Prescribing Justice–Protecting Doctors, the Rx For Healthy Patients Podcast #2

Below images link to podcast.

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

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

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

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

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

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

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

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

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

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

 

 

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

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

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

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

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

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

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

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

 

A Culture of Deference

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Bertram knows these are crimes.

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

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

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

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

Bertram e-mail 12:7:15

 

 

 

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Please donate–Making significant gains.

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Fraud Upon the Court

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

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

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

William Congreve, The Double-dealer

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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Massachusetts Governor Charlie Baker Moves to Control Professional Boards

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Baker moves to control professional boards

By Christian M. Wade Statehouse Reporter May 11, 2016

BOSTON — Dozens of independent boards that regulate doctors, barbers, electrical workers and an array of other professionals could soon be pulled under the state’s umbrella — a move that trade groups complain smacks of government overreach.

Lawmakers are considering a bill filed by Gov. Charlie Baker to limit the independence of licensing boards and give the state the power to “review and veto” any action deemed to stifle competition.

The proposal responds to a U.S. Supreme Court opinion last year that boards controlled by members of the profession they regulate are not immune from antitrust lawsuits.

In that case, the court ruled that the state dental board in North Carolina had no protection from antitrust claims when it issued cease-and-desist orders to companies offering teeth-whitening services.

Baker administration officials say the ruling leaves licensing boards in Massachusetts vulnerable.

Even legal actions may be challenged, Mike Kaneb, Baker’s deputy legal counsel, told a legislative committee on Tuesday.

“Individual board members can be sued,” he added.
But exerting authority over the boards is also raising concerns.

Frank Callahan, president of the Massachusetts Building Trades Council, which represents about 75,000 skilled construction workers, said the state needs to address the issue but he’s concerned the governor’s proposal would give the state too much power over the boards.

Boards that oversee electricians and other skilled trades already have state oversight, to varying degrees, he noted, as well as lawyers to ensure their decisions comply with federal anti-trust laws.

 

Baker moves to control professional boards | News | eagletribune.com 13/5/16 11:14 PM

Several representatives of trade groups opposed the proposal at the legislative hearing. Robert Butler, business manager for Sheet Metal Workers Local 17, called it a “solution to a nonexistent problem.”

“This bill would allow the state to make decisions without any public input or recourse,” he said.

Baker, a Republican, has promised to make the state more business- friendly, in part by cutting through red tape. In a statement, he said licensing rules and limits on professionals “have the effect of restraining trade and commerce” and are bad for business.

Donna Kelly-Williams, president of the Massachusetts Nurse’s Association, criticized his plan in comments to lawmakers.

“With this directive, it seems as though the governor would like to turn the Board of Registered Nurses and other similar boards into nothing more than vehicles to spur economic competition at the expense of the public health and safety,” she said.

Baker administration officials said that’s not the intent.

“The only motivation for the governor’s bill is to respond to the changes in law,” Kaneb said Tuesday.

Since the Supreme Court ruling, legislation to exert more control over independent licensing boards has been introduced in least six other states, according to the National Conference on State Legislatures.

In Massachusetts, the Division of Professional Licensure oversees 45 boards, which regulate more than 370,000 individuals and businesses in some 50 trades and professions.

Most board members are volunteers appointed the governor and operate independently from the state.

Baker signed an executive order last year directing the licensing division and other agencies to conduct monthly reviews of recent board decisions to determine if any violate federal laws.

Martin W. Healy, chief counsel for the Massachusetts Bar Association, said the state must act quickly to comply with the Supreme Court ruling to ensure that its boards don’t face legal challenges.

 

Baker moves to control professional boards | News | eagletribune.com 13/5/16 11:14 PM

“This is a major issue for the state that needs to be addressed quickly,” he said. “You would have a very difficult time attracting talented people to these positions if they could held personally liable for the board’s decisions.”

Christian Wade covers the Massachusetts Statehouse for the North of Boston Media Group’s newspapers and websites.

MA – State Oversight of Professional Licensing Boards – annot

Dr. Oliver Sacks: Disruptive Physician

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The article below regarding one of my personal hero’s Dr.  Oliver Sacks was published  by my friend Dr. Bharani Padmanabhanm in the Valley Patriot Ledger.  Thank God the current inept and illegitimate regime was not in place during Dr. Sacks’ formative years. His sympathetic and disruptive brilliance would have surely been snuffed out at its inception.  How many Oliver Sacks are we  losing today?  One can only wonder.


Choose Dr. Oliver Sacks over Lucian Leape or Alice Newton

By: Dr. Bharani PadmanabhanSept. 2015

Bharani-PadmanabhanDr. Oliver Sacks passed away last week from melanoma of the eye. He was best known for awakening people frozen into catatonic parkinsonism by the Spanish Flu and forgotten at the Beth Abraham Home for the Incurables. All they needed to awaken into normal life was a bit of levodopa. It was Dr. Sacks who thought of it and put his professional life on the line to give it to them. If you haven’t seen “Awakenings” yet, the time is now.

Of course that wasn’t the first time he had gone out of his way for a patient. When a blind, paralyzed, terminally ill patient learned Dr. Sacks was an avid motorbiker, she expressed a wish to take one last ride with him along the twisties of Topanga Canyon (Cali 27). Dr. Sacks arrived one fine Sunday with 3 heavy bikers who all carried the patient out to Dr. Sacks’ bike and securely tied her in place to him and his bike. She loved the ride. Dr. Sacks was almost fired as a result for being “unprofessional” and “disruptive” but was saved by the patient’s staunch support.

That he was almost fired tells us all we need to know about those who occupy the higher rungs in medicine.

It wasn’t any better after he awakened the catatonic. “Professional” doctors from the big teaching hospitals, who had all condemned the patients as beneath their time, “publicly roasted” Dr. Sacks for proving they were uncaring wastes of space.

Things have gotten a million times worse thanks to Harvard’s Dr. Lucian Leape who has relentlessly campaigned against the likes of Dr. Sacks and through the American Medical Students Association has ensured future generations of American doctors will not be like Dr. Sacks.

Dr. Sacks represented everything Dr. Leape loathes and defames as “disruptive” – he cared totally about the individual patient, their lives, hopes, dreams, and humanity.
Unlike Dr. Leape, Dr. Sacks did not sit around telling other doctors that they killed 100,000 patients every year and that they needed to purchase expert consultancy from his LeapFrog Group.

Instead, he devoted his life to his patients and to reminding the general public that neurological patients were as human as us all, and sometimes a bit special. He loved it when they survived their deficits or excesses and thrived.

Never ever did Dr. Sacks look upon patients as a number or a means to an end, a stone upon which to step to falsely boost one’s “career.”

Meaning, he was never ever like Harvard’s Dr. Alice Newton, who crushes good families to build herself up as an expert in “medical child abuse” (whatever that is) without any evidence and even when the evidence clearly shows that the parents are loving and never harmed their child.
Harvard’s Dr. Alice Newton has finally been shown to be a total fraud three times in a row, first in the Justina Pelletier case, then the Wilson baby case and now this very week, in the Irish Nanny case.

In the real world, three times and you’re out is enforced, even in law. When it comes to Harvard teaching hospital doctors however, we can expect the law to be ignored.

After all, it is always the cold ambitious sociopathic fraud who climbs the ladder and receives the accolades, awards, research grants and gushing write-ups in the Globe. The kind that Ben Hecht termed “The Respectables.”

Dr. Sacks, as expected, had only 20 published papers to his name and none of the long list of awards “the Respectables” give each other. Other members of “The Respectables” did not fall over themselves to laud him to the stars. Her Majesty’s Sir Donald Berwick never called Dr. Sacks a fine doctor, for example, though Sir Donald gushed all over Dr. Vivek Murthy.

The people of Massachusetts would be well advised to choose the likes of Dr. Sacks over Dr. Leape or Dr. Newton for their own care or their loved ones’. Dr. Sacks’ own patients certainly did and remained under his care almost till the end of his life.

Choose a physician who lives for his or her patients, who values and celebrates individuals and their inalienable rights, someone who treats each individual as important, someone who is totally disruptive on behalf of his or her patient, someone totally your advocate.

The difference between Dr. Sacks and the standard teaching hospital variety could not be more stark.

Bharani Padmanabhan MD PhD is a neurologist who specializes in multiple sclerosis in the Boston area. scleroplex@gmail.com

Policy and Regulatory Decision Making in the Medical Profession: A Framework to Identify the influence of Special Interest Groups and “Bent” Science

Could some of the current problems such as the marked increase in physician suicide, sham-peer review, and physician burnout be the result of bent science? Bent science is bad medicine. It needs to be exposed and addressed. If it exists then how do we identify and shine a light on it?

https://disruptedphysician.com/2015/02/12/bent-science-and-bad-medicine-the-influence-of-special-interest-groups-on-medical-regulation-and-a-framework-for-policy-analysis/

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

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Physician Health Programs are not Above the Law

Are Physician Health Programs (PHPs) above the law?  

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

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

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

Removing Accountability

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

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

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

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

A Culture of Impunity

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

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

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

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

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

Quest Diagnostics

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

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

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

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

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

 “PHP-Approved Attorneys”

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

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

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

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

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

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

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

Crooked Board Attorneys

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

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

Originally posted on Article 8:Antitrust litigation hasn’t disappeared, but rather changed its focus. Instead of targeting the great railroad empires of the late 19th century, today’s antitrust efforts focus on more minute industries, like dentistry. In October, the Supreme Court heard arguments for North Carolina State Board of Dental Examiners v. Federal Trade Commission, in which…

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

Urgent Action Needed on Proposed Legislation in North Carolina–Removing Due Process from Doctors a Harbinger of Wide-Scale Political Abuse of Psychiatry

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I received the email below from Dr. Jesse Cavenar, Jr. regarding legislative changes that would severely infringe on the rights of doctors as licensees of the North Carolina Medical Board and subject them to distinctly non-impartial diagnostic psychiatric evaluations and remove all possibility of due process.  These developments could possibly herald the wide-scale abuse of psychiatric evaluation and treatment by two governmental agencies acting in collusion with utterly no oversight or accountability.  Namely the Federation of State Physician Health Programs (FSPHP) and the Federation of State Medical Boards (FSMB).  As a state Representative who is also a physician told me this morning –“this bill is representative of a prevailing attitude that does not realize what is really happening.”


Bill H453 can be seen here:  H543v2 – 04152015[10]

NC Audit can be seen here:  http://www.ncauditor.net/EPSWeb/Reports/Performance/PER-2013-8141.pdf

This is the bill, entitled H453  that is before the NC legislature this session.  My reading of the bill is that the bill is a disaster.  It seems to be an attempt by the lobbyists and lawyers to remove many existing features of the present law. In particular, I would direct your attention to two features:

1) It appears that all mention of due process has been removed from the law. The NC State Auditor found that the NCPHP had not afforded due process as required by law, so one simply changes the law to remove all mention of due process.

2) There is a clause inserted in the law to immunize the NCPHP against civil liability for the performance of the NCPHP function. In other words, the state statute declares that one cannot bring legal action against the NCPHP because they are immune. This is absurd. These people should be no more immune than any other doctor in the state of North Carolina.

In addition, the proposed statute seems to attempt to haze out whether the NCPHP record is or is not a medical record. As you will see, one would be entitled to a copy of an ³Assessment² but it would appear not the entire medical record. This is contrary to the NC Medical Board position paper on medical records. I would urge everyone to immediately contact his or her appropriate Senator and Representative to register opposition to this bill as written, and to urge that an expert panel of disinterested physicians and attorneys be appointed to write a new bill that would be appropriate.

A colleague of mine who is a medical ethicist has reviewed this and had the following to say: ³Well, well!  I think the most interesting thing here is that someone has tried to get the NC Legislature to immunize the existing system against any countering action.  This, it seems to me, is tacit admission of culpability.²  Well stated, I would say.

                 Jesse

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

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

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

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

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

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

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

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

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

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

The simple fact is no criteria exist.

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

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

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

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

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

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

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

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

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

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

Article 8

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

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