Collusion between state physician health programs (PHPs) and commercial drug testing labs using non-FDA approved drug and alcohol tests

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I recently offered 25,000 dollars in prizes to anyone who could disprove that Dr. Luis Sanchez committed multiple felonies based on documents that provide direct evidence of a chargeable crime.  No additional evidence is needed.  So far no one has been knocking at my door and nary a call from anyone.

How can we interpret this?   Are the prizes not worthy of the time involved in such an endeavor?  No, I think there is something for everyone including 2oo volumes of the Classics in Medicine. A  current listing on Amazon is listing 187 volumes for almost $5000 and in addition to this I am offering dozens of 1970s skateboards, 2 vintage Schwinn Krate bikes, autographs from polio vaccine pioneers Sabin and Salk, multiple signed and one-of-a-kind items related to Boston politician James Michael Curley, a menu, cocktail menu, matchbook and other very rare items from Boston’s Cocoanut Grove which was the site of the  deadliest nightclub fire in history in 1942, signed lithographs and prints from Warhol and Keith Haring and a signed poster from Adam Ant.  So the prizes are not chopped liver and burnt toast.  The prizes are worthy so in a time or work/benefit analysis the benefits are high. What about the time or work involved?  Would the work and time it takes to disprove this claim make it not worth the effort like trying to prove some logic or mathematical theorem? The James Randi Educational Foundation offered 1 million dollars to anyone who could prove that homeopathy works but no one has claimed it yet.  Why?  Because homeopathy does not work.  My challenge is fairly simple as the documents are a quick read and the claims direct and specific.  All one has to do is read the documents in search of acts that might be considered crimes and use a legal reference to see if they correspond to criminal code. If your examination of the documents finds everything is on the up-and-up or just one or two acts commensurate with felonies then the prizes are yours.  A simple task that should take less than an hour or two.  So why is no one knocking at my door?  No one is knocking for the same reason the million dollar homeopathy reward hasn’t been claimed.  The reason no one is knocking at my door is because Luis Sanchez did in fact commit multiple felonies.  I could double the prizes, give you everything I own and offer my very soul but there would still be no one knocking.

So the question for us is this, how is it possible that an individual contracted by a state agency could commit felony crimes that are documented by direct evidence and not be called on it?   The crimes include flagrant forensic fraud no different from Annie Dookhan who faked, forged and fabricated some 60,00 samples at the Massachusetts crime lab.  Fabricating evidence is fabricating evidence so how is it possible that this fabrication of evidence has not been identified and addressed by anyone?  First of all there is no direct oversight or independent oversight to state physician health programs (PHPs).  Not one agency exists that can accept a complaint, investigate it and punish offenders.  Second, there is an inability or unwillingness to investigate or punish the offenders for various reasons.  PHPs have portrayed themselves as allies to law enforcement and have requested they defer to them any issues related to physicians.   When crimes are reported to local and state police and other law-enforcement agencies they are deemed the illusory product of a diseased mind. States Attorneys General legally represent occupation board. Policy dictates they side with medical boards so individual doctors are rebuffed if they ask for help. The FBI will not investigate.  I was told unless the AGO requested it or a public outcry ensued they would not address any issues regarding physician health programs including laboratory fraud and diagnosis rigging. This inability or unwillingness to meaningfully investigate the offenders is a pervasive problem and represent a total systems failure. No one is minding the minders and no one wants to mind the minders. The agencies that could and should investigate crimes are taking a “not-my-problem” stance.  The medical boards have agreed to absolute deference to PHPs and additionally have individuals or groups within the board who are able to block, deflect and otherwise dismiss information implicating the state PHP. All of the documents seen below were provided to Physician Health and Compliance Board counsel Deb Stoller beginning in 20111 but she apparently kept all the documents to herself.  Her ethical obligation when being provided with evidence of forensic fraud and other crimes was to notify the proper authorities.  She did not. She suppressed all of the information with direct evidence of crimes, an act that is much more grave and vile than Dookhan as the documents show collusion between the MA PHP and one of the drug testing labs used by almost all state PHPs.  The documents provide direct evidence of lab fraud and falsification of evidence that is clear and specific.  No alternative explanations exist.  Concealing this type of misconduct just allows it to continue and what is seen here is not rare.  I have heard from many many doctors who claim they were given bogus tests at this very same lab.   Sadly I have heard of many suicides related to these very same tests.  Faced with the “not my problem” stance of agencies that could and should do something but did not these doctors became hopeless and helpless and killed themselves out of despair. Their locus of control was completely lost and their was no lifeline.  Selective application of the law is the root of government corruption and destroys the moral authority of the government. It inevitably leads to collapse and chaos.  The Massachusetts Board of Registration in Medicine has ignored these documents for five years and assert that the PHP has not committed any crimes because they have not been charged with any crimes.  Nonsense and logical fallacy.  The PHP did commit crimes and so too did Board attorney Deb Stoller when she was given direct evidence of them–misprision of a felony in multiples.

Ignoring misconduct not only allows it to continue it allows it to spread.   The plan is to spread these same non-FDA approved of unknown validity and easily manipulated with no accountability to other populations  including students and kids.  It was also recently suggested that the organization Luis Sanchez is past president of, the Federation of State Physician Health Programs (FSPHP)  be put in charge of national public policy for not just doctors but for everyone.

The simple fact is that doctors are being subject to diagnostic rigging and forensic fraud and nobody cares. This is by design and fueled by the anti-doctor sentiment spread by these same groups with propaganda meant to spread the bogus dangers of a hidden cadre of drug addled and besotted doctors.  It doesn’t exist but the stature of doctors in the public eye has suffered because of the mythology they created.  Don’t get me wrong as any doctor with a substance abuse problem or addiction should be removed from practice and not be able to practice until safe to do so. But that is not what is happening here.

The majority of doctors being monitored by state physician health programs do not have a problem.  They have loosened the diagnostic criteria so that essentially anyone referred to them is given a diagnosis and treated.  Why? Because it is a money maker.  All costs are out-of-pocket and no insurance is involved.  The “PHP-approved” assessment centers all charge around $ 4500 for an “assessment” which inevitably leads to a 3-month inpatient stay for treatment to the tune of about $80,000.   This is then followed by a five-year monitoring contract with random drug and alcohol testing 1-3 x per week.  That is a total of 260 to 780 tests and the laboratory developed tests are not cheap. You do the math.  The drug and alcohol assessment and testing industry makes a pretty penny off this operation and they want to bring it to you-It is in fact a Trojan horse.

So by ignoring this type of misconduct it will only get worse.  People tend not to get concerned unless it impacts them.  This will.  Someday you or a family member may be in this same situation.  It boggles my mind that doctors can be given diagnoses when they do not meet the criteria for the given diagnosis and this is confirmed by outside independent experts.  This occurs because those giving the diagnosis have no accountability. They have removed themselves.  But in actual fact this is political abuse of psychiatry. It is egregious.

Diagnosing someone with a disease they do not have should be a never event. The perpetrators should not only have their licenses removed but they should be punished for the crime.   Forensic fraud should also be a never-event but as seen below it is done without fear of sanction-by fax no less.  Giving false diagnoses and fabrication of drug and alcohol tests are actions that should never be tolerated.  Not even once.  How can this be happening in the United States of America?   Unless people speak up this will only escalate.  Below is a detailed analysis of the multiple crimes used for the $25,000 challenge.  Give it a read and try to disprove the claim that Luis Sanchez committed multiple felonies. If you can you win all the prizes. If you can’t then I ask that you be outraged and do something about it as you or someone you love may be next.  Ignoring this type of misconduct is not going to make anything better.




Fraud is distinguished from negligence, ignorance, and error by virtue of the fact that it is intentional. Fraudulent intent is established by examining the documentation of decisions and behaviors of those involved.

Innocent parties don’t normally alter documents or conceal information.

Innocent parties don’t normally “update” donor ID numbers  or  lab reports to “reflect that chain of custody be maintained as requested in the document below faxed from Physician Health Services, Inc. (PHS) to United States Drug Testing Laboratories (USDTL) on July 19th, 2011.

The lab report PHS is referring to is seen below which is positive for the alcohol biomarker phosphatidylethanol at a level of 365.4 ng/ml   (cutoff level for a positive test is 20 ng/ml.

Note both the chain of custody and Donor ID # are listed as 461430 and there is no collection date, collectors name or location listed.   The specimen was received on  July 8, 2011 and reported on July 14, 2011 according to the document.     On July 19th, 2011 Mary Howard requests that a collection date of July 1st, 2011 be added and that the Donor ID #  be changed from  461430 to #1310.

What is the significance of this?    My unique identifier for  for random drug and alcohol testing is #1310 and I had this same test drawn on July 1st, 2011.

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The document are from the USDTL “Litigation Packet” received December 3, 2011 which can  be seen here:   USDTL-LitigationPacket12:2011

USDTL “updated” the test. The document below shows they added my ID # and a collection date of July 1, 2011.

It is the responsibility of the Medical Review Officer (MRO) to make the final determination as to whether or not the positive result reported by the laboratory is reported to anyone else.

The previous Medical Director of the Massachusetts PHP, Physicians Health Services, Inc. (PHS) for fourteen years, Dr. Luis Sanchez, is also a past President of the FSPHP although PHS did not enter into formal partnership with the FSPHP until 2013. The Director of Program Operations at PHS, Linda R. Bresnahan, MS, is the current Secretary of the FSPHP.

PHS, inc. exclusive use of out of state treatment programs has been challenged. In the past PHS, Inc. has adamantly refused to allow physicians to be evaluated in State despite it being one of the medical hubs of the country. Physicians in Massachusetts who are referred for evaluation in Kansas, Georgia, Alabama, and West Virginia as PHS has convinced the Board that only these facilities are ‘experienced in the assessment and treatment of health care professionals.” In actual fact the medical directors of all of these preferred facilities are also ASAM physicians with the vast majority being in 12-step “recovery” themselves and a close colleague if not friend of the medical director of the state PHP.

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“A body of men holding themselves accountable to nobody ought not to be trusted by anybody.”

― Thomas Paine 

Our minds tell us, and history confirms, that the great threat to freedom is the concentration of power. Government is necessary to preserve our freedom, it is an instrument through which we can exercise our freedom; yet by concentrating power in political hands, it is also a threat to freedom. Even though the men who wield this power initially be of good will and even though they be not corrupted by the power they exercise, the power will both attract and form men of a different stamp.”  

—Milton Friedman


Dr. Luis Sanchez, M.D. served as the Medical Director of Physician Health Services, Inc. (PHS) for 15-years.  Massachusetts state Physician Health Program (PHP) for 15-years.  He retired in March 2013 and Dr. Steven Adelman . Sanchez also served as President of the national organization for state PHPS, the  Federation of State Physician Health Programs (FSPHP).Screen Shot 2015-07-28 at 6.44.29 AM

The “PHP-blueprint” is being promoted as a “new paradigm”  with a success rate twice that of other treatment programs (80%).  With numbers this high, the argument goes, why bother with anything else?  The attached slides are from a presentation Sanchez gave at a legal issues conference.  His presents the ACGME definition of professionalism that includes competencies in altruism, accountability, excellence, duty, honor and integrity, and respect for others.    Sanchez also addressed these topics in an article he wrote for the Journal of the American Medical Association (JAMA) entitled  Disruptive Behaviors Among Physicians.  In thiis article he discusses a “medical culture of safety” with “clear expectation and standards.” Sanchez affirms the importance of values and codes-of-conduct in the practice of medicine, and calls on physician leaders  to “commit to professional behavior.”

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PHS Director of Operations Linda R. Bresnahan has also been involved in leadership positions at the FSPHP including acting a Executive Secretary and Interim Executive Director.

PHPs recommend referral of physicians if there are any concerns such as getting behind on medical records.  As PHS Associate DirectorJudith Eaton explains “when something so necessary is not getting done, it is prudent to explore what else might be going on.”  If the PHP feels that doctor needs an assessment they will send that doctor to a “PHP-approved” facility “experienced in the assessment and treatment of health care professionals.” The physician must comply with any and all recommendations of the assessment center.  To assure this the physician must sign a monitoring contract with the PHP (usually five years). USDTL is one of the labs PHPs have contracted with for forensic drug and alcohol testing.

USDTL drug testing laboratory claims to advance the”Gold Standard in Forensic Toxicology.”  “Integrity: Results that you can trust, based on solid science” is listed as a corporate value. “Unlike other laboratories, our drug and alcohol testing begins and ends with strict chain of custody.” “When people’s lives are on the line, we don’t skip steps.”  Joseph Jones, Vice President of Laboratory Operations explains the importance of chain-of-custody in this USDTL video presentation.


Forensic Drug and Alcohol Tests: The Need For Integrity and Accountability of the Sample

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“Forensic” drug-testing differs from “clinical” drug-testing in how the results are used. “Clinical” tests are used for medical purposes in diagnosing and treating a patient.

A “forensic” test is used for  non-medical purposes.  It is not used for patient care, but for detecting licit and illicit substances in those who should not be using them. Pre-employment and employee assistance and professional monitoring programs are examples.Screen Shot 2014-05-08 at 2.17.18 AM

Forensic testing is held to a higher standards because the consequences of a positive result can be grave and far reaching. A positive forensic test can result in loss of rights of the individual being tested and his or her loved ones. Mistakes are unacceptable.

The Federation of State Medical Boards Policy on Physician Impairment supports this position stating “chain-of-custody forensic testing is critical” (page 14) and the “use of a Medical Review Officer (MRO) for screening samples and confirming sample results” (page 21).

Any and all drug testing requires chain-of-custody. The custody-and-control form is given the status of a legal document because it has the ability to invalidate a test that lacks complete information.  Chain-of-custody provides assures specimen integrity. It provides accountability. 

Screen Shot 2014-11-06 at 7.25.46 PM The job of the MRO is to ensure that the drug testing process is followed to the letter and reviews the Custody and Control form for accuracy.  The MRO also rules out any other possible explanations for a positive test (such as legitimately prescribed medications).  Only then is the test reported as positive.

The legal issues involved in forensic testing mandate MRO review. According to The Medical Review Officer Manual for Federal Workplace Drug Testing ProgramsScreen Shot 2013-12-19 at 12.20.46 PM

the sole responsibility of the MRO is to”ensure that his or her involvement in the review and interpretation of results is consistent with the regulations and will be forensically and scientifically supportable.”

“Fatal flaws” such as lack of chain-of-custody form, missing tamper proof seal, missing signatures, or a mismatch of the sample ID and chain of custody ID invalidate the test.   It is not reported.  Tight chain-of-custody and MRO review is critical for the accountability and integrity of the sample.

The Medical Review Officer Certification Council  provides a certification process for MROs. TheyScreen Shot 2014-04-30 at 12.47.25 PMalso  follow their own Code of Ethics.   In accordance with these standards PHS has an MRO to review all positive tests.  As added assurance the FSPHP guidelines state that all positive tests must be approved by the Medical Director.


Regulation and the Medical Profession–The need for Integrity and Accountability in Physician Leadership and Health Care Policy.

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The  July 19th, 2011 fax from PHS seen below is in reference to the lab report from USDTL seen above.  In it PHS requests the report be “updated”to donor ID number “1310” and  to “reflect that the chain of custody was maintained.”

The lab report is a positive test for the alcohol biomarker (Phosphatidyl Ethanol) or PEth, an alcohol biomarker introduced by the Federation of State Physician Health programs and marketed by USDTL and other labs to detect  covert alcohol use..

There is no record of where, when or by whom it was collected.

Screen Shot 2014-11-06 at 11.17.32 PMBoth the donor ID # and chain of custody are listed as 461430.

The purpose of chain-of-custody is to document the location of  a specimen in real time.  “Updating” it is not an option.  It is prohibited.  Updating the “chain of custody to reflect that chain of custody was maintained”  is a clear indicator that it was not maintained.

ID #1310 is the unique identifier I was issued by PHS.  It is used as a unique identifier, just like a name or social security number, to link me to any sample collected for random drug and alcohol screening. #1310 identifies me as me in the chain-of-custody.    On July 1st, 2011 I had a blood test collected at Quest Diagnostics.

The sample was collected at Quest Diagnostics on July 1, 2011 but these documents were not obtained until December 3, 2011 and were included in the “litigation packet” which documents chain-of-custody and is generated on any and all forensic drug testing.   It provides proof that the test was done on who it was supposed to have been done and that all required procedure and protocol was followed. It protects the donor form being falsely accused of illicit substance use.  In most employee drug-testing programs the litigation-packet is provided on request immediately.  It is a transparent process.  This is not the case, however, at PHS.

I requested the litigation packet immediately after the positive test was reported on July 19, 2011.  PHS first refused, then tried to dissuade me.  They finally agreed but warned there would be “unintended consequences.    The entire litigation packet can be seen here:   Litigation Packet 12:3:2011

The positive sample has no chain-of-custody linked to me, no date, and no indication where it was collected or who collected it.   In addition there was no “external” chain of custody for the sample. The custody-and-control form was missing.

With multiple fatal flaws (6/6)  rendering it invalid, USDTL should have rejected it by their own written protocol.

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USDTL did not reject it. The document below shows that USDTL added my ID # 1310 and added a collection date of July 1, 2011–the day I submitted the sample.

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“REVISED REPORT PER CLIENTS REQUEST”  

And in doing so the lab that claims “integrity” and “strict chain of custody” readily, and with no apparent compunction” manufactured a chain-of-custody and added a unique identifier by faxed request.

The litigation packet was signed by Joseph Jones on December 3, 2011.   There was no record of where the sample was from July 1st to July 8, 2011. No external chain-of-custody or custody-and-control form was evident in the litigation packet.

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The V.P. for Laboratory operations for the lab that claims “strict chain of custody” and that “doesn’t skip steps” “when “peoples lives are on the line” verified a positive test as positive with no custody and control form, no external chain of custody and 6/6 fatal flaws.  What is so shocking is that  this was done without compunction or pause.  As a forensic test ordered by a monitoring program Jones knew full well it would result in significant consequences for someone.  He knew that someones “life was on the line,” knew it was wrong, and did it anyway.

A person of conscience would never do this.  It is unethical decision making  that goes against professional and societal norms.  A “moral disengagement” that represents a lack of empathy and a callous disregard for others.  I would not consider doing something like this for any price and here it appears to be standard operating procedure.

PHS reported the positive test to the Medical Board on July 19, 2011 Positive PEth July 19, 2011-1.  It was used as a stepping-stone to request an evaluation at one of three  “PHP-approved” facilities (Marworth, Hazelden and Bradford). The Medical Directors of all three facilities can be seen on this list list called “Like-Minded Docs.”  The MRO for PHS, Dr.Wayne Gavryck,  whose job was to review the chain-of-custody and validate its integrity before reporting it as positive is also on the list.  See this simplified schematic of how it works in Massachusetts.  It shows how this is a rigged game.

Expecting to be diagnosed with a non-existent problem and admitted for non-needed treatment I requested an evaluation at a non-12 step facility with no conflicts-of-interest.  Both PHS and the Medical Board refused this request in one of four violations of the Establishment Clause of the 1st amendment.

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I chose Hazelden.  The Medical Director was aware that I had just signed  a patent license agreement for an epinephrine auto-injector and he had a child with a peanut allergy.  We talked about the device and discussed the problems with current management.  I think it was because of this added personal interaction that he did not “tailor my diagnosis” as PHS most certainly requested.  Seeing me as a person rather than an object, I believe,  enabled his conscience to reject it. My discharge diagnosis found no history of alcohol issues but they could not explain the positive test. Unable to rule out that I drank in violation of my PHS contract they recommended I attend AA.

PHS mandated that I attend 3 12-step meetings per week and requested that I obtain names and phone numbers of fellow attendees so they could contact them to verify my attendance.  They also mandated that I discontinue my asthma inhalers (as the propellant contains small amounts of ethanol) that had been controlling my asthma and preventing serious attacks for the previous ten years.  I was threatened that if I had to use the inhalers or one day late on the increased payments I would be reported to the Board and lose my license.

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Sanchez states that my request for the “litigation packet” was processed on December 5, 2011 (two days after Jones signed off on it) and adds the “testing laboratory is willing to support the test results.”

In the interim I filed a complaint with the College of American Pathologists.  I also requested the missing external chain of custody documents from Quest.

I never received the chain of custody from Quest.  Instead I received a letter from Nina Tobin, Compliance Manager for Quest documenting all the errors but written to sound as if some sort of protocol was maintained.  Tobin claimed the specimen was inadvertently logged as a clinical specimen but sent on to USDTL a week later.  (See Quest Letter )

The Chief of Toxicology at MGH wrote a letter to the Board documenting all of the misconduct and irregularities stating that it was an “intentional act” perpetrated by PHS.  MLLv3finalJacob_Hafter_Esq_copy.

This letter, as well as the opinions of everyone outside of PHS was ignored. So too were any opinions of my two former Associate Directors at PHS.   The e-mail below dated October 10th, 2011 is to to Drs.John Knight and J. Wesley Boyd and I am referring to their article Ethical and Managerial Considerations Regarding State Physician Health Programs  that was about to be published. We had hoped that it would draw more attention to the problems with PHPs.

 

I was subsequently reported as “non-compliant” with AA meetings.    They could not give any details of where or when.  They then misrepresented a declaration of fact (I stated that I had started going to a specific meeting on a specific date) as an admission of guilt by saying I was referring to a different meeting.     10:23:12 PHS Letter to BORM-noncompliance.

My Chief at MGH, his Chief and others held a  conference with PHS and attempted to remove me from PHS and replace the monitoring contract with one of their own.  They refused.   When confronted with the fabricated test they dismissed it and focused on sending me to Kansas to one of the “disruptive physician” Psikhuskas where they are using polygraphs (despite the AMAs stance that it is junk science) and non-validated neuropsychological instruments that detect “character defects” to pathologize the normal.

I refused. Had I gone to Kansas I would have been given a false diagnosis and my career would be over. This is what they do.

Amy Daniels, the investigator for the College of American Pathologists contacted me in December of 2012 to see how things were going since USDTL “amended” the test.  Daniels told me that the College of American Pathologists confirmed my allegations and, as an Accrediting Agency for Forensic Toxicology mandated that USDTL correct it.  (Labs can lose accreditation if they do not comply with CAP  Standards for Forensic Drug Testing). This was done on October 4, 2012.

PHS denied any knowledge of an amended test.  I also wrote an e-mail to Joseph Jones requesting the document but he did not reply.

I contacted CAP.   On December 11, 2012 Dr. Luis Sanchez wrote a letter stating  “Yesterday, December 10 2012, Physician Health Services (PHS) received a revision to a laboratory test result”

 “The amended report indicates that the external chain of custody protocol [for that sample] was not followed per standard protocol]”

Sanchez dismisses this test as irrelevant, rationalizing neither PHS nor the Board based any actions on the test and they would “continue to disregard” it.

The  logic is that it was my behavior that resulted in any consequences.  My “non-compliance” in October led to my suspension and the test had nothing to do with it.   The sole reason for reporting me to the Board in 2011 was the positive test.  There is no other pretext to use.  It is misattribution of blame as without the test, now invalidated, there would have been no AA meetings to say I was non-compliant with.

In response to a civil complaint PHS, Quest and USDTL all took the position that the results of the fraudulent testing had absolutely nothing to do with anything.

And in response to the allegations of forensic fraud the labs claimed there was no forensic fraud because this was not a “Forensic” test but a “clinical” test.     The argument was that “clinical” tests do not require chain-of-custody and it was his behavior not these tests that resulted in consequences.   

As a “clinical” test I knew it was considered Protected Health Information (PHI)  under the HIPAA-Privacy Rule.  A patient must give written consent for any outside entities to see it.  Obtaining lab tests previously required the consent of both the patient and the ordering provider.  What PHS and the labs were apparently unaware of was the changes to the HIPAA-Privacy rule giving patients increased rights to access their PHI.   The changes removed the ordering provider requirements.  A patient has a right to obtain lab test results directly from the labs and has 30 days to do it.  CAP agreed.   USDTL sent me all of the documents.  They can be seen below:

August 6, 2014 to Langan with health materials.

The documents sent by USDTL are notable for two things:

1.  The e-mail from me to Joseph Jones dated December 10, 2012.  It can be seen on page 22 of the USDTL documents.

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2. USDTL document confirming PHS knew the test was amended 67-days before they said they did.

The document shows PHS and Sanchez were aware of the invalidity of the test on October 4, 2012.   Instead of correcting things they initiated machinations to throw me under the bus.  They officially reported me to the Board for non-compliance on October 19, 2012.

The December 11, 2012 letter signed by Sanchez states “Yesterday, December 10, 2012, PHS received a “revised report” regarding the test.  The documents show he knew about it 67-days prior.

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Although USDTL complied with the HIPAA-Privacy Rule and CAP, Quest did not.   Quest Diagnostics refused to send me copies of their lab reports claiming it was confidential and protected information that required PHS consent.  Quest required I sign a consent form with multiple stipulations regarding PHS.  I refused and contacted the Department of Justice -Office of Civil Rights.  The DOJ-OCR agreed with me and I received the Quest documents

Remember a “clinical” test can only be ordered by a physician in the course of medical treatment.  It requires authorization from the patient to obtain a “clinical” specimen and it requires written authorization as to who sees it.  Referring physician was Mary Howard.

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And below is the fax from PHS to Quest from July 1, 2011 also requested by Mary Howard.  The signature on the front is not mine.  In addition I gave the blood at 9:30 and was in my clinic at MGH at 12:23 so it couldn’t be. The WC 461430 R are dated July 2, 2011.  This is a “clinical” not “forensic” sticker.  The “R” indicates a red top tube.  The other sticker is USDTL and indicates it was logged in on July 8, 2011.

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What does it all mean?    Blood left in a red top tube ferments. This is basic chemistry.  The PEth test needs to be refrigerated and shipped overnight to prevent this.  In addition it needs to be collected with a non-alcohol wipe in a tube that has an anti-coagulant or preservative so that it does not ferment.    It requires strict procedure and protocol.

When I gave my blood on July 1st, 2011 it was as a “forensic” test per my contractual agreement with PHS.

On July 2, 2011 it was changed to “clinical.”   Why?  because “forensic” protocol would have invalidated it.

The only conceivable reason for doing this was to bypass chain-of-custody procedures.  My unique identifier #1310 was removed and the clinical specimen number was used for chain-of-custody.    The R in 461430R indicates a red top tube.

By holding on to it for one week the blood fermented.    As it was July with an average temperature close to 90 they overshot their mark a bit.   My level of 365 is consistent with heavy alcohol use–end stage half-gallon a day type drinking.

Quest then forwarded it to USDTL with specific instructions to process it as a “clinical” sample.  USDTL complied and  processed it as a clinical specimen which was reported it to PHS on July 14, 2011.

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PHS then asked USDTL to add my forensic  ID # 1310 and add a collection date of July 1, 2011 so it would appear “forensic” protocol was followed.    The reason Jones signed the “litigation packet” on December 3, 2011 was because that was when the “litigation packet” was manufactured.  A “clinical” sample does not produce one.

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USDTL willingly complied with this request.

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PHS then reported this as a “forensic” test to the Medical Board on July 19, 2011 and requested a reevaluation.

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The distinction between “forensic” and “clinical” drug and alcohol testing is black and white. PHS is a monitoring program not a treatment provider. The fact that a monitoring agency with an MRO asked the lab to process and report it as a clinical sample and then used it forensically is an extreme outlier in terms of forensic fraud. The fact that they collected it forensically, removed the forensic components and let it sit in a warehouse for a week is  abhorrent.  The fact they then specifically requested it be processed as a clinical sample deepens the malice. The fact that they then reported it to the Board as a forensic sample and maintained it was forensic up until just recently makes it egregious. But the fact that the test was changed from “positive” to “invalid” on October 4th, 2012 and they then reported me to the Board on October 8th,  2012 for “noncompliance,” suppressed it and tried to send me to Kansas where I would be given a non-existent diagnosis to delegitimize me for damage control makes it wantonly egregious.  This is political abuse of psychiatry.

Accountability requires both the provision of information and justification of what was done.

For doctors it is very difficult to obtain the information. As seen here, they put up a gauntlet to prevent the provision of what is immediate in all other drug testing programs.  I now have all of the information. What it shows is clear. This was intentional.  It was no accident.  They knew what they were doing, knew it was wrong but did it anyway.

Accountability also requires that those who commit misconduct suffer consequences. The PHPs have also put up barriers to this.    With no regulation or oversight they have no apparent accountability.

My understanding is that it works this way.   The Medical Board, Medical Society and Departments of Public Health have no oversight.   The MMS has an ethics committee but all they can do is “educate” the person if they feel there was a violation.  The DPH won’t even look at it and the Board is complicit.

My understanding is that they have convinced law enforcement that this is a “parochial” issue that is best kept within the medical community.  They have also created the impression that they are “friends” of law enforcement.  I have heard from many doctors that they have tried to report misconduct, civil rights violations and crimes to the police, AGO, and other law enforcement agencies only to be turned back over to the PHP.     By saying the physician is “impaired” it delegitimizes and invalidates the truth.  “He’s just a sick doctor,  we’ll take care of him.”  That physician then suffers consequences effectively silencing the rest.

PHS uses the Board to enforce punitive measures and temporize.   The Board puts blind faith in PHS.  Blind faith that defies common sense ( mandating phone numbers at anonymous meetings)  and disregards the law (Establishment Clause violations that are clear and well established).    The Board also temporizes to cause damage.

In my case they required a psychiatric behavioral evaluation.  I was given the choice of Kansas and a few other Like-minded assessment centers.

After petitioning for  multiple qualified psychiatrists that were summarily rejected months later for no reason one of the Board Attorneys suggested  Dr. Patricia Recupero, M.D., J.D. who is Board Certified in Forensic Psychiatry and Addiction Psychiatry.   The Board had used her in the past but not recently.  Seeing that she had been used by the Board for fit-for-duty evaluations in the past the Board accepted my petition.

Dr. Recupero wrote an 87-page report. She concluded I was safe to practice medicine without supervision, that I had never had an alcohol use, abuse or dependence problem, and that PHS request for phone numbers was inappropriate. She also documented PHS misconduct throughout my contract and concluded it was PHS actions, not mine, that led to my suspension.   What she describes is consistent with criminal harassment.  She documents the falsification of neuropsychological tests and confirms the forensic fraud.  What did the Board do?  Ignored their very own recommended and approved evaluator.

One measure of integrity is truthfulness to words and deeds.  These people claim professionalism, ethics and integrity.  The documents show otherwise.  The careers and lives of doctors are in these peoples hands.

Similar fraud is occurring across the country.  This is an example of the institutional injustice that is killing physicians.  Finding themselves entrapped with no way out, helpless and hopeless they are feeling themselves bereft of any shade of  justice and killing themselves.  These are nothing more than bullies and accountability is essential.  The “disruptive physician” moral panic has harmed the Medical Profession.

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

Wes Boyd notes that valid complaints from physicians are often dismissed as “bellyaching” by the PHPs.  Complacent that these are just good guys helping doctors and protecting the public the complaints are dismissed, tabled, deflected or otherwise ignored.  Bellyaching??   Is this bellyaching.

It is my opinion that what you see here is indefensible  Procedurally, Ethically, and Legally.

Procedurally it goes beyond negligence and represents fraud.  It violates every procedural guideline, regulation and standard of care including their very own.

Ethically it violates everything from the Hippocratic Oath to  AMA Medical Ethics to the MRO Code of Conduct.

And where was PHS MRO Wayne Gavryck? By my count he violated at least 4 of the 6 Codes of Ethical Conduct.

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What was done here violates the most fundamental ethical principles of Medicine -Autonomy, Beneficence, Nonmaleficence and justice.

Intentionally falsifying a laboratory or diagnostic test to refer for an evaluation or support a diagnosis or give unwarranted “treatment” is unconscionable.  Abuse under the utility of  medical coloration is especially egregious.

The information provided herein should negate any “peer-review” protection or immunity afforded PHS as it is undeniably and egregiously in “bad faith.” Moreover, the ordering a “clinical” test is outside PHS scope, practice, and function of PHS. According to M.G.L. c. 111, § 203 (c):

An individual or institution, including a licensed or public hospital, physician credentialing verification service operated by a society or organization of medical professionals for the purpose of providing credentialing information to health care entities, or licensed nursing home reporting, providing information, opinion, counsel or services to a medical peer review committee, or participation in the procedures required by this section, shall not be liable in a suit for damages by reason of having furnished such information, opinion, counsel or services or by reason of such participation, provided, that such individual or institution acted in good faith and with a reasonable belief that said actions were warranted in connection with or in furtherance of the function of said committee or the procedures required by this section.

Dr. Luis Sanchez and Dr. Wayne Gavryck need to be held to the same professional standards as the rest of us.

If you can support either of them procedurally, ethically, or legally, any one of them, then I will turn in my medical license with a bow on it.  If they did not commit negligent fraud by standards of care and procedural guidelines, egregious moral disengagement in violation of ALL ethical codes for the medical profession and society and break the law then disprove me.  Just one will do.

But you can’t do this then I ask that you speak up and take a stand. Either defend them or help me hold them accountable.  If a crime is committed it needs to be addressed.  Ignoring encourages more of the same.

And if this cannot be supported procedurally, ethically or legally then I want to know what is going to be done about it?

How low does the moral compass have to go before someone takes action?

Doctors are dying across the country because of people just like this.  They have set up a scaffold that removes the usual checks and balances and removed accountability.   It is this institutional justice that is driving many doctors to suicide.

So the evidence is above.  Either defend them or help me draw unwanted attention to this culture of bullying and abuse. So I am asking you to contemplate if  what you see here is ethically, procedurally or legally sound.   If you can show just one of these then I stand corrected. But if you cannot justify this on any level then I want you to help me expose this criminal enterprise. Either defend it or fight it. Silence and obfuscation are not acceptable.

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Mandating Drug-Testing of Unknown Validity while removing the procedural safeguards of forensic drug testing: The plan to introduce junk-science lab tests into the healthcare system and randomly drug test students in schools

screen-shot-2016-12-04-at-11-38-32-pmAs a physician-patient relationship renders drug testing “clinical” rather than “forensic” the consequences become “treatment” rather than “discipline.”  And that is the real reason behind all of this.    A positive “forensic” test in most employee random drug screening programs today will result in an “assessment” for substance abuse.  Most EAPs allow a choice in where that assessment takes place.  The model this system is based on, Physician Health Programs. do not allow choice as evaluations are mandated to “PHP-approved” assessment centers; a rigged game.A positive “clinical” test will result in the same thing under the ASAM White Paper proposal.  But the assessment will be at an ASAM facility and if a Substance Use Disorder (SUD) is confirmed it will result in mandated abstinence of all substances (including alcohol) and lifelong spirituality involving 12-step recovery   And by using the healthcare system as a loophole and calling this testing “clinical” rather than “forensic” the ASAM will have successfully introduced widespread testing of a variety of Laboratory Developed Tests (LDTs) of unknown validity while removing  the safeguards provided by forensic testing including chain-of-custody and MRO review.

Source: Mandating Drug-Testing of Unknown Validity while removing the procedural safeguards of forensic drug testing: The plan to Introduce Laboratory Developed Tests into Mainstream Healthcare

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The Medical Profession, Moral Entrepreneurship, Moral Panics and Social Control

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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Beyond the Schoolyard: Workplace Bullying

Disrupted Physician

quote-to-be-able-to-destroy-with-good-conscience-to-be-able-to-behave-badly-and-call-your-bad-behavior-aldous-huxley-314332This infographic on workplace bullying was created by International Business Degree Guide to convey the message that workplace bullies not only hurt people, they can also hurt business–driving away good employees in their quest for control.

Adept at dissimulation, those in authority often see what the bully expressly feigns and pretends to be. Under observation by authority the bully hides his true self and often cultivates an image designed to please and impress.

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Veiling truth to those in power protects the bully.  Reports of abuse are disbelieved or ignored; dismissed or minimized as exaggeration; deemed a product of bellyachers and whiners.  In addition to hiding his true self the bully will often tell superiors what they want to hear. The workplace bully promotes an image of loyalty, dedication and hard work to superiors and may even feign common ideals and goals.   This  impression management often works.

When bullying ends in tragedy it is often revealed that those…

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Need Allies and Funding: Please Help Continue the Fight on Disrupted Physician

Please donate! Making some serious gains and some funding would speed this up considerably!

Disrupted Physician

Please contribute!

Need allies and funding. Please see DisruptedPhysician.com and help me to continue the fight for physician health reform

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Source: Need Allies and Funding: Please Help Continue the Fight on Disrupted Physician
Physician Suicide and the Elephant in the Room
Michael Langan, M.D.

Although no reliable statistics exist, anecdotal reports suggest an alarming upsurge in physician suicide. This necessitates a reappraisal of known predisposing risk factors such as substance abuse and depression but also requires a critical examination of what external forces or vulnerabilities might be unique to doctors and how they might be involved in the descent from suicidal ideation to suicidal planning to completed suicide.

Depression and Substance Abuse Comparable to General Population

Depression and substance abuse are the two biggest risk factors for suicide. The prevalence of depression in physicians is close to that of the general population1,2 and, if one looks…

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Medical Regulation and Junk-Science: The “Medical Sanctification” of Lie-Detectors byMedical Boards and State Physician Health Programs

Disrupted Physician

Junk-Science in the Medical Profession: The Resurgence of Polygraph “Lie-Detection” in an age of Evidence-Based Medicine.

33755_1527129670651_5081648_n Circa 1995

The article below was published in the now defunct magazine Gray Areas almost twenty years ago. (Vol. 4, No. 1, Spring 1995 pp. 75-77).  It is not a research article but a critique of the use of polygraphy written for a general audience.

Antipolygraph.org founder George Maschke noted in 2008 that the article “makes a good introduction to the pseudoscience of polygraphy” and “the criticisms of polygraphy remain valid today.”  The basic assumption of any good test is that is has construct validity; that it is actually measuring what it is purported to measure.   Polygraphy is purported to detect lies but the specificity and sensitivity are about the same as a toss of a coin and has the potential to cause a great deal of harm to those who are…

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The impact of illegitimate authority on regulation of the medical profession: The overdue need for critical analsysis

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It is not wisdom but Authority that makes a law—Thomas Hobbes
In Questions of science, the authority of a thousand is not worth the humble reasoning of a single individual— Galileo Galilei

Regulatory Decisions and Public Policy 

Making sound decisions about regulation calls for an understanding of the problem it is intended to solve. Legitimate policy must be based on recognized institutions and experts. Regulatory changes demand methodologically sound science and evidence-based facts arrived at through rigorous peer review and professional oversight. The science must be reliable and unbiased. Legitimate policy must be based on legitimate institutions and expert authority grounded in wisdom. Authoritative opinion needs to be assembled with facts and best available evidence guided by science and critical reasoning to best solve a particular problem and benefit the greater good.

If the information regulatory agencies rely on to make regulatory decisions and public policy is unreliable then bad decisions, wrong decisions and flawed public policy are inevitable.   Consequences can be far-reaching and grave.

The impact of the close alliance between state medical boards and their state physician health programs (PHPs) and their national organizations on this failure to achieve the public goals with which they have been tasked has not been considered. It needs to be as the consequences of relying on this illegitimate and irrational authority have indeed been far-reaching and grave. Some of the nonsense pushed forth by the PHP movement and given “regulatory sanctification” by state medical boards is beyond belief. It would be comical if the results were not so tragic.

State Medical Boards

A physician’s right to practice medicine is granted by the state medical board in the form of a medical license. Each state has a medical practice act that defines the practice of medicine and used to regulate the medical profession. The medical board is empowered to identify and take action against doctors for substandard care, unprofessional behavior and other violations as defined by the state medical practice act. Given that medical boards are state agencies, their authority is subject to traditional constitutional constraints including equal protection and procedural due process limitations.

State Medical Boards have faced criticisms for being lax in their duty to protect the public from dangerous doctors.1,2 A recent study in the New England Journal of Medicine found that just 1% of physicians accounted for 32% of paid malpractice claims.3 One physician had at least 31 malpractice totaling more than $10 million in damages and nine of those payments were related to “failure to use proper aseptic technique” while another had at least 21 malpractice payments including eight improperly performed surgeries, three unnecessary surgeries and two surgeries on the wrong body part.   Neither of these doctors faced disciplinary action from their state medical board.

Failing to recognize the germ theory by failing to meet even the most basic standards of cleanliness and wrong-side surgery are egregious. The fact that these are not isolated one-offs but repeat offenders is reprehensible.     There is clearly something wrong with a system that allows such unfettered idiocy to flourish.

On the other hand there are increasing reports of excellent doctors with no history of malpractice or patient harm losing their licenses after one-offs, minor infractions or nothing at all.

The public’s goals would be better served if boards exercised their discretion against physicians who violate the most basic standards of professionalism and competency. They are failing to achieve this task.

The Federation of State Medical Boards (FSMB)

The Federation of State Medical Boards (FSMB) is a national not-for profit organization that gives guidance to state medical boards through public policy development and recommendations on issues pertinent to medical regulation.

Shortly after its founding in 1912, the Federation of State Medical Boards began publishing a quarterly journal addressing issues relating to medical licensing and regulation of doctors. First published in 1913 as the Quarterly of the Federation of State Boards of the United States, the publication has undergone several name changes and publication schedules. The archival organization and availability of full articles published sequentially over the past century is historically invaluable as it provides not only the regulatory by the national organization involved in the medical licensing and regulation of doctors and this archival organization facilitates an unskewed and impartial examination in its historical context. A focus on sound decision-making can be seen in the regulatory and legal medicine literature up until the 1990s.

For example when drug-testing was first introduced questions of validity became a genuine topic of concern.

By the late 1980s almost every state medical board was utilizing random drug and alcohol testing.   Noting that “not all testing methods and results are created equal,” South Carolina State Board of Medical Examiners executive director Stephen S. Seeling, J.D. addressed the critical importance of accuracy and reliability in the Federation Bulletin in 1988 and cautioned that “if boards wish to be able to use positive results of drug screens in administrative or legal proceedings, great care must be taken to insure that the results are accurate, reliable and thus legally probative.” 4 Suggesting that board members and board attorneys be familiar with specific testing methodologies Seeling concludes that:

Random drug testing is an important tool for every board in its mission to protect the public and maintain the integrity of the medical profession. Careful attention however must be given to this process to insure the reliability and legal defensibility of testing results. Failure to do so could diminish the board’s credibility in the eyes of the profession and the public, and expose the board to potentially serious legal challenges.”4

This sound decision-making unfortunately took a nasty left turn in 1995. In that year the Federation of State Physician Health Programs (FSPHP) forged a relationship with the Federation of State Medical Boards. They have been going strong ever since.

1995 FSPHP/FSMB Alliance

The Sick Physician: Impairment by Psychiatric Disorders, Including Alcoholism and Drug Dependence, published in JAMA in 1973,5 recommended that state medical societies establish programs to identify and treat “impaired physicians” which the AMA defined as “a physician who is unable to practice medicine with reasonable skill and safety to patients because of mental illness or excessive use or abuse of drugs, including alcohol.”

Physician Health Programs (PHPs) were subsequently developed to assist with the goal of rehabilitating and monitoring doctors as an alternative to disciplinary action by state medical boards. Preferring rehabilitation to probation or license revocation so long as the public was protected from imminent danger, most medical boards accepted the concept with support and referrals.

PHPs existed in almost ever state by 1980. Often staffed by volunteer physicians and funded by the state medical society, these programs served the dual purpose of helping sick doctors and protecting the public. As an alternative to disciplinary action these programs advocated for physicians who developed illness, assured they got proper treatment and provided monitoring to assure they remained healthy. The mechanics and mentality of PHPs were initially quite variable.

The model used today came out of the “impaired physician movement,” which according to British sociologist G. V. Stimson is “characterized by a number of evangelical recovered alcoholic and addict physicians, whose recovery has been accompanied by an involvement in medical society and treatment programs. Their ability to make authoritative pronouncements on physician impairment is based on their own claim to insider’s knowledge.”6

In 1987, the Atlanta Journal and Constitution ran a series of reports after five patients in the “Impaired Professionals” program at Ridgeview Institute created by G. Douglas Talbott in Atlanta killed themselves7 and least 20 more died by suicide after leaving Ridgeview.8 It was reported doctors were coerced into Ridgeview and then threatened and bullied to comply with any and all demands under threat of loss of licensure. All patients were indoctrinated into A.A. and forced to confess they were alcoholics or addicts or threatened with expulsion and with not being certified or advocated for with their Medical Boards.

A “recovering” alcoholic and addict who had previously been a successful cardiologist Talbott created the DeKalb County Impaired Physicians Committee for the Medical Association of Georgia in 1975 and subsequently founded the Georgia Disabled Doctors Program for the assessment and treatment of physicians, in part because “traditional one-month treatment programs are inadequate for disabled doctors.” He created the “Impaired Professionals” program at Ridgeview to provide this specialized treatment. 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,” 9 because Ridgeview “enjoys unparalleled connections with many local and state medical societies that work with troubled doctors,” and “licensing boards often seek recommendations from such groups in devising an approved treatment plan”

money1-richdoctorThe Constitution reported that those in charge of the program are often “physicians who themselves have successfully completed Ridgeview’s program.”9  The impaired physician movement emphasizes disease and therapy, rather than discipline and punishment. They believe that alcoholism and addiction is a chronic relapsing brain disease requiring lifelong abstinence and 12-step spiritual recovery. The drug or alcohol abuser or addict is a person lacking adequate internal controls over his behavior and for his own protection as well as the protection of society external restraints are required including involuntary treatment.

“Contingency-management,” or systematic use of reinforcement is a type of treatment used in the mental health field in which patient’s behaviors are rewarded (or less often punished). It has successfully been used in substance abuse treatment by using prizes or vouchers for positive reinforcement by, for example giving prizes or vouchers for negative drug screens or following up for an appointment.10,11. At Ridgeview, a doctor’s medical license was being used as the leverage. This is not contingency management. It is extortion.

Many addiction professionals were highly critical of Talbott’s methods, including LeClair Bissell.7 and Assistant Surgeon General John C. Duffy who said that Ridgeview suffered from a “boot-camp mentality” toward physicians under their care.”8   “”

Talbott justified this length of stay because he claimed doctors were unique because of what he calls the “four-MDs,” ”M-Deity”, “Massive Denial” “Militant Defensiveness” and “More Drugs.”12

lab fraud $$The cost of a 28 day program at Ridgeview was $10,000 but far more for the thrice lengthy stay required by healthcare professionals..8  I would say the impetus behind this is due to just “two-MDs,” “Medical License,” and “More Money.”

A jury awarded $1.3 million to the widow of one of the deceased physicians against Ridgeview,13 and other lawsuits initiated on behalf of suicides were settled out of court, but nothing else has changed.14

These suicides did not generate any reaction from the medical community at large and any doctor referred by a PHP for an assessment today will spend at least 3 months in treatment. ”   It is inevitable. The Dicto simpliciter argument of “terminal uniqueness” has been cemented as in 1995 this PHP model won the lottery.   A 1995 issue of The Federal Bulletin: The Journal of Medical Licensure and Discipline, published by the Federation of State Medical Boards, contains articles outlining PHP programs in 8 separate states. Although these articles were little more than descriptive promotional pieces written by state PHP program directors with no described study-design or methodology the journals Editor proclaimed “the success rate of the programs and others like them approach 90%.” 15 and “cooperation and communication between the medical boards and the physician health programs must occur in an effort to protect the public while assisting impaired physicians in their recovery.” 15 The 8 state PHPs were all based on Talbott’s methodology.

Screen Shot 2015-01-09 at 1.59.40 AMNonsense such as the “four-MDs” and thrice lengthy treatment has been accepted without scrutiny. Logical fallacy is written as science. For example Merlo and Gold use the “appeal to consequences” logical fallacy to justify the extended length of stay stating that “physicians with a substance use disorder are not typical of addicts in general, it is not useful to apply standard professional guidelines… Rather, because of the public health consequences of relapse, most physicians who are addicted are treated more aggressively and for longer periods” than non-physicians.

According to Merlo and Gold “Physicians will lobby for a level of care that minimizes the disruption of their daily life. However, it is generally not advisable to grant the physician’s request for treatment in the least restrictive environment, but rather to maximize the treatment dose and duration to improve effectiveness and reduce the likelihood of relapse and further damage to health, family, and the ability to practice. Depending on the response to treatment, physicians typically undergo 3 to 6 months of intensive treatment in a structured program and 5 years of urine testing with controlled, contingency-managed outpatient follow-up.16 This  gibberish has no basis in reality. It is made up out of whole cloth.  No evidence-base exists and it is  propaganda based fear that defies not only reason but common sense.

“Potentially Impairing Illness” “Relapse Without Use” “Dumb and Dumber”

 The Federation of State Medical Boards House of Delegates adopted an updated Policy on Physician Impairment at their 2011 annual meeting approved the concept of “potentially impairing illness.”

According to the Federation of State Physician Health Programs …”physician illness and impairment exist on a continuum with illness typically predating impairment, often by many years. This is a critically important distinction. Illness is the existence of a disease. Impairment is a functional classification and implies the inability of the person affected by disease to perform specific activities.”

Screen Shot 2016-06-07 at 7.48.20 AM“Process addiction” was added as a potentially impairing illness including compulsive gambling, compulsive spending, compulsive video gaming, and “workaholism.” According to the FSPHP “the presence of a process addiction can be problematic or even impairing in itself, and it can contribute to relapse of a physician in recovery. As such, process addictions should be identified and treated.” They define three levels of relapse. “Relapse without use” is a 12-step concept. G. Douglas Talbott defines it as “stinkin thinkin.”Screen Shot 2016-06-07 at 7.44.04 AM

According to Judith Eaton of the Massachusetts PHP, Physician Health Services, Inc. (PHS), not having “complete, accurate, and up-to-date records” could be a red flag for such a potentially impairing illness as “when something so necessary is not getting done, it is prudent to explore what else might be going on.”

The FSMB and state medical boards have gone on to condone polygraph testing and non-validated neuropsychological testing pseudoscience in their “disruptive physician” exams.   Is the magic 8 ball and tea leaves next? How low does the credibility compass have to go before someone stands up and calls bullshit on this carnival?   The most egregious of indiscretions has been the introduction and acceptance of junk-science.

“Medical Sanctification of Junk-science”

Those behind the Inquisition knew they did not have to convince everyone to get what they wanted, just Ecclesiastical and political authority. The same applies here. Ethyl Glucuronide (EtG) was introduced in 1999 as a biomarker for alcohol consumption,17 and subsequently suggested as a tool to monitor health professionals by Dr. Gregory Skipper because of its high sensitivity to ethanol ingestion.

content-1What is so egregious about this is there was absolutely no evidence base. Skipper, who was convicted of a felony in Oregon and had his licenser revoked but got it back by claiming he was redeemed through A.A. read about it and after a study on just 14 patients pitched it to a drug testing company as a Laboratory Developed Test (LDT). The LDT pathway is a shortcut to get lab tests approved (under the premise that it will be used in treating a person medically and is thus of benefit) but Skipper took advantage of this loophole to develop a “forensic” LDT. He then used his position as the Alabama PHP Director to pitch it to the Medical Board before the ink dried.

As an LDT the FDA has no control over advertising so the lab can make any claims they want and in this case they claimed a positive EtG (> 100) was definitive proof of drinking. The State PHPs started using them on physicians. As PHPs were using them, the labs were able to sell it to other groups seeing they were “medically sanctified.” The test was subsequently found to be so sensitive that it could measure incidental exposure to alcohol in foods, over the counter cold medications, mouthwash18,19, hand sanitizer gel20, and nonalcoholic wine.21 Sauerkraut and bananas have even been shown to cause positive EtG levels.

After a Wall Street Journal Article came out debunking the test most monitoring programs abandoned it. PHPs did not. Talbott puts out a list of literally hundreds of products doctors need to avoid including colognes, mouthwashes, and foods.

Skipper simply kept raising the cutoff point from 100 to 250 to 500. It is now known hand sanitizer alone can cause a level of 2000. He subsequently introduced other tests as confirmatory tests.Screen Shot 2015-03-19 at 9.02.57 PM

Many people had licenses revoked, loss of custody of their children, went back to jail, and suffered multiple other losses. If you look at the evidence base it is absent. There is nothing. The emperor has not clothes. This is a racket and the damage has been grave.

These same people are trying to sell the “PHP-blueprint” and its array of non-validated test to other populations as the “new paradigm” just as they did with the snake oil tests. The same carney hucksters are promoting the whole enchilada as a package deal. In “Six lessons from state physician health programs to promote long-term recovery” Robert Dupont and Dr. Greg Skipper attribute a high success rate to the following factors:22

(1) Zero tolerance for any use of alcohol and other drugs;

(2) Thorough evaluation and patient-focused care;

(3) Prolonged, frequent random testing for both alcohol and other drugs;

(4) Effective use of leverage;

(5) Defining and managing relapses; and

(6) The goal of lifelong recovery rooted in the 12-Step fellowships.22

Caveat emptor people. Caveat emptor!  Any argument should be based on its own merits and methodology and evidence must be examined to discern its validity. Hopefully other agencies will look at this with a more jaundiced eye and less obtusity than the FSMB and state medical boards.

Unfortunately the position of the regulatory agencies towards this illegitimate authority and irrational authority has been one of uncritical acceptance and blind faith. It is the absence of objective assessment and critical analysis that has enabled the FSPHP and PHPs to gain tremendous sway in the medical profession and cause tremendous harm to the medical profession. By confusing ideological opinions with professional knowledge the medical boards have rubber stamped whatever’s been thrown their way and for this they should be ashamed. The impact of this close alliance between state medical boards and their state physician health programs (PHPs) and their national organizations on the current state of medicine has not been examined. It needs to be.

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  1. Jost TS, Mulcahy L, Strasser S, Sachs LA. Consumers, complaints, and professional discipline: a look at medical licensure boards. Health matrix. Summer 1993;3(2):309-338.
  2. Galusha BL. Quality initiatives. The role of medical licensing and disciplinary boards. Quality assurance and utilization review : official journal of the American College of Utilization Review Physicians. Aug 1988;3(3):66-70.
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  4. Seeling SS. Thoughts on the reliability of drug testing. Federation bulletin / Federation of State Medical Boards of the United States. Aug 1988;75(8):230-234.
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  9. 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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  11. Lussier JP, Heil SH, Mongeon JA, Badger GJ, Higgins ST. A meta-analysis of voucher-based reinforcement therapy for substance use disorders. Addiction. Feb 2006;101(2):192-203.
  12. Gonzales L. When Doctors are Addicts: For physicians getting Drugs

is easy. Getting help is not. Chicago Reader. July 28, 1988, 1988.

  1. Ricks WS. Ridgeview Institute loses $1.3 million in suit over suicide. Atlanta Journal and Constitution. October 11, 1987, 1987: A1.
  2. Durcanin C. The suicides at Ridgeview Institute: Staff members didn’t believe Michigan doctor was suicidal. Atlanta Journal and Constitution. December 18, 1987, 1987: A8.
  3. Schneidman B. The Philosophy of Rehabilitation for Impaired Physicians. The Federal Bulletin: The Journal of Medical Licensure and Discipline. 1995;82(3):125-127.
  4. Merlo LJ, Gold MS. Successful Treatment of Physicians With Addictions: Addiction Impairs More Physicians Than Any Other Disease. Psychiatric Times. 2009;26(9):1-8.
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  7. Reisfield GM, Goldberger BA, Pesce AJ, et al. Ethyl glucuronide, ethyl sulfate, and ethanol in urine after intensive exposure to high ethanol content mouthwash. Journal of analytical toxicology. Jun 2011;35(5):264-268.
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  9. Hoiseth G, Yttredal B, Karinen R, Gjerde H, Christophersen A. Levels of ethyl glucuronide and ethyl sulfate in oral fluid, blood, and urine after use of mouthwash and ingestion of nonalcoholic wine. J Anal Toxicol. Mar 2010;34(2):84-88.
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ASAM plan to have doctors drug test Almost everyone using non- FDA approved testing

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The Plan to… Require Doctors to Drug-Test all Patients
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Chain-of-Custody refers to the document or paper trail showing the collection, control, transfer, analysis and disposition of laboratory tests. It is the written documentation of a specimen from the moment of collection to the final destination to the review and reporting of the final results. The multi-part chain-of-custody form, or “custody and control” form, is part and parcel of this process. It contains stickers to sign and seal the specimen so that it cannot be tampered with and the form itself is signed by the appropriate parties as the test specimen travels from place to place. Information is added to the form as it travels from person to person. It has been given the status of a legal document as it has the ability to invalidate a specimen with incomplete information. Once the sample is analyzed it is reviewed by a Medical Review Officer (MRO) for final review. In the case of a positive test it is the responsibility of the MRO to ascertain an intact chain-of-custody, determine whether an alternative explanation exists for the positive test such as a prescribed medication, and then and only then report the test as a “true positive.”

The MRO looks for what are called “fatal flaws” and, should one be present, invalidates the test. A fatal flaw requires the test be rejected as it were never drawn. It invalidates it and it cannot be used.

Forensic versus Clinical Drug Testing

Forensic drug testing is done for medico-legal purposes. It is used for testing people for substances of abuse or substances in those who should not be using them. Forensic drug testing results in consequences. These consequences can be grave and far-reaching if the drug-testing is being done by a regulatory agency or some other body given the power to sanction or punish. Loss of careers, of child-custody, and of rights and freedoms can all depend on results of a single test.

IMG_0701Random drug-testing done in the workplace is also forensic but the consequences are usually quite different. A positive drug-test done in this manner typically results in an assessment, treatment if indicated, and compliance with some sort of monitoring protocol in order to return to work.

Forensic drug testing follows more stringent guidelines than clinical testing because of these consequences. Some are more stringent than others, requiring split-specimen samples and the use of only certified labs. But the minimum requirements for any and all drug testing include strict chain-of-custody procedures and review by a certified MRO.

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Clinical drug testing, on the other hand, occurs in the course of a doctor caring for a patient. It is done to diagnose and treat and cannot be used outside this purview. The results of a clinical test are part of the medical record and deemed ‘Protected Health Information’ (PHI). The results are protected by HIPPA and cannot be disclosed to anyone not directly involved in your direct medical care without your written consent. There are no additional guidelines in place for clinical drug-testing as patient autonomy is preserved. A positive result could result in a recommended course of action by the physician but it is still up to the patient whether or not to follow that recommendation. It is not imposed. But there are some groups who want to change that by blurring the lines between “forensic” and “clinical” drug testing.

The ASAM White Paper on Drug Testing

According to the ASAM White Paper on Drug Testing, clinical drug-testing “employs the same sound procedures, safeguard, and systems of information management that are used for all other health-related laboratory tests, tests on which life-and-death medical decisions are commonly made.” In the box above they describe the multiple safeguards in place and requirements demanded of “forensic” drug testing, but do not mention the reason these uncompromising and multiple specifications exist is to protect the donor from a false accusation of drug or alcohol use. They proceed to define “clinical drug testing” as “part of a patient examination performed for the purposes of diagnosis, treatment, and the promotion of long-term recovery”, noting that clinical testing “must meet the established standards of medical practice and benefit the therapeutic relationship, rather than meeting the formal legal requirements of forensic testing.” The authors then state that the “majority of drug testing done today” includes both forensic and clinical elements, using individuals on parole and probation as examples.

The logical fallacy here is striking. It is comparing apples and oranges. After detailing the specific quality-assurance safeguards designed to prevent the donor of a drug or alcohol test from being falsely accused of illicit use, the authors give a general definition and purpose of “clinical” testing then state that when testing for drugs the systems in place are up to snuff as it is already being used to make life-and-death medical decisions. The take-home message is that “forensic” testing is unnecessary hyperbole designed for legal challenges. The clinical lab systems in place are used for critically important testing so it can be used for drug-testing. After all, parolees and probationers don’t require it.

Forensic guidelines developed in collaboration with occupational and environmental medicine specialist, clinical and forensic toxicologists, pathologists and others, and each of these requirements exists to assure the validity and accuracy of the testing process and protect the donor. If “clinical” testing context had fit the bill then “forensic” testing would not have evolved. Labs ordered clinically in the course of patient care are interpreted within the context of multiple other pieces of data. Lab errors occur all the time and are interpreted in that context.

Oftentimes a lab will not fit with the clinical picture and, when that happens, a repeat lab is ordered for verification. Specimens get collected in the wrong tube and specimens get lost but in the clinical setting they simply get reordered and there are no consequences to patient care. In contrast drug testing is an all-or-none one-shot test and the results have consequences. It is for that reason they must be valid.

Chain-of-custody and MRO review are critical and that is why most drug-testing programs follow the forensic protocol. And the example of non-forensic drug-testing parolees and probationers is misleading. Any Employee Assistance Program that has a union or some other group looking out for their best interests uses strict “forensic” guidelines. Parolees and probationers have no power and have no choice. Besides, the National Association of Drug Court Professionals uses the Laboratory Developed Tests these same people introduced to test individuals on probation or parole in the criminal justice system just as they do in the PHPs.

The ASAM White Paper:

“Encourages wider and ‘smarter’ use of drug testing within the practice of medicine and, beyond that, broadly within American society. Smarter drug testing means increased use of random testing* rather than the more common scheduled testing,* and it means testing not only urine but also other matrices such as blood, oral fluid (saliva), hair, nails, sweat and breath when those matrices match the intended assessment process.

In addition, smarter testing means testing based upon clinical indication for a broad and rotating panel of drugs.”

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 Puzzle solved- Medical Board PHP Compliance counsel another rigged gauntlet–outcome predetermined and PHCU assassins for PHP

 Massachusetts Board of Registration in Medicine Attorney Deb Stoller’s “Fraud on the 


Stay tuned -Physician Health and Compliance Unit Board (PHCU) counsel Deb Stoller’s Fraud on the Court beyond reprehensible and much more abhorrent then below. The last piece of the puzzle is  in place.  This is a closed system designed to prevent exposure if the corruption and fraud. Tone at the top not only unethical but psychopathic machiavellianism.  Rotten to the core.
PHCU Board counsel was Developed as independent unit outside the Board at large and given power to act both as hearing officer and present PHS cases to the Board and recommend Board disposition.  That’s right -the PHCU Holds all the cards and the deck is stacked. 
“Fraud on the court” occurs when the judicial machinery itself has been tainted, such as when an attorney, who is an officer of the court, is involved in the perpetration of a fraud or makes material misrepresentations to the court. Fraud upon the court makes void the orders and judgments of that court.
Bulloch v. United States, 763 F.2d 1115, 1121 (10th Cir. 1985 states: “Fraud upon the court is fraud which is directed to the judicial machinery itself and is not fraud between the parties or fraudulent documents, false statements or perjury. … It is where the court or a member is corrupted or influenced or influence is attempted or where the judge has not performed his judicial function — thus where the impartial functions of the court have been directly corrupted.”

It has recently become evident that the Director of the Board of Registration in Medicine’s Physician Health and Compliance Unit, attorney Deb Stoller, has been unethically and unlawfully withholding and concealing documentary evidence that is not only exculpatory to me but reveals that Physician Health Services (PHS) engaged in misconduct and fraud. She has essentially been concealing their crimes.

The “Administrative Record” filed by the Board was absent copious documentation of major importance and all of it was submitted through the care of Ms. Stoller. The missing documents include multiple petitions and supporting documents that are neither irrelevant nor superfluous. Each of these documents contains sufficient indicia of reliability to meet probative value.Concealing material fact, misrepresentation and making false statements to a state administrative agency is unethical. It constitutes abuse of power and fraud.

Fraud on the court occurs where a party tampers with the fair administration of justice by deceiving “the institutions set up to protect and safeguard the public” or otherwise abusing or undermining the integrity of the judicial process. Hazel-Atlas Glass Co. v. Hartford-Empire Co., 322 U.S. 238, 246 (1944).

The United States Court of Appeals for the First Circuit skillfully defined the concept of fraud on the court in Aoude, supra at 1118, as follows: “A `fraud on the court’ occurs where it can be demonstrated, clearly and convincingly, that a party has sentiently set in motion some unconscionable scheme calculated to interfere with the judicial system’s ability impartially to adjudicate a matter by improperly influencing the trier or unfairly hampering the presentation of the opposing party’s claim or defense.”

 LMs. Stoller is in violation of the Rules of Professional Conduct including Mass.R.Prof.C. 3.4(c). Fairness to Opposing Party and Counsel which states in part: A lawyer shall not: (c) knowingly disobey an obligation under the rules of a tribunal except for an open refusal based on an assertion that no valid obligation exists.

Mass.R.Prof.C Advocate Rule 3.3 Candor Toward The Tribunal reads:

(a)A lawyer shall not knowingly:

(1) make a false statement of fact or law to a tribunal or fail to correct a false statement of material fact or law previously made to the tribunal by the lawyer; (3) offer evidence that the lawyer knows to be false. If a lawyer, the lawyer’s client, or a witness called by the lawyer, has offered material evidence and the lawyer comes to know of its falsity, the lawyer shall take reasonable remedial measures, including, if necessary, disclosure to the tribunal. A lawyer may refuse to offer evidence, other than the testimony of a defendant in a criminal matter, that the lawyer reasonably believes is false; (b) A lawyer who represents a client in an adjudicative proceeding and who knows that a person intends to engage, is engaging or has engaged in criminal or fraudulent conduct related to the proceeding shall take reasonable remedial measures, including, if necessary, disclosure to the tribunal,; (c) The duties stated in paragraphs (a) and (b) continue to the conclusion of the proceeding, and apply even if compliance requires disclosure of information otherwise protected by Rule 1.6.

And under Mass.R.Prof.C. 8.4(c, d, h. It is professional misconduct for a lawyer to: (c) engage in conduct involving dishonesty, fraud, deceit, or misrepresentation; (d) engage in conduct that is prejudicial to the administration of justice; (h) engage in any other conduct that adversely reflects on his or her fitness to practice law.

The Supreme Judicial Court (SJC) reviews the Board’s decisions in part for constitutional error, see Mass.Gen.L. ch. 30A, Sec. 14(7), and is permitted to gather evidence “in cases of alleged irregularities in procedure before the agency [when those irregularities are] not shown in the record.” Mass.Gen.L. ch. 30A, Sec. 14(5). The Court may look beyond the record if it appears the agency deliberately or negligently excluded documents that may have been adverse to its decision.

On a writ of certiorari, the court’s review “is confined to the record and is for the purpose of correcting legal error, [and therefore] the inquiry about the presence or absence of genuine issues of material fact, germane to summary judgment procedure, is inappropriate. . . . [The reviewing court] need only inquire whether the commission’s decision was ‘legally tenable and supported by substantial evidence on the record as a whole.”‘ Gloucester v. Civil Serv. Comm’n, 408 Mass. 292 , 297 (1990), quoting Commissioner of Health & Hosps. of Boston v. Civil Serv. Comm’n, 23 Mass. App. Ct. 410 , 411 (1987). See G.L.c. 31, s. 2 (b); Mayor of Revere, supra at 319-322.

Fraud is distinguished from negligence, ignorance, and error by virtue of the fact that it is intentional; involving some level of calculation. Negligence is: “the failure to use such care as a reasonably prudent and careful person would use under similar circumstances.” In a professional context, it is defined as: “conduct which falls below the standard established by law for the protection of others against unreasonable risk of harm… it is characterized chiefly by inadvertence, thoughtlessness, inattention, and the like.”. Fraud, in contrast, is not accidental in nature, nor is it unplanned. Those who commit fraud know what they are doing and are deliberate in their efforts. They are also aware that it is unethical, illegal, or otherwise improper.

Fraudulent intent is established by examining the documentation of decisions and behaviors associated with those under suspicion. As explained in Coenen: “Manipulation of documents and evidence is often indicative of such intent. Innocent parties don’t normally alter documents and conceal or destroy evidence.

As explained in Black’s Law Dictionary, fraud is an intentional distortion of facts and truth for the purposes of inducing another to give up something of value that they possess or to relinquish a legal right that they might otherwise retain. It is additionally defined as a “false presentation of a matter of fact whether by words or by conduct, by false or misleading allegations or by concealment of that which should have been disclosed which deceives and is intended to deceive another.”

I believe it is safe to conclude that the parties here participated in fraud.

The “litigation-packet” did not merely show “chain-of-custody” issues but forensic fraud. Misrepresenting invalid forensic test results as valid is the definition of forensic fraud. Ms. Stoller should have immediately assessed the “clear-weight” of this evidence, entered it into the docket for reconsideration and given me an opportunity to be heard. She did not.

The Federation of State Medical Board Policy specifically requires strict “chain of custody.” She violated the Board’s very own standards and then blocked me from returning to practice by putting barriers in place, refusing to allow independent evaluations and protracting the time –drawing this out in order to cause as much damage as possible to my family and me.
Mr. Bertram alleges PHS has not committed any crimes because the agency has not been charged with any crimes. This is logical fallacy. They have not been charged with any crimes because the very agencies capable of charging them with crimes are ignoring or otherwise overlooking them for various reasons. Furthermore, If I see someone being stabbed in the back I can reasonably conclude it is a crime. Colluding with a laboratory to intentionally misrepresent laboratory data is laboratory fraud and covered under Title 18 of the United States Criminal Code (Wire fraud 18 USC 1343, False Statements 18 USC 1001, Conspiracy 18-USC 371, False Claims 18-USC 287 and Obstruction of Justice 18-USC 1505). I believe all of these are applicable here. In addition Dr. Sanchez violated M.G.L 156 (B) Section 69 by making false statements to a state agency.

PHS has convinced the Board not to “second-guess” their decisions and apparently the Board has convinced state AGOs to not “second-guess” theirs; each presupposing the integrity of the individuals and validity of the decisions of the agencies in question. As a result complaints by doctors of serious crimes and abuse are ignored. Fact and truth do not matter as the agencies blindly support one-another. This removes all aspects of accountability including answerability and justification for one’s actions. It is a flawed system.

In the past the SJC has overturned the Board’s decisions on due process grounds, see, e.g., Morris v. Board of Reg. in Medicine, 405 Mass. 103, 110, 539 N.E.2d 50, 54 (1989) (vacating Board decision because proceedings “denied [the physician] fairness in a due process sense.”).

This interference with the administration of Justice, abuse of authority and denial of constitutional rights warrant the Board Orders be reversed, vacated and corrected. “The touchstone of due process is protection of the individual against arbitrary action of government.” (Wolff v. McDonnell, 418 U.S. 539, 558 (1974). “[i]n a just society those who govern, as well as those who are governed, must obey the law.” (United States v. Leon, 104 S. Ct. 3430, 3457 (1984) (Stevens, J., dissenting).

The Courts have held that the Massachusetts and Federal Administrative Procedure Acts require both the agency and the court to consider the entire record, including testimony given at the hearing. In Friends of Edgartown Great Pond v. DEP, 446 Mass. 830, 845 (2006), the SJC recognized that the agency must consider the hearing evidence, finding the agency hearing complied with the Administrative Procedure Act requirements because “the record illustrates that over the course of the five-day hearing, the administrative law judge carefully considered all of the relevant evidence.”

The record compiled here illustrates that over the course of four years the Board not only failed to carefully consider any of the relevant evidence but most likely never saw any of it.

Our Constitution mandates that level of legal process due to reflect “respect enforced by law for that feeling of just treatment which has been evolved through centuries of Anglo-American constitutional history and civilization.” Joint Anti-Fascist Refugee Comm. v. McGrath, 341 U.S. 123, 162, 71 S.Ct. 624, 95 L.Ed. 817 (1951) (Frankfurter, J., concurring)

Ms. Stoller violated multiple professional regulations, ethics and the law in an ongoing campaign in which she blocked the administration of justice. By concealing the truth she prevented both exculpatory evidence favorable to my case and detrimental to the opposing party (involving misconduct and crimes from ever coming to light. It is quite clear the full Board never saw these documents. The fact that the latest Board action did not have any of the documents or petitions submitted over the past year is prima facie evidence of Fraud on the Court. Ms. Stoller needs to be held accountable and I am requesting the SJC uses whatever power it has available to make certain this occurs. Ms. Stoller needs to be disciplined for her actions and this discipline needs to be commensurate with her crime. In this case nothing less then disbarment and criminal charges would fit that bill.
In the Matter of Michael L Langan, M.D.

Petitioner
ON PETITION FOR A WRIT OF CERTIORARI (SJC-2015-0267)
TO THE
MASSACHUSETTS
SUPREME JUDICIAL COURT FOR THE COMMONWEALTH
MOTION TO DECIDE THE MATTER ON THE PAPERS DUE TO INTENTIONAL CONCEALMENT OF KEY DOCUMENTS AND “FRAUD ON THE COURT”
The Administrative Record filed by the Board and Assistant Attorney General Bryan Bertram’s oppositional statements suggest that the Director of the Board’s Physician Health and Compliance Unit, Attorney Debra Stoller has been interfering with the administration of justice by suppressing documentation provided as key evidence and the petitionary arguments accompanying them. The amount of missing information is profound and in review of all of the documents including Board Orders and the Board’s oppositional response to my complaint it is evident that the documents were concealed from the full Board. Mr. Bertram’s arguments are based on a very limited record as both exculpatory documents supporting my position and documents indicating misconduct by PHS were intentionally blocked by attorney Deb Stoller in violation of professional regulation consistent with Fraud on the Court. She engaged in misrepresentation, concealment and other misconduct in interference with the administration of justice.
Fraud on the court occurs when the judicial machinery itself has been tainted, such as when an attorney, who is an officer of the court, is involved in the perpetration of a fraud or makes material misrepresentations to the court. Fraud upon the court makes void the orders and judgments of that court. In Bulloch v. United States, 763 F.2d 1115, 1121 (10th Cir. 1985), the court stated “Fraud upon the court is fraud which is directed to the judicial machinery itself and is not fraud between the parties or fraudulent documents, false statements or perjury. … It is where the court or a
member is corrupted or influenced or influence is attempted or where the judge has not performed his judicial function — thus where the impartial functions of the court have been directly corrupted.” Ms. Stoller has in fact violated:
Mass.R.Prof.C. 8.4(c, d, h). Misconduct. It is professional misconduct for a lawyer to: (c) engage in conduct involving dishonesty, fraud, deceit, or misrepresentation; (d) engage in conduct that is prejudicial to the administration of justice; (h) engage in any other conduct that adversely reflects on his or her fitness to practice law.
Mass.R.Prof.C. 3.4(c). Fairness to Opposing Party and Counsel. A lawyer shall not: (c) knowingly disobey an obligation under the rules of a tribunal except for an open refusal based on an assertion that no valid obligation exists;
Rules of Professional Conduct Rule 3.4: Fairness to Opposing Party and Counsel
A lawyer shall not:
(a) unlawfully obstruct another party’s access to evidence or unlawfully alter, destroy, or conceal a document or other material having potential evidentiary value. A lawyer shall not counsel or assist another person to do any such act;
(b) falsify evidence, counsel or assist a witness to testify falsely, or offer an inducement to a witness that is prohibited by law;
(c) knowingly disobey an obligation under the rules of a tribunal except for an open refusal based on an assertion that no valid obligation exists;
(d) in pretrial procedure, make a frivolous discovery request or fail to make reasonably diligent effort to comply with a legally proper discovery request by
On March 9, 2015 an Affidavit was filed with this Court (Affidavit of Michael Langan in Support of Motion for Relief Pursuant to Earlier Court Order) because Attorney Deb Stoller refused to schedule a hearing despite this Court’s request that she do so. In this Affidavit I outline the multiple unwarranted and unjustified delays and state “my legitimate concern is that the Board will simply ignore my most recent January 20, 2015 Petition for Re-instatement. My fears are well grounded as the Board has engaged in a persistent pattern of ignoring my every reasonable effort at trying to be re-instated; and the board has abused the administrative law process to accomplish this. It was only after this Affidavit was filed with this Court that Ms. Stoller even put me on the schedule.
It appears my fears were indeed well grounded as they actually did ignore my January 20, 2015 petition. It appears the April 16, 2015 Board Hearing was simply a “sham review” to satisfy this Court’s request.
The Administrative Record compiled for the April 16, 2015 Board Hearing was absent copious relevant documents including the January 20, 2015 Petition on which it was ostensibly based. In fact, the sole petition is close to one year old. Since that time I have submitted five more petitions that are absent. Since that time I have submitted multiple documents and petitions that are not found anywhere in the Board’s record. Although some of the key documents presented to the Board since 2011 are contained therein, there is no index indicating the date they were received and this brings into question when and if these mitigating and even exculpatory documents were ever even considered.
Mr. Bertram’s oppositional statements underscore these violations and bring the abuse of authority and denial of Constitutional rights to a level of outrageousness. Mr. Bertram states “in his most recent petition to the Board to stay the suspension (“January 2015 Petition”), Dr. Langan submitted a report from an independent psychiatric evaluation (favorably opining as to his fitness to practice medicine) satisfying the first condition, but he did not satisfy the Board’s other conditions because he did not propose suitable (or any) monitoring plans with his petition. Instead, Dr. Langan sought to challenge the Board’s findings that he twice previously
violated the LOA even though he never challenged those violations before, and the time to do so has long since passed.” (page 2)
“Dr. Langan had in the past submitted a letter from Dr. Timothy Wilens, dated February 14, 2014, reporting to the Board that to the date of that letter Dr. Langan remained alcohol and substance free. Id at 158. But, that is not evidence that Dr. Langan remained abstinent in the months preceding the January 2015 Petition to the Board.” (page 8)
Mr. Bertram is correct. The February 14, 2014 report from Dr. Wilens does not cover the months preceding the January 2015 Petition to the Board, but the attached letters from Dr. Wilens dated April 24, 2014 and April 3, 2015 certainly do. The January 2015 Petition was heard at an April 16, 2015 Board Hearing and the April 3, 2015 letter from Dr. Wilens states: “I have monitored him (Langan) clinically and over the past year have been ordering and monitoring urine and saliva” toxicology tests and notes he will continue following me. This letter was written 13 days prior to the April 16th Board Hearing but absent from the Administrative Record filed by the Board October 9, 2015. The letter was provided to Board attorney Deb Stoller both by U.S. Postal service and e-mail. Additionally, it was hand delivered with the other supporting documents of my January 2015 Petition to Board attorney Tracy Ottina at the April 16th, 2015 Board Hearing.
The only possible explanation for the absence of this letter from the Administrative Record is that it was intentionally withheld. The fact that Mr. Bertram argues the absence of such documentation was used in the Board’s reasoning process to deny my Petition suggests the Board never saw it.
Due to the limited number of straightforward issues pertaining to my case (i.e. no patient care or other issues that could be used as a pretext)

this rises to the level of a Brady violation. A Brady analysis has three prongs. First, “the evidence at issue must be favorable to the
accused.” Strickler v. Greene, 527 U.S. 263, 281-282, 119 S. Ct. 1936, 144 L. Ed. 2d 286 (1999). Second, it “must have been suppressed by the

state.” Id. at 282, 119 S. Ct. 1936. Third, “prejudice must have

ensued.” The absence of a monitoring plan is the sole issue Mr. Bertram
identifies as being a factor in the Board’s denial of my petition therefore in this context had I provided a monitoring plan my petition would not have been denied. Mr. Bertram goes on to state that I have never challenged the Board’s findings that I violated my Letter of Agreement. The copious documentation I I have provided this court shows I have been challenging these findings since day one and due to the limited number of issues leading to my suspension and the documentary evidence I have provided to Ms. Stoller that is exculpating to me and incriminating for PHS I suspect it was all suppressed.
Ms. Stoller is abusing her position of authority to deny due process and fundamental fairness with the administration of Justice. She is denying Constitutional rights and violating the Rules of Professional Conduct including Mass. R. Prof. C. 3.4(a), (b), (c); 3.3 (a), (b), (c) and 8.4(a), (c), and (d)
Additionally, I have provided evidence that PHS is engaging in crimes making her in violation of Advocate Rule 3.3 Candor Toward The Tribunal which reads:
(a) A lawyer shall not knowingly:
(1) make a false statement of fact or law to a tribunal or fail to correct a false statement of material fact or law previously made to the tribunal by the lawyer;
(3) offer evidence that the lawyer knows to be false. If a lawyer, the lawyer’s client, or a witness called by the lawyer, has offered material evidence and the lawyer comes to know of its falsity, the lawyer shall take reasonable remedial measures, including, if necessary, disclosure to the tribunal. A lawyer may refuse to offer evidence, other than the testimony of a defendant in a criminal matter, that the lawyer reasonably believes is false.
(b) A lawyer who represents a client in an adjudicative proceeding and who knows that a person intends to engage, is engaging or has engaged in criminal or fraudulent conduct related to the proceeding shall take reasonable remedial measures, including, if necessary, disclosure to the
tribunal.
(c) The duties stated in paragraphs (a) and (b) continue to the conclusion of the proceeding, and apply even if compliance requires disclosure of information otherwise protected by Rule 1.6.
In a November 12, 2015 Motion to Enlarge Time to Respond to Petition Mr. Bertram states “… the undersigned Assistant Attorney General discovered that the certified administrative record was potentially incomplete. After conferring with the Board, it was determined that a copy of Dr. Langan’s petition for reconsideration that resulted in the Board order now under review was inadvertently omitted from the record. (The document was also absent from the Board’s internal docket of this proceeding, resulting in the error by the Board’s staff who assembled the record.)
According to the May 7, 2015 Board Order: “The licensee has not submitted any new documentation that contradicts any of the documents cited to above and found in the Board’s February 6, 2013 Order of Suspension. In the absence of such documentation, there is no basis for rescinding the Board’s vote based on this argument.”
In other words, as with Dr. Wilen’s letter, the Board never saw it and the proposition that this was “inadvertent” is implausible.
In addition to Dr. Wilen’s letter, three petitions were filed with the Board of Registration in Medicine in preparation for the April 16, 2015 Board Hearing. These are dated January 20, 2015 and February 20, 2015 and make reference to a September 3, 2014 Petition in which I introduced a recently acquired document from October 4, 2012.
The October 4, 2012 document from United States Drug Testing Labs (USDTL) to Dr. Luis Sanchez reports the invalidity of the confirmatory test from July 2011 and was the result of an investigation by the College of American Pathologists and precedes Dr. Sanchez report to the Board that I was non-compliant by two weeks. It is essentially exculpatory as Sanchez claimed in a written letter to the Board that he had not become cognizant of the invalidity of the test until December 10, 2012 (67-days later) and these contradictory documents in juxtaposition are prima facie evidence of misrepresentation and dishonesty. Sanchez concealed the test revision and reported non-compliance with my monitoring contract to the Board on October 19, 2012, two weeks after he was informed of the tests invalidity.
 
In fact the Administrative Record submitted by the Board contains just one Petition from May 25, 2014 that was submitted after Dr. Patricia Recupero completed her 87-page report opining I was safe to practice medicine without restriction and documenting the misconduct of PHS . This report as well as other supportive documentation previously provided to the Board from July 2011 to April 2014 the time they were produced was included with the petition (pages 153-180).
The record provides no index of when these documents were received. No timeline exists. They are not acknowledged in the written Board orders and no consideration is given to them in their written opinion. This brings into question whether or not this information was even available at the time of both Board orders. Was this information taken into account at the time it was provided or was it intentionally withheld or discarded at the time?
Due to the profound removal of due process and fundamental fairness as well as the inability of Mr. Bertram to develop an accurate oral argument due to the limited information contained in the official record I respectfully request the Court proceed with judicial review based on the documents.
Respectfully Submitted,
Michael Langan, M.D. December 9, 2015