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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.