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.


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.


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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Article from The Valley Patriot Newspaper: “State Auditor’s Office Protects The Big Swamp From The Law.”

Audit officially started May 7, 2019. Office of State Auditor Suzanne Bump’s Director of Audit Planning and Review Billy Keefe refused to address any of the evidence of fraud prior to the start of the audit. Now that the audit has started he is disregarding it and excluding it from the audit (claiming it would bias results!). He is essentially excluding all evidence of fraud from the Physician Health and Compliance (PHC) Board counsel audit for purposes of determining no fraud exists! Need to terminate this tainted audit ASAP and put a spotlight directly on the documents Keefe is trying to bury.

Disrupted Physician

The article below by Dr. Bharani Padmanabhan was published in The Valley Patriot  in print in April.  Will update when it is available online.

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State Auditor’s Office Protects The Big Swamp From The Law

Bharani Padmanabhan MD PhD

People on food stamps are the lowest rung on the economic ladder, people who need charity just to eat. Going after poor people helps bureaucrats pretend they care about taxpayers. By targetting people on assistance, the state auditor’s office fools everyone by deflecting attention from its refusal to audit high crimes by the ‘elite’ reptiles in control of the Massachusetts swamp.

This week the state auditor’s office preened itself on identifying $10.7 million of Medicaid fraud. In absolute terms this $10.7 million is a hill of beans given that we lose $4 billion annually to healthcare fraud nationally. Given that Massachusetts’ fiscal 2018 healthcare budget is $21.7 billion, this $10.7 million…

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The Need to Put a Spotlight on Physician Health and Compliance Medical Board Attorney Professional Misconduct and Fraud

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The 2006 Duke Lacrosse case put a spotlight on prosecutorial misconduct.  District Attorney Mike Nifong was appropriately disbarred, jailed for a day and disgraced after it was exposed there was no evidentiary basis for the case and that he withheld exculpatory DNA evidence for 9-months.  As the elected D. A.  Nifong had tremendous power over the lives of the accused since no one was going to challenge his discretion.

A spotlight needs to be put on the misconduct of state employed medical board (MLB) attorneys affiliated with state physician health programs (PHPs).   These attorney positions were created for purposes of influencing legal, regulatory and public health policy advancing the interests of the stakeholders and to prevent the corruption and shakedown racket from being exposed by blocking any evidence of misconduct or fraud presented.  They are also tasked with initiating and bringing disciplinary proceedings to a predetermined conclusion if  a physician under monitoring contract is reported  “non-compliant.”  These attorneys  conceal, misrepresent and fabricate evidence.  They essentially function as physician health medical board prosecutors (PHMBS). These attorneys have tremendous power over the lives of the accused and no one challenges their discretion.Screen Shot 2019-02-25 at 10.41.37 PM

The Office of State Auditor Suzanne Bump officially started an investigation of Massachusetts Board of Registration in Medicine  Physician Health and Compliance (PHC) Board Counsel in May.

It is essential that the fraud and egregious misconduct these attorneys are participating in be exposed and that they face disciplinary action.

Screen Shot 2019-02-24 at 3.21.28 PMI am aware of 3 suicides that were the direct result of Physician Health and Compliance Board Counsel managed by attorney Robert Harvey.

Moreover, this misconduct is not isolated to Massachusetts. This systemic abuse of administrative process is ubiquitous.

Through  updated Public Records Law I have obtained previously unobtainable records including all of the evidence submitted to PHC Board Counsel. Much of this evidence was extremely difficult to obtain. These records requests have revealed all documents pertaining to forensic lab fraud were either concealed or omitted by PHC Board Counsel.  The documents have never been before a tribunal.  The “litigation packet” has been fraudulently concealed since December 2011.  The simple fact of the matter is these document show flagrant forensic fraud.  This is not a “chain-of-custody error” and pointing to the words “update” “revise” and “correct” to claim it is means you are either complicit or just plain stupid.  The lab fraud is the exact same type as Dookhan except there was no documentation of her misdeeds as plainly articulated ion these documents and the consequences of these tests extend far beyond the Hinton crime lab and are far more grave.  The fact that V.P. of Laboratory Operations Joseph Jones added an ID number to an already positive test knowing that a person was attached to it by faxed request is sociopathic.  I have seen documents illustrating the same fraud from the same lab signed by this same tub of lard.  The fact that PHC Board counsel concealed documentation of clear criminal fraud involving a state PHP and the drug and alcohol lab used by PHPs nationally is despicable.

I am aware of multiple suicides resulting from this very same test at this same lab.

The second set of documents illustrate how the fraud was covered up.  After an outside investigation the lab was forced to invalidate the test but Joseph Jones added the comment “external chain of custody was not followed per standard protocol” which is technically true but an absurd minimization given he falsely created it at the request of Sanchez. The revised lab was reported to PHP Director Sanchez but instead of disclosing the revised test he reported “non-compliance” with support group meetings (a requirement that resulted from the positive test).    PHC Manager Robert Harvey was provided documentation of full compliance with meetings and no contradictory evidence was ever produced.   

On February 6, 2013 the Board suspended my license and Harvey would not provide the reason so my attorney could file an appeal.  He tolled the time until after the deadline for appeal passed and when my attorney attempted to convince him to extend the appeal deadline Harvey replied “that ship has sailed.”   The statement of reasons for the decision identified 4-documents relied on as evidence.  2-documents contained dates of reported attendance at meetings that were not in dispute.  The other 2-documents claimed to contradict the attendance reports were unknown and unidentifiable.   Under updated Public Records Law effective January 1, 2017 and only through the efforts of lawyers with the Department of Public Records and interventions by the Supervisor of Records all 4-documents were disclosed by the Board’s Records Access Officer Gerard Dolan.  The documents identified amount to 6-pages total.  The documents provide direct documentary proof that none of the contradictory facts exist.  Harvey fraudulently misrepresented an item of evidence submitted on my behalf to corroborate attendance at meetings and a rebuttal argument destroying the entire factual premise of the case.   The attorney misconduct is unprecedented on many levels but the simple fact of the matter the 2-statements presenting the contradictory findings of fact are false and these are 100% material to the decision.

Screen Shot 2019-06-28 at 8.53.34 PM.pngThe Office of the State Auditor does not have the authority to prosecute criminal fraud but they do have the authority to investigate it and report it to the proper agencies.  The documents show criminal fraud and Harvey is the perpetrator and I am a victim of his fraud.  At a minimum this requires investigation by the Board of Bar Overseers as what is seen is egregious.  RAO Dolan has refused to acknowledge the false statements but they are so obvious you would have to close your eyes.  He had a duty to disclose the false statements and take remedial measures when he was made aware of them.  He instead told the attorneys at the Department of Public Records that they had no business reading the documents and their job was just to provide them.  He also told the Supervisor of Records she had no authority to question the Board’s valid Orders.   The Auditor does. Determining the truth or falsity to the statements simply requires reading the asserted facts found in the statements and examining the true facts found in the documents identified as providing them.  This takes about 5-minutes. 

MA BORIM Board counsel Robert Harvey’s Misconduct (part 1)

MA BORIM Board counsel Robert Harvey’s Misconduct (part 2)

“It is as if the Board didn’t see any of the evidence” is a comment I have heard from  scores of doctors, nurses and other healthcare practitioners across the country.   Truth be told they probably didn’t see any of it.

These medical licensing board (MLB) attorney liaisons to physician health programs exist in every state. The infrastructure pertaining to how they operate may differ but what they do in mechanics and mentality remains the same.

Screen Shot 2019-02-26 at 9.20.58 PMThe “PHP-approved” assessment and treatment centers are engaging in fraud through non-existent and exaggerated diagnoses and the contracted  labs are engaging in lab fraud to fabricate positive tests used to coerce the victim into signing a new contract or initiating another.   There is little oversight in the rehab industry and insurance fraud is rampant. Cash only no insurance accepted reduces  accountability to zero.  The drug and alcohol testing laboratory’s utilize non-FDA approved tests with no oversight or Screen Shot 2019-02-26 at 6.22.07 PMregulation–no agency exists that can both investigate and sanction.  PHPs are good organizations that have become corrupted over time by corrupt individuals.  These attorneys monitoring physician health compliance are corrupt individuals who were place within medical boards to add an additional layer of protection.  All evidence supporting the accused is disregarded, deflected or dismissed.  So too is any evidence implicating the PHP or its affiliates in misconduct or fraud.  

Screen Shot 2019-02-25 at 8.06.19 AMWhile the testing and treatment affiliates are engaging in fraud, these attorneys are engaging in “fraud on the court.”   This is an extortion racket where the PHP makes the threat and PHC Board Counsel pulls the trigger.  The monitoring contracts signed with PHPs and letters of Screen Shot 2019-02-25 at 8.05.32 AMagreement signed with medical boards are signed under coercion, undue influence and duress.  If referred to a PHP the  threat of “non-compliance” begins the moment you walk in the door.  If the PHP recommends an evaluation at an out-of-state facility it is done under threat of reporting non-compliance to the medical board with risk of loss of licensure and livelihood.  These are not genuine agreements. There is no mutual assent.

These attorneys have no interest in presenting truth or pursuing justice.  It is also frequently observed that these attorneys do not follow the rules and have no conscience or moral compass–the only external and internal controls that keep any society free and just for everyone.  They have an utter disregard for fact, truth and consequences.

If a PHP reports “non-compliance” they are tasked with initiating the board proceedings and bringing them to a pre-determined conclusion.  They appear to be following a scripted template in which the only stream of evidence that appears before the medical board is the polluted PHP narrative and its affiliated referral sources and assessment, testing and treatment centers.

Screen Shot 2019-02-25 at 9.51.32 AMIt also appears that it is their responsibility to craft and calibrate a statement of reasons for the decision that complies with all legal, regulatory and professional standards.  If the audit of PHC Board Counsel looks at compliance with regulatory,  legal and professional standards they will not detect the fraud.

Paper statements showing compliance are meaningless when taken out of context.  The compliance narrative all too often excludes consideration of how human beings act in organizations.  Corruption by definition is covert and hidden.  The decision making is fragmented.  Accountability firewalls and the diffusion of responsibilities make it difficult to detect individual wrongdoing.

Screen Shot 2019-03-24 at 1.45.57 AMThese attorneys  are engaging in factual misconduct.  They hide and conceal and misrepresent and fabricate evidence to support the decision.  Almost everyone who is unjustly coerced into a PHP obtains 2nd. 3rd and even 4th opinions from bona fide experts and here that includes world class facilities and some of the top experts in the field.  The auditors need to look at the statement of reasons for the decision, verify the facts asserted and examine the records for what is missing.  If my records are any indication they scan the records into the Board’s Digital Imaging Unit after the Board meetings for which they were submitted.

Screen Shot 2019-02-24 at 4.35.41 PMThey are able to freely engage in false misrepresentation and fraud because of the flawed policy and procedure intentionally put in place for exactly this reason.  This policy and procedure benefits the  stakeholders in the drug and alcohol testing, assessment and treatment industry and remove all due process rights of the accused. PHC Board Counsel have removed the right to a full and fair hearing.  They have removed the right to present evidence and argument supporting one’s case.

Board Policy 94-002  created the position of PHC Board Counsel outside the Enforcement Division of the Massachusetts Board of Registration in Medicine (Board). Policy 94-002 includes the provision that PHC Board Counsel be able to act as their own hearing officers in cases involving physician health and compliance issues.   The Board appoints a “hearing officer” to conduct an adjudicatory proceeding according to the procedures set forth in the Massachusetts Administrative Procedures Act. Mass. Gen. L. ch. 30A. 

It is the hearing officers responsibility to make all decisions regarding the admission or exclusion of evidence.  They not only prepare and present cases to the Board but have carte blanche power to pick and choose what evidence is presented to the Board.  They have also blocked the ability of the accused to ever get evidence before the full boardand it is foolproof.  The only opportunity for a hearing is before a single Board member.

The procedures for violation of probation agreement. (adopted June 9, 1993) dictate what occurs in the event of a report of “non-compliance.”  They allow the unilateral presentation of evidence to the full board at a “meeting.”  If the Board votes to suspend Screen Shot 2019-02-25 at 9.53.43 PMthen a hearing can be requested before a single board member within a limited time-frame but the hearing officer has full discretion of what evidence is accepted.  These mechanisms completely blocking the ability to get evidence before the full Board were Screen Shot 2019-02-26 at 1.30.17 PMput in place because Board members come and go.  For risk management in preventing an honest  Board member with integrity from possibly seeing something and asking too many questions they simple introduced procedures that remove the risk and use the 1 or 2 unethical Board members they can trust to rubber-stamp the determination and decision. The wrongdoing seen here cannot be minimized.


Please contribute to my Gofundme.  Attorney Harvey’s misconduct and fraud has caused a great deal of harm to my 3-daughters especially my youngest daughter Josephine who had to leave her school because of these crimes. We are about to suffer another major loss and would greatly appreciate any help to avoid it.  Also please help me hold this guy accountable!


February 6, 2013 Board Order(annotated)

EXHIBIT 2 (Documents identified as providing evidentiary facts presented in 2013 Order Statement of Reasons 9-12) (1)

Statements (9) and (11) present true findings of fact but misrepresent the same attendance records as distinctly different


Statement (10) and (12) are false statements and intentional fraudulent misrepresentations.






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Medical Urban Legend–The Legacy of the 4 MDs and why B.S. Needs to be Identified from the Get-Go!


Disrupted Physician

photo “Because I can Biotches! That’s right..because I can!”

According to G. Douglas 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 any other inhabitants of our society.   Physicians are unique. Unique because of their incredibly high denial”, and this genetically inherent denial is part of what he calls the “four MDs.” Used to justify the thrice lengthier length of stay in physicians the “four-MDs” are as follows: “M-Deity”, “Massive Denial” “Militant Defensiveness” and “More Drugs.”

He states that “Impaired doctors must first acknowledge their addiction and overcome their ‘terminal uniqueness’ before they can deal with a drug or alcohol problem.”
Now some  doctors are arrogant undisciplined egotists but narcissistic personalities exist in any profession and expanding traits that may apply to a small percentage of doctors to include all doctors as a…

View original post 1,475 more words

The Lemonheads—Beautiful

Disrupted Physician

Video post by @mllangan1.

Every day is so wonderful
Then suddenly it’s hard to breathe.
Now and then I get insecure
From all the pain, I’m so ashamed.

I am beautiful no matter what they say.
Words can’t bring me down.
I am beautiful in every single way.
Yes, words can’t bring me down… Oh no.
So don’t you bring me down today.

To all your friends you’re delirious,
So consumed in all your doom.
Trying hard to fill the emptiness.
The pieces gone, left the puzzle undone.
is that the way it is?

Source: The Lemonheads – Beautiful

Written by Linda Perry.

Reliability of hair drug tests up for debate

via Reliability of hair drug tests up for debate

The Birth of Junk-Science in Drug and Alcohol Testing

The attached article concerns the reliability of hair-strand tests routinely accepted in child welfare cases in Ontario   as evidence of parental drug or alcohol abuse.  A positive test can lead to loss of parental custody of children.

The risk for false-positive results appears to be higher in women because of the higher use of alcohol-based hair products and the limitations of these tests are addressed in the article.

Almost 98% of ingested alcohol is eliminated through the liver in an oxidation process that involves its conversion to acetaldehyde and acetic acid, but the remaining 2% is eliminated through the urine, sweat, or breath.1

Ethyl Glucuronide (EtG) was introduced in 1999 as a biomarker for alcohol consumption,2 and was subsequently suggested as a tool to monitor health professionals by Dr. Gregory Skipper, M.D.,  because of its high sensitivity to ethanol ingestion.3

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This minor metabolite of alcohol was reported by  Skipper, M.D. and Friedrich Wurst, M.D., in November 2002 at an international meeting of the American Medical Society, to provide proof of alcohol consumption as much as 5 days after drinking an alcoholic beverage, well after the alcohol itself had been eliminated from the body.

In his study Dr. Skipper arbitrarily chose a value of 100 as a cut-off for EtG. The rationale behind this value is not cited.

In 2003, because of these and other reportedly remarkable results (e.g., positive findings, confirmed by admissions by the tested individuals, after traditional urine tests had registered negative), Skipper pitched the test to National Medical Services, Inc. (NMS labs) and it was developed as a Laboratory Developed Test (LDT).

So began EtG testing began in the United States, and this paved the way for the hair tests described. The urine EtG test introduced by Skipper is the index case and prototype for an array of unproven forensic tests introduced to the market as LDTs.

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Against the Rising Tide: Looking for Biostatisticians and Epidemiologists to help shape Drug-Testing Policy to be more Evidence-Based

via Against the Rising Tide: Looking for Biostatisticians and Epidemiologists to help shape Drug-Testing Policy to be more Evidence-Based

Wanted!–a Few Honest Statisticians, Biostatisticans and Epidemiologists who want to make a difference..

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It is only a few public policy steps and minor changes in state regulatory statutes before what is described in the ASAM White Paper on Drug Testing comes to fruition.  Before we know it the Drug and Alcohol Testing Industries “New Paradigm” as described here by Robert Dupont will be ushered in.  From the ASAM white Paper:


Backed by the multi-billion dollar drug and alcohol testing, assessment and treatment industry the public policy positions of the American Society of Addiction Medicine (ASAM) have invariably passed. There has been little if any meaningful opposition.

To prevent this future drug testing dystopia, that includes testing schoolchildren, we need to take a step back and analyze the reliability and credibility of the “evidence-base” behind these multiple non-FDA approved (Introduced as Laboratory Developed Tests (LDTs) to bypass FDA approval) “forensic” drug and alcohol tests and testing devices (The alcohol biomarkers EtG, EtS, PEth; SCRAM (Subcutaneous Remote Alcohol Monitoring Bracelet);CDPB (Cellular Digital Photo Breathalyzer); and Hair Testing- Psychemedics, etc.) the ASAM proposes be used on the population at large.  These tests include nail, hair, saliva, breath, blood and urine and they plan on utilizing the Medical Profession as a urine collection agency by calling this testing a “medical evaluation” rather than “monitoring” for drug and alcohol use.   This change in semantics enables them to bypass the usual forensic drug testing protocol (that includes strict chain-of-custody collection and MRO review) designed to minimize false-positives because the results of erroneous test can be grave and far reaching.  According to the ASAM white paper the “clinical” collection of specimens as is good enough as the results of a positive test will result in “treatment” rather than “punishment.”

Amazingly, there has been no Academic review of these tests, let alone a Cochrane type critical analysis.  It is essentially untapped territory.  In addition there has been no Institute of Medicine type Conflict of Interest Analysis.  

Sinclair Lewis’ “Elmer Gantry” and the “physician wellness” crusade.

via Sinclair Lewis’ “Elmer Gantry” and the “physician wellness” crusade.

Sinclair Lewis’ 1927 novel Elmer Gantry is a satire on fundamentalist  religion in 1920s America. The eponymous character is  a greedy and debauched womanizer  who reinvents himself as an evangelical minister. The Reverend Dr. Elmer Gantry is a carney huckster who weasels himself into becoming the leader of a large Methodist congregation.   He organizes crusades against immorality while he himself is amoral. Gantry is an unethical and unprincipled power hungry narcissist who contributes to the downfall, injury and even death of those around him.  Lewis’ portrayal of pious hypocrisy and opportunism of fanatical religiosity was denounced from pulpits across the country.  The book was banned in Boston and many other cities with official censorship boards.    Public libraries and some booksellers refused to stock it and the author was threatened with litigation, jail, injury and even death.  The attempts at censorship backfired and the novel quickly went to number one on the fiction bestseller list.

The “religion racket” no longer has the power to determine what we read.  Unfortunately, similar groups have gained tremendous sway.  The “rehab racket” has erected a scaffold able to remove our constitutionally protected rights and civil liberties not only legally but under the pretense of doing so out of our own best interests.      According to Erich Fromm  rational authority is based on competence, experience and mutual respect.  Irrational authority is often disguised as benevolent paternalism and is designed to perpetuate or intensify conditions of inequality through the use or threat of force, deceptiveness and secretiveness.

This system has unfortunately given power and allowances to unethical individuals  who are able to exert control over other individuals under the guise of “treatment” regardless of whether or not those individuals even need it as inherent in the current chronic brain disease model of addiction is the importance of external control.



Please support my Godundme

Sinclair Lewis’ “Elmer Gantry” and the “physician wellness” crusade.

“Some people without brains do an awful lot of talking, don’t you think?”
L. Frank Baum, The Wonderful Wizard of Oz

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Elmer Gantry

Sinclair Lewis’ 1927 novel Elmer Gantry is a satire on fundamentalist  religion in 1920s America. The eponymous character is  a greedy and debauched womanizer  who reinvents himself as an evangelical minister. The Reverend Dr. Elmer Gantry is a carney huckster who weasels himself into becoming the leader of a large Methodist congregation.   He organizes crusades against immorality while he himself is amoral. Gantry is an unethical and unprincipled power hungry narcissist who contributes to the downfall, injury and even death of those around him.  Lewis’ portrayal of pious hypocrisy and opportunism of fanatical religiosity was denounced from pulpits across the country.  The book was banned in Boston and many other cities with official censorship boards.    Public libraries and some booksellers refused to stock it and the author was threatened with litigation, jail, injury and even death.  The attempts at censorship backfired and the novel quickly went to number one on the fiction bestseller list.

The “religion racket” no longer has the power to determine what we read.  Unfortunately, similar groups have gained tremendous sway.  The “rehab racket” has erected a scaffold able to remove our constitutionally protected rights and civil liberties not only legally but under the pretense of doing so out of our own best interests.      According to Erich Fromm  rational authority is based on competence, experience and mutual respect.  Irrational authority is often disguised as benevolent paternalism and is designed to perpetuate or intensify conditions of inequality through the use or threat of force, deceptiveness and secretiveness.

This system has unfortunately given power and allowances to unethical individuals  who are able to exert control over other individuals under the guise of “treatment” regardless of whether or not those individuals even need it as inherent in the current chronic brain disease model of addiction is the importance of external control.

The Federation of State Physician Health Programs (FSPHP) has has played a large part in this.   The FSPHP has operated as an unexamined authority for the past 25-years and contains individuals whose pious hypocrisy and carney hucksterism would make Gantry blush.  Everything they have done has been done to benefit themselves and their drug and alcohol assessment, testing and treatment affiliates in the provision of protections, power and profit.  The FSPHP has pushed bad practice and policy with no discernible scrutiny or meaningful opposition.   The impact of any and all of this has yet to be examined.   It needs to be.

In Democracy in America Alexis de Tocqueville (1805-1859) warned that the greatest threat the United States faces is the “tyranny of the majority “and that state  power would end up concentrated in a single authority until its citizens were “reduced to nothing better than a flock of timid and industrious animals, of which the government is the shepherd,” noting  that the newest incarnation of despotism was likely to be ushered in by the “avowed lover of liberty” who is a “hidden servant of tyranny.”  “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”  Today several thousand “legislative rules” and regulations are passed each year silently. The impact of this so-called  “regulatory dark matter” is usually unknown until  it hits us and such is the case here.

Examining the specific practice and policy that has been pushed by the FSPHP (and ratified by state medical boards and their national organization the Federation of State Medical Boards) reveals a body of false-claims making that is designed to facilitate the systemic use of coercion and threats, removal of due process protections and fundamental rights from physicians (and other health care professionals) and prevent, block and eliminate any  evidence of the consequences.    This practice and policy collective has created a culture of impunity, immunity and deference that is able to successfully conceal egregious ethical violations and crimes.  Uncovering and exposing this wrongdoing is nearly impossible as the gauntlets that have been put in place are multiple and they remain largely unseen.    What lies beneath, however,  is  self-apparent and this system of institutional injustice is undoubtedly a major contributor to the grossly underreported suicide epidemic in the medical profession and the reticence of those who actually need help with substance use and other mental health problems to seek help for those problems.  They are afraid an it is as plain-and-simple as that.

The FSPHP has been able to conceal the truth, avoid investigation and prevent punishment for wrongdoing for years and they have done this by systematically and systemically removing themselves from all accountability and all outside inquiry.

Direct and specific questioning appears to be their Achille’s heel as has been seen in the increasing torrent of articles and reports critical of these programs .  In a rebuttal to Pauline Anderson’s article “Physician Health Programs: More Harm Than Good?”  FSPHP President Doris Gunderson dismissed concerns of fraud and abuse in one fell swoop as  “allegations rather than facts”  and as second hand anecdotes.  Countering allegations of an absence of oversight and regulation she states:

“In fact, we operate under a microscope, answering to individual practitioners, medical boards, malpractice carriers, defense attorneys, state attorneys, medical societies, hospitals, medical schools and residency training programs. We are also accountable to patient safety entities and a Board of Directors.”

Untrue.  Accountability demands both provision of information and justification for actions to outside entities capable of punishing misconduct. . What was done and why?  No such entity exists and no pathway for appeal or grievance redressal exists either. Zero accountability.  Ditto for the “PHP-approved” assessment and treatment centers. As cash only out-of-pocket private facilities they remove themselves from the prying eyes of insurers.

In response to Emmy Award winning P.J. Randhaw’s 2019 investigative journalism piece addressing these issues seen here the FSPHP and its state affiliate would not even respond to direct questioning on these issues.  The stance seems to be to ignore these systemic and serious allegations and hope they will go away.  They will not go away.   Simple and direct questions deserve simple and direct answers and the unwillingness to address the particular and remarkably similar allegations of exceptionally egregious misconduct and fraud is unacceptable.  The silence speaks volumes.

The North Carolina PHP Audit  found the past FSPHP President and NC PHP director Warren Pendergast could not even identify  qualitative or quantitative indicators that are used for “approving”  the “PHP-approved” assessment centers.  The best justification he could come up with was “reputation” and “word of mouth” yet state medical boards (and other licensing boards)  mandate evaluations at these  facilities and specifically exclude  non-“PHP-approved” facilities.

This is enforced by the Federation of State Medical Boards Policy on Physician Impairment.  Each state managed by the FSPHP utilizes the same dozen or so facilities and each state medical board mandates it under threat of disciplinary action.  It is in fact a rigged game.

Denying accusations of coercion Gunderson states in her rebuttal to Anderson’s article:

“The detractors of PHPs interviewed for the article maintain that PHPs are coercive. Yet the report fails to mention that PHPs have no authority to mandate treatment and monitoring, suspend or revoke licensure, or otherwise discipline physicians.”

screen-shot-2015-10-07-at-7-11-18-pmThe report fails to mention it because it is more either/or logical fallacy based on the false dichotomy between “treatment” and “punishment” that is often used to promote the FSPHP mythology.  Although PHPs do not have the legal authority to mandate, suspend or revoke a license they have the functional authority to do so. This is also dictated by public policy.  (ASAM Policy on Coordination Between Treatment Providers,  Professionals Health Programs, and Regulatory Agencies).

Legitimate authority articulates ethical, evidence-based, or internally consistent arguments when challenged.  Legitimate authority does not simply delegitimize one’s opponent and use logical fallacy and obfuscation to avoid addressing the substance of  the argument. In her rebuttal Gunderson claims the North Carolina Audit was favorable because no evidence of abuse was found.  This is akin to a serial killer claiming victory because no bodies were found in his dungeon replete with torture devices and restraints. State auditor Beth Woods set this straight when she told the BMJ in  Physician Health Programs Under Fire  that the holes were big enough in the program “you could drive a truck through them” and it would be “difficult, if not impossible, to defend” oneself against an incorrect assessment” as no ability to “appeal a diagnosis or assessment” existed.

screen-shot-2016-01-13-at-9-52-11-am“Compounding the problem, said Wood, was that “the chief executive and medical director were in total control of entire process.” They assessed allegedly impaired doctors, but when those assessments were contested, they were responsible for presenting complaints to the state medical board. The doctors concerned were not allowed to be present and were not allowed to see the programs’ medical reports on them.”

The  inability to obtain one’s own medical records or lab reports is the first obstacle one must overcome. The second barrier is that even if documents are obtained there is no one to give them to.  The third is the existence of “point people” who deflect, block and otherwise dismiss valid complaints.  The only oversight provided to the involved labs is an an accreditation agency, the  College of American Pathologists (CAP) They can investigate and correct but do not have the ability to sanction.

screen-shot-2016-12-09-at-1-13-29-pmOf the many hundreds of doctors I have spoken to and who have taken my survey not one has been able to obtain evidence of abuse.  It was either refused, censored or doctored.

Research on street criminals suggests the certainty of punishment has the strongest deterrent effect (basically will I be caught) and the more people think they will be arrested for a crime the less likely they are to commit it.

Criminals weigh their actions against possible gains and consequences and the risk of consequences in this system have been essentially zero.  Diagnosis rigging, coercion, threats and abuse are rampant because they have no fear of punishment.

The Chairman of the commission that examined the  causes of the 2008 financial collapse compared the  relatively small fines paid by corporations to “someone who robs a 7-Eleven, takes $1,000 and being able to settle for $25 and no admission of wrongdoing.”  He added,“Will they do it again? Absolutely, because it pays.”

This misconduct that is seen in this racket is comparable to someone who robs a 7-Eleven for $1,000 and never gets caught so then robs as many 7-Elevens as he can for as much as he can and then realizing there is essentially zero chance of getting caught expands the enterprise to robbing as many convenience stores as he can.

This illegitimate authority of self-proclaimed experts has successfully gained power and removed all accountability.     Unethical and unprincipled  narcissism  has unfortunately become the tone at the top.

 Tone at the Top

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An expectation of irreproachable ethics and honesty ideally sets the bar for leadership in any organization. Without ethical integrity, falsity will flourish.

Adherence to societal and professional ethical codes is a universal obligation.  It excludes all exceptions.  Good leadership requires correct moral and ethical behavior of both the individual and the organization.   Integrity is necessary for establishing relationships of trust.  It requires a true heart and an honest soul.  People of integrity instinctively do the “right thing” in any and all circumstances.

“Tone at the top” refers to the  ethical atmosphere created by an  organization’s leadership as it creates an ethical atmosphere that inevitably cascades throughout the organization – for good or for bad as the case may be.   A strong tone at the top is essential to ensure strong internal control and effective governance.  It requires that upper management lead by example and action. This includes rewarding ethical behavior and punishing misconduct. An ethical tone at the top  holds those below accountable for unethical actions and imposes sanction those who do bad things and improper or unethical conduct is not tolerated, condoned or overlooked.

But when those in top positions set the wrong it will inevitably  trickle down as those below follow in their leaders fraudulent footsteps.    Unprincipled and unethical leaders create unprincipled and unethical followers and this creates an organizational culture that becomes a breeding ground for corrupt practices such as conflicts of interest, self-dealing, illegal activities and abuse.  Such a culture places both the viability of the organization and its stakeholders at risk.

In his book Without Conscience, Dr. Robert Hare notes  “If we can’t spot them, we are doomed to be their victims, both as individuals and as a society” and Dr. Clive Boddy in Corporate Psychopaths observes that “unethical leaders create unethical followers, which in turn create unethical companies and society suffers as a result.”

The Federation of State Physician Health Programs (FSPHP) make authoritative pronouncements on professionalism and ethics.  In  Disruptive Behaviors Among Physicians past president of the organization Dr. Luis Sanchez pontificates on a “culture of safety“ and promotes “clear expectations and standards.” He calls on leaders in the medical profession to “commit to professional behavior” and to lead by example.  But truth is comprehended by examining actions not words.  One measure of integrity is truthfulness to words and deeds and by that measure Sanchez, Skipper, Teitelbaum, Pendergast and numerous other self-proclaimed “leaders” of the “physician-wellness” movement fall miserably short.

As with Reverend Dr. Elmer Gantry the carney huckster who weaseled himself into becoming the leader of a large Methodist congregation these individuals have managed to weasel themselves into positions of power and the impact has been far reaching and grave. Organizing crusades against immorality while he himself was amoral the unethical and unprincipled power hungry narcissist Gantry contributed to the downfall, injury and even death of those around him.  So too have the pious hypocritical opportunists who have reinvented themselves  as experts and authority in this arena and unless courage and resistance steps up the noble profession of medicine will be utterly demolished without a brick standing.