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

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

Michael Langan, M.D.

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

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

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

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

Depression and Substance Abuse no Different from General Population

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

Job Stress and Untreated Mental Illness Risk Factors

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

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

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

Perceived Helplessness, Hopelessness, Bullying and Defeat

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

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

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

Organizational Justice Important Protective Factor

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

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

Historical Precedent-the Suicides at Ridgeview

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

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

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

Contingency Management = Extortion Using Medical License

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

Fraud, Malpractice, False Diagnoses and False imprisonment

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

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

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

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

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

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

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

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

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

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Urgent Need to Admit to the Problem

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

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

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

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

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

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

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

 How many more must die before this happens?

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

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  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.
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  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.
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  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

Rep. DeFazio – Dr. Dover vs. The Oregon Medical Board

Rep. DeFazio – Dr. Dover vs. The Oregon Medical Board
— Read on drdovervsomb.weebly.com/rep-defazio.html

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Emergency Physician with Depression Chronicles Her 10-Year Fight to Keep Her License – ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.
— Read on www.acepnow.com/article/emergency-physician-with-depression-chronicles-her-10-year-fight-to-keep-her-license/

Systematic Abuse and Misuse of Psychiatry in Physicians’ Health Programs Discussed in the Journal of American Physicians and Surgeons

TUCSON, Ariz., Dec. 7, 2018 /PRNewswire/ — Physicians’ Health Programs (PHPs) are part of the medical regulatory-therapeutic complex intended to protect the…
— Read on www.prnewswire.com/news-releases/systematic-abuse-and-misuse-of-psychiatry-in-physicians-health-programs-discussed-in-the-journal-of-american-physicians-and-surgeons-300761899.html

“There are risks and costs to action. But they are far less than the long range risks of comfortable inaction”- John F. Kennedy

via “There are risks and costs to action. But they are far less than the long range risks of comfortable inaction”- John F. Kennedy

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“There are risks and costs to action. But they are far less than the long range risks of comfortable inaction”- John F. Kennedy

Born – May 29, 1917
Brookline, Massachusetts,
Died- November 22, 1963
Dallas, Texas, aged 46

“A man does what he must–in spite of personal consequences, in spite of obstacles and dangers and pressures–and that is the basis of all human morality.”–JFK

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Thanksgiving Day Proclamation 1963-JFK

“As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them.”– Thanksgiving Day Proclamation 1963—John F. Kennedy.

IMG_1072Let us therefore proclaim our gratitude to Providence for manifold blessings–let us be humbly thankful for inherited ideals–and let us resolve to share those blessings and those ideals with our fellow human beings throughout the world.

On that(this) day let us gather in sanctuaries dedicated to worship and in homes blessed by family affection to express our gratitude for the glorious gifts of God; and let us earnestly and humbly pray that He will continue to guide and sustain us in the great unfinished tasks of achieving peace, justice, and understanding among all men and nations and of ending misery and suffering wherever they exist.

–Thanksgiving Day, 1963

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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.

 

Comments on Medscape (as of November 24, 2018)

Dr. Patrick Bradley|  Family Medicine 

The dilemma facing doctors in an emotional crisis is illustrated by an article this monthin the Sydney Morning Herald by Professor Steve Robson, president of Royal Australian and New Zealand College of Obstetricians and Gynaecologists, entitled  THE KNOCK ON THE DOOR THAT STOPPED MY SUICIDE …….”. He said that he “ found medical school difficult – I was not a natural academic……Halfway through 1988, I felt overwhelmed with inadequacy. I had a patient die and I felt responsible. My consultants ….were not exactly glowing in their feedback……I had an all pervasive sense of failure….I could see no way out…So one night I made careful plans to kill myself…..I stole some supplies from the wards…..Incredibly , a work colleague arrived unexpectedly and began knocking on the door…That impromptu visit saved my life….I made an appointment with a GP ( Family Medicine Practitioner)in the town. To this day I remember this GP’s advice: Under no circumstances tell anybody or see a psychiatrist…..If I had a record of suicidality or mental illness, I would never be able to income-protection insurance and I would probably never get a good job….I tried antidepressant treatment but I remember it being very unpleasant ……The GP warned me that if anyone found out about prescriptions for antidepressants I might be in trouble with the Queensland Medical Board, perhaps struck off until I could prove myself….. Today, I am president of my college. I have had a good career. There was light at the end of the long, dark tunnel. I just couldn’t see it at the time……Today I am not ashamed of how I felt or what I did 30 years ago. I am ashamed that I have not used my position to advocate more strongly for colleagues in difficult emotional circumstances. …. When trainees of the college of which I am president took their own lives , I stayed silent. When a junior doctor took his own life while working at the same hospital where I tried the same thing I stayed silent. Enough silence……If you feel the way I did 30 years ago , seek help. Who knows where you might end up.”

Ayanya Toldstory|  Psychologist 

@Dr. Patrick Bradley Thank you for sharing your story, Dr. Bradley. Space is very limited here. I believe Dr. Manion stated he was planning to write a book based on the stories of physicians and other healthcare professionals who’ve been abused by their boards. In your story, a GP was telling you to NEVER go to a psychiatrist and she told you an Rx for anti-depressants could cause you trouble given the nature of boards and their associates. Then you stated that things have changed and you are now doing well and you feel you took the right action so many years ago. I feel as if I missed the middle rel in the film. I would love to somehow know more about the B between the A and C.

Dr. Kernan Manion|  Psychiatry/Mental Health 

In the US, the primary issue is not shame in having an episode of “mental illness” per se (a poor term itself), it’s being corralled into a state-sponsored diagnosis and treatment racket and then having your career ruined. The very intervention causes mental illness! Finally, due to the efforts of diverse groups, state medical boards have been cautioned about asking invasive questions on license applications and renewals about one’s personal history of such illness.

Even there, the primary issue wasn’t about the asking of the questions, it was what happened after one answered in the affirmative about a current (and in treatment) or past episode of a “mental illness” like an episode of depression or anxiety. One would then be sent to what amounts to a pseudo-psychiatric RICO and then have one’s life ruined by a supposedly benevolent agency acting on behalf of the state to “protect the public.”

Part of this horrific scenario has to do with these agencies’ play on the taboos around the term “mental illness.” Having an episode of a readily treatable emotion-centric illness which has somatic representations, i.e. depression or anxiety, takes on an entirely different meaning under the term “mental illness.” Thus, all situational episodes of such an illness get classed under this term which has too many taboo associations which evoke images of zombie-like people walking around Frankenstein-like with frontal lobectomies.

It’s a compound problem that can’t be fully addressed here. Suffice it to say that 1) having an episode of a mental-based illness which is treatable is not the same as being “mentally ill;” and 2) such is nevertheless rightfully in the domain of one’s utmost protected health information and should never be revealed to a licensing entity without solidly established cause and protection from harm. And I would add an additional caveat: given the horror stories from states across the country pertaining to abuses of psychiatry by state-sponsored physician health programs (PHPs), no physician in their right mind should participate in one without thorough research into its integrity, sensitivity and mechanism of grievance. PHPs’ own trade association FSPHP refuses to intervene in cases of reported abuse by its members and refuses to allow institution of a nationally standardized external audit. What are they afraid of?

Dr. cathryn wield|  Emergency Medicine 

Why is the general press not aware of what is going on?  It seems that there is a consensus of opinion here – physicians prepared to go ‘on the record’.  What has been said in this article is surely a national scandal! I am British (although living in Colorado) and have elsewhere on Medscape commented on our own Doctors Support Network, run by doctors for doctors. We are a small nation and comparable in size to ‘one state’ in many ways, so I realize that comparisons are not valid.

The British physician regulatory body the GMC (General Medical Council) has been brought to task, because of the seriously high rate of suicide of doctors who are ‘referred’ to them for ‘investigation’. It is a worldwide problem.

Doctors are patients too. They require the same degree of high quality, confidential advice and treatment as anyone else – more so when mental health is concerned. When this is not in place, fear prevents timely help and treatment – we all know that – it is obvious. I wrote something similar to this as a letter to the ‘GMC News’ in 2004, three years after my complete  recovery and return to work from a prolonged and severe depression.

However the reality is that until doctors start speaking out about their mental health, the successful treatment and recovery, as well as the horror stories, this will not change.

Thank you to those who have done this already. We need more to come forward. The shroud of secrecy needs to be broken. We cannot tell our patients that there is no shame in being mentally ill if we do not believe this ourselves.

Dr. Kathryn Kennedy|  Psychiatry/Mental Health 

We have needed this for so long now!

Dr. David Ostrow|  Psychiatry/Mental Health 

I don’t think that I have ever seen a MedScape article on such a controversial subject that received unanimous support from so many commentators and from many extremely prominent senior physicians whom I respect for their ethical and common sense approach to difficult issues. My heart goes out to the woman who lost her son due to the over-reaching and inappropriate actions of a State PHP, and to all the practitioners who described the Kafka-esque treatment they received. And if the AMA and other National Medical Associations won’t investigate and put an end to these abuses, where are our State Medical Boards in sorting out this mess? Surely they aren’t all run by persons with COIs that are personally profiting at the expense of the physicians (and their patients) being destroyed by unsubstantiated allegations and diagnoses! Obviously, the takeover of US healthcare by for-profit companies has done more harm than lining the pockets of health corporation executives and insurance companies with the resources that should be going into service delivery.

Ayanya Toldstory|  Psychologist 

@Dr. David Ostrow  Please don’t call me Shirley. : ) Seriously though, It is not simply wishful thinking to believe that not ALL State Medical Boards could be thick with the Conflicts of Interest (COI) you mention. There is logic to the proposition. However, we must remember that there are centralized “unifying” players who in the name of “standardization,” wield great influence. I won’t go into the natural dynamics here, but there is a Federation of State Medical Boards. As they lean, likely the others in the Federation lean. Personally, I have not heard any tales of “Great Debates” or splits within the Federation (FSMB). That’s not good.
Dr. Kernan Manion|  Psychiatry/Mental Health 

@Dr. David Ostrow

Unfortunately, neither AMA nor APA appear to be particularly concerned about the gross abuse of psychiatry by boards, PHPs and so called peer review committees. Nor aboutthe ensuing irreparable harm to physicians and to THEIR patients, not to mention to their already overworked colleagues who are saddened and burdened by their regulatory ensnarement but feel helpless to intervene.

Make no mistake, there ARE just medical boards and compassionate and ethical PHPs. Likewise can be said for the legal system where there are non-power abusing prosecutors and fair judges. But that doesn’t mean that there can’t be rot in the judicial system that results in a horrible miscarriage of justice. Sadly, the same for boards, PHPs and peer review entities. And with neither governmental oversight nor medico-legal accountability, and operating with virtually iron-clad immunity from suit, the means of confronting and correcting these administrative prosecutorial abuses is essentially non-existent.

I’m hopeful that both AMA and APA will soon come to their senses, if only due to demand by their newly aware members confronting them with these horrors. But if they don’t, when these abuses are made visible which they inevitably will be (one only recall the Catholic Church and Penn State pedophilia scandals), it’s hard to imagine physicians keeping their memberships in organizations that permit such abuse of their members.

Then again, and I dread to conceive it, it’s possible that membership “has its privileges” and the abuse so tyrannically dispensed is disproportionately weighted towards those not protected by such membership and inner circle connectedness. After all, multiple medical societies proudly exclaim their parental role in creating their states’ PHPs. It’s not inconceivable that they have amongst their membership directors of some of these PHPs as well as those having financial ties with the “preferred programs.” It is well known that one or more PHP directors are esteemed members of their national societies.

This would be troubling indeed, but could certainly account for AMA’s and APA’s apathetic response.

Meanwhile, what to do? Caveat doctor. Consider carefully where you want to practice. If medical boards, PHPs and peer review committees can irreparably harm physicians’ hard earned careers and do so with impunity and with no legal recourse for the physician, why risk practicing in such a state? Perhaps it’s only when a state cannot recruit top medical talent and is seen as a 3rd rate medical system that its governor and legislators will finally choose to act.

Dr. M S|  Internal Medicine 

Rise up-fight the Power!

Ayanya Toldstory|  Psychologist 

@Dr. M S  Cheers to that! Except for the fact that I don’t like to fight. Sigh. Hopefully fighting now will lead to reforming and replacing the present powers with sensible and fair powers, bringing about a return to sanity. But now? Yes, we MUST fight. It WILL be worth it. One of the things we must do is to dispell the idea that there are magic “others” among us who will do the fighting while the rest stand back and await the outcome. There are no magic “others.” Whether you are drafting demands in your own state or assisting someone who is doing this, you must expect that if YOU aren’t fighting, fighting isn’t happening.

Dr. Patrick Bradley|  Family Medicine 

Dr Kernan Manion is to be congratulated for founding the Centre for Physicians Rights after his own shocking treatment by the Medical Board and its Physician Health Program.

We had the same problem in Australia until a spate of young doctor suicides forced authorities to look again at this entire process including the Mandatory Reporting Laws concerning health professionals. Such secretive processes are open to abuse and are now being reviewed.

The most high profile case was that of Dr Chloe Abbott , a 29 year old doctor in training , and a former national representative swimmer. She was a tireless advocate for doctors in training and a representative on AMA and national health bodies negotiating with political leaders.

When a close friend, also a doctor in training , committed suicide Chloe became depressed. Her registration was suspended and she was committed to a psychiatric hospital for two months. After her discharge she also took her own life. Her family were appalled at the way she was treated. Her sister Micaela Abbott summed up the way Chloe had been treated , “ eaten alive by the medical profession.” Her mother Leonie Eagles said she would advise all parents not to let their children study medicine.

These Physician Health Programs seem to have more in common with totalitarian government’s “re-education” camps than the humane therapeutic programs that Dr Karl Menninger would have provided.

One has to wonder whether enforced psychiatric treatment is more harmful than no treatment at all.

When one also considers the high rate of burn out and suicide in the medical profession and that many doctors regret that they chose medicine and would not advise their own children to study medicine then something is surely wrong.

Once again thank you Dr Kernan Manion for your well needed and courageous initiative.

Dr. Kernan Manion|  Psychiatry/Mental Health 

@Dr. Patrick Bradley Deeply appreciative of your comment and sharing Dr. Abbott’s story. I and my colleagues at CPR have received a deluge of mail detailing horror stories of their own or of a colleague’s abusive treatment. We’re compiling a book of stories of physicians’ Kafkaesque experiences in this dystopian medical regulatory nexus. We also anticipate upcoming articles expanding the traditional definition of abuse of psychiatry to encompass this shadowy and thoroughly unregulated nexus. We know we have a growing base of physicians, lawyers, legislators and association leaders who are eager to confront this menace to physician wellbeing but thus far have had no means of doing so. While extraordinarily lackadaisical (if not professionally negligent), we anticipate that AMA and APA will come to their senses when physicians – some of whom are their members – publicly share their stories of abuse. Currently, neither the Federation of State Medical Boards nor the Federation of State Physician Health Programs has shown one iota of concern or need for self-examination. This is indeed regrettable.

We’d welcome your submitting Dr. Abbott’s story for the book and invite all physicians and significant others to submit their stories for consideration of inclusion. We can be reached via the website linked in the Medscape article.

Dr. Louise Andrew|  Emergency Medicine 

@Dr. Patrick Bradley Chloe Abbott’s story is truly a travesty.  Reprehensible that it took shaming of the agencies involved regarding two senseless suicides of promising young physicians to force needed change in your country’s system.

I’m sure similar tragedies have happened in the US and in Canada, and it simply has not yet come to national attention because of the stigma and probably disbelief on the part of reporters that such could happen in a country supposedly governed by rule of law, and at the hands of fellow physicians, whose entire profession is founded on relief of suffering and disease, and whose oath after all, is first, to Do No Harm.

Physicians have allowed this to happen, by ignoring the problem, by labeling sufferers as “impaired” and in need of “rehabilitation” which just happens to be available at considerable cost and extraordinary length of stay because of unholy alliances between those who provide such expensive “rehabilitation” and those who diagnose the need for such using unscientific methods and ignoring accepted medical criteria—based upon a profit motive.

Only physicians ourselves can begin to address the problem.  We can’t depend on organized medicine however, because largely the same individuals are in power in organized as in regulatory medicine.

No, it will require grass roots effort, by those who acknowledge the potential impact of Niemoller’s vignette upon physicians ourselves.  Thus, the critical need for CPR.

Dr. John DeBanto|  Gastroenterology 

I am happy to see that such an organization exists.  Too often physicians are vilified for relatively minor indiscretions.  There does not appear to be an alternative to help physicians who may want it or need it.  Rather, their admission is penalized so  many suffer in silence as they are afraid to come forward.  Furthermore, those that submit anonymous accusations are not held accountable if they are wrong.  By then, the physicians reputation and status is ruined.

Dr. Michael Langan|  Internal Medicine 

The AMA’s “not my department” response is unacceptable.  It is the same tinkering with the laws and statutes of the local state legislature that has allowed this to occur. The fundamental freedoms and rudimentary rights of health care practitioners have been removed all under the banner of “protecting the public.”  They are not protecting the public and many are being harmed. Silence, deflection and anonymity in response to a nationwide and serious problem is unacceptable. DisruptedPhysician,com/blog

Michael Rosenblatt|  Other Healthcare Provider 

Regulation is seen by some law-makers as a  way to protect the public. But it also has a dark side, one that is experienced by any doctor who has been or is a victim of sham peer review. Regulation can be “molded” by people who are in power to use successfully against their adversaries for a variety of reasons, almost none having to do with protecting the public.

One example is practice committees, which are used by hospitals to get rid of doctors who may challenge their ruling class. In almost any specialty it is easy to find certain practices that are “controversial.” These can be cherry picked to push the balance against any physician who takes on difficult cases. Before they know it, they have a Board action against them. Perhaps it was authored by a colleague who has a reduced patient volume since you got into town? Did you speak brusquely to a hospital employee or nurse? Did you accidentally snub a colleague and insult them? Do you have an open political difference or have been politically active against legalized abortion?

The National Data Bank was established to protect the public against “bad” doctors jumping from state to state. Now it has be weaponized against largely innocent physicians to prevent lawsuits by them against hospitals.

I don’t want this note to be political. But  when discussing sham peer review it is inescapable. In the US, states are largely and historically defined  for controlling healthcare and practitioners, NOT Federal Government.  Some wish to reverse that metric.

Fortunately there are other people interested in helping physicians deal with sham peer review. The Center for Peer Review Justice is another. Perhaps surprisingly, it is run by a podiatrist who has garnered over 16 years of successful battles in this arena for his mostly MD clients. Because you essentially have NO Constitutional right to practice medicine, lawyers have few options. If you dare instigate a lawsuit, you can and will expect to be Data Banked in retribution.

Sham peer review has led to the suicides of caring doctors. I caution all physicians to recognize that not every US political party believes in “control by regulation.” Whom you vote for counts.

Michael M. Rosenblatt, DPM

Ayanya Toldstory|  Psychologist 

@Michael Rosenblatt Thank you, Dr. Rosenblatt. Well stated. More than more exposé, you are helping to reveal the mechanics of this “machine.” It is in fact time for us to begin turning in this direction. It is extremely important to have urgent individual resources available to us when we find ourselves injured but we also need to neutralize the injurers.

Dr. Kernan Manion|  Psychiatry/Mental Health 

Over the five year course of our Physician Advocacy Study Group, we – about a dozen physicians of various specialties – have spoken or corresponded with literally hundreds of physicians around the country who have shared horror stories about their abuse at the hands of medical boards, physician health programs (“professional assistance” type programs) and dishonest (sham) peer review committees.

Some in the group are themselves survivors of this abuse; others are deeply impassioned ethical physicians who have consulted on and treated falsely diagnosed or falsely framed physicians.

Our inquiry began with a belief that this was a travesty of justice for just a few unfortunate physicians caught up in an unregulated system. But as we compared notes, and then commented in articles just like this one, and received emails and phone cals from other physicians and lawyers around the country, we realized this was much larger than just a few docs wrongfully apprehended in a disciplinary roundup.

As @Dr. Jesse Cavenar & @ Dr. Anne Phelan-Adams noted in their Niemoeller quote, there’s a natural tendency to avoid involvement with issues like this. For one, the administrative injustice and the accompanying psychological abuse is so mind-boggling as to be unbelievable – as in “that just can’t be.” For another, there’s fear of retaliation. And another, the comforting belief that there MUST be justice available for these docs, or that surely they MUST’VE done something wrong.

I and our study group can assure you – this abuse is real and its breadth and severity jaw-dropping. And it shows no signs of letting up. Because there is no government oversight of these regulatory entities and no legal accountability. Boards can make whatever accusations they want and legally overpower you and drive you to bankruptcy. PHPs can make up whatever diagnosis they want, order you to their “ referred” programs and essentially brand you as mentally ill for life. And there is utterly NO INTEREST by the professional societies which should protect physicians’ rights in investigating this. One must wonder why.

And physicians must begin demanding answers.

Check out the website: http://www.physicianrights.net. We’re going to be publishing a book very soon featuring physicians’ stories and practical advice. Sign up on the website to stay informed and join us in making positive change to protect physicians’ – and patients’ – rights.

Dr. Danielle Cherdak|  Neurology 

I am heartened to see this article and to know that these amazing people are doing something I have only dreamed about doing myself.

Dr. Jim Behan|  Psychiatry/Mental Health

I wish this group success. ‘What is potent for good’ (the protection of the public) ‘is powerful for evil’ by an unregulated and unchecked abuse of power which oppresses good doctors. How is that in the public interest? The ghost of Kafka still shuffles its faltering way through the rack employed by unethical abuse of power and lack of due process.

Dr Jim Behan Psychiatrist

Ayanya Toldstory|  Psychologist 

It appears that this article has come to the attention of a Facebook group called Patient Safety Action Network (PSAN) Community. It seems as if the group is made up of some sincere good people who have had difficulties with Medical and other Healthcare Regulatory Boards from the patients’ end. From what I can gather, many of them have complained to the Medical Boards in their states and have been brushed off. It seems as if they have found it next to impossible to get any real action. One contributor suggested their contributors write comments on this article. Please feel free to differ, but I think it would be wonderful for them to write in and give us an opportunity to create an alliance. Imagine their concern. They (as patients and patient advocates) have NO way to feel confident in their providers. I would like to validate this concern and validate their very legitimate fears. We (healthcare providers) believe it or not, are patient advocates too. Unfortunately, I am acutely aware that not healthcare providers are patient advocates. Not all healthcare providers are ethical. Not all healthcare providers are competent. Real protection of the public and of patients is going to come when we as a society can RELIABLY tell the difference. Healthcare Regulatory Boards (not all, but unfortunately most, I believe) have betrayed us – as have the State governments which house them. They DO NOT protect the public. Because of the way they are structured GOOD, ethical and competent, and indeed, some of the BEST providers are attacked and destroyed while truly dangerous, unethical, self-serving, “well-connected” providers are allowed to slide when complaints are made against them, and they are allowed to remain in circulation. Whether it be the Patient Safety Action Network or any other person or group concerned FIRST about patient safety, we are on your side. Please join us in finding a path to transparency, justice, and safety we can ALL have confidence in.

The Healthcare Alliance for Regulatory Board Reform (HARBR) supports the Center for Physician Rights (CPR) for the sake of patients and the GOOD providers who put them first.

Dr. Anne Phelan-Adams|  Family Medicine 

@Ayanya Toldstory Hello Ayanya.  Thank you so much for letting us know about these organizations.  The more individuals and groups are involved, the harder it is for us to be written off as a bunch of “poor me; sour grapes looneys”    You have articulated an important point that MLB are failing to protect the public and, in fact, are doing harm by eliminating these “good, ethical and competent” HCP’s. Imagine a test that gave false positives 80% of the time.  We would scrap that test!  But, when it comes to the MLB system, their diagnosis and treatment are wrong 80% of the time.  The entire system needs to be scrapped and rewritten to include due process for the individual under investigation.  Again, thanks for this.

Anne Phelan-Adams, MD

Dr. Michael Langan|  Internal Medicine 

Yes the majority of those I have heard from over the past few years ( now an average of 4 per week) do not meet the diagnostic criteria for a SUD ( or any of the other diagnoses they are being given by the out-of-state “PHP-approved” assessment and treatment centers they are being referred to by the PHPs ( and mandated under threat of summary suspension by the state MLBs). The majority of those caught in this maw of sham adjudicatory proceedings have obtained 2nd, 3rd and even 4th opinions by bona fide experts ( i.e. not simply those “in recovery” and the ASAM credentialed “experts” who staff these preferred facilities). It should also be emphasized all of this is out-of-pocket and none the assessment, testing or “treatment” is covered by insurance.

Disruptedphysician.com/blog

Dr. Ramon Baker|  Family Medicine 

@Ayanya Toldstory Thank you for your insight, Dr Toldstory. Although I have never been the subject of a lawsuit in over 40+ years of practice, the spectre always sat on my shoulder. This problem was always a distraction from what could have been a more productive way of practicing (family) medicine. There are a number of things I could have handled better, such as being too forthright in giving “bad” news to a patient (without benefit of a second opinion). The traumatic impact on him still haunts me today. We may be called upon to share another physician’s “day in court” as a material witness, and should take this on gladly, as though it were our own concern.

On the other hand, people being people, you will not always be treated fairly by patients, whose motives or misconceptions may prompt them to seek redress from any “review organization” they can find. This sort of cat-and-mouse thing takes time to resolve, and taxes a physician’s effective care for other patients. I never forgot a text recommended to us by a truly empathetic psychiatrist entitled “Patients Who Trouble You”. In one example, the patient may appear condescending by providing a litany of well-known doctors who previously treated them; in reality, the patient may be hoping you will find them worth caring for. It is useful to acquire a passing knowledge of some other bizarre patient behaviors that may interfere with the care of a particular patient, some as rare (??) as that of a schizophrenic or seductive individual. At times, my experiences with daily patient contact could range from the mundane, the intriguing, the paranoid and simply being on “thin ice” (i.e., “What is he/she actually in here for?”). We have been well-advised to document, document, document.

If something strange is noted in a patient’s behavior, it may be well to refer to it discreetly…you may literally find it useful if that same patient surfaces ten years later to challenge (litigiously) your “failure” to recommend a follow-up or a referral – when the facts deem it to be otherwise. (Yes, it is a satisfying feeling…)

It is ironic that individuals are drawn to the healing profession with a sense of altruism, yet that same profession can, unfortunately, subject those individuals to psychological stress and isolation. This is certainly a much-needed set of resources for all physicians – to heal the Healers.

Dr. Louise Andrew|  Emergency Medicine 

As mentioned in the article, my interest in this issue stems from a longstanding concern about physician suicide based on the several I’ve been aware of during my career (see e.g. http://bit.ly/MDSuicide ).  I am a 5th generation physician, and have never had any involvement with a MLB except as a legal consultant, or with a PHP.  Except that I used to strongly support the latter for physicians struggling with health issues. ( http://bit.ly/PHP_MLB ) Now that I have been studying these organizations for a number of years, I must agree with the sentiments of Dr. Shackelford, Dr. Miday and others who have recognized a seemingly systematized pattern of abuse coming from many of these institutions that can have career- or life-ending consequences for physicians.

And having been a doubter myself that this could happen in a country based on democratic principals of rule of law and fundamental fairness, I can relate to Dr. Cavenar’s reminder about Martin Niemoller’s warning as applied to this situation. (“I did not speak out…because I was not a drug user….”disruptive” physician…or aging doc…”)  Eventually you will attain a category that is being subjected to this scrutiny (in the name of public safety).

I have taught for years about the ravages of litigation stress on physicians.  There is something called a “white coat myth”, employing which doctors tell themselves that as long as they do the best they can, for as many as they can, for as long as they can, that they will be safe from harm such as malpractice lawsuits and other professional insults that feel unfair.

If you subscribe to this myth of safety based upon your fundamental uprightness, then you will be able to categorize those physicians who experience difficulties with malpractice claims or medical board challenges as “not like me”, and thus insulate yourself for a time…until one of these things DOES come for you.

WHEN that happens, it will be easy for you to recognize the unfairness.  But it might be too late.

I would encourage everyone who reads this article to explore further the underpinnings of the organization in formation http://bit.ly/CPRSite  and to help in any way that you can.

Dr. Janet Angelo|  Psychiatry/Mental Health 

It certainly seems like there have been some abuses of these processes. I’m not surprised that the AMA has no no arm to protect physicians from this kind of thing. I left that organization several years ago.

Dr. Anne Phelan-Adams|  Family Medicine 

@Dr. Janet Angelo Janet.  I left the AMA not too long after the “Sunbeam” scandal which was not the first time the AMA had, due to profit motive, improperly aligned itself with a business or industry.   I decided that, if the AMA couldn’t run with just dues and charitable organizations and without any quid pro quo conflicts, that their board members were too many making too much $.

Thanks so much for your interest and comments.

Ayanya Toldstory|  Psychologist 

@Dr. Anne Phelan-Adams @Dr. Janet Angelo  I am glad to hear these comments about the AMA. I am sad to know that the AMA is also problematic, but I was afraid Psychology was alone in dealing with it’s problematic, self-asserted, de facto, leading professional association, the oligarchic American Psychological Association.

Janice Ellery|  Psychologist 

@Ayanya Toldstory @Dr. Anne Phelan-Adams @Dr. Janet AngeloAlthough I am still an APA member, I was recently disappointed  to learn that the organization basically “leases” it’s endorsement to insurance companies, credit cards, etc for a profit. It seems like many of our professional associations are now acting more like for profit, publicly traded corporations.

Dr. Jesse Cavenar|  Psychiatry/Mental Health 

@ Dr. Anne Phelan-Adams  I have now practiced medicine for 55 years as a Navy flight surgeon, general surgeon, psychiatrist and psychoanalyst. I have served as an expert witness in many state, federal, and military trials and never have I seen anything as outrageous and egregious as certain PHPs and medical boards. I believe there is a complete lack of integrity and veracity in some members of certain PHPs and medical boards. Further, it is my opinion that if the courts had not found that these same PHPs and medical boards have sovereign immunity, the PHPs and medical boards would have massive major litigation brought again them and would have a major problem in trying to defend their actions.

Until organized medical groups complain loudly, nothing is likely to change. The passivity and self-interest of some physicians is overwhelming to me.  I am reminded of:

“First they came for the socialists, and I did not speak out—because I was not a socialist. Then they came for the trade unionists, and I did not speak out— because I was not a trade unionist. Then they came for the Jews, and I did not speak out—because I was not a Jew. Then they came for me—and there was no one left to speak for me.”

There are a number of physicians who read of these issues concerning PHPs and medical boards and think to themselves, “Thank goodness I haven’t been caught up in this” and refuse to get involved. To paraphrase the quote above, …”there is no one left to speak for” the vast majority of physicians.  It is a deplorable state when one allows personal passivity to permit the situation to get to its present state, in my opinion.

As I have been asked recently if I have been in personal difficulty with the PHP or medical board, let me state for the record that I have not. I do not use alcohol, and do not take meds except for diagnosed medical issues. In the interest of full disclosure, let me note that I have been counseled twice for singing too loudly in church. I am trying to do better.

Jesse O. Cavenar, Jr., M.D.

Dr. Anne Phelan-Adams|  Family Medicine 

@Dr. Jesse Cavenar

Yes,  Niemoeller’s quote is every bit as salient today as it was back then.  One thing that distressed me in reading comments from my piece, “…..Dominos” was the number of people who stated something to the effect that  “This would never happen to me; i’m too professional…” or too perfect or whatever other rationalization they might give.      These are the folks I most worry about as human beings, not those of us who know we are flawed and have our limitations and our breaking points, but those of us who think otherwise.

Speaking truth to power is difficult and dangerous; were it not, it wouldn’t require courage.

On a personal note, Jesse, I have a great deal of respect for you and what you are doing.  My father was a Navy man and the most honorable and honest person I’ve ever met, and one of the most intelligent.  I owe him a great deal.  You and he would have gotten  along very well.

Anne Phelan

Dr. Susan Haney|  Emergency Medicine 

@Dr. Jesse Cavenar Careful not to see a PHP-preferred evaluator, who may diagnose “misphonia” for your “singing disorder”, then order 90 days of residential treatment at a PHP-preferred facility!   😉

Dr. karen miday|  Psychiatry/Mental Health 

I only wish that CPR was up and running before my physician son died by suicide in 2012. His final calls were to his state PHP. Instead of urging him to follow through with the treatment plan he and his psychiatrist had decided upon that day, which involved seeking a recovery program of his own choosing, they recommended that he report to them first. He was found dead the following morning. I have no doubt that his fear of loss of licensure was what drove him over the edge. He had already suffered the humiliation of a mandated 90 day stay at a residential treatment program, where he was diagnosed as “alcohol dependent” when he clearly was not. It is clear that PHP’s tailor the diagnosis to the treatment, rather than the other way around. My hope is that Dr. Manion’s much needed advocacy group will save physician lives. Although too late for my son, it is not too late for others.

Dr. Helen Muhlbauer|  Psychiatry/Mental Health 

@Dr. karen miday, your tragedy is beyond measure. Thank you for sharing your situation. I am so sorry for your loss.

Dr. Susan Haney|  Emergency Medicine 

@Dr. karen miday I am so saddened that your son was essentially killed by this type of unethical (and immoral) practice of medicine by his state’s PHP.  I applaud Dr. Manion’s physician advocacy work, and I share his hope that CPR will save lives (his choice of moniker for this new organization is both memorable and clearly appropriate).

I think that we should ALL work to make this system of exploitation and endangerment explicitly illegal, and clearly written into law, state by state (as you probably know, each state has its own laws regulating the both the practice of medicine and the operation of PHP’s within its boundaries).  Perhaps if we can threaten to hold those who enrich themselves through what amounts to gross medical malpractice by PHP extortion schemes, we can help our doctors to safely access appropriate medical care when they (like everybody else) get sick.

People who practice medicine, including both physicians and non-physicians practicing under the statutory immunity umbrella of PHP’s, should be held criminally and civilly responsible for their misdeeds.  Physicians deserve ethical medical care for ourselves when we become patients.  Unethical medical care can kill us too.

Dr. karen shackelford|  Emergency Medicine 

Among many other good reasons for formation of this advocacy group is to provide education – to physicians and to the greater community. Incoming medical students should be aware that they are committing to a path that essentially strips them of rights many Americans take for granted – including the right to autonomy when making healthcare decisions and the right to privacy with respect to personal health information. It is undoubtedly necessary to have a mechanism to protect the public from impaired doctors, but over the years, medical boards and physician health programs have expanded their “mission” with what appears to be an underlying financial and professional agenda that now makes it necessary to create mechanisms to protect doctors. A pattern of widespread abuse has resulted from lack of accountability for procedures and practices that are mandated by self-appointed experts, who have institutionalized their expertise by creating the addiction medicine specialty, and who use the threat of loss of career, reputation, and professional identity to ensure compliance with a system in which they are the primary beneficiaries. The Center for Physician Rights will counter the silence once engendered by shame and an automatic presumption of guilt derived from the moral authority vested in institutions such as medical boards.

Dr. Mary Johnson|  Pediatrics, General 

I cannot tell you how heartened I am to hear about this.  Twenty years ago I was driven out of my hometown (and a Pediatric Practice I started from scratch) for defying the threats of hospital executives to answer a terrified nurse’s call in the middle of the night, saving a baby’s life and reporting it to hospital Peer Review.  I was fired two weeks later – without ANY review of what happened or due process conducted.  I was in public service – a National Health Service Corps provider!?!  The Federal government dived under a desk when I begged for help.  All of what happened was reported to the NC Medical Board (and JCAHO) and they DID NOTHING with regards to the despicable/unprofessional behavior of the doctor I reported – and certainly nothing to assist me legally.  You see the doctors on the Peer Review Committee are protected from legal scrutiny – but those who report ARE NOT.  Whistleblower protection is a MYTH.  I litigated to settlement (in my favor) – but (because I had a local lawyer out-of-his-depth) was swindled of fair restitution there – because hospital executives lied about the confidentiality of their “non-profit” books (and what was in them) during discovery.  I reported that – and spent YEARS trying to get my case to the FBI/SBI – but hit a stone wall with the local DA’s office – who would not make a simple referral (protecting all of the bigwigs who sat on the hospital board and donated to his campaign).  I was a woman who had the courage to stand up/report malfeasance when it happened and was brutalized for it.  OBTW, the hospital involved is now floundering, desperately searching for a bail-out – courtesy of the overpaid/overrated executives who destroyed my hometown dream.

Fast forward twenty years to 2017 and almost the same thing happened again – this time I was a university employee sold across a state line as a slave – courtesy of a merged system that is supposedly overseen by two states (who were told what was going on before the approved the merger) . . . and that after over a year living and working under constant threats against my career and livelihood by hospital executives who made their bonuses/cooked their books by not paying me fairly for my overtime and teaching.  It was brazen age/sex discrimination AND retaliation (for reporting bad behavior/bad care) – yet state and Federal oversight is NON-EXISTENT to the point of collusion (the Russians have NOTHING on these people).  You’re supposed to hire the $500/hour lawyer to fight a case when you have to concentrate on surviving/moving on.

It’s CRIMINAL what these hospitals and regulatory bodies are doing to good doctors just trying to do right by patients.  Employed/contracted physicians, in particular, have ZERO basic rights.  And the Medical Boards have DONE ZIP to advocate for their licenses.

Dr. JOHN FRASER|  Pediatrics, General 

@Dr. Mary Johnson Unfortunately, medical boards will never advocate for their licensees.  Their stated mission is to protect the “public” from said licensees.

Dr. Kernan Manion|  Psychiatry/Mental Health 

@Dr. JOHN FRASER @Dr. Mary Johnson And sadly, up until now, there’s been no organization to protect the public, i.e. physicians and their patients, from predatory, non-overseen and yet completely immune-from-suit medical boards and PHPs. In fact, two senior physicians in the Physicians Advocacy Study Group received written confirmation from both the NC Governor and the NC Attorney General specifying that they had no authority to oversee, investigate or hold accountable these entities even though they have explicitly broken the law.

It seems that it’s never occurred to anyone to ask “who’s minding the minders?”

In NC, we now know. NO ONE. An anonymous allegation, even emanating from within the medical board itself, can wreck your career. And there’s not a damned thing you can do about it.

Before you seek licensure in a state, you might want to check to see who oversees its medical board and PHP. If no one, consider that your career could be at risk of annihilation if you practice there. Best that you look elsewhere.

Ayanya Toldstory|  Psychologist 

@Dr. JOHN FRASER @Dr. Mary Johnson  Actually, if that is how it really was, it would be an acceptable and good thing. Unfortunately, the healthcare licensing boards fail to protect the public. The fact that they, instead, lead the public to believe they ARE protected, ENDANGERS the public. At the same time, the boards are not simply “not advocating” (not advocating is fine), but they are persecuting licensees. Even licensees who are actually involved in wrong-doing don’t deserve persecution. ALL of us – patients, the public, and providers deserve fair, due process, justice. That is all we’re asking for.

Dr. Enver Deliu|  Family Medicine 

College of physicians and surgeons in Canada just like your board is aprosecutor, investigator, judge and after you finish nerve breaking launched disciplinary process denies your elementary right of appeal their some times monstruous decision, does that sound familiar? Yes of course its typical for autoritative dictatorship which is rarely seen today and only in some bana countries and college of physicians unfortunatelly in the most developed countries, what a match…then we have this CMPA (whatever is called in USA) who collect significant amount of money from us yet, engage second hand lawyers to “defend” us from these vultures at the college of course with poor or no positive results at all. This raketeering organisation exists because of this crazy system that shows no respect whatsoever to their “colleauges”,treat us like criminals, forces us to prove that the claim is or might be false or has no merit (guilty until proven otherwise). Personally I remember asking these “high profile”lawyers to take the medical act to court as in addition to other crazy/ irrational things set in it the same it denies our elementary rights ( rights waranted by constitution) the one that even the most notorious criminals have and that is the right of appeal, they say that is not their job, of course its not because if these crazy medical acts were not the way they are these second class lawyers would have no job to do. Its unbeleivable how tolerant or better said big cowards we physicians can be. Obviously we dont care much, for as long as its not about me, not thinking that soon these wich hunters will come after you and get you just like many other colleagues………..

Dr. Jesse Cavenar|  Psychiatry/Mental Health 

For some thirty years while practicing at Duke University, as I was both a psychoanalyst and psychiatrist, I was the “doctor’s doctor”. I saw physician patients who had been diagnosed and treated at the NCPHP; I was alarmed at some of the diagnoses that these patients had been given, as I believed those diagnoses to be markedly in error. Several colleagues agreed with my concern and we attempted to approach NCPHP personnel about our concerns. After being rebuffed, we went to the Governor, spoke with his Chief of Staff, and the NC State Auditor did a yearlong performance audit of the NCPHP. That audit is public information and can be found on the internet.

I attempted to assist one young physician who was diagnosed as having alcohol abuse. However, this man had never been given a Breathalyzer or had a blood alcohol done. He met none of the required diagnostic criteria for alcohol abuse, and even the NCPHP psychiatric consultant stated to me in writing that the man did not meet the required diagnostic criteria. NCPHP personnel refused to discuss this with me even after the young physician gave me a power of attorney to represent him.  This man was detained in the NCPHP for thirteen months at a cost in time and money of $100,000.

I attempted to discuss this with the NCMB and met with a stone wall.  A NCMB investigator refused to take documentation from me that clearly demonstrated that the diagnosis of this man was in error, and the NCMB refused to respond in a meaningful manner to various questions I directed to them.

Most alarming, however, is the fact that the attorney who represented this man has told me in writing that the NCPHP personnel acknowledged that this man “was not an alcoholic” but that treatment wouldn’t hurt him and the NCPHP was treating him prophylactically so that he wouldn’t develop a problem in the future.  This will leave most physicians shaking their head in disbelief.  It would be analogous to a physician stating that he put a patient in intensive care for a lengthy period even though the patient had no symptoms, did not meet the diagnostic criteria for any illness, but was put into intensive care so that he didn’t develop some illness.  This strikes me and my colleagues as sheer nonsense.

I regret to report that this is not an isolated case.  Far from it.

Jesse O. Cavenar, Jr., M.D.

Professor and Vice Chairman Emeritus

Department of Psychiatry

Duke University

Associate Chief of Staff (Ret)

Veterans Administration Medical Center

Durham, NC

Colonel, Medical Corps, U.S. Army (Ret)

Dr. Anne Phelan-Adams|  Family Medicine 

@Dr. Jesse Cavenar When you describe physicians as “shaking their heads in disbelief”, I have to wonder if that’s part of the strategy, “Do something so outrageous that it can’t be believed and thus isn’t taken seriously and we’ll avoid detection.”  Maybe I’m giving PHP’s and their associated MLBs too much credit for planning such a strategy, but, having seen such strategy in other areas, such as politics and governance, I can’t help but wonder.    Thanks for your very articulate and salient comment.

Dr. Anthony De Luca|  Pediatrics, General 

Unfortunately, State Medical Licensing Boards can be kangaroo courts.  You have all the risks and none of the rights of a defendant in a court of law.  And there is no judge to monitor the prosecution.

Dr. Aldyth Buckland|  Family Medicine 

This sounds like an important support group for doctors. Well done!

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…

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