May 2, 2017 Oral Argument Before Massachusetts Supreme Judicial Court

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Zena Crenshaw-Logal

Executive Director at National Judicial Conduct and Disability Law Project, Inc.

Want to know how it all got started? Michael Langan, M.D., host of our internet radio broadcast, “Protecting Doctors, the Rx for Healthy Patients” and author of the blog “Disrupted Physician”, recently had a few moments to share that story before the Massachusetts Supreme Judicial Court.

Listen carefully to Dr. Langan’s presentation and the response by counsel for the Massachusetts Board of Registration in Medicine.

Then decide if you’ve heard an account of bureaucratic terrorism.

Is this not the Board’s message? Question us and we’ll destroy you in a tangle of red tape, vague aspersions, loop holes, and delays.

And will a man and his family be a cost that the Court considers worth paying to vindicate the seemingly unadulterated power of a state agency — all purportedly in the name of medical patient safety?

https://lnkd.in/e9R67W

VIEW THE ORAL ARGUMENTS @ https://lnkd.in/e9R67WU

Documentation of Collusion Between state Physician Health Program and Drug-Testing Lab provided to Board Counsel Deb Stoller and Tracy Ottina  December 15, 2011 

(Bertram claims this was carefully considered at a December 21, 2011 Board Hearing but it is date-stamped one month after the hearing).  The document is notable for several reasons:

1. It shows clear evidence of collusion between the state physician health program (PHP) and its drug testing lab to commit forensic fraud (the detail is way beyond any of the documentary evidence found in the Dookhan case).  It includes a faxed request from the PHP to the lab requesting the donor ID # on an already positive drug test be changed and the chain-of-custody be “updated.”

2.  The documents show top-down corruption as the collusion is between the medical director of the state PHP (Physician Health Services, inc), Dr. Luis Sanchez (who is also past president of their national organization the Federation of State Physician Health Programs (FSPHP)  which is based in Massachusetts and the Vice President of laboratory operations at United States Drug Testing Labs (USDTL), Joseph Jones.

3.  The documentation of fraud was provided to Board of Registration in Medicine “board” counsel Deb Stoller and Tracy Ottina on December 15, 2011 but never acknowledged or addressed by the board.  Since 2011 scores of suicides have been attributed to allegedly falsified tests (these same tests from the same lab and ordered by state PHPs throughout the country–in the past few months I know three doctors who have killed themselves as a result of the same chains-of-causation (starting with these falsified tests).  Board counsel Stoller was involved in blocking due process and fundamental fairness in the  case of one doctor who killed himself here in Massachusetts who was a friend of mine.  She and Ottina and the Physician Health and Compliance Unit have evidently been  concealing evidence provided by doctors that is both exculpating for them and implicates the PHP in misconduct for years.   It appears that is their function as these “liaisons” to medical boards were put in place at the request of PHPS and apparently operate in the same manner as the “PHP-approved” assessment and treatment centers (who engage in “diagnosis rigging” to charge for assessments ($4-8K) and (inevitable) “treatment” (overwhelming majority of cases unneeded) to the tune of $80-120K) followed by 5-year contracts for drug and alcohol testing using expensive non-FDA approved and non-regulated laboratory developed tests (LDTs) 1-3 week for up to $600.00 per week.  All of this is cash only out-of-pocket no insurance accepted (if it were the racket would be dismantled within a month).    These document contain direct evidence of crimes (including felonies)-no other evidence is needed.

Stoller and Ottina were provided evidence forensic fraud in December of 2011, concealed it and the consequences have been much more far-reaching and grave than Annie Dookhan—-the number of families, careers and lives that have been destroyed since December 2011 is inestimable!   Dozens if not hundreds of suicides have occurred since that time, the loss of countless careers and the snuffing out of careers as they are just beginning (they are now targeting medical students–more sheep for the slaughter). This racket is starting to be exposed in the medical community and the chatter is increasingly increasing–it will make the mainstream media shortly and this grand-scale corruption will be clear.

So what is Massachusetts going to say when it is realized two state attorneys and an assistant AGO knew about it all along and did nothing for years?  There is no plausible deniability here and the willful blindness and veil of constructed ignorance are tread shallow water.   Forensic Fraud and Perjury are not that complicated and obvious to anyone with a modicum of common sense.   AAG Bertram claims no crimes have occurred because no one has been charged with any.  Brilliant!  I didn’t go to law school but I always thought that a crime was determined by the actions (or inactions) of someone as applied to written laws.

Please take a look at the documents.    The  big story  will come out sooner or later.  You should be a part of the solution and on the right side of history when this whole shit-house goes up in flames!

MOTIONS FILED PRIOR TO ORAL ARGUMENTS

1,  Motion to Take Judicial Notice of Adjudicative Facts

2.  Motion to TakeJudicial Notice of Law (Establishment Clause of the First Amendment)

3..Motion to Take Judicial Notice of Adjudicative Facts Pertaining to Violation of the Establishment Clause of the First Amendment

MOTIONS FILED AFTER ORAL ARGUMENTS

4. Petition for Judicial Notice

Source: Medical Students at Risk as Fraudulent Physician Health Programs (PHPs) Cast a Wider Net–Need to Address This Problem at State Level

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Please donate to this effort below.  Your contribution can and will make a difference.  https://www.gofundme.com/PHPReform

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Beyond the Schoolyard: Workplace Bullying

This infographic on workplace bullying was created by International Business Degree Guide to convey the message that workplace bullies not only hurt people, they can also hurt business–driving away good employees in their quest for control.

Adept at dissimulation, those in authority often see what the bully expressly feigns and pretends to be. Under observation by authority the bully hides his true self and often cultivates an image designed to please and impress.  Veiling truth to those in power protects the bully.  Reports of abuse are disbelieved or ignored; dismissed or minimized as exaggeration; deemed a product of bellyachers and whiners.

In addition to hiding his true self the bully will often tell superiors what they want to hear. The workplace bully promotes an image of loyalty, dedication and hard work to superiors and may even feign common ideals and goals.   This  impression management often works.

When bullying ends in tragedy it is often revealed that those who could and should have done something about it knew about it and did nothing.  This failure to act may be the result of blinkered apathy, willful ignorance and even malicious complicity.  This is especially true when the  political and ideological views of the bully align closely with those in charge and the victim of bullying is remotely aligned.

Moral superiority, bigotry, racism and other biases all too often factor into the equation.

Perhaps those without sufficient empathy of others to take action when reports of abuse and harassment are reported to them will do their jobs if they realize workplace bullying might harm them personally or what they value most.

via Beyond the Schoolyard: Workplace Bullying.

Source: Beyond the Schoolyard: Workplace Bullying

Beyond the Schoolyard: Workplace Bullying

WorkplaceBullies

Share this infographic on your site!

Beyond the Schoolyard: Workplace Bullying

Not only do workplace bullies hurt people, they can also hurt business – driving away good employees in their quest for control. What can you do if you find yourself having to face a bully every day?

Share this infographic on your site!

Beyond the Schoolyard: Workplace Bullying

Not only do workplace bullies hurt people, they can also hurt business – driving away good employees in their quest for control. What can you do if you find yourself having to face a bully every day?

Not All That Different …

Schoolyard bullies vs. workplace bullies
Both share a need for control – exercising power through humiliation of a target. If reinforced by cheering kids, fearful teachers or ignoring administrators, there is no reason to change and it often continues into adulthood. (1)

What Is a Workplace Bully?

Characteristics of a workplace bully: (2)

  • Tormenters
  • Tattlers
  • Finger pointers
  • Publicly pick on people
  • CC the whole world in emails
  • Point out your mistakes and tell everyone

Narcissism and self-orientation

What workplace bullies usually score high on in personality tests (3)

Bullying Victims

How many workers are dealing with bullies?
50%
Workers who say they’re treated rudely at least once a week (in 2011); up from 25% in 1998 (4)
66%

Bullying victims who had to lose or give up their jobs to make the bullying stop (1)
40% of workplace bullies are women, picking on other women more than 70% of the time. (5)

How Bullying Can Hurt Your Business

Work is stressful enough on its own, but adding a bully to the mix can make it unbearable.
9% of people say they’re happy at the office. (3)
Less than 1/3
Employees who say they’re engaged at work (3)

Workplace bullying can have serious negative effects on employees, such as: (6)

  • Stress
  • Absenteeism and low productivity
  • Lowered self-esteem and depression
  • Anxiety
  • Digestive upset
  • High blood pressure
  • Insomnia
  • Trouble with relationships due to stress over work

All of this can hit the company’s bottom line, causing: (6)

  • High turnover
  • Low productivity
  • Lost innovations
  • Difficulty hiring quality employees due a “hostile work environment” reputation

Got a Bully? Here’s How to Deal

Avoid the workplace in the first place (1)

  • Ask why the job is open and how long the predecessor was there (turnover is a bullying sign)
  • Ask about the attitude toward “workaholics.” If it’s expected, then you can know what you’re getting into
  • Ask about policies and codes that help ensure a respectful workplace

Once you encounter a bully (5)

  • Don’t get emotional (bullies like that)
  • Don’t blame yourself (the problem is the bully, not you)
  • Do your best work
  • Build a support network
  • Document everything
  • Seek help
  • Get counseling
  • Stay healthy
  • Educate yourself about policies
  • Don’t expect to change the bully
  • Start a new job search

25% of workplace bullying deals with discrimination. If that’s the case, you can talk to an attorney. (7)

Don’t hire a bully
Recognize certain traits in an interview process: They usually interview well due to a desire to control the situation. Invite them to an informal lunch and see if they’re empathetic (good) or brag about “cracking the whip” (bad). (8)

Sources:

1. http://www.workplacebullying.org
2. http://www.forbes.com
3. http://www.usatoday.com
4. http://hbr.org
5. http://www.huffingtonpost.com
6. http://www.bullyingstatistics.org
7. http://www.ivillage.com
8. http://www.ere.net

Legal Representation in “Physician Health” Matters: A Swamp in Need of Draining.

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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.  Most of those involved in representing physicians before medical boards in these matters are former board attorneys or assistant AGOs. When those outside this cloister  appear before medical boards they are like a deer in the headlights.  It is a new terrain where all due process and familiar protocol have been removed.  Truth and evidence are irrelevant as labyrinthine administrative procedure and protocol are used to trump all other consideration.  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.  The current pool is glutted with those who will not “bite-the-hand-that feeds.” They depend on referrals from state physician health programs for their livelihood and this precludes going against the tide.

 

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

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

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

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

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

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

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

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

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




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

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

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

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

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

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

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

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

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

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

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

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

― Thomas Paine 

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

—Milton Friedman


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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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“REVISED REPORT PER CLIENTS REQUEST”  

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

August 6, 2014 to Langan with health materials.

The documents sent by USDTL are notable for two things:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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USDTL willingly complied with this request.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Righteous Vocational Fury and “the need to be ballsy and capable of rebellion”in the medical profession -apt and universally applicable words from BMJ

 

img_1156The majority of doctors are of good heart and sound mind.  Most doctors strive to do the right thing and the correct thing to the best of their capabilities in any given circumstance. Most doctors by nature are intelligent, inquisitive and caring. Their actions are not driven by self-interest or greed but by  thoughtful reasoning and moral compass. As in any population, of course, vast differences exist in individual characteristics including intellectual acumen, empathy and common sense.  Those bereft of moral compass and the intolerant and prejudiced walk among us in all professions.  Medicine is no exception.  The simple truth to the matter is  overwhelming majority of people are good people. They are honest, have integrity and are guided by conscience.  Most police officers are not trigger-happy racists.   Most Catholic priests do not have an affinity for alter-boys. And most doctors do not hand out opiates like halloween candy.  What we hear about are the exceptions not the rule.

John Forbes Nash was an American mathematician who made fundamental contributions to differential geometry and game theory and portrayed by Russel Crowe in the 2001 film A Beautiful Mind. Nash described a type of equilibrium in which these harmful exceptions were kept at bay by the population majority with empathy and reasoning.  This small minority of the population was kept in check by countermeasures.  Miscreant actions were met with law and other measures that provided consequences for actions outside societal norms. Thus self-serving actions in one’s best interest but at the expense of others was stifled and prevented from gaining a foothold in the majority population.

In regard to the medical profession an apt example of Nash equilibrium is the case of Detroit Doctor Farad Fata  who devised a scam to diagnose cancer in patients who did not in fact have cancer to profit from the unneeded treatment; an unconscionable scheme incomprehensible to those of ethical integrity. His pocket was lined with 34 million dollars over the years.  When he was eventually caught the Federal prosecutor recommended a 175 year prison sentence due to his egregious acts and he was sentenced to 45 years in prison.  Although someone contemplating a risk benefit analysis of diagnosing healthy patients with cancer as a means to put coins in their purse is undoubtedly a rare event the severe consequences of Farad’s action serves as a deterrent.  Criminal reasoning also employs a risk/benefit analysis regarding the chances and consequences of getting caught.

screen-shot-2016-12-13-at-8-01-35-pmWhat might Nash think of a population in which this minority of deviants was not punished for their actions but instead given “treatment” in a communal area where they were able to interact with others of the same constitution ?  What do you think Nash might say if individually and collectively this same population was put in a position of power over others but without any oversight, regulation or accountability?  A disequilibrium would inevitably ensue with grave complications to the rest.

Screen Shot 2016-12-13 at 6.21.28 PM.pngCoraline is a children’s novella written by the British author Neil Garman in 2002. It has been compared to Lewis Carroll’s  Alice’s Adventures in Wonderland and adapted into a film in 2009.  Coraline is a little girl who moves into a new house with her parents.  She is constantly bored and unhappy her parents do not give her the attention she wants and while exploring the house she finds a door that leads to an alternate version of her reality where her parents are fun and attentive and everything seems wonderful but things get creepy very quickly.  Her parents look like her parents but instead of their eyes they have shiny black buttons and she soon finds herself in a horrific and dark place that looks like reality but slightly off and terribly ominous and threatening.  Such is the case with the medical profession today. Somewhere along the line it took a nasty left turn and although looks the same its slightly off nature has become threatening and crippling to many. An erosion in the hierarchy has occurred and much of the practice and policy pushed by the self-interest groups to regulators and administrators is not only bad, it is absurd.

Most doctors strive  to do the “right thing” but it is difficult.  Gauntlets have been put in place that cannot be maneuvered by those who strive to do their best and do not cut corners. The current environment precludes creativity and despises independent thought. Both professional and private life is held to demands of the unthinking obtuse. It defies logic, reasoning and common sense.

Doctors have become nothing more than collared dogs, leashed and led by the authoritative pronouncement of unexamined, illegitimate and irrational authority.  Evidence-base, critical reasoning and common sense have taken a back seat to power and control.

screen-shot-2016-12-13-at-8-05-29-pmMy hero’s in medicine both historically and personally have always been the maverick’s -those doctors with superlative and almost preternatural clinical acumen who can make the  right diagnosis when no one else could or have made daring and unprecedented contributions to the field.

One example would be  Dr. William Morgan who helped Boston win the World Series a dozen years ago by performing a surgical procedure he invented on Curt Schilling’s ankle that allowed him to pitch when all the other experts said it was impossible. It worked.

When someone makes a diagnosis that eludes others or pioneers an innovative mechanism to improve the science of medicine it is an event that should be cheered and applauded not jeered and dismissed.

Of all the sad stories I have heard one particularly hit a nerve.  A patient who was having intractable abdominal cramping and pain remained undiagnosed after multiple colonoscopies and endoscopies.  He went to an older doctor who diagnosed him with an obscure diagnosis (splenic flexure syndrome) that is easily treatable and diagnosed and cured the patient of his pain with dispatch.   When I was in medical school this would warrant three cheers and a toast. That is not what happened.  Those clueless individuals wielding the endoscopes and colonoscopes who could not piece the puzzle were not happy that a general practitioner made a diagnosis that was nowhere on their radar. They reported him to hospital administration and the bullying and mobbing that ensued became too much.  Deemed a disruptive physician he slit his throat during an operation. An assured comeuppance to the dregs that drove him there.

What do those in the physician health and regulatory corner of medicine think of maverick doctors?. The quote below is from an article in The Federal Bulletin, the official journal of the Federation of State Medical Boards (FSMB) entitled Proctoring of Disciplined Health Care Professionals: Implementation and Model Regulations. It is these regulations that helped shape the current physician health paradigm.

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The implication is danger (not all of them mind you) but lets identify and weed them out. The right to “due process” as other practitioners is a curious remark and am unclear what exactly is meant here as:  1. due process is a right that should be afforded everyone and anyone; why is this even be considered unless they dispense it in different ways to different folks, and 2. Physician health programs have completely removed due process from doctors through ‘medicalization.” It does not exist.  One of their selling points to the medical boards was its absence as they could remove a doctor from practice immediately and “without the constraints” of due process.  All it takes is the mere accusation of  a “potentially impairing illness.”  That is what the did with Dr. Morgan. They have also done it to some of the brightest minds I have known in medicine.  It is tragic.  It is also not on the radar of most.  The institutional injustice and absent redress has led to an epidemic of suicides and it is time this be acknowledged.   Physician suicide is not caused buy “student loans” or “overwork.’ Those are challenges that can be overcome.  Suicides occur when one is helpless, hopeless and trapped and that is what is happening here. I cringe every time I read some half-baked speculation on the cause of physician suicide.  Those who need help are afraid to get help and those who do not need help are being entrapped in a system that is more than happy to “loosen” the diagnostic criteria and provide unnecessary treatment for a “tailored” diagnosis.  Follow the money.

And while outspoken in denouncing what they regard as unethical and unprofessional behavior by other doctors, many of those who hold others to account are resistant to apply even the most minimal standards to their own activities. The primary author of the model regulations surrendered his medical license in 2001 after allegations of an “inappropriate ‘extended relationship'” with one of his patients.   A not all that uncommon scenario in this population.

Doctors have been subjected to an intentional diminution of stature and much of this has to do with the moral panics and bogus dangers of doctors that has been spewed to the public by these very same organizations as they have gained a seat at the table of power.

screen-shot-2016-12-13-at-8-33-17-pmAuthority needs to be grounded in wisdom and  guided by ethical principles and codes of conduct.  Such is not the case.   If the information agencies rely on to make decisions and policy is unreliable then bad decisions, wrong decisions and flawed public policy can occur.  The consequences can be far-reaching and grave.

Rank-and-file doctors exist not in a repose of complacency but of disquietude. By nature they do not typically speak up.  Most are afraid to.  They have effectively been stifled by threat and fear.  What is stunning is the commonality of this.

The BMJ paper below by Sophie Cooke refers to the practice of medicine in the U.K. but is apt and applicable in the U.S.  Historically doctors have not vociferously spoke up as much as those in other professions. They tend to remain quiet and do not want to make waves. I have been contacted by many doctors who could speak out and make a difference but they don’t. The question that incessantly tugs at me is when will these people say “enough” and say something.  Can what has been done even be undone at this point.  Cooke speaks of “righteous vocational fury” and that the vocation needs to “be ballsy and capable of rebellion.”   We too need to stand as one and speak out against illegitimate and irrational authority.  We need to proclaim “enough is enough” and identify and remove illegitimate authority.   What does it take for someone to stop bemoaning the current state of medicine quietly and silently and get “ballsy” enough to vociferously protest and rebel?  Stand up.

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Link to BMJ article here.

Editor’s Choice

In search of a good nanny

BMJ 2016; 355 doi: http://dx.doi.org/10.1136/bmj.i6565 (Published 08 December 2016)Cite this as: BMJ 2016;355:i6565

Sophie Cook, clinical reviews editor, Author affiliations,   scook@bmj.com

Nannying, like medicine, is a vocation. The good nanny was everything a family could wish for: she cared for, helped, and guided her family to make their own decisions, knowing when to interfere and, crucially, when to butt out.

This week Simon Capewell and Richard Lilford debate whether, when it comes to states, nannying makes us healthier and whether information or legislation is the way to change health behaviour (doi:10.1136/bmj.i6341). Lilford explains, “There can be no autonomy if the state, rather than the individual, is the custodian of personal values.” He warns, “The nanny state’s impatient and sometimes self righteous zeal could do more harm than good.” Capewell argues that, on the contrary, a “nanny state means ensuring a healthy environment for all” and underpins every health determinant in Ivan Maslow’s hierarchy of needs, such as safety and love, to allow us to enjoy our health and fulfil our true potential.

One group lacking many fundamentals of Maslow’s pyramid is homeless people, who often struggle to access healthcare. Anne Gulland describes how some successful UK projects have broken down barriers to services (doi:10.1136/bmj.i6511). Helpful tips include drop-in clinics, more flexible appointment times, and awareness that lack of a permanent address is not a barrier to registering with a GP.

From a group that struggles to access healthcare to a group offered it in abundance: pregnant women. Karin Nelson and colleagues look at the role of electronic fetal monitoring in labour and at how an intervention that was initially introduced to reduce cerebral palsy (it has not) has subsequently been linked to increased rates of caesarean delivery and litigation (doi:10.1136/bmj.i6405). They call for doctors, courts, and the public to recognise the lack of proof for routine electronic monitoring and remind us that technologies in healthcare can have unintended consequences.

And finally, as we approach the end of a turbulent year in the NHS Margaret McCartney tells us it’s a sense of vocation that keeps it going (doi:10.1136/bmj.i6526), with doctors committed to going the extra mile. But this commitment also means that professionals can be exploited, she says, and that vocation “needs to be ballsy and capable of rebellion.” Will 2017 bring the “righteous vocational fury” she is hoping for?




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I am Offering Over $25,000 in cool prizes to anyone who can prove fewer than 3 felonies were committed by past FSPHP President Sanchez as shown by documentary evidence alone! I claim I can detect multiple very serious crimes in these documents–prove me wrong and the whole lot is yours!

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Federation of State Physician Health Programs (FSPHP) removed from accountability with low risk of suffering consequences for misconduct

According to Erich Fromm rational authority is based on competence, experience, and mutual respect.  Irrational authority is often disguised as benevolent paternalism and is designed to perpetuate or intensify conditions of inequality through the use or threat of force, deceptiveness, and secretiveness.

The Federation of State Physician Health Programs (FSPHP) has has operated as an unexamined authority for the past 25-years .  They have pushed practice and policy unquestioned and without opposition that has gravely harmed individual doctors, the medical profession itself and the public at large.  Everything they have done has been done to benefit themselves and their drug and alcohol assessment, testing and treatment affiliates in the provision of protections, power and profits.

Examining the specific practice and policy pushed reveals a body of false-claims making designed to facilitate the systemic use of coercion and threats, remove all due process protections and fundamental rights from physicians and prevent, block and eliminate the evidence.  This practice and policy collective has created a culture of impunity, immunity and deference that is able to successfully conceal ethical violations and crimes.  Uncovering their wrongdoing is a nearly impenetrable gauntlet. It is a system of institutional injustice that is undoubtedly a major contributor to the suicide epidemic in the profession.  They have been able to conceal the truth, avoid investigation and prevent punishment for years by removing themselves from all accountability and outside inquiry. Direct and specific questioning appears to be their Achille’s heel as the recent spat of articles critical of these programs is showing just how much of an illegitimate authority they really are.

In her rebuttal to Pauline Anderson’s article “Physician Health Programs: More Harm Than Good?” FSPHP President Doris Gunderson dismissed the accusations of fraud and abuse in one fell swoop as  “allegations rather than facts” and second hand anecdotes.  Countering allegations of an absence of oversight and regulation she states:

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“In fact, we operate under a microscope, answering to individual practitioners, medical boards, malpractice carriers, defense attorneys, state attorneys, medical societies, hospitals, medical schools and residency training programs. We are also accountable to patient safety entities and a Board of Directors.”

Untrue. Accountability demands both provision of information and justification for actions to outside entities capable of punishing misconduct. . What was done and why?  No such entity exists and no pathway for appeal or grievance redressal exists either. Zero accountability.  Ditto for the “PHP-approved” assessment and treatment centers. As cash only out-of-pocket facility they remove themselves from the prying eyes of insurers.

screen-shot-2016-01-13-at-9-55-47-amThe North Carolina PHP Audit  found the past FSPHP President and NC PHP director Warren Pendergast could not identify the qualitative or quantitative indicators used for “approving”  PHP-approved facilities. The best he could come up with is “reputation” and “word of mouth” yet state medical boards mandate evaluations of doctors at these  facilities and specifically exclude  non-“PHP-approved” facilities.This is enforced by the Federation of State Medical Boards Policy on Physician Impairment.  Each state managed by the FSPHP utilizes the same dozen or so facilities and each state medical board mandates it under threat of disciplinary action.  It is in fact a rigged gam

Denying accusations of coercion Gunderson states in her rebuttal to Anderson’s article:

“The detractors of PHPs interviewed for the article maintain that PHPs are coercive. Yet the report fails to mention that PHPs have no authority to mandate treatment and monitoring, suspend or revoke licensure, or otherwise discipline physicians.”

screen-shot-2015-10-07-at-7-11-18-pmThe report fails to mention it because it is more either/or logical fallacy based on the false dichotomy between “treatment” and “punishment” that is often used to promote the FSPHP mythology.  Although PHPs do not have the legal authority to mandate, suspend or revoke a license they have the functional authority to do so.   This is also dictated by public policy.  (ASAM Policy on Coordination Between Treatment Providers,  Professionals Health Programs, and Regulatory Agencies).

Legitimate authority articulates ethical, evidence-based, or internally consistent arguments when challenged.  Legitimate authority does not simply delegitimize one’s opponent and use logical fallacy and obfuscation to avoid addressing the substance of an argument. In her rebuttal Gunderson claims the NC Audit was favorable to them because no evidence of abuse was found.  This is akin to a serial killer claiming victory because no bodies were found in his dungeon replete with torture devices and restraints. State auditor Beth Woods set this straight when she told the BMJ in  Physician Health Programs Under Fire  that the holes were big enough in the program “you could drive a truck through them” and it would be “difficult, if not impossible, to defend” oneself against an incorrect assessment” as no ability to “appeal a diagnosis or assessment” existed.

screen-shot-2016-01-13-at-9-52-11-am“Compounding the problem, said Wood, was that “the chief executive and medical director were in total control of entire process.” They assessed allegedly impaired doctors, but when those assessments were contested, they were responsible for presenting complaints to the state medical board. The doctors concerned were not allowed to be present and were not allowed to see the programs’ medical reports on them.”

Multiple Barriers Removing Accountability at Multiple Levels

The  inability to obtain one’s own medical records or lab reports is the first obstacle one must overcome. The second barrier is that even if documents are obtained there is no one to give them to.  The third is the existence of “point people” who deflect, block and otherwise dismiss valid complaints.  The only oversight provided to the involved labs is an an accreditation agency, the  College of American Pathologists (CAP) They can investigate and correct but do not have the ability to sanction.

screen-shot-2016-12-09-at-1-13-29-pmOf the many hundreds of doctors I have spoken to and who have taken my survey not one has been able to obtain evidence of abuse.  It was either refused, censored or doctored.   I have obtained documentary evidence that is specific, detailed and unequivocal.

It is therefore critical it be recognized for what it shows and it is morally imperative that those involved be held to account as the documents illustrate clearly and undeniably a collusion between a state PHP and its drug testing lab to fabricate evidence.  The corruption is top-down as it involves another former FSPHP President Luis Sanchez and the VP of Laboratory operations at USDTL Joseph Jones.  As explicit and detailed as it is in revealing unequivocal  black and white crimes it has been ignored by the usual channels.

Research on street criminals suggests the certainty of punishment has the strongest deterrent effect (basically will I be caught) and the more people think they will be arrested for a crime the less likely they are to commit it. Criminals weigh their actions against possible gains and consequences and the risk of consequences in this system have been essentially zero.  Diagnosis rigging, coercion, threats and abuse are rampant because they have no fear of punishment.  The Chairman of the commission that examined the  causes of the 2008 financial collapse compared the  relatively small fines paid by corporations to “someone who robs a 7-Eleven, takes $1,000 and being able to settle for $25 and no admission of wrongdoing.” He added,“Will they do it again? Absolutely, because it pays.” This is like someone who robs a 7-Eleven, takes $1,000 and never gets caught so he goes to the next 7-Eleven and takes $2000 then hits as many 7-Elevens as he can for as much as he can.

Multiple Crimes, Multiple Felonies and Egregious Misconduct.  Fabrication, Falsification, Concealment and Perjured Evidence. Color-of-Law Abuse, Civil Rights Violations 

In June of 2011 I signed a patent-license agreement with a company to bring an epinephrine auto-injector to FDA approval  within three years.  It was recently mentioned in an NBC news article in the wake of Mylan’s Epipen price hike and the patent  documents can be seen here and a slideshare overview here.  This was successfully derailed the following month when I was asked by the state PHP to have an alcohol test.  This was for no apparent reason. I have never been accused of having an alcohol problem and my work performance at MGH was reported as “impeccable.” There were no issues in any arena.  The events are described in detail here, here, and here.

The blood test was reported positive to the medical board on July 19, 2011 as seen here:   positive-peth-july-19-2011    I requested records but PHS refused but relented in December 2011 and I obtained the   USDTL Litigation Packet  which contained a faxed request from PHS to the lab requesting my unique  identification number and a “chain-of-custody” be added to an already positive report See key docs here.:12:3:2011 Litigation Packet (Selected)

The records showed falsely created and fabricated evidence. Clear fraud. I filed a complaint with the College of American Pathologists CAPLetter.  They investigated and forced USDTL to correct the test as reported in an  October 4, 2012 letter from the lab to Sanchez. Instead of revealing the correction the two concealed the revision and reported “non-compliance”  two weeks later  and board took disciplinary action against my license.  In December 2012 CAP contacted me to followup on the outcome of the revised test which I was unaware of.   I informed them they did not tell me and confronted  PHS but they claimed no knowledge of it.. On December 11, 2012 Sanchez reports to the board that he just found out that the test was revised but it had nothing to do with the disciplinary action taken by the board..  Sanchez and Jones deny there was any correction 67-days earlier and stand by their guns.

In August of 2014 I was able to obtain the complete USDTL documents under new HIPPA-Privacy Rule for labs which removed PHS approval.  Full docs can be seen here:  August 6, 2014 to Langan with health materials.   The  October 4, 2012 correction from USDTL to Sanchez  contradicting Sanchez claim of not finding out about the correction until December is included.Note the language used in the  Letter claiming Sanchez was informed of the revised  test 67-days after he actually was.

Recently obtained documents under records reform act –  Langan PDF copy  They show documents entered as evidence date-stamped and entered into the administrative record after the hearings at which they were to be heard.   Multiple others missing and never addressed.   It is now clear that Stoller concealed all documents relating to PHS misconduct since December of 2011.

Specific and detailed evidence of criminal activity was provided to Board Attorney Deb Stoller over the course of more than five-years. This showed clear collusion between the state physician health program and one of their preferred national drug testing labs.  It is important to recognize the gravity of what this means.   I provided a state officer with evidence of crimes similar to Annie Dookhan–clear fabrication and collusion to fabricate evidence. She suppressed it.     This is much much worse than Annie Dookhan as the lab is used by state physician health programs across the country and over the past five-years their have been multiple suicides of doctors who have allegedly been given fabricated drug and alcohol tests just like mine.    Many of these doctors were given positive tests right before they were to complete a 5-year contract and this is a pattern that seems to be occurring as the rule rather than the exception.   Facing five more years of abuse some doctors have chosen to end their lives rather than continue with the PHP.

Specific and detailed evidence of the fraud was given to Deb Stoller over the course of five-years and she did nothing about it to protect Sanchez.   The impact of this is much greater and the consequences much more severe than what occurred with Dookhan.  As The documents clearly showed felony crimes this is egregious and indefensible.

screen-shot-2016-12-09-at-1-14-00-pmWhat is chilling is that this request to falsify evidence was done by fax and the lab complied with full knowledge that the positive-test would result in grave and possibly permanent consequences for someone.  The moral detachment of Jones is incomprehensible to me.  If I was offered a  million dollars at this moment to fabricate a drug test on some stranger I would not do it. I would not for any amount of money and I don not believe the majority of my friends would either.I also contacted Jones (  August 6, 2014 to Langan with health materials ) and told him of the severe consequences this was having for my family but he did not respond.   Had it not been for the new HIPAA -Privacy rule I would never have obtained these documents and without the record reforms act I would never have obtained the evidence implicating Stoller ( Langan PDF copy )

screen-shot-2016-12-09-at-1-13-52-pmIt is now time to enter phase two of exposing the corruption of PHPs. It is now necessary to necessary to relentlessly contradict the lies and falsehoods and and present the evidence with logic and clarity.    It is necessary to name names, point fingers and demand that direct and specific answers to direct and specific questions.  It is time to shine a bright light on the specific  unethical and illegal acts detailed here. They are the rule not the exception and the diagnostic rigging and forensic fraud make these more murders than suicides. This is a public health emergency.   By my estimates over 80% of those being monitored by PHPs do not even meet the diagnostic criteria for substance use disorder or any other psychiatric disorder.  It is political abuse of psychiatry.

screen-shot-2016-04-26-at-10-58-19-pmLegitimate authority has a responsibility to be truthful to one’s words and deeds and policies need to be enforced in a consistent manner.  State PHPs are engaging in fraud in collusion with their preferred drug and alcohol assessment, testing and treatment centers.   They are giving diagnoses to individuals who do not meet the diagnostic criteria for a given diagnosis to provided unneeded treatment. They are financially exploiting doctors under threat of disciplinary action against there medical licenses.

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The Board claims no crimes were committed because no one has been charged with any crimes.  No, Dr. Sanchez has committed very serious crimes including multiple felonies. This can no longer be ignored. These crimes can be determined by the documentary evidence alone. They are self-evident.

To settle the matter once and for all I am offering over $25,000.00 in cool prizes to the first person who can disprove my claim that Dr. Sanchez committed multiple felonies.    My claim is that by simply looking at the dates and documents multiple felonies are clear.  They are not equivocal.  The first person to disprove this assertion may collect each and every item pictured below.  You can even write up a legally binding contract and I will sign it. There is something for everyone and if anyone has any questions about any of it feel free to ask.screen-shot-2016-09-09-at-7-26-42-pm

To summarize,  I can find multiple clear  felonies in the documents that need no further inquiry. They are black letter law and involve fraud, concealment, perjury and other crimes.  Policies and laws need to be enforced equally.   The Board cannot play favorites and give allowances to its friends when it comes to criminal activity.  Sanchez is licensed by the medical board just as I am and the screen-shot-2016-09-09-at-9-08-18-pmboard’s position on the fraudulent practice of medicine is quite clear.

One felony would be demand the board address what is seen here.  Multiple felonies make it inexcusable to ignore and if it is ignored it will be relentlessly addressed again and again and again.   As it is so difficult to obtain evidence it is necessary that this be addressed with full measure as a precedent.  People just like this are harming good doctors across the country and unless you are profiting from the drug and alcohol testing and treatment racket you should be disgusted at what is seen here.   The fact that Sanchez pontificates on the behavior of others makes this particularly egregious.  Moreover, Jones also tests newborns and other groups with these same tests.  If he is this unethical who knows what amount of damage has occurred.  Anyone of integrity and conscience should be outraged by what is seen here.  As it is one of the clearest and most specific examples of laboratory fraud I am going to be asking for help getting this out–it should be used to show how this type of drug and alcohol testing can be abused.

Direct and specific questions deserve direct and specific answers. This will need to be addressed directly as it is not going away and neither am I.   If cannot disprove fewer than three felonies than they need to be addressed.   Suspect similar point-people in other agencies protecting them.

If multiple felonies were not committed then  you would think at this very moment there should be people knocking on the door trying to get my attention so they can collect these prizes.    I don’t hear anybody knocking, do you?

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Prizes as Below

Medical Students and Physician Health Programs–A Modest Proposal to Medical School Administrators to Prevent a Potentially Impairing Catastrophe

screen-shot-2016-03-10-at-10-17-17-pmIt is hard to imagine a more stupid or more dangerous way of making decisions than by putting those decisions in the hands of people who pay no price for being wrong. 
-Thomas Sowell

I have been contacted by multiple medical students since my post concerning state physician health programs (PHPs) targeting medical students. These students have reported similar stories of coercion into unneeded treatment under the threat of being pulled from medical school.  They were told either comply with the demands of the PHP or you will not be coming back next semester.

Potentially Impairing Diagnosis

One concerning pattern that is emerging in these reports are students that are being referred to these programs not because of any specific concern or precipitant event, but because of a past diagnosis or existing long-term diagnosis that has been stable under treatment by qualified professionals.  Two students who contacted me have had ADHD since high school under control with legitimately prescribed Adderall , two had histories of depression long resolved and another  was being treated for depression with a legitimately prescribed anti-depressant.   These students were in the dark as to why they were being referred to the PHP, knew nothing about PHPs and had no idea any adverse consequences were a possibility.  They initially thought this was some sort of student health type wellness “check-in” where they would just touch base for reassurances regarding proper diagnosis and treatment and that would be the end of it.   Such  was not the case as things took a nasty left-turn for them once they met with the PHP.  Each was referred for out-of-state evaluations. Each was given a diagnosis with recommendations for inpatient treatment.   Each was told by their medical schools that if they did not comply with recommended inpatient treatment they would be pulled out of school the following semester and not be coming back.  Each has met a dead end negotiating with their schools. Only one student is capable of getting the money to complete the recommended treatment  which is out-of-pocket and not covered by insurance (60-80 thousand dollars on average).screen-shot-2015-04-03-at-2-48-33-am

How did this occur?  The inpatient evaluation centers justified their treatment recommendations by questioning the stability of their diagnoses and expressed concerns about possible underlying issues potentially precipitating future impairment. The conclusions were that they would “benefit from treatment” and that the evaluators “could not advocate” it would be safe for them to continue medical school because of their “potentially impairing illness” and the possibility of future patient harm. Of course substance abuse issues were also raised as both students with ADHD were given diagnoses of “Amphetamine Use Disorder” and two others were given a diagnosis of possible “Alcohol Use Disorder.” The latter was based entirely on a positive PEth (Phosphatidyl-ethanol) biomarker (a test introduced and promoted by physicians involved in state physician health programs.

What boggles the mind is that these students all provided letters from their treatment providers and obtained independent and comprehensive evaluations from outside experts contradicting the diagnoses and disavowing inpatient treatment as well as collateral support letters.  None of it was acknowledged let alone addressed.  Two students asked why they needed inpatient treatment when they had expert opinions deeming it unneeded and they were fine.

“Because they are the experts.”

Now the assumption of omniscience,  blind faith and the spirit of authoritarianism are unacceptable mindsets in academic medicine.  The validity and reliability of opinions lie in their underlying methodology and evidence base. Reliance on the personal authority of any expert or group of experts is the fallacy of appeal to authority.  Social and academic responsibility demand investigation and questioning when contradictory evidence is presented especially when the consequences can be permanent.  The American philosopher and feminist theorist Marilyn Frye defined oppression as “a system of interrelated forces and barriers which reduce, immobilize and mold people who belong to a certain group, and effect their subordination to another group.”  Individuals in academia should play not be willing participants in a system of institutional injustice and the role of detached bystander giving full deference and allowances to these pious wolves is no different than being a willing henchman.  The result is the same. screen-shot-2015-03-25-at-9-01-24-pm

It appears the  Federation of State Physician Health Programs (FSPHP) has used the same tactics with academic administrators as they have with regulatory and hospital administrators. They have convinced them to not question their methods or motives lest it “undermine a culture of professionalism.” They have done this by claiming.

  1. We are the experts. We are benevolent. We are here to help.
  2. Leave it all up to us.  No worries. Referral  is the first step so do not burden yourselves with preliminary investigations of board disciplinary meetings.  We will do all the work and take the burden off of the administration.  No more in-house review.
  3. By the way questioning our authority undermines our authority.  We are the experts and we are doing all the work. We should make this official by written policy and procedure. No questioning our diagnoses.

While outspoken in denouncing what they regard as unethical and unprofessional behavior by other doctors, they are resistant to apply even the most minimal standards to their own activities.

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Unexamined, Illegitimate and Irrational Authority

It is important to recognize that the Federation of State Physician Health Programs (FSPHP)  has been making authoritative pronouncements on physician health issues as unexamined authority since 1990. Over the past 25-years they have influenced a large body of practice and policy with no meaningful opposition. It only takes a modicum of investigative research to reveal each specific practice, each legal, regulatory and healthcare policy the pushed and each position they took on the issues.  It is simple to identify the what, when and why on all of it.  One invaluable resource is the The Journal of Medical Regulation  archives which is the official publication of the Federation of State Medical Boards.  It has been fully archived online with every issue in chronological order containing full articles.  An index related to all practice and policy pushed by the FSPHP is easily generated by putting in keywords related to physician impairment.

screen-shot-2016-12-08-at-3-34-23-pmOnce practice and policy is identified a risk/benefit type analysis can be done on each and this is a rather simple matter as the issues are fairly black and white.  Statistics is not needed-just common sense and logic.   What one will find is that the practice and policy promoted by the FSPHP has not in the best interests of doctors or society but in the best interests of the FSPHP and the drug and alcohol testing and treatment industry .  In short, the individual practices and policies have provided physician health programs with more power and protection while incrementally removing the fundamental rights and due process protections of doctors with the end result being not only control of their professional behavior but their private lives.  To benefit the drug and alcohol testing and treatment and treatment industry they have pushed a plethora of bad ideas including introducing junk-science for forensic drug testing and limiting physician evaluations to only “PHP-approved” assessment and treatment centers.   A public policy analysis is long overdue.   So too is a conflict of interest analysis and a critical analysis of the”research” which consists of two categories; 1. Research showing that shows the high success rates and benefits of PHPs 2. Research on laboratory developed tests (LDTs) and other dubious testing methodology they have introduced (such as non-validated neuropsychological testing for diagnosing disruptive physicians) and promoted    (including polygraphs which is unbelievable since AMA policy discounts them as a game of chance.).   All practice and policy that has been pushed by the FSPHP was accepted by the FSMB (and others) without question or concern.   It has all  been done with no meaningful opposition.

It was not until 2012 that anyone stood up and challenged their policy and practice.  In 2012 John Knight, M.D. and J. Wesley Boyd, M.D., PhD published a Journal of Addiction Medicine article entitled Ethical and Managerial Considerations Regarding State Physician Health Programs and they state:

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

screen-shot-2015-11-17-at-11-00-44-pmHighlighting the  significant financial conflicts-of-interest between PHPs and their preferred assessment the authors add:

“..if the PHP highlights a physician as particularly problematic, the evaluation center might—whether consciously or otherwisetailor its diagnoses and recommendations in a way that will support the PHP’s impression of that physician.”

As any first-year  medical student knows a “diagnosis” is derived from signs and symptoms. It is something that is arrived at. It cannot be “tailored” like a suit.  It represents diagnosis rigging and fraud. And as the “recommendations” inevitably amount to inpatient treatment this equates with the political abuse of psychiatry.   This paper generated little interest.  Just as facts, evidence and reason are drowned out under the all encompassing misappropriation of the term “denial” the serious allegations of Knight and Boyd were drowned out under the bogus claim of the successful outcomes of these programs.

Emerging and Emergent Concerns of Diagnosis Rigging and Fraud

 Pauline Anderson’s  Physician Health Programs: More Harm Than Good? has recently opened the door to exposing the financial exploitation and abuse of doctors by state physician health programs (PHPs) and their preferred drug and alcohol testing and treatment facilities. The August 2015 Medscape News article was the first mainstream medical publication to specifically address the coercive tactics of these programs and the dearth of oversight and accountability.

screen-shot-2016-09-30-at-1-31-17-pmIn her  rebuttal  to Medscape Medical News  FSPHP President Doris Gunderson claims that PHPs do indeed have oversight. She states:

 In fact, we operate under a microscope, answering to individual practitioners, medical boards, malpractice carriers, defense attorneys, state attorneys, medical societies, hospitals, medical schools and residency training programs. We are also accountable to patient safety entities and a Board of Directors. 

This statement is untrue.  Accountability requires both the provision of information and justification for actions to a a truly independent outside agent capable of providing sanctions for misconduct. This requires an outside independent organization with both investigatory and disciplinary authority. No such agency exists for these programs. Multiple articles questioning these programs integrity and intent have come out since this time such as “Physician health programs under fire”  published in the British Medical Journal (BMJ) and written by  BMJ editor Jeanne Lenzer.  None received any meaningful response.  The fact that the President of the FSPHP responded to the BMJ with logical fallacy and half-truths is concerning.  Another past president of the FSPHP who was the medical director of the North Carolina PHP was unable to identify what qualitative indicators and quantitative measurements went into “approving” the “PHP-approved” facilities.  The only response he could give was reputation and word of mouth.  He could not provide any criteria. and did not plausibly answer the question.The audit of the NC PHP can be found here.  Documentation that another past president of the FSPHP is involved in forensic fraud and fabrication of evidence is precise and clear.  It is indefensible.  These are all past presidents of the FSPHP and their inability to provide direct and simple answers to direct and simple questions is inexcusable.

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Removal of Due Process Through “Medicalization”

Physician health programs (PHPs) are viewed as facilitating “treatment” not “punishment” and are analogous to criminal justice system policy aimed at solving social problems by obtaining individual compliance to a given social structure.  Given the assumption that these programs are providing help to those suffering from a substance use or psychiatric disorder provides great political leverage with decision makers. Given that these same organizations have actively stoked the politics of fear by creating the mythology of  a hidden cadre of drug addled and disruptive doctors posing a danger to patients removes any possible thread of lifeline for the accused.  The mere accusation of substance abuse or behavioral deviance is used to disregard the claims of the accused. 

images-31-copyMedicalization removes the constitutional safeguards of due process.   The potential for abuse is especially the case in the absence of clearly articulated and openly established program policies and procedures.

The Urgent Need for a “Counterpower”

It is critical to create some type of  due process or redress for putative impaired medical students who are the objects of state physician health program therapeutic interventions. At present there is no “counterpower” to PHP control.  This could take the form of an advocacy group or intervention review organization with the goal of ensuring the veracity of both the claims and purported diagnosis and make certain that individual rights were not circumvented in the name of “help.” Although it is difficult to stand up to”authority” and not “make waves” it is essential to do so as soon as possible.

Students monitored under the current paradigm find themselves straining at a dual leash. The obstacles that are  thrown in their paths by the physician health rabble are as onerous as they are unnecessary. It is essential that some sort of appeals and support process be implemented as this situation is corrected.   Social and academic responsibilities always demand the scholarly search for truth and the correction of error.  Give some allowances while this sorts itself out.

Mark Twain said that it is “easier to fool people then to convince them that they have been fooled.”  The ease of this task is undoubtedly inversely proportional to the complexity and scope of the bamboozle. The current physician health paradigm rests on a  “Big Lie” which can be defined as something repeated loud enough and often enough that it drowns out all opposing viewpoints.  The “Big Lie” here was the proposition that doctors are different and doctors are dangerous.  A scaffold of false claims creating a false -construct has been built upon the “Big Lie” –it is a constructed reality that is false.  It is a house of cards that is easily debunked.   All it will take to do this is the interest and the will to do so.

A Modest Proposal-Facts Matter and a Diagnosis is Derived from Signs and Symptoms-It Cannot be “Tailored”

screen-shot-2016-09-30-at-1-30-53-pm In the interim I propose the following.  It would not be that difficult to set up a second opinion through medical schools involving an anonymous group of their own experts.  The reason for this  anonymity is self-evident. The primary reason other doctors do not speak up against these programs is the fear of being targeted themselves.  Allowing physician health programs carte blanche authority is bad policy and being bamboozled into accepting this group as unquestioned expert authority is a fools game.  Providing independent evaluation is a simple task and if the independent evaluation concludes there is no problem then rest assured there is no problem.

One of the saddest aspects of this is the damage done to society by the injury inflicted on otherwise capable and brilliant students whose careers are being snuffed out by charlatans and fools.

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

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

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

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One of the great mistakes is to judge policies and programs by their intentions rather than their results

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Milton Friedman (July 31, 1912 – November 16, 2006) was an American economist who received the 1976 Nobel Memorial Prize in Economic Sciences


In an article written for the March 2015 Physician Health News, the official newsletter of the Federation of State Physician Health Programs (FSPHP) President Doris Gunderson reviews the history of the organization in honor of its 25th anniversary. She writes:

“In 1990 the FSPHP was born out of a need for individual state programs to work together in discussing and promoting best practices and especially to influence national public policy.”

For the last quarter century the FSPHP has pushed a plethora of both practice and policy (legal, regulatory and healthcare) that claims to assist state physician health programs in identifying, managing and monitoring impaired physicians and protect the public from harm.It was recently suggested by the Chief Editor of American Society of Addictions Medicine (ASAM) Weekly News that this same group take the helm in influencing public policy for addiction medicine at large (i.e. not just doctors but everyone from our kids to our pregnant mothers to our elderly) on a national organizational level.

It is time we examined both the authority and the knowledge claims on which they are based.

In her rebuttal to Pauline Anderson’s August 2015 Medscape article ‘Physician Health Programs: More Harm Than Good?  Gunderson dismissed criticisms as “allegations rather than facts” and “second hand anecdotes.”

In response to allegations that PHPs have no oversight Gunderson comments:

“In fact, we operate under a microscope, answering to individual practitioners, medical boards, malpractice carriers, defense attorneys, state attorneys, medical societies, hospitals, medical schools and residency training programs. We are also accountable to patient safety entities and a Board of Directors.”

The list of organizations Gunderson has to “answer” to appears to be many of the  organizations and societies that physician health programs interact with.  She might as well add Blockbuster for getting her videos back on time. This is not meaningful oversight.  Oversight equates with accountability and that requires answerability (the provision of information) and justification for one’s actions. It also requires the presence of an outside organization truly independent of the group that is able to sanction or punish individuals for wrongdoing or misconduct.     No such organization exists for state physician health programs. Period.  There is no organization that exists that is able to investigate a complaint of misconduct and provide sanctions.  The same applies to their primary business associates, the assessment and treatment centers (because they are private pay and out-of-pocket) and drug and alcohol testing labs (because they use non-FDA approved tests).  The entire racket is unaccountable and unexamined.

Kathryn Pyne Addelson  warned that what we should fear most is “unexamined” authority. “Illegitimate politicization and rampant irrationality find their most fruitful soil when our activities are mystified and protected from criticism.”

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This group has been protected from criticism for the better part of a generation. They have enjoyed making authoritative pronouncements as unexamined authority. Their power depends entirely on not being questioned as what is behind the curtain is flimsy and dredged,  a Potemkin village.   The recent Medscape and BMJ articles are revealing that confrontation with direct and precise questions results in nothing but logical fallacy, distortions and lies.  They are utterly incapable of responding with a direct and precise answer.   Gunderson’s response to absent oversight  is just another example of this logical fallacy and distortion.  This is not how rational authority responds. This is not how legitimate authority responds.  I kindly invite her to debate this.  I would like a back-and-forth to clarify.  It is a simple question that deserves a simple answer and I know she follows my blog as she used her own name and e-mail address.

The cumulative comments on the articles critical of these programs are revealing a system of oppressions, injustices and illusions.   A more recent article on Medscape,  “One-Man Fight:  MD Takes on State Medical Board, PHP” reports the same pattern of coercion, absence of due process and diagnosis rigging for sham peer review that I am hearing from doctors across the country.   The comments section to this article are also overwhelmingly critical of PHPs.  They are pertinent, articulate and precise and missing from them is any semblance of a rebuttal by the FSPHP, their apologists or anyone else.   The writing is on the wall as they say. And for that reason we call upon all those of good will in both the medical profession and the public at large to join us in this confrontation with illegitimate, irrational and immoral authority.

  1. Gunderson D. Message From the President  Twenty-Five Years: A Remarkable Journey. Physician Health News. 2015;20(March).
  2. Addelson KP. The Man of Professional Wisdom. In: Fonow MM, Cook JA, eds. Beyone Methodology: Feminist Scholarship as Lived Research. Bloomington: Indiana University Press; 1991:16-35.

Disrupted Physician

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How your Employee Assistance Program (EAP) is at Risk for Fraud and Abuse: What you need to know about the “PHP-Blueprint” and “New Paradigm”

screen-shot-2016-10-13-at-10-27-30-pmEmployee Assistance Programs (EAPs)

Employee assistance programs (EAPs) evolved from the “industrial” or “occupational” alcohol programs (OAPs) of the 1940s that were developed by companies to address alcohol abuse and its impact on the workplace. The first of these programs was developed by Dupont de Nemours and Company from 1941-1944 followed by Kodak in 1945 (Royce and Scratchley, 1989). These  programs were typically staffed by a recovering alcoholic employee working in cooperation with corporate medical departments or a union health clinic and the sole referral source was to the recently formed self-help group Alcoholics Anonymous (AA).   The primary intervention was to “confront the alcoholic’s job performance decline and denial using possible job loss as leverage toward seeking help.”

screen-shot-2016-10-18-at-11-25-14-pmWith time these programs broadened to include other issues that could potentially impact job performance. Worker Assistance Programs (WAPs) emerged in the 1950s when companies such as Consolidated Edison, Standard Oil of New Jersey, and American Cyanamid extended their alcoholism programs to also address mental health issues in their employees (Roman, 1981; Steele, 1995).

In the 1970s  EAP-related legislation was passed and this markedly increased the number of these workplace programs. The Hughes Act ( Public Law 91-616 ) established the National Institute of Alcohol Abuse and Alcoholism (NIAAA) as part of the United States Department of Health and Human Services (USDHHS) and these organizations  subsequently developed guidelines applicable to  both the public and private sectors. Public Law 92-255 mandated their existence at all federal agencies and military institutions and in 1972 the Hughes Act was amended to also include drug abuse (Public Law 92-255 ). The amendment also required USDHHS Guidelines serve as the model for all federal programs. On September 15, 1986 President Ronald Reagan signed Executive Order 12564 stating a desired goal of achieving a Drug-Free Federal Workplace. This use of drug testing by governmental agencies then led to an increase in drug-testing by private employers and by 1986 more than a quarter of Fortune 500 companies were drug-testing job applicants

screen-shot-2016-10-10-at-2-58-23-pmAnother significant development was the formation of private EAP firms that began to offer EAP services and drug-testing  via contracts with employers.  One such example is Bensinger, DuPont & Associates (BDA) which was founded in 1982 by former DEA Chief Peter Bensinger and National Institute on Drug Abuse (NIDA) founding director Robert Dupont.  BDA became the sixth largest employee assistance program (EAP) provider in the United States and provided workplace drug testing and other services to some 10-million employees of companies such as Kraft Foods, American Airlines, Johnson & Johnson and the Federal Aviation Administration (FAA).  On December 1, 2015 Bensinger, DuPont & Associates was acquired by the Canadian firm of Mourneau Sheppel which employs 4000 plus individuals  and has approximately 20,000 clients ranging from small businesses to some of the largest corporations in North America.

The company now known as BDA Moreau Sheppel represents the largest employee assistance program (EAP) provider in the entire world.

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Ethical Considerations in Workplace Drug-Testing and EAP Management

EAPs can be managed internally by staff employees of a company or organization who contract with outside vendors for drug-testing or externally by an EAP provider such as BDA Moreau Sheppel.  The primary goal is to address an employees problem (such as a substance abuse or mental health issue)  before that given problem impacts job performance.  In this way EAPs are  viewed as mutually beneficial; they provide timely help to an employee experiencing a problem in addressing that problem and at the same time potentially avert absenteeism, poor work performance, accidents and termination of a valuable employee. They are designed to help both the employee and the employer in a “win-win” situation. The goals, therefore, should be identical.  The goals should  be convergent.

Although many of these programs offer mental health counseling and other such services, the core function of EAPs does not include diagnosis or treatment but to facilitate and ascertain diagnosis and treatment. Those referred to EAPs (either through self-referral or by someone else) are assessed and referred to outside sources, either individual practitioners or institutional agencies, that have expertise and experience in assessing and diagnosing the presenting problem. It is the EAP’s function to oversee and make sure that the presenting problem is not only properly assessed, addressed, diagnosed and treated (if indicated) but that the presenting problem remains managed and under control.   This requires a period of monitoring or oversight to provide reassurance; progress reports from supervisors, compliance reports from treatment providers, and periodic drug and alcohol testing (if the problem involved substance use) are all part and parcel of a typical EAP.

EAPs have two primary business relationships: 1)  a network of individuals and/or programs to which they refer individuals for assessment and treatment, and 2) laboratories capable of performing drug and alcohol testing. The integrity of an EAP is therefore dependent on  the integrity and quality of its referral sources and laboratory operations. Those assessing, testing and treating must have education, experience and expertise in assessing, testing and treating the problems presented to them.  They must be valid and reliable and it goes without saying that any and all assessment, testing and treatment must be objective, honest and without any conflicts-of-interest.

screen-shot-2016-10-10-at-10-23-26-pmThis topic is addressed in the book Employee Assistance Programs: What Works and what Doesn’t by Lawrence Mannion in which he  discusses the notion of “control” in the context of managed mental health care. For those wishing to control any direction, entity or circumstances pertaining to these types of services Mannion states:

“..if the ends or purposes of those doing the controlling are in accord with the ends or purposes intrinsic or inherent in the thing being managed there is no conflict.”(page 133).

A 2001 study that looked at EAP professionals perceptions of ethical issues related to their business practices found that 22% of those surveyed identified “referrals” and “ownership structures” as among the most important and critical ethical issues facing the industry (Sharar, White, and Funk, 2001). Many of the respondents expressed concerns that the organizations owning and operating EAPs expected them to generate treatment revenue via a pattern of preferential referral to specific programs or practitioners and were concerned that this financial conflict-of-interest undermined the fundamental obligation of providing “neutral” and “objective” assessments to individuals with problems.  To prevent the appearance of unethical conduct the recommendation below were made.

-Fully disclosing (to both employer and client) any affiliations with proposed referral options;

.-Offering an “objective” presentation of more than one referral option to the client;

-Providing clinical justification that the referral is in the best interests of the client;

-Refusing to accept any direct gain or financial remuneration for referring clients;

-Instituting a peer review program to monitor and evaluate the quality and appropriateness of referrals; and

-Developing a utilization/service summary report for employers containing detailed information on patterns of referral for continuing care and treatment.

In 1998 the American Medical Associations Council on Ethical Affairs suggested that incentive programs should be based on quality (rather than quantity) of services or referrals and that linking financial incentives to individual treatment decisions should be avoided (AMA, 1988). In summary any and all referrals need to be objective, honest and fair. They need to be reliable and valid. So too does any and all drug-testing. Most employee drug-testing follows a standardized protocol. Although errors do occur, the procedures followed by the vast majority of employee assistance program providers aim to minimize error. Most programs were implemented and evolved in collaboration with unions or other groups working on behalf of the best interests of the employee.

When drug testing initially entered the workplace many issues had to be worked out. Those in favor of drug-testing insisted that they had the right to demand a drug-free workplace and pointed to decreased productivity, increased accidents and absenteeism as potential consequences of drug abuse. Opponents challenged the constitutionality and reliability of drug-testing and also emphasized the necessity of distinguishing  work life from private life. If a person smoked a joint on the weekend, they reasoned, it is no concern of management so long as they performed competently come Monday. Many in the medical community dismissed mandatory drug testing at the time as “chemical McCarthyism.”   Nevertheless,  drug-testing for better or for worse did enter the workplace.  Most of these programs were implemented with the oversight and collaboration of unions or some other group advocating for the rights and interests of those being tested. Procedures and protocols were discussed, deliberated and had to be agreed on before implementation.   In his 1984 book Designing Employee Assistance Programs, David Masi emphasizes the need for the close involvement of unions in workplace  drug-testing and other EAP services in order to “protect employee rights”as well as the employers responsibilities in doing so (Masi, 1984). Most programs simply followed the already established Federal Workplace Drug Testing Guidelines and this is still the case for most EAPs today. The Mandatory Guidelines for Federal Workplace Drug-Testing Programs provide strict procedure and protocols specifically designed to protect the rights of those being tested. The Department of Transportation (DOT), United States Nuclear Regulatory Commission, and many other safety-sensitive organizations follow these stringent guidelines which include only using certified labs, strict chain-of-custody procedures and Medical Review Officer (MRO) assessment of all positive tests to rule out alternative explanations or “innocent-positives” (such as a prescribed drug). It is also the job of the MRO to verify that strict chain-of-custody was maintained from the collection of the sample to its final analysis.  Additionally, only FDA approved drug-testing methods are utilized. This strict protocol assures a high level of validity and reliability (although mistakes can and do occur) to reduce the risk of someone being falsely labeled as a drug or alcohol user.  False-positive-tests are absolutely unacceptable as the results of a positive drug-test can be grave, far-reaching and sometimes even permanent.

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Physician Health Programs (PHPs)

Physician health programs (PHPs) are basically just employee assistance programs (EAPs) for doctors. They  evolved from 1970’s “impaired physicians programs” much like EAPs evolved from the occupational alcohol programs (OAPs) of the 1940s. These programs were designed to both help sick doctors and protect the public in the same manner EAPs were designed to help sick employees and protect a company. The mechanics and mentality should be exactly the same. If the PHP feels a doctor is in need of an assessment he or she is then referred to an outside facility for evaluation (and treatment if that is indicated and in this system “treatment” is virtually guaranteed.  The PHP then monitors the doctor for a period of time (typically five-years) to make sure that the problem remains under control.  Monitoring inevitably includes at least weekly abstinence based substance abuse testing (including alcohol) using non-FDA approved laboratory developed tests (LDTs) no matter what the presenting problem.  As with EAPs, one can self-refer to these programs or be referred by someone else and the latter can be done anonymously and with guaranteed confidentiality for the referrer.

In the context of PHPs being EAPs for doctors, the Federation of State Physician Health Programs (FSPHP) functions in the same manner as an EAP provider. The FSPHP s a non-profit corporation formed in 1990 to promote best-practices in state PHPs and influence policy.  This  EAP for doctors is being called the “PHP-blueprint”.

Although this model of EAP management is currently just being used on doctors, nurses, and other health care professionals;  parts of the criminal justice system; and some areas of the airline industry, the grand plan is to move this model of care to other populations.  Moving the “PHP-blueprint” to other occupations and populations is what is being deemed the “New Paradigm.”  

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The “PHP-blueprint” and the  “New Paradigm”

The American Society of Addiction Medicine (ASAM) White Paper on Drug Testing  describes the current practice of drug-testing in various contexts and explains how physicians and other healthcare providers can “use drug-testing to discourage non-medical drug use and ‘diversion’ of controlled substances” to “encourage appropriate entry into addiction treatment,” identify relapse and “improve outcomes of addiction treatment” through the use of “long-term post treatment monitoring.”  The paper proposes random mandatory drug-testing by medical professionals (pediatricians to obstetricians to geriatricians) using not only urine but blood, oral fluid (saliva), hair, nails, sweat and breath.”

Screen Shot 2016-10-18 at 11.41.24 PM.pngThe White Paper’s  writing Committee Chair, Dr. Robert Dupont, described this  “New Paradigm” in his keynote speech before the Drug and Alcohol Testing Industry Association (DATIA) in 2012 and claimed this model “sets the standard for effective use of drug testing” (Dupont, Drug Testing and the Future of American Drug Policy 2012)  Dupont then proposed the “PHP-blueprint” be expanded to other workplace populations,  healthcare students and schools. His audience, the Drug and Alcohol Testing Industry Association (DATIA)  represents more than 1,200 companies involved in the drug and alcohol testing industry for profit and even employs their own DC-based lobbying firm, Washington Policy Associates.

In a 2012 article entitled “Six lessons from state physician health programs to promote long-term recovery” Dupont and co-author Dr. Greg Skipper describe the need to”reach more of the 1.5 million Americans who annually enter substance abuse treatment stating that:

“This model of care management for substance use disorders has been pioneered by a small and innovative group of the nation’s physicians in their determination to help other physicians save their careers and families while also protecting their patients from the harmful consequences of continued substance abuse. In fulfilling the professional admonition “physician: first heal thyself,” these physicians have created a model with wide applicability and great promise.” (Dupont, R., Skipper, G. 2012)

screen-shot-2016-03-10-at-5-31-28-amThese six lessons are:

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

(2) thorough evaluation and patient-focused care;

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

(4) effective use of leverage;

(5) defining and managing relapses; and

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

screen-shot-2016-10-18-at-11-38-32-pmThe “PHP-blueprint” is being promoted as “Gold standard” and a “New Paradigm” of recovery.  In other words it is being proposed that the model of care management currently being used on doctors and managed by the FSPHP replace your current EAP.  And like a faulty smoke-detector or a misfired Epipen you won’t realize or possibly even care about  it until it happens.

The question for us, then, is this:

Are the ends or purposes of those managing physician health programs the same as or in accordance with those being managed by these programs?

Moreover, will the ends and purposes of the physician health model of care be in accordance with the ends and purposes of those who will potentially be managed by this model of care in the “New Paradigm?

The answer to the first question is a resounding “NO.”  Complaints of coercion, abuse and other misconduct and fraud are rampant.  Doctors are, in fact,  being diagnosed with substance use disorder and other problems when they do not meet the diagnostic criteria for substance use disorder or other problems and being forced into unnecessary and unneeded treatment while those  who do have substance use disorders and mental illness are being provided cookie-cutter treatment that is often inappropriate and inadequate treatment.  Why?  The money of course.  Do the homework and follow the money.

It is necessary that we conform our thinking and behavior to objective reality rather than an illusion and the version of the physician health model being put forth by those promoting the “PHP-blueprint” and the “New Paradigm”is at marked variance to those being managed by the model and for further reading start with the following:

  1.  British Medical Journal feature “Physician health programs under fire” by Jeanne Lenzer
  2. The “PHP-Blueprint”–A Trojan Horse for Profit and Wider Social Control:  Watching helplessly, as Cassandra did, while the soldiers emerge and wreak their predicted havoc.
  3. “New Paradigm” is a business model not a medical model
  4. Physician Suicide and “Physician Wellness” –Time to start talking about the elephant in the room!

In Employee Assistance Programs: What Works and what Doesn’t, Mannion states:

“We need to spend less time making hyperbolic statements about change and entertaining grandiose ideas about strategic alliances and more time developing criteria or standards to determine what does and what does not belong under the canopy of employee assistance. More specifically what is that principle or principles on the basis of which we can develop a criterion or criteria to determine those activities that could legitimately come under the heading of employee assistance?” (page 165-166)

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REFERENCES

American Medical Association, Council on Ethical and Judicial Affairs. Reports on Ethics in ManagedCare.Chicago, Ill.: American Medical Association Press, 1998

Dupont, R and G. Skipper “Six Lessons from State Physician Health Programs to Promote Long Term Recovery” Journal of Psychoactive Drugs 44 (1) 2012 (72-78)

Dupont, R. “Drug Testing and the Future of American Drug Policy” Presentation at the DATIA Annual Conference. San Antonio, Texas. April 19, 2012.

Jett K. Employee Assistance Programs–Government’s Role in an Expanding Field. In: Mecca AM, ed. Prevention 2000–A Public/Private Partnership: CHRF:69-81.

Manion, L. “Employee Assistance Programs: What Works and What Doesn’t” Praeger, Westport, CT. 2004

Massi, D. Designing Employee Assistance Programs. American Management Associations, New York, NY 1984

Roman P. From Employee Alcoholism to Employee Assistance. Journal of studies on alcohol. 1981;42(3):244-272.

Royce JE, Scratchley D. Alcoholism and Other Drug Problems: A Revised Edition of Alcohol Problems and Alcoholism. New York, NY: Simon & Schuster, Inc.; 1989.

Sharar D, W White, and R. Funk. “Business ethics and employee assistance/managed behavioral healthcare: A national survey of issues and challenges.” Journal of Behavioral Health Services and Research (submitted for peer review and publication April 2001).

Sharar, D., and W. White “Referrals and Ownership Structures: The first of two articles on the need for a revised ethic in employee assistance considers whether ownership structures can improperly influence EAP professionals.”

Steele P, Trice H. A History of Job Based Alcoholism Programs: 1955-1972. Journal of Drug Issues. 1995;19:511-532.

The New Paradigm for Recovery Making Recovery-and Not Relapse-the Expected Outcome of Addiction Treatment. Washington, D.C. March 2014 2014.

Making some serious gains.  Let’s not lose the momentum.  Please donate to my Gofundme here

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