“It is easier to believe a lie one has heard a hundred times than a truth one has never heard before.” –Robert S. Lynd
1980s–Your Money or Your Medical License
Ridgeview Institute was a drug and alcohol treatment program for “impaired physicians” in Georgia created by G. Douglas Talbott, a former cardiologist who lost control of his drinking and recovered through the 12-steps of Alcoholics Anonymous. Up until his death on October 18, 2014 at the age of 90, Talbott owned and directed a number of treatment facilities for impaired professionals, most recently the Talbott Recovery Campus in Atlanta, one of the preferred referrals for physicians ordered into evaluation and treatment by licensing boards today.
G. Douglas Talbott is a prototypical example of an “impaired physician movement”physician–in fact in many ways he may be considered the”godfather” of the current organization. He helped organize and serve as past president of the American Society of Addiction Medicine (ASAM) and was a formative figure in the American Medical Association’s (AMA’s) Impaired Physician Program.
According to Talbott, “impaired doctors must first acknowledge their addiction and overcome their ‘terminal uniqueness’ before they can deal with a drug or alcohol problem.” “Terminal uniqueness “ is a phrase Talbott uses to describe doctors’ tendency to think they can heal themselves.“M-Deity” refers to doctors “being trained to think they’re God;”3 blinded by an overblown sense of self-importance and thinking that they are invincible-an unfounded generalization considering the vast diversity of individuals that make up our profession.
Although this type of personality does exist in medicine, it is a small minority -just one of many opinions with little probative value offered as factual expertise by the impaired physician movement and now sealed in stone.
This attitude, according to some critics, stems from the personal histories of the treatment staff, including Talbott, who are recovering alcoholics and addicts themselves. One such critic was Assistant Surgeon General under C. Everett Koop John C. Duffy who said that Ridgeview suffered from a “boot-camp mentality” toward physicians under their care and “assume every physician suffering from substance abuse is the same lying, stealing, cheating, manipulating individual they were when they had the illness. Certainly some physicians are manipulative, but it’s naïve to label all physicians with these problems.”1
American Society of Addiction Medicine (ASAM) President (1981-1983) LeClair Bissell was also highly critical of Talbott’s approach. Bissell, co-author of the first textbook of ethics for addiction professionals4 when asked if there was any justification to the claim that doctors are sicker than other people and more vulnerable to addiction replied:
“Well, based on my treatment experience, I think they are less sick and much easier to treat than many other groups. I think one reason for that is that in order to become a physician…one has to have jumped over a great many hurdles. One must pass the exams, survive the screening tests and the interviews, be able to organize oneself well enough to do examinations and so on, and be observed by a good many colleagues along the way. Therefore I think the more grossly psychotic, or sicker, are frequently screened out along the way. The ones we get in treatment are usually people who are less brain-damaged, are still quite capable of learning, are reasonably bright. Not only that, but they are quite well motivated in most cases to hang on to their licenses, the threat of the loss of which is frequently what puts them in treatment in the first place. So are they hard to treat? No! Are they easy patients? Yes! Are they more likely to be addicted than other groups? We don’t know.”5“I’m not much for the bullying that goes along with some of these programs,” Bissell commented to the Atlanta Journal and Constitution in 1987.3
The constitution did a series of reports after five inpatients died by suicide during a four-year period at Ridgeview.6 In addition there were at least 20 more who had killed themselves over the preceding 12 years after leaving the treatment center.1
Bissell, the recipient of the 1997 Elizabeth Blackwell Award for outstanding contributions to the cause of women and medicine remarked: “When you’ve got them by the license, that’s pretty strong leverage. You shouldn’t have to pound on them so much. You could be asking for trouble.”3
According to Bissell: “There’s a lot of debate in the field over whether treatment imposed by threats is worthwhile…To a large degree a person has to seek the treatment on his own accord before it will work for him.”3
A jury awarded $1.3 million to the widow of one of the deceased physicians against Ridgeview,7 and other lawsuits initiated on behalf of suicides were settled out of court.6
The Constitution reported that doctors entered the program under threats of loss of licensure “even when they would prefer treatment that is cheaper and closer to home.”8 The paper also noted that Ridgeview “enjoys unparalleled connections with many local and state medical societies that work with troubled doctors,” “licensing boards often seek recommendations from such groups in devising an approved treatment plan,” and those in charge are often “physicians who themselves have successfully completed Ridgeview’s program.”8
In 1997 William L. White interviewed Bissell whom he called “one of the pioneers in the treatment of impaired professionals.” The interview was not published until after her death in 2008 per her request. Noting that her book Alcoholism in the Professions9“ remains one of the classics in the field”, White asked her when those in the field began to see physicians and other professionals as a special treatment population; to which she replied:
“When they started making money in alcoholism. As soon as insurance started covering treatment, suddenly you heard that residential treatment was necessary for almost everybody. And since alcoholic docs had tons of money compared to the rest of the public, they not only needed residential treatment, they needed residential treatment in a special treatment facility for many months as opposed to the shorter periods of time that other people needed.”10
1995 –The Big Con
In 1995 the impaired physicians movement gained an uninvited seat at the table of power. They accomplished this by offering “treatment” as an alternative to “discipline” and reporting remarkably high success rates. Talbott reported a “92.3% recovery rate according to information compiled from a five-year follow-up survey based on complete abstinence and other treatment.”11
A 1995 issue of The Federal Bulletin: The Journal of Medical Licensure and Discipline, published by the Federation of State Medical Boards, contains articles outlining impaired physician programs in 8 separate states. Although these articles were little more than descriptive puff-pieces written by the state PHP program directors and included no described study-design or methodology the Editor notes a success rate of about 90% in these programs and others like them 12 and concludes:
“cooperation and communication between the medical boards and the physician health programs must occur in an effort to protect the public while assisting impaired physicians in their recovery.” 12No one bothered to examine the methodology to discern the validity of these claims and it is this acceptance of faith without objective assessment that has allowed the impaired physician movement through the ASAM and FSPH to advance their agenda; confusing ideological opinions with professional knowledge.
“There is nothing special about a doctor’s alcoholism,” said Bissel
“These special facilities will tell you that they come up with really wonderful recovery rates. They do. And the reason they do is that any time you can grab a professional person by the license and compel him or her into treatment and force them to cooperate with that treatment and then monitor them for years, you’ll get good outcomes—in the high 80s or low 90s in recovery rates—no matter what else you do.”10“The ones I think are really the best ones were not specialized. There were other well-known specialty clinics that claimed all the docs they treated got well, which is sheer rot. They harmed a great many people, keeping them for long, unnecessary treatments and seeing to it that they hit their financial bottom for sure: kids being yanked out of college, being forced to sell homes to pay for treatment, and otherwise being blackmailed on the grounds that your husband has a fatal disease. It’s ugly.”10Stanton Peele’s “In the Belly of the American Society of Addiction Medicine Beast” describes the coercion, bullying, threats and indoctrination that are standard operating procedure in Talbott’s facilities.13 Uncooperative patients, “and this covers a range of sins of commission or omission including offering one’s opinion about one’s treatment,” are “threatened with expulsion and with not being certified-or advocated for with their Boards.”13
The cornerstone of treatment is 12-step spiritual recovery. All new patients are indoctrinated into A.A. and coerced to confess they are addicts or alcoholics. Failure to participate in A.A. and 12-step spirituality means expulsion from the program with the anticipated result being loss of one’s medical license.
In May 1999 Talbott stepped down as president of the American Society of Addiction Medicine (ASAM) as a jury awarded Dr. Leonard Masters a judgment of $1.3 million in actual damages and an undisclosed sum in punitive damages for fraud, malpractice, and the novel claim of false imprisonment.14
The fraud finding required a finding that errors in the diagnosis were intentional. Masters, who was accused of overprescribing narcotics to his patients was told by the director of the Florida PHP that he could either surrender his medical license until the allegations were disproved or submit to a four-day evaluation.
Masters agreed to the latter, thinking he would have an objective and fair evaluation. He was instead diagnosed as “alcohol dependent” and coerced into “treatment under threat of loss of his medical license. Staff would routinely threaten to report any doctor who questioned any aspect of their diagnosis or treatment to their state medical boards “as being an impaired physician, leaving necessary treatment against medical advice,”14 the equivalent of professional suicide.
Masters, however, was not an alcoholic.
According to his attorney, Eric. S. Block, “No one ever accused him of having a problem with alcohol. Not his friends, not his wife, not his seven children, not his fellow doctors, not his employees, not his employers, No one.” 15
He was released 4 months later and forced to sign a five-year “continuing care” contract with the PHP, also under continued threat of his medical license.
Talbott faced no professional repercussions and no changes in their treatment philosophy or actions were made. They still haven’t. They have simply tightened the noose and taken steps to remove accountability.
2011–The Federation of State Medical Boards (FSMB) as Pawn of the Federation of State Physician Health Programs (FSPHP)
Up until his death, Talbott continued to present himself and ASAM as the most qualified advocates for the assessment and treatment of medical professionals for substance abuse and addiction.16
The 2011 FSMB Policy on Physician Impairment identifies, defines, and essentially legitimizes “potential impairment” and “relapse without use.”
A PHP Should be empowered to conduct an intervention based on clinical reasons suggestive of potential impairment. Unlike the Board which must build a case capable of withstanding legal challenge, a PHP can quickly intervene based on reasonable concern."
“Empowered” to conduct an “Intervention” for reasons “suggestive” of “potential” impairment means a doctor can be pulled out of practice for anything. It essentially gives them carte blanche authority. The disregard for physician rights, due process and validity is self-evident.
in 2011 The ASAM issued a Public Policy Statement on coordination between PHPs, regulatory agencies, and treatment providers recommending that only “PHP approved” treatment centers be used in the assessment and treatment of doctors. A recent audit of the North Carolina PHP found financial conflicts of interest and no documented criteria for selecting the out of state treatment centers they used. The common denominator the audit missed was that the 19 “PHP-approved” centers were all ASAM facilities whose medical directors can be seen on this list.
The FSMB House of Delegates adopted an updated Policy on Physician Impairment at their 2011 annual meeting distinguishing “impairment” and “illness” stating that Regulatory Agencies should recognize the PHP as their expert in all matters relating to licensed professionals with “potentially impairing illness.”
In most states today any physician referred for an assessment for substance abuse will be mandated to do so in a facility just like Ridgeview.
There is no choice. In mechanics and mentality, this same system of coercion, control, and indoctrination has metastasized to almost every state only more powerful and opaque in an unregulated gauntlet protected from public scrutiny, answerable and accountable to no one. Laissez faire Machiavellian egocentricity unleashed. For what they have done is taken the Ridgeview model and replicated it over time state by state and tightened the noose. By subverting the established Physician Health Programs (PHPs) started by state medical societies and staffed by volunteer physicians they eliminated those not believing in the mentality of the groupthink. They then mandated assessment and treatment of all doctors be done at a “PHP-approved” facility which means a facility identical to Ridgeview. This was done under the scaffold of the Federation of State Physician Health Programs (FSPHP). They are now in charge of all things related to physician wellness in doctors.
G. Douglas Talbott defines “relapse without use” as “emotional behavioral abnormalities” that often precede relapse or “in A A language –stinking thinking.” AA language has entered the Medical Profession and no one even blinked. It will get worse.
The ASAM has monopolized addiction treatment in the United States. It has imposed it on doctors through the FSPHP. The FSPHP political apparatus exerts a monopoly of force. It selects who will be monitored and dictates every aspect of what that entails. It is a, in fact, a rigged game.
PHPs no longer represent the interests of doctors or the public but the interests of the drug and alcohol testing, assessment and treatment industry.
It is important to recognize that PHPs do not represent the interests of doctors or the public. PHPs represent the interests of the “recovery industry” including the multi-billion dollar drug and alcohol testing, assessment and treatment industries. Claiming an 80% success rate in doctors this system of institutional injustice is being brandished as the “new paradigm” of addiction treatment. Claiming it a replicable model, the plan is to convince other employee assistance programs to implement the “PHP-blueprint.”
There is enormous inertia—a tyranny of the status quo—in private and especially governmental arrangements. Only a crisis—actual or perceived—produces real change. When that crisis occurs, the actions that are taken depend on the ideas that are lying around. That, I believe, is our basic function: to develop alternatives to existing policies, to keep them alive and available until the politically impossible becomes politically inevitable.-Milton Friedman
- Durcanin C, King M. The suicides at Ridgeview Institute: Suicides mar success at Ridgeview with troubled professionals. Atlanta Journal and Constitution. December 18, 1987, 1987: A13.
- Gonzales L. When Doctors are Addicts: For physicians getting Drugs is easy. Getting help is not. Chicago Reader. July 28, 1988, 1988.
- King M, Durcanin C. The suicides at Ridgeview Institute: A Doctor’s treatment program may be too tough, some say. Atlanta Journal and Constitution. December 18, 1987a, 1987: A12.
- Bissell L, Royce JE. Ethics for Addiction Professionals. Center City, Minnesota: Hazelden; 1987.
- Addiction Scientists from the USA: LeClair Bissell. In: Edwards G, ed. Addiction: Evolution of a Specialist Field. 1 ed: Wiley, John & Sons, Incorporated; 2002:408.
- Durcanin C. The suicides at Ridgeview Institute: Staff members didn’t believe Michigan doctor was suicidal. Atlanta Journal and Constitution. December 18, 1987, 1987: A8.
- Ricks WS. Ridgeview Institute loses $1.3 million in suit over suicide. Atlanta Journal and Constitution. October 11, 1987, 1987: A1.
- King M, Durcanin C. The suicides at Ridgeview Institute: Many drug-using doctors driven to Ridgeview by fear of losing licenses. Atlanta Journal and Constitution. December 18, 1987b, 1987: A1.
- Bissell L, Haberman PW. Alcoholism in the Professions. Oxford University Press; 1984.
- White W. Reflections of an addiction treatment pioneer. An Interview with LeClair Bissell, MD (1928-2008), conducted January 22, 1997. Posted athttp://www.williamwhitepapers.com. 2011.
- Williams c. Health care field chemical dependency threat cited. The Tuscaloosa News. January 16, 1988, 1988: 16.
- Schneidman B. The Philosophy of Rehabilitation for Impaired Physicians. The Federal Bulletin: The Journal of Medical Licensure and Discipline. 1995;82(3):125-127.
- Peele S. In the Belly of the American Society of Addiction Medicine Beast. The Stanton Peele Addiction Website (accessed March 28, 2014)http://web.archive.org/web/20080514153437/http://www.peele.net/debate/talbott.html.
- Ursery S. $1.3M verdict coaxes a deal for doctor’s coerced rehab. Fulton County Daily Report. May 12, 1999b 1999.
- Ursery S. I was wrongly held in alcohol center, doctor charges. Fulton Count y Daily Report. April 27, 1999a 1999.
- Parker J. George Talbott’s Abuse of Dr. Leon Masters MD (http://medicalwhistleblowernetwork.jigsy.com/george-talbott-s-abuse-of-leon-masters ). Medical Whistelblower Advocacy Network.
15 thoughts on “Recovery Related Racket: The Federation of State Physician Health Programs (FSPHP) represents the drug and alcohol testing, assessment and treatment industry not us. We need to name the enemy.”
Excellent scholarship and incisive analysis! I plan to write a more extensive comment subsequently. One aspect that I would like to elaborate on is the issue of initial diagnoses that are embellished or even contrived by a PHP clinician acting with unquestioned (and unquestionable) infallibility, invariably backed by the licensing board and which diagnosis is nearly invariably seconded by the “preferred program” which PHP and the Board order one to attend. This becomes especially problematic when one understands that some PHPs (NCPHP for one) have (until very recently) adamantly refused to disclose their evaluation report to the subject physician. Their recent change of policy authorizing release of their report may have come about as a result of the NC Auditor’s finding in their 2014 Performance Audit of NCPHP that it had essentially violated the due process rights of over 1,140 physicians over the preceding decade.
The second aspect which I plan to cover is the curious phenomenon of PHPs declaring that they are not medical corporations, its clinicians are not acting in the role of clinicians, and that they do not actually conduct diagnostic evaluations for the Board (although the Board has explicitly ordered that a “mental examination” be conducted by NCPHP!). However, when one does finally see such a report, it is equivalent to a diagnostic psychiatric consultation throughout its construction. They seem to have been able to get away with this by registering as and claiming that they are nothing but “educational public charities.” This has allowed them, with full cover by their corresponding medical board, to conduct forensic diagnostic psychiatric evaluations, make diagnostic pronouncements that can’t be questioned, much less seen, and claim that these are some sort of “protected peer review” process. As “educational public charities,” they carry no malpractice insurance.
Hmmm. Make a contrived dx; can’t see the report; Board backs it up; PHP tells you they didn’t do a dx evaluation (but Board acts on it as though it were) and tells you it was “peer review” but you still can’t see it; you get sent to a “preferred program” run by their cabal who invariably return a dx consistent with the PHP preferred one (which of course is not really a dx … must be just a hunch…) and you’re now captive in the PHP “program” for 5 years. What could be wrong with that? (!?!?)
I guess if you’re part of the gravy train – nothing (if you don’t mind squashing any internal ethical qualms you might have).
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Part of what particularly bothers me right now is the financial risk. If I had signed the monitoring contract 2 years ago,I would have been sent back for another 3 mo-$55.000 enforced lockdown stay. Think it out. Last winter,2 feet of snow in my yard,frequent storms,I could never have made it to the caduses meetings(Greenfield,Pittsfield or Worcester) available less than once a week. It is a setup for failing. In fact,nothing in the monitoring contract is closer than a minimum of 30 min drive away. Spending my retirement funds that way would be foolish. That the system demands it is criminal. Beth
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I don’t understand why physician health programs are controlled mostly by non-physicians or ex-addict doctors who coerce the “impaired” into a one size fits all treatment program, whether the physician has a psychiatric disorder, a chemical dependency, and/or were “disruptive” in some way. There should be a confidential process of assisting colleagues in getting individually-based help for mental health or substance abuse problems, or for doctors to get help themselves, without worrying about possible reporting by their treatment providers, colleagues, partners, and employers. I thought that’s what the PHPs were originally set up to do, but now it sounds like many are coercive or even threatening, if their physician-client is deemed non-compliant with their ideas of diagnosis and treatment. I cannot see how this would meet the goals of salvaging otherwise fine physicians or protecting the public.
If the current PHPs are not set up to do what they originally were supposed to do, there should be other, safer, options for physicians to get appropriate treatment before it is too late- for them or their patients.
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You said it so succinctly.
PHPs have lost credibility in demanding adherence to their one philosophy / draconian system in which physicians are subjected to flawed if not fraudulent assessments conducted by people who lack training and discernment. These programs and the “preferred facilities” to which they force compliance to attend now seem like little more than a RICO system of internal referral guaranteed to bankrupt and indenture the physician, and extort him or her for the rest of their professional lives. They serve to give the appearance of an independent multi-person assessment but in reality serve as “yes men” to the PHP referrer which feeds their lucrative referral pipeline.
What is desperately needed is a comprehensive state-by-state performance audit to ensure compliance with fundamental due process, established civil rights and transparency of the administrative judicial process. Every state PHP must have an identified and accountable governmental body to which one can appeal should PHP violate these rights. Every PHP must be registered as a medical corporation which is REGULATED by the board, not collaboratively overseen by it. It should carry appropriate malpractice insurance, not simply errors and omission insurance suitable for the 501(c)3 “educational public charities” they falsely represent themselves be.
As with these sorts of changes, a groundswell of factually based confrontation must take place on a continuous basis to educate the myriad institutional supporters of PHPs, e.g. medical societies, hospitals, insurers and the administrative and judicial system, of the scope of PHPs’ digression and the profoundly unethical, illegal and dangerous mode of operation by which they’ve been conducting their business.
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You want me to name the enemy? I read this article with great fascination, along with all the comments.
Maybe I am missing the point, but how drug and alcohol treatment is handle for anyone is just wrong!
This topic is a huge peeve of mine, no really. I would put up in my top 5 “know way more than a person should know areas”. Here are the things that jumped out to me. A: Compassion Fatigue in the medical field of any kind, and self medicating. B: Yes, we need to drug and alcohol test all medical professional on a random basis. Just simple alcohol stays in the system for approximately 80 hours (ETG test). Even 48 hours out of a person tying one on, I don’t want that person doing anything at work, medical or non-medical. Plain in simple you are lying to yourself, if you think you can be best the next day after drinking heavily. C: Okay, let us talk the so called recovery systems. Bahahahahahaha. What a racket! This is where I out my foot down. You have to seek private counsel for treatment! End of the subject. Pick 2 private alcohol and drug recovery experts and stick with them I will get to why I say 2, in a minute. Recovery is a science based treatment. Not witch craft coming from a blue book, that was written by a man while he was in an LSD treatment center. WHO said that? Me! What is so alarming about this AA thing is it is a cult. What is even more alarming is talk about separation of church and state(sarcasm). Judges across this country mandate AA for offenders….whoa I need watch my manners here….AA is a proven failed system over generations. The great B himself died a screaming drunk. All these recovery centers that claim to be faith free, still drag those crazy 12 steps in somehow and modify them to seem non-religious. (let the hate mail begin) There is no ^^^ to thank for sobriety, It is a lot of hard work and science based. Now, back to why I say 2 recovery specialists. The majority of addicts of any kind will (and I may offend the author) need a skilled addiction psychiatrist. For whatever reason, and don’t quote me on these numbers please. I would say 95% will need one prescription or another to manage either withdrawals or underlying untreated mental conditions. Be it short term mental condition or life long. The second should be a counselor. Now here is the kicker, and people hate this. Those 2 have to talk to each other! Addicts are con artists, when actively using. There has to be checks and balances, and 2 approaches to treatment. Not ONE person’s knowledge should be used to treat an addict. It is a team effort, but NOT a group effort!
Did I just miss the point of this article??
PS nice work.
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The majority of doctors caught in this system are not addicts or even instance abusers- it is a racket. EtG too flawed and misused – not FDA approve and should be removed from market.
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“put my foot down” I hate typos.
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Man I enjoy learning new stuff and take directions/corrections nicely. How else do you learn 🙂
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