 4th opinions by bona fide experts ( i.e. not simply those “in recovery” and the ASAM credentialed “experts” who staff these preferred facilities). It should also be emphasized all of this is out-of-pocket and none the assessment, testing or “treatment” is covered by insurance.

Disruptedphysician.com/blog

Dr. Ramon Baker|  Family Medicine 

@Ayanya Toldstory Thank you for your insight, Dr Toldstory. Although I have never been the subject of a lawsuit in over 40+ years of practice, the spectre always sat on my shoulder. This problem was always a distraction from what could have been a more productive way of practicing (family) medicine. There are a number of things I could have handled better, such as being too forthright in giving “bad” news to a patient (without benefit of a second opinion). The traumatic impact on him still haunts me today. We may be called upon to share another physician’s “day in court” as a material witness, and should take this on gladly, as though it were our own concern.

On the other hand, people being people, you will not always be treated fairly by patients, whose motives or misconceptions may prompt them to seek redress from any “review organization” they can find. This sort of cat-and-mouse thing takes time to resolve, and taxes a physician’s effective care for other patients. I never forgot a text recommended to us by a truly empathetic psychiatrist entitled “Patients Who Trouble You”. In one example, the patient may appear condescending by providing a litany of well-known doctors who previously treated them; in reality, the patient may be hoping you will find them worth caring for. It is useful to acquire a passing knowledge of some other bizarre patient behaviors that may interfere with the care of a particular patient, some as rare (??) as that of a schizophrenic or seductive individual. At times, my experiences with daily patient contact could range from the mundane, the intriguing, the paranoid and simply being on “thin ice” (i.e., “What is he/she actually in here for?”). We have been well-advised to document, document, document.

If something strange is noted in a patient’s behavior, it may be well to refer to it discreetly…you may literally find it useful if that same patient surfaces ten years later to challenge (litigiously) your “failure” to recommend a follow-up or a referral – when the facts deem it to be otherwise. (Yes, it is a satisfying feeling…)

It is ironic that individuals are drawn to the healing profession with a sense of altruism, yet that same profession can, unfortunately, subject those individuals to psychological stress and isolation. This is certainly a much-needed set of resources for all physicians – to heal the Healers.

Dr. Louise Andrew|  Emergency Medicine 

As mentioned in the article, my interest in this issue stems from a longstanding concern about physician suicide based on the several I’ve been aware of during my career (see e.g. http://bit.ly/MDSuicide ).  I am a 5th generation physician, and have never had any involvement with a MLB except as a legal consultant, or with a PHP.  Except that I used to strongly support the latter for physicians struggling with health issues. ( http://bit.ly/PHP_MLB ) Now that I have been studying these organizations for a number of years, I must agree with the sentiments of Dr. Shackelford, Dr. Miday and others who have recognized a seemingly systematized pattern of abuse coming from many of these institutions that can have career- or life-ending consequences for physicians.

And having been a doubter myself that this could happen in a country based on democratic principals of rule of law and fundamental fairness, I can relate to Dr. Cavenar’s reminder about Martin Niemoller’s warning as applied to this situation. (“I did not speak out…because I was not a drug user….”disruptive” physician…or aging doc…”)  Eventually you will attain a category that is being subjected to this scrutiny (in the name of public safety).

I have taught for years about the ravages of litigation stress on physicians.  There is something called a “white coat myth”, employing which doctors tell themselves that as long as they do the best they can, for as many as they can, for as long as they can, that they will be safe from harm such as malpractice lawsuits and other professional insults that feel unfair.

If you subscribe to this myth of safety based upon your fundamental uprightness, then you will be able to categorize those physicians who experience difficulties with malpractice claims or medical board challenges as “not like me”, and thus insulate yourself for a time…until one of these things DOES come for you.

WHEN that happens, it will be easy for you to recognize the unfairness.  But it might be too late.

I would encourage everyone who reads this article to explore further the underpinnings of the organization in formation http://bit.ly/CPRSite  and to help in any way that you can.

Dr. Janet Angelo|  Psychiatry/Mental Health 

It certainly seems like there have been some abuses of these processes. I’m not surprised that the AMA has no no arm to protect physicians from this kind of thing. I left that organization several years ago.

Dr. Anne Phelan-Adams|  Family Medicine 

@Dr. Janet Angelo Janet.  I left the AMA not too long after the “Sunbeam” scandal which was not the first time the AMA had, due to profit motive, improperly aligned itself with a business or industry.   I decided that, if the AMA couldn’t run with just dues and charitable organizations and without any quid pro quo conflicts, that their board members were too many making too much $.

Thanks so much for your interest and comments.

Ayanya Toldstory|  Psychologist 

@Dr. Anne Phelan-Adams @Dr. Janet Angelo  I am glad to hear these comments about the AMA. I am sad to know that the AMA is also problematic, but I was afraid Psychology was alone in dealing with it’s problematic, self-asserted, de facto, leading professional association, the oligarchic American Psychological Association.

Janice Ellery|  Psychologist 

@Ayanya Toldstory @Dr. Anne Phelan-Adams @Dr. Janet AngeloAlthough I am still an APA member, I was recently disappointed  to learn that the organization basically “leases” it’s endorsement to insurance companies, credit cards, etc for a profit. It seems like many of our professional associations are now acting more like for profit, publicly traded corporations.

Dr. Jesse Cavenar|  Psychiatry/Mental Health 

@ Dr. Anne Phelan-Adams  I have now practiced medicine for 55 years as a Navy flight surgeon, general surgeon, psychiatrist and psychoanalyst. I have served as an expert witness in many state, federal, and military trials and never have I seen anything as outrageous and egregious as certain PHPs and medical boards. I believe there is a complete lack of integrity and veracity in some members of certain PHPs and medical boards. Further, it is my opinion that if the courts had not found that these same PHPs and medical boards have sovereign immunity, the PHPs and medical boards would have massive major litigation brought again them and would have a major problem in trying to defend their actions.

Until organized medical groups complain loudly, nothing is likely to change. The passivity and self-interest of some physicians is overwhelming to me.  I am reminded of:

“First they came for the socialists, and I did not speak out—because I was not a socialist. Then they came for the trade unionists, and I did not speak out— because I was not a trade unionist. Then they came for the Jews, and I did not speak out—because I was not a Jew. Then they came for me—and there was no one left to speak for me.”

There are a number of physicians who read of these issues concerning PHPs and medical boards and think to themselves, “Thank goodness I haven’t been caught up in this” and refuse to get involved. To paraphrase the quote above, …”there is no one left to speak for” the vast majority of physicians.  It is a deplorable state when one allows personal passivity to permit the situation to get to its present state, in my opinion.

As I have been asked recently if I have been in personal difficulty with the PHP or medical board, let me state for the record that I have not. I do not use alcohol, and do not take meds except for diagnosed medical issues. In the interest of full disclosure, let me note that I have been counseled twice for singing too loudly in church. I am trying to do better.

Jesse O. Cavenar, Jr., M.D.

Dr. Anne Phelan-Adams|  Family Medicine 

@Dr. Jesse Cavenar

Yes,  Niemoeller’s quote is every bit as salient today as it was back then.  One thing that distressed me in reading comments from my piece, “…..Dominos” was the number of people who stated something to the effect that  “This would never happen to me; i’m too professional…” or too perfect or whatever other rationalization they might give.      These are the folks I most worry about as human beings, not those of us who know we are flawed and have our limitations and our breaking points, but those of us who think otherwise.

Speaking truth to power is difficult and dangerous; were it not, it wouldn’t require courage.

On a personal note, Jesse, I have a great deal of respect for you and what you are doing.  My father was a Navy man and the most honorable and honest person I’ve ever met, and one of the most intelligent.  I owe him a great deal.  You and he would have gotten  along very well.

Anne Phelan

Dr. Susan Haney|  Emergency Medicine 

@Dr. Jesse Cavenar Careful not to see a PHP-preferred evaluator, who may diagnose “misphonia” for your “singing disorder”, then order 90 days of residential treatment at a PHP-preferred facility!   😉

Dr. karen miday|  Psychiatry/Mental Health 

I only wish that CPR was up and running before my physician son died by suicide in 2012. His final calls were to his state PHP. Instead of urging him to follow through with the treatment plan he and his psychiatrist had decided upon that day, which involved seeking a recovery program of his own choosing, they recommended that he report to them first. He was found dead the following morning. I have no doubt that his fear of loss of licensure was what drove him over the edge. He had already suffered the humiliation of a mandated 90 day stay at a residential treatment program, where he was diagnosed as “alcohol dependent” when he clearly was not. It is clear that PHP’s tailor the diagnosis to the treatment, rather than the other way around. My hope is that Dr. Manion’s much needed advocacy group will save physician lives. Although too late for my son, it is not too late for others.

Dr. Helen Muhlbauer|  Psychiatry/Mental Health 

@Dr. karen miday, your tragedy is beyond measure. Thank you for sharing your situation. I am so sorry for your loss.

Dr. Susan Haney|  Emergency Medicine 

@Dr. karen miday I am so saddened that your son was essentially killed by this type of unethical (and immoral) practice of medicine by his state’s PHP.  I applaud Dr. Manion’s physician advocacy work, and I share his hope that CPR will save lives (his choice of moniker for this new organization is both memorable and clearly appropriate).

I think that we should ALL work to make this system of exploitation and endangerment explicitly illegal, and clearly written into law, state by state (as you probably know, each state has its own laws regulating the both the practice of medicine and the operation of PHP’s within its boundaries).  Perhaps if we can threaten to hold those who enrich themselves through what amounts to gross medical malpractice by PHP extortion schemes, we can help our doctors to safely access appropriate medical care when they (like everybody else) get sick.

People who practice medicine, including both physicians and non-physicians practicing under the statutory immunity umbrella of PHP’s, should be held criminally and civilly responsible for their misdeeds.  Physicians deserve ethical medical care for ourselves when we become patients.  Unethical medical care can kill us too.

Dr. karen shackelford|  Emergency Medicine 

Among many other good reasons for formation of this advocacy group is to provide education – to physicians and to the greater community. Incoming medical students should be aware that they are committing to a path that essentially strips them of rights many Americans take for granted – including the right to autonomy when making healthcare decisions and the right to privacy with respect to personal health information. It is undoubtedly necessary to have a mechanism to protect the public from impaired doctors, but over the years, medical boards and physician health programs have expanded their “mission” with what appears to be an underlying financial and professional agenda that now makes it necessary to create mechanisms to protect doctors. A pattern of widespread abuse has resulted from lack of accountability for procedures and practices that are mandated by self-appointed experts, who have institutionalized their expertise by creating the addiction medicine specialty, and who use the threat of loss of career, reputation, and professional identity to ensure compliance with a system in which they are the primary beneficiaries. The Center for Physician Rights will counter the silence once engendered by shame and an automatic presumption of guilt derived from the moral authority vested in institutions such as medical boards.

Dr. Mary Johnson|  Pediatrics, General 

I cannot tell you how heartened I am to hear about this.  Twenty years ago I was driven out of my hometown (and a Pediatric Practice I started from scratch) for defying the threats of hospital executives to answer a terrified nurse’s call in the middle of the night, saving a baby’s life and reporting it to hospital Peer Review.  I was fired two weeks later – without ANY review of what happened or due process conducted.  I was in public service – a National Health Service Corps provider!?!  The Federal government dived under a desk when I begged for help.  All of what happened was reported to the NC Medical Board (and JCAHO) and they DID NOTHING with regards to the despicable/unprofessional behavior of the doctor I reported – and certainly nothing to assist me legally.  You see the doctors on the Peer Review Committee are protected from legal scrutiny – but those who report ARE NOT.  Whistleblower protection is a MYTH.  I litigated to settlement (in my favor) – but (because I had a local lawyer out-of-his-depth) was swindled of fair restitution there – because hospital executives lied about the confidentiality of their “non-profit” books (and what was in them) during discovery.  I reported that – and spent YEARS trying to get my case to the FBI/SBI – but hit a stone wall with the local DA’s office – who would not make a simple referral (protecting all of the bigwigs who sat on the hospital board and donated to his campaign).  I was a woman who had the courage to stand up/report malfeasance when it happened and was brutalized for it.  OBTW, the hospital involved is now floundering, desperately searching for a bail-out – courtesy of the overpaid/overrated executives who destroyed my hometown dream.

Fast forward twenty years to 2017 and almost the same thing happened again – this time I was a university employee sold across a state line as a slave – courtesy of a merged system that is supposedly overseen by two states (who were told what was going on before the approved the merger) . . . and that after over a year living and working under constant threats against my career and livelihood by hospital executives who made their bonuses/cooked their books by not paying me fairly for my overtime and teaching.  It was brazen age/sex discrimination AND retaliation (for reporting bad behavior/bad care) – yet state and Federal oversight is NON-EXISTENT to the point of collusion (the Russians have NOTHING on these people).  You’re supposed to hire the $500/hour lawyer to fight a case when you have to concentrate on surviving/moving on.

It’s CRIMINAL what these hospitals and regulatory bodies are doing to good doctors just trying to do right by patients.  Employed/contracted physicians, in particular, have ZERO basic rights.  And the Medical Boards have DONE ZIP to advocate for their licenses.

Dr. JOHN FRASER|  Pediatrics, General 

@Dr. Mary Johnson Unfortunately, medical boards will never advocate for their licensees.  Their stated mission is to protect the “public” from said licensees.

Dr. Kernan Manion|  Psychiatry/Mental Health 

@Dr. JOHN FRASER @Dr. Mary Johnson And sadly, up until now, there’s been no organization to protect the public, i.e. physicians and their patients, from predatory, non-overseen and yet completely immune-from-suit medical boards and PHPs. In fact, two senior physicians in the Physicians Advocacy Study Group received written confirmation from both the NC Governor and the NC Attorney General specifying that they had no authority to oversee, investigate or hold accountable these entities even though they have explicitly broken the law.

It seems that it’s never occurred to anyone to ask “who’s minding the minders?”

In NC, we now know. NO ONE. An anonymous allegation, even emanating from within the medical board itself, can wreck your career. And there’s not a damned thing you can do about it.

Before you seek licensure in a state, you might want to check to see who oversees its medical board and PHP. If no one, consider that your career could be at risk of annihilation if you practice there. Best that you look elsewhere.

Ayanya Toldstory|  Psychologist 

@Dr. JOHN FRASER @Dr. Mary Johnson  Actually, if that is how it really was, it would be an acceptable and good thing. Unfortunately, the healthcare licensing boards fail to protect the public. The fact that they, instead, lead the public to believe they ARE protected, ENDANGERS the public. At the same time, the boards are not simply “not advocating” (not advocating is fine), but they are persecuting licensees. Even licensees who are actually involved in wrong-doing don’t deserve persecution. ALL of us – patients, the public, and providers deserve fair, due process, justice. That is all we’re asking for.

Dr. Enver Deliu|  Family Medicine 

College of physicians and surgeons in Canada just like your board is aprosecutor, investigator, judge and after you finish nerve breaking launched disciplinary process denies your elementary right of appeal their some times monstruous decision, does that sound familiar? Yes of course its typical for autoritative dictatorship which is rarely seen today and only in some bana countries and college of physicians unfortunatelly in the most developed countries, what a match…then we have this CMPA (whatever is called in USA) who collect significant amount of money from us yet, engage second hand lawyers to “defend” us from these vultures at the college of course with poor or no positive results at all. This raketeering organisation exists because of this crazy system that shows no respect whatsoever to their “colleauges”,treat us like criminals, forces us to prove that the claim is or might be false or has no merit (guilty until proven otherwise). Personally I remember asking these “high profile”lawyers to take the medical act to court as in addition to other crazy/ irrational things set in it the same it denies our elementary rights ( rights waranted by constitution) the one that even the most notorious criminals have and that is the right of appeal, they say that is not their job, of course its not because if these crazy medical acts were not the way they are these second class lawyers would have no job to do. Its unbeleivable how tolerant or better said big cowards we physicians can be. Obviously we dont care much, for as long as its not about me, not thinking that soon these wich hunters will come after you and get you just like many other colleagues………..

Dr. Jesse Cavenar|  Psychiatry/Mental Health 

For some thirty years while practicing at Duke University, as I was both a psychoanalyst and psychiatrist, I was the “doctor’s doctor”. I saw physician patients who had been diagnosed and treated at the NCPHP; I was alarmed at some of the diagnoses that these patients had been given, as I believed those diagnoses to be markedly in error. Several colleagues agreed with my concern and we attempted to approach NCPHP personnel about our concerns. After being rebuffed, we went to the Governor, spoke with his Chief of Staff, and the NC State Auditor did a yearlong performance audit of the NCPHP. That audit is public information and can be found on the internet.

I attempted to assist one young physician who was diagnosed as having alcohol abuse. However, this man had never been given a Breathalyzer or had a blood alcohol done. He met none of the required diagnostic criteria for alcohol abuse, and even the NCPHP psychiatric consultant stated to me in writing that the man did not meet the required diagnostic criteria. NCPHP personnel refused to discuss this with me even after the young physician gave me a power of attorney to represent him.  This man was detained in the NCPHP for thirteen months at a cost in time and money of $100,000.

I attempted to discuss this with the NCMB and met with a stone wall.  A NCMB investigator refused to take documentation from me that clearly demonstrated that the diagnosis of this man was in error, and the NCMB refused to respond in a meaningful manner to various questions I directed to them.

Most alarming, however, is the fact that the attorney who represented this man has told me in writing that the NCPHP personnel acknowledged that this man “was not an alcoholic” but that treatment wouldn’t hurt him and the NCPHP was treating him prophylactically so that he wouldn’t develop a problem in the future.  This will leave most physicians shaking their head in disbelief.  It would be analogous to a physician stating that he put a patient in intensive care for a lengthy period even though the patient had no symptoms, did not meet the diagnostic criteria for any illness, but was put into intensive care so that he didn’t develop some illness.  This strikes me and my colleagues as sheer nonsense.

I regret to report that this is not an isolated case.  Far from it.

Jesse O. Cavenar, Jr., M.D.

Professor and Vice Chairman Emeritus

Department of Psychiatry

Duke University

Associate Chief of Staff (Ret)

Veterans Administration Medical Center

Durham, NC

Colonel, Medical Corps, U.S. Army (Ret)

Dr. Anne Phelan-Adams|  Family Medicine 

@Dr. Jesse Cavenar When you describe physicians as “shaking their heads in disbelief”, I have to wonder if that’s part of the strategy, “Do something so outrageous that it can’t be believed and thus isn’t taken seriously and we’ll avoid detection.”  Maybe I’m giving PHP’s and their associated MLBs too much credit for planning such a strategy, but, having seen such strategy in other areas, such as politics and governance, I can’t help but wonder.    Thanks for your very articulate and salient comment.

Dr. Anthony De Luca|  Pediatrics, General 

Unfortunately, State Medical Licensing Boards can be kangaroo courts.  You have all the risks and none of the rights of a defendant in a court of law.  And there is no judge to monitor the prosecution.

Dr. Aldyth Buckland|  Family Medicine 

This sounds like an important support group for doctors. Well done!

Doctor Loses Medical License For Legally Treating Her Menstrual Cramps With Cannabis

Screen Shot 2018-09-08 at 11.55.01 AMWashington’s physician health program prohibits doctors from legal cannabis use. When Dr. Yolanda Ng was offered a job as a pediatric nephrologist at Providence Sacred Heart Children’s Hospital in Spokane, Washington, she was forced to take a drug test. It turns out using a cannabis tincture to treat the pain from her menstrual cramps would effectively end her medical career.
— Read on herb.co/marijuana/news/doctor-yolanda-ng-lost-medical-license-for-cannabis-use/