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Anonymous referrals to state PHPs can result in loss of careers, families and even lives.   I have heard from doctors targeted due to age , religion, sexual preference , nationality, political stance and appearance.  Referred to the  state PHP with an anonymous complaint of “alcohol on breath” or “anger issues,” these good doctors were removed from practice under the guise of protecting the public.   By claiming a doctor has a  “potentially impairing illness” and falsely labelling him or her with a substance use or behavioral disorder they are able to remove due process and remove any doctor from practice. The system is designed to give the appearance of legitimacy.   It is not.  The stories I have heard and continue to hear from doctors  and medical students are as horrific as they are heartbreaking.  I have heard from female doctors who refused to go out on a date with, spurned sexual advances and even been raped by other doctors who then reported them to their state PHP for damage control.   I have heard from many doctors who discovered misconduct such as insurance or Medicare fraud who were promptly reported to their PHP and doctors who were reported by competitors for patients.   I have heard from doctors reported out of jealousy, anger, racism and bigotry.    Some of these storied can be seen on who have thwarted sexual advances and even been raped who were reported to their state “letters from those abused and afraid

My work in physician health reform has resulted in some significant gains.  For example the Medscape article  Physician Health Programs- More Harm Than Good? by Pauline Anderson was the result of  Medscape Editor taking an interest in my tweets about a year earlier and contacting me and taking an interest in my blog.  Physician Health Programs- More Harm Than Good?    broke new ground as it was the first mainstream medical article critical of PHPs. This was read by British Medical Journal Editor Jeanne Lenzer and this led to “Physician health programs under fire.”    In this article published in the BMJ she takes on the financial conflicts of interest, abuse and fraud in PHPs and the FSPHP’s response to direct and specific questions revealed what an irrational and illegitimate authority they are.   They cannot provide direct and simple answers to direct and simple questions and remain tongue tied to this day.

By all counts their days are numbered and the articles mentioned above and more to come are the direct result of bottom-up activism.  So too is a forthcoming audit by Massachusetts state Auditor Suzanne Bump whose office has already interviewed enough abused doctors to warrant an investigation which will hopefully look into the misconduct and fraud being perpetrated by the Massachusetts PHP in collusion with a specific group of attorneys within the medical board that blocks due process and conceals evidence to protect the PHP and harm innocent doctors.

It took 25 years for the FSPHP to rise.  Let’s hope their demise is much quicker.  They need to be named as the enemy and addressed on a state by state basis.  We have dealt some significant blows and I would like to keep throwing some direct punches to the enemy but at this point it is getting difficult due to financial matters and I urgently need funding and support.

 

The need for allies and funding is urgent as time is critical.  We have to expose this group as an illegitimate and irrational authority, expose their fraud and scams and expose the backgrounds of some of the individuals involved.    Physician health programs should not longer be considered the elephant in the room.  All you have to do is look at documentary facts  and evidence to see what is happening and any ignorance at this point would have to be deemed willful ignorance.  You cannot continue to ignore the obvious.  To those within the PHPs and their sympathizers and apologists your silence speaks volumes To save American Medicine it is essential this be exposed, investigated and the perps held accountable.  Silence is no longer an option.

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Letters From Those Abused and Afraid

Letters From Those Abused and Afraid.

I’m hearing from more and more doctors via my survey, emails and phone calls.  At this point the patterns are becoming crystal clear and they involve the same “physician wellness” actors, the same “PHP-approved” assessment and treatment facilities and the same commercial “forensic” drug testing labs.

It is all the same M.O.  A false accusations  is made followed by misrepresentation of laboratory developed tests (LDTs) or outright forensic fraud.    A referral is then made for an “evaluation” at one of the “PHP-approved” facilities where an “assessment” is “tailored” to fit a pre-determined diagnosis.  The PHP then says do anything and everything we say or we will “end you.”  And all too often that is exactly what they do.   It is Political Abuse of Psychiatry plain and simple.   It does not get any more egregious than this folks.

The Doctors dying from this system of institutional injustice are not dying by suicide.  This is more akin to murder and the murderers have removed themselves from all aspects of accountability including answerability, justification for actions and the ability to be punished by third party actors truly outside the system. It is a rigged game.

the-world-is-a-dangerous-place-to-live-not-because-of-the-people-who-are-evil-but-because-of-the-people-who-don_t-do-anything-about-itThe sociopaths responsible for ordering false assessments and falsified drug and alcohol testing as well as those complying with it in the drug and alcohol testing, assessment and treatment industry need to be held accountable.

Those ordering the falsified tests and assessments are essentially putting guns to the heads of doctors.  The labs and rehab centers complicit in this fraud are pulling the trigger.  Simple as that.

You can see some of these letters here:  Letters From Those Abused and Afraid.

Oliver Wendell Holmes, the Massachusetts Medical Society, Tinsel Erudition and Pretended Science Redux

images-10As the oldest medical society in the United States the Massachusetts Medical Society can count some of the greatest minds in the history of American medicine as members.  My how far we have fallen.  This same author has previously unintelligibly compared the field of medicine to Barbra Streisand’s face and shamelessly and opportunistically blamed the Boston Marathon bombing on “marijuana withdrawal.” 
 
The sophomoric mnemonics are neither clever nor illuminating.  Unworthy of  Readers Digest circa 1957, this dumbing down of doctors needs to end.  The very soul and practice of medicine is being castrated and lobotomized by the same dull and very very blunt instrument. 
How does one reconcile the fact that the very same medical society that publishes the New England Journal of Medicine is allowing this type of tripe and rabble to get past editorial review?  In 1969, through an act of the state legislature, the Massachusetts Medical Society updated its mission to read:

“The purposes of the Massachusetts Medical Society shall be to do all things as may be necessary and appropriate to advance medical knowledge, to develop and maintain the highest professional and ethical standards of medical practice and health care, and to promote medical institutions formed on liberal principles for the health, benefit and welfare of citizens of the commonwealth.”

With a foundation and history built and based on of scholarship and critical thought we need to support the highest levels of science, fact, intelligence and reason.  Stupidity tries but it should not rein.    Before the Boston Society for the Diffusion of Useful Knowledge in 1842, Dr. Oliver Wendell Holmes delivered two long lectures entitled “Homeopathy and Its Kindred Delusions.” He characterized one of its popular practitioners, Dr. Robert Wesselhoeft, as one of those:  

“Emperics [quacks], ignorant barbers, and men of that sort…who announce themselves ready to relinquish all the accumulated treasure of our art, to trifle with life upon the strength of these fantastic theories.” That “pretended science” as Holmes called it, was “a mingled mass of perverse ingenuity, of tinsel erudition, of imbecile credulity, and artful misrepresentation, too often mingled in practice…with heartless and shameless imposition.”

And Holmes words are as apt and appropriate today as they were in mid 19th Century Boston!   Probably more so.

History has recurrently proved that false constructs and groundless concepts allow for endless error.

The Massachusetts Medical Society needs to come to the realization that Physician Health Services is engaging in procedural, ethical and legal breaches.  
The evidence is clear that past medical director Dr. Luis Sanchez and Director of operations Linda Bresnahan are engaging in not only unethical but criminal activity within the walls of the MMS.  Egregious misconduct including forensic fraud and political abuse of psychiatry can be seen in detail here, here and here.
This is not a matter  of opinion but a matter of fact.  It has been ascertained by outside agencies and can also be confirmed by two former associate directors at PHS.    What more does the MMS need?   This type of misconduct can have grave and far reaching consequences for referred doctors and needs to be addressed urgently with precise, firm methods.   To ignore the problem or suggest that it does not exist will only cause more damage.
The majority of Massachusetts Medical Society members are honest, thoughtful and responsible.   Most are unaware of the ethical and criminal allegations concerning PHS..  It is time they become aware as sunshine is the best disinfectant.   As the most crucial step in solving a problem is admitting it exists I am requesting this be ascertained or refuted based on the documents and examined procedurally, ethically and legally. If there is no problem then the MMS should have no problem supporting or justifying the actions of Dr. Luis Sanchez, Dr. Wayne Gavryck and Linda Bresnahan. If the MMS cannot justify, support or defend these actions then it must be concluded that these individuals have violated professional protocol,,  professional and community ethics and the law. And if that is the case it is the responsibility of the MMS to admit the problem exists, define it and address it.  It is the responsibility of the MMS to facilitate exposure and that those engaged in wrongdoing be held appropriately accountable for their actions.  I am sure no one at the MMS would disagree that forensic fraud be met with Zero-tolerance.    The criminal and ethical violations shown here do not comport with any codes of conduct including those of the medical society.   Those engaging in forensic fraud must be removed.
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Good leadership requires correct moral and ethical behavior of both the individual and the organization. .  Integrity is necessary for establishing relationships of trust.  It requires a true heart and an honest soul.  People of integrity instinctively do the “right thing” in any and all circumstances.  Adherence to ethical codes of the profession is a universal obligation.  It excludes all exceptions.  Without ethical integrity, falsity will flourish.

The documentary evidence here shows fraud. It is intentional.  All parties involved knew what they were doing, knew it was wrong but did it anyway.  The schism between pious rhetoric and reality is wide.

One measure of integrity is truthfulness to words and deeds.  These people claim professionalism, ethics and integrity.  The documents show a reality of hypocrisy and sanctimony.   But the hypocrisy seen here is also a danger because the careers and lives of doctors in Massachusetts are in these peoples hands.

-Michael Langan, M..D.
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Disrupted Physician

images-10As the oldest medical society in the United States the Massachusetts Medical Society can count some of the greatest minds in the history of American medicine as members.  My how far we have fallen.  This same author has previously unintelligibly compared the field of medicine to Barbra Streisand’s face and shamelessly and opportunistically blamed the Boston Marathon bombing on “marijuana withdrawal.”
 
The sophomoric mnemonics are neither clever nor illuminating.  Unworthy of  Readers Digest circa 1957, this dumbing down of doctors needs to end.  The very soul and practice  of medicine is being castrated and lobotomized by the same dull and very very blunt instrument. 
How does one reconcile the fact that the very same medical society that publishes the New England Journal of Medicine is allowing this type of tripe and rabble to get past editorial review?  In 1969, through an act of the state legislature, the Massachusetts Medical…

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Gay Doctor coerced by Physician Health Program (PHP) into mandated 12-step treatment and monitoring for sex addiction: The slippery slope begins

The civil and human rights violations remain hidden.  The crimes remain hidden. So too will this. It appears the FSPHP is following the same pattern they have with the “impaired” and “disruptive” physicians–to discriminate.    The targeting of gay, lesbian or transgender doctors for what they do in their private lives is predictable.  I just heard from one of these doctors who was told by the PHP that  if he did not cooperate with them in addition to losing his medical license the state medical board would make his sexual history part of the public record and available on their website!

It is an inevitable part of this well oiled slope of coercion, control, obedience and abuse.The import of this can not be overestimated.

via Gay Doctor coerced by Physician Health Program (PHP) into mandated 12-step treatment and monitoring for sex addiction: The slippery slope begins.

The “Impaired Physician”–Increasing the grand scale of the hunt

“Wretched creatures are compelled by the severity of the torture to confess things they have never done and so by cruel butchery innocent lives are taken; and by new alchemy, gold and silver are coined from human blood.”  Father Cornelius Loos  ( 1592 )

 

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How Impaired Physicians Can be Helped–Medscape Business of Medicine Article Published February 24, 2015. Click on image to access

 

How can impaired Physicians be helped?

1.   Impairment among physicians is growing:  Why?  

Answer:  It is not.   State Physician Health Programs (PHPs) are “diagnosing” impairment when there is no impairment.  They are pathologizing the normal and expanding in scope to increase the grand scale of the hunt.

2.  What’s the Prognosis for Impaired Physicians?

Answer:  Not Good.   Those who need help (the truly impaired)  are afraid to get help for fear of being monitored by their state PHP while many of those ensnared by PHPs are not impaired.   There is absolutely no oversight, regulation or accountability.  This needs to be evaluated in the context of physician suicide.    The system is one of institutional injustice and abuse of power. 

3.  Is your knowledge of physician impairment up-to-date?  

Answer:   No.  This will only occur after an evidence-based Cochrane type review separates information from misinformation; An objective non-biased investigation by outside actors identifying any conflicts-of-interest, misconduct or lack of evidence-base in the current system and separating the art and science of the medical profession from the politicalization and exploitation of the medical profession.

The list of doctors on Like-Minded Docs  solves the final piece of a  puzzle. It explains why so many doctors across the country are claiming fabrication and manipulation of personality and cognitive tests to support nonexistent diagnoses at these “PHP-approved” assessment centers.    The relationship between the state PHP’s and the “PHP-approved” assessment centers is the same as it is between the state PHPs and the corrupt labs.

As Drs. John Knight and J. Wesley Boyd note in Ethical and Managerial Considerations Regarding State Physician Health Programs, published in the Journal of the American Society of Addiction Medicine,  this is what is known as “tailoring a diagnosis”–a euphemism for the political abuse of psychiatry.  According to the Global Initiative on Psychiatry “Political abuse of psychiatry refers to the misuse of psychiatric diagnosis, treatment and detention for the purposes of obstructing the fundamental human rights of certain individuals and groups in a given society.”   The shoe fits here.  In fact it fits very well.

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The Global Initiative on Psychiatry opposes the Political_Abuse_of_Psychiatry  wherever  it may occur and “supports those psychiatrists and psychiatric organizations that pressure the offending states to discontinue the practice and lobby vigorously those organizations which are wavering. The main way for individuals and organizations to work is through diplomatic channels. It is necessary to expose the practice and to embarrass countries that are at fault by expelling them from organizations such as the World Psychiatric Association. This can only be ensured by properly organized open investigation of psychiatric practice and interviews with the alleged victims”

Political abuse of psychiatry in the profession of medicine needs to be treated in the same way.

An evidence based Cochrane type assessment of their “research” and an Institute of Medicine Conflict of Interest review are long overdue.

In evaluating a physician for “impairment” or being “disruptive” the Physician Health Programs (PHPs)  under the Federation of State Physician Health Programs (FSPHP)  are not gathering data to form a hypothesis.  They are making data fit a hypothesis that arrived at the out-of-state “PHP-approved” assessment center well before the alleged miscreant doctor.

With guilt assumed from the start, no due process, no appeal, and no way out physicians are being bullied, demoralized, and dehumanized  to the point of hopelessness, helplessness and despair.

This needs to end now.

Medicine is predicated on competence, good-faith, and integrity. 

Medical ethics necessitates beneficence, respect, and autonomy. 

The scaffold erected here is designed for coercion and control. 

Exposure, transparency, and accountability are urgent. 

The emperor has no clothes.

Sunshine is the best disinfectant.

https://artbylisabelle.wordpress.com/2015/03/01/three-shells-and-a-pea-asam-fsphp-and-lmd/

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Unethical Mental Health Practices: What do they look like?

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“Nearly all men can stand adversity, but if you want to test a man’s character, give him power”-Abraham Lincoln

A review of some of the common unethical  practices perpetrated by unscrupulous mental health providers published by  Anchored-in-Knowledge.

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Anchored In Knowledge Counseling

I recently spoke with a former colleague who shared a story of a young 17-year-old who was killed during a physical restraint (stay tuned for my Personal Stories Week on Psychcentral, coming August 17th-24th, for more on this story). She was not only disgusted by her colleagues but shocked that the agency suspended these three men with pay. This story sparked another story which sparked a series of questions about unethical behaviors and what they look like within mental health agencies. I have taken the opportunity to list a few below. Please feel free to share your experiences of unethical behaviors within mental health agencies in the comments section below.

What are common unethical practices?

It’s difficult for many families to determine what is ethical and what is unethical. Here is a list of unethical behaviors that often occur in mental health facilities:

  • Neglecting to meet with clients during a…

View original post 608 more words

Neuropsychological Misconduct –Making the Data fit the Diagnosis Part 1: Denial

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In May 1999, Dr. G. Douglas Talbott stepped down as president of the American Society of Addiction Medicine (ASAM) down as a jury awarded  Dr. Leonard Masters a judgment of $1.3 million in actual damages and an undisclosed sum in punitive damages for malpractice, fraud, and false imprisonment.  The fraud finding required that the errors in the diagnosis were intentional.

Masters was accused of improper prescribing and referred to the Florida Physician Health Program (PHP).  The PHP Director, a recovering alcoholic, gave him two choices-either lose your license or be evaluated at one of our assessment centers.   Believing he would have an objective evaluation that would clear him, Masters chose the latter.  His assessment resulted in a diagnosis of “alcohol dependence” and he was required to enroll in the Talbott Recovery Program where he was released 4 months later and forced to sign a 5-year monitoring contract with the Florida PHP.

But Masters was not an alcoholic.   According to his attorney,  Eric. S. Block,

“No one ever accused him of having a problem with alcohol. Not his friends, not his wife, not his seven children, not his fellow doctors, not his employees, not his employers, No one.


The type of treatment given Dr.Masters had been previously implicated in the suicides of at least 25 doctors at one of Talbott’s facilities.    Neither the exposure of these suicides nor the associated lawsuits resulted in any changes in treatment protocol.    Dr. Master’s successful lawsuit didn’t either.

Changes were made; not to the treatment protocol but to the medical record.  In order to prevent future malpractice suits for intentional fraud and false imprisonment they would make certain the medical records supported the diagnosis using a variety of tactics including  cherry picking,  suppression of specific information and deliberate avoidance of key facts, unprovable and un-disprovable statements, and a lot of illogical incomprehensible jabber all designed to make the data fit the diagnosis.

And in the year  2015 a doctor is required to be evaluated at a facility exactly like this  There is no choice. They simply stacked the deck and tightened the noose.


Neuropsychological Misconduct –Making the Data fit the Diagnosis Part 1:  Denial

To further complicate matters, many evaluation/treatment centers are dependent on state PHP referrals for their financial viability. Because of this if, in its referral of a physician, the PHP highlights a physician as particularly problematic, the evaluation center might–whether consciously or otherwise–tailor its diagnoses and recommendations in a way that will support the PHP’s impression of the physician.”  -John Knight and J. Wesley Boyd.  in “Ethical and Managerial Considerations Regarding State Physician Health Programs,”  Journal of Addiction Medicine  2012

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Dr. Stephen Snook, PhD

To “consciously tailor a diagnosis” is fraud.  To consciously tailor” recommendations (which would logically be an inpatient admission as I doubt the recommendations for a “problematic” physician would be send him home!) is the political abuse of psychiatry.

In 2008 I was asked to have an evaluation at Talbott by the Massachusetts PHP.  Like Masters I expected a fair evaluation. The evaluation was because of a positive urinalysis for the metabolite of a medication I was taking and there were no other issues.  I brought with me a letter from the manufacturer of the medication I was taking stating that it was manufactured from the substance found in my urine.  In addition I had two forensic toxicology tests done (fingernail and hair) by an independent lab.  My work performance and bedside manner had always been rated as superb. In my 13 years at Harvard Medical School and 10 at Massachusetts General Hospital I had never had or even been threatened with malpractice.  And if you talked to any of my supervisors, coworkers, nurses, students or patients they would have nothing negative to say.

But the folks at Talbott did not contact any of my supervisors, coworkers, nurses, students or patients.  They only spoke with PHS.   When I arrived at Talbott for the four day evaluation almost the entire first day was spent trolling my bank accounts, credit-limit, and retirement fund to see how much I could pay for up to 3-months of inpatient treatment. They even asked me if I had anyone I could borrow up to $80,000.00 for the cash only “PHP-approved” facility.  I next met with the Medical Director Dr. Paul Earley who told me my future was in his hands and I was in denial.  He told me I would never practice medicine again if I did not accept treatment.  I refused.  Any attempts at communication or questions were met with thought stopping memes and gibberish.    Simple questions were deflected with “you need a check up from the neck up” and “your best thinking got you here.”  I then had a neuropsychological exam done by Dr. Stephen Snook that included the MMPI and an IQ test.  At the end of the four day evaluation I met with the assessment team who told me that the neuropsychological tests revealed  “denial” and “cognitive impairment,” that I could not safely practice medicine and that I needed up to three months of treatment.   I looked at the evaluation which appeared to be a template for confirmatory distortion.  Most of it was subjective psychobabble I could not disprove but I did notice one-big red flag I could.  I had done some work with the MMPI in college.  Basing  my diagnosis of denial on the MMPI Dr. Snook’s interpretation was as follows:

The MMPI-2 and the MCMI-III were completed as self-report measures of psychological functioning and personality characteristics. An analysis of his response style to this inventory showed that he understood the items, but responded in a rather guarded and cautious manner. His pattern of responding is typical of an individual who may be seen as making a naïve and unsophisticated attempt to appear in a positive light. There may be a pattern of minimizing and denying even common human faults. Such a pattern of responding is not unusual in such an assessment, but may reflect a person who is not particularly insightful in terms of his won feelings and behavior. Additionally, such patterns of responding are also seen in individuals who are particularly moral or religious. Due to the level of defensiveness noted on the resulting profile, a degree of caution is warranted in interpreting these results.

The Minnesota Multi-phasic Personality Inventory

In 1942, Hathaway and Mckinley published the original Minnesota Multi-phasic Personality Inventory (MMPI). It is the most widely used psychological test in the world and has been translated into 150 languages.1. It is also the most extensively researched psychological test in history.2

Since its publication it has been revised only once and this revision is referred to as the MMPI-2.

The MMPI-2 is an objectively interpreted personality instrument with empirically validated scales. A high score on a particular clinical scale is associated with certain behavioral characteristics. These scale “meanings” are objectively applied to the test taker.

People taking the MMPI-2 are asked to give one of three responses to each of 567 items: true, false, or cannot say. The responses are scored on seven validity scales and a variety of clinical scales. The test is then scored by transforming raw scores into uniform T scores with a mean of 50 and a standard deviation of 10.

The MMPI has diagnostic value as its findings can help confirm or refute the diagnostic judgments drawn from other information obtained from the patient’s history.

The MMPI-2 is easy to score by counting item responses for each scale and recording them on a profile sheet or by using a computerized scoring program. The objective scoring procedures for the MMPI-2 assure reliability in the processing of the individual responses.

The MMPI consists of Validity Scales and Content (Basic) Scales. The creators of the MMPI were aware of the fakability of a verbal inventory and they attempted to develop several validity indicators. These are internal measures that would point to the individual who was not responding honestly.3

Although the scoring is objective, the interpretation is not. In practice clinicians generally select specific interpretations from already published possible interpretations, such as those found in an MMPI-2 handbook or a computerized report.   Commercially available tests, well written manuals, and dozens of research studies facilitate but do not ensure proper and responsible test use.

According to The Handbook of Psychological Assessment,4the L (Lie Scale):

…consists of 15 items that indicate the extent to which a client is attempting to describe himself or herself in an unrealistically positive manner. Thus, high scorers describe themselves in an overly positive and idealized manner. The items consist of descriptions of relatively minor flaws to which most people are willing to admit.”

“If the clients score is considered high, it may indicate the person is describing himself or herself in an overly favorable light. This may result from conscious deception or, alternatively, from an unrealistic view of himself or herself.”

Examples of these questions include:

I do not always tell the truth

I do not like everyone I know

I would rather win than lose a game

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In Psychological Assessment with the MMPI-25, it is noted that the L scale, when elevated, “reflects naïve or obvious attempts by a person to look unusually virtuous, culturally conservative, overly conscientious, and above moral reproach,” and adds that “L scale scores above a T score of 65 are unusual except in persons…or are in situations…that prompt them to present themselves in their ‘best light’.”

In Forensic Uses of Clinical Assessment Instruments,6 Archer notes that high scorers on the L-scale “present in an unusually virtuous manner and deny personal flaws that most people would be willing to admit.”

In Psychometrics :An Introduction 7 it is stated that the L-scale consists of 15 items that describe “minor flaws and weaknesses to which most people are willing to admit” and is “intended to reflect a respondent’s attempt to present an overly positive impression.”

The Psychologists’ Desk Reference8 notes indicate that individuals who score high on this scale are “presenting an overly favorable picture of themselves.”

The K scale (Correction Scale) also measures defensives and guardedness. It evaluates some of the same behavior as the L scale but much more subtly.9

The original purpose of this scale was to identify “defensiveness against psychological weakness and…a defensiveness that verges upon deliberate distortion in the direction of making a more ‘normal’ appearance.”3

To evaluate the K scale properly the specific population must be noted. In a college population a T-score on this scale between 50 and 65 is typical on the MMPI-2.9 People scoring in this range are indicating that their lives are satisfactory, that they are basically competent, and that they can manage their lives. When T = 65 or above these people are indicating “not only that they are competent people and can manage their own lives, but also that they are a bit cautious about revealing themselves. Such scores are usually obtained when a person is defensive, and/or when the test administrator does not fully explain the reason for the test.”9

Raw Scores show Dr. Snook fabricated interpretation out of whole cloth  Elevated L-scale > 65  Mine = 49

When I got back to Boston I asked MGH neuropsychologist Dr. Lauren Pollak to contact Dr. Snooks office under the guise of continuity of care.  She requested that the MMPI raw data and my score sheet be sent to her.  As they usually refuse to send records and labs to doctors we waited  until he was out of town.  The raw data confirmed what I suspected—Dr Snook made up the interpretation to make it look as if I was in denial (elevated L-scale, “reluctant to admit to even common faults”, “unsophisticated attempt to appear in positive light.” All of my validity scales were within normal limits. My L-scale T score was 49 but he wrote his assessment as if it were 65!

The scoring sheet that I filled out in March of 2008 with a #2 pencil can be seen Here.   The scoring sheet  showed all of my MMPI validity test T-scores within normal limits. Moreover, Dr Snook’s raw data showed that he scored the test correctly. The scoring sheet was then run independently through the MGH Neuropsychology Departments computer and showed exactly the same thing. So there was no error in scoring. An error in scoring could be understandable. People make mistakes. But this was intentional and undeniable.

Both the original scoring sheet and his raw data show a T score of 49 on the L-scale which is normal any way you slice it. 49 is at the pinnacle of the bell shaped curve when looking at standard deviations.

This is not misinterpretation. This is not a close call. There is no controversy, ambiguity, alternative explanation, difference of opinion, or lack of clarity. MY SCORE COULD NOT BE MORE NORMAL. IT IS THE DEFINITION OF NORMAL.

There is also no defense of this as it was not a transcription error, a mathematical error, oversight, or forgetting to carry the 1 when adding. This was not a misplaced decimal or a misapplication of a fraction. There is no excuse, no rationalization, and no reason behind this.

MMPI scoring is standardized and objective. There is an MMPI manual that explains how the test is scored. It explains T-scores, standard deviations, percentiles; and what these mean and how to interpret them.

An error of quantification is understandable. An error of qualitative interpretation from quantitative data is not.

As a clinical neuropsychologist Dr Snook knows this.

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Confirmatory Distortion

“Confirmatory distortion” is the process by which an evaluator, motivated by the desire to bolster a favored hypothesis, intentionally engages in selective reporting or skewed interpretations of data thereby producing a distorted picture. It is an “indisputable conscious endeavor to find and report information that is supportive of one’s favored hypothesis.10

In other words it is a conscious decision and not an unconscious bias..

I requested Talbot and Dr. Snook address the fraud and rewrite the interpretation and recommendations.  I then complained to PHS not knowing at the time that they were the ones who requested it.  The requests were ignored.

I then filed a complaint with the Georgia Psychological Association. They confirmed the fraud and forced Dr. Snook to correct the test. Below is his apology. An apology received only because his back was to the wall. “Profound apologies”–Give me a break.  There would not be one if the Georgia Psychological Association did not force him to.

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I have since spoken to a couple dozen doctors who have the same template on their evaluations.   An elevated L-scale would be unusual in any doctor even if he were an alcoholic or addict. It is only the very naïve and unsophisticated who would think they can show themselves in a positive light by answering questions of obvious attempt such as “I never lie.” And if a class action lawsuit comes about this is one of the items that could be used to prove the systemic fraud. Obtain the score sheets from the facilities on anyone with this same interpretation and it will most likely show fabrication in the same manner.

Next up is the cognitive impairment piece.  Just like the MMPI they manipulate the IQ tests to show cognitive impairment by shaving off points in the executive function subcategories.

Snook is one cog in this system of fraud. He and others like him should have their licenses revoked permanently. There is no excuse. How many careers have ended because of his contribution to this scam? How many have died?

As always with my posts, if he cares to contest it and can disprove the fraud I’ll take the post down. As with all the others they can’t. If they could’ve they would’ve.

And this is the reason I was targeted by Linda Bresnahan.  Upset that I got one of their own in trouble she threatened retribution.   “You won’t be a doctor in five years” she said.   “Dead, relapsed or in jail  I don’t care.”  “Dead?” I said.

“Either that or you’ll wish you were”.   And when Drs. John Knight  and J. Wesley Boyd were removed from PHS and were no longer there to protect me she made good on her threat.  She and Luis Sanchez fabricated an alcohol test in retribution for calling out one of their own.

  1. Butcher JN, Williams CL. Essentials of MMPI-2 and MMPI-A Interpretation. 2nd Edition ed: University of Minnesota Press; 2000.
  2. Butcher JN, Rouse SV. Personality: individual differences and clinical assessment. Annu Rev Psychol. 1996;47:87-111.
  3. Levitt EE, Gotts EE. The clinical application of MMPI special scales. 2nd ed. Hillsdale, N.J.: L. Erlbaum Associates; 1995.
  4. Groth-Marnat G. Handbook of psychological assessment. 4th edition. ed. New York: J. Wiley; 2003.
  5. Friedman AF, Lewak R, Nichols DS, Webb JM. Psychological assessment with the MMPI-2. Mahwah, N.J: L. Erlbaum Associates; 2001.
  6. Archer RP. Forensic uses of clinical assessment instruments. Mahwah, N.J.: Lawrence Erlbaum Associates, Publishers; 2006.
  7. Furr RM, Bacharach VR. Psychometrics : an introduction. Los Angeles: Sage Publications; 2008.
  8. Koocher GP, Norcross JC, Hill SS. Psychologists’ desk reference. New York: Oxford University Press; 1998.
  9. Duckworth JC, Anderson WP. MMPI & MMPI-2 : interpretation manual for counselors and clinicians. 4th ed. Bristol, Pa.: Accelerated Development; 1995.
  10. Rogers R. Forensic use and abuse of psychological tests: multiscale inventories. J Psychiatr Pract. Jul 2003;9(4):316-320.

MMPI-2

GENERAL CONSIDERATIONS

Level                           Uniform T-Score                Percentile Equivalent

Extremely High         85-90                                             >99.8->99.9

Very High                  75-80                                            98->99

High                             65-70                                            92-96

Moderately High       55-60                                            73-85

Average                      45-50                                             34-55

Moderately Low       35-40                                            4-15

Very Low                    30                                                   <1

• MMPI-2 Manual Elevation Levels:

o Very High ≥ 76

o High 66-75

o Moderate 56-65

o Modal/Average 41-55

o Low ≤ 40

• 3,4,5,6,9,0 = character scales; 1,2,7,8 = symptom scales

• Acute: Elevated symptom scales, high F (out of ordinary distress), low K (feel

helpless in dealing with increased stress)

• Chronic: Lack of elevation on symptoms scales (or 1-8 > 2-7), moderately low K

(T= 45-55), lower F (T<60)

                

 

                             VALIDITY SCALES

• Interrelationships of Scales:

o Hi F, Lo L & K: Client is admitting to personal and emotional problems, may be

asking for help, unsure of abilities to deal w/ problems, good tx prognosis

o Hi L & K, Lo F: Client is attempting to deny problems and feelings, underreporting

of problems, attempt to present self in most positive light, most likely using primitive

defenses, problems usually chronic and therefore may be built into personality,

adequate social adjustment to see world as either good or bad

o L < F < K: Appropriate resources to deal w/ problems and not experiencing much

Integrity and Accountability—Going on two months and no winners stepping forward. Defend the MRO Procedurally, Ethically or Legally and you win all the prizes

As the Medical Review Officer (MRO)  for the Massachusetts state Physician Health Program (PHP), Physician Health Services, Inc. (PHS, inc.), Dr. Wayne Gavryck’s responsibility is simple.  He is supposed to verify that the chain-of-custody  in any and all drug and alcohol testing is intact before reporting a test as positive.

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Note Dr Gavryck is: 1. Certified by ASAM; 2. A .Certified Medical Review Officer (MRO) who “serves PHS in this capacity.” Although Dr. Gavryck serves PHS I would beg to differ on the MRO function. Accessed from PHS Website 1/15/2015 http://www.massmed.org/Physician_Health_Services/About/PHS_Associate_Directors/#.VM1dZlXF-hY

 

 

 

 

 

 

 

 

 

Dr. Gavryck evidently did not do that here.  In fact for more than a year he helped cover up an alcohol test that was intentionally fabricated at the behest of PHS Director of Operations Linda Bresnahan (who told me when I confronted her with the fact that I have never had or ever even been suspected of having an alcohol problem “you have an Irish last name–good luck finding anyone who will believe you!”

It took a formal complaint with the College of American Pathologists to get the truth out.  The whole fiasco can be seen here and here.

What Gavryck and his co-conspirators did is egregious and ethically reprehensible.  It shows a complete lack of moral compass and personal integrity.  What was done from collection to report to coverup  and everything in-between is indefensible on all levels (procedurally, ethically, and legally).

The documentary evidence shows with clarity that this was not accident or oversight.  It was intentional and purposeful misconduct.  I think everyone would agree that there should be zero-tolerance for forensic fraud in positions of power.    Any person of honor and civility would agree.

Transparency, regulation, and accountability are necessary for these groups.   It is an issue that needs to be acknowledged and addressed not ignored and covered up.

If Dr. Gavryck can give a procedural, ethical, or legal explanation of what was done then I stand corrected. Just one will suffice.  I’ll erase my blog and vanish into the woodwork.  But If he cannot then this needs to be addressed openly and publicly.   And whether he was involved in the original fraud or not is irrelevant. As the MRO for PHS it is his responsibility to correct it–however late the hour may be.

Perhaps Dr. Gavryck needs to see some of the damage he has caused in order to take this responsibility. Known as a “bag man” who simply rubber stamps positive tests at the request of Sanchez and Bresnahan (much like Annie Dookhan)  he does not see the damage that is caused. Forensic fraud has grave and far reaching effects and in this case has severely impacted many people and include patient deaths.

Perhaps Dr. Gavryck needs to take a “moral inventory” and see that this this type of behavior causes real damage to real people and put a face on it.

It is people just like this who are killing physicians across the country.   The body count is vast and multiple.  And those who are caught doing dirty deeds such as this need to be held accountable.

Please help me get this exposed, corrected, and rectified.  The doctors of Massachusetts and the doctors of this entire country deserve better than this.

via Integrity and Accountability—Defend the MRO Procedurally, Ethically or Legally and win 100 Volumes of the Classics in Medicine Library and Salk and Sabin Autographs!.

 

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The MRO Code of Ethics--Seems like Dr. Gavryck's breaking them in sequential order!

The MRO Code of Ethics–Seems like Dr. Gavryck’s breaking them in sequential order!

 

Integrity and Accountability—Defend the MRO Procedurally, Ethically or Legally and win 100 Volumes of the Classics in Medicine Library and Salk and Sabin Autographs!

Disrupted Physician

Integrity and Accountability—The Declining State of Physician Health and the Urgent Need for Ethical and Evidence-Based Leadership.

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Sabin and Salk Autographs

“The incompetent or unprincipled physician, licensed to practice medicine by a too complaisant State, is the greatest menace to scientific medicine – as great a menace as all the cultists put together.”  —Dr. Morris Fishbein  (The Medical Follies.  New York:  Boni Liverlight, 1925 p. 71)

“There is no place in science for consensus or opinion, only evidence”  —Claude Bernard


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Sabin, Salk and the Classics in Medicine Library

Polio is nearly a thing of the past thanks to to Dr. Jonas Salk and Albert Sabin. In 1952 Salk discovered and developed the first successful vaccine for polio and combined with Albert Sabin’s 1961 oral vaccination the du0 effectively obliterated the contagious polio virus.  Once a deadly threat to our  country and future there were 93,000 cases of polio reported in the…

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Accountability Needed for Criminal Fraud Committed by Physician Health Programs

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If we’re looking for the source of our troubles we shouldn’t test people for drugs, we should test them for stupidity, ignorance, greed and love of power.” –P.J. O’ Rourke

Fraud is distinguished from negligence, ignorance, and error by virtue of the fact that it is Intentional; involving some level of calculation.1 Negligence is: “the failure to use such care as a reasonably prudent and careful person would use under similar circumstances,”  and characterized chiefly by “inadvertence, thoughtlessness, inattention, and the like.”2.  Fraud, in contrast, is not accidental in nature, nor is it unplanned.2-4 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  can be established by examining the documentation of decisions and behaviors associated with those involved. 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.”5

A chain of custody is generated in real time. It cannot be done retroactively. To do so constitutes fraud.   What is remarkable is with what apparent ease this was done.  There is no compunction, concern or inquiry from top to bottom at either of these agencies and documents a Machiavellian egocentricity. The acts are those of morally disengaged bullies who lack compassion and integrity.

One would assume that the state of Massachusetts would have a low tolerance for forensic fraud in the wake of the Annie Dookhan lab scandal,  especially when the perpetrators are contractors with the Department of Public Health (DPH) and work within the walls of the Massachusetts Medical Society (MMS).

The problem is Physician Health Programs (PHPs) have set up procedural barriers designed to bloc, ignore, marginalize and bury.  Truth is misrepresented, censored and suppressed.  The DPH and MMS have no oversight or regulation over Physician Health Services (PHS) and PHPs have convinced law enforcement that doctors police themselves.

Accountability needs to be rooted in organizational purpose and public trust.  When an organization operating within or contracting with an institution is committing  serious misconduct and fraud, then it becomes the institutions responsibility to investigate and correct it.  How low must the moral compass go before the MMS and DPH recognize what is self-evident to everyone else?   This would not have happened 20 years ago. What is happening to the profession of medicine when the institutions that are supposed to represent physicians and the public health allow individuals who are obviously and inexcusably engaging  in behavior antithetical to their own expressed ideals and purpose?

Corrupt individuals cannot be hired or retained by an employer without some level of institutional negligence, apathy or even encouragement.

Rationalization involves either self-delusion regarding the acceptability of fraud related to behavior under “special circumstances” or a disregard for the law as unjust or somehow inapplicable.5 Coenen explains that rationalization is the process by which someone   “determines that the fraudulent behavior is “okay” in her or his mind. For those with deficient moral codes the process of rationalization is easy. For those with higher moral standards it may not be quite so easy; they may have to convince themselves that a fraud is okay by creating “excuses” in their minds.

There is a diffusion of responsibility when verification is required and repercussions warranted.  This system of institutional injustice and forensic fraud between state Physician Health Programs and these corrupt labs is occurring across the country. I have spoken to the spouses and parents of multiple doctors who have killed themselves because this same thing was done to them.  Their deaths are being caused by people just like this and accountability is needed.

 

  1. Albrecht WS, Albrecht CO. Fraud Examination and Prevention. Mason, Ohio: South-Western Educational Publishing; 2003.
  2. Black HC. Black’s Law Dictionary. 6th ed. St. Paul, Minnesota: West Group; 1990.
  3. Albrecht WS, Albrecht CO, Albrecht CC, Zimbelman MF. Fraud Examination. 4th ed. Mason, Ohio: South Western Cengage Learning; 2011.
  4. O’ Lord A. The Prevalence of Fraud . What should we as academics be doing to address the problem? Accounting and Management Information Systems. 2010;9(1):4-21.
  5. Coenen T. Essentials of Corporate Fraud. Hoboken, NJ: John Wiley & Sons, Inc.; 2008.

 

 

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Disrupted Physician


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

― Thomas Paine 

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 USDLT video presentation.

Dr. Luis Sanchez, M.D. recently published an article entitled Disruptive Behaviors Among Physicians in the Journal of the American Medical Association discussing the importance of  of a “medical culture of safety” with “clear expectations and standards.”  Stressing the importance of values and codes-of-conduct in the practice of medicine, he calls on physician leaders  “commit to professional behavior.”

Sanchez is Past President of…

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