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.
  2. Frank E, Dingle AD. Self-reported depression and suicide attempts among U.S. women physicians.The American journal of psychiatry. Dec 1999;156(12):1887-1894.
  3. Brewster JM. Prevalence of alcohol and other drug problems among physicians. JAMA : the journal of the American Medical Association. Apr 11 1986;255(14):1913-1920.
  4. Anthony J, Eaton W, Mandell W, al. e. Psychoactive Drug Dependence and abuse: More Common in Some Occupations than in Others? Journal of Employee Assistance Res. 1992;1:148-186.
  5. Stinson F, DeBakely S, Steffens R. Prevalence of DSM-III-R Alcohol abuse and/or dependence among selected occupations. Alchohol Health Research World. 1992;16:165-172.
  6. Hughes PH, Brandenburg N, Baldwin DC, Jr., et al. Prevalence of substance use among US physicians. JAMA : the journal of the American Medical Association. May 6 1992;267(17):2333-2339.
  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.
  10. Lester D, Walker RL. Hopelessness, helplessness, and haplessness as predictors of suicidal ideation. Omega. 2007;55(4):321-324.
  11. Beck AT. Hopelessness as a predictor of eventual suicide. Annals of the New York Academy of Sciences. 1986;487:90-96.
  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.
  13. Hertz MF, Donato I, Wright J. Bullying and suicide: a public health approach.The Journal of adolescent health : official publication of the Society for Adolescent Medicine. Jul 2013;53(1 Suppl):S1-3.
  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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New Center for Physician Rights Helps Protect, Guide Doctors (Article Published in Medscape Medical News November 9, 2018)

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

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New article by Pauline Anderson published in Medscape Medical News.

Please follow link and comment.


News > Medscape Medical News > Psychiatry News

New Center for Physician Rights Helps Protect, Guide Doctors

Pauline Anderson

November 09, 2018

 

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

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

 

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

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

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

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

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

One-Stop Shop

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

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

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

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

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

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

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

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

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

“Critical” New Resource

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

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

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

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

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

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

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

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

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

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

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

Civil Rights Violation?

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

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

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

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

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

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

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

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

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

A Sense of Hope

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

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

Manion’s plan also includes educating legal groups.

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

Another important role of the CPR is advocacy.

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

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

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

Auditor Report Follow-up?

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

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

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

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

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

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

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

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

No Place for Financial Gain

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

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

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

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

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

Class Action Lawsuit

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

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

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

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

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

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

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

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

Currently, he and his team are awaiting class certification.

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

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

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

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

AMA Weighs In

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

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

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

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

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

 

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

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

Moral Crusades and Moral Panics as a Means of Social Control in the Medical Profession

The terms “impaired physician” and the “disruptive physician” are used as labels of deviancy. As deviants who allegedly threaten the very core of medicine (patient care) and the business of medicine (profit) they must be stopped at all costs. Belief in the seriousness of the situation justifies intolerance and unfair treatment. The evidentiary standard is lowered. Aided by a “conspiracy of silence” among doctors in which impaired colleagues are not reported necessitates identification of them by any means necessary. Increase the grand scale of the hunt.

Disrupted Physician

IMG_9005The Medical Profession, Moral Entrepreneurship, and Social Control

Sociologist Stanley Cohen  used the term “”moral panic” to characterize the amplification of deviance by the media, the public, and agents of social control.1  Labeled as being outside the central core values of consensual society, the deviants in the designated group are perceived as posing a threat to both the values of society and society itself.   Belief in the seriousness of the situation justifies intolerance and unfair treatment of the accused.   The evidentiary standard is lowered.

Howard Becker describes the role of “moral entrepreneurs,” who crusade for making and enforcing rules that benefit their own interests by bringing them to the attention of the public and those in positions of power and authority under the guise of righting a society evil. 2

And according to cultural theorist Stuart Hall, the media obtain their information from the primary definers of social…

View original post 2,652 more words

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

cropped-screen-shot-2016-10-10-at-9-32-40-pm1https://www.gofundme.com/PHPReform

“It is very difficult to collect the documentary evidence but Dr Langan has done it. And the auditors are angry because now they cannot say they do not know.

Henry Morgenthau proved that everyone at the State dept. knew about the holocaust as it was unfolding and concealed the facts to avoid public pressure to save the Jews. Everyone at the state auditor’s office is no better.

The auditors know that these crimes by Board lawyers and the medical society caused numerous doctors to commit suicide in the prime of their life. These suicides occurred because the state auditor knew about the crimes and ongoing deaths of despair and did nothing. Same as the diplomats at State during the holocaust.”

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

The history of the “impaired physician movement” and the takeover of American Medicine by ASAM addiction addicts.

“With one arm around the shoulder of religion and the other around the shoulder of medicine, we might change the world.”—Twelve Steps and Twelve Traditions, AA World Services, Inc (1953).
 
Screen Shot 2018-01-15 at 3.26.56 PMPlease donate at  https://www.gofundme.com/PHPReform

 
In order to comprehend the current plight of the Medical Profession and the dark clouds that lie ahead it is necessary to understand the history of the “impaired physician movement” and the American Society of Addiction Medicine.

In 1985 the British sociologist G. V. Stimson wrote:

“The impaired physician movement is characterized by a number of evangelical recovered alcoholic and addict physicians, whose recovery has been accompanied by an involvement in medical society and treatment programs. Their ability to make authoritative pronouncements on physician impairment is based on their own claim to insider’s knowledge.”1

The impaired physician movement emphasizes disease antherapy rather than discipline and punishment and believes that addiction is a chronic relapsing brain disease requiring lifelong abstinence and 12-step spiritual recovery. The drug or alcohol abuser or addict is a person lacking adequate internal controls over his or her  behavior;  for his own protection as well as the protection of society external restraints are required including involuntary treatment.

The American Society of Addiction Medicine can trace its roots to the 1954 founding of the New York City Medical Society on Alcoholism (NYCMSA) by Ruth Fox, M.D whose husband died from alcoholism.

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Finding that alcoholics in her psychoanalytic practice did not recover when she used conventional analytic approaches, she taught her patients about alcoholism as a disease and introduced “them to AA meetings held in her living room.”2

A number of physicians in the New York Medical Society were themselves recovering alcoholics who turned to Alcoholics Anonymous for care.3

The society, numbering about 100 members, established itself as a national organization in 1967, the American Medical Society on Alcoholism (AMSA).3

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The group promoted the concept of alcoholism as a chronic relapsing disease requiring lifelong spiritual recovery through the 12-steps of AA.

By 1970 membership was nearly 500.2Screen Shot 2014-02-22 at 2.47.51 PM

In 1973 AMSA became a component of the National Council on Alcoholism (NCA), now the National Council on Alcoholism and Drug Dependence (NCADD) in a medical advisory capacity until 1983.

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“Abstinence from alcohol is necessary for recovery from the disease of alcoholism” became the first AMSA Position Statement in 1974.2

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In 1985 ASAM’s first certification exam was announced. According to Dr. Bean-Bayog, chair of the Credentialing Committee:

“A lot of people in the alcoholism field have long wanted physicians in the field to have a high level of skills and scientific credibility and for this body of knowledge to be accredited.”2

And in 1986 662 physicians took the first ASAM Certification Exam.medical

By 1988 membership was over 2,800 with 1,275 of these physicians “certified” as:

“having demonstrated knowledge and expertise in alcoholism and other drug dependencies commensurate with the standards set forth by the society.”4
“While certification does not certify clinical skill or competence,” the Board explained, “it does identify physicians who have demonstrated knowledge in diagnosis and treatment of alcoholism and other drug dependencies.”5
Somehow, I don't think this is quite what they had in mind!

Achieving “recognized board status for chemical dependence” and fellowships in  “chemical dependency”  are among the five-year objectives identified by the group.  These are to come to fruition by  “careful discussion, deliberation, and consultation” to “determine its form and structure and how best to bring it about.”5

The formation of ASAM State Chapters begins with California, Florida, Georgia, and Maryland submitting requests.6

In 1988 the AMA House of Delegates votes to admit ASAM to the House. According to ASAM News this “legitimizes the society within the halls of organized medicine.”2

In 1989 the organization changes its name to the American Society of Addiction Medicine (ASAM).2

Since 1990, physicians have been able to list addiction medicine as a self-designated area of practice using the specialty code “ADM.”

By 1993 ASAM has a membership of 3,500 with a total of 2,619 certifications in Addiction Medicine.

The Membership Campaign Task Force sets  a goal to double its membership of 3,500 to 7,000 by the year 2000 to assure “the future of treatment for patients with chemicals. It represents a blueprint for establishing addiction medicine as a viable entity.”7

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Ninety physicians become Fellows of the American Society of Addiction Medicine (FASAM) in 1996 “to recognize substantial and lasting contributions to the Society and the field of addiction medicine.”8

Among the honorees are Robert DuPont, G. Douglas Talbott, Paul Earley, and Mel Pohl. In addition to at least five consecutive years of membership and certification by the Society, Fellows must have “taken a leadership role in ASAM through committee service, or have been an officer of a state chapter, and they must have made and continue to make significant contributions to the addictions field.”8

The American Board of Addiction Medicine (ABAM) is formed in 2007 as a non-profit 501(C)(6) organization “following conferences of committees appointed by the American Society of Addiction Medicine” to “examine and certify Diplomats.”9

In 2009 National Institute on Drug Abuse (NIDA) Director Nora Volkow, M.D., gives the keynote address at the first ABAM Screen Shot 2014-11-18 at 10.12.23 AMboard certification diploma ceremony.10

According to an article in Addiction Professional “Board certification is the highest level of practice recognition given to physicians.”

“A Physician membership society such as ASAM, however, cannot confer ‘Board Certification,’ ” but a“ “Medical Board such as ABAM has a separate and distinct purpose and mission: to promote and improve the quality of medical care through establishing and maintaining standards and procedures for credentialing and re-credentialing medical specialties.”

The majority of ASAM physicians meet these requirements by “working in a chemical dependency treatment facility, taking continuing medical education courses in addiction, or participating in research.”11

“In the United States accredited residency programs in addiction exist only for psychiatrists specializing in addiction psychiatry; nonpsychiatrists seeking training in addiction medicine can train in nonaccredited ‘fellowships,’ or can receive training in some ADP programs, only to not be granted a certificate of completion of accredited training.”11

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Specialty recognition by the American Board of Medical Specialties, fifty Addiction Medicine Fellowship training programs and a National Center for Physician Training in Addiction Medicine are listed as future initiatives of the ABAM Foundation in 2014.

The American Society of Addiction Medicine’s mission is to “establish addiction medicine as a specialty recognized by professional organizations, governments, physicians, purchasers, and consumers of health care products, and the general public’12   

In this they have succeeded.

And in the year 2014 G.V. Stimson’s characterization of the “impaired physician movement” remains as accurate and apt as it was in 1985. But the “number of evangelical recovered alcoholic and addict physicians” has increased dramatically  (outnumbering Addiction Psychiatry by 4:1)  and their involvement in  medical society and treatment programs” has been realized and enforced through the state Physician Health Programs and their “PHP-approved’ assessment and treatment centers.Screen Shot 2014-11-18 at 10.11.55 AM

Their “ability to make authoritative pronouncements on physician impairment…based on their own claim to insider’s knowledge”  has become public policy and sanctified by Regulatory Medicine -essentially the Word of the Lord.

And the 1953 Alcoholics Anonymous prophecy that “With one arm around the shoulder of religion and the other around the shoulder of medicine, we might change the world” is also coming to pass.

But the world is not changing for the better as that arm around the shoulder of religion has its fingers deep in the pockets of the multi-billion dollar drug and alcohol testing and assessment and treatment industries.  And the arm around the shoulder of medicine has its fingers clamped tightly around its throat; a stranglehold in full throttle suffocating the Profession of Medicine with no meaningful opposition I can see.

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  1. Stimson GV. Recent developments in professional control: the impaired physician movement in the USA. Sociology of health & illness. Jul 1985;7(2):141-166.
  2. Four Decades of ASAM. ASAM News. March-April 1994, 1994.
  3. Freed CR. Addiction medicine and addiction psychiatry in America: Commonalities in the medical treatment of addiction. Contemporary Drug Problems. 2010;37(1):139-163.
  4. American Medical Society on Alcoholism & Other Drug Dependencies Newsletter. Vol III. New York, NY: AMSAODD; 1988:12.
  5. Ursery S. $1.3M verdict coaxes a deal for doctor’s coerced rehab. Fulton County Daily Report. May 12, 1999b 1999.
  6. AMSAODD News. Vol III. New York, NY: American Medical Society on Alcoholism & Other Drug Dependencies; 1988.
  7. Membership Campaign Update. ASAM News. Vol VIII: American Society of Addiction Medicine; 1993:11.
  8. ASAM News. Vol 12. Chevy Chase, MD: American Society of Addiction Medicine; 1997:20.
  9. http://www.abam.net/about/history/.
  10. Kunz KB, Gentiello LM. Landmark Recognition for Addiction Medicine: Physician certification by the American Board of Addiction Medicine will Benefit all Addiction Professionals. Addiction Professional. 2009. http://www.addictionpro.com/article/landmark-recognition-addiction-medicine.
  11. Tontchev GV, Housel TR, Callahan JF, Kunz KB, Miller MM, Blondell RD. Specialized training on addictions for physicians in the United States. Substance abuse : official publication of the Association for Medical Education and Research in Substance Abuse. Apr 2011;32(2):84-92.
  12. http://www.asam.org/about-us/mission-and-goals.

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Win a 1964 Rolling Stones Vinyl  45 signed by Mick Jagger, Keith Richards, Brian Jones, Bill Wyman and Charlie Watts–It is yours if you can show physician health program director Dr. Luis Sanchez committed fewer than 3 felonies!

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via Win a 1964 Rolling Stones Vinyl  45 signed by Mick Jagger, Keith Richards, Brian Jones, Bill Wyman and Charlie Watts – just detect fewer than 3 felonies in the attached documents.   

It has been almost 1.5 years since I offered over $25 thousand dollars in cool prizes to anyone who could show that past president of the Federation of State Physician Health Programs (FSPHP)  and Medical Director of Physician Health Services, inc. (PHS) Dr. Luis “the dirty” Sanchez did not commit multiple felonies  (December 9, 2016).  All of the the prizes can be seen below.

I am Offering Over $25,000 in cool prizes to anyone who can show past FSPHP President Sanchez did not commit at least 3 felonies based on documentary evidence alone! I claim the documents show direct evidence of multiple serious crimes –prove me wrong and the whole lot is yours!

Perhaps the booty isn’t good enough so I added a 1964 Decca  7″ 45 RPM original pressing of Little Red Rooster  (A) and Off the Hook (B) on vinyl signed by Mick Jagger, Keith Richards, Brian Jones, Bill Wyman and Charlie Watts.  . All anyone has to do is look at the documents and show how Sanchez committed fewer than three felonies. If Sanchez committed only two felonies you win!  If Sanchez committed just one felony you win!  Simple enough? Should be easier than HQ.

Dr. Sanchez machinations and misconduct can be seen here.  It took a formal complaint with the College of American Pathologists to get the truth out.  More of this fiasco can be seen here and here.   What Sanchez  and his co-conspirators did is egregious and ethically reprehensible.  It shows a complete lack of moral compass and personal integrity.  What was done from collection to report to coverup  and everything in-between is in fact indefensible on all levels (procedurally, ethically, and legally).  So too are the actions of Board attorney Deb Stoller (who not only covered it up forensic fraud but was complicit in it) and those of Assistant Attorney General Bryan Bertram (who is continuing to participate in a cover-up of a cover-up) in violation of ethics and professional conduct. In a perfect society Sanchez would have his medical license revoked and the other two would have been disbarred by now.  In a perfect society all three would be held accountable for crimes.  Does Bertram’s superiors know what he is doing? I don’t think so.  They will at some point.

I think everyone would agree that there should be zero-tolerance for forensic fraud and cover-up and cover-ups of cover-ups in positions of power.    Any person of honor and civility would agree. The documentary evidence shows with clarity that this subterfuge and chicanery was not accident or oversight.  It was intentional and purposeful misconduct.  It is indefensible. Attorneys cannot ignore the obvious.

Transparency, regulation, and accountability are necessary for these groups.

To be fair if Sanchez  can give any  procedural, ethical, or legal explanation for his actions then I stand corrected.  Same applies to his apologists, lackeys and  morally challenged counterparts Stoller and Bertram.  Just one will suffice.  I’ll erase my blog and vanish into oblivion.  No questions asked. Into the woodwork.  But If this trio  cannot then this malfeasance needs to be addressed openly and publicly.   It is their agencies responsibility to correct this –however late the hour may be.  My suspicion is that all of this has been blocked from going upstream.

Forensic fraud has grave and far reaching effects and in this case has severely impacted many people and includes patient deaths. Perhaps this trio needs to take a “moral inventory” and see that this this type of behavior causes real damage to real people and put a faces on it.  The increasing comments on Pauline Anderson’s latest Medscape article would be a start.

Perhaps Sanchez, Stoller and Bertram  need to be asked these questions by an  investigative reporter. Direct and simple questions deserve direct and simple answers.  “Not my department” and “no comment” are no longer acceptable.  We need to demand answers.

It is people just like this who are killing physicians across the country.   The body count is vast and multiple. This type of behavior is directly and temporally related to the recent epidemic of suicides in doctors.  They have removed themselves from conventional accountability by withholding information and suppressing facts. No longer.  The sympathizers and apologists who refuse to acknowledge or investigate wrongdoing will be held to account. Sanchez, Stoller and Bertram believe they are beyond reproach; complacent in the belief they are protected from harm and insulated from investigation.   The evidence, however, is not going away. Neither am I. Neither are the growing legion of ethical individuals who want to drain this swamp.

Corruption is misuse of entrusted power.  It occurs when those who have been given authority to carry out expected goals instead use their position and power to benefit themselves and others close to them. Abuse of power is particularly egregious when that person is doing the opposite of what he or she is supposed to do.

Accountability is necessary to prevent corruption and necessitates both the provision of information and justification for actions;  what was done and why?   The other defining factor of accountability is the ability of outside actors to punish and sanction those who commit misconduct or wrongdoing.    Without these constraints corruption is inevitable.

This is corruption plain and simple and  The doctors and patients of Massachusetts and the doctors and patients of this entire country deserve better than this.

As no checks and balances exist I am offering 25K in prizes and now adding a 1964 45″ signed by the Rolling Stones; Mick Jagger, Keith Richards, Brian Jones, Bill Wyman and Charlie Watts.  One of the problems in this system cognitive dissonance and the belief that there must be something more to it.  There isn’t.  Fact is I could offer you my car, everything I own or my very soul and you would still not be able to disprove that Sanchez committed multiple felonies, that Stoller not only  covered it all up but was complicit and that Bertram is engaging in a cover-up of a cover-up by misusing administrative law and is in violation of the rules of professional conduct and basic ethics and morality. So here’s the ticket.  Either come get the prizes or help me get this exposed and dismantled.  Either defend them or help me hold them accountable. Silence is not an option.

Source: Adding 1964 Rolling Stones Decca 7″ 45″Off the Hook” Vinyl signed by Mick Jagger, Keith Richards, Brian Jones, Bill Wyman and Charlie Watts to 25 K in prizes previously offered to the first person who can disprove FSPHP President did not commit multiple felonies!
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Article from The Valley Patriot Newspaper: “State Auditor’s Office Protects The Big Swamp From The Law.”

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 is a convenient farce. Almost a rounding error at 0.049% of annual state health costs and 0.27% of the annual national fraud.

The auditor’s enabling statute, MGL ch. 11 § 12, declares: “Section 12. The department of the state auditor shall audit the accounts, programs, activities and functions directly related to the aforementioned accounts of all departments, offices, commissions, institutions and activities of the commonwealth, including those of districts and authorities created by the general court and including those of the income tax division of the department of revenue.” Note it says SHALL, not may if you feel like it.

The state auditor’s office goes after poor people to conceal the fact that the vast majority of our ‘departments, offices, commissions, institutions and activities’ go totally unaudited. As a matter of common sense, where do you think the vast majority of the money disappears? Naturally we didn’t hear about the invisible State Police salaries from the state auditor either.

For three years now Dr Michael Langan and I have been trying to get the state auditor’s office to audit the state medical board and its illegal kickback relationship with the Massachusetts Medical Society. This effort involved emails and meetings in person with Deputy Auditor Ken Woodland and with Director William Keefe, who is with the Bureau of Special Investigations and allegedly the point person to combat white collar crime. As with everything to do with state government, reality is a bummer.

Dr Langan presented Keefe with hard evidence that showed Board lawyer Robert Harvey fabricated a false document to serve as a pretext for suspending a doctor’s license as punishment for refusing to pay extortion money to the medical society. A classic protection racket with license suspension as the Board’s form of breaking the victim’s leg. At a minimum it was Keefe’s duty to report Harvey to the SJC’s Bar Overseers for violating its Rules on Professional Conduct. Keefe did not.

Dr Langan presented Keefe with hard evidence that showed Asst. AG Bryan Bertram consciously lied to the court and concealed evidence of forensic fraud and obstruction. Exactly like the state lawyers did in the Sonja Farak case. At a minimum it was Keefe’s duty to report Bertram to the SJC’s Bar Overseers for violating the Rules and obstructing justice. He did not.

Dr Langan presented Keefe with hard evidence that showed a long-running procurement fraud and kickback scheme between the medical society and Board lawyers that involved hundreds of thousands of dollars. It has been three years and the auditors have refused to audit, let alone report crime.

Two years ago I presented Deputy Auditor Woodland in person with documents showing the renting out of the Board by its lawyers to other doctors in order to ‘take out’ their competition. I also gave him documents showing the parking of tax dollars by the Board in a private foundation invisible to the public. A secret slush fund.

Here is Keefe’s response today (4/4/18): “Sir, As Ken and I have discussed with you and Michael, we will be looking into your concerns when we audit the agency. Bill Keefe.” So, when I report a crime, it is merely ‘my concern.’

It is very difficult to collect the documentary evidence but Dr Langan has done it. And the auditors are angry because now they cannot say they do not know.

Henry Morgenthau proved that everyone at the State dept. knew about the holocaust as it was unfolding and concealed the facts to avoid public pressure to save the Jews. Everyone at the state auditor’s office is no better.

The auditors know that these crimes by Board lawyers and the medical society caused numerous doctors to commit suicide in the prime of their life. These suicides occurred because the state auditor knew about the crimes and ongoing deaths of despair and did nothing. Same as the diplomats at State during the holocaust.

(Bharani Padmanabhan MD PhD is a multiple sclerosis neurologist. On July 12, 2017 the state medical board stole his license because he reported Medicaid fraud to the government. scleroplex@gmail.com)

Senate Bill 286 attempts to rein in dictatorial actions of State Board of Medical Examiners, runaway investigators

This is tomorrow and the link below contains ALL the committee members emails:

http://house.louisiana.gov/H_Cmtes/HealthAndWelfare.aspx

Remember, this has already passed the FULL Senate UNANIMOUSLY (NON-PARTISAN), but the house may be a harder sell.

Our opponents are going to make a big charade. A shit show of logical fallacy and spin. Propaganda, threats and misinformation. During the European witch-hunts the legal notion of crimen exceptum (an exceptional and most dangerous crime] allowed for the suspension of the normal rules of evidence to punish the guilty. Same premise. Sanctimony, feigned piety and hypocritical devoutness will all be used to justify torture and torment. After all that’s a small price to pay when it comes to protecting the public from drug addled doctors throwing opiates out like candy from a parade float.

“Witch hunting,” wrote the historian Rossell Hope Robbins, “was self-sustaining and became a major trade, employing many people, all battening on the savings of the victims.” Same applies to these asshats so if you have not place your vote in this 11th hour then please do so now. Make it short and sweet. Quick and to the point.

I am in FAVOR of SB 286, The Physician’s Bill of Rights

I am a ______ healthcare professional who has been a victim of laws which have provided me no due process. Ordinary procedures are enough to assure the safety of the public without risking the destruction of the lives of good doctors unduly. There is no place in our country for any person or class of persons to be denied due process, period.

For what it’s worth (and sadly) these matters are often decided by the number of FOR letters any given voter has vs. AGAINST letters they have.

Louisiana Voice

Physicians Health Foundation (PHF), which for years has abetted the Louisiana Board of Medical Examiners in targeting vulnerable medical practitioners in a manner reminiscent of the tactics employed by the Louisiana State Board of Dentistry, now finds itself in the crosshairs of State Sen. John Milkovich (D-Shreveport).

Both boards have for years flown under the radar of governors, legislators and the media but more and more, attention is being given to their near-autonomous rule by intimidation and extortion.

PHF, also known as the Healthcare Professionals’ Foundation of Louisiana (HPFL), is located on Bluebonnet Boulevard in Baton Rouge and it currently is about halfway through a three-year, $1.35 million contract with the Board of Medical Examiners to run a “Statewide Operations of Physicians Health Program.”

And, since the Board of Dentistry has been mentioned, it might be worth noting that PHF also is just over a year into a three-year, $287,000…

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