Sinclair Lewis’ “Elmer Gantry” and the “physician wellness” crusade.

via Sinclair Lewis’ “Elmer Gantry” and the “physician wellness” crusade.

Sinclair Lewis’ 1927 novel Elmer Gantry is a satire on fundamentalist  religion in 1920s America. The eponymous character is  a greedy and debauched womanizer  who reinvents himself as an evangelical minister. The Reverend Dr. Elmer Gantry is a carney huckster who weasels himself into becoming the leader of a large Methodist congregation.   He organizes crusades against immorality while he himself is amoral. Gantry is an unethical and unprincipled power hungry narcissist who contributes to the downfall, injury and even death of those around him.  Lewis’ portrayal of pious hypocrisy and opportunism of fanatical religiosity was denounced from pulpits across the country.  The book was banned in Boston and many other cities with official censorship boards.    Public libraries and some booksellers refused to stock it and the author was threatened with litigation, jail, injury and even death.  The attempts at censorship backfired and the novel quickly went to number one on the fiction bestseller list.

The “religion racket” no longer has the power to determine what we read.  Unfortunately, similar groups have gained tremendous sway.  The “rehab racket” has erected a scaffold able to remove our constitutionally protected rights and civil liberties not only legally but under the pretense of doing so out of our own best interests.      According to Erich Fromm  rational authority is based on competence, experience and mutual respect.  Irrational authority is often disguised as benevolent paternalism and is designed to perpetuate or intensify conditions of inequality through the use or threat of force, deceptiveness and secretiveness.

This system has unfortunately given power and allowances to unethical individuals  who are able to exert control over other individuals under the guise of “treatment” regardless of whether or not those individuals even need it as inherent in the current chronic brain disease model of addiction is the importance of external control.

 

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Dental, Medical boards wield enormous leverage over licensees, but Supreme Court ruling could temper that

Posted on Louisiana Voice

February 23, 2019 by tomaswell

Trying to decipher which was the first to employ Gestapo-like extortion as a means of controlling licensees is like solving the chicken-or-the-egg riddle, but there’s no question that the methods employed by the Louisiana Board of Dentistry and the Louisiana State Medical Licensing Board are eerily similar.

Both employ highly questionable investigative methods, both impose stiff fines followed by even more outrageous fines if the licensee displays any will to resist what may even be bogus charges, and both make generous use of the most effective punishment: revocation of licenses—taking away the victim’s very means of earning a livelihood.

And both also occasionally force recalcitrant dentists and physicians to attend costly rehab clinics either in addition to or in lieu of license revocations. And those rehab clinics can cost as much as $30,000 a month.

Sometimes, a professional is sent to a facility that has its own abuse problems. Take the case of Slidell dentist KENNETH STARLING, who, in addition to having to pay an $8,000 fine, was sent by the dental board to a place called Palmetto Addition Recovery Center in Rayville in Richland Parish in 2010.

But PALMETTO, it turned out, was involved a 2009 lawsuit after one of its staff members, Dr. Douglas Wayne Cook, became sexually involved with one of the center’s patients.

And even while at Palmetto, the dental board continued targeting him. Could that be because he practiced in the same town as influential board member Dr. Edward Donaldson?

And while the practices of the dental board have been publicized often by LouisianaVoice, the state medical board essentially plays by the same rules. And, just as with the dental board, the name of Palmetto Addiction Recovery Centers surfaces on a regular basis in report after report, along with Pine Grove Recovery Centers in Hattiesburg, Mississippi, and Physicians’ Health Foundation of Louisiana.

I have chosen to delete the names and locations of the following examples, but the cases serve as examples of an uneven playing field, often dependent upon on the physician in question:

Following his arrest on charges of distribution and possession of controlled and dangerous substances in 2005, Dr. __submitted to substance abuse evaluation at Palmetto. “Apparently, the physician had submitted to chemical dependency treatment on two prior occasions. Upon his discharge from Palmetto, he underwent residential treatment at Pine Grove. His license was reinstated in 2009 but in 2013, the board received information indicating that the physician “had returned to the use of controlled or other mood-altering substances.” In 2018, after being placed on indefinite probation in 2014, his license was “reinstated without restriction.”

___________entered a plea of guilty to one count of Medicaid fraud in 2002 and subsequently underwent in-patient chemical dependency evaluation for cocaine abuse. Following completion of his criminal penalty, he was referred to Physician Health Foundation’s Physician Health Program (PHP). Following his reinstatement in 2008, he was disciplined again in 2018, this time placed on probation for unspecified violations.

___________ was diagnosed in 1999 with cocaine and alcohol addiction and in 2000 was referred to Talbott Recovery Campus in Atlanta, Georgia through Physicians’ Health Foundation and later to Fontainebleau Treatment Center in Mandeville. His license was reinstated in 2006 but in 2007, he again came under scrutiny for drug abuse and was again referred to a PHP monitoring program and he was placed on probation by the board for a 10-year period in 2008. He was reinstated “without restriction” in 2018.

____ entered a plea of guilty to one count of health care fraud in 2009. In addition to criminal penalties, the board suspended his license for 90 days, placed him on probation for five years, and fined him $3,000. Following his reinstatement in December 2009, it was subsequently learned in 2011 that he had been issuing prescriptions of narcotics, including OxyContin, from his home and vehicle since May 2009 under the auspices of a practice site not approved by the board. The board again suspended his license, this time for six months and he was placed on probation for 10 years.

_____ voluntarily entered into a two-week program at DePaul Hospital in New Orleans for cocaine dependency in 1995 and 1996 before transferring to Talbott Marsh in Atlanta. The board in 1998 ordered him into additional treatment in PHP at Palmetto and placed him on probation for five years. In 2003, he was again placed on five-year probation for failure to comply with requirements set forth in the 1998 order. His license was reinstated “without restriction” in 2018.

But when a Lafayette NEUROSURGEON becomes involved in suspected arson and subsequently enters a plea of guilty to one count of felony obstruction of justice, the Louisiana State Board of Medical Examiners is strangely silent.

Dr. Nancy Rogers was arrested in 2012 in connection with the fire at Levy-East Bed & Breakfast in Natchitoches, a blaze that caused $500,000 in damage to the unoccupied building. No motive has been given for the fire, but investigators determined it to have been intentionally set.

But in the case of Dr. ARNOLD FELDMAN of Baton Rouge, the board came down especially hard.

In a terse December 20, 2018, LETTER TO FELDMAN, board Executive Director Vincent Culotta, Jr., wrote, “Per the decision and order of the Louisiana State Board of Medical Examiners dated April 13, 2015, the amount due is as follows:

Cost of proceeding—$456,980.60
Administrative fine—$5,000
Total: $461,980.60.

This is not intended as a treatsie on Feldman’s guilt or innocence, but it’s rather difficult to fathom what “proceedings” could cost nearly $457,000 but that’s the way the dental and medical examiners boards operate. While members of both boards are appointed by the governor, they are apparently accountable to no one and able to set fines and costs at whatever amounts they wish.

Feldman served briefly as a member of the Physicians’ Health Foundation until he started asking questions that made certain people uncomfortable. Four months later, he found himself in the board’s crosshairs. But during his short tenure, he learned that the medical board funnels about a million dollars a year into the foundation. Apparently, there is no accounting for those funds.

Moreover, he said, the so-called “independent judges” hearing cases for possible board disciplinary action are paid by the board investigator’s office, which creates something of a stacked deck going into the process—not to mention an obvious conflict of interest.

Physicians aren’t the only ones to encounter an uncooperative medical board. The Legislative Auditor was forced to SUE the board in order to obtain board records so that it could perform its statutorily-mandated job of auditing the board’s financial records.

Senate Bill 286, the so-called physicians’ Bill of Rights, passed the SENATE by a unanimous 36-0 vote last year but never made it to the floor of the House after being involuntarily deferred in committee.

But a rare unanimous DECISION by the U.S. Supreme Court exactly two months later, on February 20, could impact the way these boards mete out exorbitant fines.

Even though the high court’s ruling on Timbs v. Indiana is considered a blow aimed at criminal justice reform, particularly in the so-called policing for profit through asset forfeiture, its effects could spill over into the way civil fines are handed down by regulatory bodies.

The ruling, written by Justice Ruth Bader Ginsburg, falls back on the Eighth Amendment that guarantees that no “excessive fines” may be imposed, a concept that dates back to the Magna Carta and later embraced by the framers of the U.S. Constitution.

It will be interesting to see if any dentist or physician victimized by either of these boards files legal action based on the Supreme Court’s most recent ruling.

If someone does, it could be a game changer.

Louisiana Voice

Trying to decipher which was the first to employ Gestapo-like extortion as a means of controlling licensees is like solving the chicken-or-the-egg riddle, but there’s no question that the methods employed by the Louisiana Board of Dentistry and the Louisiana State Medical Licensing Board are eerily similar.

Both employ highly questionable investigative methods, both impose stiff fines followed by even more outrageous fines if the licensee displays any will to resist what may even be bogus charges, and both make generous use of the most effective punishment: revocation of licenses—taking away the victim’s very means of earning a livelihood.

And both also occasionally force recalcitrant dentists and physicians to attend costly rehab clinics either in addition to or in lieu of license revocations. And those rehab clinics can cost as much as $30,000 a month.

Sometimes, a professional is sent to a facility that has its own abuse problems. Take…

View original post 1,141 more words

Doctors fear controversial program made to help them

Disrupted Physician

 

Link to Article

Many say a controversial program designed to help doctors with mental health issues is out of control, destroying careers and causing some doctors to commit suicide.

Link to Video

Screen Shot 2019-02-17 at 10.27.49 PM.png

Author: Investigative Reporter: PJ Randhawa, Erin Richey

Dr. Gary Hammen admits that he was tired on the job.
In 2017, he had a newborn at home and a packed schedule as an anesthesiology resident, on top of a sleep disorder stemming from an injury he got serving our country as a soldier overseas.

But to him, the questions his supervisors asked crossed a line.

“They asked me, is this a drug problem? Are you sure you’re not using drugs?” he recalled. “I was floored.”

The questions came after months of exhaustion for Hammen.

Hammen says repeated, 24-hour shifts were taking their toll on his mental and physical health. Most weeks, he worked more than ninety hours and slept…

View original post 1,806 more words

Regulation of the Medical Profession: The Influence of Special Interest Groups and “Bent” Science

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In  Bending Science: How Special Interests Corrupt Public Health Research 1  Thomas McGarity and Wendy Wagner describe how special interest groups scheme to advance their own economic or ideological goals by using distorted or “bent” science to influence legal, regulatory and public health policy.

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The authors describe a “separatist view” of science and policy that assumes scientific research is sufficiently reliable for public policy deliberations and legal proceedings when it reaches them.  This is illustrated as a pipeline in which it is presumed  the scientific community has properly vetted the information flow through rigorous peer-review and professional oversight.  The final product that exits the pipeline is understood to be unbiased and produced in accordance with the professional norms and procedures of science.   The reliability, integrity and validity of the final product is indubitably accepted.The separatist  view does not consider the possibility that the scientific work exiting the pipeline could be intentionally shaped and contaminated by biasing influences as it flows through the pipeline.  When this occurs the final product exiting the pipeline is distorted or “bent” and bent science can result in bad decision making and bad policy.

Bent science starts with a pre-determined outcome and works backward from a desired result. It is not true science. Those orchestrating the deception (“benders”) use a variety of tactics and strategies to shape, package and spin science to support their own hidden agenda and suppress opposing science.

Benders attempt to hide, dismiss and debunk contrarian research and unsupportive science.  Benders will attack and harass the science and scientists that pose a threat to their interests. Using carefully crafted studies designed to confirm a desired outcome, the pre-determined conclusions are subsequently promoted and publicized to the relevant stakeholders who are often unable ( or sometimes unwilling) to discern real science from junk-science.

Misinformation, propaganda, and deception are disseminated in a variety of venues. Public relations firms are used to manipulate public perception and freelance writers are hired  brandish favorable consensus statements.  Authoritative reviews and critiques are ghostwritten under the names of  “outside experts” who profit both monetarily and by adding a high-profile publication to their resume.

Opinion is paraded as fact and with a dearth of professional oversight the charade usually goes unnoticed and unopposed.

Data-dredging, cherry picking, confirmatory bias, confirmatory distortion, fabrication, falsification, exaggeration, and a whole host of deceptive tactics are used to work backward from an already determined result.

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Any information that contradicts the answer is manipulated, undermined, suppressed or downplayed; even if it is the result of real science and evidence-based research; even if it is the truth.  Professional procedure, protocol and ethics are off the table.  It is an underhanded free-for-all. Bare knuckle boxing. Trash your opponents work and label it junk-science. Undermine the integrity of your opponents.  Use ad hominem attacks to question the opponents motives. Claim the scientists are hacks on the take.  Start rumors about them.Loudly claim you are the one who is evidence based. Proclaim professionalism and authority.  Quibble. Move the goalpost.   Nit-pick and split hairs.  Proclaim over and over and over again you are the one who is evidence based.

And the problem is it usually works.  It is an unfair playing field.  When no meaningful barriers are in place to detect cheating and identify cheaters they usually win.

Bending science can have serious and sometimes horrific consequences and multiple examples including the Tobacco and pharmaceutical industry are given in the book.

Calling for immediate action  to reduce the role that bent science plays in regulatory and judicial decision making, the authors emphasize the assistance of the scientific community is necessary in designing and implementing reform.

“Shedding even a little light on how advocates bend policy -relevant science could go a long way toward remedying these problems.  Indeed, precisely because the advocates have overtaken the law in this area, heightened attention to the social costs of bending science could itself precipitate significant change.”

But there are difficulties in challenging bent science including a general lack of recognition of the problem. With an absence of counter-studies to oppose deliberately manufactured ends-oriented research this would be expected.

Bent science involves the deliberate manufacturing of a pool of  information designed to promote a specific agenda.  A level playing field would require a pool of opposing research specifically addressing that agenda.  In reality this requires both the incentive and the power to do so–an unlikely scenario short of an equally well funded competitor or sufficient public concern about the problem.

In fact counter-forces are often nonexistent. Investigatory techniques developed and promoted by the FBI crime lab (such as firearms identification and intoxication testing) is one example described in the book.  These techniques evolved with little meaningful oversight from the larger scientific community and could be badly bent but there is no meaningful pool of information to disprove them.  The authors aptly state that   “defendants in most criminal cases lack resources to mount effective challenges, much less undertake their own counter-research.”

And part of the “art” of bending involves swaying public opinion and the mainstream media is typically aligned with the benders so opposing viewpoints seldom make the headlines.

Additionally, there is no meaningful oversight or avenue to pursue accountability. No systems exist to prevent, catch and publicly expose bent-science or those who bend science.

The influence of special interest groups on the practice of medicine is unknown.  No one has examined the role of bent science in the rules, regulations, policies and decisions made by those who are in charge of the standards of medical practice and professional behavior of doctors but as a regulated profession governed by the  decisions and policies of regulators it is certainly possible.

Regulation of the Medical Profession

Alexis de Toqueville once observed that a key feature of American government was the decentralized character of administration. “Written laws exist in America,” he wrote, “and one sees the daily execution of them; but although everything moves regularly, the mover can nowhere be discovered. The hand which directs the social machine is invisible.”2

Administrative law is the body of law that allows for the creation of public regulatory agencies and contains all of the statutes, judicial decisions and regulations that govern them. Administrative agencies implement their powers in the form of rules, regulations, orders and decisions.   State medical boards are the regulatory agencies responsible for the licensure and discipline of physicians. They grant the right to practice medicine in the form of a medical license and each state has Medical Practice Act that governs and defines the practice of medicine. The medical board is empowered to take action against a doctor for substandard care, unprofessional behavior and other violations as defined by the state Medical Practice Act.

Administrative Code governs the licensure and disciplinary process and the State Administrative Procedure Act governs the legal process (due process, discovery, etc.). Regulatory changes are enacted through procedural, interpretive and legislative rules.

Both medical practice acts and administrative procedure acts are subject to change.  Changes in medical practice acts can redefine what is acceptable practice and what constitutes professional behavior. This can increase the power and control these agencies have over doctors both professionally and socially.

Changes in Administrative practice acts can decrease what rights a doctor has if this power and control is abused.  Changes in the wording of administrative code and administrative practice acts can have profound implications in these rights including due-process, timeliness of being heard, rights to appeal decisions and time-constraints for judicial review.

And when these changes occur they do so silently.  The hand that directs the machine is indeed invisible.  The consequences, however, are not.  These changes not only impact those touched by the hand but can have a systemic impact on the entire profession.

State medical practice acts as well as administrative practice acts and code are susceptible to change and therefore susceptible to the influence of special interest groups benefitting from such change.  Regulation of the medical profession is thus susceptible to bent science.

Bent Science and the Medical Profession

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The impact of bent science on the regulation of the medical profession has not been studied. As a profession governed by regulatory agencies medicine is certainly not immune to the influence of special interest groups who could in turn influence public policy and regulatory decisions, rules and regulations to benefit their own interests.

Making sound decisions about regulation calls for an understanding of the problem it is intended to solve. This demands methodologically sound science and evidence-based facts arrived at through rigorous peer review and professional oversight. The science on which policy decisions are made must be reliable and unbiased. Legitimate policy must be based on recognized and legitimate institutions and experts.

If the information regulatory agencies rely on to discipline doctors and protect the public is unreliable then serious consequences can occur.

It would be beneficial to look for changes in public policy, guidelines, rules and regulations involving the medical profession and examine the reasons behind them. When did the problem present? Who presented it? Was it based on methodologically sound and accurate data?  What organizations do the problem presenters represent?  What organizations or individuals aligned or associated with the presenters might benefit?  What are the consequences?  Who is harmed?

Howard Becker describes the role of “moral entrepreneurs,” who crusade for making and enforcing rules that benefit their own interests by bringing them to the attention of the public and those in positions of power and authority under the guise of righting a society evil.8   

The mechanics and mentality is similar to the science benders and, as discussed below,  they use some of the same techniques.

Moral entrepreneurs take the lead in labeling a particular behavior deviant and spreading this label throughout society.  They associate the behavior of some group with a society evil, affix an easily recognizable label to it and then express the conviction that the evil must be combated.  Labeled as being outside the central core values of consensual society, the deviants in the designated group are perceived as posing a threat to both the values of society and society itself.

Activities can rise to the level of ‘social problems” when harm or danger is attributed to those activities and governmental powers are called upon to put an end to those harms. Bent science requires convincing others of a viewpoint and the likelihood of this occurring increases when the activity that is identified as a problem resonates with underlying societal concerns and anxieties.  The problem is then endorsed by experts who give legitimacy to such claims.3,4 This legitimacy results attracts media attention which further enforces support from both the public and policy makers.5,6  

As a result any bent science directed at regulatory and public policy decision making should be clearly visible.

The sociologist Stanley Cohen used the term ”moral panic” to characterize the amplification of deviance by the media, the public, and agents of social control.7 According to cultural theorist Stuart Hall, the media obtain their information from the primary definers of social reality in authoritative positions and amplify the perceived threat to the existing social order. The authorities then act to eliminate the threat.9 The dominant ideas or ideologies are reproduced by relying on the opinions of the defining authority and then spread through the media.

An internet search of what labels have been affixed to doctors in association with a threat to society there are three.  A google search of “impaired physician” yields 20, 600 results; “disruptive physician” yields 17, 400 results; and “aging physician” yields 27, 800 results. A large number of these articles, opinion pieces and reviews associate impaired, disruptive and aging physicians with patient death and other adverse events, medical error, and malpractice.   The labels affixed to these physicians have been characterized as a major threat to public health and the rhetorical tools used in many of these articles seems aimed at increasing public anxiety.

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A PubMed search yields 154 results for the “impaired physician”; 47 results for the “disruptive physician”; and 19 results for the “aging physician.”  Many of these are opinion pieces written by the same group of physicians and aimed at hospital administrators, regulators and those involved in the legal or business aspects of medicine.

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There is, in fact, no evidence based research that associates the impaired, disruptive or aging physician with any adverse events. The “impaired,” “disruptive” and “aging” physician labels  as evinced by a quick google search seem escalated far beyond the level warranted by the existing evidence.

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The “impaired” and “disruptive” labels have taken on the status of moral panic and the “aging” label, which is being associated with cognitive impairment, seems to be heading in that direction. The number of articles being published and lectures being given on the dangers of cognitively impaired doctors is increasing.  It has not yet reached the level of public awareness the impaired and disruptive have.

To acknowledge that the current level of concern about these labels is exaggerated is not to suggest they do not exist. They do.  But the disparity between the evidence-base, or lack thereof, and the level of concern warrants further investigation.

To be clear,  doctors who are impaired by drug and alcohol abuse need to be removed from practice to protect the public and receive treatment;  doctors who are abusive to others or engage in behavior that threatens patient care need to be held accountable for their actions; and doctors who are cognitively impaired due to dementia need to be removed from practice and evaluated by the proper specialists.  If a diagnosis of dementia is confirmed then they need to be removed from practice.

What is the motivation behind the “impaired,” “disruptive” and “aging” physician labels and the multiple articles linking these labels to patient harm and medical error?  There is no data driven evidence so where does it come from?   Could moral entrepreneurs be behind it?  If so then there should be evidence  of bent science and to examine this we must look for evidence that these labels have been used to influence regulatory decisions, rules, regulations and policy.

And with the recently archived Journal of Medical Regulation this task can be easily accomplished.

The Journal of Medical Regulation as Timeline and Framework for Policy Evaluation

The Federation of State Medical Boards (FSMB) is a national not-for profit organization that gives guidance to state medical boards through public policy development and recommendations on issues pertinent to medical regulation. Shortly after its founding in 1912, the Federation of State Medical Boards began publishing a quarterly journal addressing issues relating to medical licensing and regulation of doctors. First published in 1913 as the Quarterly of the Federation of State Boards of the United States, the publication has undergone several name changes and publication schedules. From1921 to 1999 it was published monthly as the Federation Bulletin. In 1999 it was changed to the quarterly Journal of Medical Licensure and Discipline and in 2010 was revised to the Journal of Medical Regulation The Journal of Medical Regulation is in the process of archiving all issues dating back to 1913.

Presently every paper dating back to 1967 is available online and the archival organization and availability of full articles published sequentially over the past half-century is historically invaluable.   As the official journal of the national organization involved in the medical licensing and regulation of doctors, this archival organization allows for an unskewed and impartial examination in both historical and cultural context. We can identify when particular issues and problems were presented, who presented them and how.

The Journal of Medical Regulation archives provides a structured context to examine these issues in their historical and cultural context.  This facilitates a retrospective analysis.  As a timeline it allows identification of when the issues were presented.  It also allows us to look at the events preceding the problem, who benefited from them, and the consequences. Could these factors be involved in influencing the regulation of medicine and shaping the medical profession? Could bent science have been involved in regulatory and administrative changes that have significantly impacted the rights and well-being of doctors and how the profession of medicine is defined?  Could some of the current problems such as the marked increase in physician suicide, sham-peer review, and physician burnout be the result of bent science?  If bent science is contributing to bad policy and bad decision making then it need to be exposed and addressed.  Bent science is bad medicine and if it exists then we need to urgently shine a light on it.

  1. McGarity TO, Wagner WE. Bending Science: How Special Interests Corrupt Public Health Research. Cambridge, MA: Harvard University Press; 2008.
  2. de Toqueville A. Democracy in America. New York: Penguin Books; 1984.
  3. Blumer H. Social Problems as Collective Behavior. Social Problems. 1971;18:298-306.
  4. Stone DA. Causal Stories and the formation of policy agendas. Political Science Quarterly. 1989;104:280-300.
  5. Best J. Threatened Children, Rhetoric and Concern about Child Victims. Chicago University of Chicago Press; 1990.
  1. Gerbner G, Gross L. The scarey World of TV’s heavy viewer. Psychology Today. 1976;9(89):41-45.
  2. Cohen S. Folk Devils and Moral Panics: The Creation of the Mods and Rockers (New Edition).Oxford, U.K.: Martin Robertson; 1980.
  3. Becker H. Outsiders: Studies in the Sociology of Deviance. New York: Free Press; 1963.
  4. Hall SC, Critcher C, Jefferson T, Clark J, Roberts B. Policing the Crisis: Mugging, the State, and Law and Order. London: Macmillan; 1978.
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Doctors fear controversial program made to help them

 

Link to Article

Many say a controversial program designed to help doctors with mental health issues is out of control, destroying careers and causing some doctors to commit suicide.

Link to Video

Screen Shot 2019-02-17 at 10.27.49 PM.png

Author: Investigative Reporter: PJ Randhawa, Erin Richey

Dr. Gary Hammen admits that he was tired on the job.
In 2017, he had a newborn at home and a packed schedule as an anesthesiology resident, on top of a sleep disorder stemming from an injury he got serving our country as a soldier overseas.

But to him, the questions his supervisors asked crossed a line.

“They asked me, is this a drug problem? Are you sure you’re not using drugs?” he recalled. “I was floored.”

The questions came after months of exhaustion for Hammen.

Hammen says repeated, 24-hour shifts were taking their toll on his mental and physical health. Most weeks, he worked more than ninety hours and slept no more than four hours a night.

More than a year earlier, he met with his supervisors to tell them about his sleep disability, and offer them schedule recommendations from his sleep doctor.

He says supervisors promised, but failed to make any accommodation to his schedule or his sleep disability.

Weeks after his supervisors asked him about drugs, he got a call that made him think they didn’t believe him.

An organization called a Missouri Physician’s Health Program wanted him to fly to an addiction recovery center in another state, to be checked out.

Hammen couldn’t believe what was happening. “I had a bad feeling about it,” he said. “The whole thing just felt wrong.”

But he had no choice; colleagues warned him that if he didn’t follow the PHP’s requirements, he could lose his license and his career.

PHPs, or Physician’s Health Programs, are meant to help doctors with addiction or other psychological problems. But some, including Hammen, claim that doctors are sometimes falsely accused and getting help that they don’t need. They say the result drains their savings, endangers their licenses, and has even led some young doctors to take their own lives.

Nearly every state has a PHP. Some states have more than one. They started in the 1980s, often with closeties to the state’s medical boards or hospital associations. Medical industry professionals told 5 On Your Side’s I-Team that now big money is involved, and the lack of regulation turned a well-meaning measure into something that doctors fear even when they need help.

Dr. Wes Boyd of Harvard University is one of the skeptics. He used to work for a state PHP. Now he and others have raised concerns about these programs in the American Medical Association’s Journal of Ethics and in other respected publications.

“The physician is basically at the mercy of the PHP,” said Boyd. “There is no one outside the program looking at them, monitoring their practices and making sure that they’re really acting in a benevolent way.”

Boyd told us that when a PHP gets a tip about a supposed problem doctor, there is usually no way for the physician to appeal or dispute it. Instead, he or she must go to a “preferred” treatment center for evaluation. That center has complete authority to decide which doctors need treatment and how much.

Hammen made the flight to a treatment center, where evaluators made an unusual diagnosis. They said he had “provisional alcohol disorder,” something Hammen never heard of before.

“They hadn’t even talked to my wife to see if I drink. Most people wouldn’t make that sort of diagnosis without talking to some sort of outside person beside the patient,” said Hammen.

That diagnosis, Hammen thought, came from the fact that he told evaluators he and his wife shared a bottle of wine over the course of several dinners that week. It’s the only thing listed in the part of his evaluation describing his alcohol use.

Many of the treatment centers that PHPs refer doctors to are for-profit and specialize in addiction, even though doctors enter PHP monitoring because of stress and depression as well.

The I Team found many of the “preferred” treatment centers also donate money to the PHP trade organization: the Federation of State Physician Health Programs (FSPHP). Newsletters on the FSPHP website show several treatment centers are donors and exhibitors at FSPHP events.

Boyd told the I-Team that the bottom line motivates the centers to push doctors into treatment regardless of whether it’s really needed.

“Even in cases where there was no substance dependence, these centers come back and say, ‘You need to stay for 30 or 90 days of treatment,’” he said. “It is very hard not to think that financial motivations were behind the misdiagnoses.”

That can mean weeks of being unable to work, attending a treatment center that might not even offer services that doctors really need, with no way to get a second opinion or to choose their own care.

Even doctors who need help find the system difficult to navigate, with a high price to them and their community. Karen Miday once hoped that her son would get to help the community as a Cancer Specialist, but now he’ll never get that chance.

The words he left behind in a suicide note are so painful that she never took it out of the police department’s evidence envelope. But she read them to KSDK’s PJ Randhawa to show what he was feeling at the end of his life.

“That ‘I love you’ line stays with me,” she said.

“This is just the end of the line for my particular train,” Dr. Greg Miday wrote. “Earth wasn’t a great place for me.”

Dr. Greg Miday was 29 years old when he finished his residency in St. Louis in 2012. Friends and colleagues described him as bright, talented, and gentle. Under the surface, he also battled a drinking problem.

Miday’s last phone call was to the Missouri PHP. Karen Miday believes they had a chance to help him.

“I think all they needed to do was say, get yourself to a place of safety, you know, we’re behind you. That was all they needed to do,” she said.

Dr. Miday had been to one of the program’s approved out-of-state treatment centers before, where he followed the PHP’s requirements exactly. Then, just as he was about to start a new fellowship, he had a relapse.

Karen told the I-Team that he knew he needed help, but he also didn’t want to lose his new job. He suggested to the PHP that he could go to the outpatient program at a recovery center in St. Louis. This would let him keep his job and get treatment.

When Dr. Miday called the Missouri PHP, they said he must go to one of their “preferred” centers outside of the state. If he didn’t, the organization said, they would report Dr. Miday to the medical board.

“I think he thought there was no way out,” Karen said. “They have dual agency. It’s like being a policeman and a therapist at the same time.”

The list of approved facilities for Missouri physicians to get treatment includes just one in the state of Missouri. The nearest out-of-state option is in Lawrence, Kan.

“There’s no legitimate reason why they should have that handful of centers around the country that they prefer to use,” said Boyd.

“You start thinking after a while if there’s some diagnosing for dollars going on because now it’s not just substance use disorders, but now the “disruptive physician” and they’re talking about aging physicians,” said Miday.

Many doctors told the I-Team that the same lack of options that Dr. Miday felt is the reason that they fear contacting their local PHP when they really need help. That could put you at risk.

“If they’re afraid to ask for help, the chance that you’re going to get a doctor who shouldn’t be taking care of patients that day, goes up.  And you won’t even be able to know what the chances that that’ll happen. Because nobody will say anything,” said Hammen.

The I-Team reached out to the Missouri Physician’s Health Program with questions, and even went to the home of program director Bob Bondurant, RN, to ask them. He declined to talk about the doctors’ concerns, as did the Missouri Medical Association, and the Missouri Board of Healing Arts.

The National Federation of State PHPs declined to answer any of our specific questions about how their programs work. Instead, they issued this statement:

“Physician Health Programs (PHPs) across the United States and Canada provide physicians and other health care professionals a resource to ensure they are healthy, can practice their craft and at the same time ensure public safety. Today’s physicians often suffer from stress and burnout. A smaller number develop substance use disorders and depression. We are a ready resource to physicians with such untreated conditions who would otherwise be at risk to the public an/or face loss of licensure by their state medical board. PHPs lessen the significant barriers that stand in the way of physicians asking for help. 

Treatment is necessarily different for those in safety-sensitive professions, such as pilots and physicians; PHPs help physicians access care specifically designed to their needs. Our goal is to restore physicians’ lives and safely return them to patient care. Research as shown that the PHP care model has unmatched long-term consequences for substance use disorders. Additional research demonstrates successful graduates of PHP’s have a lower risk of malpractice.”

“There’s no legitimate reason why they should have that handful of centers around the country that they prefer to use,” said Boyd.

“You start thinking after a while if there’s some diagnosing for dollars going on because now it’s not just substance use disorders, but now the “disruptive physician” and they’re talking about aging physicians,” said Miday.

Many doctors told the I-Team that the same lack of options that Dr. Miday felt is the reason that they fear contacting their local PHP when they really need help. That could put you at risk.

“If they’re afraid to ask for help, the chance that you’re going to get a doctor who shouldn’t be taking care of patients that day, goes up.  And you won’t even be able to know what the chances that that’ll happen. Because nobody will say anything,” said Hammen.

The I-Team reached out to the Missouri Physician’s Health Program with questions, and even went to the home of program director Bob Bondurant, RN, to ask them. He declined to talk about the doctors’ concerns, as did the Missouri Medical Association, and the Missouri Board of Healing Arts.

The National Federation of State PHPs declined to answer any of our specific questions about how their programs work. Instead, they issued this statement:

“Physician Health Programs (PHPs) across the United States and Canada provide physicians and other health care professionals a resource to ensure they are healthy, can practice their craft and at the same time ensure public safety. Today’s physicians often suffer from stress and burnout. A smaller number develop substance use disorders and depression. We are a ready resource to physicians with such untreated conditions who would otherwise be at risk to the public an/or face loss of licensure by their state medical board. PHPs lessen the significant barriers that stand in the way of physicians asking for help. 

Treatment is necessarily different for those in safety-sensitive professions, such as pilots and physicians; PHPs help physicians access care specifically designed to their needs. Our goal is to restore physicians’ lives and safely return them to patient care. Research as shown that the PHP care model has unmatched long-term consequences for substance use disorders. Additional research demonstrates successful graduates of PHP’s have a lower risk of malpractice.”

 

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