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

As Louisiana dentists testify to the rank corruption of the Louisiana Dentistry Board, Inspector General Street’s investigation is revealed to be so easily dismissive that a former Dental Board executive had to be reminded that he even conducted an investigation at all.

Sound Familiar?

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Via:  Sound Off Louisiana 

Louisiana Inspector General Stephen Street

On Wednesday, April 4, 2018 at the Louisiana Senate Commerce Committee, several dentists and a former Louisiana Dentistry Board (LDB) executive, Diana Chenevert, testified to the rank corruption which has plagued the LDB for years.  They were testifying in favor of SB-260 by Sen. John Milkovich (D-Shreveport).  The bill would allow a person who has a disciplinary action brought against him by a professional licensing board or commission to elect to have the matter moved to the Louisiana Division of Administrative Law for a disciplinary adjudication by an administrative law judge.  Highlights of testimony are provided in the following video:

Highlights of testimony at Louisiana Senate Commerce Committee meting on SB-260.

Especially noteworthy entailing the preceding video is Senate Chairman Martiny asking Ms. Chenevert whether she reported the contents of her testimony to law enforcement (see from 19:27 – 19:59 mark of the video).

Ms. Chenevert first indicated, “no,” (i.e. that she had not reported the alleged criminal activity to any law enforcement agency); however, upon Dr. Ryan Haygood stepping out of his seat on the first row and whispering in her ear, she corrected her testimony to indicate that she had in fact reported the alleged criminal activity to Louisiana Inspector General Stephen Street.
Long-time subscribers to Sound Off Louisiana are well aware of our extensive efforts to demonstrate Street’s extensive historical financial difficulties (Federal tax liens and occupational license tax liens) which demonstrate that he is in no way financially independent as he portrays.
 Street has also been quite sensitive to our questioning of him regarding his independence of the Governor of Louisiana.  Most recently, we revealed former Alcohol and Tobacco Commissioner Murphy Painter’s efforts to strip Street’s Inspector General Office of its law-enforcement status.Over two years ago, we at Sound Off Louisiana were told by several dentists that they had met with Street and that his office had “assured without any doubt that arrests and prosecutions are going to arise from all that has transpired at the Dentistry Board.”  Well, despite all of the alleged criminal acts depicted in the video above, the following letter from Inspector General Street to Sen. Barrow Peacock dated January 25, 2018 demonstrates that, even with all of that alleged criminal activity, Street managed to find a way to “close our file.”:

 

Finally, Stephen Street is required by statute to report instances of potential criminal activity to the appropriate Federal, State, or local law-enforcement agencies.  That fact is evidenced in the following highlighted statute:

We’d love to see evidence of Street having done so regarding the activity described in the above video, but as he will quickly tell you, all of the Inspector General’s records and work papers are privileged.  Our money is on him never having done so, and it provides yet one more reason why his office needs to be abolished just as Corey delaHoussaye called for over two years ago.

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Louisiana Needs to Rein in Unaccountable Medical Board, States AAPS — AAPS | Association of American Physicians and Surgeons

The Louisiana legislature is considering a bill that would give physicians the same due process rights as citizens accused of a crime, instead of treating them as guilty until proven innocent, states the Association of American Physicians and Surgeons (AAPS). Senate Bill 286 by Sen. John Milkovich, D-Shreveport, would assure that physicians have the right […]

via Louisiana Needs to Rein in Unaccountable Medical Board, States AAPS — AAPS | Association of American Physicians and Surgeons

The Louisiana legislature is considering a bill that would give physicians the same due process rights as citizens accused of a crime, instead of treating them as guilty until proven innocent, states the Association of American Physicians and Surgeons (AAPS). Senate Bill 286 by Sen. John Milkovich, D-Shreveport, would assure that physicians have the right to know their accusers and have access to all the evidence and documents acquired in the investigation.

“Medical board proceedings are not like a court of law, where the accused has to be proven guilty before a jury and an unbiased judge,” states AAPS director Jane M. Orient, M.D. “It’s a form of administrative law, where an unaccountable government agency is prosecutor, judge, jury, and executioner. Physicians have little opportunity to present a defense.”

“Sanctions imposed by the board can be the equivalent of a professional death sentence,” she said. “And actual deaths through suicide have occurred, as in the case of a doctor who found that his livelihood was destroyed despite reinstatement of his license.”

There is a nominal (and expensive) right to a review in court, but the Louisiana State Board of Medical Examiners has reportedly not lost a review in 20 years. “Courts typically rubber-stamp the decisions of ‘expert’ boards,” Dr. Orient stated. “Proposed legislation would give a physician the right to a de novo trial, in which the court would look at the evidence first-hand for itself.”

In Texas, where a physician got a rare favorable decision from an administrative law judge, she noted that the judge was forced to resign under pressure from the Texas Medical Board.

Public Citizen opposes the law because it would supposedly “hinder the conduct of LSBME investigations” and thus somehow impede its ability to “protect the public from dangerous doctors.” It especially objects to allowing physicians to request that an investigator be replaced for being “biased, hostile, or unfair.”

“Public Citizen, which styles itself as a ‘consumer advocacy group,’ rates medical boards based on the number of doctors they punish,” states Dr. Orient, “without regard to justice. Truly questionable doctors may get complaints dismissed, while good doctors are ruined, perhaps because they reported a patient safety issue and incurred the displeasure of a politically well-connected entity.”

“The public would not be made safe from criminals by imprisoning people based on anonymous complaints without proof of guilt. Doctors are citizens too, not Public Enemy Number One,” she concludes.

The Association of American Physicians and Surgeons (AAPS) is a national organization representing physicians in all specialties, founded in 1943.

Webinar: The Perilous Physician Licensing Landscape–Kernan Manion, M.D.

Screen Shot 2018-04-25 at 2.14.02 AM.pngA week ago, I presented a live webinar “The Perilous Physician Licensing Landscape” to over 50 physicians with guest panelist Dr. Michael Langan.

Here’s a link to the replay and the handout. You’re welcome to share it with whomever you feel might benefit.

Free webinar: “The Perilous Physician Licensing Landscape”

It’s understandable why so many physicians registered. Because the problem is huge. The numbers of complaints that medical boards receive and investigate (a significant number anonymously) is staggering. And too many physicians are put through a needless “guilty until proven innocent” ordeal costing them tens of thousands of dollars in legal fees and even lost practice income. And that doesn’t even include the financial and immense psychological costs incurred if you’re sent to a Physicians Health Program for “assessment.”

While the threat of a malpractice suit is ever-present, and sadly too many of us know the hazards of being named a defendant, fewer physicians are exposed to the challenge of getting entangled in a medical board investigation, a mandatory PHP assessment or a hostile peer review.

You or a colleague may be amongst them. If so, you’re in that select group of physicians who have to get up to speed quickly in dealing most effectively with these challenges. We can help.

And we know – all too well – that most physicians really have no idea how nasty and complex things can become in these dealings.

Both Michael and I have delved pretty intensively into understanding these entities, their unchecked power and the mind-boggling cost and effort required to challenge their sovereignly immune deliberations, preserve all of one’s due process and civil rights, while maintaining one’s practice and protecting one’s patients from dangerous and unwarranted interruption of care.

Too often, and too late, one may discover that notions of due process are little more than apparitions. That perhaps is the most shocking realization at the outset.

And it really derails most docs.

In our thousands of hours of case consultation and study, we came to some startling conclusions about these processes which we share in our webinar.

We’ve also seen how each physician so ensnared has had to fight their battle as though she or he and their counsel were the only ones who’ve ever travelled this path.

With the overview you’ll get from our webinar, and further the wealth of insight and strategy considerations we offer in consultation, you’ll discover that you and your colleagues don’t have to face this battle alone, using up your life savings and psychological reserves to engage in costly and nearly inevitably futile legal battles.

It’s vital to realize: the decisions you make from the outset of engagement with these entities will set you on a pathway that, unexamined, WILL extremely limit your subsequent courses of action. Bottom line, you’ve got to become fully educated about the territory and the choices you’re given and actively involved in the process. In these cases, ignorance, brashness and passivity spell disaster.

And that’s why we offered this webinar and why we’ve embarked on providing in depth case consultation, guidance and support.

We’re staunch physician advocates who know the territory and who insist on fairness and transparency.

This isn’t about ignoring bona fide issues of legitimate concern. We don’t believe in skirting issues. If a physician or other healthcare provider has a bona fide impairing mental illness or substance abuse problem or significant behavioral disorder (e.g. legitimately assessed “disruptive physician” et al.), we believe they ought to – and need to – address these issues in the most straightforward and ethical manner possible.

But we also believe that EVERY PHYSICIAN and healthcare provider under the jurisdiction of a state occupational licensing board and a so called “Physicians Health Program” not only deserves but is entitled to due process and respectful, professional and ethical treatment.

We know the pain and we know the cost of being ensnared in these potentially career-ending proceedings. We’ve borne witness to hundreds of physicians’ and other healthcare professionals’ stories and offered countless hours of support and guidance.

We have many insights to share about this danger-laden territory, in fact too many to compress into this 30 minute webinar. But we wanted to make sure we provided an overview in the most concise way possible. We believe that this knowledge could mean the difference between returning to practice and having all that you’ve worked for taken away.

Here’s the link again to our free webinar:

“The Perilous Physician Licensing Landscape”

You may also have colleagues who could greatly benefit from this ground-breaking webinar. We welcome getting the word out so we can help guide many more physicians – naive, vulnerable and overwhelmed – through these dangerous straits. So feel free to pass this along. We’re confident they’d appreciate knowing about it too.

Kindest regards,

Kernan Manion, MD

p.s. by the way, we offer all viewers a free 30 minute “case scenario” confidential discussion. The direct link to schedule that is in the replay email you’ll get as soon as you register.

via Webinar: The Perilous Physician Licensing Landscape–Kernan Manion, M.D.

Webinar: The Perilous Physician Licensing Landscape–Kernan Manion, M.D.

Screen Shot 2018-04-25 at 2.14.02 AM.pngA week ago, I presented a live webinar “The Perilous Physician Licensing Landscape” to over 50 physicians with guest panelist Dr. Michael Langan.

Here’s a link to the replay and the handout. You’re welcome to share it with whomever you feel might benefit.

Free webinar: “The Perilous Physician Licensing Landscape”

It’s understandable why so many physicians registered. Because the problem is huge. The numbers of complaints that medical boards receive and investigate (a significant number anonymously) is staggering. And too many physicians are put through a needless “guilty until proven innocent” ordeal costing them tens of thousands of dollars in legal fees and even lost practice income. And that doesn’t even include the financial and immense psychological costs incurred if you’re sent to a Physicians Health Program for “assessment.”

While the threat of a malpractice suit is ever-present, and sadly too many of us know the hazards of being named a defendant, fewer physicians are exposed to the challenge of getting entangled in a medical board investigation, a mandatory PHP assessment or a hostile peer review.

You or a colleague may be amongst them. If so, you’re in that select group of physicians who have to get up to speed quickly in dealing most effectively with these challenges. We can help.

And we know – all too well – that most physicians really have no idea how nasty and complex things can become in these dealings.

Both Michael and I have delved pretty intensively into understanding these entities, their unchecked power and the mind-boggling cost and effort required to challenge their sovereignly immune deliberations, preserve all of one’s due process and civil rights, while maintaining one’s practice and protecting one’s patients from dangerous and unwarranted interruption of care.

Too often, and too late, one may discover that notions of due process are little more than apparitions. That perhaps is the most shocking realization at the outset.

And it really derails most docs.

In our thousands of hours of case consultation and study, we came to some startling conclusions about these processes which we share in our webinar.

We’ve also seen how each physician so ensnared has had to fight their battle as though she or he and their counsel were the only ones who’ve ever travelled this path.

With the overview you’ll get from our webinar, and further the wealth of insight and strategy considerations we offer in consultation, you’ll discover that you and your colleagues don’t have to face this battle alone, using up your life savings and psychological reserves to engage in costly and nearly inevitably futile legal battles.

It’s vital to realize: the decisions you make from the outset of engagement with these entities will set you on a pathway that, unexamined, WILL extremely limit your subsequent courses of action. Bottom line, you’ve got to become fully educated about the territory and the choices you’re given and actively involved in the process. In these cases, ignorance, brashness and passivity spell disaster.

And that’s why we offered this webinar and why we’ve embarked on providing in depth case consultation, guidance and support.

We’re staunch physician advocates who know the territory and who insist on fairness and transparency.

This isn’t about ignoring bona fide issues of legitimate concern. We don’t believe in skirting issues. If a physician or other healthcare provider has a bona fide impairing mental illness or substance abuse problem or significant behavioral disorder (e.g. legitimately assessed “disruptive physician” et al.), we believe they ought to – and need to – address these issues in the most straightforward and ethical manner possible.

But we also believe that EVERY PHYSICIAN and healthcare provider under the jurisdiction of a state occupational licensing board and a so called “Physicians Health Program” not only deserves but is entitled to due process and respectful, professional and ethical treatment.

We know the pain and we know the cost of being ensnared in these potentially career-ending proceedings. We’ve borne witness to hundreds of physicians’ and other healthcare professionals’ stories and offered countless hours of support and guidance.

We have many insights to share about this danger-laden territory, in fact too many to compress into this 30 minute webinar. But we wanted to make sure we provided an overview in the most concise way possible. We believe that this knowledge could mean the difference between returning to practice and having all that you’ve worked for taken away.

Here’s the link again to our free webinar:

“The Perilous Physician Licensing Landscape”

You may also have colleagues who could greatly benefit from this ground-breaking webinar. We welcome getting the word out so we can help guide many more physicians – naive, vulnerable and overwhelmed – through these dangerous straits. So feel free to pass this along. We’re confident they’d appreciate knowing about it too.

Kindest regards,

Kernan Manion, MD

p.s. by the way, we offer all viewers a free 30 minute “case scenario” confidential discussion. The direct link to schedule that is in the replay email you’ll get as soon as you register.

Related:   Guest Post: “The Perilous Physician Licensing Landscape” by Kernan Manion, MD

Guest Post: “The Perilous Physician Licensing Landscape” by Kernan Manion, MD

medico-legal

Over the years, many have visited Michael’s audacious blog as he’s dared open eyes about concealed abuse by medical boards, physician health programs and hospital-based peer review committees. 

Through shared experience, Michael and I have been studying these issues for nearly a decade. We are amongst a handful of physicians nationally who get the big picture and know the career-threatening challenges one faces in responding to and interacting with medical licensing boards, PHPs and related entities.

In fact, we’ve been founding members of a study group loosely referred to as the Coalition for Physician Advocacy (which I’ve cross linked to from here on occasion). Amongst the members of that think tank are a major writer-advocate of PHP reform; an MD JD whose focus is on disability law, mental health issues and litigation stress; a former vice chair of psychiatry at a well-recognized academic center; and an established addictions psychiatrist who is multiply boarded and is also a retired brigadier general. All have come together to address what we collectively feel are major abuses of privilege by a significant number of state medical boards and PHPs. We have observed the remarkable similarity in many of these due process deprived dealings to that of sham peer review. 

You would likely recognize our Coalition members’ names from their prominent articles and comments on many blog pieces over these last several years in Medscape, KevinMD, Medical Economics; Journal of Addiction Medicine; et al. Just look anywhere where Michael or I have posted comments. And with each gathering comment bearing witness to these gross abuses, we are gaining immense strength.

Michael encouraged me to convey through this guest post that we’re offering a free informational webinar “The Perilous Physician Licensing Landscape” on Monday 4/16 at 8pm EDT specifically pertaining to the issues. 

You can register here: http://bit.ly/LicensePeril

Over the years, we have collectively spoken with hundreds of physicians who have shared their stories of abuse at the hands of these agencies and the harm that has ensued to their practices, their careers and their patients. Of course, throughout this ordeal, their personal and family lives have been thrown into turmoil as well.

This concise webinar will provide not only an overview of these key issues and what we’ve learned through hundreds of consultations but also some very practical “do’s and don’ts” in dealing with medical boards and PHPs. And these pertain not only to physicians and all others in healthcare – both with degrees and still in preparation – but to their families and even their counsel. 

We’ve heard many heart-rending stories of immense suffering and injustice meted out by these unregulated entities. Many have been badly traumatized, so much so that they fear retribution and further harm if they dare speak out.

And it’s our goal to use our expertise to help our fellow physicians negotiate their way through these very dangerous waters.

Be sure to join us Monday 4/16 at 8pm EDT for The Perilous Physician Licensing Landscape.”

Register here: http://bit.ly/LicensePeril

And even if you can’t make it, be sure to register in order to get the replay link and any handouts.

I can’t close without offering tribute to Michael’s perseverance in the face of all adversity. He’s continued to expose these abuses, and suffered greatly for it. I am confident, in significant part due to his relentlessly hard-hitting well researched essays, that national exposure is growing, that journalists are taking note and the powers that have so menacingly operated like demonic Wizards of Oz are now having to examine their vulnerability to their reckless sadism being exposed. 

On behalf of Michael and myself, I hope this finds you well and that you’ll be able to join us for the webinar.

Kernan Manion, MD

p.s. In the event that you know of colleagues who might benefit, please share this invite – just copy the url of this webpage and paste it in an email.

p.p.s. And … if you’re on any social media or physician discussion groups (e.g. Sermo, Doximity, LinkedIn et al.), just copy and paste this link below into your post inviting people to attend. Knowledgeable career-saving help is available. You don’t need to face it alone. Learn what you can and need to do to protect your career in the event that your license is jeopardized by these entities. Here’s the link again: http://bit.ly/LicensePeril

Bob Dyer: Fallen physicians are sometimes bullied

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All the way up in British Columbia, Dr. Louise B. Andrew could feel the pain of an Akron nurse who was being financially gouged by a Summa Health rehabilitation program. The internationally known physician/attorney read my column about Brian (his last name was withheld), who was participating in a program for medical professionals who had run into trouble with alcohol and/or drugs and were trying to regain their licenses. Brian was among eight fellow nurses, physicians and pharmacists who were paying $457 each for a 60-minute group therapy session every week. Private half-hour sessions were billed at $247, and each urine drug screen was $150. But Dr. Andrew says that, in the overall scheme of medical professionals trying to work their way back into action, Brian’s financial pain was the equivalent of a boo-boo.

“While the price charged to your Brian was excessive for outpatient group therapy and urine testing, it pales in comparison to what physicians are typically charged for ‘specialized’ ‘rehab services,’ ” Andrew wrote in a lengthy email.

“Physicians are almost always sentenced to 90 days inpatient stay in one of a handful of ‘preferred’ facilities … [a designation based] primarily on the willingness of the facility to tailor the diagnosis according to the recommendation of the PHP [Physician Health Program].”

“The ‘specialized’ ‘services’ provided at these facilities are AA meetings run by high-school-educated recovering addicts. The costs can typically be in the range of $1,000 to $1,500 per DAY. They’re not covered by insurance (avoids the possibility of insurance fraud) and typically must be paid in cash up front.

“Physicians are told that their license is worth re-mortgaging their homes, sacrificing their children’s educational or their own retirement funds. If the physician refuses, he or she is reported to the medical board as being ‘in denial’ — even when there is little or no evidence of substance use or abuse — and the typical result of such reporting is licensure loss.

“I know this from consulting with numerous physicians across the country who have been subjected to this scheme, resulting in bankruptcy, homelessness and, in some cases, suicide.”

In addition to writing and lecturing, she uses her law degree to assist physicians who need legal help.

Andrew runs a number of websites (among them: http://www.mdmentor.com and http://www.physiciansuicide.com.) and is highly involved in suicide prevention for doctors — a bigger problem than you might guess.

Oddly enough, Andrew was originally a big fan of PHPs, saying they were a safe alternative to suffering in silence. But as a recent article in Clinical Psychiatry News pointed out, after serving as the liaison from the American College of Emergency Physicians (ACEP) to the Federation of State Medical Boards from 2006 to 2014, she had a major change of heart.

Today, she is worried that PHPs “may have taken on the role of what is more akin to ‘diagnosing for dollars.’ ”

In a column for Emergency Physician’s Monthly, she wrote, “My convictions have changed dramatically. Horror stories that colleagues related to me while I chaired ACEP’s Personal and Professional Well-Being Committee cannot all be isolated events.

“For example, physicians who self-referred to the PHP for management of stress and depression were reportedly railroaded into incredibly expensive and inconvenient out-of-state drug and alcohol treatment programs, even when there was no coexisting drug or alcohol problem.”

(If you want to know more about this, Andrew goes into great detail at http://bit.ly/PHP_MLB)

To be sure, nobody wants to be treated by a doctor who is suffering from drug and/or alcohol problems.

But if we really believe addictions are diseases, rather than criminal activity, and if we believe that rehabilitation is possible, these physicians ought to have a path back that has a lot less to do with lining pockets and a lot more to do with healing.

Bob Dyer can be reached at 330-996-3580 or bdyer@thebeaconjournal.com. He also is on Facebook at http://www.facebook.com/bob.dyer.31

Source: Bob Dyer: Fallen physicians are sometimes bullied

 

 

The Need for Regulatory Oversight of Laboratory Developed Tests (LDTs) in Drug and Alcohol Testing

Disrupted Physician

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Laboratory Developed Tests

Questions about the accuracy and marketing of Laboratory Developed Tests (LDTs) led to last years debate on whether or not  the U.S. Food and Drug Administration (FDA) should regulate a subset of diagnostic tests currently exempted from oversight. Designed to bring clinical tests to market such as those for rare diseases that the costly FDA process would otherwise preclude,  the LDT pathway bypasses Federal regulation and oversight.  The LDT pathway additionally bypasses any semblance of accountability. It is an honor system and, as with any honor system, it is a system that can be exploited by the dishonorable.

Questions about the validity of these tests raised concerns over patient safety and this led to a call for oversight.  Among those asking for regulation were  Massachusetts Senators Edward J. Markey and Elizabeth Warren.

Opponents of regulation argued that  the LDT  pathway enables new and pioneering tests to be developed quickly and improve patient…

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