Competent, Ethical and Fair Legal Representation for Doctors —A Possible New Niche area for Lawyers.

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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 “PHP-Approved Attorneys”

My survey has revealed an additional factor stacking the deck and removing accountability from PHPs.  The attorneys ostensibly representing doctors are also part of the racket.

A doctor referred to a PHP will be given a list of 3 or 4 attorneys by the PHP who are “experienced in working with the medical board.” What they do not tell you is that theses attorneys are hand-picked or cultivated to abide by the rules dictated by the PHP.

They will not “bite the hand that feeds” and any procedural, ethical or criminal misconduct by the PHP will not be addressed.     Laboratory fraud, false diagnoses, and Establishment Clause violations are off limits.

The primary purpose of these attorneys is to enforce payment for laboratory fees and demand compliance with whatever the PHP demands.  Their primary purpose is to keep doctors powerless under the PHP and prevent misconduct, including crimes, from being discovered.

The attorney pool is currently over-served by those serving two clients and most of those outside simply do not know enough about the “physician health”  legal issues related to doctors.  When they appear before the board it is as if they are a deer in the headlights.  It is a new terrain where all due process and familiar protocol have been removed.  Of course this was all facilitated by changes in administrative and medical practice acts orchestrated by the physician health movement “in the interests of protecting the public.  This must be recognized and addressed.

Skilled negotiators and lawyers with administrative law experience would do well to consider representation for doctors before medical boards regarding “physician health” matters.

It is not that esoteric, complicated or difficult.   As with the rest of the population, most have just not critically analyzed the issues behind the curtain.

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Backdraft: How Firefighter Arson was Reduced by Admitting, Defining and having Zero-Tolerance for the Problem–A Lesson for the Medical Profession

Backdraft: How Firefighter Arson was Reduced by Admitting, Defining and having Zero-Tolerance for the Problem–A Lesson for the Medical Profession.

Some researchers believe that firefighter arsonists undergo a mental process referred to as RPM: the arsonist Rationalizes the crime, Projects blame, and Minimizes the consequences.
The impact of firefighter arson can be severe. People die or are seriously injured, including fellow firefighters. Homes are destroyed. An arsonist from within the fire department can disgrace the whole department, and his actions diminish public trust.  Several states that have experienced the crime of firefighter arson have developed new legislation that directly impacts the prosecution of firefighters accused of arson.
The most crucial step was admitting that the problem exists.  The second was defining the problem. The third was having zero tolerance for those engaged in the problem.    States that have taken this approach have found a marked reduction in firefighter arson.

Physician Suicide and Physician Wellness Programs: We Really Need to Start Talking About the Elephant in the Room.

Physician Suicide

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 population 1,2 and, if one looks critically at the evidence based literature, substance abuse in medical professionals approximates that of the general population.  Controlled studies using DSM diagnostic criteria suggest that physicians have the same rates (8-14%) of substance abuse and dependence as the rest of the population 3 and slightly lower rates compared to other occupations.4,5 Epidemiological surveys reveal the same. Hughes, et al.6 found a lifetime prevalence of drug or alcohol abuse or dependence in physicians of 7.9%, markedly less than the 14.6% prevalence reported in the general population by Kessler.7

State Physician Health Programs

Perhaps it is how physicians are treated differently when they develop a substance abuse or mental health problem.

Physician Health Programs (PHP) can be considered an equivalent to Employee Assistance Programs (EAPs) for other occupations. PHPs meet with, assess and monitor doctors who have been referred to them for substance use or other mental or behavioral health problems. Originally developed as “impaired physician” programs, the PHPs were created to help doctors who developed problems with substance abuse or addiction an alternative to disciplinary action by State Medical Boards. These programs existed in almost every state by 1980. Often staffed by volunteer physicians and funded State Medical Societies, these programs served the dual purpose of helping sick colleagues and protecting the public. 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. Most EAPs were developed with the collaboration of workers unions or some other group supporting the rights and interests of the workers.  As there is no such organization representing doctors, PHPs developed in the absence of regulation or oversight.    As a consequence there is no meaningful accountability.   

In Ethical and Managerial Considerations Regarding State Physician Health Programs published in the Journal of Addiction Medicine in 2012, John Knight, M.D. and J. Wesley Boyd, M.D., PhD who collectively have more than 20 years experience with the Massachusetts PHP state that:

“Because PHP practices are unknown to most physicians before becoming a client of the PHP, many PHPs operate out- side the scrutiny of the medical community at large. Physicians referred to PHPs are often compromised to some degree, have very little power, and are, therefore, not in a position to voice what might be legitimate objections to a PHP’s practices.”8

Noting that “for most physicians, participation in a PHP evaluation is coercive, and once a PHP recommends monitoring, physicians have little choice but to cooperate with any and all recommendations if they wish to continue practicing medicine,” Knight and Boyd raise serious ethical and managerial questions about current PHP policies and practice including conflicts of interest in referrals for evaluation and treatment, lack of adherence to standards of care for forensic testing of substances of abuse, violations of ethical guidelines in PHP research, and conflicts of interest with state licensing boards.

Knight and Boyd recommend “that the broader medical community begin to reassess PHP’s as a whole” and that “consideration be given toward the implementation of independent ethical oversight and establish and appeals process for PHP clients who feel they are being treated unfairly.” 8 They also recommend the relationship of PHP’s between the evaluation and treatment centers and licensing boards be transparent and that national organizations review PHP practices and recommend national standards “that can be debated by all physicians, not just those who work within PHPs.”8 Unfortunately this has not happened. Most physicians have no idea that the state physician health programs have been taken over by the “impaired physicians movement.”

In his Psychology Today blog,  Boyd again recommends oversight and regulation of PHPs.   He cites the North Carolina Physicians Health Program Audit released in April of 2014 that reported the below key findings:

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As with Knight and Boyd’s paper outlining the ethical and managerial problems in PHPs, the NC PHP audit finding that abuse could occur and not be detected generated little interest from either the medical community or the media.

Although state PHPs present themselves as confidential caring programs of benevolence they are essentially monitoring programs for physicians who can be referred to them for issues such as being behind on chart notes. If the PHP feels a doctor is in need of PHP “services” they must then abide by any and all demands of the PHP or be reported to their medical board under threat of loss of licensure.

State PHP programs require strict adherence to 12-step doctrine9 yet many of the physicians monitored by them are neither addicts nor alcoholics. Some do not even have substance abuse issues and there are reports of “disruptive” physicians being diagnosed with “character defects” at the “PHP-approved” facilities that do these assessments.   PHPs require abstinence from drugs and alcohol yet use  non-FDA approved Laboratory Developed Tests in their monitoring programs. Many of these tests were introduced to commercial labs and promoted by ASAM/FSPHP physicians.10-12

LDTs bypass the FDA approval process and have no meaningful regulatory oversight.   The LDT pathway was not designed for “forensic” tests but clinical tests with low risk.   Some are arguing for regulation and oversight of LDTs due to questionable validity and risk of patient harm.13

These same physicians are claiming a high success rate for PH programs9 and suggesting that they be used for random testing of all physicians.14

As with LDTs, the state PHPs are unregulated, and without oversight. State medical societies and departments of health have no control over state PHPs.

Their opacity is bolstered by peer-review immunity, HIPPA, HCQIA, and confidentiality agreements. The monitored physician is forced to abide by any and all demands of the PHP no matter how unreasonable-all under the coloration of medical utility and without any evidentiary standard or right to appeal.

The ASAM has a certification process for physicians and claim to be “addiction” specialists. This“board certification” is not recognized by the American Board of Medical Specialties and is not a recognized medical specialty. The goal of the ASAM is to be recognized as the experts in addiction medicine with the consensus expert opinion based on the 12-step prohibitionist brain disease model. The ASAM has aligned itself with a number of inpatient drug treatment centers  (Hazelden, Talbott, Marworth, Bradford,etc) and are heavily funded by the drug testing industry.   It is in fact a “rigged game.”

State PHPs are non-profit non-governmental organizations and have been granted quasi-governmental immunity by most State legislatures from legal liability.

By infiltrating “impaired physician” programs they have established themselves in almost every state by joining, gaining power, and removing dissenters. Groupthink and 12-step indoctrination are the goals. By advertising as advocates for doctors who are “caring,” “confidential resources,” “giving help,” and advocating for “colleagues in need” the outward appearance is one of benevolence.

The biggest obstacle is that this system allows them to throw the normal rules of conduct under the imperative of a higher goal assumed to trump all other consideration. Those outside of programs either defend or ignore the reports of ethical and criminal violations, complacent in their trust of these “experts” claiming they are just helping sick doctors and protecting the public.

With no oversight or regulatory body involved this is all done with impunity, immunity, and undercover. They use the accusation of substance abuse as an indication to disregard the claims of the accused. The physician is left without rights, depersonalized, and dehumanized. The imposition of confinement, stigmatization, lack of oversight of the organizations, peer-review protected confidentiality, and lack of procedural protection is a one-way train to hopelessness and despair.

By establishing a system that of coercion, control, secrecy, and misinformation, the FSPHP is claiming an “80% success rate” 15and deeming the “PHP-blueprint” as “the new paradigm in addiction medicine treatment.

The ASAM/FSPHP had a major influence on the DSM-V where drug abuse and dependence are no longer separate entities. They are also working behind the scenes to get legislation to randomly drug test all physicians.

They are now after the “disruptive physician” and the evidentiary criteria are fairly low and red flags include “deviating from workplace norm in dress or conduct” and being tardy for meetings.

They have identified “the aging physician” as a potential problem because “as the population of physicians ages,””cognitive functioning” becomes “a more common threat to the quality of medical care.”

The majority of physicians are unaware that the Federation of State Medical Boards House of Delegates adopted an updated Policy on Physician Impairment in 2011 that uses addiction as an example of a “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.”

“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 including the novel “relapse without use.”

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Bullying, Helplessness, Hopelessness and Despair

Perceived helplessness is significantly associated with suicide.16 So too is hopelessness, and the feeling that no matter what you do there is simply no way out17,18 Bullying is known to be a predominant trigger for adolescent suicide19-21 One study found that adolescents in custody who were bullied were 9.22 times more likely to attempt suicide than those were not bullied.22

Heightened perceptions of defeat and entrapment are known to be powerful contributors to suicide.23,24 The “Cry of Pain” model 25,26 specifies that people are particularly prone to suicide when life experiences are interpreted as signaling defeat which is defined as a sense of “failed struggle” or loss of social position and resources.. The person is unable to identify an escape from or resolution to a defeating situation, a sense of entrapment proliferates with the perception of no way out, and this provides the central impetus for ending ones life.

There is also evidence that rescue factors such as social supports may play a role in preventing suicide. These rescue factors act buffers to protect against suicide in the face of varying degrees of life stress.27,28 The study of female physicians revealed meetings to discuss stressful work experiences as a potential protective factor, 29 and support at work when difficulties arose appeared to be a protective factor for the male physicians.30   Research involving Finnish physicians found that control over one’s work and organizational justice were the most important determinants of work-related wellbeing.31,32 Organizational justice is related to fairness and refers to an individuals perception of an organizations behaviors, decisions, and actions and how these influence one’s own attitudes and behaviors and has been identified as a psychosocial predictor of health and wellbeing33 34 Low organizational justice has been identified as a notable risk factor for psychological distress and depression.35,36

A recent report indicates that job stress, coupled with inadequate treatment for mental illness may play a role in physician suicide..

Using data from the National Violent Death Reporting System the investigators compared 203 physicians who had committed suicide to more than 31,000 non-physicians and found that having a known mental health disorder or a job problem that contributed to the suicide significantly predicted being a physician.1

Physicians were 3.12 times more likely to have a job problem as a contributing factor. In addition, toxicology testing showed low rates of medication treatment.  The authors concluded that inadequate treatment and increased problems related to job stress are potentially modifiable risk factors to reduce suicidal death among physicians.

They also warned that the database used likely underestimated physician suicides because of “underreporting and even deliberate miscoding because of the stigma attached.”

I can think of nothing more institutionally unjust than an unregulated zero-tolerance monitoring program with no oversight using unregulated drug and alcohol testing of unknown validity.

We have heard of numerous suicides due to these institutionally unjust programs.   Three doctors died by suicide in Oklahoma in a one month period alone (August 2014).   All three were being monitored by the Oklahoma PHP.   I went to an all boys high-school of less than 350 students yet a classmate a couple years ahead of me died by suicide a few months ago. He was being monitored by the Washington PHP. His crime?  A DUI in 2009–a one-off situational mistake that in all likelihood would never have recurred.  But as is often the case with those ensnared by state PHPs he was forced to have a “re-assessment” as his five-year monitoring contract was coming to an end.  These re-assessments are often precipitated by a positive Laboratory Developed Test (LDT) and state medical boards mandate these assessments can only be done at an out-of-state “PHP-approved” facility.    Told he could no longer operate and was unsafe to practice medicine by the PHP and assessment center he then hanged himself.  And at the conclusion of Dr. Pamela Wible’s haunting video below are listed just the known suicides of  doctors; many were being monitored by their state PHPs–including the first name on the list– Dr. Gregory Miday.

None of these deaths were investigated. None were covered in the mainstream media.   These are red flags that need to be acknowledged and addressed!    This anecdotal evidence suggests the oft-used estimate of 400 suicides per year (an entire medical school class) is a vast underestimation of reality—extrapolating just the five deaths above to the entire population of US doctors suggests we are losing at least an entire medical school per year.

As physicians we need to demand transparency, oversight, regulation and auditing by outside groups. This is a public health emergency.

To wit:

They first came after the substance abusers and I did not speak out because I was not a substance abuser.

They then came for those with psychiatric diagnoses and I did not speak out because I was not diagnosed with a psychiatric disorder.

They then came after the “disruptive physician” and I did not speak out because I was not disruptive.

They then came after the aging physician and I did not speak out because I was young.

They then came after me and there was no one else to speak out for me.

  1. Ford DE, Mead LA, Chang PP, Cooper-Patrick L, Wang NY, Klag MJ. Depression is a risk factor for coronary artery disease in men: the precursors study. Archives of internal medicine. Jul 13 1998;158(13):1422-1426.
  2. Frank E, Dingle AD. Self-reported depression and suicide attempts among U.S. women physicians. The American journal of psychiatry. Dec 1999;156(12):1887-1894.
  3. Brewster JM. Prevalence of alcohol and other drug problems among physicians. JAMA : the journal of the American Medical Association. Apr 11 1986;255(14):1913-1920.
  4. Anthony J, Eaton W, Mandell W, al. e. Psychoactive Drug Dependence and abuse: More Common in Some Occupations than in Others? Journal of Employee Assistance Res.1992;1:148-186.
  5. Stinson F, DeBakely S, Steffens R. Prevalence of DSM-III-R Alcohol abuse and/or dependence among selected occupations. Alchohol Health Research World. 1992;16:165-172.
  6. Hughes PH, Brandenburg N, Baldwin DC, Jr., et al. Prevalence of substance use among US physicians. JAMA : the journal of the American Medical Association. May 6 1992;267(17):2333-2339.
  7. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry. Jun 2005;62(6):593-602.
  8. Boyd JW, Knight JR. Ethical and managerial considerations regarding state physician health programs. Journal of addiction medicine. Dec 2012;6(4):243-246.
  9. DuPont RL, McLellan AT, White WL, Merlo LJ, Gold MS. Setting the standard for recovery: Physicians’ Health Programs. Journal of Medical Regulation. Mar 2010;95(4):10-25.
  10. Skipper GE, Weinmann W, Thierauf A, et al. Ethyl glucuronide: a biomarker to identify alcohol use by health professionals recovering from substance use disorders. Alcohol and alcoholism.Sep-Oct 2004;39(5):445-449.
  11. Skipper GE, Thon N, Dupont RL, Baxter L, Wurst FM. Phosphatidylethanol: the potential role in further evaluating low positive urinary ethyl glucuronide and ethyl sulfate results.Alcoholism, clinical and experimental research. Sep 2013;37(9):1582-1586.
  12. Skipper GE, Thon N, DuPont RL, Campbell MD, Weinmann W, Wurst FM. Cellular photo digital breathalyzer for monitoring alcohol use: a pilot study. European addiction research.2014;20(3):137-142.
  13. Sharfstein J. FDA Regulation of Laboratory-Developed Diagnostic Tests: Protect the Public, Advance the Science. JAMA : the journal of the American Medical Association. Jan 5 2015.
  14. Pham JC, Pronovost PJ, Skipper GE. Identification of physician impairment. JAMA : the journal of the American Medical Association. May 22 2013;309(20):2101-2102.
  15. McLellan AT, Skipper GS, Campbell M, DuPont RL. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. Bmj. 2008;337:a2038.
  16. Rivers I, Noret N. Potential suicide ideation and its association with observing bullying at school. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. Jul 2013;53(1 Suppl):S32-36.
  17. Lester D, Walker RL. Hopelessness, helplessness, and haplessness as predictors of suicidal ideation. Omega. 2007;55(4):321-324.
  18. Beck AT. Hopelessness as a predictor of eventual suicide. Annals of the New York Academy of Sciences. 1986;487:90-96.
  19. Hinduja S, Patchin JW. Bullying, cyberbullying, and suicide. Archives of suicide research : official journal of the International Academy for Suicide Research. 2010;14(3):206-221.
  20. Hertz MF, Donato I, Wright J. Bullying and suicide: a public health approach. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. Jul 2013;53(1 Suppl):S1-3.
  21. Kim YS, Leventhal B. Bullying and suicide. A review. International journal of adolescent medicine and health. Apr-Jun 2008;20(2):133-154.
  22. Kiriakidis SP. Bullying and suicide attempts among adolescents kept in custody. Crisis.2008;29(4):216-218.
  23. Taylor PJ, Gooding P, Wood AM, Tarrier N. The role of defeat and entrapment in depression, anxiety, and suicide. Psychological bulletin. May 2011;137(3):391-420.
  24. Lester D. Defeat and entrapment as predictors of depression and suicidal ideation versus hopelessness and helplessness. Psychological reports. Oct 2012;111(2):498-501.
  25. Williams JMG. Cry of Pain. Harmondsworth: Penguin; 1997.
  26. Williams JMG, Crane C, Barnhofer T, Duggan DS. Psychology and suicidal behavior: elaborating the entrapment model. In: Hawton K, ed. Prevention and treatment of suicidal behavior: from science to practice. Oxford: Oxford University Press; 2005:71-89.
  27. Borowsky IW, Ireland M, Resnick MD. Adolescent suicide attempts: Risks and protectors.Pediatrics. 2001;107(485).
  28. Clum GA, Febbraro GAR. Stress, social support and problem-solving appraisal/skill: Prediction of suicide severity within a college sample. Journal of Psychopathology and Behavioral Assessment. 1994;16:37-46.
  29. Fridner A, Belkic K, Marini M, Minucci D, Pavan L, Schenck-Gustafsson K. Survey on recent suicidal ideation among female university hospital physicians in Sweden and Italy (the HOUPE study): cross-sectional associations with work stressors. Gender medicine. Apr 2009;6(1):314-328.
  30. Fridner A, Belkic K, Minucci D, et al. Work environment and recent suicidal thoughts among male university hospital physicians in Sweden and Italy: the health and organization among university hospital physicians in Europe (HOUPE) study. Gender medicine. Aug 2011;8(4):269-279.
  31. Lindfors PM, Meretoja OA, Toyry SM, Luukkonen RA, Elovainio MJ, Leino TJ. Job satisfaction, work ability and life satisfaction among Finnish anaesthesiologists. Acta anaesthesiologica Scandinavica. Aug 2007;51(7):815-822.
  32. Heponiemi T, Kuusio H, Sinervo T, Elovainio M. Job attitudes and well-being among public vs. private physicians: organizational justice and job control as mediators. European journal of public health. Aug 2011;21(4):520-525.
  33. Elovainio M, Kivimaki M, Vahtera J. Organizational justice: evidence of a new psychosocial predictor of health. Am J Public Health. Jan 2002;92(1):105-108.
  34. Lawson KJ, Noblet AJ, Rodwell JJ. Promoting employee wellbeing: the relevance of work characteristics and organizational justice. Health promotion international. Sep 2009;24(3):223-233.
  35. Hayashi T, Odagiri Y, Ohya Y, Tanaka K, Shimomitsu T. Organizational justice, willingness to work, and psychological distress: results from a private Japanese company. Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine. Feb 2011;53(2):174-181.
  36. Lang J, Bliese PD, Lang JW, Adler AB. Work gets unfair for the depressed: cross-lagged relations between organizational justice perceptions and depressive symptoms. The Journal of applied psychology. May 2011;96(3):602-618.

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In Mechanics and Mentality the Physician Health Program “Blueprint” is Essentially Straight, Inc. for Doctors.

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In 2012 former Nixon Drug Czar Robert Dupont, MD delivered the keynote speech at the Drug and Alcohol Testing Industry Association (DATIA) annual conference and described a “new paradigm” for addiction and substance abuse treatment. He advocated zero tolerance for alcohol and drug use enforced by monitoring with frequent random drug and alcohol tests. Detection of any substances is met with “swift and certain consequences.”

And then he proposed expansion of this paradigm to other populations including workplace, healthcare, and schools.

Robert Dupont was a key figure in launching the “war on drugs” — now widely viewed as the failed policy that has turned the US into the largest jailer in the world.

Screen Shot 2014-02-23 at 8.06.56 PMIn the 1970s, Dupont administered the experimental drug rehab program called “The Seed” – that was later deemed by congress to use methods similar to those used on American POW’s in North Korea. He would later go on to consult for “Straight, Inc”, a rehab program that treated troubled teens as “addicts”, often for minor infractions or normal teenage behavior.

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Deemed the “family oriented treatment program,” Dupont encouraged organization and expansion. Targeting the children of wealthy white families parents fears were used to refer their kids to the programs. Signs of hidden drug use such as use of Visine, altered sleep patterns, and changes in clothing style were used as indications for referral. Any child who arrived would be considered an addict in need of their services. Coercion, confrontation, command and control were the guiding principles. Submit or face the consequences. We know what’s right. The idea was to strip the child of all self-esteem and then build him back up again in the straight image. Abused, dehumanized, delegitimized and stigmatized-the imposition of guilt, shame, and helplessness was used for ego deflation to facilitate canned and condensed 12-step as a preparatory step on the path of lifelong spiritual recovery.

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Children were coaxed or terrorized into signing confessions, berated, and told they were in “denial.” Inaccurate and false diagnoses were given to wield greater control. Reports and witness accounts now indicate that many of the kids did not even have drug problems but by creating a “moral panic” about teenage drug use they exploited parents fears for profit. Straight, Inc. became the biggest juvenile rehabilitation center in the world for rehabilitation and treatment of addiction.

12 year old girl admitted to inpatient addiction rehabilitation for sniffing a “magic marker”–Once!

A Deficiency Correction Order was issued by the Executive Office of Human Services, Office of Children, Commonwealth of Massachusetts Services to Straight, Boston in 1990 that read in part:

“Although Straight’s statement of services states that Straight serves chemically dependent adolescents, a review of records and interviews with staff demonstrate that Straight admits children who are not chemically dependent. For example, one twelve-year-old girl was admitted to the program although the only information in the file regarding use of chemicals was her admission that she had sniffed a magic marker.”

Straight was always making outlandish claims of success but there was no scientific evidence based data to support it. In September 1986 USA TODAY ran an article headlined:  DRUGS:  Teen abusers start by age 12 which opened with:  “Almost half of the USA’s teen drug abusers got involved before age 12…”Screen Shot 2015-05-15 at 12.51.23 AM

The article was based on a study conducted by Straight, Inc.

Many former patients of Straight were so devastated by the abuse that they took their own lives. Since then, Dupont has been a key figure in the proliferation of workplace drug testing programs, and once advocated for drug testing anyone in the workplace under the age of 40.1,2Screen Shot 2015-05-15 at 1.47.15 AM

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The Physician Health Program (PHP)  blueprint is essentially Straight, Inc. for Doctors in both Mechanics and Mentality

The “new paradigm” Dupont speaks of before the Drug and Alcohol Testing Industry Association is modeled after state physician health programs (PHPs) and as was done with Straight, “remarkable” claims of success are being made.3-6 Promoted as “Setting the standard for recovery” PHPs are now being pitched to other populations7

0 Dupont and Dr. Greg Skipper proclaim the “need to reach more of the 1.5 million Americans who annually enter substance abuse treatment, which now is all too often a revolving door.”8 They conclude:

This model of care management for substance use disorders has been pioneered by a small and innovative group of the nation’s physicians in their determination to help other physicians save their careers and families while also protecting their patients from the harmful consequences of continued substance abuse. In fulfilling the professional admonition “physician: first heal thyself,” these physicians have created a model with wide applicability and great promise.8

In “Six lessons from state physician health programs to promote long-term recovery” Dupont and Skipper attribute this success rate to the following factors:8

(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.8

Slide27As with Straight, the majority of those admitted to PHPs are not even addicts.  The Federation of State Physician Health Programs (FSPHP) was able to convince Federation of State Medical Boards, to adopt the notion of “potentially impairing” illness and “relapse without use” to promote early intervention using the same false logic as Straight, Inc. and the 12-year old with the magic marker.  ( i.e. teen drug abuse starts by age 12 and that any sign or symptom inexorably progresses to impairment justifying  “treatment”).

Signals for “impairment” can be as benign as not having “complete, accurate, and up-to-date patient medical records.”  according to Physician Health services, the Massachusetts Physician Health Program and subsidiary of the Massachusetts Medical Society.

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Despite the overwhelming amount of paperwork physicians now have, incomplete or illegible records could be construed as a red flag, since, as Associate Director of PHS Judith Eaton notes “when something so necessary is not getting done, it is prudent to explore what else might be going on.”

 It is a false premise “feel-good fallacy” with faulty conclusions.  And because it is being perpetrated on doctors (and those in the criminal-justice system) no one seems to care.   But this is merely a wedge for a grander plan.

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Dupont has  been heavily involved in studies using non-FDA approved laboratory developed tests and other devices of unknown validity on doctors in PHPS and promoting the use of these tests for forensic monitoring.9,10   

And they want to bring these tests to you. Propaganda and misinformation has been designed to sway public opinion.

A Medscape article from   “Drug abuse among Doctors: Easy, Tempting, and Not Uncommon” is a prototypical example of the propaganda and misinformation being used to sway public policy and opinion.  Focusing on a small study  ( n =55) done by Lisa Merlo (Director of Research for the Florida PHP). Dr.Marvin Seppala  states in the article that impaired  doctors are:

“….often described as the best workers in the hospital,” he says. “They’ll overwork to compensate for other ways in which they may be falling short, and to protect their supply. They’ll sign up for extra call and show up for rounds they don’t have to do.” Physicians are intelligent and skilled at hiding their addictions, he says. Few, no matter how desperate, seek help of their own accord.”

There is no evidence base for a hidden cadre of drug-impaired doctors causing medical error. A critical review of the literature reveals no evidence base exists.  Moreover, this blather does not even comport with reality.  It defies reason and even basic common sense.

Screen Shot 2014-03-15 at 5.09.11 PMBut through misinformation and deceptive propaganda similar to that used by Straight these groups have created “moral panics” aimed at physicians designed to separate them from everyone else.

To be sure, doctors who are practicing impaired due to substance abuse need to be removed from practice both to get the help they need and to protect the public. But that is not what is happening.   Instead, what is occurring is that doctors can get caught up in this system for any number of reason. Indeed, some of these physicians have no history of drug-addiction—they are the equivalents of the 12-year-old girl caught sniffing a magic marker.

And this is how the scam works.

When doctors monitored by their PHP test positive they are forced to have an evaluation at a “PHP-approved” treatment center.  In 2011 the American Society of Addiction Medicine (ASAM) issued a Public Policy Statement recommending physicians in need of assessment and treatment be referred only to “PHP approved” facilities.  The medical directors of the “PHP-approved” facilities can be found on this list of “Like-Minded Docs”.

In 2011, The organization that oversees the licensing for all medical doctors, the Federation of State Medical Boards, adopted a new policy and approved the concept of “potentially impairing illness.” and the Orwellian notion of drug “relapse without use.” 

This implies that they will be able to ruin any doctor who does not comply or who is found guilty, even if fraudulently.

The question might be, “Why?” As with anything, we have to think about who profits.

Indeed, Dupont has remained a vocal and influential spokesman for drug and alcohol testing. But he along with former DEA head Peter Bensinger run a corporate drug-testing business. Their employee-assistance company, Bensinger-Dupont is the sixth largest in the nation.

Now, they also want to extend these tests to drivers.11,12 and Federal Workplace Drug Testing Programs.

They would like to replace the current system used in pilots, bus drivers, and Federal Employees with “comprehensive drug and alcohol testing.”13 AND THEY ARE promoting hair testing, 14Their goal is 24/7 sobriety with complete abstinence 15, and zero tolerance.16

Their claims of success are based on a single retrospective cohort study looking at the outcomes of 904 physicians monitored by 16 different State PHPs.17

An 80% success rate is claimed but 102 of the 904 participants were “lost to follow up” and of the remaining 802, 155 failed to complete the contract.

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So what happened to the 24 of who “left care with no apparent referral,” the 85 who “voluntarily stopped or retired,” and the 48 who “involuntarily stopped” or had their “license revoked.”  Whether you leave a PHP voluntarily, involuntarily, or with no apparent referral it is the end.. The plug is pulled. Game over.   Comparing this to other populations where the consequences are not as terminal is like comparing apples to oranges.

But the bigger question is what happened to the 157 physicians who left or stopped? How many of those killed themselves. The study reports 6 suicides, 22 deaths, and another 157 who are no longer doctors.   How many of the 22 deaths were suicides and what happened to the 157 who stopped for no apparent reason?   Using the last recorded clerical status as an endpoint obfuscates the true endpoints.  Where are they now?  Alive or dead?

Propaganda and misinformation is  designed to sway public opinion and it is all hidden from public view and scrutiny. Absolutely no oversight or regulation from outside agencies exists for PHPs and very little exists for the “PHP-approved” up-front cash only assessment and rehabilitation facilities.  The commercial drug-testing labs using non-FDA approved LDTs have no accountability either.  No agencies exist to hold them accountable for errors or even intentional misconduct.  The College of American Pathologists (CAP)  is the only avenue for complaint and CAP is an accreditation agency that can only “educate” not “discipline.”  It is a system that fosters and fuels misconduct as no consequences exist for wrongdoing and they built it that way.

The American Society of Addiction Medicine erected this scaffold state-by-state. And that is how it must be removed. It is a system of coercion, control, and fear. Crimes like the ones being committed here in Massachusetts must be investigated as crimes. The perpetrators must be held accountable.

It is a system of institutional injustice that is killing physicians by driving them to hopelessness, helplessness, and despair. The general medical community needs to awaken to the reality of the danger to expose and dismantle it at the State level.  And many of the doctors caught in this maw do not even have an addiction or substance abuse issue –equivalent to the 12-year old girl in referred to Straight for sniffing a magic marker.  On the other hand many of those in charge of the administration of these programs have engaged in egregious even horrific misconduct and have a history of manipulating the system.

Secondly, all of the so-called “research” must be subject to evidence base review. It is not there.

And thirdly, the numerous, intertwined and myriad conflicts of interest must be addressed – because it’s money that is the big driver of this “benevolent” interest in whether or not you are sober.

With over 20 years experience as Associate Directors of the Massachusetts PHP, Physician Health Services, Inc. (PHS,inc.), Dr.’s J Wesley Boyd, MD, PhD and John R. Knight of Harvard Medical School published an Ethical and Managerial Considerations Regarding State Physician Health Programs pointing out serious conflicts of interest and ethical issues involving PHP programs and the need “to review PHP practices and recommend national standards that can be debated by all physicians, not just those who work within PHPs.”

They recommend ethical oversight of PHPs, a formal appeals process for physicians, periodic auditing, a national system for licensing, and recommend “the broader medical community begin to reassess PHPs as a whole in an objective and thoughtful manner.” Unfortunately, this has not occurred.  It urgently needs to.  Because the Physician Health Program “Blueprint” is essentially Straight inc. in both mechanics and mentality. and those killing themselves are the equivalent of the 12-year old girl caught sniffing a magic marker.

Unlike Straight, inc.,  no FaceBook site dedicated to the  “memory of those gone” yet exists for the many many doctors killed and being killed  by the “PHP-blueprint.”   It should and someday, believe me, it will.

  1. Engs RC. Mandatory random testing needs to be undertaken at the worksite. Controversies in the Addiction Field. Vol 1. Dubuque, IA: Kendall/Hunt; 1990:105-111.
  2. Dupont RL. Never trust anyone under 40: What employers should know about Molly Kellogg in the workplace. Policy Review. Spring 1989:52-57.
  3. DuPont RL, McLellan AT, Carr G, Gendel M, Skipper GE. How are addicted physicians treated? A national survey of Physician Health Programs. Journal of substance abuse treatment. Jul 2009;37(1):1-7.
  4. White WL, Dupont RL, Skipper GE. Physicians health programs: What counselors can learn from these remarkable programs. Counselor. 2007;8(2):42-47.
  5. Skipper GE, Campbell MD, Dupont RL. Anesthesiologists with substance use disorders: a 5-year outcome study from 16 state physician health programs. Anesthesia and analgesia. Sep 2009;109(3):891-896.
  6. Yellowlees PM, Campbell MD, Rose JS, et al. Psychiatrists With Substance Use Disorders: Positive Treatment Outcomes From Physician Health Programs. Psychiatric services. Oct 1 2014.
  7. DuPont RL, McLellan AT, White WL, Merlo LJ, Gold MS. Setting the standard for recovery: Physicians’ Health Programs. Journal of Medical Regulation. Mar 2010;95(4):10-25.
  8. Dupont RL, Skipper GE. Six lessons from state physician health programs to promote long-term recovery. Journal of psychoactive drugs. Jan-Mar 2012;44(1):72-78.
  9. Skipper GE, Thon N, Dupont RL, Baxter L, Wurst FM. Phosphatidylethanol: the potential role in further evaluating low positive urinary ethyl glucuronide and ethyl sulfate results. Alcoholism, clinical and experimental research. Sep 2013;37(9):1582-1586.
  10. Skipper GE, Thon N, DuPont RL, Campbell MD, Weinmann W, Wurst FM. Cellular photo digital breathalyzer for monitoring alcohol use: a pilot study. European addiction research. 2014;20(3):137-142.
  11. Voas RB, DuPont RL, Talpins SK, Shea CL. Towards a national model for managing impaired driving offenders. Addiction. Jul 2011;106(7):1221-1227.
  12. DuPont RL, Voas RB, Walsh JM, Shea C, Talpins SK, Neil MM. The need for drugged driving per se laws: a commentary. Traffic injury prevention. 2012;13(1):31-42.
  13. Reisfield GM, Shults T, Demery J, Dupont R. A protocol to evaluate drug-related workplace impairment. Journal of pain & palliative care pharmacotherapy. Mar 2013;27(1):43-48.
  14. DuPont RL, Baumgartner WA. Drug testing by urine and hair analysis: complementary features and scientific issues. Forensic science international. Jan 5 1995;70(1-3):63-76.
  15. Caulkins JP, Dupont RL. Is 24/7 sobriety a good goal for repeat driving under the influence (DUI) offenders? Addiction. Apr 2010;105(4):575-577.
  16. DuPont RL, Griffin DW, Siskin BR, Shiraki S, Katze E. Random drug tests at work: the probability of identifying frequent and infrequent users of illicit drugs. Journal of addictive diseases. 1995;14(3):1-17.
  17. McLellan AT, Skipper GS, Campbell M, DuPont RL. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. Bmj. 2008;337:a2038.Screen Shot 2014-02-25 at 1.06.55 PM

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Letters from those Abused and Afraid

Screen Shot 2015-03-27 at 1.24.08 AMLetters From Those Abused and Afraid

images-2I get many e-mails, letters and phone calls from doctors, nurses and others who have been abused by  “professional health programs” (PHPs).

Most are anonymous.  Afraid of being identified and punished by the PHP, very few leave comments on my blog revealing their names or potentially identifiable information.

This is understandable.   By simply reporting “noncompliance” to the medical boards a state PHP can end their careers. As it was with the Inquisition this system relies above all else on silence and secrecy.   Speaking out can result in “swift and certain consequences.”

They are afraid.  Some are undoubtedly suffering from PTSD.  Most have developed a “learned-helplessness”   Many have reported abuse and even crimes to their medical societies, medical boards, law enforcement, the media and others only to have the door slammed in their faces.-myself included..   They have no advocacy or support and feel no one cares.   Their locus of control, identify and self-worth have been suddenly ripped from them without recourse. There is no lifeline.

PHPs are ostensibly  Employee Assistance Programs (EAPs) for doctors in both mechanics and mentality.   EAPs assist employees with substance abuse, personal problems and other issues.    They do not diagnose or treat “patients” but refer to outside professionals who do.  The critical difference between EAPs and PHPs is PHPs have mandated all assessment and treatment be done by their own.  These “PHP-approved” facilities are economically and ideologically intertwined with the PHP.  The conflicts of interest are serious and many.

PHPs also use non-FDA approved junk-science drug and alcohol testing they introduced.  The procedural safeguards most EAPs use to  protect the donor ( certified labs, FDA-approved validated tests, split-specimen, strict chain-of-custody, MRO review) have been reviewed.  Unvalidated “personality” assessments they also introduces are being used in “disruptive” physician evaluations guaranteed to find “character defects” to justify monitoring contracts. They implement polygraphs despite the AMAs previous conclusion they are scientifically unsupportable.

It is an institutionally unjust system of coercion, control and abuse that is unregulated, opaque and protected.  There is no answerability and they are accountable to no one.

But regulatory agencies have readily adopted policies not only unsupported by science and evidence-based research but outside the normative principles and practice of medicine.

Granting PHPs authority to limit assessments and treatment to their own facilities  offends the fundamental rights of the individual.

Informed consent (or refusal)  constitutes a basic rule of the lawfulness of medical practice according to national and state medical practice acts governing the profession.  It is a basic principle  of all published principles of medical ethics.

Involuntary treatment is motivated by either potential harm to others (for the good of society) or by need for treatment and/or potential self harm.

Involuntary treatment should be a confined to those gravely disabled by psychiatric disorders or substance abuse.  It necessitates reflection under the ethical principles of autonomy and beneficence.

A single DUI,  transient psychological issue such as grief or anxiety, and even sham peer-review can easily land a doctor into forced assessment and involuntary treatment at a “PHP-approved” facility.

Involuntary assessment and treatment involves legal, clinical ethical, and deontological consideration in its demarcation.

The economic and ideological aspects need to be considered here.

How is it this paradoxical assessment and treatment paradigm legitimized and justified within a profession that emphasizes evidenced based decision making and beneficence and autonomy as two of the basic principles of medical ethics?

  To sell the “PHP Blueprint” to other EAPs it is necessary to prevent doctors from speaking the truth.  Very few want their names, states or other unique identifiers published for fear of  consequences and retaliation.

The letters below have only been posted after being approved by their  authors-MLL

4/20/15

Dear Michael Langan

I love your writings analysing the power relations and psychopathy that is running rampant in every sphere of life, including sadly, medicine…

Your logo of the the two serpents represents the fight between good and evil, to me…

It was encouraging that you ‘liked’ the post from the blog as writing in relative isolation is very hard.

So thanks a bunch !

Take good care of yourself – truth tellers are precious and rarer than gold dust !

3/5/2015

Comment: I am Board Certified in Internal medicine. I have endured years of emotional, psychological and spiritual abuse at the hands of the Washington Physician’s Health Program. I have suffered through a long list of injustices without recourse. They include, but are not limited to discrimination, abuse of power, breach of contract and repeated and WILLFUL medical negligence.

Because the actions of the WPHP have been SO egregious, I assumed what was happening to me must be extraordinarily rare.

I have nothing to hide. And I have shared my story with any and all who would listen. To date, my voice, my rights and now my life have been dismissed as unimportant. MY LIFE!! It’s apparently better that I die than my tormentors be questioned and compelled to defend their indefensible and evil behavior.

I am meeting with one last attorney tomorrow. I fully expect him to ignore the basic, indisputable and well documented facts of my case. Namely, there is massive and systematic malfeasance being committed by a tax payer funded agency in the State of Washington who act with omnipotence and without oversight. I have no reason to believe he will respond any differently than the others with whom I have met. HE WON’T CARE! HE WILL NOT BE MOVED. He will make statements that suggest I DESERVE this treatment. And that my life, as well as my imminent death, is unworthy of his time or efforts.

Once my assumptions about this last meeting are officially confirmed, I am committed to the only course of action available to me. The only thing which will put an end to this nightmare.

Today I stumbled upon your website. And today, for the first time, I have learned that my case is not rare. I suspect the other physician victims in this matter have occasionally allowed themselves to dream wistfully of justice. Justice which they have seen thwarted at every turn. Perhaps they, like me, have dreamily imagined the relief and joy and LIFE they would experience if the truth were simply presented and the perpetrators held accountable. I have imagined standing up in court and triumphantly affecting justice for myself as well as all of the other current and future victims. I deliver a powerful defense of justice. My ‘dream speech’. I have imagined that I might still live. And then I wake up.

And so today, imagine my shock, when I found my ‘dream speech’ here. My speech. Reasonable. Honest. Consistent. And based firmly in truth, justice and defense of the powerless against the (arbitrarily) powerful. My speech, it seemed, but authored by another.

Thank you, Dr. Langan.  You have given a voice to my struggles. Please never stop speaking for me, and people like me, many of whom, I fear, will not survive to see justice.

Despite my intention to die, I actually WANT TO LIVE! And I will live and fight on if I ever believe that there is even a small chance of justice for me and the other innocent victims of PHP’s and the ‘treatment’ centers with whom they contract (Talbott in my case. Purely evil and loathsome human beings, for the record).

So, because I do WANT to live…PLEASE HELP ME, SIR!

Can you refer me to attorneys, individuals or groups who might advocate for me and the other victims? Do you have any specific words of hope or encouragement?

Please note my name. Please add me to the list of innocent victims of these power hungry, narcissistic BULLIES.

I don’t expect to live through this. And in a way, the PHP, Talbott and the addiction ‘experts’ with whom I have been tragically acquainted are correct…My life is worth very little. But this issue is so much larger than I. I can die with some serenity if I believe there will be meaningful justice for others like me. And that those responsible will be held to account.

Thank you Dr. Langan. Thanks to all of those involved in the creation and maintenance of this website. Although your shining beacon is barely perceivable through the darkness of injustice which surrounds and seeks to extinguish it…it is the only glimmer of hope I have found during my slow death by PHP.


3/2/2015

Dr. Langan:

Thank you for your articles and research regarding PHPs and “impaired” physicians.  I have become involved in this issue after someone close to me struggled with depression during residency.  Sadly, they lacked the resources, support and coping skills and ended up committing a crime with a misdemeanor charge.  Despite their treatment and rehabilitation, they were dismissed from residency.  Not sure if they will ever get to practice clinical medicine.  It is very sad. they are very smart, great doctor and very empathetic towards patients. 

After their situation, I started looking on blogs and found that many residents had shared similar instances.  Many reported struggling with depression and the stresses of residency put them over the edge– like the perfect storm of stress, fatigue, and loneliness that could exploit anyone’s weaknesses.   It seems like during residency, we are emotionally as well as legally vulnerable.  Many of these residents have never been able to resume training at their institutions despite their demonstration of clinical competence and emotional maturation.  According to that medscape article, that is a huge loss to society, socially and financially.

Sadly, there still so much stigma surrounding mental health, and I think it may be worse in our profession. 

I am very concerned regarding the future of our profession.  We are becoming robots in a health care factory.  Our own personal lives are being compromised as well as quality patient care. 

I appreciate all you are doing to shed light on this very important issue.

Thank you for your time and consideration


2/17/2015

Dear Dr. Langan:

Thank you for your insight, eloquence, and concern for all of us. These Boards and other administrative bodies claim that they are “protecting the public,” but healthcare providers are the public too. And they’re killing us. 

The problem is not unique to physicians. I am a nurse practitioner, and we share some of the same burdens. Although the numbers are growing, there are so few NPs nobody has studied suicidality among our profession. There is still the same fear of malpractice, professional bullying (nurses “eat their young,”) and the taboo of asking for help. 

A trivial, third-party complaint to the State Board didn’t cost me my license, but it did cost me my job and my mental health. The pain I endured: the relentless questions about my personal life… it was jarringly intrusive. All of this was conducted by a bullying investigator: a man who had no medical training.  The Board took it upon itself to ask detailed questions about my personal life and relationships, as if they would somehow psychoanalyze me. The investigator started his conversation by advising me that the Board does not honor the Fifth Amendment.

I’ve heard others—physicians—tell me of similarly murky complaints that dragged on. A cardiologist I know was instantly fired and rendered unemployable for year under similar circumstances. He struggled to feed his kids. Nobody died. Nobody got hurt. He didn’t have a substance abuse problem or divert drugs. He practiced within his scope. The case was eventually dismissed, and he’s back in business. But he has never totally recovered.

A simple, free email to the Board can cost a physician or nurse practitioner his or her livelihood in a split second.

All of this detracts from the dangers posed by inept or otherwise dangerous clinicians. We’ve all met them, seen them in practice, seen their charts, or heard stories. I think everyone I know can name a clinician who showed up drunk to work, billed fraudulently, or who was so incompetent that he or she should not be practicing.

It has been ten months. The Board hasn’t had any further questions, but they never dismissed the case, claiming that they have a massive backlog. My health and livelihood are inconsequential to them. I’m still being prescribed scheduled benzos and z-drugs just so I can make it day to day.

I came very close to suicide more than once, but I evaded psychiatric admission because then I’d lose my license without a doubt. Again, “protecting the public?” I deliberately avoided emergent medical care because of the Board.

I chose another path: I left the profession, and I have lost my sense of self. Twelve years of school, $350,000 in tuition, and four degrees were rendered worthless by a single third-party email. Above all, my pride in my  clinical acumen, passion for learning, anal retentive charts, sensitivity, and professionalism also went down the drain.

The Board’s notion of “protecting the public” also means kicking good providers out of the business. Our emotional lives are destroyed, our finances wrecked, and we live in fear. There is no “speedy and public trial,” no “jury of our peers.” Although Conrad Murray MD fled to Trinidad, where he is working as a cardiologist (hopefully not prescribing propofol for insomnia), an open complaint renders me ineligible for licensure in all fifty states, all Canadian provinces, the Netherlands, and Australia. 

Assuming that the Board dismisses the case, I don’t know if I could ever return to practice. It’s too hard to live in fear of a backstabbing patient or family member, and the ineptitude and glacial pace of a medical board. I want to clobber anyone who says, “and this too shall pass.” It’s not quite like that.

I am trying to re-establish myself in some second career, but that is hard to face. I cringe every time I open my email and mailbox in fear of a letter from the Board. I know I did nothing wrong, but that’s not how the system works.  

I still fight the urge to take my own life.


1/17/2015

Great website. Presents an alternate view I have never seen in action and I have had to report a number of MDs to our state’s PHP. Thanks for the insights.


2/8/2015

I am an RN in a monitored program in PA which includes forced AA attendance. I have 22 years as an RN with 10 years of military service which includes a one year deployment to Iraq. I am willing to speak out. Too many are afraid of losing their licenses to practice.


1/14/2015

A review of 14 studies found that the relative risk of suicide in physicians compared with the general population is between 1.1 and 3.4 for men and 2.5 to 5.7 for women,  http://www.currentpsychiatry.com/index.php?id=22661&tx_ttnews[tt_news]=175910, furthermore, studies have indicated higher rates of suicide among psychiatrists and anesthesiologists.

There are a variety of theories on why physicians commit suicide.  Depression is the most common explanation given.  Certainly, there’s a lot of stress involved in our profession.  We deal with death and dying.  We’re held to impossible standards.  Managed/mangled care and the restrictions of government plans/laws/policies on the  one hand restrict what we can do for our patients.  On the other hand however, are the viscous  packs of attorneys waiting to cull the herd.  Let’s not forget the State Medical Boards, out there striving to “protect the patients”, generally done in cahoots with the “Physicians Health Programs”.  These two entities form a deadly collusion that is inescapable—and of course, linked to the packs of predators circling to ensure that we will suffer the consequences for actions that we may have little if any control over.

I am one of the unfortunates.

I haven’t committed suicide (obviously), nor made an attempt at it.  Certainly I’ve had thoughts about it—who among us hasn’t?  My strong religious convictions prevent any serious consideration of this “permanent solution to a temporary problem”.

I am also one of the fortunates.

This is largely due to the foundation of faith that I have.   Years ago I made what may have been a mistake.  I prayed for patience & humility.  We tend to be an impatient and yes, at times an arrogant lot.  I recognized those character flaws in myself and asked Him for help.

 I should have asked for the grace to overcome these shortcomings.  Grace is a gift, a “freebie” if you will.

Patience is gained through trials.  Humility generally through humiliation.

I have learned that where there is pain in life, there is often a lesson—look for it, learn from it.  Running from it merely guarantees that it’ll be presented again, and again and again until it’s learned, often with a few extra presentations after the initial effort to dodge the trial.

The study of theology has lead to the interesting concept that suicide is actually a sin of pride.  Yes, depression is involved, but the pride plays it’s role with the thought that;  “I don’t deserve this trial so I’m choosing to take myself out of the game”.

My personal belief is that only God has the power to give and take life.  The reader is certainly entitled to their own belief.  Mine has evolved by study and prayer over decades.

There is a growing movement afoot across all 50 states for attorneys employed by State Medical Boards to direct their investigators to report possible transgressions directly to the attorneys instead of to the physician board members  http://woundedhealersnc.net/.  The attorneys have thus usurped the role of a professional board; to ensure that we’re held accountable by our peers.  These attorneys then draft their own perspective of what happened, often putting “spin” or “slant” to the report to prejudice the board members to carry out the actions that these attorneys deem to be appropriate.  The Board Members have unwittingly abdicated their responsibilities.  This leaves physicians at the mercy of Board attorneys.  These attorneys were initially tasked with ensuring that the Board members didn’t violate any laws in their disciplinary actions against wayward licensees.  Board members are busy physicians in their own rights.  They have their practices and with the attendant problems associated with them, as do the rest of us.  Typically, they go to their state capital for a couple of days a month to do their “official duties”.  The attorneys present the information for the “rubber stamp” of the Board’s approval.  

Worse still are the “consent orders” drafted by the State Board attorneys.  A key part of such an order is the “findings of fact” describing the (alleged) transgressions.  The hapless licensee is often coerced to signing these flagrantly fictitious documents with threats that the attorney-derived discipline will be much lighter than what the Board will mete out.  It’s actually not uncommon for “defense” attorneys to collude with the Board attorneys, urging the clients that they are supposed to be defending into signing the consent order.  Signing the order will have many grave consequences http://woundedhealersnc.net/documents/lip/index.htm.  As a hapless victim, I had no concept of such unethical yet commonplace activities.  

There is documentation of an extremely arbitrary nature of punishments on www.woundedhealersnc.net ; A physician and his mid-level go out to a dinner presentation by the local pharmaceutical representative.  Driving home afterwards, the physician crashes the vehicle.  Both are intoxicated.  The mid-level spends 2 weeks recuperating in the hospital.  The physician/driver gets a “Public Letter of Concern”.

Another physician is out of state on vacation, gets a DUI, truthfully reports it during his annual license renewal and is taken out of practice for four years.  Some practitioners NEVER return to practice.  Substance abuse issues are treated extremely harshly.

Killed somebody with negligence?  Oh, no problem, that will only get you a “Public Letter of Concern” in North Carolina.

You were seduced by a patient?  Big problem!  There’s to much of a “power imbalance” since you’re a medical practitioner, mid-level or otherwise.  You may possibly NEVER practice medicine again.  There’s documentation of a psychiatrist who married a patient, the State Board found out about it and took her license away; she was to much of a risk for sexually assaulting other patients.  Ultimately she was allowed to have her license back on the condition that she never practice psychiatry again!

I was also unaware that state boards are incentivized to discipline as many physicians as possible, as harshly as possible, for as long as possible.

I was indeed one of the innocents.

Knowledge is indisputably power.  The site quoted above provides a wealth of information of the workings of the “system” in North Carolina.  The “Great North State” is hardly alone in their approach.

The Physician Health Programs (PHP’s) are another area of concern.  It’s a shame that the stated purpose of the PHP’s is to help return impaired practitioners to active practice.  These groups throw the very physicians who need help the most the furthest under the bus in full collusion with the Board.  They’re typically staffed by psychiatrists who are members of “addiction societies” that aren’t much more than diploma mills.  The PHP’s often claim to be performing “peer review” while disregarding the legal requirements for peer review.  The PHP’s/Medical Societies/State Boards are parasitic symbionts that prey upon those of us who have been used up and burnt out by the non-system of healthcare that exists.

 Does this sound like a pattern is developing? “Disregarding the legal requirements…”

In North Carolina, the complaints were of such a volume that the NCPHP was audited and found to have numerous deficiencies.  Next, all 57 of their licensing and professional boards were audited.  All of them showed problems—the most common that they did not report to anybody for supervision!  These are routine violations of the General Statutes of the state.

Every state has a state auditor whose function is to ensure that state agencies fulfill their assigned duties efficiently and honestly.  Most State Medical Boards and PHP’s have NEVER been audited.  Anybody can report their concerns to their state auditor.

Attorneys are supposed to uphold the law; isn’t this ironic?

There is ample evidence of collusion among the players; Defense attorneys who should be defending their clients against their Board (sometimes the Boards actually recommend individual attorneys that they “work well together” with to wayward licensees).  Board Attorneys are clearly involved as are the PHP’s.

State Medical Societies are also generally in the same bed with the Boards & PHP’s.  Governor’s generally rely on the Societies to recommend prospective Board members.  It’s not uncommon for the first question at an “investigative hearing” to request information on whether the licensee is a member of the local state society.  What would the purpose of such a question be?  Simple.  It’s well-documented that membership has a “protective” function.  It’s not absolute, but exists nonetheless.

In one case, the Board remanded a full mental health evaluation.   The result was that the licensee had a mild autism spectrum syndrome (something a good many of us have), an autism spectrum disorder that is characterized by difficulties with social skills and non-verbal communication—but with benefits such as intense interest and expertise in certain areas (like medicine!).  

 The function of a Board is to maintain scope of practice.  Family physicians don’t do craniotomies.  Yet, despite the absence of a single mental health professional on the Board, the recommendations of 3 independent professional organizations, all recommending immediate return to practice for the licensee were ignored.

The Board posted the practitioners protected health information, including mental health information on their website.  The most basic rights to privacy were clearly violated.  The licensee never gave permission for such an intrusion!

The ADA covered disability was dealt with by an indefinite suspension—all with the full collusion of the NCPHP.  The ADA requires “reasonable accommodations”.  Indefinite suspension is punitive—certainly not a reasonable accommodation!  Again, it cannot be over-emphasized that Board attorneys have a strong desire to punish whenever, wherever, for as long as possible.

The licensee signed the contract with the NCPHP.  The licensee was held to the terms, but the advocacy mandated by the contract was never delivered; “the Board attorney said he wasn’t interested in anything I have to say in your favor, his mind is made up, there’s nothing I can do to help…” was the limit of advocacy received.

 Advocacy?

Collusion is a more accurate description.

The theme song from the hit movie and TV show M*A*S*H* is “Suicide is Painless” by Johnny Mandell.  This epidemic is more of an endemic among our profession.  We can’t keep “looking the other way”.  

 There are two major forms of suicide.

Active suicide would best be described as a former colleague who went into the recovery room one Sunday afternoon when it was deserted, took a scalpel and did a full-length carotidotomy on himself.  He made a posthumous statement.  Another ran out in front of a box truck on the interstate.  It took his head off.

Passive suicide is best shown by 5 of the NC Medical Board victims.  This Board tends to pursue physicians from their mid-40’s to mid-60’s, the top income-producing time of our careers.  They usually have assets to poach.  Usually by that age, we’re taking some form of medications for our own health issues.  A diabetic who purposely forgoes his insulin…   Suicide?  It won’t be reported as such.  What do YOU think?

We will never eliminate all of our stressors.  There will always be the “less fit members of the herd”, which is sad.  This is more appropriate for other animals at other positions on the evolutionary tree.  Why should the most noble of professions be relegated to those branches of that tree?

We need to reach out to each other.  We need to reach out to our state auditors.  Another resource that surprised me is a different agency.  There is an agency whose primary function is “to deal with corruption in public officials both appointed and elected”.

Does this sound like an appropriate agency to engage against our Boards & PHP’s?  It’s the Federal Bureau of Investigation, commonly known as the FBI!

All that it takes for evil to triumph is for good men to do nothing.  When we organize we change from individual targets to a formidable force.  State Medical Societies, unfortunately, are not the answer.  Typically state governor’s turn to them for nominations to staff the boards.  In North Carolina, lawsuits have been settled out of court that involve the alliance between the Board, Medical Society & PHP.

 Perhaps the best solution would be to revamp the system.  Maybe it’s time for a Federal Medical Board.  At the very least, State Boards should be restructured so that investigators do not report to the attorneys, but directly to the Board Members.  It will mean more work for the Boards, but they’ll at least resume functioning in the manner originally intended.

–Wounded Healer


12/31/2014

This whole lack of accountability and oversight within the PHP’s makes me sick. I was sent to PHP for evaluation and suspicion of drug abuse by my employer hospital. I was only suffering from side effects of Paxil causing a SSRI Discontinuation Syndrome. The diagnosis was completely missed because the PHP sent me to a rehab center in Los Angeles. I am sure you know this one very well.  

I was coming there for IDE, Intensive Diagnostic Evaluation not recovery and rehab. After arrival I was forced to enter their rehab program completely against my will. I was on my way out the door and about to call a cab when the program director threatened me with absolute coercion.

He said if I left he would assume I had drugs in my possession and that this would negatively affect my evaluation and would be reported to the PHP and state medical board as a form of noncompliance, and that my career and license would be in jeopardy. How is that possible when I was not sent there by any state board or regulatory agency as I was there voluntarily.

The only incentive to force me into admission rather than having my workup done as an outpatient was purely financial. Employer was paying the bill, so it was in their best financial interest to force me into admission at $1800/day and $1400/urine sample and charge for all the transportation to and from all the outsourced facilities for my “evaluation”.

The facility was run by the most inept, unethical group of charlatans I have ever encountered in any field of service not just healthcare. I could not understand how they were qualified to provide medical evaluations when they are not legally allowed to provide any form of treatment for anything. These people were nothing more than middle-management screw ups. They have to outsource everything. They did not even have a crash cart on site.  One of their clients had a tonic-clonic seizure during group therapy as a result of a brilliant PA who decided to withhold the clients chronic benzodiazepine therapy because of her personal beliefs that benzos are horrible medications for anyone.  Where is the physician co-signature and oversight on this brilliant therapeutic decision? No one except the doctors in rehab even knew how to react. It was a total fiasco and state of panic for all the rehab employees. Luckily the client didn’t dislocate something, die or worse, suffer anoxic encephalopathy. I was in fear for my life after witnessing this my first day.

What’s even more concerning is that this rehab center is supposedly one of the best and has exclusive referral from every state PHP.

They had me stay with recidivist junkies and participate in 12 step when I had no substance abuse issues at all, in fact my social life was so boring, that my hair test wasn’t even positive for alcohol. I had to recite scriptures in group therapy, admit that I was helpless, and powerless, and a weakling. Admit that I had to submit to a higher power since I was an addict. I had to submit to random urine drug tests which costs $1400 each 3-5 times per week.

Then when I cannot produce a sample on the spot (paruresis) I am threatened to be reported to the State Medical Board for noncompliance.  A college dropout working as a technician at a rehab does not even have the authority to make this type of threat. I was also forced to shave in front of a female technician with the bathroom door open; she stated that this was policy and I had to relinquish my razor after every shave because I could use it to inflict harm on myself. I then asked why is there a whole drawer full of sharp cutlery in the kitchen that me and my junkie roommates have access to 24/7??? 

I saw a psychiatrist and handed him my diagnosis on a silver platter from my history , i.e. Paxil withdrawal yet SSRI Discontinuation Syndrome was not even on his differential. I was in a state of constant agitation, sleep deprivation from insomnia, severe depersonalization. Ended up in the ER at UCLA for intractable Migraine HA, Sleep deprivation, Dehydration, mild AKI and had to be medicated with IV crystalloid, Phenergan to combat emesis and finally induce sleep (going on 4th day of insomnia at that point). 

Less than 24 hours after the ER visit I am sent for Neuropsychological testing extensively, which violated just about every code of conduct and ethics under the American Psychological Association in regards to testing validity. I was then labeled “disabled” based on the results. the treatment center was then going to recommend that I stay and additional extended period so they could “rehabilitate” me. They realized now that they did not have my credit card on file because I refused to provide them with it at admission as my employer, was paying for everything for the first month. Next they discover that I do not have disability insurance, and now know that they have just ruined my life.  It will take a minimum of 6 months before I can be retested to prove that I have no cognitive impairment and am not disabled. Now my chances of getting disability insurance in the future are ruined.

The treatment center then released me and I returned home to the PHP.  I then had to sign a five year contract, enlist in a drug monitoring contact with “RecoveryTrek” which I had to perjure myself and illegally claim that I was a substance abuser and was in “recovery.” I immediately sought legal counsel because of this nonsense. Shortly into my so called recovery I had to take my Maintenance of Certification Board Exam in Internal Medicine. Passed exceptionally and with ease. How could I be cognitively impaired?

Go figure! The neuropsychological test was readministered locally by a different provider as I told the PHP there was no way I would ever consent to going back to the treatment center.  The neuropsychologist was pretty pissed off about everyone’s mismanagement of my case starting with my employer.  I tested fine, and then the PHP released me from the program and cleared me to return to work. The entire experience has jaded my enthusiasm in medicine. I had to take almost a year off to reflect on how I was used as a pawn in everyone’s game.

I experienced coercion, collusion, fraud, incompetence, and saw a part of evil in this world that I never new existed. I was a prisoner, starting my day by having to call a monitoring center to see if I had to be drug tested for that day, every  day of the week.  I was not allowed to leave the state; how can a PHP legally restrict my civil rights this way when I was not under a court order, and not even under state medical board referral? I was not allowed to have a sip of alcohol during my monitoring, even though I had tested negative for any evidence of drug use. I had to meet with board of directors every month and discuss my case, which no one had clue about regarding why I was even in a PHP.  This violated all of my rights to privacy regarding my medical condition. The contract that I initially had to sign with the PHP had statements within claiming they could report any information about me to any regulatory agency without even substantiating any facts or validity. This is just a clever way of saying they can lie about you and there is nothing you can do about it legally.  There is complete lack of due process. Your civil rights are stripped. You are beaten down into despair and desperation. You are told if you don’t comply your license would be in jeopardy and your career will be over. This cost me thousands of dollars in legal fees, thousands of dollars to be retested and prove I was not impaired, hundreds of dollars each month for PHP dues and random urine drug screening.

I put up with this B.S. for six months, and honestly could not have fulfilled a 5 year contract. If I had not been released (since there was no condition to monitor) I would probably be dead today. I would not be surprised that PHPs have actually caused in increase in physician suicide rate.  I cannot fathom the degree of humility physicians experience having to do this for five years. And the only reason these rehab centers claim such a high success rate for recovery is that they hold a gun to your head and threaten you to be in compliance with everything they recommend. So yeah, doctors have a lot more to lose.  I now understand how these PHP’s are in collusion with rehab centers. What they are doing is a violation of fair trade acts and would fall under the RICO act. The problem is nobody is investigating them for conspiracy and fraud. They all fly under the radar because they believe they are providing a service that ensures public safety. Its a multi-billion dollar scam industry. What’s more sad is that nobody really cares what physicians are subjected to. In fact the public likely finds joy in fact that docs are treated this way. The state of California hates doctors, so the rest of the country probably does too. People probably enjoy knowing doctors are held to higher standards than the rest. That they are usually required to stay 90 days in rehab while all other professionals stay 28 days, that they are financially ruined by rehab centers. That they have been stripped of all their rights while in a PHP monitoring program. That they are more subject to discrimination based on age or coexisting medical problems like diabetes and hypertension. I have actually seen cases of MDs sent to PHPs for monitoring of hypertension and regardless of why you are sent there you must comply with drug monitoring.

The rehab centers are now tapping into other territory that further identify this as a conspiracy. Department of Transportation, Aviation, and Law Enforcement are going to be their next victims. I can’t wait to see how the police officers are going to respond to this nonsense.

This was an eye opening experience. There is no profession that is worth going through this amount of humility. PHP’s will likely remain above the law, continue to have no accountability and oversight, which is a travesty of justice.  I hope you will share my experience.  My case is rather unique in my opinion.  It’s evidence that no physician should ever voluntarily enter a PHP at an employer’s request. You would be much better off to simply quit/resign.


12/27/2014

I know of pharmacist who are forced into the program and held hostage by their license. They are also required to do “inpatient” treatments of at least three months and continued random monitoring for five years as well.

Once they have you by the proverbial ball, they milk you till you are dry. It is nothing but a scam. The funny thing is that for healthcare professionals who relapse while in the program, they are sent back to “rehab”(inpatient) again once more for milking while they feed you the same b.s. they did the first time.

What is becoming even more alarming is that at least in one case, Texas, if you call PHP for help or to inquire about help, even though nothing has been reported at work or to the board, and you identify yourself and spill your guts about your issue/s asking for your options you are automatically signing up for a trip to rehab and five years of monitoring.

If you decided that you are not interested what they have to offer, they will tell you they would report you to the board at that stage (of course at the beginning of the conversation they tell you it is confidential, but it is confidential as long as you voluntarily start their program since you spilled the beans.

I would be very careful calling the state PHPs asking for information. I would do it from a blocked phone and use an alias before talking to them.

Maybe others who information about other states can also shed some light on this.


12/7/2014

It is really tragic that so many valuable doctors are lost without reason.  That State Medical Boards can strip a physician of his hard earned license without due process. That there is no oversite of these boards. That boards and PHPs bully and harass physicians, even to the point of suicide. About 400 physician commit suicide every year. That’s a loss of an entire medical school every year! A colleague of mine committed suicide after facing medical board charges that had no signifigance anyway. This is occurring in the face of a physician shortage as baby boomers age.


12/30/2014

Turns out, I am one of those recovering alcoholics (9+ years) with a lot of experience in AA. It was a large part, though not all, of my treatment. I found it personally helped me a lot. And I also agree with your position.

Based on my experience in AA, things I heard at AA meetings and things I read in AA literature:

– the AA message should be spread via “attraction, rather than promotion”

– AA does not claim to be any kind monopoly in the field of addiction treatment

– AA is fully self-supporting, declining outside contributions

– AA is not professional and not organized

And so having a large body of physicians outside of AA promoting AA is, in my opinion, contrary to multiple AA traditions – particularly if this situation creates controversy. I personally find AA needs no extra promotion, and alternative treatment programs ought to be encouraged just as well as further scientific research into the addiction problem.

The whole thing was meant as a very open, welcoming, non-judgemental, informal gathering of alcoholics talking to each other. Extremism, government coercion, public promotion, money – all those things do a lot more harm than good.

At any rate, thanks for your thoughts, Dr. Langan. Best of luck in the future, I’ll keep following along.


12/25/2014

As an airline pilot who made the monumental mistake of believing that the “E” in EAP (Employee Assistance Program) really meant “assistance”, I can only nod my head in sad agreement to everything above. Between “treatment” (indoctrination in AA dogma) and monitoring my decision to ask for assistance in dealing with a series of health and personal issues that I (for the first and so far only time in my life) tried to use alcohol to numb has changed my life forever. I have lost 7 years of my life. My faith in the rule of law in our society is completely gone. The stress and humiliation of having my career depend on my ability to convince people in this program that I have been “converted” (let’s call it what it is: living a lie) have been indescribably painful. It has affected every aspect of my life. My physical and mental health has suffered as has my personal relationships. My only hope is that court decisions like the recent one in the Hazle trial will once and for all end this damaging and unconstitutional practice.


12/1/2014

Comment: Excellent research. What is astounding is that some (if not all) PHPs are using EtGs and EtSs and PEths DESPITE explicit advisories by SAMHSA over a span of 6 years! These advisories noted that a) they were not FDA approved; b) there was insufficient research; c) that there were too many false positives; and d) using such tests in such a setting as the forensic environment where someone’s career and reputation could be put at risk was highly dangerous. Further, as I discovered only recently, NCPHP not only runs these tests on new evaluations it conducts on involuntary (and unsuspecting) physicians who have been ordered (under specious circumstances) to be evaluated by NCPHP, NCPHP adamantly refused to release the results of the tests to the physician, though you can be assured the results were used to “make their case” for a pre-determined diagnosis.

I think it is fair to say that their use of these tests is not simply unethical; it constitutes highly risky human experimentation conducted with neither the subject’s consent nor with approval of an IRB.

One can also presume that PHPs have sold this junk science to their associated medical boards in giving them what appears to be substantial evidence to bolster their case. And one can also presume that medical boards have simply accepted it as though it were valid, essentially doing nothing to challenge the invalidity of the test and the violation of due process and thus virtually rubber-stamping the annihilation of a physician’s career.

When you engage these research epidemiologists in this endeavor (is there yet a group called “Epidemiologists for Social Responsibility?”), you may also ask them to review data form board and PHP actions in which this data was – in any way – involved in the assessment of their case, whether playing a major role or only an incidental one. The introduction of this misleading – and therefore fraudulent – laboratory data into these physicians’ adjudication would seem to serve as a solid basis for invalidating their fraudulent assessment and ensuing “conviction.”

Personally, I believe this is of such immense importance that it ranks up there with the flawed hair and fiber analysis assessments that were done by the FBI which my courageous colleague Dr. Fred Whitehurst called attention to in the late ’90’s (and lost his job over, via a massive campaign of discrediting and innuendo of “mental illness.”) It took nearly 15 years but finally, the DOJ saw the immensity and breadth of the false prosecution based on flawed “evidence” and ordered the FBI to reopen over 21,000 cases of potentially flawed hair and fiber analysis!

I truly believe the same outcome is going to materialize here – it has to! Physicians (and soon many other seemingly well-paid professionals who are judged able to afford the “private addictions treatment for professionals” scam) have been falsely assessed and compelled into costly (and embarrassing) treatment programs and prolonged monitoring (with extra time for balking – i.e. “being disruptive”) by the PHP prison-industrial complex. All with no chance of fair hearing, no chance to challenge the validity of the evidence, and high likelihood of reprisal if one doesn’t “go along.” This pervasive abuse of authority and process must be aggressively confronted.


11/27/2014

Great site!  There is so much corruption in medical boards & PHP’s.  We need to take it upon ourselves to evaluate what our agencies are doing and turn them into the state auditor of every sight for performance and forensic auditing.  Auditors DO listen and DO investigate, but they need to be led to the need for an audit.  The best way to do this is for those of us who have been assaulted and battered by these agencies to document what has been done to ourselves and our peers and let the auditors know what is going on!


11/22/2014

I have enjoyed reading your web log.  I have empathy for your plight.  I am involved in a parallel organization known as the HIMS program (Human Intervention and Motivational Study)  

I can’t help but notice that several of the names you have listed under ‘like-minded docs’, are ‘professionals’ I have also encountered.  Namely, Joe Garbely who did my initial psychiatric evaluation, Lynn Hankes, a urologist who advises HIMS and the FAA, and William Green, my current psychiatrist.  I am told a component of my $1500 dollar meeting with Dr Green (Physical and Psychiatric) will be composed of inquisitions into my involvement in Alcoholics Anonymous and progress in my step work. This is the man who told me I must attend three AA meetings weekly and my aftercare group therapy must involve AA in order to be approved for FAA Special Issuance (the FAA Gold Standard). I was also informed that non compliance would mean a rejection of my application by the Feds. All of this after I informed Dr. Green that there simply was ‘no correlation’ between Alcoholics Anonymous involvement and my sobriety and that I found the program to be psychologically harmful to my well being.

If you have any further information on the three ‘like-minded docs’ I have encountered in my journey kindly point this out to me.  I am sure there are more but I must thank you for providing the missing pieces of the puzzle from the medical perspective. Its eye opening to say the least. Have you spoken with the same attorneys the pilots have? I am sympathetic with your plight.  The worst mistake I ever made was asking for help and the process of psychological hazing, indoctrination, and coercion did nothing but steepen my situational depression.

Jonathan

Thank you for your earnest work on this subject.  We are not alone in this.

Jonathan


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Disrupted Physician 101.4–The “Impaired Physician Movement” takeover of State Physician Health Programs

These ASAM “addiction experts” have become so numerous they have been able to take over almost all the state Physician Health Programs (PHPs). Their national association—the Federation of State Physician Health Programs (FSPHP)–has a stated goal of universal acceptance of the 12-step doctrine: lifelong abstinence, and spiritual recovery as the one and only treatment, as spelled out in the “PHP Blueprint.”

Very much like Straight, Inc in the 70s and 80s, they have cast a wide net with doctors to ensnare them in an endless loop of drug testing and rehab—whether the tests are fabricated or not. The doctors will enjoy no sympathy from the public, and complaining about it is deemed a sign of your “disease.” Furthermore, ASAM recommends that physicians only be referred to “PHP approved” facilities.

The medical directors of these facilities can all be found on this list of ”Like-Minded Docs.” Surprisingly, many Like-Minded Docs were former addicts and alcoholics, some even with criminal backgrounds. There are felons and even double-felons on the list.

It’s a rehab shell game. Heads I win tails you lose.

And the program is expanding. The organization that oversees the licensing for all medical doctors, the Federation of State Medical Boards, adopted a new policy and approved the concept of “potentially impairing illness” and the Orwellian notion of “relapse without use.”

Signals for “impairment can be as benign as not having “complete accurate, and up-to-date patient medical records” according to Physician Health Services, the Massachusetts PHP. Despite the overwhelming amount of paperwork Doctors now have, incomplete or illegible records could be construed as a red flag, since as Associate Direct of PHS Judith Eaton notes “when something so necessary is not getting done, it is prudent to explore what else might be going on.” The question is, who is next?”

Disrupted Physician

Forget what you see
Some things they just change invisibly–Elliott Smith

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Physician Impairment

The Sick Physician: Impairment by Psychiatric Disorders, Including Alcoholism and Drug Dependence, published by the American Medical Association’s (AMA) Council on Mental Health in The Journal of the American Medical Association in 1973,1 recommended that physicians do a better job of helping colleagues impaired by mental illness, alcoholism or drug dependence. The AMA defined an “impaired physician” 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.”

Recognition of physician impairment in the 1970s by both the medical community and the general public led to the development of “impaired physician” programs with the purpose of both helping impaired doctors and protecting the public from them.

IMG_1010The 1975 media coverage of the deaths of Drs. Stewart and…

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Institutional Justice and Quality Disparity in Drug and Alcohol Monitoring–The Contrast Between MBTA Operators and Massachusetts Doctors is Shocking

Safety-Sensitive Occupations 

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In Backfire Step 1: Expose the Injustice–Forensic Fraud being committed by PHPs in Collusion with Corrupt Labs,  I used documentary evidence from my own case to show how the PHPs and labs are engaging in undeniable and indefensible forensic fraud. The documents speak for themselves and it does not take a toxicologist or Medical Review Officer to understand that “Updating” a “chain-of-custody”and adding a new ID # to an already positive test breaches all procedural and professional guidelines, medical and societal ethics and state and federal law.  It exemplifies how PHPs are blocking the “provision of information” required by most substance of abuse testing programs.   Whereas most substance of abuse testing guidelines require not only answerability but “timely” answerability, PHPs use tactics that block and delay such information. These tactics include both refusing to provide the information and dissuading those monitored from requesting it.

In my case it took 5 months to obtain the “litigation packet” (a  documentary record generated on any and all “forensic” drug and alcohol testing that records the “chain-of-custody” from initial collection to final analysis.   The litigation packet I received in December of 2011 from a test collected by Quest Diagnostics can be seen here:  USDTL Litigation Packet.

If you take a look at it you will see that no documentation exists regarding the specimen from when it was collected July 1st, 2011 to when it was reported as positive on July 19th, 2011 by Dr. Luis Sanchez, Medical Director of the Massachusetts PHP, Physician Health services, inc. (PHS).  There is, in fact, absolutely no external chain of custody documenting the collection, handling and transport of the specimen.  This in itself, according to each and every guideline ever published in the history of forensic testing invalidates the test.

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But more importantly, the litigation packet revealed evidence that the reported positive test was not the result of oversight or accident but deliberate and intentional–forensic fraud by fax.  Although this laboratory misconduct and fraud is undeniable and indefensible PHPs have no oversight or regulation.  Neither do the labs.

Most individuals being tested for substances of abuse by employee assistance programs have a union or some other organization protecting their best interests. In the case of a suspected fraudulent or mishandled test these groups facilitate accountability by helping to obtain the information and requesting justification of actions.   No such agencies exist for those being monitored by PHPs.  No avenue of complaint against PHPs exist.  In addition to no FDA oversight, “forensic” LDTs (unlike clinical LDTs) are exempt from Clinical Laboratory Improvement Amendments of 1988 (CLIA).   The only avenue of complaint against a lab utilizing forensic LDTs is through the College of American Pathologists (CAP). As an accreditation agency, however, they are limited in what they can do as a result of an investigation.  Whether the complaint involves accidental lab error or intentional fraud the only action CAP can take at the conclusion of an investigation is to threaten the lab with loss of accreditation if the lab does not come into compliance with their “Forensic Drug Testing Checklist.”  They can also force the lab to “correct” these tests under threat of loss of accreditation.   This is what CAP did in my case which brings us to  Backfire Step 3: Reframe: emphasize the injustice, counter reinterpretation.

Drug testing that follows mandated guidelines provides procedural safeguards that protect the donor.  .Accountability demands both the provision of information (answerability) and justification for ones actions.   both those administering the tests and those performing the tests are held accountable by outside agencies.   The system is transparent and when the validity or integrity of a test is questioned the employer and lab must provide the records and documentation.

Why are doctors allowing PHPs to use drug and alcohol testing of unknown validity? We require evidence-base and adherence to professional protocol and ethical guidelines in every other arena but this one.   Using the fallacious appeal to authority, however, the impaired physicians movement doctors (FSPHP) convinced regulatory boards that these tests were valid, reliable and necessary. In fact the sensitivity and specificity is unknown so the false-positive rate is unknown. In addition, with no regulation or oversight, positive tests can be the result of deliberate misconduct and, with no agency to sanction those engaging in the misconduct, it can continue unchecked.

It is time we demand better care for our fellow doctors.  It is time we debunk the mythology surrounding the required length of stay in rehabilitation facilities that is three-times longer than anyone else.  There is nothing unique about being a doctor that warrants this.  No evidence base exists.   PHPs need to be reformed and rebuilt as programs of institutional justice.  The current state of affairs is one of coercion, control and abuse.

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Backfire Step 1: Expose the Injustice–Forensic Fraud being committed by PHPs in Collusion with Corrupt Labs


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I will be putting up a survey shortly and want to hear your stories.  One of the recurrent themes I keep hearing from those victimized by PHPs is falsified drug and alcohol tests.   Attached is an example of what they are capable of.

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Quote by Dr. Greg Skipper, MD, FASAM, FSPHP

Remember, this group has essentially removed themselves from accountability in drug and alcohol testing via the use of Laboratory Developed Tests (LDTs), a loophole which avoids FDA approval and oversight.   Whereas most drug testing is transparent and held accountable, the PHPs use testing that is opaque, unregulated and accountable to no one.  Accountability demands both the provision of information and justification for ones actions. PHPs block both.  While most drug-testing requires the immediate provision of information if the test is questioned (as it should be), PHPs have put forth the logical fallacy that doctors have some sort of inherent expertise in toxicology and pharmacology and can “figure out” how to circumvent the testing process if they were to get copies of their lab results.  They block this provision of information.  And even if this information is ultimately provided, as seen below,  no outside organizations exist to hold them to account.  They do not have to justify their actions to anyone.  No safeguards exist to assure integrity and honesty of the sample.   No safeguards exist to assure the integrity and honesty of those ordering the sample either.

The documents below show forensic fraud.  This is undeniable and indefensible. It does not take a toxicologist or Medical Review Officer to understand what “chain-of-custody” is and that “updating” one constitutes misconduct, fraud and (as seen here) criminal activity.   These documents were obtained 5 months after a falsified test was ordered by Linda Bresnahan, Director of Operations at Physician Health Services, Inc. (PHS, inc.) the Massachusetts PHP via fax no less.  The blood test was drawn on July 1, 2011.  On July 19th, 2011 Ms Bresnahan requests (through the PHP secretary Mary Howard) that an already positive test for the alcohol biomarker phosphatidylethanol be “updated” with  ID # 1310 and a “chain-of-custody. (which is an oxymoron-a “chain-of-custody” by definition cannot be “updated.”  Unveleivably the lab does it without hesitation or any apparent compunction.   The documents speak for themselves.  ID # 1310 just happens to be my ID number.  When I complained that no one ever accused me of ever having an alcohol problem she replied:

“You have an Irish last name-good luck finding anyone who will believe you!” 

For a more detailed analysis see here, here and here.  And where was the Medical Review Officer during all of this?  Good question and one he will not answer!  And no one else is holding him to account.   This needs to change.


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1. Supression of Dissent: Basic Information

2. The keys to backfire

• “Reveal: expose the injustice, challenge cover-up

• Redeem: validate the target, challenge devaluation

• Reframe: emphasize the injustice, counter reinterpretation

• Redirect: mobilize support, be wary of official channels• Resist: stand up to intimidation and bribery”

via Helpful resources for those abused and afraid — via www.bmartin.cc .

American Doctors Are Killing Themselves and No One Is Talking About It–By Gabrielle Glaser via the Daily Beast

Screen Shot 2015-03-23 at 7.31.40 PMVia the Daily Beast:   http://www.thedailybeast.com/articles/2015/03/23/american-doctors-are-killing-themselves-and-no-one-is-talking-about-it.html

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Excerpt:

“Doctors who acknowledge problems with substances or mental health are typically referred to a physicians health program, or PHP. These organizations evaluate, monitor, and treat physicians. Established initially in the 1970s, PHPs, which exist in almost every state, were intended to divert physicians suffering from alcohol or drug problems from censure from their state medical boards. PHPs are incorporated as nonprofits and have autonomy from the boards. But some PHPs breach confidentiality if they fear a doctor is a danger to the public. And some state medical boards also fund their PHPs. Since the boards hold the keys to licensure, many say this is a conflict of interest.

There are growing concerns about whether PHPs have the right approach to the job. They typically send doctors to rehab programs rooted in the faith-and-abstinence principles of Alcoholics Anonymous. While AA’s 12 steps might work for some with alcohol-use disorders, critics say most PHP recommendations are ill suited for patients with mental health problems.

J. Wesley Boyd, a Harvard psychiatrist who left his post as assistant director of the Massachusetts PHP over a disagreement about practices there, says PHPs routinely intimidate their clients. In an article he co-wrote for the Journal of Addictions Medicine in 2012, Boyd noted that many doctors who seek or are referred by colleagues for treatment are mandated to attend pre-selected rehabilitation facilities for 60 to 90 days. Afterward, they must agree to monitoring and drug testing, typically at their own cost. When doctors resist PHP recommendations, they risk losing their livelihood and their licenses.”

For full article see:  http://www.thedailybeast.com/articles/2015/03/23/american-doctors-are-killing-themselves-and-no-one-is-talking-about-it.html

When Dentists Go Too Far: North Carolina Board of Dental Examiners v. Federal Trade Commission

Screen Shot 2015-03-17 at 12.25.17 PMhttp://www.forbes.com/sites/georgeleef/2015/03/04/eeoc-keeps-its-losing-streak-intact-reinforces-the-case-against-administrative-law/


The recent strike down of anticompetitive regulation in N.C. dental case opens the door to antitrust litigation against other state Regulatory Agencies such as Medical Boards.

The Federation of State Physician Health Programs has set up a “hidden” system of coercion and control using various methods (policy and moral entrepreneurship, changes in state medical practice acts and administrative procedure, misuse of health law, etc.) to create a system that lacks oversight and regulation. As a power unto themselves they are accountable to no one.

Although originally funded by medical societies and staffed by volunteer doctors in order to help sick colleagues and protect the public, any system can be subverted for profit and power, and these programs have been taken over by groups representing the multi-billion dollar drug and alcohol testing, assessment and treatment industry and become reservoirs of bad medicine and fraud. All manner of abuse can be hidden under a veil of benevolence. Although most are afraid to speak publicly under fear of punishment and retaliation (“swift and certain” consequences, summary suspension) I have herd from many many doctors in multiple states. Their stories are all the same.

In addition to misconduct related to the non-FDA laboratory developed tests (they themselves introduced into the market using a loophole that bypasses FDA approval) there are reports of coercion into unneeded evaluation and treatment at a couple dozen or so “PHP-approved” facilities under threat of loss of licensure.

Reports to a state PHP can be done anonymously with confidentiality guaranteed to the reporter. Any report will result in a meeting with the state PHP and if they feel a licensee is in need of an assessment they require it be done at a “PHP-approved” assessment center.

As non-profit tax exempt corporations, PHPs do not provide clinical assessments. They can only recommend assessments.  State Regulatory Agencies (Medical Boards, Nursing Boards, etc.) have accepted the PHPs requirements of limiting assessments to those approved by the PHP.   In fact many states mandate assessments to solely  “PHP-approved” assessment centers under threat of summary suspension of a professional license.

An Audit of the North Carolina PHP by State Auditor Beth Woods, however,  found financial conflicts-of-interest in the use of these predominantly out-of-state assessment facilities to which the N.C. PHP was referring and the state Medical Board was requiring.  Woods requested the qualitative indicators and quantitative measures used to  “approve” these assessment centers from the N.C. PHP but they were unable to produce any documentation showing any quality indicators or objective criteria existed!  The best response they could come up with was “informal” methods and “reputation.” The full audit can be seen here.

Imagine if the FDA gave this reply if  asked to provide the criteria used to “approve” medications or medical devices in the “FDA-approval” process!

Making matters even worse, the Medical Director of the N.C. PHP, Dr. Warren Pendergast was serving as President of their national organization, the FSPHP at the time of the audit.

The simple fact is no criteria exist.

A recent class action lawsuit in Eastern Michigan found this same pattern of referral to out-of-state assessment and treatment centers ( Marworth, Talbott, Hazelden. Promises,etc.)

State referrals to “PHP-approved” facilities has become a matter of public policy. Both the American Society of Addiction Medicine and the Federation of State Medical Boards have issued public policy statements stating that only “PHP-approved” centers be utilized by Regulatory Agencies in the assessment and treatment of their licensees.  Moreover, these policies specifically exclude “non-PHP-approved facilities and often involve a limited time-frame.  No choice, no appeal and no bartering.  Do it. Do it now and if you don’t suffer the consequences.

These public policy statements can be seen in the 2011 ASAM “Public Policy Statement on Coordination between Treatment Providers, Professionals Health Programs and Regulatory Agencies” and the 2011 FSMB “updated Policy on Physician Impairment.”  Many state Regulatory Agencies have strictly adhered to these policy recommendations.

What this means is that  states are mandating evaluations at  “PHP-approved” facilities even though there is no documentable or plausible reason for doing so.  No measurable criteria exist as to how the list of “approved” facilities were “approved” yet they have “cornered the market,” removed choice and created an imposed monopoly under threat of loss of professional licensure.

In reality no official “PHP-approved” list exists.  Neither does any objective published criteria for approving them.  At the same time state Regulatory Agencies and Boards are forcing evaluations on licensed professionals at these couple-dozen or so facilities.  They are excluding patient autonomy and choice violating the fundamental freedoms of the individual and informed consent.

All semblance of due process has been removed.  If  a plausible reason existed (i.e. they met some minimum standard of credentialing, quality or patient outcome) for referring to a proscribed list of assessment centers it could be arguably justified.  Without such criteria, and in light of the economic and ideological conflicts of interest involved, it is patently unjustifiable.

Even more disturbing is, as Drs. John Knight and J. Wesley Boyd (who collectively have more than 20 years experience as Associate Directors at the Massachusetts PHP, PHS, Inc.) pointed out in their 2012 paper published in the Journal of the American Society of Addiction Medicine,  many of these facilities are willing to “tailor” the diagnosis and recommendations of an evaluation to fit the wishes of the PHP.    “Tailoring” an assessment and recommendations to anything other than what the true data show is healthcare fraud.  It is, in fact,  the political abuse of psychiatry.

PHPs started out as “Physicians Health Programs” but many are transitioning to “Professionals Health Programs”  to widen the net.  For example in Michigan  and Florida the state PHP covers all health care practitioners from Acupuncturists to Veterinarians. PHPs have also entered non -healthcare employee assistance programs (EAPs) such as the aviation industry and the grand plan is expansion to  non-healthcare professions. They are doing this by claiming remarkable success rates and brandishing themselves as the “gold-standard” of substance abuse treatment.   Interestingly, the same individuals claiming how successful PHP programs are are the same individuals profiting from the drug and alcohol testing they introduced.  Anyone with any sort of license is at risk.

So whether you cut hair, teach, take care of patients or even drive a car they could be coming after you next and they don’t have to convince you of the validity and reliability of their services–they only need to convince those who regulate your license and, as we have seen, they are very accomplished at persuasion in this department.

And that is why we need more state audits of PHPs and Medical Boards.  The starting point is simple. Request from the state PHP and Board  a  list of “PHP-approved” facilities and the criteria by which they were approved. What should be a simple reply will undoubtedly not be as they will not be able to provide either.

Article 8

Antitrust litigation hasn’t disappeared, but rather changed its focus. Instead of targeting the great railroad empires of the late 19th century, today’s antitrust efforts focus on more minute industries, like dentistry.

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