Physician Suicide and Organizational Justice: The Role of Hopelessness, Helplessness and Defeat

Physician Suicide and Organizational Justice: The Role of Hopelessness, Helplessness and Defeat

Michael Langan, M.D.

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They can be a terror to your mind and show you how to hold your tongue
They got mystery written all over their forehead
They kill babies in the crib and say only the good die young
They don’t believe in mercy
Judgement on them is something that you’ll never see
They can exalt you up or bring you down main route
Turn you into anything that they want you to be–Bob Dylan, Foot of Pride

In  F. Scott Fitzgerald’s  The Great Gatsby, Nick Carraway observes that “the loneliest moment in someone’s life is when they are watching their whole world fall apart, and all they can do is stare blankly”      In 1896 Émile Durkheim described “melancholy suicide” as being “connected with a general state of extreme depression and exaggerated sadness, causing the patient no longer to realize sanely the bonds which connect him with people and things about him. Pleasures no longer attract.”     Heightened perceptions of defeat and entrapment are known to be powerful predictors of suicide. According to the “Cry of Pain” model people are particularly prone to suicide when life  experiences are interpreted as signaling defeat, defined as a sense of a “failed struggle.” Unable to find some sort of resolution to a defeating situation, a sense of entrapment proliferates and the perception of no way out provides the central impetus for ending one’s life.

Although no reliable statistics yet exist, anecdotal reports suggest a marked rise in physician suicide in recent years. From the reports I am receiving it is a lot more than the oft cited “medical school class” of 400 per year.

This necessitates an evaluation of predisposing risk factors such as substance abuse and depression, but also requires a critical examination of what external forces may be involved.  What acute and cumulative situational and psychosocial factors are involved in the descent from suicidal ideation to planning to completion?   What makes suicide a potential option for doctors and what acute events precipitate and trigger the final act?

Depression and Substance Abuse no Different from General Population

The prevalence of depression in physicians is close to that of the general population1,2 and, if one looks critically at the evidence based literature, substance abuse in medical professionals approximates that of the general population.  Controlled studies using DSM diagnostic criteria indicate that physicians have the same rates (8-14%) of substance abuse and dependence as the general population,3 and slightly lower rates compared to other occupations.4,5  Epidemiological surveys reveal the same. Hughes, et al.6 reported a lifetime prevalence of drug or alcohol abuse or dependence in physicians of 7.9%, markedly less than the 14.6% prevalence reported in the general population by Kessler.7

Job Stress and Untreated Mental Illness Risk Factors

Job stress coupled with inadequate treatment for mental illness may be factors contributing to physician suicide according to one recent study. Using data from the National Violent Death Reporting System, Gold, Sen, & Schwenk, 2013 8 compared 203 physicians who had committed suicide to more than 31,000 non-physicians and found that having a known mental health disorder or a job problem that contributed to the suicide significantly predicted being a physician.

Physicians were 3.12 times more likely to have a job problem as a contributing factor. In addition, toxicology testing showed low rates of medication treatment.  The authors concluded that inadequate treatment and increased problems related to job stress are potentially modifiable risk factors to reduce suicidal death among physicians. They also warned that the database used likely underestimated physician suicides because of “underreporting and even deliberate miscoding because of the stigma attached.”8

Few studies have evaluated the psychosocial stressors surrounding physician suicide but there is no reason to believe they are any different from the rest of the population. Although the triggering life events and specific stressors may vary outside, the inner psyche and undercurrent of thoughts and feelings should remains the same.   Perhaps the same drivers of suicide identified in other populations are contributing to physician suicide.

Perceived Helplessness, Hopelessness, Bullying and Defeat

Perceived helplessness is significantly associated with suicide as is9Hopelessness10,11  Bullying is known to be a predominant trigger for adolescent suicide12-14   One study found that adolescents in custody who were bullied were 9.22 times more likely to attempt suicide than those were not bullied.15

Heightened perceptions of defeat and entrapment are known to be powerful contributors to suicide.16,17

The “Cry of Pain” model 18,19 specifies that people are particularly prone to suicide when life experiences are interpreted as signaling defeat which is defined as a sense of “failed struggle” or loss of social position and resources.. The person is unable to identify an escape from or resolution to a defeating situation, a sense of entrapment proliferates with the perception of no way out, and this provides the central impetus for ending ones life. There is a helplessness and hopelessness that precipitates the descent from ideation, to planning, and then to finality.

Organizational Justice Important Protective Factor

In a study on Italian and Swedish female physicians, degrading experiences and harassment at work were found to be the most powerful independent variables contributing to suicidal thoughts.20Degrading work experiences harassment, and lack of control over working conditions were found to be associated with suicidal thoughts among Italian and Swedish male university physicians.21

Evidence exists for the role of rescue factors (i.e. social support) as buffers against suicide in the face of varying degrees of life stress.22,23 The study of female physicians revealed meetings to discuss stressful work experiences as a potential protective factor, 20 and support at work when difficulties arose appeared to be a protective factor for the male physicians.21   In line with this, studies of Finnish physicians found that control over one’s work and organizational justice were the most important determinants of work-related wellbeing.24,25 Organizational justice has been identified as a psychosocial predictor of health and wellbeing. 26 27  Low organizational justice has been identified as a notable risk factor for psychological distress and depression.28,29

Historical Precedent-the Suicides at Ridgeview

Could these factors be playing a role in physician suicide?  They evidently did at the Ridgeview Institute, a drug and alcohol treatment program for impaired physicians in Metropolitan Atlanta created by G. Douglas Talbott.

Talbott helped organize and served as past president of the American Society of Addiction Medicine (ASAM) and was a formative figure in the American Medical Association’s (AMA’s) Impaired Physician Program. He has owned and directed a number of treatment facilities for impaired professionals, most recently the Talbott Recovery Campus in Atlanta, one of the preferred referrals for physicians ordered into evaluation and treatment by licensing boards.

After creating the DeKalb County Impaired Physicians Committee for the Medical Association of Georgia, Talbott founded the Georgia Disabled Doctors Program in 1975 in part because “traditional one-month treatment programs are inadequate for disabled doctors.” According to Talbott, rehabilitation programs that evaluate and treat the rest of the population for substance abuse issues are incapable of doing so in doctors as they are unlike others. He bases this uniqueness on “incredibly high denial”, and what he calls the “four MDs,” “M-Deity”, “Massive Denial” “Militant Defensiveness”, and “More Drugs.”30

Contingency Management = Extortion Using Medical License

According to Talbott, “impaired doctors must first acknowledge their addiction and overcome their ‘terminal uniqueness’ before they can deal with a drug or alcohol problem.” “Terminal uniqueness “ is a phrase Talbott uses to describe doctors’ tendency to think they can heal themselves. “M-Deity” refers to doctors “being trained to think they’re God,”31 an unfounded generalization considering the vast diversity of individuals that make up our profession. This attitude, according to some critics, stems from the personal histories of the treatment staff, including Talbott, who are recovering alcoholics and addicts themselves. One such critic was Assistant Surgeon General under C. Everett Koop John C. Duffy who said that Ridgeview suffered from a “boot-camp mentality” toward physicians under their care and “assume every physician suffering from substance abuse is the same lying, stealing, cheating, manipulating individual they were when they had the illness. Certainly some physicians are manipulative, but it’s naïve to label all physicians with these problems.”32

American Society of Addiction Medicine (ASAM) President (1981-1983) LeClair Bissell was also highly critical of Talbott’s approach. Bissell, co-author of the first textbook of ethics for addiction professionals 33 when asked if there was any justification to the claim that doctors are sicker than other people and more vulnerable to addiction replied:

“Well, based on my treatment experience, I think they are less sick and much easier to treat than many other groups. I think one reason for that is that in order to become a physician…one has to have jumped over a great many hurdles. One must pass the exams, survive the screening tests and the interviews, be able to organize oneself well enough to do examinations and so on, and be observed by a good many colleagues along the way. Therefore I think the more grossly psychotic, or sicker, are frequently screened out along the way. The ones we get in treatment are usually people who are less brain-damaged, are still quite capable of learning, are reasonably bright. Not only that, but they are quite well motivated in most cases to hang on to their licenses, the threat of the loss of which is frequently what puts them in treatment in the first place. So are they hard to treat? No! Are they easy patients? Yes! Are they more likely to be addicted than other groups? We don’t know.”34

I’m not much for the bullying that goes along with some of these programs,” Bissell commented to theAtlanta Journal and Constitution in 1987.31

The Constitution did a series of reports after five inpatients committed suicide during a four-year period at Ridgeview.35  In addition there were at least 20 more who had killed themselves over the preceding 12 years after leaving the treatment center.32

Bissell, the recipient of the 1997 Elizabeth Blackwell Award for outstanding contributions to the cause of women and medicine remarked: “When you’ve got them by the license, that’s pretty strong leverage. You shouldn’t have to pound on them so much. You could be asking for trouble.” 31

According to Bissell: “There’s a lot of debate in the field over whether treatment imposed by threats is worthwhile…To a large degree a person has to seek the treatment on his own accord before it will work for him.”31

A jury awarded $1.3 million to the widow of one of the deceased physicians against Ridgeview,36 and other lawsuits initiated on behalf of suicides were settled out of court.35

The Constitution reported that doctors entered the program under threats of loss of licensure “even when they would prefer treatment that is cheaper and closer to home.” 37

The paper also noted that Ridgeview “enjoys unparalleled connections with many local and state medical societies that work with troubled doctors,” “licensing boards often seek recommendations from such groups in devising an approved treatment plan,” and those in charge are often “physicians who themselves have successfully completed Ridgeview’s program.”37

The cost of a 28-day program for nonprofessionals at Ridgeview in 1987 was $10,000 while the cost was “higher for those going through impaired-health professionals program,” which lasted months rather than 28 days.32

In 1997 William L. White interviewed Bissell whom he called “one of the pioneers in the treatment of impaired professionals.” The interview was not published until after hear death in 2008 per her request.   Noting her book Alcoholism in the Professions 38 “remains one of the classics in the field”, White asked her when those in the field began to see physicians and other professionals as a special treatment population. She replied:

“When they started making money in alcoholism. As soon as insurance started covering treatment, suddenly you heard that residential treatment was necessary for almost everybody. And since alcoholic docs had tons of money compared to the rest of the public, they not only needed residential treatment, they needed residential treatment in a special treatment facility for many months as opposed to the shorter periods of time that other people needed.”39


Talbott claimed a “92.3 percent recovery rate, according to information compiled from a five-year follow-up survey based on complete abstinence and other treatment.”40

“There is nothing special about a doctor’s alcoholism,” said Bissel

“”These special facilities will tell you that they come up with really wonderful recovery rates. They do. And the reason they do is that any time you can grab a professional person by the license and compel him or her into treatment and force them to cooperate with that treatment and then monitor them for years, you’ll get good outcomes—in the high 80s or low 90s in recovery rates—no matter what else you do.”39

“The ones I think are really the best ones were not specialized. There were other well-known specialty clinics that claimed all the docs they treated got well, which is sheer rot. They harmed a great many people, keeping them for long, unnecessary treatments and seeing to it that they hit their financial bottom for sure: kids being yanked out of college, being forced to sell homes to pay for treatment, and otherwise being blackmailed on the grounds that your husband has a fatal disease. It’s ugly.”39

Stanton Peele’s “In the Belly of the American Society of Addiction Medicine Beast” describes the coercion, bullying, threats and indoctrination that are standard operating procedure in Talbott’s facilities.41 Uncooperative patients, “and this covers a range of sins of commission or omission including offering one’s opinion about one’s treatment,” are “threatened with expulsion and with not being certified-or advocated for with their Boards.”41 The cornerstone of treatment is 12-step spiritual recovery. All new patients are indoctrinated into A.A. and coerced to confess they are addicts or alcoholics. Failure to participate in A.A. and 12-step spirituality means expulsion from the program with the anticipated result being loss of one’s medical license.

Fraud, Malpractice, False Diagnoses and False imprisonment

In May 1999 Talbott stepped down as president of the American Society of Addiction Medicine (ASAM) as a jury awarded Dr. Leonard Masters a judgment of $1.3 million in actual damages and an undisclosed sum in punitive damages for fraud, malpractice, and the novel claim of false imprisonment.42  The fraud finding required a finding that errors in the diagnosis were intentional. After being accused of excessive prescribing of narcotics to his chronic pain patients, Masters was told by the director of the Florida PHP that he could either surrender his medical license until the allegations were disproved or submit to a four-day evaluation. Masters agreed to the latter, thinking he would have an objective and fair evaluation, but was instead diagnosed as “alcohol dependent” and coerced into the Talbott recovery program. He was forced to stay in the program under threat of his medical license as staff would routinely threaten to report any doctor who questioned any aspect of their diagnosis or treatment to their state medical boards “as being an impaired physician, leaving necessary treatment against medical advice”42  which would mean the loss of his licensure.

However, Masters was not an alcoholic. According to his attorney, Eric. S. Block,  “No one ever accused him of having a problem with alcohol. Not his friends, not his wife, not his seven children, not his fellow doctors, not his employees, not his employers, No one.” 43   He was released 4 months later and forced to sign a five-year “continuing care” contract with the PHP, also under continued threat of his medical license. Talbott faced no professional repercussions and no changes in the treatment protocols were made. Talbott continued to present himself and ASAM as the most qualified advocate for the assessment and treatment of medical professionals for substance abuse and addiction up until his death last year.44

Same System Imposed on Doctors Today—Institutional Injustice Worse due to Laboratory Developed Tests. Fortified Scaffold and Tightened the Noose.

In almost all states today any physician referred for an assessment for substance abuse will be mandated to do so in a facility just like Ridgeview. There is no choice. There is one difference however.   When the Ridgeview suicides occurred the plethora of laboratory developed tests were not yet introduced.

A decade ago Dr. Gregory Skipper introduced the first laboratory developed test for forensic testing and used it on doctors in physician health programs.   These non-FDA approved tests of unknown validity presented a new unpredictable variable into the mix with a positive test necessitating another assessment at an out of state treatment facility—a “PHP-approved” assessment facility. The addition of this laboratory Russian Roulette renders the current system much worse than it was at the time of the Ridgeview suicides.

And if a positive test occurs there are no safeguards protecting the donor. LDTs are unregulated by the FDA. There is no oversight and no one to file a complaint with.

In addition state PHPs have no oversight or regulation.  They police themselves. Medical boards, departments of public health and medical societies provide no oversight. Accountability is absent.

Moreover they have apparently convinced law enforcement that when it comes to doctors it is a “parochial issue” best handled by the medical community. I have been hearing from doctors all over the country who have tried to report crimes to the local police, the state Attorney General and other law enforcement agencies only to be turned back over to the very perpetrators of the crimes. “He’s a sick doctor, we’ll take care of him.”

The “swift and certain consequences” imposed on those monitored in these programs is an effective means of silencing most.   The media has generally bought into the  exaggerated danger of the “impaired” and “disruptive” physician constructs created by these groups.  The media has in fact, intentionally or otherwise,  been complicit in spreading  the propaganda and misinformation put out by these groups to create moral panics associated with these false constructs and the bogus dangers they pose.   Reporting corruption and fraud to local newspapers and investigative reporters is largely futile.   This is not because these reports lack veracity or supporting evidence but because the reports are being made by doctors who have been accused of substance use or behavioral problems.  The mere label “impaired” or “disruptive” seems sufficient to disregard the claims of the accused.

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Urgent Need to Admit to the Problem

There has been an increase in physician suicide in the past decade.   By my estimate the numbers are going to be far higher than the oft-cited 400 per year. The speculation as to cause has been unenlightening and in fact frustrating.   Knowledge of anatomy, access to dangerous drugs, increased workload and even student loans have been proposed as contributing factors. Although there has been some tangential mention of physician health programs it has been indirect.

Direct and defined discussion is necessary and state PHPs need to be named as a possible contributor to suicide.  Admitting the possibility there is a problem is the first crucial step in defining and addressing the problem.    The 1980s historical precedent is correlated with physician suicide.  The current system is not only based on Ridgeview but has been fortified in scope and power.  The physician health movement has effectively removed due process from doctors while removing answerability and accountability from themselves.

And they have not only fortified the scaffold but widened it from substance abusing doctors to all doctors. “Potential impairment” and “relapse without use” were introduced without any meaningful resistance and they are now using a panoply of non-FDA approved laboratory developed tests of unknown validity to test for substances of abuse in a zero-tolerance abstinence based monitoring program.

With no regulatory oversight the stage is set not only for error but misuse as witch-pricking devices for punishment and control.  Doctors across the country are complaining of the very same abuses Leonard Masters did–false diagnoses, misdiagnosis, unneeded treatment and fraud.

In summary, any doctor who is referred to their state PHP today is required to have any assessment and treatment at a “PHP-approved” facility based on Ridgeview.  It is mandated.  There is no choice.  Coercion, control and abuse at Ridgeview was associated with multiple suicides in doctors in the 1980s.  

The use of non-FDA approved tests of unknown validity worsens the abuse and fits the “cry of pain” model of hopelessness, helplessness and despair.  Locus of control is  lost and organizational justice is absent.   The factors associated with suicide are loud and clear.  

Why is it so difficult to provoke further discussion and inspire critical thinking on this topic?   Examining, questioning and researching strategies for recognizing  (and undoing ) oppressive institutional structures should be recognized and supported by everyone.   Cognitive dissonance, apathy, ignorance (willful or otherwise), indifference and neutrality to issues concerning oppression and abuse only serves to reinforce oppression and abuse.   To be confronted or resolved these issues must be recognized and addressed and this is not going to happen until everyone is involved in it’s interrogation.

 How many more must die before this happens?

Why is the relationship between these programs and physician suicide still an elephant in the room?

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Dental, Medical boards wield enormous leverage over licensees, but Supreme Court ruling could temper that

Posted on Louisiana Voice

February 23, 2019 by tomaswell

Trying to decipher which was the first to employ Gestapo-like extortion as a means of controlling licensees is like solving the chicken-or-the-egg riddle, but there’s no question that the methods employed by the Louisiana Board of Dentistry and the Louisiana State Medical Licensing Board are eerily similar.

Both employ highly questionable investigative methods, both impose stiff fines followed by even more outrageous fines if the licensee displays any will to resist what may even be bogus charges, and both make generous use of the most effective punishment: revocation of licenses—taking away the victim’s very means of earning a livelihood.

And both also occasionally force recalcitrant dentists and physicians to attend costly rehab clinics either in addition to or in lieu of license revocations. And those rehab clinics can cost as much as $30,000 a month.

Sometimes, a professional is sent to a facility that has its own abuse problems. Take the case of Slidell dentist KENNETH STARLING, who, in addition to having to pay an $8,000 fine, was sent by the dental board to a place called Palmetto Addition Recovery Center in Rayville in Richland Parish in 2010.

But PALMETTO, it turned out, was involved a 2009 lawsuit after one of its staff members, Dr. Douglas Wayne Cook, became sexually involved with one of the center’s patients.

And even while at Palmetto, the dental board continued targeting him. Could that be because he practiced in the same town as influential board member Dr. Edward Donaldson?

And while the practices of the dental board have been publicized often by LouisianaVoice, the state medical board essentially plays by the same rules. And, just as with the dental board, the name of Palmetto Addiction Recovery Centers surfaces on a regular basis in report after report, along with Pine Grove Recovery Centers in Hattiesburg, Mississippi, and Physicians’ Health Foundation of Louisiana.

I have chosen to delete the names and locations of the following examples, but the cases serve as examples of an uneven playing field, often dependent upon on the physician in question:

Following his arrest on charges of distribution and possession of controlled and dangerous substances in 2005, Dr. __submitted to substance abuse evaluation at Palmetto. “Apparently, the physician had submitted to chemical dependency treatment on two prior occasions. Upon his discharge from Palmetto, he underwent residential treatment at Pine Grove. His license was reinstated in 2009 but in 2013, the board received information indicating that the physician “had returned to the use of controlled or other mood-altering substances.” In 2018, after being placed on indefinite probation in 2014, his license was “reinstated without restriction.”

___________entered a plea of guilty to one count of Medicaid fraud in 2002 and subsequently underwent in-patient chemical dependency evaluation for cocaine abuse. Following completion of his criminal penalty, he was referred to Physician Health Foundation’s Physician Health Program (PHP). Following his reinstatement in 2008, he was disciplined again in 2018, this time placed on probation for unspecified violations.

___________ was diagnosed in 1999 with cocaine and alcohol addiction and in 2000 was referred to Talbott Recovery Campus in Atlanta, Georgia through Physicians’ Health Foundation and later to Fontainebleau Treatment Center in Mandeville. His license was reinstated in 2006 but in 2007, he again came under scrutiny for drug abuse and was again referred to a PHP monitoring program and he was placed on probation by the board for a 10-year period in 2008. He was reinstated “without restriction” in 2018.

____ entered a plea of guilty to one count of health care fraud in 2009. In addition to criminal penalties, the board suspended his license for 90 days, placed him on probation for five years, and fined him $3,000. Following his reinstatement in December 2009, it was subsequently learned in 2011 that he had been issuing prescriptions of narcotics, including OxyContin, from his home and vehicle since May 2009 under the auspices of a practice site not approved by the board. The board again suspended his license, this time for six months and he was placed on probation for 10 years.

_____ voluntarily entered into a two-week program at DePaul Hospital in New Orleans for cocaine dependency in 1995 and 1996 before transferring to Talbott Marsh in Atlanta. The board in 1998 ordered him into additional treatment in PHP at Palmetto and placed him on probation for five years. In 2003, he was again placed on five-year probation for failure to comply with requirements set forth in the 1998 order. His license was reinstated “without restriction” in 2018.

But when a Lafayette NEUROSURGEON becomes involved in suspected arson and subsequently enters a plea of guilty to one count of felony obstruction of justice, the Louisiana State Board of Medical Examiners is strangely silent.

Dr. Nancy Rogers was arrested in 2012 in connection with the fire at Levy-East Bed & Breakfast in Natchitoches, a blaze that caused $500,000 in damage to the unoccupied building. No motive has been given for the fire, but investigators determined it to have been intentionally set.

But in the case of Dr. ARNOLD FELDMAN of Baton Rouge, the board came down especially hard.

In a terse December 20, 2018, LETTER TO FELDMAN, board Executive Director Vincent Culotta, Jr., wrote, “Per the decision and order of the Louisiana State Board of Medical Examiners dated April 13, 2015, the amount due is as follows:

Cost of proceeding—$456,980.60
Administrative fine—$5,000
Total: $461,980.60.

This is not intended as a treatsie on Feldman’s guilt or innocence, but it’s rather difficult to fathom what “proceedings” could cost nearly $457,000 but that’s the way the dental and medical examiners boards operate. While members of both boards are appointed by the governor, they are apparently accountable to no one and able to set fines and costs at whatever amounts they wish.

Feldman served briefly as a member of the Physicians’ Health Foundation until he started asking questions that made certain people uncomfortable. Four months later, he found himself in the board’s crosshairs. But during his short tenure, he learned that the medical board funnels about a million dollars a year into the foundation. Apparently, there is no accounting for those funds.

Moreover, he said, the so-called “independent judges” hearing cases for possible board disciplinary action are paid by the board investigator’s office, which creates something of a stacked deck going into the process—not to mention an obvious conflict of interest.

Physicians aren’t the only ones to encounter an uncooperative medical board. The Legislative Auditor was forced to SUE the board in order to obtain board records so that it could perform its statutorily-mandated job of auditing the board’s financial records.

Senate Bill 286, the so-called physicians’ Bill of Rights, passed the SENATE by a unanimous 36-0 vote last year but never made it to the floor of the House after being involuntarily deferred in committee.

But a rare unanimous DECISION by the U.S. Supreme Court exactly two months later, on February 20, could impact the way these boards mete out exorbitant fines.

Even though the high court’s ruling on Timbs v. Indiana is considered a blow aimed at criminal justice reform, particularly in the so-called policing for profit through asset forfeiture, its effects could spill over into the way civil fines are handed down by regulatory bodies.

The ruling, written by Justice Ruth Bader Ginsburg, falls back on the Eighth Amendment that guarantees that no “excessive fines” may be imposed, a concept that dates back to the Magna Carta and later embraced by the framers of the U.S. Constitution.

It will be interesting to see if any dentist or physician victimized by either of these boards files legal action based on the Supreme Court’s most recent ruling.

If someone does, it could be a game changer.

Louisiana Voice

Trying to decipher which was the first to employ Gestapo-like extortion as a means of controlling licensees is like solving the chicken-or-the-egg riddle, but there’s no question that the methods employed by the Louisiana Board of Dentistry and the Louisiana State Medical Licensing Board are eerily similar.

Both employ highly questionable investigative methods, both impose stiff fines followed by even more outrageous fines if the licensee displays any will to resist what may even be bogus charges, and both make generous use of the most effective punishment: revocation of licenses—taking away the victim’s very means of earning a livelihood.

And both also occasionally force recalcitrant dentists and physicians to attend costly rehab clinics either in addition to or in lieu of license revocations. And those rehab clinics can cost as much as $30,000 a month.

Sometimes, a professional is sent to a facility that has its own abuse problems. Take…

View original post 1,141 more words

Doctors fear controversial program made to help them

Disrupted Physician

 

Link to Article

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.

Link to Video

Screen Shot 2019-02-17 at 10.27.49 PM.png

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…

View original post 1,806 more words

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

 

Link to Article

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.

Link to Video

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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