Defending MA BORM Deb Stoller’s Five-Year Concealment of Fraud–Nothing Left but Logical Fallacy and Lies

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“To be sure, and to put this matter to rest for the Court once and for all, the Board has retrieved from off site storage those materials before the Board in December 2011. The documents that Dr. Langan claims were “suppressed” are in fact there—and this should not be surprising given the Board’s many orders since that time, all of which have disclaimed any reliance on the July 2011 PEth test.”

“Documents are typically entered into the electronic repository after being used or after a proceeding not before”

—Assistant Attorney General Bryan Bertram who is defending the Board of Registration in Medicine (“Board”) before Justice Hines in my case before the Massachusetts Supreme Judicial Court.

Related:  MA Board Attorney Deb Stoller’s Fraud Upon the Court

Screen Shot 2016-08-06 at 3.58.19 PMThe excerpt above is taken from the 2006 Massachusetts Board of Registration in Medicine  Annual Report and describes the Board’s  Document Imaging Unit.   The Document Imaging Unit scans agency documents into an electronic database and according to the Boards 2009 Annual Report has “allowed the agency to standardize and automate its processes for storing and retrieving documents.”   The  quotes above it are from Assistant AGO Bryan Bertram in response to recently acquired documents proving that Board attorney Deb Stoller was provided irrefutable, undeniable and  unequivocal evidence of forensic-fraud between the Massachusetts PHP (Physician Health Inc.) and a drug testing lab but concealed it and has been concealing it for over five-years.

The appeal to an imaginary storage unit and cart-before-the horse logic are just two of many absurdly illogical and nonsensical statements that he has used to defend the indefensible.

On June 8, 2016  I requested a handful of documents from the Board of Registration in Medicine under a new Records Reform Act that had up until now been refused.   146 pages of docs were received within 24 hours and can be seen here:   Langan PDF copy

Only one of the five documents had a legible date-stamp on it.   The rest were blurred and indecipherable. Requests for clarification have been stifled with the last response from the Board on  June 17th claiming they were “working on it. ”  Multiple subsequent inquiries have been ignored.  Verifying these dates should be simple and take a matter of minutes.  Why all the fuss?

The only document with a legible date stamp was a December 15, 2011 letter  from my attorney  requesting  an attached “litigation packet ” be considered at a December 21, 2011 Board proceeding.  (I had requested the “litigation packet” as one of the documents but had never seen the letter).    Needless to say it wasn’t.

 

 

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Both the letter and the 47-page “litigation packet” are date-stamped   January 17, 2012.

The letter is addressed to physician health and compliance unit (PHCU) Board counsel Deb Stoller and cc’d to her underling Tracy Ottina.  The documents show clearly that the two were in possession of these documents  prior to a December 21st Board hearing.  They are date-stamped 27 days after the hearing and to support his claim that    “documents are typically scanned into the electronic repository after being used or after a proceeding, not before” Bertram uses the transcript of the same proceedings as an example as the December 21  document is date stamped  December 29 (8 days after the proceeding).  Apples and oranges.  Scanning a a transcript of a proceeding into the Board’s Digital Imaging Unit the following week is  understandable  but scanning a document that was submitted as evidence to be heard at that same proceeding  27-days after it took place and 18-days after the record of the proceeding was scanned is not.  It is very fishy for a number of reasons and defies common sense.

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But  Bertram claims the date-stamp is meaningless and wants to put the matter to rest once and for all.   In his  response opposing  a Motion to Produce Documents  (he does not want to produce them) he provides 3 footnotes (presumably to give an impression of legitimacy)  providing confirmation that the documents had been  carefully considered  at the December 21, 2011 proceedings by reviewing not only its minutes and records but procuring the original documents that were being stored off-site.

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Bertram also claims PHS has not committed any crimes because they have not been charged with any crimes.  This is called denying the antecedent or inverse error.  It is a logical fallacy where the consequent is an indicative conditional  claimed to be false because the antecedent is false. ( A, then B; not A, therefore not B).    

If it is raining, then the grass is wet.
It is not raining.
Therefore, the grass is not wet.

The argument is invalid because there are other reasons for which the grass could be wet such as spaying it with a hose.   There are multiple reasons for which someone who committed a crime has not been charged with a crime.

There is always a time-frame between the two and many who commit crimes never get caught.    Luck, stealth, cleverness, and multiple other variables might be involved.  Jimmy Savile molested and raped scores of children for decades and he was never caught.  As a major fundraiser for hospitals this fiend had free rein to prey on sick and helpless  little kids in hospital beds .

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They have not been charged with any crimes because the very agencies capable of charging them with crimes are ignoring or otherwise overlooking them for various reasons.  If I see someone being stabbed in the back  I can reasonably conclude they committed a crime. Savile got away with what he did because of a culture of deference. Because he was powerful others made allowances for him.  Monsters thrive in a culture of deference.

 

A Culture of Deference

According to Policy 94-002 (which has disappeared from the Board’s website) Board counsel for the Physician Health and Compliance Unit (PHCU) was created outside the Enforcement Division of the Massachusetts Board of Registration in Medicine (Board).  PHCU advises the board on issues related to drug and alcohol abuse and mental or physical impairment that may affect a doctor’s ability to practice and unit staff prepare and present cases to the board’s complaint and licensing committees to make sure identified impaired physicians comply with the terms of any rehabilitation agreements. According to Policy 94-002 the responsibilities of PHCU Board counsel include “serving as a hearing officer in some cases and resource in all cases involving physician health and compliance issues.”

The Board appoints a “hearing officer” to conduct an adjudicatory proceeding according to the procedures set forth in the Massachusetts Administrative Procedures Act. Mass. Gen. L. ch. 30A. It is the hearing officers responsibility to make all decisions regarding the admission or exclusion of evidence. Administrative procedure requires that hearing officers consider the probative value of the evidence and file it in the Administrative Record.

Massachusetts Board of Registration in Medicine PHCU Board counsel is run by attorney Deb Stoller with attorneys Robert Harvey and Tracy Ottina.  They have been given the power to act as “hearing-officers” on cases and present cases to the Board and  recommend disciplinary action.

Medical Boards provide deference to their physician health experts and their in-house compliance counsel who have been given the power of  judge, jury and executioners.

They give little thought or time to what is presented as predetermined fact. That the Board is not under any active supervision from the executive branch has been confirmed in writing to the Massachusetts Legislature by Governor Charles Baker in a letter accompanying his Bill (H.4188) which aimed to finally establish a framework for active supervision and oversight over the Board.

As independent units within the board who act as hearing officers and present cases the PHCU may be working with PHS in the same manner as the drug-testing labs engaging in laboratory fraud and the “PHP-approved” assessment and treatment centers that are “tailoring” diagnoses. It appears that Stoller and the PHCU is not representing the best interests of the Commonwealth  but those of the state physician health programs and under current management state PHPs represent the best interests of the billion dollar drug and alcohol assessment, testing and treatment industry.  The PHCU’s are clearly part of the racket.  It is a rigged game with a stacked deck existing within a culture of deference.

Obtaining the evidence is one barrier that has prevented exposure of this corruption. Another is the unwillingness of agencies available to hold them accountable. PHS has no oversight or accountability and the labs and assessment and treatment centers have minimal oversight. As these are non-FDA approved lab tests the FDA provides no oversight.   They  have  pushed public policy recommending  regulatory agencies provide deference to their authority and expertise.

This creates an organizational systems failure as the Board is deferring to the state physician health program and the states attorney Generals are deferring to the Board.   Each  complacent  in the integrity and good-faith of the agency before it.   This creates a complete organizational systems failure.

Governor Baker’s recent move to control professional boards seemed a promising step and I provided detailed documentation to the Director of Constituent Services at the Office of the Commissioner for Public Health,  Helen Rush-Lloyd ( Helen.Rush-Lloyd@state.ma.us   617-624-5223 ) who informed me on June 7 she would provide the name of the appropriate contact person to respond.  The email can be seen here: Physician Health and Compliance Unit.   Last I heard it was turfed to attorneys at the Board by whoever the appropriate contact person was and I have not been able to get a name.  As this too appears to be a dead-end it is important to find out who is responsible.  This is a system in which they often place their own people into positions where they can block, punt, deflect, dismiss and otherwise derail valid complaints.  For example they have a “point-person”on the Massachusetts Medical Society ethics committee who blocks valid complaints from ever reaching review.  They are turfed at the door and I would not be surprised if they placed one of their own or one of their apologists into this venue as well and this requires the provision of a name to see who is responsible and who should be held accountable.

The totality of evidence provides clear and convincing proof that PHCU Board counsel Deb Stoller has been suppressing evidence for years. The filed Administrative Record was missing every item I submitted including a critical document he claims was lost due to my “hand-delivery” of it.   I still cannot wrap my head around the connection between hand-delivery and losing it. I believe he’s so entrenched in his pervasive denial of facts and outside opinion and so used to shifting the burden and blaming me he couldn’t think of anything else.

One thing is for certain. The Board does not want to produce the records to Justice Hines. I realized this after I filed the “Motion to Expand the Record” as Bertram made it clear on multiple occasions the Board would not object to anything I filed with the Court to add to it.   Had I not known about the 10-day time limit to file the a motion to expand the record the Court would be limited the documents provided and none of mine were included. This is another administrative law trick frequently used to control the information that is seen.  If the December 2011 documents were considered then I would like to hear the logic.  The documents in question show black letter law crimes. They show specific crimes.   Any schoolchild could detect them.   The documents show flagrant forensic fraud  between Dr. Luis Sanchez and the VP of Lab Operations at USDTL Joseph Jones and this is  representative of the top-down corruption and unethical tone at the top that pervades this system.

None of the forensic fraud or perjury or concealment has ever been addressed by the Board and missing  evidence and unaddressed key arguments provide clear and convincing proof that Stoller has been concealing evidence for years.

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  Dr. Luis T. Sanchez, M.D. served as the Director of the Massachusetts physician health program, Physician Health Services (PHS) from 1998 until 2013.   He is past President (2005-2009) of their national organization, the Federation of State Physician Health Programs (FSPHP).

In  Disruptive Behaviors Among Physicians   stresses the importance of  of “clear expectations and standards”  and  values and codes-of-conduct in the practice of medicine and calls on physician leaders  “commit to professional behavior.”

One measure of integrity is truthfulness to words and deeds.  These people claim professionalism, ethics and integrity.  Colluding with a laboratory to intentionally misrepresent laboratory data is laboratory fraud and covered under Title 18 of the United States Criminal Code (Wire fraud 18 USC 1343, False Statements 18 USC 1001, Conspiracy 18-USC 371, False Claims 18-USC 287 and Obstruction of Justice 18-USC 1505). I believe all of these are applicable here. In addition Dr. Sanchez violated M.G.L 156 (B) Section 69 by making false statements to a state agency.  Later documents show clear evidence of his perjury and concealment.   August 6, 2014 to Langan with health materials.

The fact that medical boards and public health departments are aware of criminal acts being committed  by this “authority” and others like him yet do nothing to address its existence will inevitably lead to worse.  A culture of deference allows this type of behavior to fester and thrive for years and even decades.  If dictatorships can be defined as systems in which there is a prevalence of thinking in destructive rather than ameliorative terms then the the physician health movement fits.

Many of the  “PHP-approved attorneys” who ostensibly represent doctors who are under PHP monitoring but only do so within the boundaries of the PHPs wishes are former board attorneys and assistant AGOs.  My suspicion is that the PHPs have preferred attorneys they use within the AGOs administrative legal division and the agency at large is unaware of what happens within this system.

Lord Acton warned that we should not make moral allowances for powerful people just because they are powerful. If a common man murdered someone, Acton explained, he should hang. But when a king or queen murders, we make allowances for it. “I would hang them higher than Haman, for reasons of quite obvious justice, still more, still higher, for the sake of historical science” Acton wrote.  The same dynamic applies here.

One thing is for certain.  There should be zero-tolerance for forensic fraud perpetrated by those in positions of power.   This is  worse than Annie Dookhan as her victims were abstractions.  She did not see the damage that resulted from her laboratory misconduct.

And as far as I can find, these documents are the most elaborate and complete representation of the mechanics of forensic fraud available and show the sequential steps between the requesting party and complicit lab.   The documents also show how easy laboratory misconduct is accomplished as well as the moral detachment of the involved parties.

Bertram knows these are crimes.

 I have also informed him that since 2011 there have been multiple suicides related to allegedly falsified alcohol tests at the same lab seen here and the ongoing concealment  of laboratory fraud is equally abhorrent as those who engage in it. I am unclear of his motive in defending a cover-up of forensic fraud in the wake of other lab scandals but  one other thing is for certain.  When  this racket is exposed the record will show who knew about it and when.  

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The 146 pages provided within 24 hours is the package containing the December 11, 2011 docs and all the others with smudged dates.  I already have the documents but I need the dates.

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Bertram 11:16:15 e-mail requesting he address the issues

Bertram e-mail 11:16:15 requesting he address key arguments.

Bertram e-mail 12:7:15

 

 

 

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Fraud Upon the Court

“Fraud Upon the court” occurs when the judicial machinery itself has been tainted, such as when an attorney, who is an officer of the court, is involved in the perpetration of a fraud or makes material misrepresentations to the court. Fraud upon the court makes void the orders and judgments of that court.

Bulloch v. United States, 763 F.2d 1115, 1121 (10th Cir. 1985 states: “Fraud upon the court is fraud which is directed to the judicial machinery itself and is not fraud between the parties or fraudulent documents, false statements or perjury. … It is where the court or a member is corrupted or influenced or influence is attempted or where the judge has not performed his judicial function — thus where the impartial functions of the court have been directly corrupted.”

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

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

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

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

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

Mass.R.Prof.C Advocate Rule 3.3 Candor Toward The Tribunal reads:
(a)A lawyer shall not knowingly:
(1) make a false statement of fact or law to a tribunal or fail to correct a false statement of material fact or law previously made to the tribunal by the lawyer; (3) offer evidence that the lawyer knows to be false. If a lawyer, the lawyer’s client, or a witness called by the lawyer, has offered material evidence and the lawyer comes to know of its falsity, the lawyer shall take reasonable remedial measures, including, if necessary, disclosure to the tribunal. A lawyer may refuse to offer evidence, other than the testimony of a defendant in a criminal matter, that the lawyer reasonably believes is false; (b) A lawyer who represents a client in an adjudicative proceeding and who knows that a person intends to engage, is engaging or has engaged in criminal or fraudulent conduct related to the proceeding shall take reasonable remedial measures, including, if necessary, disclosure to the tribunal,; (c) The duties stated in paragraphs (a) and (b) continue to the conclusion of the proceeding, and apply even if compliance requires disclosure of information otherwise protected by Rule 1.6.

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

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

 

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

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

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

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

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

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

The Federation of State Medical Board Policy specifically requires strict “chain of custody.” She violated the Board’s very own standards and then blocked me from returning to practice by putting barriers in place, refusing to allow independent evaluations and protracting the time –drawing this out in order to cause as much damage as possible to my family and me.

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

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

 

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

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

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

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

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

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The Regulatory Capture of American Medicine by the Drug and Alcohol Testing, Assessment and Treatment Industry

But in this Court, what Diff’rence does appear!
For every one’s both Judge and Jury here;
Nay, and what’s worse, an Executioner.

William Congreve, The Double-dealer

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Regulatory capture is a form of government failure that occurs when a regulatory agency created to act in the public interest, instead advances the commercial or political concerns of special interest groups that dominate the industry or sector it is charged with regulating and introduced in an article by George J. Stigler in 1971 entitled The Theory of Economic Regulation. The main idea of the article can be summarized in Stigler’s (1971: 3) affirmation that:

“…as a rule, regulation is acquired by the industry and is designed and operated primarily for its benefits.”

The basic hypothesis of Stigler is that an industry may use—or rather abuse—the coercive public power of the State to establish and enforce rules in order to obtain private gain.

Historians will at some point recognize 1995 as the “regulatory capture” inception point of American medicine when the  Federation of State Physician Health Programs ( FSPHP ) forged a relationship with the Federation of State Medical Boards (FSMB), the national organization responsible for the licensing and discipline of doctors and memorialized in a 1995 Journal of Medical Licensure and Discipline(Vol82N3)with articles claiming high success rates in eight state PHPs.

An accompanying Editorial written by past President of the FSMB Barbara S. Schneidman, MD, MPH concluded that:

“cooperation and communication between the medical boards and the physician health programs must occur in an effort to protect the public while assisting impaired physicians in their recovery.”

Roger A. Goetz of the the Florida Impaired Practitioners Program, for example reported that 84% of all referrals to the PRN “Occur prior to any violation of the Medical Practice Act or any evidence of patient harm.” Journal of Medical Licensure and Discipline(Vol82N3)  As protecting the public from patient harm is the primary directive of medical boards those statistics seem pretty impressive!   That the PRN prevented inevitable spirals of drug addled and besotted doctors from mayhem is questionable as how many were just like Leonard Masters?  After being accused of overprescribing Goetz told Masters he could either relinquish his license or have an evaluation. Masters chose the evaluation thinking he would be returning in 4-days but was diagnosed as an alcoholic and spent 4-months.  He didn’t even have a drinking problem.  He successfully sued G. Douglas Talbott and the facility for false imprisonment, malpractice and fraud.

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Goetz was also instrumental in promoting the chronic-relapsing brain disease model as a pathway to return revoked medical licenses.  No matter how abhorrent their  behavior,  by misplacing blame on the “disease” doctors who should have hung up their smocks forever quickly returned to practice as they didn’t do it the drugs or alcohol did.    In this manner serial sex-offenders, pedophiles,  date-rapists using roofies and fiends who replaced dying cancer patients narcotics with saline and let them die in agony were quickly returned to the fold.    The error in this thinking is that for the most part drugs and alcohol may induce good people to do disinhibited things or stupid things but they do not make good people do bad bad things. Empathy and moral compass are innate and the majority of doctors would not roofie drinks or take away dying patients pain meds under any influence. Unfortunately no test exists for psychopathy.

Many found employment as medical directors of these specialized programs and others became active in their states PHPs.

Since that time the FSPHP has duped the FSMB easier easier than a carney dupes a rube.

They asked the FSMB to approve public-policy to request state medical boards provide absolute deference to their state PHPs as their experts in all things related to physician health and to agree to never ever question their decision making skills regarding monitored doctors lest it “undermine a culture of professionalism” and this was agreed to.

Deference is acceptable but agreeing to blind deference and accepting the delusion of infallibility is unwise.  A culture of deference is unacceptable.  Lord Acton noted in a letter to a friend that the main point he was trying to get across when he wrote “Power tends to corrupt, and absolute power corrupts absolutely”was not that power corrupts powerful people but that power corrupts other people.  This dynamic certainly holds here. They make allowances.

Since that time they have expanded from ‘impaired physicians” to “disruptive physicians” to the “aging physician.”  They have gained power and autonomy without regulation or oversight and by removing transparency and absolutely zero accountability they have essentially run amuck.

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In 1995 this was a simple but growing shakedown scheme using a medical license to extract money under the threat of its loss. The PHP refers doctor X to “PHP-approved facility” for an evaluation and the “PHP-approved” facility tells doctor X you will stay here until I say so or I tell the PHP you ain’t gettin your license back.  Doctor X  stays because he knows the PHP can do it as the PHP is not going to be questioned by the medical board.They refer to it as “contingency-management” but it essentially meets the criminal definition of extortion.

Business has boomed since 1995 as they introduced non-FDA approved drug and alcohol tests into the market even though they are unvalidated with very low specificity. Junk-gadgets such as the SCRAM alcohol monitoring bracelet and the Soberlink cellular photo breathalyzer have been promoted as accurate and valid.  None of this has any oversight but their linkages with the drug and alcohol testing, assessment and treatment industry has become an enormous gold mine.  Both the drug-testing and assessment and treatment industry are multi-billion dollar enterprises.

The FSMB even made it public policy for medical boards to provide deference to PHPs and consider them experts in all things  physician health.   In this manner they have introduced a panoply of junk science, brought legions of polygraph examiners out of their basements and rebranded the 360 degree personal development employee assistance tool as a bona fide diagnostic instrument used for disruptive physician evaluations.  The FSMB has also accepted concocted and imaginary concepts such as “potentially impairing illness” and “relapse without use” as not only nonfictional but medically scientific truth.   If they proposed tiddlywinks for assessment of the “aging” physician the FSMB would probably buy it.  Is potentially potentially impairing illness next.?   There has been no apparent inquiry or opposition to this.

Accountability requires both the provision of information and justification for actions and they have minimized both.  Prohibiting doctors from obtaining their own assessments, medical records and drug-testing records markedly reduces risk of exposure as does prohibiting release of those records to third parties.   Cash only prevents inquiry from insurers. The PHPs have no oversight or regulation.  The drugscreen-shot-2016-02-09-at-3-39-27-am and alcohol testing labs have no FDA oversight as the tests are non-FDA approved. Other than accreditation agencies such as the College of American Pathologists there is no agency to investigates error or misconduct. CAP cannot sanction.  The assessment and treatment centers have little oversight or regulation.   In sum this system refuses to provide information and even if they did provide information they do not have to justify it to anyone and no agency exists to punish them even if they could not justify it.  Zero accountability.

And with zero accountability corruption not only thrives but is inevitable.   The simple extortion scheme from 1995 has now grown to around two dozen “PHP-approved” assessment and treatment centers and state boards require that only “PHP-approved” facilities be used and specifically excludes non “PHP-approved” facilities.   The preferred facilities engage in “diagnosis rigging” and false diagnoses to warrant unneeded treatment.  The labs such as USDTL and Quest engage in laboratory misconduct and will create a falsely positive test at client request.    It is a closed system where everything is kept within the PHP circle.

And complete regulatory capture has been achieved through autonomous units within Boards that essentially serve as PHP protection units and hired guns.  They protect the PHP and their friends and also act as an assassin squad to do whatever the PHP wants them to do to suspend, revoke and interfere with the medical licenses of doctors any which way they want.

In Massachusetts Policy 94-002 created Physician Health and Compliance Unit (PHCU) Board counsel as an independent unit outside the enforcement division of the Massachusetts Board of Registration in Medicine by design.

These units were created at the request of state physician health programs ostensibly to monitor the compliance of doctors under monitoring their monitoring contracts.   The MA PHCU Board counsel is run by attorney Deb Stoller and also includes attorneys Robert Harvey and Tracy Ottina.

Screen Shot 2016-08-06 at 2.22.27 PMPHCU Board counsel were additionally afforded the  power to act as both “hearing-officers” on cases and present these same cases to the Board and recommend disciplinary action. This was by design also.  They were set up to hold all the cards and it is a stacked deck.

This additional circle around the closed-loop system provides an additional layer of protection to prevent the fraud and abuse from being discovered.  That the  Massachusetts Board is not under any active supervision from the executive branch has been confirmed in writing to the Massachusetts Legislature by Governor Charles Baker in a letter accompanying his Bill (H.4188) which aimed to finally establish a framework for active supervision and oversight over the Board.

These units enforce PHP policy and requirements including the restriction of assessments to the out of state (“PHP-approved”) assessment and treatment centers and forbid any outside assessments.    Any doctor in Massachusetts will be forced to go to Georgia, Alabama, Arkansas, Kansas  or some other remote venue for an evaluation under the guise of special knowledge.   Any doctor reported to the PHCU as “non-compliant” is summarily suspended. Truth and evidence are irrelevant. The opinions of all outside experts no matter how qualified or how many are not only dismissed they are patently ignored  with eyes wide shut.   They simply do not register anything outside the racket.  They abuse administrative law procedure to dismiss, deflect and delay.   Having the power to act as both a  hearing-officer to accept or exclude evidence and present cases to the Board and make disciplinary recommendations provides them with absolute power to render judgment.   It means they are in charge of every decision made, and they have the power to be rid of whomever they choose as judge, jury and executioner.  The Board’s simply defer to PHCU Board counsel and give little thought or time to what was presented and ratify whatever is asked. They are uninformed and disengaged.

The system is almost foolproof.   It is a culture of impunity and deference.  To make matters worse states Attorney Generals defer to the medical-board and their physician health experts.  The AGO represents the state agency and its expert in legal challenges and crimes reported by doctors are dismissed at the outset.  The agency responsible for investigating rackets and laboratory and healthcare fraud as well as civil rights violations and color of law abuse is the states AGO. No one is minding the minders.

The assistant AGOs representing boards appear to use the same tactics as the PHCU Board counsel and a similar moral disengagement mentality but it is unclear what the interface is with the PHP/medical board and states AGOs.  If anyone has any insight please advise as I have not figured it out.  Perhaps they agreed to deference to the medical board/PHP just as the medical board agreed to deference to the PHP.  Perhaps they have specific administrative attorneys who they use or even a cadre within but it is implausible that the entire AGO would be supporting the rehab racket.

But in the final analysis this has resulted in is a complete systems failure where corruption and abuse is occurring as a product of bad apples in plain view and within the walls of regulatory medicine with each agency deferring to the integrity and honesty of its predecessor. This is not good governance.

Historians will someday look back at the fall of American medicine and wonder how it was allowed to happen and link systemic as well as specific problems pervasively plaguing the profession with regulatory capture by the drug and alcohol testing, assessment and treatment industry.

 

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Forensic Fraud Beyond Annie Dookhan–It’s Time to Wake up to the Reality of Systemic Corruption Between State Physician Health Programs (PHPs) and Drug-Testing Labs.

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The attached documents show the Massachusetts physician health program ( PHP), Physician Health Services, inc. (PHS) and a commercial drug testing lab United States Drug Testing Labs, inc. (USDTL) engaging in red-handed flagrant forensic fraud.

This is not lone-nut  Annie Dookhan drug-testing falsification  but misconduct indicative of top-down systemic corruption done via fax and thus appears to be standard operating procedure.

Screen Shot 2015-05-04 at 8.19.51 AMThe documents herein are part of a “litigation packet” (the documented chain-of-custody required for all forensic testing) for an alcohol biomarker test (PEth) drawn July 1, 2011 and reported as a positive on July 19, 2011 to the Massachusetts Board of Registration in Medicine (” Board”).  The “litigation packet”  is considered a legal document and it is generated in real time to document where, and under what conditions a given specimen is at a given time.

The documents here include  a faxed memo from PHS to USDTL 7/19/2011 requesting an identifying ID#  and a “chain of custody” be added to an already positive test.  Seldom is a document available that shows how the perpetrators of laboratory fraud do it–this is complete from start to finish.

A chain of custody is generated in real time. It cannot be done retroactively.

To do so constitutes fraud.

With no compunction, concern, or consternation this sociopathic mercenary subordinates science in order to put coins in his purse and complies with this improper request and adds a unique ID number to an already positive specimen.

Moreover, when the test was questioned the, PHP requested that USDTL support the test as a valid positive. And Joseph Jones did so with full knowledge there was no chain-of-custody and the ID # and date of collection were added.  The alliance is consistent with a civil conspiracy and the crimes are felonious.

The act is also flagrantly antithetical to the process of Medical Review Officer (MRO) review —one of the basic tenets required of all forensic drug tests and requisite to report one as positive.

But like an arsonist firefighter,  Jones does the exact opposite of what he is supposed to.   With complete disregard of the basic codes of conduct and MRO guidelines he reports as positive a test that would not meet the minimum requirements for an at home over-the -counter clinical lab to consumer test let alone let alone one of forensic import.

A test with multiple fatal flaws and no chain of custody, no collection date,and absent any clue of a unique identifier was in fact reported as a positive to please a client.  It is egregious, indefensible, and unconscionable.  It is illegal.  Most importantly it is immoral.

Positive drug and alcohol tests can end lifetime careers, tear apart families, and trigger suicides. And I am hearing of more and more suicides caused by these laboratory tests done by Dr. Jones and corrupt illegitimate authority like Dr. Sanchez.

The consequences are grave and far reaching.  An organizational culture capable of willing participation and continued support of forensic fraud cannot be trusted.

Cognizant that the consequences to the donor are significant and possibly irreversible and catastrophic exhibits a careless disregard for truth that is unconscionable.  That this was done without hesitation or thought is egregious.

It is purposeful and with undeniable malice. It represents institutional and sinister corruption. And it exemplifies the top-down sociopathic, predatory, and uncaring organizational culture that is undermining democracy and eroding civil liberties.

But the most disturbing fact of this is that those who should do something about it blind themselves.

The Board of Registration in Medicine protects Dr. Sanchez. He is apparently allowed to commit any crimes he wants and it is worth reading through all of the documentation as he compounds felonies over time.

The political abuse of psychiatry and false diagnoses are acts that violate the most basic and fundamental medical and social ethical codes. They should be met with zero tolerance by the medical community as well as society at large.

Remarkably the Massachusetts Department of Health and Human Services is also aware of this. Apparently learning nothing from the Annie Dookhan case, certain individuals have hemmed and hawed for over six months without any response in a torpid stasis.  As protectors of the public health one would think there would be some urgency to address the fact that a state contracted agency is engaging in undeniable laboratory misconduct and fraud.

The crimes are many and include state and federal crimes as well as violation of the HIPAA criminal statute as they changed a “forensic” sample to “clinical” in order to bypass chain of custody. They then changed it back to “forensic” and misrepresented it as such up until recently.

This needs to get be addressed outside the medical profession.  As  a society and culture within a society and culture the  prevalence of thinking has become destructive rather than ameliorative under the influence of the “impaired physicians movement.”    The ease with which pernicious ideas and attitudes have pervaded the regulatory and organizational and regulatory culture of medicine is frightening.

The fact that medical boards and public health department are aware of criminal acts being committed  by this “authority” yet do nothing to address its existence will inevitably lead to worse .

If dictatorships can be defined as systems in which there is a prevalence of thinking in destructive rather than ameliorative terms then the “physician wellness” paradigm” shoe fits.    There are multiple warning signs that the profession of medicine is becoming subordinated to the guiding philosophy of the “physician wellness” movement,

One thing is for certain.  There should be zero-tolerance for forensic fraud perpetrated by those in positions of power.   Any intentional laboratory fraud guided by malice is egregious but the scope and severity of what was done here involving collusion to fabricate evidence to coverup the crime, and concealment of the truth when the lab was forced to correct the test by an outside agency is  particularly egregious.    The fact that Dr. Luis Sanchez hid the fact that he was made aware of the corrected test on October 4, 2012 and  reported non-compliance with requirements that directly resulted from that very test for “damage control” under “color of law” is unconscionable.   But the fact that he did these things and lied about it is undeniable.  The facts are self-evident.

This is much worse than Annie Dookhan as her victims were abstractions.  She did not see the damage that resulted from her laboratory misconduct.  These people knew what they were doing, knew it was wrong and did it anyway.   And unlike Annie Dookhan, Sanchez saw the damage he was causing as that was his intent.

As far as I can find, these documents are the most elaborate and complete representation of the mechanics of forensic fraud. They show the sequential steps between the party requesting it and the response of the complicit lab.  The documents illustrate how easy laboratory misconduct is accomplished and the moral detachment of the involved parties.  The fact that it involves top-down corruption cannot be overestimated.

The most obvious crime is the violation of M.G.L 156 (B) section 69 involving reporting false statements.

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The fact that this was test was ordered as a “forensic” specimen then changed to a “clinical” specimen makes it a HIPPA violation as changing it to “clinical” created  “protected health information” (PHI).     In fact, the only reason I was able to obtain the October 4, 2012 document proving Dr. Sanchez lied was due to a change in the HIPPA-Privacy Rule enabling “patients’ to obtain laboratory results without authorization from the agency that ordered it.   Without this allowance Sanchez would still be maintaining he did not find out about the correction until December.   Well the documentary proof shows he lied.

Moreover, PHS is not a treatment provider and cannot order clinical specimens.  It is an ultra viresact outside of their designated scope of authority as a non-profit organization.

What Sanchez did here is also in violation of the HIPAA criminal statute.

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The elements of a criminal offense under HIPAA are fairly straightforward.  To commit a “criminal offense” under HIPAA, a person must knowingly and in violation of the HIPAA rules do one (or more) of the following three things.:  use or cause to be used a unique health identifier, obtain individually identifiable health information relating to an individual or disclose individually identifiable health information to another  person.   Criminal penalties under HIPAA, tiered in accordance with the seriousness of the offense, range from a fine of up to $50,000 and/or imprisonment up to a year for a simple violation to a fine up to $100,000 and/or imprisonment up to five years for an offense committed under a false pretense and a fine up to $250000 and/or imprisonment up to ten years for an offense committed with intent to sell, transfer, or use individually identifiable health information for commercial advantage , personal gain, or malicious harm.

Requesting the sample be changed to “clinical” created PHI and the fact that it was under false pretense and intended to cause malicious harm is quite evident.

Although PHS is not a covered entity Quest Diagnostics is and as a business associate they can be linked by the conspiracy statute:

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And that is why outside forces need to be involved. These are serious crimes and they have created serious consequences.  I have heard of multiple suicides in doctors caused by these tests.  How many doctors have died as a result of Jones colluding with  individuals just like Sanchez?   The results of these tests can have grave, far reaching and even permanent consequences.  They can ruin careers and destroy families.   Sanchez and Jones know this.  Their moral disengagement here shows an absence of empathy and complete disregard of what consequences may result.

The Board of Registration in Medicine is protecting Dr. Sanchez and the DPH has its head in the sand.

It is my understanding that groups like PHS have led law enforcement to believe that all matters involving doctors should be handled by the medical community.  This has created barriers as doctors reporting crimes have found it difficult to get them investigated or even reported let alone charged.

Law enforcement needs to address this. This needs to be exposed.

.I have been told that in other states where similar situations exist in which the truth is unable to penetrate the proper channels it should go directly to the Governor.

I would like to get these documents to Governor Charlie Baker and any help in making this happen would be appreciated.

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

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

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

Sanchez is Past President of the Federation of State Physician Health Programs (FSPHP).  According to their website the FSPHP “serves as an educational resource about physician impairment, provides advocacy for physicians and their health issues at local, state, and national levels, and assists state programs in their quest to protect the public.”  In addition the FSPHP “helps to establish monitoring standards.”  The FSPHP is the umbrella organization of the individual State PHPs.

Sanchez is also the previous Medical Director of the Massachusetts state PHP, Physician Health Services, Inc. (PHS).  According to their website PHS is a “nonprofit corporation that was founded by the Massachusetts Medical Society to address issues of physician health. PHS is designed to help identify, refer to treatment, guide, and monitor the recovery of physicians and medical students with substance use disorders, behavioral health concerns, or mental or physical illness.

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


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

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

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

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

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

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

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

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

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

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

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


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

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Good leadership requires correct moral and ethical behavior of both the individual and the organization. .  Integrity is necessary for establishing relationships of trust.  It requires a true heart and an honest soul.  People of integrity instinctively do the “right thing” in any and all circumstances.  The majority of doctors belong to this group.

Adherence to ethical codes of the profession is a universal obligation.  It excludes all exceptions.  Without ethical integrity, falsity will flourish.

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

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

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

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

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

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

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

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

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

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

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

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

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“REVISED REPORT PER CLIENTS REQUEST”  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

August 6, 2014 to Langan with health materials.

The documents sent by USDTL are notable for two things:

1.  The e-mail from me to Joseph Jones dated December 10, 2012.  It can be seen on page 22 of the USDTL documents.  Screen Shot 2014-11-10 at 11.21.18 AM

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2. USDTL document confirming PHS knew the test was amended 67-days before they said they did.Screen Shot 2014-08-06 at 4.50.02 PM

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

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

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

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

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

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

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

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

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

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

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

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

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USDTL willingly complied with this request.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Physician Health Programs (PHPs) are not above the law; They just think they are

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Physician Health Programs are not Above the Law

Are Physician Health Programs (PHPs) above the law?  

 Unable to get law enforcement to take cognizance of reported abuse, many doctors I have spoken with believe that the actors involved are impervious to criminal liability.  Complaints of fabrication and fraud involving PHPs and their affiliates to the police, the Attorney General and other law enforcement agencies have been given no credence,  tabled or dismissed with little investigation.

Believing these agencies are deliberately ignoring credible complaints and the documentary evidence placed before them, some have concluded that state PHPs have been given the power to commit crimes with impunity and immunity.

PHPs are not above the law.  It is by removing themselves from and blocking the usual routes of accountability and absolute operational control of the testing, assessment and treatment process that has enabled misconduct to remain hidden, unrecognized or excused. The crimes exist but they remain undetected, unnoticed and unpunished.

Removing Accountability

The essence of accountability is answerability which means having the obligation to answer questions regarding decisions and actions.   This requires the transmission of information when it is requested.  The accountable actor provides the information to the overseeing actors in a transparent manner.

Accountability also requires explanation and justification for the information provided. What was done and why? Standards, rules, regulations, codes, laws and other benchmarks are then applied by the overseeing actor to determine if the information provided was appropriate or inappropriate.

The availability and application of sanctions for illegal or inappropriate actions uncovered through answerability is also a necessary component of accountability. This is necessary to impose restraint on authority and power.  Lack of enforcement of sanctions contribute to the creation of a culture of impunity.

The usual mechanisms that exist to impose restraint and create incentives for appropriate behavior and actions are absent. No outside oversight exists to limit their power or subject them to a set of rules.  No regulation exists to curb abuse.

A Culture of Impunity

The authority accorded PHPs and the power they exercise exist in a culture of impunity.

The key findings of the2014  North Carolina PHP Audit are below:.

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No indications of abuse were found,  a point brandished by the PHP as redeeming  and proving no abuse was occurring. In actual fact it is an ominous finding that also relates to their apparent ability to violate the law. 

The audit found no indications of abuse but that abuse could occur and not be detected because of an absence of due process for the complainant, excessive control of the complaint process by the PHP and absence of oversight by either the medical board or medical society.  What this means is that a doctor with no power is making a complaint against an unsupervised agency with enough power to influence the investigation of a complaint against itself.  The reason no indications of abuse were found is because the system is specifically designed to hide abuse.  That is the intent.

Absence of transparency, regulation and oversight coupled with control of information enables both censorship and doctoring of records.   Strict Confidentiality is enforced by HIPAA, peer review protection, and drug and alcohol confidentiality law.  

Quest Diagnostics

PHPs are able to suppress and conceal criminal activity but they are also able to  manufacture information designed to hide misconduct.  

The North Carolina Audit found no objective selection criteria for the out of state assessment and treatment centers because none exist other than ideological mindset and monetary gain.  The same facilities are used by most state PHPS.  They are, in fact, mandated as they are the “PHP-preferred” facilities.  

In 2011 The American Society of Addiction Medicine (ASAM) issued a public policy statement on coordination between PHPs, regulatory agencies, and treatment providers. recommending only “PHP-approved” treatment centers be used and the statement specifically excludes ‘non-PHP” recognized facilities.  

What the Audit diid not discover is the medical directors of all of the “PHP-approved” facilities can all be seen on this list of Like-Minded Docs.  It is a rigged game    Every aspect of drug-testing, assessment and treatment is kept hidden and secret and within control of the PHP.

It is a rigged game in which they have removed themselves from all aspects of accountability.  They have, in effect, manufactured a culture of impunity at our expense.

 “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.

Crooked Board Attorneys

Perhaps the lowest bottom feeders  playing a role in this culture of impunity are those whose job is to ostensibly ensure that due process and fundamental fairness are followed.    It is becoming quite clear that some of the state employed attorneys within medical boards control the flow of information by picking and choosing what is before the board for consideration.    Many of these attorneys go on to represent doctors in cases before the board.   If these attorneys acted as zealous advocates on behalf of their clients they would never get a referral again and because of this the system is plugged with an attorney pool unwilling to win but simply compromise.

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

Originally posted on 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. In October, the Supreme Court heard arguments for North Carolina State Board of Dental Examiners v. Federal Trade Commission, in which…

https://disruptedphysician.com/2015/03/20/when-dentists-go-too-far-north-carolina-board-of-dental-examiners-v-federal-trade-commission/

Monopolies, Self-Referral and Shell Games: The Need for Antitrust Investigation of Physician Health Programs and their “PHP-Approved” Assessment and Treatment Centers

On the above list can be found the Medical Directors of a number of drug and alcohol rehabilitation facilities. I did not make up this list. An updated version can be seen right here on the “like-minded doc” website.

Talbott, Marworth, Hazelden, Promises, and another two-dozen or so “PHP-approved” assessment and treatment centers are represented on this list. State Physician Health Programs (PHPs) refer doctors to these facilities for evaluations. PHPs are non-profit tax-exempt organizations. They do not evaluate or treat patients. If a physician is referred to a PHP for a suspected problem the assessment must be done at an outside facility which will invariably be linked to a name on the list of Like-Minded Docs.

What most people do not know, however, is that this is an exclusive arrangement. Evaluations are constrained to one of these facilities. It is mandated. No bargaining. No compromises. No choice. In other words it is a coercion.

Disrupted Physician

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Three shells and a pea–ASAM, FSPHP, and LMD.

“PHP-Approved” Assessment and Treatment Centers

On the above list  can be found the Medical Directors of a number of drug and alcohol rehabilitation facilities.  I did not make up this list.  An updated version can be seen right here on the “like-minded doc” website.

Talbott, Marworth, Hazelden, Promises, and another two-dozen or so “PHP-approved”  assessment and treatment centers are represented on this list.    State Physician Health Programs (PHPs) refer doctors to these facilities for evaluations.  PHPs are non-profit tax-exempt organizations.  They do not evaluate or treat patients.   If a physician is referred to a PHP for a suspected problem the assessment must be done at an outside facility which will invariably be linked to a name on the list of Like-Minded Docs.

What most people do not know, however, is that this is an exclusive arrangement.    Evaluations are constrained to one of these facilities…

View original post 95 more words

The Problems with Recognizing Problems as Problems: Medication Records, Firefighter Arsonists and Machiavellian Sociopaths

Pharmacard:  A Prescription Drug Monitoring System Designed to Record Drug Histories and Reduce the Incidence of “Drug Misadventuring.”
 
As a medical student in 1990 I saw a 79 year old woman in the emergency room with intractable nausea and vomiting.   Earlier that week she had seen her primary care physician for nausea and a mild cough.   Diagnosed with bronchitis,  she was given a prescription for erythromycin.  Her husband brought in her medications including digoxin which can cause nausea
when blood levels are too high.  A  markedly high level came back on the blood draw indicating  digitalis toxicity.  I spoke to her primary care physician who was unaware of her digoxin prescription; completely clueless that she was prescribed the foxglove plant extract by a cardiologist for an irregular heart beat.images-22
Digitalis was first described by William Withering in 1785 for heart conditions and this is considered the beginning of modern therapeutics.  Sometime after erythromycin became available in 1952 it was discovered that taking the two drugs together increased digoxin levels. This simplest  type of drug interaction is called interference and occurs when one drug either accelerates of slows down the metabolism or excretion of the other.
Based on the progression of symptoms her husband reported and the elevated levels on admission this woman undoubtedly had elevated digitalis levels when she was seen by her doctor earlier in the week.   Unaware of the digitalis he inadvertently worsened her condition by giving her a medication that elevated her levels even further. She was lucky.
introduction-to-adverse-drug-reactions-14-638The Boston Collaborative Drug Surveillance Program found digoxin to be the second most commonly implicated drug in causing death in hospitalized patients and the most commonly implicated drug implicated in hospital admissions (N Engl J Med 291:824–828, 1974).
Digitalis toxicity in those who die outside of the hospital often goes unrecognized as most are elderly and assumed to have died from age related causes.
Seeing several more cases of drug related problems caused by ignorance of current medications and lack of communication prompted an  interest in drug misadventures.  I also became interested in developing a computerized up to date and accurate record accessible by all health care providers in real time , a closed loop system of “portable” information easily transferred among all health care providers be they primary doctors, pharmacists or emergency room personnel.
Research pharmacologist Dr. Edward Gallaher and I brainstormed over ideas and eventually came up with a computer program using  WORM (write-once-read-many) optical technology used in compact disc systems. much like a CD-R but without the spinning disc.  The credit-card sized disk could store up to two megabytes of data on an optical layer that could be written once and never changed. An optical card-reader interfaced with any IBM compatible PC.   The plan was to place card readers at pharmacies, medical offices and emergency rooms.  We called it Pharmacard.
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Pharmacard System Developed. ASTI Connections. Vol 4. Eugene, OR: Advanced Science and Technology Institute; 1992.

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Although computerized medical records existed in 1992 they were predominantly stand alone with many just replicating the paper record without word search capability.  Moreover these programs did not communicate with one another so no information portability existed between the entities involved.  Communication of information from pharmacy to doctors to emergency room was not an option.  The system was fragmented and the search for information long.
But drug mishaps were a real problem.  As with digoxin they could be fatal.  Multiple reports of drug induced morbidity and mortality were found in literature searches.  An obvious problem existed. . Many were drug interactions such as that with digitalis and erythromycin.  From my viewpoint the need for addressing the problems caused by inadequate and and incomplete records was not only self-evident but a priority.   Solutions however were few.  “Brown-bag” sessions in which patients bring in a paper bag containing all of their meds were held periodically.  Little booklets titled “patient medication records” were given to patients to update and record their new and current prescriptions.
PHARMACARD4In addition to an up to date medication list we decided to put in the bare but essential elements of the medical record that would be needed in an emergency; these consisted of demographics, emergency contacts, a basic problem list, allergies and a baseline EKG.
An available baseline EKG was decided based on its presence making it much easier to detect a problem by looking for differences.  A baseline EKG would conceivably facilitate the timing and accuracy of diagnosis.  In addition it would save money because without a comparison the default is admission.
We then applied for multiple research grants for funding to do a pilot study.  All were rejected and contained comments suggesting we pitch our wares to the computer people not the medical people-this is computer science not medical science.
We received very little interest at an AMA poster presentation in Washington D.C.  Few people would even read the poster with most taking a quick glance and redirecting straight ahead as if they were avoiding a street-corner pollster.   Those who did read it were either non-plussed, perplexed or cynical.
A research psychopharmacologist M.D.,PhD from France  asked permission to give me some advice.   He then told me it would not work.   He said the idea was great, it would work as intended and probably help prevent drug related problems.  But that did not matter because no one
gets it yet.”
   Aside from a handful of people intimately involved in the research most everyone else finds this useless as do most people at the  conference.  This means nothing to them.
PHARMACARD5 They don’t see the problem and they don’t see a need for a solution. Many believe it is the patient’s responsibility to keep track of their medications and that any problem associated with not providing their medication list up to date were self-inflicted.”  He said it will be a different story in five or ten years when the problem is acknowledged and accepted by the rank and file.
In 1999 the Institute of Medicine published To Err is Human: Building a Safer Health Care System placing  patient safety high on the nation’s health care agenda.  Medical errors, adverse drug reactions and interactions were deemed a big problem. Identifying ways to keep track of medications became a priority and multiple business ventures popped up and got their hats in the ring.    Suddenly everyone not only recognized the problem but imparted the sense they knew it all along.  Seven years had gone by and our project had then fallen by the wayside. In addition our optical platform was obsolete.
As with firefighter arson this illustrates the most crucial step in addressing a problem is admitting the problem exists.  Firefighter arson had been documented for over a century but not properly addressed.  The  extent of the problem was not publicly recognized until  a  Special Report: Firefighter Arson was done by the Department of Homeland Security, the United States Fire Administration and the National Fire Data Center in 2003.   The most crucial step was admitting 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.
PHARMACARD1The  problem of not recognizing  problems as problems can also be applied to individuals;  Bill Cosby comes to mind.  So too does FSPHP self-appointed drug-testing expert Dr. Gregory Skipper whose irresponsible introduction of junk-science drug testing into the marketplace through a loophole  has undoubtedly caused many more deaths than Dr. Harold Shipman who killed more than 250 patients in the U.K. by injecting them with morphine.
Skipper’s introduction of junk science drug and alcohol testing and use of cutoff points he pulls out of a hat and then moves upward as the problems are exposed is shameful.     The fact that he unleashed this on other doctors knowing full well what would happen in a zero tolerance program needs to be revealed.
My survey is revealing many suicides as a direct result of these tests, including those of medical students and residents.  And most of those who have died were not  even remotely addicts or alcoholics.  They were reported anonymously,  given one of these tests and asked to be evaluated at a “PHP-approved” assessment center  where a diagnosis was confirmed followed by  3-4 months of inpatient treatment.   I am finding out most of the doctors referred to PHPs do not have any problems but the PHPs and their affiliates are giving false diagnoses, false drug testing and using threats to control them and there is little they can do about it.    Skipper’s complete lack of empathy for his victims as he continues to put  coins in his purse is abhorrent.       Meanwhile the death  count continues to rise.Slide39Screen Shot 2015-03-12 at 11.17.53 PM

Moving the Goalpost–Criminal Violations of HIPAA by PHS, Quest and USDTL

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Information obtained under HIPAA Privacy Rule

1.August 6, 2014 to Langan with health materials   2. Quest-Clinical

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The elements of a criminal offense under HIPAA are fairly straightforward.  To commit a “criminal offense” under HIPAA, a person must knowingly and in violation of the HIPAA rules do one (or more) of the following three things.:  use or cause to be used a unique health identifier, obtain individually identifiable health information relating to an individual or disclose individually identifiable health information to another  person.   Criminal penalties under HIPAA, tiered in accordance with the seriousness of the offense, range from a fine of up to $50,000 and/or imprisonment up to a year for a simple violation to a fine up to $100,000 and/or imprisonment up to five years for an offense committed under a false pretense and a fine up to $250000 and/or imprisonment up to ten years for an offense committed with intent to sell, transfer, or use individually identifiable health information for commercial advantage , personal gain, or malicious harm.

One of the ways physician health programs are engaging in forensic fraud  using laboratory developed tests (LDTs) is by changing them from “forensic” to “clinical” samples in order to bypass chain-of-custody.  As there is no regulation or oversight of the entire testing process it is easy to do.  PHPs have no oversight or regulation.  Neither do the commercial drug testing labs using these tests.  They are non-FDA approved and CLIA exempt so the only avenue of complaint is the College of American Pathologists (CAP) which is an accreditation agency that does not have the power to sanction.


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In terms of criminal penalties  I would aim for the $25000 and 10 year mark as the cumulative documentation of HIPAA breaches committed by PHS, Quest and USDTL under false pretense are many and severe.

The Department of Health and Human Services Office for Civil Rights confirmed that my blood test from July 1, 2011 was intentionally changed to a clinical specimen and sent to USDTL with specific instructions to process it as a clinical specimen.  Under the updated HIPAA-Privacy Rule “patients’ have the right to request their records directly from labs without authorization of the ordering provider.

It is important to recognize that all three parties had misrepresented this test as “forensic” since 2011. I have been requesting the “external chain-of-custody” from Quest since December of 2011 and the “appended test” from V.P. of Laboratory Operations Joseph Jones since December of 2012 when I was informed that it was changed from positive to invalid on October 4, 2012.

The new documents provided by USDTL include the October 4, 2012 revised test contradicting Dr. Luis Sanchez letter that he “just found out about” the revised test 67-days later.

The importance of this cannot be overstated as I filed a complaint with the College of American Pathologists in January of 2012. The  investigation confirmed my suspicion that the test was fraudulent and as a result CAP mandated that USDTL revise the test.

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USDTL did so and reported it to Dr. Sanchez but both concealed it and Sanchez took action against my license the following week.

“Moving the Goalpost” is a frequent tactic of PHPs whereby they make a new allegation and disregard the original.   By controlling the information that is provided they are able to suppress and conceal whatever they want by misusing existing health care confidentiality law.

The October 19, 2012 report for noncompliance with my contract was done  under “color of law” and resulted in suspension of my medical license.   The new documentation shows that all three parties were involved in the fraud and the coverup.

The information USDTL provided even contains an email from me to Joseph Jones  from December of 2012 requesting that he provide a copy of the October 4, 2012 revision which he ignored.

In response to demand letters from my attorney all three defended themselves by claiming the July 1, 2011 test had absolutely nothing to do with my suspension and blamed it on my non-compliance.  The new documentation shows that I was reported for noncompliance after Dr. Sanchez was made aware of the revised test.

As the three parties colluded to produce PHI and used it with malice in a conspiracy to commit fraud and I am therefore requesting that charges be filed against these parties under the HIPAA criminal statute:

The HIPAA criminal statute, 42 U.S.C.A. § 1320d-6, reads in pertinent part:

”A person who knowingly and in violation of this part—

•   uses or causes to be used a unique health identifier;
•   obtains individually identifiable health information relating to an individual; or
discloses individual identifiable health information to another person, shall be punished as provided in subsection (b) of this section.”


”Whoever willfully causes an act to be done which if directly performed by him or another would be an offense against the United States, is punishable as a principal.” 18 U.S.C. § 2(b).

 All three parties knew this was intentionally changed from a forensic to a clinical sample and PHI. Instead of correcting an error both Quest and USDTL took steps to conceal this information.   In fact, the complicity of the three parties, cover-up and extent of damages caused by it make this the worst HIPAA-criminal violation to date. I can find nothing comparable and the damages have still not been corrected.

Luis Sanchez was notified  of the invalidity of the test on October 4, 2012 but suppressed it for 67-days.    This was a result of my complaint to the College of American Pathologists (CAP) that launched an investigation which revealed no external chain-of-custody existed for the specimen rendering it invalid.  This was revealed to PHS on October 4th, 2012 but instead of disclosing this and correcting things Dr. Luis Sanchez reported me to the Board  for “noncompliance” less than 2 weeks after it was revealed to him that the test was invalid.     He then wrote a letter on December 11, 2012 stating that he “just found out” about the invalid test.


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Sanchez violates M.G.L. (B) Section 69 on 3 separate occasions 1. July 28, 2011 when he reports the fabricated test to the Board of Registration in Medicine (BORM) 2. October 19, 2012 when he reports non-compliance with my contract leading to my suspension. 3. December 11, 2012 when he reports PHS was made aware of the invalidity of the test the day prior when it was actually 67-days prior (and 2 weeks prior to the report of non-compliance). His attempt at “moving the goal-post” was made clear with the August 2014 provision of the October 4, 2012 report from USDTL to Sanchez. Both USDTL and Sanchez suppressed this information to conceal the crime.




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The additional evidence was provided in December of 2011 with the litigation packet. Since that time Ms. Stoller has received exculpatory evidence that undeniably refutes the test including an investigation by the College of American Pathologists. In addition Ms. Stoller has been made aware point by point the crimes involved. She is aware that this is not only “invalid” but the product of forensic fraud. Her stance has been to ignore each and every point and support PHS regardless of facts and truth while professing to serve the public interest.



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Letter from USDTL to Sanchez reporting the absence of external chain-of-custody and invalidating the positive test. This was concealed until August of 2014.



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While concealing the October 4th test correction Sanchez reports “non-compliance” with A.A. meetings. The positive test was the sole justification for the A.A. meetings.



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Sanchez claims that he just found out about the revised test 67-days after he actually did. Note he makes it a point to state that the test did not cause any consequences confident that the October 4, 2012 document will remain concealed.


A  Request to Inspect and Copy Protected Health Information and  Authorization for Use or Disclosure of Patient’s Protected Health Information was sent to USDTL in July and August of 2014.

The July 1, 2011 PEth test was drawn as a forensic specimen and subsequently changed to “clinical” (rendering it PHI) at the request of Quest’s client, PHS, Inc on July 7th, 2011.  USDTL sent the materials within the 30 day deadline.

Quest Diagnostics, however, refused to comply with my request for the authorization and release of information forms required for them to draw a clinical specimen (which I knew did not exist) as well as any documentation related to the request by PHS that Quest  (in violation of all regulations, professional standards, and clinical laboratory law) changed a “forensic” to a “clinical” specimen.  The Quest attorney insisted that I sign a “release” from PHS.

PHS and the colluding labs were apparently unaware  of the updated HIPAA regulations removing the need to obtain a signed release from a “provider” to obtain PHI.

 I only received it because the DOJ-OCR agreed that this was PHI and forced Quest to send it.    

PHS manipulated the test, set up a system in which they could claim me non-compliant , then did so immediately after the test was amended and hoped I would never find out.

On 10/4/2012 USDTL amended the test noting “external chain of custody was not followed per standard protocol” invalidating the test (this was the result of the initial CAP investigation under the assumption it was a forensic test).  This was faxed to PHS but they withheld this information from me and the Board of Registration in Medicine.

The very next week they deemed me  “non-compliant.” 

PHS then officially reported me to the BORM as “noncompliant” on 10/19/2012.

On 12/10/2012 I found out from Amy Daniels of CAP that the test had been amended. I then called PHS and they issued a letter the very next day 12/11/2012 stating “Yesterday, December 10, 2012 Physician Health Services (PHS) received a revision to a laboratory test” referring to the July 1, 2011 PEthstat.  They  then try to cover themselves by claiming they were not aware of any action taken by the board as a result of this test.

The documents reveal that PHS is violating multiple state and federal criminal laws including clinical laboratory laws.  It not only involves forensic manipulation but sending laboratory specimens as “clinical” samples when they are not authorized to do so and misrepresenting them as “forensic.” 

Joseph  Jones goes on record as a strict advocate of quality control and chain-of-custody with his “Defense in Depth Strategy” video and multiple written documents proclaiming how USDTL follows strict and rigid protocol.  Well the ” litigation packet”  contradicts and even negates this.  How can any of USDTLs testing be trusted in light of what is seen here.

 There is nothing that correlates that test with me and for all intents and purposes it could be a positive template used specifically for this type of misconduct.    They pointed out that it does not pass the  common sense factor (i.e. what would an average person think under normal circumstances about this?)

What it shows is that Mary Howard of PHS changed a test that was drawn as a “forensic” test to “clinical.”    She is listed as the ordering “physician.”  None of the required information exists to obtain a clinical sample. There are no authorization forms signed by me or to whom the information can be disclosed–clear violations of “Prohibited Activities” under Massachusetts law governing clinical laboratories.

Quest and USDTL representation has already clarified that PHS requested this test be sent by Quest to  USDTL as a “clinical sample” with specific instructions to process it as a “clinical” sample.  PHS is a monitoring agency not a treatment provider.

A “clinical” laboratory specimen is defined (CLIA, DPH, HHS, state laboratory law, essentially everyone) by its use in the diagnosis and treatment of a patient in a  doctor-patient relationship. It necessitates patient “care” which PHS is unable to legally provide as a “non-profit” charitable organization. 

As this is both “bad-faith” and ultra vires “confidentiality agreements” and “peer review” protection should no longer be an issue.  Just one removes it.

 PHS is an agency that utilizes drug and alcohol screens to detect if doctors are using substances they are prohibited to use.  It is not a clinical provider.  I am sure Bresnahan has spun some sort of logical-fallacy argument to say it is, but the documentary facts negate this.  Organizational purpose is clear. As a monitoring agency their drug and alcohol testing is forensic.    This brings in to question their “charitable organization” non-profit status.

Accountability requires both the provision of information and justification for actions

Accountability also requires consequences for violations of professional standards-of-care, ethical codes of conduct and the law

PHS is able to do what they do by both blocking information and relying on others to overlook, table or otherwise dismiss valid complaints–complacent that these are good people helping doctors and protecting the public.  The current incarnation does neither

There should be zero tolerance.  PHS has been unaccountable for this type of behavior but this needs to be addressed. 

Accountability requires both answerability, justification and consequences.     There is no conceivable procedural, ethical or legal justification for what is shown here.   The compounding of crimes over time is self-evident and therefore it is the responsibility of the state to hold him accountable for his crimes. The fact that he pontificates on professionalism and stands in judgment of others makes it even more important.    There are no exceptions to the rules or the law..

 And we now know why Quest was so reluctant to provide the records.  Quest was complicit in this and obtained and processed a known forensic sample as “clinical” without any of the required documents.  The test lists “ordering physician” as Mary Howard (who is a secretary at PHS).  There are no signed release of information forms or authorization forms indicating who my PHI could be distributed to.

This is in violation of the HIPAA criminal statute.  As a business associate  It is my understanding  PHS can be tied to it by the conspiracy statute.

There should be zero-tolerance for this type of criminal activity.   There is no excuse for forensic manipulation and this must be addressed.  The people who are engaging in this should be in jail yet they remain unscathed.  This is a systemic problem that is best met with head on and in real time.  It makes Annie Dookhan look like a girl scout.


7/1/2011—PHS requests blood test at Quest Diagnostics.  No outside factors are involved in  PHP requesting this.   There is no outside complaint or concern behind it.  I provide blood sample using my PHS unique identifier #1310

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7/28/2011—verbal report that test was positive to the Board of Registration in medicine and requests I have a “reevaluation.”

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I request test results in form of “litigation packet” but PHS tries to dissuade me and eventually threatens me with “unintended consequences.”

11/29/2011—PHS agrees to provide “litigation packet. Check dated 11/29/2011 is given for payment.

12/5/2011—Receive USDTL Litigation Packet   Sole document from Quest is a fax that is time stamped and arrived 3 hours after the specimen was collected when I was in clinic at MGH rendering this impossible.  In addition it is not my signature:

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Signature on Quest document

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A fax from PHS to USDTL is also included requesting that my ID # 1310 and a “chain-of-custody” be added to an already positive specimen with no unique identifier connecting it to me.

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PHS asking that my ID # 1310 be added to this sample and

PHS asking that my ID # 1310 be added to this sample and “chain-of-custody” be updated

A report dated 7/20/11 from USDTL “revised report per clients request” and “corrected donor ID from 46130 to 1310 and “corrected collection date to 7/1/2011”

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USDTL adds my ID # 1310 to an already positive sample and adds collection date of July 1, 2011

Note this backdating of chain of custody and addition of my ID # is on 7/20/11  (one day after Dr. Luis Sanchez reported the test as positive to the Board of Registration in Medicine. )

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Joseph Jones certifies that the specimen was processed with laboratory SOP. This is signed on 12/3/2011

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Note that Dr. Luis Sanchez “explained that the testing laboratory is willing to support the test results and provide the litigation packet’ December 5, 2011

Note- the “PHP-referred” attorneys are an essential part of this racket.   Although ostensibly representing your interests they are also serving the PHP as they will not go beyond certain boundaries.  They will not address the forensic fraud facilitated by the labs or the “tailoring” of assessments to fit the diagnosis.  Their other job is 12-step facilitation.  They enforce mandated 12-step and essentially threaten you that the medical board will suspend you if you do not show them you accept it.   My attorney would not even contact the labs involved.    Although discovery of the fraud would have been exculpatory my attorney felt a better approach would be to blame the positive test on my asthma inhalers and referred me to an “expert witness” who for $3000..00 would write a letter supporting this.   I even write a letter for him to USDTL.  He will not contact the labs but offers to do so if Linda Bresnahan “wants him to.”  The deferential almost sycophantic exchange is seen below.Screen Shot 2015-05-07 at 10.32.33 AM Screen Shot 2015-05-07 at 10.31.17 AM

12/14/2011—Bresnahan replies that the one page document with my forged signature is sufficient external chain of custody.

Screen Shot 2015-05-07 at 9.26.53 AM12/19/2011–I try to do everything I can to  get my attorney to address the lab issue.  In any other profession this would have been immediately resolved.  The lab fraud would have been exculpatory. but in this rigged system it is avoided.    The fact that the attorney who is supposedly working for you is actually working against you is a very significant breach of trust It is an essential part of the racket.

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12/29/12—As I  am determined to get the truth about the test I request that when that happens the board allow me to repetition for reconsideration.  Confident that the College of American Pathologists will confirm the fraud this letter is written to Board Attorney Deb Stoller.

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Letter to Board Attorney Deborah Stoller. My contract with PHS was extended for 2 years because I asked for an evaluation at an independent facility not affiliated with PHS and the Like-minded docs. This letter is important as it shows the import of the PEth test which PHS will later say is irrelevant as they “move the goalpost.

1/12/2012—I send “litigation packet” to the College of American Pathologists (an accreditation agency that does not have power to sanction but can investigate and force lab to correct errors under threat of loss of accreditation)

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3/22/2012 – Quest New England Compliance Manager, Nina Tobin in response to my persistence in obtaining the absent Quest “chain-of-custody” provides letter documenting all of the errors in collection and process in a letter that seems to try to give the impression some sort of protocol was followed. She notes it was “ logged as a clinical sample.” Note no indication of the validity of the sample and that this was processed as a clinical sample.

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10/8 2012 –I am called by my attorney and told PHS is deeming me “noncompliant’ with my contract.

10/19/2012—I am verbally reported to the Board of Registration in Medicine for noncompliance with my contract.  This is followed by a written letter:  10:23:12 PHS Letter to BORM-noncompliance

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11/5/2012—Inquisition_10_Pushing_Off_Bridgen appears to be “a purposeful and intentional act by PHS to show MLL’s 7/1/11 test as valid when in reality this test was invalid, and involved both fatal laboratory errors and lack of adequate MRO review of results. Anything based on MLL’s 7/1/11 test as a confirmatory positive should be reversed, rectified and remediated.”   This letter remains unacknowledged by Board Attorney Deborah Stoller.

12/5/2012 – Contacted by Amy Daniels (investigator for CAP) to follow up on the “appended lab.” She tells me that the July 1, 2011 lab was amended on 10/4/2012 and reported to PHS. I contact PHS and they deny it.

12/11/2012– Dr. Sanchez issues a letter stating “Yesterday, December 10, 2012 Physician Health Services (PHS) received a revision to a laboratory test” referring to the July 1, 2011 test. He claims the test had no consequences.

2/6/2013—I am suspended by Board of Registration in Medicine for the “non-compliance” reported by Dr. Luis Sanchez.

6/23/2014-Letter from PHS attorney Paul W. Shaw claiming PHS immune from damages and documenting that the lab draw was performed by PHS ‘in its capacity as a charitable corporation.” He states “you should be aware that the suspension of Dr. Langan’s license had absolutely nothing to do with the blood test referenced in your letter or any actions on the part of PHS, as detailed in the Board of Registration in Medicine’s {Board Order} dated February 6, 2011” referring to my suspension for the “noncompliance reported by Dr. Luis Sanchez.

6/27/2014—Letter from USDTL attorney William F. Burke stating that “the blood sample was tested clinically at the request of Quest Diagnostics” and that “Dr. Langan’s blood sample was provided to USDTL by Quest Diagnostics on behalf of Physician Health Services as part of medical treatment..”   He states “Dr. Langan’s suspension was the result of his inability to comply with the terms of his contract.”

8/6/2014—in response to my request for PHI USDTL provides record. This includes documentation that Dr. Luis Sanchez was made aware of the revised test on 10/4/2012.   Note the very next week on 10/8/12 my attorney informed me that he was reporting me to the Board of Registration in Medicine for “noncompliance’ and officially did so on 10/19/12.

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Also included in the record is an e-mail from me to Dr. Jones December 10, 2012 with subject “please provide amended lab report.” I request a copy of the amended lab report ASAP specifically to “clarify the truth about this test as explicitly as possible before this goes any further.” I state “PHS has used this test to cause, and continue to cause, a significant amount of harm.” He does not respond to this request for what is now documented PHI.   I am suspended 2 months later for non-compliance.

Joseph Jones had already corrected the test 10/4/2012 but both he and PHS concealed it while PHS “moved the goalpost” by deeming me non-compliant.

10/9/14—Receive documents from Quest Attorney Fay Caldwell.   No release of information forms or other HIPAA required documentation is found.

Ordering Physician is listed as Mary Howard.  (secretary at PHS).   Documents reveal no custody and control form information only that it was changed to a clinical specimen by Ms. Howard on July 5, 2011 and sent to USDTL on July 7,2011.

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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


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Firefighter Arson

In his book “Fire Lover: A True Story,” Joseph Wamnaugh profiles Fire Captain and  Senior Arson Investigator for the Glendale California  Fire Department John Orr.  Known for his uncanny instincts in solving arson cases, Orr often astounded other investigators with his seemingly brilliant deductions in determining the causes of incendiary crime.

As it turns out, neither instinct nor brilliance played any role.   Orr solved many of these cases by first-hand  knowledge. He actually started many of the infernos he fought.  Burning down businesses and homes for over a decade, investigators suspect Orr may have intentionally set as many as 2000 fires.

John Orr

John Orr

One involved a large Pasadena hardware store that killed four people including a 3-year old toddler and his grandmother. Orr is now serving a life-sentence at Lompoc Penitentiary.  Details of his arsonist acts are described in chilling detail in his own book,  “Points of Origin…playing with fire.”

The problem of arsonist firefighters is not new. In Firesetting Firefighters: Reconsidering a Persistent Problem–Firefighter Arson Research, Matt Hinds-Aldrich reconsiders historical context by drawing upon an original dataset of 1,213 firefighters arrested for arson dating back to the early nineteenth century.   Screen Shot 2015-04-27 at 3.55.38 PM

These cases have generally been attributed to “bad apples,” and prevention has hence been focused on identification by screening of candidates in the same manner as police departments–methods that may successfully identify and weed out criminals turned cops but not cops turned criminals.

This type of screening is unlikely to isolate those with inverted perceptions of morality for whom the normal rules do not apply.   There is no test to identify individuals joining the police force  “who might get so caught  up in making things right or getting their guy that they would push procedural, legal or ethical boundaries.”  There is no test that would have identified John Orr.

The 1991 film Backdraft illustrates this type of warped morality in portraying a firefighter turned arsonist who attempts to make a moral political statement about the dangers of reducing firefighter staffing by setting a series of explosive fires to prove the social value of firefighters.  Hinds-Aldrich describes an ends-justifies-the-means occupational overzealousness in which these individuals in their efforts to do what they think is right take matters into their own hands and begin freelancing.
 Occupational socialization and commitment go awry and firefighter arsonists may attempt to downplay their acts and believe the risks are manageable or even justified and necessary.  They may believe they are truly providing the community a valuable service by eliminating dilapidated and crime-ridden properties-noble corruption all done for the greater good. 
  In a large number of cases studied by Hinds-Aldrich, at least two firefighters at the same department were involved in the fire-setting. They worked together. In Louisiana, authorities discovered that several firefighters from two rural districts were setting dozens of fires each year, mostly grassland but eventually buildings.
The majority of firefighters are individuals of integrity, good-heart and moral compass.  But an estimated 100 firefighters are arrested for arson each year.  Many others have avoided detection due to a confluence of factors.  Hinds-Aldrich notes some have even returned to work as firefighters at a later date. Some have been let go by their department without formal investigation under the rationalization that the threat was removed.  The desire to keep this behind closed-doors is understandable as the arsonist, as a firefighter, puts a stain on a noble profession.   How many of these returned to their old habits is unknown.  Historically no methods have been in place to detect, investigate and hold accountable those who are engaging in behavior that is the antithesis of their public responsibility and trust.
But this behavior has consequences that are sometimes grave and permanent.   As Wamnaugh notes:  “The damage they do in one fire can be enormous. I mean it can be a calamity, just one crime.”
 Backdraft was loosely based on firefighter Ray Norton Jr who was in 1985 was convicted of conspiring with seven other “sparkies” to set 219 blazes in and around Boston during a 14-month arson spree.  The group was motivated by the mistaken belief that the fires would force local governments to hire more firefighters after widespread layoffs in the 1980s. The group started with trash bins and vacant buildings but this soon escalated to burned houses, churches, factories, restaurants, a Marine Corps barracks and the Massachusetts Fire Academy.   More than 300 people were injured and $22 million in property was destroyed.  This illustrates the concept of so called “noble corruption” and the power of “groupthink.”
What are the motivational factors involve?   Some experts previously hypothesized arsonist firefighters may have been motivated by situational factors, boredom or wanting to participate in the job they were tasked with doing –putting out fires.   Others have theorized that becoming a firefighter was a direct consequence of being a firebug; a deliberate volitional choice similar to a foot fetishist becoming a shoe salesman.
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This seems plausible on the surface.  It makes sense in the same vein of logic as Willie Sutton’s explanation as to why he robbed banks–“that’s where the money is.”   If firefighter arsonists are the product of a pyromaniacs wish fulfillment in choosing a vocation that supports and a fire fetish then screening to identify this pathology makes perfect sense.  Identify and remove the threat before the damage occurs.   If Florsheims wanted to extirpate all foot fetishists a screening system identifying any unusual proclivity for toes could be developed.  The underlying reliability and validity of that screen, however, depends on multiple factors including the truthfulness of the potential shoe salesman.  It’s much more complicated.  It is a safe assumption that selling shoes does not create a fetish for feet. Some foot fetishists become shoe salesmen but I would guess few shoe salesmen become foot fetishists.
In the case of arsonist firefighters evidence suggests that it is much more complicated.  Arsonist firefighters are not the simple product of a firebug choosing a vocation that provides an  increased incidence of engaging in and a closer proximity to their avocation.  Joining the profession does not appear to be deliberate machination to acquire an unmolested backstage pass to start fires.    The personality profiles of firefighters who engage in arson seems to involve an interplay between insecurity and power.  Therefore the usual screening procedures are ineffective as this type of personality predisposes these individuals to evolve into arsonists over time.  It is an evolution fostered by the reinforcement of power and control.   Such was the case with Orr.
According to Joseph Waughnaugh:  “It’s power and control. They’ve not only created a living thing, they’ve created a living thing that is the object of massive attention.”
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One of the primary motives for firefighters who commit arson was found to be the desire to be seen as a hero.  Those with deep-seated insecurities and feelings of powerlessness, such as Orr, are provided with a feeling of empowerment over society.    These individuals are suddenly given attention, recognition and validity they never had.  Retaliation for some grievance, real or imagined, may also sometimes play a role.
“They may be the first to call in a fire, the first on the scene, and one of the most eager, excited, and enthusiastic members of the response team. Their main reason for lighting the fire is so they can appear as a hero, either by being the first to spot the flames, or by rescuing people and saving property. Extreme cases of firefighter arson involve fires set in occupied structures. When a firefighter sets fire to an occupied structure, the potential for being a life-saving hero is even greater. In North Carolina, one firefighter would set fire to an occupied house, and then return to the scene and rescue the family. His need for excitement, being worshiped, and getting attention predominated over any concern about the terrible danger to which he exposed the occupants”
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 Wellness Suicides and Medical Review Officer Forensic Fraud 

Multiple parallels exist between firefighter arsonists and physician wellness experts.   Misuse of entrusted power occurs when those who have been given authority to carry out expected goals instead use their position and power to benefit themselves and others close to them. Abuse of power is particularly egregious when that person is doing the opposite of what he or she is supposed to do.

The firefighter who commits arson is an example of this phenomenon.   So too would be a program that ostensibly promotes the health of doctors but is in reality driving them to suicide or a Medical Review Officer (MRO) ( whose sole job is to prevent the donor of a drug or alcohol test from being falsely accused of drug or alcohol use) falsely accuse a donor of drug or alcohol use by engaging in fraud.

Some of the same psychodynamics and sociocultural factors are probably involved.  A disproportionate number of arsonist firefighters are volunteer firefighters (75%) who offered to help fight fires and ended up doing the opposite..   A large majority of  physician wellness experts were doctors who had had their licenses revoked and were only able to practice medicine again by becoming “addiction medicine” specialists and offering to help other doctors.  As a result these programs self-select for doctors who did something severe enough to lose their licenses and getting their licenses back does not necessarily mean they have changed. Many used the “salvation” card to get their licenses back.  “I’ve changed.”  “I want to help others.”  “I’ve been redeemed.”

Designed with the dual purpose of helping sick doctors and protecting the public, many of the current state Physician Health Programs (PHPs) do neither.  Paradoxically they have become reservoirs of bad medicine and institutional injustice.  Part of the problem is the PHPs have removed themselves from answerability and accountability.  Accountability necessitates both the provision of information and justification for actions;  what was done and why?   The other defining factor of accountability is the ability of outside actors to punish and sanction those who commit misconduct or wrongdoing.    Without these constraints corruption is inevitable.  As we have seen, much of this is by intentional design.  PHPs have no oversight or outside regulation.    No avenue exists to file a complaint let alone investigate one.  In addition those who do file complaints are targeted for retaliation and retribution via “swift and certain consequences” that can be irreversible.    Because of this, few ensnared by these programs speak out and those outside dare not speak up out of fear of being targeted themselves.  This provides the necessary secrecy and silence they need in order to operate.

As with firefighter arson, few people are pointing their fingers at PHPs and claiming any problems with them.  Any suggestion of misconduct or wrongdoing is inevitably ignored, delayed, blocked, rationalized or justified.

Most worrisome is the fact that outside agencies who should and could be doing something about ethical violations, procedural irregularities and even crimes are doing nothing.  As a result  inverted systems of morality involving procedural, ethical and criminal violations against doctors are able to not only exist but thrive.

This needs to change. Everyone in the medical profession must be and should be prepared to admit that there are ethical, procedural and legal breaches being committed by State PHPs and that precise, firm methods are needed to combat the situation.  To ignore the problem or suggest that it doesn’t exist will only increase the damage caused by the impaired physician movement as well as destroy the morale of good and honest doctors.  We must talk to all doctors about forensic fraud, neuropsychological fraud and physician suicide.  We must investigate, charge and convict the perpetrators of these crimes.   No exceptions.  The most crucial step in exposing firefighter arsonist was admitting the problem exists.  The most crucial step in exposing physician wellness corruption is admitting the problem exists.  Although we have made some gains this has not yet happened.


Defend the Medical Review Officer (MRO)

It is now over five months and no one has been able to procedurally, ethically or legally justify the actions of Dr. Wayne Gavryck and the Massachusetts PHP, Physician Health Services, Inc.  I had previously offered 100 volumes of the Classics in Medicine Library to anyone who could do so.  (see prior blog below).  No one has.

Therefore I am going to lower the bar and increase the prizes.  If anyone can think of anything that would hypothetically justify the actions of Gavryck and PHS procedurally, ethically or legally then they win my complete collection of the Classics in Medicine Library. On top of that I will add my collection of Cocoanut Grove artifacts as seen below.  Just one will do.


 Cocoanut Grove Artifacts including menu, wine list, and matchbook

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The Cocoanut Grove was a popular nightclub and restaurant lo located at 17 Piedmont Street in Downtown Boston. On Saturday November 28, 1942 it was the scene of  a tragic and deadly fire that killed 492 people and injured many more.  Fourteen hospitals received the injured and the dead: Beth Israel, Boston City, Cambridge (MT Auburn St.), Cambridge City, Carney, Chelsea Naval,  Faulkner, image012

image010Massachusetts General, Massachusetts Memorial, Peter Bent Brigham, St. Elizabeth’s, St. Margaret’s, and U.S. Marine. Boston City Hospital took the majority of patients (134) and Massachusetts General Hospital took 39.

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Boston City Hospital merged with the Boston University Medical Center Hospital and unfortunately the majority of its records and archives have been lost. Fortunately, we know more about the practices and techniques used at Mass General as a result their excellent archives and due to the June, 1943 Annals of Surgery, which was dedicated to the Symposium on the Management of the Cocoanut Grove Burns at the MGH.

While innovations in burn treatment were a major focus, burns were not the only medical problem. Upon arrival at the hospitals, it was obvious that a large number of patients had severe respiratory distress. Some patients image014showed evidence of obstruction to the air passages. Non-burn specialists were quickly called to the scene to perform laryngoscopes, tracheal suction and tracheotomies. Such a large number of respiratory patients at one time enabled doctors and researchers to better understand the impact of various treatments, leading to many advances in the field.

img018image002See https://www.flickr.com/photos/boston_public_library/sets/72157631071090782/ http://www.cocoanutgrovefire.org/ 



Previously blogged:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Sabin and Salk Autographs

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

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


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Sabin, Salk and the Classics in Medicine Library

Polio is nearly a thing of the past thanks to to Dr. Jonas Salk and Albert Sabin. In 1952 Salk discovered and developed the first successful vaccine for polio and combined with Albert Sabin’s 1961 oral vaccination the duo effectively obliterated the contagious polio virus.  Once a deadly threat to our  country and future there were 93,000 cases of polio reported in the U.S. Between 1952 and 1953 alone. ElaineBurnsBut thanks to Sabin and Salk the last case of naturally occurring polio in the U.S. occurred in 1979.

 
full body respirator or “iron lung” needed to treat patients whose respiratory muscles became paralyzed by polio

October 23, 2014 was the centenary of Jonas Salk’s birth and in honor of his 100th birthday I am sponsoring a contest to win framed autographs of both Jonas Salk andAlbert Sabin as seen above.  In addition,  you will receive 100 volumes of the Classics in Medicine Library published by Gryphon Editions whose “mission is the preservation of the literary and intellectual heritage of the noble professions that we serve”

These are exact facsimiles of the original classics bound in leather and include works by William Osler, Harvey Cushing and Paul Dudley White.

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Background

According to British sociologist G. V. Stimson the  “impaired physician movement” is characterized by a “number of evangelical recovered alcoholic and addict physicians, whose recovery has been accompanied by involvement in medical society and treatment programs.” Their “authoritative pronouncements on physician impairment is based on their own claim to insider’s knowledge.”

In this regard Dr. Wayne Gavryck, M.D. is a prototypical example.

An ex-alcoholic with a history of malpractice, Gavryck quit drinking through Alcoholics Anonymous, became “board certified” in “Addiction Medicine” and became involved with the Massachusetts PHP,  Physician Health Services, Inc. (PHS) where he has been an Associate Director since 1988.  He serves as their Medical Review Officer (MRO).

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The “impaired physician movement” has gained tremendous sway through the American Society of Addiction Medicine and the Federation of State Physician Health Programs.  The ASAM is not a valid medical specialty but a “special interest group” that represents the chronic relapsing brain disease with lifelong abstinence and 12-step recovery model of addiction and the companies that profit from it financially ( drug and alcohol testing labs,  12-step inpatient assessment and treatment centers) and politically  (Drug War advocates,  Anti -Medical Marijuana advocates).   The impaired physician movement gained a seat at the table of power in medicine by bamboozling regulatory and administrative medicine.   This illegitimate and irrational authority is in charge of almost every state PHP in the United States.     ASAM physicians joined their state PHPs, gained power, and then removed those who did not agree with the groupthink and doublethink.  Blind obedience and control  are favored over fairness, truth and evidence-base.   As with other states under the FSPHP, blindly obedient doctors are kept on while those who  question the science  and ethics of the groupthink are removed.  The  PHP-Drug Testing Laboratory and  “PHP approved” assessment and treatment center industrial complex requires a Medical Review Officer of blind faith who places the goals of the FSPHP above all other considerations including the Hippocratic Oath.  The system requires doctors who are willing to participate in “moral disengagement” of wrongdoing including professional, ethical and legal violations.    To erect this scaffold they have put in place barriers to exposure and accountability. By declaring themselves “experts” they have used logical fallacy to temporize  deflect and otherwise stifle accountability. With no oversight or regulation they are, in fact, accountable to no one.   The appeal to authority and esoteric knowledge is an effective means of  extinguishing valid concerns.  Complacent that this is a group of benevolent organizational purpose those who should know better and could do something about it rationalize their apathy and indifference.   A necessary step in exposing and addressing this  problem is imposing accountability.    If an organization is able to  engage in conduct that is the antithesis of accepted professional guidelines and standards of care,  in violation of professional and societal mores and codes-of-conduct and  is illegal then there is a systemic problem.  This problem can fortuitously be addressed by examining standards of care, conduct and criminal codes for breaches.   If a breach is found then it needs to be explained and justified.  One of the tactics of the FSPHP is to deflect criticism under the logical fallacy of appeal to authority.  We are the experts. We know better.  That is where it usually ends.   But accountability requires both the provision of information and justification of actions.  My hypothesis is that this group is committing fraud, violating ethics and flouting the law in an irrefutable manner.  If this is not true then my hypothesis should be able to be refuted.  It cannot.  And for that reason I am putting my money where my mouth is.


Accountability

In all fairness,  If Gavryck can justify his actions either procedurally, ethically or  legally and back it up by any written protocol, guideline or standard then he wins and I will refrain from any more criticisms.  In addition I will hand deliver to him the Salk and Sabin autographs and 100 volumes of the classics in medicine, apologize and remove this entire blog.

Accountability requires both the provision of information and justification of actions.  One way of examining this is to look at the body professional and ethical standards and state and federal law.   The FSPHP has blocked the provision of information regarding drug-testing.  Although it has taken over three years I have obtained the all of the information pertaining to a July 1, 2011  test that should have immediately been rejected by the MRO. It is an invalid test.

Dr. Gavryck violated every conceivable procedural guideline and standard-of-care there is for an MRO,  the Medical Review Officer Certification Council’s Codes of Ethical Conduct and both State and Federal Law.   This can be ascertained by looking at the documentation.  I have done this and found hundreds of documents that support the accusation that as an MRO Wayne Gavryck breached protocol, engaged in unethical behavior and broke the law.  Prove me otherwise with just one credible source and  the prizes are yours.

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Contest Rules

Your job is to review the documentary evidence and records from PHS, Quest Diagnostics and USDTL and assess the actions and decisions made by the MRO)

If you can show that  these decisions were the result of  legitimate reasoning based on published guidelines or protocol, ethically defensible or did not break any laws and cite one credible source that concurs with this point of view then you have won.

If you can show that these decisions were the product of legitimate and thoughtful reasoning in accordance with established guideline, ethical codes then I will hand-deliver the items to you.

 If you can justify, support or defend the actions of the Medical Review Officer (MRO):

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  2. Ethically; 

  3. or Legally;IMG_0577 - Version 2 

You win all of the prizes! Simple as that!

In fact, If you can support  just one of these the entire lot is yours.

If you can show Dr. Gavryck did not breach any and all published Standards-of-Care andProfessional Protocols and Guidelines regarding drugs-of-abuse testing, OR that he did not violate any and all Codes of Conduct and Ethical Guidelines of the Medical Profession from Hippocrates to the American Medical Association OR that he did not violate multiple State and Federal Laws you win Salk and Sabin autographs and all of the books.

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All of the documents and details regarding the forensic fraud, concealment, coverup and deliberate misrepresentation to a state agency under color of law can be seen here:

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

To Review:   Any and all drug testing requires chain-of-custody.   “Forensic” drug testing differs from “clinical”drug testing because the consequences of a falsely positive test can be grave and far reaching.  Because the results of  a positive test can result in the loss of rights and liberties of the person taking the test it is essential that it be done correctly.  False-positive tests are unacceptable so strict chain-of-custody procedure and MRO review assure specimen integrity.    This provides accountability and the custody

The custody-and-control form records chain-of-custody and is given the status of a legal document as it has the ability to invalidate a test that lacks complete information.  The job of the MRO is to invalidate specimens without intact chain-of-custody.

The MRO job is fairly simple.  If a lab reports a positive test for any substance the MRO must check that the signatures, dates, times and other information on the custody-and-control form are correct and per protocol.  Chain-of-custody must be accurate and complete.   The MRO looks for “fatal flaws” on the chain-of-custody form.  If a “fatal flaw is present then the test is invalidated and the test is not reported as “positive” but “invalid.”

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The sole  job of the MRO is to ensure that the drug testing process and chain-of-custody procedure is followed to the letter.  The MRO reviews the Custody and Control form for accuracy and completeness.  The MRO also rules out any other possible explanations for a positive test (such as legitimately prescribed medications).  Only then is a test reported as positive.

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The legal issues involved in forensic testing mandate MRO review. According to The Medical Review Officer Manual for Federal Workplace Drug Testing Programs

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

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Corruption is misuse of entrusted power.  It occurs when those who have been given authority to carry out expected goals instead use their position and power to benefit themselves and others close to them. Abuse of power is particularly egregious when that person is doing the opposite of what he or she is supposed to do.

Accountability is necessary to prevent corruption and necessitates both the provision of information and justification for actions;  what was done and why?   The other defining factor of accountability is the ability of outside actors to punish and sanction those who commit misconduct or wrongdoing.    Without these constraints corruption is inevitable.

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Although Gavryck may serve PHS, it is not in the capacity of a certified medical review officer; by my count  the documentary evidence alone shows that he violated four of the seven Medical Review Officer Certification Council Codes of Ethical Conduct.  In addition to violating the MRO  Ethical Conduct he violated every other code I can think of from the Hippocratic Oath to the AMA Code of Ethics. and everything in between.

As the MRO for PHS Gavryck’s responsibility is simple.  He is supposed to verify that the chain-of-custody  of the sample was intact before reporting a test as positive.

This is indefensible on all levels (procedurally, ethically, and legally). The documents show with clarity that this was not accident or oversight, but intentional and purposeful misconduct

There should be zero-tolerance for forensic fraud of this sort.   Those of integrity and moral compass would agree.     Transparency, regulation, and accountability are necessary.  It is an issue that needs to be acknowledged and addressed not ignored and covered up.

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

Perhaps Dr. Gavryck needs to see some of the damage he has caused in order to take this responsibility. Known as a “bag man” who simply rubber stamps positive tests at the request of Linda Bresnahan, much like Annie Dookhan, he does not see the damage that is caused. Forensic fraud has grave and far reaching effects and in this case has severely impacted many people and include patient deaths. Perhaps Dr. Gavryck needs to take a “moral inventory” and see that this this type of behavior causes real damage to real people and put a face on it.

Please help me get this exposed, corrected, and rectified. The physicians of Massachusetts deserve better than this.

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Neuropsychological Misconduct –Making the Data fit the Diagnosis Part 2: Cognitive Impairment

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Doctored Wechsler IQ–Boilerplate subtraction of subsets -diagnsosis = cognitive impairment

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

The lawsuit apparently resulted in some changes in the evaluation process.  The errors were deemed intentional in the Masters case as the charts lacked sufficient data for the false diagnosis. Judging by what we see here they are generating intentionally erroneous tests to support an intentionally erroneous diagnosis.

In 2008 I went to Talbott Recovery Center in Atlanta for a 96-hour evaluation due to a positive urine test reported for a substance closely related to a medication I was prescribed.  Despite obtaining a letter from the pharmaceutical manufacturer stating that the drug found in my urine was, in fact, the parent compound of the drug I was prescribed and despite a negative forensic fingernail test  (done by USDTL) I was forced by Linda Bresnahan to have an “assessment.”

I arrived with 4500.00 which was about 500 dollars short for the evaluation. I had requested a forensic hair test  and did not realize they were so expensive.   The primary concern for most of the morning I arrived was when the remaining 500 dollars would arrive. In fact I was told that I would not be able to be admitted until I paid in full.

I had an appointment with an internist, Dr George MacNabb that he cancelled when he found out  I had not  yet paid in full. I have to admit that I, nor anybody I know at MGH, has refused care to a patient based on pre-payment.

The 96-hour assessment included the physical exam, neuropsychological and cognitive testing in addition to drug and alcohol testing by urine and hair.  After finding out my hair test and toxicology screens were negative and in light of my supporting negative nail tests and letter from the pharmaceutical manufacturer I was pretty confident I was good to go but ended up wishing they would have told me the hair test didn’t count before I paid the extra cash.

At the completion of the  96-hour assessment I was brought to their conference room and  told by Dr. Paul Earley and his his assessment team that I needed to stay for treatment.   “I don’t understand,” I said..”I have negative hair (3 months) and nails (6 months), an explanation for the positive test and have never had any problems at work.   I was then told that based on my neuropsychological and cognitive testing I was in denial and “cognitively impaired”  and that they could not advocate for my safely practicing medicine.

I was then taken to accounting to see how I would come up with the 18-25K for treatment. On the last page of my assessment report it states that “Dr Langan agreed with this assessment and recommendations and requested to return home to collect his funds to return for treatment at the Talbott Recovery Campus.”

It is well documented that Talbott will “keep you until the money runs out.”

I had given them a list of people to contact who could verify my work performance was excellent and there were no concerns from anyone including nurses, patients and students.  I asked why they had not contacted my Chief, nurse practitioner or any of my coworkers and was told they had enough information from the PHP Besides, one of them told me “they might cover for you so we can’t put much weight in their opinions.”

My first impression when I started reading the report was that it was another persons assessment given to me by mistake.  The neuropsychology report indicating “denial” I knew was wrong as I recognized the language reporting an elevated L-scale.  Thinking at the time it was an unintentional mistake I asked it be looked at as it was impossible. The L-scale or “Lie-scale” is a “validity” scale that picks up someone trying to portray himself in a positive light so you have to take the rest of the results with a grain of salt. It only works in unsophisticated naive individuals who answer blanket questions related to essentially good an bad behaviors or traits (such as “have you ever lied?”)  believing that is what the audience is looking for.   As a result,  only people bereft of enough common sense to understand that concrete blanket statements are implausible.

Dr. Snook wrote an interpretation of my L-scale as if it were positive ( > 65).  It was later confirmed to be 49 (as normal as normal can be on this) after obtaining the scoring sheet and raw data but even confronted with this he refused to correct it and only did so after the Georgia Psychological Association forced him to.  He engaged in intentional fraud at the request of PHS to show pathology where there is none and in terms of medical ethics there should be zero tolerance for this.  Zero!  Political abuse of psychiatry to give a false diagnosis for economic or political gain is antithetical to both medical and societal ethics.    It is unconscionable in light of all of the doctors who have killed themselves after being evaluated by these programs.

And although I can’t prove it, the  IQ test above was also doctored as I have taken it before and “comprehension” was my best score.   The computer shaves off points to lower comprehension and reasoning subscales and they give a diagnosis of “cognitive impairment.”    I subsequently took it in Boston two weeks later and went back up again!  I wonder what happened in Atlanta?   I could not disprove this one however as there is no raw data generated to prove whether I incorrectly interpreted a proverb or couldn’t tell him what I would do if I found a stamped envelope on the street.


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

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

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Dr. Stephen Snook, PhD

Confirmatory Distortion

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

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

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

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

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

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

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

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

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

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