I am Offering Over $25,000 in cool prizes to anyone who can show past FSPHP President Sanchez did not commit at least 3 felonies based on documentary evidence alone! I claim the documents show direct evidence of multiple serious crimes –prove me wrong and the whole lot is yours!

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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 game.

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 Wood 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

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Medscape Article Now Live! Please comment and tell your stories now!

screen-shot-2017-01-27-at-11-34-00-amLink to Medscape article by Pauline Anderson Here:

Link to illegible, post-dated and undated documents submitted as evidence  and mentioned in article can be seen here>  board-records-obtained-june-2016

Link to document written June 6, 2013 but date-stamped as being received in 2012 ( both by hand and apparently by the Board’s Document Imaging Unit (DIU)  > Back to the Future: Massachusetts Board of Registration in Medicine


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Michael Langan, MD, a Boston-based internal medicine specialist who has fought the Massachusetts Physician Health Service (PHS) and Board of Registration in Medicine for years to reinstate his license, has suffered a setback but is bolstered by a new development.

A justice of the Supreme Judicial Court of Massachusetts has denied Dr Langan’s petition to invalidate the 2013 suspension of his medical license for not meeting conditions to have his license reinstated.

However, a new law has enabled Dr Langan to access his records. According to Dr Langan, these documents show that the court did not consider key evidence in his case, as demonstrated by the fact that his hearing occurred after the date of receipt that is stamped on the documents. This may offer an opportunity to reopen his case.

The court decision, which was handed down in December by Associate Justice Geraldine Hines, states that although Dr Langan completed required psychiatric evaluations, he “did not submit a suitable worksite or substance abuse monitoring plan. In combination with his violation of the LoA [Letter of Agreement] meeting requirement, the board’s decision to affirm its prior suspension of petitioner’s license to practice medicine is supported by the record. The board’s decision to deny reinstatement in the absence of an acceptable plan is affirmed.”

“It’s unbelievable; everyone is dumbfounded,” said Dr Langan of the decision.

Dr Langan is appealing the denial of his petition, a process that will take an estimated 6 months.

He maintains that the PHS committed “forensic fraud” and concealed doing so.

“If I couldn’t win with all the direct evidence of felony crimes that you don’t need to be a lawyer to recognize, then I don’t think anyone can,” he told Medscape Medical News.

The PHS is a confidential resource for physicians and medical students seeking help for a variety of physical and behavioral health concerns, which may include difficulties with substance use.

In 2007, Dr Langan was at Massachusetts General Hospital (MGH) and Harvard University when he approached the PHS to help him with his dependence on Vicodin, an opioid analgesic.

He became dependent on Vicodin after a bout of chickenpox during residency, when he developed shingles. He stressed that there were no work-related problems associated with use of this drug.

 He was an inpatient at the Talbott Recovery Center in Georgia for more than 3 months, after which he signed the requisite 5-year contract with the PHS that included regular drug testing.

According to Dr Langan, there were no problems until mid-2011, when a report from the US Drug Testing Laboratories found he was positive for phosphatidylethanol (PEth), a blood marker for chronic alcohol use.

The level detected was 365.4 ng/mL, which “is the equivalent of drinking a half gallon of whisky a day,” or a sign of end-stage alcoholism, said Dr Langan, who insists he has never had an alcohol problem.

“That the test was invalid at this point should have been self-evident,” said Dr Langan.

Lab Fraud?

Suspecting that there had been “lab fraud” and that he would “end up being admitted for 3 months,” Dr Langan said he requested, but was denied, an independent evaluation outside the 12-step PHP-approved list of facilities. Because his request was denied, he attended one of the approved facilities, Hazelden Addiction Treatment Center, in Minnesota, where he “was cleared.”

 “They noted no past or present history of alcohol use or abuse and sent me back after a 4-day evaluation,” he said.

An independent investigation by James G. Flood, PhD, who has been chief of toxicology at MGH for nearly 30 years, concluded in a November 5, 2012, letter to Dr Langan’s lawyer “that there is a purposeful and intentional act by PHS” to show Dr Langan’s test as valid “when in reality this test was invalid and involved both fatal laboratory errors” and inadequate review of the results.

Any confirmatory, positive finding based on the July 2011 test “should be reversed, rectified and remediated,” Dr Flood writes.

 Among the “many errors in sample collection, processing and transportation,” said Dr Flood, was that the documentation that was received with the specimen did not have a date and time of specimen collection. Moreover, the person who collected the specimen was not properly identified, the signature of the sample donor was missing, and there was no tamper-proof seal affixed to the specimen.

Dr Flood claims the sample was directed to the wrong laboratory, where it sat for several days. The storage conditions of the sample while at that laboratory were not documented.

Following an investigation by the College of American Pathologists, in October 2012, Dr Langan’s laboratory test result was corrected from having a positive result to being an invalid test, but he said he did not learn of this change until months later.

 In a letter to the Massachusetts Board of Registration in Medicine, Luis T. Sanchez, MD, who at the time was the director of the Massachusetts PHS, said the amended report indicates that the “external chain of custody protocol [for that sample] was not followed per standard protocol.”

Dr Sanchez noted that, on the basis of the revised report, “PHS will continue to disregard the July 2011 PEth test result.”

Dr Langan requested the record of the chain of custody pertaining to his testing. This document showed that the test was “not only invalid but falsely created,” said Dr Langan. He added that it included a fax from the PHS requesting that his identification number be added to an already positive test and that the chain of custody be updated.

“You can’t update a chain of custody, as it is generated in real time,” said Dr Langan. “This is forensic fraud. It clearly shows collusion between the PHS and the lab.”

In an October 2012 letter, Dr Sanchez alleged that Dr Langan did not attend required peer support group meetings, but according to Dr Langan, this claim is “without fact or support.” Dr Langan maintains that he attended all required meetings. He also maintains that the PHS actions were in “retaliation” for requesting the chain of custody record.

Massachusetts PHS Director Dr Sanchez did not respond to a request from Medscape Medical News for clarification.

 Medscape Medical News also sought comment on recent developments in Dr Langan’s case from the Massachusetts Attorney General’s Office, which declined to comment.

“The AG’s [Attorney General’s] Office often defends state agencies in litigation and we typically do not comment on behalf of our clients, who in this case is the Board of Registration in Medicine,” Emily Snyder, deputy press secretary, Office of Massachusetts Attorney General, told Medscape Medical News in an email.

Intentional Delay?

Dr Langan alleges that the PHS “intentionally delayed” his efforts to undergo a psychiatric evaluation that was necessary to have his license reinstated. He said the PHS insisted he get this evaluation out of state, even though he suggested three Boston-area board-certified experts.

 The Board of Registration in Medicine eventually approved an evaluation by Patricia Recupero, MD, from the Law and Behavioral Health Program at the University of Rhode Island.

Dr Recupero’s November 2013 report determined that Dr Langan “is safe to return to the practice of medicine without further supervision,” that he “has an excellent prognosis and a very low risk of relapse,” and he “has not had an alcohol use, abuse or dependence problem.”

Many of the conflicts between the PHS and Dr Langan revolve around positive test findings, Dr Recupero notes in her letter.

 It is “critical to understand” the inadequacies of such tests for physician monitoring for purposes of relapse, she notes. She added that the source of the alcohol in Dr Langan’s test results cannot be determined and that many products – mouthwash and hand sanitizers among them – can create a false-positive test.

Dr Langan acknowledges he used hand sanitizers in the course of his work as a physician. Owing to severe allergies, he also uses prescribed asthma inhalers, which contain alcohol as a propellant.

Dr Recupero also notes that “almost without exception,” Dr Langan’s test findings have been below the minimum level to declare a test positive and that positive findings “are not a sign of relapse.”

 It was her opinion that, should he require additional treatment and supervision, the PHS should not be involved. A spokesperson for the PHS confirmed that it has not been involved in matters related to Dr Langan for at least 3 years.

Dr Langan said that since it suspended his medical license, the board has “engaged in a persistent pattern of ignoring my every reasonable effort at trying to be reinstated” and has “abused the administrative law process to accomplish this.”

Medscape Medical News contacted the Massachusetts medical board as well as its counsel, Deb Stoller, but received no response.

“Close to Homeless”

A memorandum to the Supreme Judicial Court, filed May 13, 2016, proposed a settlement between Dr Langan and the board. In return for the immediate reinstatement of Dr Langan’s license, he would be monitored for a maximum of 3 months by Dr Recupero and Timothy E. Wilens, MD, codirector of the Center for Addiction Medicine at MGH.

That memorandum was accompanied by letters from Dr Recupero and Dr Wilens agreeing to the terms, but according to Dr Langan, it has been “ignored.”

“The board did not acknowledge or address the proposals in any way,” said Dr Langan.

Dr Langan maintains that he “never ever” had any patient care or malpractice problems during his 15 years at MGH. In fact, his supervisors and colleagues reported that his work performance has been “superlative” on all counts, he said.

Many in the addiction medicine and psychiatric community support Dr Langan. He has letters from high-profile physicians in the field who verify that he is safe to practice medicine.

A first petition was filed in the Supreme Court on October 22, 2014, but the judge dismissed it because it had not been filed within the required 60-day period. Dr Langan’s most recent petition was filed July 3, 2015.

The past few years, he said, have taken a toll on his family. They have lost their home and health insurance because of his inability to practice his profession.

Disheartened by this latest setback, Dr Langan is looking into the possibility of becoming licensed in another state and leaving Massachusetts.

But Dr Langan has renewed hope. Under Massachusetts’ new Public Records Reform Law, which went into effect January 1, 2017, “the board was forced to comply with my request for records within 10 days,” and has done so, he said.

According to Dr Langan, these records show some irregularities that may bolster his case.

“A letter dated December 15, 2011, introducing exculpatory evidence was date-stamped January 17, 2012, almost 1 month after the hearing where it was submitted as evidence. All of the other documents had either illegible or absent date-stamps,” he said.

Please sign petition for state audit of Massachusetts physician health program (PHP), Physician Health Services, Inc. (PHS)–Evidence of top-down corruption

Screen Shot 2015-08-29 at 2.37.54 PMTo sign the petition please click here.

Why this is important

State Physician Health Programs (PHPs) were originally developed by competent and caring physicians to help colleagues who developed problems with addiction or substance abuse.

As an alternative to disciplinary action by state Medical Boards they provided a safe haven for sick doctors while also protecting the public from impaired physicians.This image as a humanitarian agency with virtuous organizational purpose has created an absence of the need to guard.   Any system can be subverted, but as self-governing organizations with no meaningful transparency, oversight, regulation or accountability these organizations were particularly vulnerable to exploitation.

State PHPs have been gradually taken over by the Federation of State Physician Health Programs (FSPHP). The FSPHP is an offshoot of  the American Society of Addiction Medicine (ASAM), the self-proclaimed “voice of addiction medicine.”

A “self-designated” medical specialty, American Board of Addiction Medicine (ABAM) “board certification” is not recognized by the American Board of Medical Specialties (ABMS).

Through a torrent of propaganda and misinformation, however, combined with strategic and successful lobbying efforts they have gained tremendous sway in the field of addiction medicine. Advancing the 12-step rehab drug testing agenda they have modified and monopolized the field. By cozying up to regulatory boards and politicians they have altered the rules, statutes, and regulations to provide immunity, impunity, and confidentiality. All of this was done without difficulty or any meaningful opposition. They have swayed legal opinion and successfully tinkered with the system to amend rules and policies.

Many consider the ASAM and FSPHP to be corporate front groups, organizations whose agendas match those of corporate interests but who claim no formal relationship. In this case the agenda is 12-step rehabilitation industry and the drug testing industry. Over the past 10 years the ASAM has grown to over 3000 physicians. Within this group there is a subset of recovery fundamentalists who have populated the PHPs. Many have also become medical directors of the rehabilitation facilities to which they refer. By removing dissenting physician who do not agree with the groupthink they have successfully taken over the State PHP system. The evidentiary standard is low. They encourage confidential referral from colleagues and provide immunity to those who refer. If the PHP believes a physician “could benefit” form their services there is no choice. The FSPHP political apparatus exerts a monopoly of force. It selects who will be monitored and dictates every aspect of the evaluation and monitoring process. Conflicts of interest abound.

Control has replaced conduct and ideology has trumped science and reason. It is a system that fosters corruption and impunity. There have been reports of gross misconduct and breaches of standards of care, ethical violations, and civil rights violations. Basic human rights violations and criminal activity has been reported.

In Massachusetts caring and competent physicians such as J. Wesley Boyd and John R. Knight were removed from the State PHP, Physician Health Services, Inc. (PHS). In an article written for the Journal of Addiction Medicine in 2012 they address some of these concerns and suggest the “broader medical community begin to reassess PHPs as a whole.” They recommend independent oversight, transparency, national standards, periodic auditing, and an appeals process. They state:

“Because PHP practices are unknown to most physicians before becoming a client of the PHP, many PHPs operate outside 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 PHP’s practices.”

The FSPHP has introduced junk science such as Ethyl Glucuronide, Ethyl Sulfate, and Phosphatidylethanol as long term alcohol biomarkers with no evidence base. They did this by getting them approved as “Laboratory Developed Tests” (LDTs) to bypass FDA scrutiny. There is no evidence-based support for these tests but the FSPHP convinced Regulatory Agencies (medical boards) that they were valid tests. This “medical sanctification” of these bogus tests resulted in other monitoring programs utilizing them and, unregulated by the FDA, the labs doing the tests could claim they were accurate and reliable with no repercussion. they are claiming the PHP programs as the “new paradigm in addiction treatment” claiming an 80% success rate. They have also created a myth that medical mistakes are the result of a hidden cadre of drug addicted doctors and are behind the recent call to randomly drug test all physicians. Of course who will run such a program? They will. They also want to expand to other organizations such as the DOT.

There is a lot of anecdotal evidence that the marked suicide rate in physicians is because of this.

The propaganda and misinformation is based on a study that is misleading and full of methodological flaws.

In “Ethical and Managerial Considerations Regarding State Physician Health Programs,” published in the Journal of Addiction Medicine in 2012, John Knight, M.D. and J. Wesley Boyd, M.D., PhD recommend ”the broader medical community begin to reassess PHP’s as a whole” and that “consideration be given toward the implementation of independent ethical oversight and establish and appeals process for PHP clients who feel they are being treated unfairly.”

They also recommend the relationship of PHP’s between the evaluation and treatment centers and licensing boards be transparent and that national organizations review PHP practices and recommend national standards “that can be debated by all physicians, not just those who work within PHPs.”

In evaluating a physician this group is not gathering data to form a hypothesis but making data fit a hypothesis that arrived well before the physician did. And this may be part of the explanation for the recent marked increase in physician suicide. With guilt assumed from the start, no due process, no appeal, and no way out physicians are being bullied, demoralized, and dehumanized to the point of hopelessness. This needs to end now.

Medicine is predicated on competence, good-faith, and integrity. Medical ethics necessitates beneficence, respect, and autonomy. The scaffold erected here is designed for coercion and control. Exposure, transparency, and accountability are urgent. An evidence based Cochrane type assessment of their “research” and an Institute of Medicine Conflict of Interest review are long overdue.

In addition it is a “rigged game” as the ASAM makes the public policy and the FSPHP enforces it. Furthermore the FSPHP mandates that physicians be evaluated at a “PHP-approved” facility. All of the medical directors of these facilities (which number around 20) are ASAM physicians “in recovery.” It is essentially self-referral.

A State Audit done in North Carolina found no oversight or regulation of the State PHP from either the state Medical Board or the Medical Society. In addition they found lack of due process for physicians and exposed the conflicts of interest between the PHP and the out of state treatment programs. They concluded abuse could occur but not be detected.  It is the same scaffold present in Massachusetts.

The Medical Director and CEO of the North Carolina Physicians Health Program (NCPHP) Dr. Warren J. Pendergast, M.D. is the immediate past President of the Federation of State Physician Health Programs (FSPHP)  and the audit findings of the NCPHP are standard operational procedure for other state programs fully infiltrated by the FSPHP.

The same infrastructure that exists in North Carolina and Massachusetts exists in other states.   In this system there is absolutely no oversight from the medical board, the medical society, department of health or anyone else for that matter.  They truly have removed all aspects of accountability.

PHS, inc. has been given cart blanche power in the assessment, treatment, monitoring, and disposition of all physicians referred to them.

The previous Medical Director of the Massachusetts PHP, Physicians Health Services, Inc. (PHS) for fourteen years (prior to Dr. Steve Adelman) , Dr. Luis Sanchez, is also a past President of the FSPHP.

And although  PHS did not enter into formal partnership with the FSPHP until 2013, Sanchez and PHS Director of Operations Linda Bresnahan (who was interviewed for the recent Medscape article critical of PHPs) have both had long term involvement in the political hierarchy of the FSPHP and, in fact, helped develop the prototype for other states.

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 close colleagues,  if not friends of the medical directors of other state PHPs.

There is also documentary evidence that PHS, inc. is colluding with third parties (labs and treatment centers) to misrepresent test results and diagnoses in conspiracy to commit fraud.  Documentation shows purposeful and intentional act to commit “confirmatory distortion” which is the deliberate misinterpretation or misrepresentation of facts to support a predetermined hypothesis.

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

To consciously “tailor” a diagnosis or recommendation based on the PHPs impression of a physician is fraud.

Documentary evidence shows how PHS, inc. is engaging in fraud by colluding with a “PHP-approved” assessment center to fabricate and falsify neuropsychological tests to show “denial” and “relapse” with normal objective raw data being interpreted as abnormal. (again verified by a third-party oversight agency which resulted in the colluding party being forced to correct the results under threat of disciplinary action).

But without any regulation or meaningful oversight of PHS and no appeal process or avenue for the reporting or investigation for the physician, PHS has been able to get away with this misconduct with impunity and immunity. Complaints are either ignored, dismissed, or justified by sympathizers, apologists and a great deal of “willful ignorance.”

There should be zero tolerance for forensic fraud at all levels but when a person’s career, life and liberty are at stake and the perpetrator is in a position of power this conduct is particularly egregious. The damage done by a positive drug or alcohol test can be severe, far-reaching, and permanent. Intentionally and purposefully misrepresenting drug or alcohol tests by manipulation and fraud is unethical and needs to be addressed in real time. Those who engage in such behavior need to be held accountable for their actions.

For these reasons I petition Suzanne Bump to initiate a performance audit on PHS, inc. to detect fraud and abuse. There is currently no meaningful way to report, investigate, and hold accountable abuse of power in PHS, inc. Transparency, oversight, regulation, and accountability are essential.

The Physicians of the Commonwealth of Massachusetts deserve better than this.

Medscape Medical News—Physician Health Programs: More Harm Than Good? State-Based Programs Under Fire

Screen Shot 2015-07-27 at 9.11.46 AMMedscape Medical News > Psychiatry

Physician Health Programs: More Harm Than Good?
State-Based Programs Under Fire
Pauline Anderson
August 19, 2015

There is growing scrutiny of US physician health programs (PHPs), which are state-based plans for doctors with substance abuse or other mental health problems.

Detractors of the PHP system claim physicians who voluntarily disclose they have mental health or drug problems can be forced into treatment without recourse, face expensive contracts, and are frequently sent out of their home state to receive the prescribed therapy. Some physicians allege that during their interaction with the treatment centers, large amounts of money were demanded up front before any assessment was even conducted.

In addition, critics assert that there is no real oversight and regulation of these programs.

Called by turns coercive, controlling, and secretive, with possible conflicts of interest, some say the PHP experience has led vulnerable physicians to contemplate suicide.
Two states ― North Carolina and Michigan ― have already been asked to step in and investigate many of the issues raised by PHP critics. In North Carolina, the state agreed with many of the concerns raised and recommended “better oversight” by its medical board and society. And in Michigan, litigation in the form of a class action lawsuit has been launched against the Health Professional Recovery Program (HPRP), a program similar to PHPs.

Michael Langan, MD, an internal medicine specialist in Boston, has first-hand experience with a PHP.

Dr Langan was at Massachusetts General and Harvard University in Boston when he approached the Massachusetts state PHP to help him get off an opioid analgesic. He had begun taking the drug to help him sleep after developing shingles and said he spent several months in prescribed PHP treatment after “signing on the dotted line.”

On his first day at the assessment center, Dr Langan said he was asked how he was going to pay $80,000 cash. “This was before they even evaluated me,” he told Medscape Medical News. Subsequently, Dr Langan said he underwent an independent hair and fingernail analysis that turned out to be negative “for all substances of abuse.”

Since then, he has been documenting possible cases of negative interaction with these organizations. The system, he says, leaves physicians “without rights, depersonalized and dehumanized.”
He fears that the role of PHPs has expanded well beyond its original scope, becoming monitoring programs that have the power to refer physicians for evaluation and treatment even on the basis of administrative failings, such as being behind on chart notes, he said.

He has heard reports of “disruptive physicians” being diagnosed with “character defects.” The monitored physician, he added, “is forced to abide by any and all demands of the PHP ― no matter how unreasonable ― under the coloration of medical utility and without any evidentiary standard or right to appeal. Once in, it’s a nightmare.”

Disempowered, Without Recourse

It is estimated that 10% to 12% of physicians will develop a drug or alcohol problem at some point during their careers.

PHPs were initially established to help physicians grappling with a substance abuse or mental health problem and to provide them with access to confidential treatment while avoiding professional investigation and potential disciplinary action.

Often staffed by volunteer physicians and funded by state medical societies, the original intent of these programs was to help health professionals recover while protecting the public from potentially unsafe practitioners.

PHPs assess and monitor the physicians referred to them. In most states, physicians who comply with PHP recommendations can continue to work, provided they undergo regular drug testing and other testing to ensure sobriety.

Some PHPs are run by independent nonprofit corporations, others by state medical societies. Still others receive support from state medical licensing boards. The relationship of each PHP to the state medical board varies. The scope of services offered through PHPs also differs.

Today, such programs exist in every state except California, Nebraska, and Wisconsin and are represented by an umbrella organization known as the Federation of State Physician Health Programs (FSPHP).

According to its mission statement, the FSPHP’s mandate is to “support physician health programs in improving the health of medical professionals, thereby contributing to quality patient care.”

Coercive Process

Concerns about the PHP system have been percolating for a number of years. In 2012, an editorial by J. Wesley Boyd, MD, PhD, Cambridge Health Alliance and Harvard Medical School, and John R Knight, MD, Boston Children’s Hospital and Harvard Medical School, published in the Journal of Addiction Medicine brought many of the issues to the profession’s attention.

In their editorial, Dr Boyd and Dr Knight alleged that once a mental health issue has been disclosed, doctors are “compelled” to enter a PHP and are instructed to comply with any PHP recommendations or face disciplinary action.

“Thus, for most physicians, participation in a PHP evaluation is coercive, and once a PHP recommends monitoring, physicians have little choice but to cooperate with any and all recommendations, if they wish to continue practicing medicine.”

In an interview with Medscape Medical News, Dr Boyd, who was associate director of the Massachusetts PHP for 6 years, elaborated on what he sees as the lack of due process afforded physicians by such programs.

“In general, these programs are given a free pass because it’s doctors helping doctors, and the feeling is that they wouldn’t be doing that if they weren’t generally nice people concerned about the well-being of others.”

Although many PHPs and the individuals running them are well intentioned, “there are generally few avenues for meaningful appeal” for doctors wishing to dispute PHP treatment recommendations, said Dr Boyd.

Approached on this question, the FSPHP’s director of program operations, Linda Bresnahan, maintains in a written response to Medscape Medical News that “options exist for a physician to seek an additional independent evaluation” and to appeal to the medical board or workplace.

Not so, said Dr Boyd, who counters that physicians have been made to feel “disempowered” and without recourse. “People tend to think that if you raise complaints, you’re just bellyaching and your complaint can’t be legitimate.”

Dr Boyd also said he has heard anecdotal reports of a number of doctors whose interactions with a PHP were so difficult they became suicidal.

“It’s not surprising that if you have your licensing board crawling up your rear end, rates of depression go up and rates of suicide go up,” he said.

Regular Audits in Order?

More and more physicians, even those involved in a PHP, feel that regular monitoring of such programs is in order. For example, Dr Boyd said there should be routine audits “to ensure that rampant abuses of power are not happening.”

Asked whether she believes random audits for state PHPs are warranted, the FSPHP’s Bresnahansaid that the federation “supports quality assurance processes, utilizing both internal and external approaches, and is working to develop guidelines for PHPs to promote accountability, consistency, and excellence.”

Michael Myers, MD, professor of clinical psychiatry, Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, in New York City, who is on the advisory board of the New York PHP, also favors audits.

Dr Myers has been in practice for 35 years, the last 20 of which have been devoted to caring for physicians and their families. There is no doubt, he told Medscape Medical News, that his state’s PHP program has been “absolutely lifesaving” for some doctors.

However, he acknowledged that there have also been “a lot of unhappy campers” who took issue with the program’s process. At the same time, though, he can recall only one physician who made a formal complaint. Dr Myers noted that the PHP program was initiated on the premise, “if we don’t govern ourselves, then someone else will do it for us.”

“We are trying to have some autonomy, but if a person is unhappy, there isn’t the same mechanism that would exist, say, at a university, where there’s a whole protocol that a professor with a grievance can follow.”

This lack of mechanism for due process was at issue in a recent Michigan class action lawsuit launched by three health care professionals (two registered nurses and one physician assistant), who claim in the statement of complaint to represent the “hundreds, and potentially thousands of licensed health professionals injured by the arbitrary application of summary suspension procedures.”

Although the state program was originally designed to simply monitor the treatment of health professionals recommended by providers, the HPRP has recently “unilaterally expanded its role to include making treatment decisions,” according to the complaints.

They state that “the mandatory requirements of HPRP, coupled with the threat of summary suspension, make involvement in HPRP an involuntary program circumventing the due process rights of licensees referred to the program.”

They also claim the “involuntary” nature of HPRP policies and procedures and the unanimous application of suspension procedures upon HPRP case closure “are clear violations of procedural due process under the Fourteenth Amendment,” the plaintiffs claim.

Initially, the three plaintiffs had their licenses arbitrarily suspended. But in each case, the suspension was promptly overturned by a judge.

For some who have been watching these events, this lawsuit just might be the catalyst to make much needed changes to physician health programs across the country.

“Kafkaesque Nightmare”

Jesse Cavenar, Jr, MD, vice chairman and professor emeritus, Department of Psychiatry, Duke University School of Medicine, Durham, Northcarolina, calls the PHP experience a “Kafkaesque nightmare.” Although he himself has not been referred to a PHP, he said a psychiatrist colleague of his, who was anonymously accused of smelling like alcohol, was evaluated and subsequently diagnosed with alcohol abuse.

According to Dr Cavenar, there was nothing to support the diagnosis. The doctor also claimed that the “thorough” physical examination noted in his record was never conducted. In the end, said Dr Cavenar, the psychiatrist was in treatment for 13 months. His medical and legal bills topped $90,000.

Dr Cavenar, who obtained power of attorney in this case, tried but failed to communicate with the treatment facility on behalf of his colleague. He also failed to obtain the medical record.

“When you have a facility that has made a diagnosis and they refuse to talk to anybody about how they made that diagnosis, you say, ‘Something is wrong here.’ ”

During his brush with the PHP system, Dr Cavenar also discovered that at least one evaluation facility has an “understanding” with the referring PHP that a physician will be diagnosed and spend a minimum 90-day interaction period in the treatment facility.

Medscape Medical News spoke to another knowledgeable, highly placed source, who asked not to be identified. He supported Dr Cavenar’s assertion of a mandatory 90-day assessment period, saying he had heard from two other physicians who had undergone treatment in the PHP system that there was in fact such a mandatory period proscribed for them in advance even of an evaluation to determine their level of need.

“I’m no bleeding heart; if you do the crime, you do the time,” said Dr Cavenar. “That’s not what we’re seeing here. We’re seeing people who didn’t do the crime but who are getting tapped with time.”

Bresnahan told Medscape Medical News via email that FSPHP is not aware of a blanket “90-day minimum interaction period” with treatment centers. Rather, among the many treatment centers familiar to PHPs, there are a variety of “programs” within the treatment centers that vary in length, and a variety of programs such as outpatient, intensive outpatient to residential treatment, and variations of residential treatment.

“Treatment centers often offer a 1- to 5-day multidisciplinary evaluation to determine treatment needs, including length of stay and outpatient vs inpatient treatment options. In general, residential treatment centers offer different programming that vary in length of stay from 30-day treatment programs to 45-day treatment programs to 90-day treatment programs.

“Along with these options, PHPs do utilize treatment centers that will provide clients with a variable number of days of treatment. In these examples, the treatment center determines the recommended length of stay during the course of treatment based on clinical needs,” she notes.

Asked about treatment costs to physicians, Bresnahan responded that she is unaware of reports of large lump sums expected on admission.

“FSPHP is unaware of excessive up-front fees in the $80,000 range,” she writes. “It is our understanding that a treatment phase can range from $5000 to $50,000 depending upon the days and the type of programs.

“A number of healthcare professional programs are now having progress with insurance reimbursement to offset portions of the cost,” she adds. “Some offer financial assistance based on a needs assessments, and some may also offer payment plans,” Bresnahan told Medscape Medical News.

Dr Cavenar felt so strongly about his colleague not having due process that he lobbied for an audit of North Carolina’s PHP.

His initial efforts were ignored by the state medical board, he said, so he approached the state governor’s office. Finally, Dr Cavenar said he and three other concerned psychiatrists successfully secured a state audit of North Carolina’s PHP system, the results of which were released in April 2014.

PHP Originator Speaks Out

According to psychiatrist Nicholas Stratas, MD, one of the problems with the North Caroline PHP is that decisions regarding a referred physician are vetted by a legal team.

Dr Stratas has a unique vantage point. He was the originator of the North Carolina PHP, was the first-ever psychiatrist and president of the North Carolina Medical Board, and still holds numerous affiliations with both Duke University and the University of North Carolina.

“In our state, the PHP has turned into something that was never intended…. [It] has become bureaucratized and legalized,” he told Medscape Medical News. “When I was on the board, we had one attorney; now, they must have six or seven attorneys, and the whole job of triaging physicians is left to the legal department.”

Dr Stratas said that at least until the state audit, the North Carolina PHP left physicians with no legal recourse once they were referred to a treatment facility.

“They have taken the position that because they are a peer review mechanism, they don’t have to comply with the nationally recognized condition that everybody should have access to their own records; they will not provide records to the physician.”

Dr Stratas related the case of a psychiatrist who after a detailed assessment was determined to have no addiction or mental health problems. This psychiatrist got caught up in the PHP system after an anonymous caller complained about “weird” behavior, according to Dr Stratas.

On questionable advice from his attorney, the psychiatrist voluntarily suspended his medical licence, thinking it was temporary and would help sort the situation out, but now he cannot get it back until he undergoes “treatment,” said Dr Stratas. After almost 2 years, said Dr Stratas, this psychiatrist is still without his medical licence.

Auditor’s Report: Potential for Undetected Abuse

The state auditor’s report found no abuse by North Carolina’s PHP. However, there was a caveat ― the report determined that abuse could occur and potentially go undetected.

It also found that the North Carolina PHP created the appearance of conflicts of interest by allowing the centers to provide both patient evaluation and treatments and that procedures did not ensure that physicians receive quality evaluations and treatment because the PHP had no documented criteria for selecting treatment centers and did not adequately monitor them.

“Abuse could occur and not be detected…because physicians were not allowed to effectively represent themselves when disputing evaluations… [and because] the North Carolina Medical Board did not periodically evaluate the Program and the North Carolina Medical Society did not provide adequate oversight,” the auditor’s report noted.

The North Carolina PHP “did not use documented criteria to select treatment centers” and “did not conduct periodic evaluation of the treatment centers to ensure compliance with established operating criteria.”

The auditor added that the program’s “predominant” use of out-of-state treatment centers placed an undue burden on physicians.

Furthermore, according to the report, the North Carolina PHP “created the appearance of conflicts of interest by allowing treatment centers that receive Program referrals to fund its retreats, paying scholarships for physicians who could not afford treatment directly to treatment centers, and allowing the center to provide both patient evaluations and treatments.”

The report recommended that physicians have access to “objective independent due process procedures” developed by the state medical board and medical society and that plans be implemented for “better oversight” of the program.

The report also stated that North Carolina’s PHP was required to make it clear that physicians “may choose separate evaluation and treatment providers” and that the PHP undertake efforts to identify qualified in-state treatment centers for physicians.

Since its release almost a year ago, many of these recommendations have been addressed by the North Carolina Medical Board.

“We absolutely embrace the auditor’s recommendations and are working really hard to implement them,” Thom Mansfield, the board’s chief legal counsel, told Medscape Medical News.

North Carolina’s PHP has undertaken to provide periodic reports to the medical board, and an independent audit of the program will be carried out every 3 years, Mansfield added.

Physicians who disagree with their assessment or treatment can now have their case reviewed by a committee independent of the PHP compliance committee and of the medical board, he said.

Mansfield also noted that the state PHP has established criteria for identifying suitable centers to conduct assessments and offer treatment, with an emphasis on developing more in-state resources. “I know the PHP is now referring people to at least two in-state centers,” he said.

In taking these actions, said Mansfield, the North Carolina Medical Board hopes it is “showing leadership” for other states.

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

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Information obtained under HIPAA Privacy Rule

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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


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




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



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



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



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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Accountability requires both the provision of information and justification for actions

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

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

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

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

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

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

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


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

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

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

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

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

Signature on Quest document

Signature on Quest document

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

breaking-bad-series-finale_article_story_main

Anatomy of a Forensic Fraud: The Reality of Drug and Alcohol Testing

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The juxtaposed documents in and of themselves reveal a number of red flags.  How does one “revise” a chain-of-custody”?    If you do a google search you will not find “chain-of-custody” as an object of the verb revise. It is an oxymoron.  A document or opinion can be revised.  A chain-of-custody, by its very definition, cannot.  This collusion to fabricate a positive test has coined a new oxymoron—“revised chain-of-custody.”     Go ahead and look it up. It is a novel one.     As it should be.

What these documents show is, in fact, indefensible ethically, procedurally and legally.  The first document signed by Dr. Luis Sanchez, past President of the FSPHP and past Medical Director of Physician Health Services, Inc.  (PHS) was sent to the Board of Registration in Medicine on December 11, 2012 and is notable for two statements.   The letter from Dr. Sanchez asserts that “Yesterday, December 10, 2012, Physician Health Services, PHS received a revision of a laboratory test result,” but it did not matter because PHS was {unaware} ” of any action taken by the Massachusetts Board of Registration in Medicine as a result of the July 28th, 2011 report.   However, based on the amended report, PHS will continue to disregard the July 21st PEth test result.”

The second document, addressed to Dr. Luis Sanchez, is dated October 4, 2012 (67 days earlier) and shows the first document to be a bald-faced lie.

On July 28h 2011 Dr. Luis Sanchez reported to the Medical Board that I had a positive alcohol test.

Although I knew that Dr. Sanchez had fabricated the test I  had no way of proving it. I requested the “litigation packet,” which records “chain-of-custody” from collection to analysis in August of 2011.  At first they  refused.  PHS then tried to dissuade me (“it will be costly, involve attorneys, etc). Finally they agreed but threatened me with “unintended consequences.”

I was finally able to get a copy of the “litigation packet”  in December of 2011.  Remarkably, it  showed that Sanchez had requested my ID # and a “chain-of-custody” be added to an already positive specimen. I reported this to the Board but they ignored it. I also filed a complaint with the College of American Pathologists.Screen Shot 2014-11-06 at 11.17.32 PM

On October 23, 2012 Sanchez reported to the Medical Board that I was “noncompliant” with requirements with A.A.  meetings that I was supposed to go to as a direct result of the positive test and my license to practice medicine was suspended as a result in December 2012.

On December 10, 2012 I contacted the College of American Pathologists who told me the test was “amended” from “positive” to “invalid” on October 4, 2012. I confronted Sanchez and PHS and they said they did not know anything about it.

The following day, December 11, 2012, they sent out a letter saying that the test was invalid but that they were “unaware of any action taken against my license as a result of the test.”  

The documents show that on  July 19th, 2011 Sanchez requested my ID # 1310 and a “chain-of-custody” be added to an already positive specimen and on October 4th 2012 the test was “appended” to “external chain of custody not followed per standard protocol.”

Please note again that  Dr. Sanchez stated on December 11, 2012 that he “just learned” about this on December 10, 2012. He reported me to the Board as “noncompliant” on October 23, 2012 and my license was suspended in December 2012.   These documents show he had full knowledge that the test was invalid and as an agent of the Board this is under “color of law.”   Both he, and PHS, need to be held accountable for this.

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Lies, Lies, and More Lies

10:19:12-Verbal Compliant Noncompliance f:u written 10:19:12–BORM Complaint Committee

The contradictory documents from Sanchez alone constitute a crime (withholding information in concealment and providing false information to a state agency).  But what he did is far far worse.

I just obtained the October 4th document. Although I knew it existed, PHS suppressed it and refused to acknowledge it.   But in response to a complaint I filed against PHS and the labs it was revealed by USDTL that the test in question (phosphatidyl-ethanol) was not sent as a “forensic” specimen but collected as a “forensic” specimen, then changed to a “clinical” specimen at the request of PHS Program Director, Linda Bresnahan.   The specimen was kept at the collecting lab (Quest) for 7 days as a  “clinical” specimen, then sent to the analyzing lab (USDTL) with specific instructions from Quest to process it and report it as a “clinical” specimen.  PHS then used it as a “forensic” specimen by reporting me to the Board of Registration in Medicine and  requesting I undergo an evaluation for alcohol abuse.

As a “clinical” specimen it is rendered “Protected Health Information” (PHI) and thus under the HIPAA Privacy-Rule.   So with the help of the College of American Pathologists I requested my PHI from both Quest and USDTL. Quest refused (for obvious reasons) but USDTL complied.   And that is how I was able to obtain the October 4th document revealing that Dr. Sanchez lied to the Medical Board.     I would love to hear him, or PHS MRO Wayne Gavryck, defend the indefensible (and unconscionable).

Dr. Sanchez is correct when he pleads ignorance of any action taken by the Board as a result of the July 21st PEth result.   It was his report to the Medical Board  that I was “noncompliant” with attending AA meetings (that I was supposed to go to as the direct and sole result of the positive test)   that he reported to the Board just two weeks after the October 4th appended test.

The test was sent as a “clinical” specimen intentionally. PHS is not a clinical provider but a monitoring agency. They cannot send clinical samples.   But since clinical samples are “protected health information” and under HIPAA the lab had to give me the records and here you have them.

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, held it for 7 days and changed it from “forensic” to “clinical” to bypass strict “chain-of-custody” requirements  deepens the malice.  The fact that they then reported it to the Board as a forensic sample and maintained it was forensic up until now makes it egregious.   But the fact that the test was changed from “positive” to “invalid” on October 4th, 2012 and Sanchez then reported me to the Board on October 23rd 2012 for “noncompliance,” suppressed it and tried to send me to Kansas for damage control makes it wantonly egregious.   (they didn’t think I’d ever find out).

Add on that the fact that I’ve been questioning the validity of the test since day 1 and they violated the HIPAA Privacy Rule over and over and this is reckless and major health care fraud.

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Fax from PHS to USDTL on July 19th, 2011 asking that my ID #1310 be added to an already positive test and a “chain-of-custody” be “updated”

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USDTL complies with PHS request to and adds my ID #1310 and a date of collection (July 1, 2011) to an already positive specimen

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No date of collection, no unique identifier linking specimen to me. Multiple “fatal flaws.”

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I file complaint with CAP January 12, 2102. CAP forces USDTL to amend test from “positive” to “invalid” which they do on October 4, 2012. PHS conceals this fact until December 11, 2012

Letter from Chief of Toxicology at MGH–Ignored by PHS, USDTL, and the BORM         11:5:12-Dr. Flood Letter–Ignored by PHS:USDTL:BORM

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Physician sues Quest Diagnostics for forensic drug test fiasco

Massachusetts physician Dr. Michael Langan has filed a lawsuit against Quest Diagnostics, alleging the lab giant was negligent and engaged in fraud and deceit in its handling of his forensic drug test sample.

http://pathologyblawg.com/pathology-news/pathology-vendors/quest-diagnostics/physician-sues-quest-diagnostics-forensic-drug-test-fiasco/?utm_source=rss&utm_medium=rss&utm_campaign=physician-sues-quest-diagnostics-forensic-drug-test-fiasco