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Nosce te ipsum. Nosce inimicum tuum
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:
“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.
The 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.”
The 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.
“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.
Of 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. There is zero-accountability. No fines. No repercussions. No risk. What has happened is not only logical but inevitable. It is time to name the enemy. The enemy is not state physician health programs (PHPs) but those in charge of them. The Federation of State Physician Health Programs (FSPHP) is a heretofore unexamined authority. Current evidence is revealing the FSPHP is also an irrational authority. It is also quite easy to show by historical documentation of the policy and practice they have pushed that they are an illegitimate authority. Illegitimate authority when identified and recognized needs to be removed.
Nosce te ipsum. Nosce inimicum tuum. Know thyself, know thy enemy. The FSPHP is the enemy. They cannot be bargained with. They need to be removed. In the interim we need to set up advocacy and watchdog groups to help and protect those already caught in this web of manipulation, oppression and fear. Wake up, Stand up and Speak up. Silence is consent. Let’s drain this swamp in 2017.
Originally posted on Article 8:Antitrust litigation hasn’t disappeared, but rather changed its focus. Instead of targeting the great railroad empires of the late 19th century, today’s antitrust efforts focus on more minute industries, like dentistry. In October, the Supreme Court heard arguments for North Carolina State Board of Dental Examiners v. Federal Trade Commission, in which…
“PHP-Approved” Assessment and Treatment Centers
On the above list can be found the Medical Directors of a number of drug and alcohol rehabilitation facilities. I did not make up this list. An updated version can be seen right here on the “like-minded doc” website.
Talbott, Marworth, Hazelden, Promises, and another two-dozen or so “PHP-approved” assessment and treatment centers are represented on this list. State Physician Health Programs (PHPs) refer doctors to these facilities for evaluations. PHPs are non-profit tax-exempt organizations. They do not evaluate or treat patients. If a physician is referred to a PHP for a suspected problem the assessment must be done at an outside facility which will invariably be linked to a name on the list of Like-Minded Docs.
What most people do not know, however, is that this is an exclusive arrangement. Evaluations are constrained to one of these facilities. It is mandated. No bargaining. No compromises. No choice. In other words it is a coercion.
“What’s wrong with that?” some may ask. These facilities are all recognized as top-drawer and first-class. Perhaps they were hand-picked on objective criteria and the PHPs are just making sure that doctors get the best assessments money can buy– decision making by experts based on knowledge and experience–picking a winner so you don’t have to.
The recent strike down of anticompetitive regulation in N.C. dental case opens the door to antitrust litigation against other state Regulatory Agencies such as Medical Boards.
The Federation of State Physician Health Programs has set up a “hidden” system of coercion and control using various methods (policy and moral entrepreneurship, changes in state medical practice acts and administrative procedure, misuse of health law, etc.) to create a system that lacks oversight and regulation. As a power unto themselves they are accountable to no one.
Although originally funded by medical societies and staffed by volunteer doctors in order to help sick colleagues and protect the public, any system can be subverted for profit and power, and these programs have been taken over by groups representing the multi-billion dollar drug and alcohol testing, assessment and treatment industry and become reservoirs of bad medicine and fraud. All manner of abuse can be hidden under a veil of benevolence. Although most are afraid to speak publicly under fear of punishment and retaliation (“swift and certain” consequences, summary suspension) I have herd from many many doctors in multiple states. Their stories are all the same.
In addition to misconduct related to the non-FDA laboratory developed tests (they themselves introduced into the market using a loophole that bypasses FDA approval) there are reports of coercion into unneeded evaluation and treatment at a couple dozen or so “PHP-approved” facilities under threat of loss of licensure.
Reports to a state PHP can be done anonymously with confidentiality guaranteed to the reporter. Any report will result in a meeting with the state PHP and if they feel a licensee is in need of an assessment they require it be done at a “PHP-approved” assessment center.
As non-profit tax exempt corporations, PHPs do not provide clinical assessments. They can only recommend assessments. State Regulatory Agencies (Medical Boards, Nursing Boards, etc.) have accepted the PHPs requirements of limiting assessments to those approved by the PHP. In fact many states mandate assessments to solely “PHP-approved” assessment centers under threat of summary suspension of a professional license.
An Audit of the North Carolina PHP by State Auditor Beth Woods, however, found financial conflicts-of-interest in the use of these predominantly out-of-state assessment facilities to which the N.C. PHP was referring and the state Medical Board was requiring. Woods requested the qualitative indicators and quantitative measures used to “approve” these assessment centers from the N.C. PHP but they were unable to produce any documentation showing any quality indicators or objective criteria existed! The best response they could come up with was “informal” methods and “reputation.” The full audit can be seen here.
Imagine if the FDA gave this reply if asked to provide the criteria used to “approve” medications or medical devices in the “FDA-approval” process!
Making matters even worse, the Medical Director of the N.C. PHP, Dr. Warren Pendergast was serving as President of their national organization, the FSPHP at the time of the audit.
The simple fact is no criteria exist.
A recent class action lawsuit in Eastern Michigan found this same pattern of referral to out-of-state assessment and treatment centers ( Marworth, Talbott, Hazelden. Promises,etc.)
State referrals to “PHP-approved” facilities has become a matter of public policy. Both the American Society of Addiction Medicine and the Federation of State Medical Boards have issued public policy statements stating that only “PHP-approved” centers be utilized by Regulatory Agencies in the assessment and treatment of their licensees. Moreover, these policies specifically exclude “non-PHP-approved facilities and often involve a limited time-frame. No choice, no appeal and no bartering. Do it. Do it now and if you don’t suffer the consequences.
These public policy statements can be seen in the 2011 ASAM “Public Policy Statement on Coordination between Treatment Providers, Professionals Health Programs and Regulatory Agencies” and the 2011 FSMB “updated Policy on Physician Impairment.” Many state Regulatory Agencies have strictly adhered to these policy recommendations.
What this means is that states are mandating evaluations at “PHP-approved” facilities even though there is no documentable or plausible reason for doing so. No measurable criteria exist as to how the list of “approved” facilities were “approved” yet they have “cornered the market,” removed choice and created an imposed monopoly under threat of loss of professional licensure.
In reality no official “PHP-approved” list exists. Neither does any objective published criteria for approving them. At the same time state Regulatory Agencies and Boards are forcing evaluations on licensed professionals at these couple-dozen or so facilities. They are excluding patient autonomy and choice violating the fundamental freedoms of the individual and informed consent.
All semblance of due process has been removed. If a plausible reason existed (i.e. they met some minimum standard of credentialing, quality or patient outcome) for referring to a proscribed list of assessment centers it could be arguably justified. Without such criteria, and in light of the economic and ideological conflicts of interest involved, it is patently unjustifiable.
Even more disturbing is, as Drs. John Knight and J. Wesley Boyd (who collectively have more than 20 years experience as Associate Directors at the Massachusetts PHP, PHS, Inc.) pointed out in their 2012 paper published in the Journal of the American Society of Addiction Medicine, many of these facilities are willing to “tailor” the diagnosis and recommendations of an evaluation to fit the wishes of the PHP. “Tailoring” an assessment and recommendations to anything other than what the true data show is healthcare fraud. It is, in fact, the political abuse of psychiatry.
PHPs started out as “Physicians Health Programs” but many are transitioning to “Professionals Health Programs” to widen the net. For example in Michigan and Florida the state PHP covers all health care practitioners from Acupuncturists to Veterinarians. PHPs have also entered non -healthcare employee assistance programs (EAPs) such as the aviation industry and the grand plan is expansion to non-healthcare professions. They are doing this by claiming remarkable success rates and brandishing themselves as the “gold-standard” of substance abuse treatment. Interestingly, the same individuals claiming how successful PHP programs are are the same individuals profiting from the drug and alcohol testing they introduced. Anyone with any sort of license is at risk.
So whether you cut hair, teach, take care of patients or even drive a car they could be coming after you next and they don’t have to convince you of the validity and reliability of their services–they only need to convince those who regulate your license and, as we have seen, they are very accomplished at persuasion in this department.
And that is why we need more state audits of PHPs and Medical Boards. The starting point is simple. Request from the state PHP and Board a list of “PHP-approved” facilities and the criteria by which they were approved. What should be a simple reply will undoubtedly not be as they will not be able to provide either.