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?

  1. Ford DE, Mead LA, Chang PP, Cooper-Patrick L, Wang NY, Klag MJ. Depression is a risk factor for coronary artery disease in men: the precursors study. Archives of internal medicine. Jul 13 1998;158(13):1422-1426.
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  7. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.Archives of general psychiatry. Jun 2005;62(6):593-602.
  8. Gold KJ, Sen A, Schwenk TL. Details on suicide among US physicians: data from the National Violent Death Reporting System. General hospital psychiatry. Jan-Feb 2013;35(1):45-49.
  9. Rivers I, Noret N. Potential suicide ideation and its association with observing bullying at school.The Journal of adolescent health : official publication of the Society for Adolescent Medicine.Jul 2013;53(1 Suppl):S32-36.
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  12. Hinduja S, Patchin JW. Bullying, cyberbullying, and suicide. Archives of suicide research : official journal of the International Academy for Suicide Research. 2010;14(3):206-221.
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  14. Kim YS, Leventhal B. Bullying and suicide. A review. International journal of adolescent medicine and health. Apr-Jun 2008;20(2):133-154.
  15. Kiriakidis SP. Bullying and suicide attempts among adolescents kept in custody.Crisis.2008;29(4):216-218.
  16. Taylor PJ, Gooding P, Wood AM, Tarrier N. The role of defeat and entrapment in depression, anxiety, and suicide. Psychological bulletin. May 2011;137(3):391-420.
  17. Lester D. Defeat and entrapment as predictors of depression and suicidal ideation versus hopelessness and helplessness. Psychological reports. Oct 2012;111(2):498-501.
  18. Williams JMG. Cry of Pain. Harmondsworth: Penguin; 1997.
  19. Williams JMG, Crane C, Barnhofer T, Duggan DS. Psychology and suicidal behavior: elaborating the entrapment model. In: Hawton K, ed. Prevention and treatment of suicidal behavior: from science to practice. Oxford: Oxford University Press; 2005:71-89.
  20. Fridner A, Belkic K, Marini M, Minucci D, Pavan L, Schenck-Gustafsson K. Survey on recent suicidal ideation among female university hospital physicians in Sweden and Italy (the HOUPE study): cross-sectional associations with work stressors. Gender medicine. Apr 2009;6(1):314-328.
  21. Fridner A, Belkic K, Minucci D, et al. Work environment and recent suicidal thoughts among male university hospital physicians in Sweden and Italy: the health and organization among university hospital physicians in Europe (HOUPE) study. Gender medicine. Aug 2011;8(4):269-279.
  22. Borowsky IW, Ireland M, Resnick MD. Adolescent suicide attempts: Risks and protectors.Pediatrics. 2001;107(485).
  23. Clum GA, Febbraro GAR. Stress, social support and problem-solving appraisal/skill: Prediction of suicide severity within a college sample. Journal of Psychopathology and Behavioral Assessment.1994;16:37-46.
  24. Lindfors PM, Meretoja OA, Toyry SM, Luukkonen RA, Elovainio MJ, Leino TJ. Job satisfaction, work ability and life satisfaction among Finnish anaesthesiologists. Acta anaesthesiologica Scandinavica.Aug 2007;51(7):815-822.
  25. Heponiemi T, Kuusio H, Sinervo T, Elovainio M. Job attitudes and well-being among public vs. private physicians: organizational justice and job control as mediators. European journal of public health. Aug 2011;21(4):520-525.
  26. Elovainio M, Kivimaki M, Vahtera J. Organizational justice: evidence of a new psychosocial predictor of health. Am J Public Health. Jan 2002;92(1):105-108.
  27. Lawson KJ, Noblet AJ, Rodwell JJ. Promoting employee wellbeing: the relevance of work characteristics and organizational justice. Health promotion international. Sep 2009;24(3):223-233.
  28. Hayashi T, Odagiri Y, Ohya Y, Tanaka K, Shimomitsu T. Organizational justice, willingness to work, and psychological distress: results from a private Japanese company. Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine. Feb 2011;53(2):174-181.
  29. Lang J, Bliese PD, Lang JW, Adler AB. Work gets unfair for the depressed: cross-lagged relations between organizational justice perceptions and depressive symptoms. The Journal of applied psychology. May 2011;96(3):602-618.
  30. Gonzales L. When Doctors are Addicts: For physicians getting Molly Kellogg is easy. Getting help is not. Chicago Reader. July 28, 1988, 1988.
  31. King M, Durcanin C. The suicides at Ridgeview Institute: A Doctor’s treatment program may be too tough, some say. Atlanta Journal and Constitution.December 18, 1987a, 1987: A12.
  32. Durcanin C, King M. The suicides at Ridgeview Institute: Suicides mar success at Ridgeview with troubled professionals. Atlanta Journal and Constitution.December 18, 1987, 1987: A13.
  33. Bissell L, Royce JE. Ethics for Addiction Professionals. Center City, Minnesota: Hazelden; 1987.
  34. Addiction Scientists from the USA: LeClair Bissell. In: Edwards G, ed.Addiction: Evolution of a Specialist Field. 1 ed: Wiley, John & Sons, Incorporated; 2002:408.
  35. Durcanin C. The suicides at Ridgeview Institute: Staff members didn’t believe Michigan doctor was suicidal. Atlanta Journal and Constitution. December 18, 1987, 1987: A8.
  36. Ricks WS. Ridgeview Institute loses $1.3 million in suit over suicide. Atlanta Journal and Constitution. October 11, 1987, 1987: A1.
  37. King M, Durcanin C. The suicides at Ridgeview Institute: Many drug-using doctors driven to Ridgeview by fear of losing licenses. Atlanta Journal and Constitution. December 18, 1987b, 1987: A1.
  38. Bissell L, Haberman PW. Alcoholism in the Professions. Oxford University Press; 1984.
  39. White W. Reflections of an addiction treatment pioneer. An Interview with LeClair Bissell, MD (1928-2008), conducted January 22, 1997. Posted athttp://www.williamwhitepapers.com. 2011.
  40. Williams c. Health care field chemical dependency threat cited. The Tuscaloosa News. January 16, 1988, 1988: 16.
  41. Peele S. In the Belly of the American Society of Addiction Medicine Beast. The Stanton Peele Addiction Website (accessed March 28, 2014)http://web.archive.org/web/20080514153437/http://www.peele.net/debate/talbott.html.
  42. Ursery S. $1.3M verdict coaxes a deal for doctor’s coerced rehab. Fulton County Daily Report.May 12, 1999b 1999.
  43. Ursery S. I was wrongly held in alcohol center, doctor charges. Fulton Count y Daily Report. April 27, 1999a 1999.
  44. Parker J. George Talbott’s Abuse of Dr. Leon Masters MD (http://medicalwhistleblowernetwork.jigsy.com/george-talbott-s-abuse-of-leon-masters ).Medical Whistelblower Advocacy Network.

 

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Please donate to this effort below.  Your contribution can and will make a difference.  https://www.gofundme.com/PHPReform

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

#EndFSPHP

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:

“THIS WHITE PAPER ENCOURAGES WIDER AND “SMARTER” USE OF DRUG TESTING WITHIN THE PRACTICE OF MEDICINE AND, BEYOND THAT,BROADLY WITHIN AMERICAN SOCIETY. SMARTER DRUG TESTING MEANS INCREASED USE OF RANDOM TESTING* RATHER THAN THE MORE COMMON SCHEDULED TESTING,* AND IT MEANS TESTING NOT ONLY URINE BUT ALSO OTHER MATRICES SUCH AS BLOOD, ORAL FLUID (SALIVA), HAIR, NAILS, SWEAT AND BREATH WHEN THOSE MATRICES MATCH THE INTENDED ASSESSMENT PROCESS. IN ADDITION, SMARTER TESTING MEANS TESTING BASED UPON CLINICAL INDICATION FOR A BROAD AND ROTATING PANEL OF DRUGS RATHER THAN ONLY TESTING FOR THE TRADITIONAL FIVE-DRUG PANEL.”
 

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.

 

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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.

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

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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…

View original post 1,806 more words