Physician Health Programs: More Harm Than Good?
State-Based Programs Under Fire
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, North Carolina, 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.
Medscape Medical News © 2015 WebMD, LLC
Send comments and news tips to news@medscape.net.
Cite this article: Physician Health Programs: More Harm Than Good? Medscape. Aug 19, 2015.
Comments on Medscape are moderated and should be professional in tone and on topic. Please see our Commenting Guide for further information. We reserve the right to remove posts at our
Comments (updated 9/15/15)
Physician Health Programs: More Harm Than Good?
Comments on Medscape are moderated and should be professional in tone and on topic. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
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Dr. Gail Hirschfield | Family Medicine
8 hours ago
Do you all know if there are any good PHPs out there, ones who are compassionate yet provide for the least intrusive monitoring which is effective?
1 like Unlike Reply Dr. Michael Langan | Internal Medicine 1 hour ago
@Dr. Gail Hirschfield @Dr. Gail Hirschfield Please see the following article published in the Journal of Addiction Medicine. I have a hard copy of the full article somewhere and can scan it and send it to you.
Physician Health Programs: The Maryland Experience
Platman, Stanley MD; Allen, Thomas E. MD; Bailey, Susan MD; Kwak, Chae LCSWC; Johnson, Stephen JD
Journal of Addiction Medicine NovDec 2013 Volume 7, Issue 6 pages 435438.
Maryland was able to achieve a 2program solution that protected both the voluntary participants while meeting the needs of the state licensing board for participants mandated by the state licensing board. This result has been well received by both the physician community and the state licensing board. This provides a model for others to use outside the “PHPblueprint” of the FSPHP.
I have yet to hear any complaints out of Maryland. It would be helpful to get some input from doctors in Maryland here if possible.
a b | Medical Student
PHPs are now being forced on doctors who are slow at charting
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20 hours ago
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INTERNAL MEDICINE
2 likes
Dr. Gail Hirschfield | Family Medicine
@a b How can this be even in the most amazing way be justified? I see no way! OCD? phooey.
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Dr. Gail Hirschfield | Family Medicine 12 hours ago @a b I am so glad to hear from a medical student…so sorry the system put you through this!
20 hours ago
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9/15/2015 Physician Health Programs: More Harm Than Good?
Dr. Michael Langan | Internal Medicine 1 hour ago Signals for “impairment” can be as benign as not having “complete, accurate, and uptodate patient
medical records.” according to Physician Health services, the Massachusetts PHP.
Despite the overwhelming amount of paperwork physicians now have, incomplete or illegible records could be construed as a red flag, since, as Associate Director of PHS Judith Eaton notes“when something so necessary is not getting done, it is prudent to explore what else might be going on.”
Read it here for yourself in “Medical Record Challenges ..A SUBTLE SIGN OF A POTENTIALLY IMPAIRING CONDITION?.” How about a NOT SO SUBTLE SIGN of being overburdened, overworked and having little time to keep up with the barrage thrown at you. Where is common sense here let alone rational thought and reasoning.
Inadequate charting is now a “Subtle sign” of a “potentially impairing condition” necessitating evaluation and possible treatment for “preaddiction” or behavioral “character defects” supported by nonvalidated psychometrics, polygraph testing, and a bunch of nondisprovable gibberish. Of course this necessitates a five year monitoring contract with the PHP and weekly drug and alcohol testing paid out of pocket as being derelict in your charting is either a sign you are already using or aa possible gateway to drug and alcohol use.
If you subsequently fall behind on your medical charting it is a sign of “relapse without use” requiring another assessment and probable treatment for “relapse prevention.”
http://www.massmed.org/NewsandPublications/VitalSigns/MedicalRecordChallenges_A SubtleSignofaPotentiallyImpairingCondition/#.Vfijo9NVhBd
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Melissa W | Health Business/Administration 3 days ago Melissa Wiggins
There’s a lot that can be done about the abuse created by these criminals, things that it’s taken me years to uncover and understand, important things.
Attorneys have stated that the NCMB “answers to nobody, they are incentivized to discipline as many as possible, as harshly as possible for as long as possible and that evidence is irrelevant, they prefer prosecution to investigation”.
These very attorneys are recommended by the NCMB to licensees being persecuted for those licensees defense. Typically the attorneys want large sums “up front” to take such an issue to hearing.
Wow!
A physician was sent for an evaluation directly by the NCMB without NCPHP evaluation (a violation of NC GS Chapter 90; which states that the Dr should have been sent to the NCPHP for evaluation). The physician was sent by the NCMB to an “NCPHPapproved” center out of a state that has half a dozen medical schools and a couple of dozen postgraduate mental health advanced degree programs.
Really? A state with this strong of an importance on higher education doesn’t have a single facility capable of evaluating wounded healers? One must go out of state to have this done.
He was sent for an “independent evaluation” (after the NCPHP contacted the facilitywhich was disclosed by the director of that facility”so that we can uncover and address all of their specific concerns”).
What does “independent evaluation” mean in this context?
This “center of excellence” as they described themselves, for the condition that the physician was later diagnosed with (despite finding 20 factual errors in their final reportfactual mistakes on what they based their diagnosis and proposed therapy on). Further research found that this facility had in fact treated “a handful” with this eventual diagnosis.
“Center of Excellence”?! Despite “a handful” of patients ultimately given this diagnosis?
Why does the NCPHP/NCMB allow and mandate the same center that makes a diagnosis do the therapy? That’s a setup for fraud and abuse! Patients are not patients at all, they’re captive annuities! Guaranteed full beds, once the diagnosis is made the treatment is mandated at that facility by the authorities. There’s nothing quite as effective as a hungry fox guarding the henhouse!
The NC State Auditor noted this in a very whitewashed report of 4/14. They also noted that the NCPHP has their annual retreat paid for by the facilities that take these referrals from NC. Are there other incentives that the auditor didn’t uncover?
To date there are at least half a dozen physician suicides directly linked to the NCMB & NCPHP.
9/15/2015 Physician Health Programs: More Harm Than Good?
How many more physicians must be sacrificed on the alter of corruption and greed? There are safeguards (ignored) in place.
NC General Statues Chapter 90 contains >100 pages of what the NCMB can and cannot do. It also provides guidance for the NCPHP & gives oversight of the NCPHP to the NCMS which is also charged. The NCMS is also involved in choosing the members of the NCMB.
In 2007 a lawsuit was filed By Burton Craig due to the role of the NCMS in supplying physicians to the NCMB. It was settled out of court, but for the next 7 years, there was not a single NCMB Board member who was an ACTIVE member of the NCMS. That finally changed this year.
Despite this history, a physician who has experienced the atrocities of the NCMB firsthand notes that the first question asked at a hearing is whether or not that physician is a member of the NCMS.
Why would this be relevant?
Each state has “General Statutes” that govern what their medical board can and cannot do as well as usually making some mention of responsibilities/oversight for the PHP if the state has one, and involvement of the Medical Society.
The Office of the Inspector General for each state should also be aware of illegal activities committed by state Medical Boards, PHP programs and Medical Society involvement/malfeasance.
There is also the US Office of Civil Rights for those whose basic civil rights have been violatedthis transcends state corruption. Complaints can be filed online. Disclosing HIPAA Protected Health Information online without consent in an order or other document by the Board, Eg. to their Public website as well as violations of the Americans with Disabilities Act would be classic reasons to contact the OCR.
The 3 forces of evil cooperate and work well together in NC.
Apparently, just as the “4th Estate” (Legislative, Executive, Judicial, Press/Media) of the Federal Government provides a series of checks and balances, NC also has a 4th estate for medical supervision; (NCMB, NCMS, NCPHP, Government officials).
Can anybody provide really good and thoughtful input on what specifically needs to be changed with Medical Boards & PHP’s? We know that this is a nationwide program; Board members are abdicating their responsibilities and allowing the attorneys of their organization to run the show, thus lightening the Board Members workload, so that the Board Members merely “rubber stamp” what the attorneys do. We’re held in contempt and are under the thumb of individual attorneys employed by the Boards, attorneys who have their own agenda. Please post your suggestions here and on the Medscape articles on PHP’s.
Predator becomes prey; imagine a fox chasing a mouse around a boulder upon which a mountain lion is perched, ready to pounce..,
4 likes Like Reply 2 days ago
Dr. Gail Hirschfield | Family Medicine
@Melissa W Going to state auditors may help. The AGO won’t help, won’t enforce. ADA is an
possibility. I would like some of the criminal complaints which involve fraud to go to the FBI. These PHPs and probably the MBs are simply rackets. Isn’t being a racket illegal?
Dr. Gail Hirschfield | Family Medicine
2 likes Unlike Reply 2 days ago
@Melissa W Ms. Wiggins, did you see this response by the Federal Society of PHPs leadership? It is on Medscape here. Of course the leadership directly benefits financially, as is pointed out:
http://www.medscape.com/viewarticle/850468
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Dr. Michael Langan | Internal Medicine 21 hours ago
I have given documentary evidence shoeing both the forensic fraud and fabricated neuropsychological testing confirmed by outside agencies to the FBI and was told that even though what the documents showed clearly was criminal that they probably would not be able to pursue it as they had to prioritize due to their workload and individual complaints are not usually pursued unless they are referred by AGO or high profile and in the media.
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Dr. karen miday | Psychiatry/Mental Health 2 days ago @melissa W. Please post to the FSPHP response on Medscape. This organization simply refuses to
believe and / or acknowledge that this is going on. They need to hear more from people like you.
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Dr. Gail Hirschfield | Family Medicine 8 hours ago
@Melissa W I am working on a reply, btw. The issue is what is to be done with these suggestions? They need to be posted on the reply to this article by Dr. Gundersen, the head of the FSPHPs. Do you need a link to that site?
9/15/2015
Physician Health Programs: More Harm Than Good?
God bless you for your post! It is a great one which goes right to the heart of the problems. Helen Keller said that alone we could do little, but together we can do much. And we will.
Some tidbits of thoughtscriminal activity needs reporting to federal authorities. State ones won’t to anything. Kickbacks are criminally illegal as is falsification of lab data, as we have seen. Kidnapping by blackmail is certainly illegal.
Civil suits against private agencies is possible, I believe, not so well covered under PHP contracts, especially if graft and corruption/coercion can be proven. Should be filed.
Marches gotten together in front of the PHP buildings with posters reading PHP KILLS, PHP=Physician Harm Program, PHPs are Physician Destruction Programs, and most especially we should march in front of key meetingsthe press will come. Also “Who is Michael Langan”? ‘”FREE DR.LANGAN”, with lapel buttons saying the same and similar, hats, banner or flags to wave, etc. “YOU COULD BE MICHAEL LANGAN” “Calling all doctors” and others. Hand the buttons out wherever you are able to.
Press to be involved…and KevinMD is drawing them. TEDtalks and Hey! Put a video on YOUTUBE about this! Maybe I will.
Gosh, off the top of my head! These articles are helpful. We have to effect change. Lives depend on us!
Thanks! Call Dr. Pam Wiblesee her companion piece here and I believe her no. is on it…it is about PHPs and Physician Suicides.
1 like
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8 hours ago
Dr. Gail Hirschfield | Family Medicine
@Melissa W Here is Dr. Wible’s video and article:
http://www.medscape.com/viewarticle/850023? inf_contact_key=61eda6d5ce24919b90a5dee36f7d6022dec3111831189b5e1a9f066ceea6b9b9
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Dr. Iris Brossard | Neurology 4 days ago
These programs are seldom “physicians helping physicians”. Many have no physicians on staff at all, or if they do, it may be one who is involved only peripherally. The rest are staffed by addictions counselors with questionable training, or people with no medical training at all.
Dr. Gail Hirschfield | Family Medicine
@Dr. Iris Brossard PHP=Physicians Harming Physicians
5 likes Like Reply 4 days ago
They have Boards they answer to, and physicians are on these boards. Still, that is no help, as I am sure these Boards rubberstamp the PHP director’s recommendations, and the director in turn probably rubberstamped his staff’s recommendations…those people, those counselors or “case managers” have questionable credentials, and of course, no credentials regarding physician health issues.
Dr. Gail Hirschfield | Family Medicine
@Dr. Iris Brossard PHP=Physician Destruction Program…
that’s what I call them
Dr. Michael Langan | Internal Medicine
1 like Like Reply 3 days ago
As doctors trained to diagnose using evidencebase and critical reasoning I ask that you analyze the articles and comments on Medscape and KevinMD and cast your vote on whether you believe the current management of the PHP system is harming or helping doctors and the medical profession. In light of the abuse of power and
1 like
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4 days ago
9/15/2015 Physician Health Programs: More Harm Than Good?
institutional injustice reported here by our colleagues it is a moral imperative. Either justify and defend this authority or reject and make your criticisms heard. Neutrality and silence are not an option when the accusations involve the political abuse of psychiatry to repress and control our colleagues. Pathologizing normality and diagnosing behavioral and cognitive illness in those without it are unconscionable acts. Those involved need to be removed from their positions of power, their medical licenses revoked and charged criminally. Being a bystander here is not acceptable. All of us know how to critically review the evidence so take the time and do it. These doctors need our help. It is our responsibility to question this authority and if these questions are not adequately answered or ignored then we need to remove them from power and reconstruct a system of integrity, transparency and accountability.
Dr. s n | Physician
3 likes Like Reply 5 days ago
It is abundantly clear after reading so many horror stories on this forum and other sites that the entire PHP system should have been ABOLISHED ages ago. Audits are not going to get the job done. Organizations find ways to pass audits. The current system and its corruption are beyond saving.
(PHPs and their collaborators are unnecessary, but even if they weren’t, they should operate COMPLETELY differently.)
Stopping the PHP “murders,” suicides, destroyed lives, destroyed careers, etc. means ABOLISHING THE PHP SYSTEM.
4 likes Like Reply 5 days ago
Dr. Gail Hirschfield | Family Medicine
@Dr. s n I think the idea and mission of PHP is sound and humane…IF it were set up properly to heal
and guide physicians.
Dr. Gail Hirschfield | Family Medicine
1 like Like Reply 5 days ago
@Dr. s n Dr. s n, did you see the reply Dr. Guderson, the head of the Federal Society of Physician Health Programs put up here on Medscape? I don’t know how to make a link to it, but maybe some responders here can do so, or you can search for it.
She came on this site with a big reply but has refused to back any of her assertions up when they have been challenged in the “Comment” section…I get the idea that would be beneath her, that her pontification should stand as truth because she wrote it.
and we all know that everything on the Internet is the truth!
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| Psychologist 6 days ago
I have spoken with Dr Langan and do truly believe the newer model of PHPs is far less than ideal. I agree there is
far too much “overpathologizing” and that participants in these programs should be heard by an independent board
9/15/2015 Physician Health Programs: More Harm Than Good?
when there are concerns to avoid bias and mislabeling.
My heart also goes out to Dr Miday and others for the terrible loss of their loved ones.
However, as someone whose life and career were literally saved years ago by my PHP, I felt compelled to write. While there are many who are inaccurately diagnosed and then go on to suffer grave consequences, there are also many of us (like me) who needed the structure and help my PHP providedboth during the darkest hours as well as throughout early recovery. As a medical educator, I have referred many residents to our PHP with excellent results. Let’s work to monitor and fix the problems; however, PHPswhen functioning as they should are muchneeded organizations. Without them, I truly believe many, many more physicians and other licensed health care professionals would die.
Many physicians are dying because of PHP abuse! That is not theoretical. How about fixing what is broken?
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Dr. Michael Langan | Internal Medicine 5 days ago
I agree with you Heidi, PHPs are necessary and intended to help both doctors and contribute to the greater good. Ideally sick doctors are identified early, given the correct diagnosis and properly treated so that they can return to work as healthy physicians.
For some doctors the current system may accomplish this but an increasingly alarming number of doctors are being given diagnoses they simply do not have and given treatment and monitoring they do not need.
At the same time many sick doctors do not get the correct treatment or are mistreated such that they get worse. In both cases doctors who are healthy or could have been restored to health if properly treated are being removed from the profession. Others suffer in silence and never get help. And who knows how many suicides come from each of these groups.
It varies state by state but the groupthink has poisoned PHPs and they have become a culture of coercion, control and fear. When punishment entails 3 months in an out of state treatment facility most people keep quiet. PHPs have become increasingly institutionally unjust.
It is incomprehensible that the medical profession would allow their own to be tested with nonFDA approved drug and alcohol testing of unknown validity and the close ties between the PHPs and the “PHPapproved” facilities need to be exposed. The financial and ideological conflicts are great.
Fixing the PHPs requires that the people responsible for subverting the system be identified and removed. The FSPHP model of authoritarian control and punitive management with no oversight or regulation needs to go.
PHPs need to be staffed by individuals of integrity and moral compass and the current system must be replaced with one of transparency, oversight, assurance of due process , freedom of choice in assessment and treatment, avenues to address complaints and a focus on helping sick doctors heal in an environment that maintains dignity, respect, empathy and care. This necessitates a firm but fair and just management and the current irrational authority does not accomplish that.
I love your last paragraph. Every part of those sentences is mandatory for fairness, justice, and healing.
Dr. Gail Hirschfield | Family Medicine
Maybe that was so years ago. It is not the status quo as you can read for yourself
here.
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Dr. Gail Hirschfield | Family Medicine
@Dr. Michael Langan Absolutely…What you say here is sane and
humane…the complete opposite of what we have with PHPs.
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Dr. mary lou courrege | Dermatology, General
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I have read this article with great concern as I know a physician who was railroaded out of practice without any legitimate basis on the false allegation that he was ‘mentally ill.” He tried in many ways to contest the false assessment done by PHP (in response to an anonymous “concern” coming from neither a patient nor a
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colleague). That PHP already had in its hands a fully valid comprehensive twelve page psych report which showed no evidence of any mental illness.
It turns out that this was done in the context of his blowing the whistle on substandard mental health care at a military base and he had a major whistleblower suit in court and a US Congressman supporting his efforts.
I’ve know this physician for more than five years and he has shown no evidence of any “mental illness.” And I’ve also seen the incredible stress he’s been under having to fight this medical board and challenge the PHP who made this false diagnosis. He’s broke and out of work.
What is particularly sad is that a patient of his, and a dear friend of mine, committed suicide as a direct result of the interruption of his care with this physician. His was truly a needless suicide as he valued his work with tis physician and was distraught when his care was abruptly interrupted.
It is so deeply troubling to me that medical boards and PHPs have this much power to destroy a caring physician’s career and cause profound patient harm in the process.
Mary Lou Courrege, M.D.
Dr. Michael Langan | Internal Medicine
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@Dr. mary lou courrege This is a common scenario and must be stopped. All it takes is an anonymous accusation to get a doctor into the hands of the state PHP and once that is done they control all aspects of the assessment and monitoring process. All outside opinion is disregarded. This is political abuse of psychiatry and must be recognized and addressed urgently.
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Dr. Gail Hirschfield | Family Medicine
@Dr. mary lou courrege I am so very sorry to read about this. We should all keep in mind the
patients who suffer when their doctors are distracted or are taken away from them.
Dr. Richard Harris | Pain Management
3 likes Like Reply 6 days ago
Leadership??? Try calling it what it isclosing the barn door after the horses are gone and have been slaughtered by other out of control individuals. You cannot win once the Medical Board simply takes the position that an assistance program in and of itself has the right to be a “closed shop” with no responsibility to answer to anyone!
The need for Physician Assistance Programs is needed, but what is needed more is an intense oversight of the program to avoid putting the physician into bankruptcy on day 1 without an iota’s shred of evidence that there is anything wrong. The State Medical Boards must take on the responsibility of having an independent voice advocating for the physician so that what actually needs to be done is done, and that the other garbage is stopped and the physician can return to practice in something approximating being a whole person again.
Dr. Kernan Manion | Psychiatry/Mental Health
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@Dr. Richard Harris Maybe we could advocate for an ombudsman system every doc brought before the MB or PHP given an ombudsman who helps negotiate them through the labyrinth and ensures their due process and civil rights and protection from harm. And who also is empowered to confront MB & PHP abuse.
Dr. Gail Hirschfield | Family Medicine
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@Dr. Kernan Manion @Dr. Richard Harris Yes, something like that. I think we need to find ways to unionize. We are getting to be employees more and more. Is there an umbrella union who could help us challenge the laws or get them changed so we could sign up with them?
Dr. Michael Langan | Internal Medicine
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The AAPS would be a possibility. I have spoken with executive director Jane Orient and they ate aware of the insanity and abuses occurring. AMA and Medical and Societies not listening. Usual Channels blocked.
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E C | Health Business/Administration 6 days ago I am happy that this issue has been circulating in the medical press. Another recent article discussed the
connection between PHPs and physician suicide. It is a real issue that needs to be brought to light. We assume
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that a physician who has been labeled impaired, must have a serious issue. But that is usually not the case. Thanks to some of these rouge PHPs, there are health providers who have been labeled impaired and suspended because of clerical errors and anonymous complaints. Here is the link to the Michigan case that is mentioned in the article. This is an extreme example of a PHP destroying careers and having total disregard for the
law. http://www.chapmanlawgroup.com/publications/HPRPClassActionComplaint.pdf
Physicians are encouraged by employers and colleagues to enter these programs and they have no idea the potential damage these programs can cause. Once labeled impaired by these program, maintaining their career becomes a very difficult battle. Sadly, that battle is too much for some.
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Dr. karen miday | Psychiatry/Mental Health
I do hope that many of you will post your comments to the FSPHP response by Doris Gunderson. I hope you will
also request a reply.
Dr. Gail Hirschfield | Family Medicine
@Dr. karen miday Where is this response? I will look for it.
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Dr. Gail Hirschfield | Family Medicine
@Dr. karen miday I looked for it, but I can’t find it! I would love to reply to any response
she put up. Maybe she pulled it?
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Dr. Gail Hirschfield | Family Medicine 6 days ago @Dr. karen miday I did! but the only one speaking up for the PHPs was really hard to take! Your
forbearance was a beauty to behold, Doctor.
Did you get the impression I was a little bothered by what I read from Dr. Gaither? lol?
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Dr. A B | Pathology 8 days ago I am so thankful this is finally coming out. How did anyone ever expect a program granted fantastic authority and
6 days ago
latitude with NO policing or accountability to be fair?
Dr. Gail Hirschfield | Family Medicine
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@Dr. Anease Brooken I do believe that was and still is the whole point. But these doctors do have money, or folks think they do, especially lawyers, who actually are very involved with the workings of these programs, and this is a way to get that money from them to ? private consulants, lawyers, and other beneficiaries of these funds.
Dr. A B | Pathology
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@Dr. Gail Hirschfield @Dr. Anease Brooken That’s been my suspicion from the moment I began looking for legal representation. Early in the process, both the PHP and the lawyer I was hiring were pitching the same line in one way or another “It’s in your best interest to just cooperate.” Then once I was so deep in and dishing out money for legal assistance, to experts, and to programs every action seemed focused on perpetuating this. They tell me they need neuropsychological testing to be sure I’m safe to practice I undergo it at Mayo Clinic through my insurance leaving their expert getting no cut of the fee. So guess what? They say the test at Mayo isn’t adequate and I need to pay their expert and their expert alone: One choice in one city. At some point I realized they were never going to stop even though I had been cleared by 2 medical doctors, 2 psychiatrist, and demonstrated normal cognitive profile on the neuropsychological testing at Mayo. EVERY independent specialist I’ve seen in this process has declared me safe to practice. I don’t believe that’s their (PHP’s, their consultants, or their lawyers’) concern at all.
Dr. Michael Langan | Internal Medicine
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In each state there are 3 or 4 attorneys who the PHP will recommend. These attorneys will not bite the hand that feeds and only work within proscribed boundaries set by the PHP. They will tell you you have no choice but to follow any and all recommendations of the PHP if you want to keep your license. If you complain to these attorneys about suspected misconduct by the PHP, assessment centers or labs they will not pursue it in any way and if you object to 12step they will tell you their is no choice. They are the first line of defense in deflecting
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complaints.
Dr. Gail Hirschfield | Family Medicine
@Dr. Michael Langan It took me awhile to figure this out.
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Dr. B B | Cardiology, General
I had an argument with the CMO at one of the hospitals I work in. He made a referral to my State PHP for disruptive behavioe. They did a perfunctory evaluation, and then wanted me to sign a contract for out of state hospitalization, followed by 4 times a week psychotherapy (60 miles from my practice). I spoke with the medical director to ask for a reassessment because they had not spoken with ANY of my colleagues at which time I was told “we NEVER reconsider our diagnoses.” That alone led me to mistrust them. Any institution which claims a 100% accuracy rate is lying to themselves and their patrons. The CMO continued to press for me to sign a PHP contract until he was fired because of a pattern of abusive behavior. In my case the ‘referral’ turned out to be a meretricious and punitive abuse of power on his part but had I knuckled under and signed a contract with PHS I would stll be in their clutches. The proposed contract offered a zillion ways to fail and essentially no way to succeed. PHP’s need oversight!
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Dr. Gail Hirschfield | Family Medicine
@Dr. B B That is an astounding revelation! How very sad it has come to this! Ridiculous, even, if not
so unbearably sad…
Dr. Kernan Manion | Psychiatry/Mental Health
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@Dr. B B Maybe we’ve gotten to a point in the police state of medicine that we need to have the equivalent of “safe houses!” Maybe we need to get a group of authentic, compassionate and treatment savvy psychiatrists, psychologists, and therapists who would all commit to providing care in absolute confidence.
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Dr. Gail Hirschfield | Family Medicine
@Dr. Kernan Manion @Dr. B B but aren’t they supposed to work this way?
Dr. Kernan Manion | Psychiatry/Mental Health
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@Dr. Gail Hirschfield @Dr. Kernan Manion @Dr. B B It IS supposed to work that way, but when Boards and PHPs start menacing the physician patient’s treating clinician, that provider may falsely believe that they’ve got to produce records. Further, the invasiveness itself causes doubt in the treating clinician and may subtly destroy the treatment relationship.
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Dr. Gail Hirschfield | Family Medicine 9 days ago
Reading this over, and seeing the depth of the corruption depicted here, and surely the very tip of the iceberg, it is obvious these guys involved are not going to give up their sinecures and honey pots easily. I think that is why we docs, not used to such evil behavior, though we probably experienced it in our own medical student experiences (I surely did! the stories I could tell of my classmates’ victimized, but me only slightly but enough)…UTMB Galveston graduate 1976
Dr. karen miday | Psychiatry/Mental Health
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Other physicians need to hear these stories. Most docs have absolutely no idea of what referral to a PHP sets in motion. My son’s referral was made by a colleague of a friend of his who had experienced my son in an offduty intoxicated state. (Yes, that is correct: “colleague of a friend” someone who didn’t even know my son and “off duty” inebriation.) I truly believe that had this person known the impact of this referral, he would have thought twice. My son finished his residency program 3 months after his fellow residents did. This, for him, was a source of deep humilation. It also prevented him from beginning a fellowship directly out of residency. I believe that when he took his life, one week before his oncology fellowship was to begin, he was in a state of panic about this happening all over again.
I do hope that “clinical vignettes” such as his will have all physicians think twice about involving themselves or a colleague in these systems. Much better to make a referral to a private, independent, psychiatrist or addictionolgist, who will treat in the usual “least restrictive” setting, rather than publicly shaming vulnerable physicians by separating them from their careers and their colleagues.
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Dr. Kernan Manion | Psychiatry/Mental Health
@Dr. karen miday You are absolutely right. Private referral to a TRUSTED and STRICTLY
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10 days ago
CONFIDENTIAL resource would definitely be the route to take.
Dr. M L | Internal Medicine
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@Dr Jesse Cavenar. It is important to recognize that the architects of the current PHP scaffold ( which they have titled the “new paradigm” was erected by the deliberate duping of organizations, politicians, the public and others. Using a plethora of logical fallacy, misinformation, propaganda and “bent science” this group has successfully bamboozled their way to the top. How they did this with the Federation of State Medical Boards can be seen by reviewing the Journal of Regulatory Medicine which has been recently archived sequentially with full articles. Proclaiming themselves experts with a 90% success rate ( which they partly tied to their specialized treatment centers requiring 3x longer lengths of stay at 3x the cost) these moral entrepreneurs offered “treatment” rather than “discipline” and continue to use this “either or” false dichotomy to promote themselves. The medical boards and FSMB accepted their claims without investigation. Since that time they have duped the boards into accepting the use of nonFDA approved drug tests they introduced ( ex felon Greg Skipper we can thank for that) , resurrecting polygraph test and removing due process for doctors. The FSMB accepted “potentially impairing illness” and “relapse without use” as valid medical definitions. The crazy train has left the tracks folks. It is important to point out that PHPs are not the problem but the current Frankenstein calling itself a PHP. We need PHPs but the current system either protects the public or helps doctors. This is the direct result of the FSPHP particularly under the unethical leadership of FSPHP Presidents Luis Sanchez and Warren Pendergast who need to be recognized as the criminals they are.
Dr. Jesse Cavenar | Psychiatry/Mental Health
6 likes Like Reply 11 days ago
Several people have questioned where our national organizations are in all of this. Let me state that I submitted an ethical complaint of some 28 pages, very tightly written and heavily supported with references and facts, to the North Carolina Psychiatric Association. As I later discovered, a colleague had submitted a complaint of over two hundred pages to the North Carolina Psychiatric Association. As it happened, our individual complaints arrived at the North Carolina Psychiatric Association headquarters on a Wednesday afternoon. As I subsequently discovered, one person on the ethics committee can be assigned as a reader. That person reads the material and then tells the remainder of the committee what he has read and so on. Then there is a vote and that is it. Most disturbing is the fact that the telephone conference call meeting of the ethics committee was on the following Monday afternoon, less than 96 hours after receipt of the two extremely detailed and documented complaints.
I had serious reservations as to whether the complaints were even read by one person. I appealed to the Chairman of the American Psychiatric Association and received a two line letter affirming the actions of the North Carolina Psychiatric Association Ethics Committee.
I have served on both state and national ethics committees. Any complaint was distributed to all members of the committee, the members not only read but studied the complaint, investigated the complaint if necessary, and then there was a face to face meeting with extensive discussion of the complaint. However, with organized psychiatry, one person on the committee can be the reader, then tell the others via a telephone conference call what he has read, a vote is taken, and that is it.
The system designed by the American Psychiatric Association would appear to many observers to be a system to “bury” complaints and make the complaints go away. Very disturbing, very depressing, very disheartening. It does not make one proud to identify with such a group.
So, in response to the question of where are our national organizations, I offer this commentary.
Dr. Gail Hirschfield | Family Medicine
3 likes Like Reply 11 days ago
@Dr. Jesse Cavenar Thanks so much for your efforts! I don’t see AMA or the state associations weighing in. This is what happened in Hitler’s Germany, I think. It is the power of the totalitarian groups over other groupsthey are either brainwashed by the propaganda or afraid to act.
We individual physicians seem to be on out own. I am not an organizer, or never have done so, but we need to organize under some leadership, someone coming forth, I guess, and do some activities as a group, like march with posters, go to the mainstream press, or Youtube or TEDtalks…those are the ideas I have presented. Individual complaints can be ignored and are ignored. Sorry for that.
I am in Texas. I would be happy to share my email. Someone said that docs were organizing on SERMO, but I couldn’t find out where. If I am able to, I will post it here.
9/15/2015 Physician Health Programs: More Harm Than Good?
Keep up the good work! PHYSICIAN’S LIVES MATTER…
Dr. Gail Hirschfield | Family Medicine
A PHP sentence can be a death sentence. PHPs kill
PHYSICIAN’S LIVES MATTER! nu?
Dr. Gail Hirschfield | Family Medicine
What about going to the mainstream press? the investigative reporters?
Dr. Thomas Bohannon | Anesthesiology
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@Dr. Gail Hirschfield Mainstream press has littletono sympathy for nurses/PAs/NPs/etc., much less physicians, who are ACCUSED of impropriety. It’s all about the headlines, the fingerpointing and hushed whispers, and then move on to the next carcass to chew on. They have a job to do. It’s not to get out the truth and inform the public it’s to sell advertising.
Where we as health professionals fail is in not taking control of our Boards. The Boards of Medicine, Nursing, Dentistry, and so on in my state have delegated all authority to the PHP. Our representatives on our professional boards just want the problem off their desks. Until our Boards decide to do their jobs, those of us like me who are under a PHP contract are SOL. I “deserved” the five year sentence, but I knew plenty of others who were forced into contracts by the PHP on the basis of nothing more than allegations of an estranged spouse as a tactic in a divorce, or even less.
Dr. Elizabeth Bartlett | Psychiatry/Mental Health
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A psychiatrist friend of mine committed suicide a year ago after two years of misdiagnosis and abuse through our PHP. A patient of his, he’d been seeing since the kid was 6, had been doing really well under Ray’s care. Minimal medication, some organics, some talking. Now the kid is twelve, being seen by a geriatric psychiatrist, on 6 meds including abilify and clozaril. kid is now a drooling idiot with no future. Well done, PHP.
Dr. Elizabeth Bartlett | Psychiatry/Mental Health
5 likes Like Reply 12 days ago
I would also like to point out, what happens to these doc’s patients when BOLIMs and PHPs go off like a rocket and suspend licenses without cause, hearings, trials, evidence? When I had to stop working I found out that within a year several of my patients who I had been able to keep out of the hospital for years were hospitalized multiple times the first year I was out of practice. After having done nothing wrong. How many patients suicide, die or get sicker because the physician they trusted was yanked away from them for no reason by overzealous BOLIMS and PHPs?
Dr. Gail Hirschfield | Family Medicine
@Dr. Elizabeth Bartlett So very true, and also at the heart of the matter.
Dr. Elizabeth Bartlett | Psychiatry/Mental Health
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Licensing boards have gotten completely out of control. I know a doc who was perfectly competent, noticed he was having an increased rate of postop complications so asked a senior attending to monitor him on this one procedure to make sure he was doing nothing wrong. After the monitoring the attending agreed the doc was doing nothing wrong, just a statistical blip. A few months later doc gets reported to his BOLIM by a nurse that he was smoking a joint at a party on a Saturday night, not on call. BOLIM says this postop complication issue proves he was impaired at work. What? Doc is forced into a 5 year contract for drug monitoring, shows up for work one day shaking and sweating because the BOLIM is threatening to suspend his license because he is missing one prescription out of his required submissions of his triplicates. He must be a drug addict. After much hysterical searching, it is discovered that his secretary sent rx form with #999 on it to the printer to get more rxs printed. Printer threw it out. BOLIM made doc get a note from the printer to confirm this. This was in 2002. It has not gotten any better people. I was afraid he was going to off himself he was so freaked out by the BOLIM’s casual capacity to completely destroy his life in an instant over nothing. None of this is legal. Be afraid. Be very afraid.
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Dr. Jesse Cavenar | Psychiatry/Mental Health http://www.medscape.com/viewarticle/849772
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9/15/2015 Physician Health Programs: More Harm Than Good?
@Dr. Elizabeth Bartlett This is very frightening and one should be very afraid when dealing with such people.
Dr. Gail Hirschfield | Family Medicine PHYSICIAN’S LIVES MATTER
Dr. Gail Hirschfield | Family Medicine
Which PHP do we gather and march in front of first? Let’s go!
Dr. Michael Langan | Internal Medicine
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Sep 1, 2015
In “Ethical and Managerial Considerations Regarding State Physician Health Programs, ” Dr.’s J Wesley Boyd and John Knight note the significant and multiple conflicts of interest that exist between State Physician Health Programs and the referral treatment centers that they use. They state:
“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.”
There is an obvious difference between impartially evaluating evidence in order to come to an unbiased conclusion and building a case to justify a conclusion already drawn. To consciously “tailor” a diagnosis of addiction or relapse based on anything other than the objective evidence violates the basic principles of medical ethics.
A state audit of the North Carolina Physicians Health Program that was released in 2014 documented the conflicts of interest and lack of quality assurance in referrals to out of state “PHPapproved” assessment and treatment programs. The same centers are used in most states including Massachusetts. and the the medical directors of the “PHPapproved” facilities can all be found on this list of “LikeMinded Docs.” The financial and political conflictsofinterest are obvious between the PHPs and the “PHPapproved” assessment and treatment centers. And there is no choice in the matter.
In 2011 the ASAM issued a Public Policy Statement on Coordination between Treatment Providers, Professionals Health Programs, and Regulatory Agencies recommending physicians in need of assessment and treatment be referred only to “PHP approved” facilities and also that PHPs need the full cooperation of the board if they deem a monitored physician noncompliant as “criticism or doubt could unintentionally undermine the PHP” In addition the ASAM wants regulatory agencies to recognize the PHP as their EXPERT in all matters relating to licensed professionals with “potentially impairing illness.” You read that right, “potentially impairing illness.” The Federation of State Medical Boards House of Delegates adopted an updated Policy on Physician Impairment at their 2011 annual meeting and approved the concept of “potentially impairing illness” and “relapse without use.”
And what might signal a potentially impairing illness you ask? According to Physician Health Services, Inc. (PHS), not having “complete, accurate, and uptodate records” could be a red flag as “when something so necessary is not getting done, it is prudent to explore what else might be going on.”
Boyd writes in Psychology Today that when he and John Knight published this paper, reviewers at 2 different journals said that the issues raised were very important but it “should not be published, essentially because doing so might bring unwanted outside attention to PHPs” and —one of them wrote the paper should be withdrawn and instead be presented at the national federation of PHPs’ annual meeting. Boyd recommends more state audits and national standards and that “because PHP practices are largely unknown to physicians until they themselves are referred to one, physicians who do register complaints about standard PHP practice are often dismissed as bellyaching.”
The time has come to draw this “unwanted attention” to PHPs. It is a moral imperative at this point.
Dr. Gail Hirschfield | Family Medicine
5 likes Like Reply Aug 31, 2015
Reading these comments has made me feel very sad. One thing that can be proven would be a link between a PHP program and any individual or company that benefitted from their “referrals”, which are completely coercive. I see a great deal of money changing hands, in short.
Isn’t that an avenue one could explore? Extortion, racketeering? as if I knew what these terms mean! well, what I read here sounds like there is coercion going on, which amounts to extortion…some journalist may be so inclined to follow this money!
Meanwhile, doctors simply have to form unions to combat big government…corrupt bureaucracies which not only endanger our careers and lives, but by a short extension, affect the lives of the patients we serve.
9/15/2015 Physician Health Programs: More Harm Than Good?
9 likes Unlike Reply Dr. Michael Langan | Internal Medicine Aug 31, 2015
@Dr. Gail Hirschfield You are correct.
Physician Health Programs (PHPs) do not represent the interests of doctors or the public but the interests of the drug and alcohol testing, assessment and treatment industry. The recovery related racket is a multibillion dollar industry. They are claiming PHPs are a replicable model and pitching it to other EAPs. http://disruptedphysician.com/2015/07/30/recoveryrelatedracketphysicianhealthprograms phpsdonotrepresenttheinterestsofdoctorsorthepublicphpsrepresenttheinterestsof thedrugandalcoholtestingassessmentandtreatme/
Dr. Gail Hirschfield | Family Medicine
@Dr. Michael Langan @Dr. Gail Hirschfield
6 likes Like Reply 12 days ago
I am so glad that there are other physicians who are championing the cause of a serious injustice our fellow physicians and other healthcare providers face. Yes, PHPs are exploitative groups which have very thinlyveiled and patently evil and illegal agendas which are simply selfserving and have nothing to do with patient or public welfare, much less the health and welfare of physicians, despite their unfortunate and deceitful name…”Physician HEALTH Programs”. I have long called the “Physician Destruction Programs” , but it seems they can rightly be called “Physician Death Programs”, no better than Gulags or other death camps found throughout the world when psychopathic people come into power. This is no exaggeration…the statistics are on my side. Let’s stand up for ourselves, peoples…before more suffer at the hands of these monsters.
Remember, “evil flourishes when good men stand by and let it” or something similar by Edmund Burke. “Animal Farm” metaphorically comes to mind as well, aw we are obviously speaking of unchecked totalitarianism.
Dr. Jesse Cavenar | Psychiatry/Mental Health
3 likes Like Reply Aug 31, 2015
In response to Dr. Pearl Jazz’s posting below, I sent emails to the Chief Executive Officer and the Executive Director of the NCPHP asking to speak with either of them regarding Dr. Jazz’s posting. In the past ninety six hours, neither has responded to my emails. I attempted to telephone, only to find that both were out of the office that day and neither has returned my call.
I am concerned if the NCPHP is formulating treatment plans prior to seeing the patient. That is totally backwards; we examine the patient, and then we determine the treatment.
It is important to realize that Dr. Jazz is a practicing physician with an active license in another state, and is simply asking to apply for a North Carolina license. Before he is even examined, he is being told all of this preposterous information. If Dr. Jazz were unable to work while “hospitalized” for three months, plus the actual expense of the hospitalization, it would run the cost up to about $150,000.
A competent, experienced clinical psychiatrist should be able to examine Dr. Jazz as an outpatient for about one hour and determine what course of action to take. In all likelihood, Dr. Jazz needs nothing more than he is presently doing. Such a competent evaluation might save Dr. Jazz the loss of his practice, a three month hospitalization, thousands of dollars, and humiliation, loss of selfesteem and a rage reaction.
Dr. Kernan Manion | Psychiatry/Mental Health
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@Dr. Jesse Cavenar Thank you for your staunch advocacy in pursuing this issue, Dr. Cavenar. The actions committed by NCPHP against Dr. Jazz are so malicious and violating of fundamental psychiatric and medical ethics as to be unfathomable. It would not surprise me if the NC Medical Board to which he applied would now attempt to compromise him by reporting him to his originating state’s medical board as having an incomplete application and that the NCPHP Medical Director was known to have raised concerns about that physician’s potential impairment. This is a nightmare. And it must be halted. In the meantime, why should ANY physician ever seek licensure in NC? Why should any physician ever answer any question on an application having to do with personal disclosure of illness?
I believe that US DHHS, one of whose divisions maintains the NPDB, needs to be alerted to the likelihood that its database of boardreported physicians has been severely compromised by false accusations and profound abuse of power such as this.
The horror stories that abound here leave one incredulous.
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I will soon be posting an opinion piece entitled:
“10 Career and Life Preserving Reasons Why You Should Never, Ever Voluntarily Go To a PHP ” It will be posted at the Center for Physician Advocacy http://www.physicianrights.wordpress.com
The entire PHP movement must come under scrutiny.
What is surprising is that no FSPHP spokespersons have yet commented on this piece.
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Dr. Michael Langan | Internal Medicine
Please click on the link below and complete the following survey if you have been monitored by a Professional
Health Program or Physician Health Program (PHP)
Professional Health Program (PHP) Survey
Please click on the link below and complete the following survey if you have been monitored by a Professional Health Program or Physician Health Program (PHP
This is a confidential survey. If you have concerns about anonymity please create an alternative alias email address (this video shows you how to create an alias Gmail address), then use the alias email address as your “name” for future correlation.
You can also cut and paste the following link to your browser.
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Dr. Michael Langan | Internal Medicine http://disruptedphysician.com/2015/06/27/physiciansuicidetheroleofhopelessnesshelplessnessand
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Aug 31, 2015
defeat/
Dr. Michael Langan | Internal Medicine
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Aug 29, 2015
Of the over 200 cases reported to me so far the preponderance of complaints involve certain states (Washington, North Carolina, Florida and Massachusetts involve the most) whereas I have heard no complaints from other states.
The common denominator seems to be the degree of influence of the FSPHP. Many of the Medical Directors of the states with the worst abuses have also been involved in the political hierarchy of the FSPHP (including two who were presidents of the FSPHP). The states with the worst abuses have essentially removed decent individuals. In Massachusetts, for example, they removed John Knight and Wes Boyd. That completed the FSPHP takeover.
9/15/2015 Physician Health Programs: More Harm Than Good?
The “impaired physician” takeover of state PHPs, and how it was done, can be seen here:
http://disruptedphysician.com/2014/11/27/disruptedphysician1014/
This problem needs to be addressed state by state. In reality, this makes it easier provided the right people become cognizant of the reality of the problem.
7 likes Like Reply Aug 29, 2015
Dr. karen miday | Psychiatry/Mental Health
12 step zealots have no business caring for their fellow physicians. Let’s leave this up to appropriately trained and
boarded psychiatrist and addictionologists, ones whose credentials are more than being in recovery themselves
10 likes Unlike Reply Aug 29, 2015
Dr. karen miday | Psychiatry/Mental Health
And what happened to evidencebased medicine here? Physicians somehow don’t deserve it? They must look to
the Higher Power instead? Let’s try treating diabetes this way.
Dr. karen miday | Psychiatry/Mental Health
Let’s just be glad that PHPs didn’t exist when Freud and Halsted were practicing.
Dr. C H | Anesthesiology
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Aug 29, 2015
I would recommend Dr. Janice Harper’s inexpensive ebook on mobbing, Mobbed! A Survival Guide to Adult Bullying and Mobbing, to anyone who has experienced this PHP abuse. Your colleagues have formed a mob against you (different from bullying). Dr. Harper is a cultural anthropologist.
Dr. David Ogle | Family Medicine
5 likes Unlike Reply Aug 28, 2015
Dear Readers and Followers of Medscape and the PHP issue. First, I would like to commend the author for publishing and posting this article. The article itself demonstrates well the complexities and web of entanglement physicians face when issues arise with a medical board whatever they may be. However, the article fails to give any hope to those of us whose careers, livelihoods and families have been decimated and destroyed by the arrogance, oppressive and tyrannical behavior of State and federal government entities such as medical boards and their spawn across America.(FSMB, PHP, FSPHP, NPDA aka the DataBank to name a few). There is NO DUE PROCESS and will be none until legislation and statutes initiated by the HCQIA (Health Care Quality Improvement Act of 1986) are reversed in that it grants sovereign immunity to States and their progeny…i.e.boards. There needs to be a reversal of all cases that denied DUE PROCESS! David Ogle MD Gresham Oregon
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Dr. Jesse Cavenar | Psychiatry/Mental Health
@Dr. David Ogle I totally agree that there is a lack of due process. Physicians must be the only group
in the country that does not get due process, and I believe it is unconstitutional.
Dr. M S | Emergency Medicine
I wish I could use my real name, or even the stae where I am, but, sadly, I can’t. I would lose my license.
I was placed in our PHP after I was diagnosed with bipolar disorder. I live and work in a state in which the medical board automatically places ALL physicians with a mental illness into a LIFETIME CONTRACT with the PHP.
I have never been disciplined.
I have never had any actions against my license.
I am, and have always been, totally compliant with treatment. I see my psychiatrist monthly, and my therapist twice monthly.
I take my meds, twice a day, always.
I have never had a manic episode, and I have had one single period of suicidal depression in the last 10 years.
2 likes Like Reply Aug 28, 2015
9/15/2015 Physician Health Programs: More Harm Than Good?
Nevertheless, I am in the PHP and will be for my entire career. Period.
Even though I have never had a substance abuse problem, I am drug tested randomly as if I did.
In the many years I have been in the program, I have never once tested positive for any substance of abuse, either urine or hair samples, and yet, they continue to test me as if I were in recovery.
My psychiatrist, my (PHPappointed) therapist, and even my PHP case worker say they see no sense in this. I am the most compliant patient they have.
It makes no difference.
There is no appeal. The only people the PHP is answerable to is the state board, and they do not care.
I spoke with the “enforcement division” of the medical board, to the person who oversees physicians like me, and was advised that no, I would never be allowed out of my contract because “Something might happen.”
Apparently, sometime in the past, a bipolar physician “went off the reservation” to use their exact words, and thus, no bipolar physicians would ever be allowed to practice in this state again without supervision by the PHP.
In our state, the medical board is appointed by the governor, and typically, is chosen from those who are politically active. Read: Raised funds for, donated big money to the governor’s campaign fund. They are answerable to no one but the governor…who, of course, never asks anything. They have complete power over the physicians in this state and no checks and balances.
I actually spoke with NAMI and the ACLU, and they told me that I would probably win a lawsuit against the state board and the PHP, since this appears to be a violation of the Americans With Disabilties Act.
I was told, off the record, of course, by someone at the state board that yes, I might very well win the case…but if I did, they would make a special project out of me.
I would get my very own investigator.
In other words, I would probably win the case, but they would make sure I lost my license.
This is my world.
Dr. karen miday | Psychiatry/Mental Health
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Aug 29, 2015
Talk about the sitmatization of mental illness! Bipolar means medical incompetience. Really? Time for PHPs and Medical Boards to get with this century. On the same page as “have you ever committed a felony?” Where is organized psychiatry? Where do they weigh in on these issues?
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Dr. Gail Hirschfield | Family Medicine
@Dr. M S Many of us would join in on such a lawsuit…there is strength in numbers.
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Aug 31, 2015
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Dr. Jesse Cavenar | Psychiatry/Mental Health
@Dr. M S Your description sounds like a third world country. As Pogo says “We have found the
11 days ago
2 likes Like Reply Aug 28, 2015
On the phone now with a physician who is being monitored by a PHP for 8 years. She fears for her career to write this herself and is permitting me to write this on her behalf.
She is in a small town in which 3 doctors died by suicide in 18 months (2 were in the PHP). She has been charged monthly fees that she can’t afford to pay. She got behind in payment of fees so she was deemed noncompliant with the program (and they make no differentiation between whether it is financial noncompliance or whether she
enemy, and it is us”.
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Dr. Pamela Wible | Family Medicine
On of several comments on my blog regarding PHPs: http://www.idealmedicalcare.org/blog/dophysician
healthprogramsincreasephysiciansuicides/
9/15/2015 Physician Health Programs: More Harm Than Good?
had relapsed on alcohol) and because she was noncompliant they extended her monitoring by another 5 years. “It is extremely frustrating,” she says. “Nothing that they have me do is covered by insurance and they have not been helpful to me (never remember what I said last time during therapy sessions). I believe the reason why I have been as successful as I have is because I sought counseling outside of the PHP. I feel so abused by them.”
“I read about the man who died after drinking on vacation (Greg Miday) and I saw the face of a physician who I know and I didn’t realize what he was going through, but he had some problems with alcohol and he finished up his charts one day and shot himself in the parking lot of his clinic. Absolutely horrific. When I heard what had happened and what his background was I thought his recovery must have not been going well. Now after being in the PHP as long as I have, I realize they are not here to advocate for you or help you.”
“I have a friend who is a psychiatrist and every time I tell him about this he is shocked. He does not understand what they are doing. The man who runs the programs is not a psychiatrist. He is in primary care and went to some kind of residency I never heard of that allows him to run a program like this.”
“The purpose of the PHP is not my treatment or to get me well. Their focus is to make sure I’m not a danger. I thought at the beginning that they wanted to help me get well. That is not their purpose. When I figured this out and came to peace with this it made it somewhat more tolerable. Their job is to organize my paperwork and take it in front of the Board so that the Board members can make sure that the public can ‘feel like’ they are protected. And their job is to collect fees.”
Dr. Michael Langan | Internal Medicine
9 likes Unlike Reply Aug 28, 2015
I can think of nothing more institutionally unjust than an unregulated zerotolerance monitoring program with no oversight using unregulated drug and alcohol testing of unknown validity. We have heard of numerous suicides due to these institutionally unjust programs. As physicians we need to demand transparency, oversight, regulation and auditing by outside groups. This is a public health emergency.
Dr. karen miday | Psychiatry/Mental Health
12 likes Like Reply Aug 28, 2015
My gratitude to all of you who have been willing to come forth with your personal experiences, and especially to those who are willing to put their names to their testimony. My son died by suicide while under the “watch” of the Missouri PHP. I do not blame them for his death, but I do believe they cut off his last hope of finding recovery in a less restrictive setting. He and his psychiatrist had made a plan that allowed for some hope that he could begin his oncology fellowhip in July rather than being mandated to a repeat abitrary 3 month treatment program. The strong arm of the PHP recommended against it. Shameful.
This system must be changed. Please, in his memory, come forth with your experience positive ones as well, although we haven’t heard many so that we can change the system for the better. Let’s do this for our fellow physicians. Those who are still alive deserve better.
Dr. Pamela Wible | Family Medicine
@Dr. karen miday Yes, I encourage you all to do the same. My video testimony
here: http://www.medscape.com/viewarticle/850023
Dr. R B | Physician
@Dr. karen miday the system should be destroyed
Dr. R B | Physician
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Any physician who is contemplating suicide due to this medical board abuse, should list the names of the individuals that drove them to it. Send the suicide note to the newspapers and state representatives. And post it online. Maybe then the public might get it.
Dr. Michael Langan | Internal Medicine
8 likes Unlike Reply Aug 27, 2015
Good leadership requires correct moral and ethical behavior of both the individual and the organization. . Integrity is necessary for establishing relationships of trust. It requires a true heart and an honest soul. People of integrity instinctively do the “right thing” in any and all circumstances. The majority of doctors belong to this group.
Unfortunately many of those involved in this system of coercion and control lack this moral compass and the reality is a lot worse than described in the article. Keep the comments coming,don’t pull punches and name names. The patterns are the same. False assessments, forensic fraud and diagnosis rigging are standard operating procedure.
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We need both local and national media coverage and legal representation outside those currently involved.
Adherence to ethical codes of the profession is a universal obligation. It excludes all exceptions. Without ethical integrity, falsity will flourish. Any system can be subverted including those of noble intent. That is what we are seeing here. To save not only good doctors but the profession of medicine it is urgent that we revolt, reform and reconstruct.. Michael Langan
DisruptedPhysician.com/blog
Dr. Eric Dover | Family Medicine
7 likes Like Reply Aug 27, 2015
What you have is the formation of an industry that needs to be fed a constant diet of “dysfunctional” doctors, just like the prison industrial complex needs a constant stream of inmates. There is money to be made and to think that Medical Board associated folks don’t have a hand in it, is to be utterly blind to the current situation. Judges have been busted for getting kickbacks from private prisons for filling prison quotas. These quotas are filled by innocents whose lives are then forever ruined. About a year ago a PA judge was busted for this a rare occasion. He must have pissed off the wrong person. Think how many lives he ruined and destroyed. This is exactly what Medical Boards and PHPs are doing to physicians and their families and patients..
Medical Boards live in little fear of repercussion. As of the passing of the Health Care Quality Information Act of 1986, set in motion by then Representative (now Senator) Ron Wyden, passed by Congress and signed into being by Prez Reagan, these peer review groups are given absolute immunity for their decisions. ABSOLUTE IMMUNITY! I have found only two cases where Fed courts have sided with physicians since the passage of that bill. In both cases it was determined that due process had been severely undermined. Most physicians will never get this far in court unable to work, get malpractice insurance, pay the bills. Most have already spent there money at the State level a worthless endeavor being that Administrative and other State courts side with the State Justice Dept. attorneys. They went to the same law schools, live in the same neighborhoods, give each other awards, etc. The last case that went all the way to the Supreme Court and won was the case of Dr. Tim Patrick vs. the Astoria Clinic and Columbia Hosp in Astoria. Its an amazing tale of how physicians in positions of power in clinic, hospital and Medical Board peer review groups can destroy physicians they don’t like. Dr Patrick fought and won. Unfortunately, the cause was lost as his case is the one that led to HCQIA of 1986.
I never went to a PHP, but my license was revoked by the Oregon Medical Board. Due process was nonexistent and abuse was plentiful. The physician board members, Exec. Director Kathleen Haley and Assistant Attorney General Warren Foote from the Oregon DOJ committed perjury, withheld records, got witnesses to commit perjury, used a supposed expert who shortly after my hearing was in trouble for such poor patient care that he killed at least one and almost another patient, the use of hearsay, inability to question witnesses, etc etc. I questioned how they conducted themselves and their investigation and I was crushed. I have a case pending in the Ninth Circuit court of Appeals. I don’t have a lot of hope from these justices based on a recent physicians case out of OR I am familiar with. My story is available at:
drdovervsomb.weebly.com.
It contains tremendous documentation of my case, but also includes my Federal Complaint and Brief. These latter two documents were done with a constitutionalist lawyer and are extremely well done. We need our cases flooding the Federal Court system. State courts are worthless and waste time and money.
Thank you for this article.
12 likes Like Reply Aug 27, 2015
j c | Medical Student
There is something very shady going on with PHPs. Lawsuits, audits, and all of these sad and unforgivable
personal experiences are coming to light.
http://www.chapmanlawgroup.com/hprpclassaction/
I hope these PHP organizations will pay out compensation.
Patrick O | Physician Assistant
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Aug 27, 2015
I call for PHPs be put under public scrutiny and held responsible for their unethical actions. ‘Physicians Health Programs’ have an alarming established business practice of extortion, falsified diagnoses, and medical fraud against healthy functioning medical professionals, as referenced at the end of my comment.
9/15/2015 Physician Health Programs: More Harm Than Good?
Dr.Steven Adelman, director of the Massachusetts PHP, doing business as PHS Inc. of Waltham, has been particularly candid about the importance of chasing margins and profits in his line of work.
Dr.Adelman wrote publicly to other PHP leaders: “Without margin, there is no mission. The time to act is now. PHPs need to incorporate a new cando, growth mindset”
Dr.Adelman’s writings, and actions show an opportunistic doctor who has eschewed his vow of service and professional code of morality to instead chase greed and personal profits. Betraying the physician’s code of ‘do no harm’, Dr.Adelman has built a lucrative career from labeling, coercing, and extorting his own medical colleagues using falsified diagnosis.
His idea of a “growth mindset” includes compromising the livelihood of his colleagues and the integrity of his own profession for profit. The “treatment centers” he sends both legitimate and knowingly fraudulent cases actively tailors diagnoses for Dr.Adelman as well provide funding to PHS Inc and an unknown amount of personal kickbacks to Dr.Adelman.
Leaving someone like him in a position of power is a worrying influence for the next generation of medical professionals and a dark direction for the future of the medical profession. Dr.Adelman’s greed driven actions parallel those of Dr. Farid Fata, the Michigan oncologist convicted of fraudulent diagnosing and “treating” healthy people while claiming a high success rate of his treatments.
I encourage all doctors who have been extorted my PHP programs to make your voice heard. Call your local state auditors to audit state PHPs and their affiliated and parent organizations. You deserve to have your stories heard by a jury of your peers. Without a formal investigation, we might never know the extent of damages PHPs have caused over the years.
The following court case sets legal precedent to recompense damages for doctors fraudulently labeled by PHPs. The defendant in this lawsuit, Dr.Talbot was mentor to today’s PHP directors.
Fulton County Daily Report May 12, 1999, Wednesday
$1.3M Verdict Coaxes a Deal for Doctor’s Coerced Rehab
Stephen Ursery, Staff Reporter
For the several medical defendants it must have been a weekend of acute discomfort.
A jury Friday had already hit them with a $1.3 million verdict for falsely imprisoning a Jacksonville, Fla., physician in an alcoholism recovery program he maintained he didn’t need. On Monday, the same disapproving DeKalb Superior Court jury would get to lay into them for punitive damages.
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Dr. Gail Hirschfield | Family Medicine
@Patrick O This is amazing, what you relate here! and sickeningl. I feel like throwing up, and not just
in my mouth.
PHYSICIAN’S LIVES MATTER
Dr. Pearl Jazz | Surgery, Other Aug 27, 2015
I recently applied for a NC medical license and the NC medical board referred me to NCPHP.The only possible reason for this was a history of depression that has been treated and stable since diagnosed in med school in 1998.
The PHP process started with a friendly phone interview. My treating PCP was on the call and testified to my health and treatment. The interviewer told me and my PCP that a followup inperson peer to peer conversation would be just a formality and there would be no evaluation or testing, just a facetoface meeting so the PHP could write a letter to the board. The only requirement was to bring $500 cash.
When I showed up to the NCPHP, I met with a social worker who didn’t know anything about my history. I felt like I was being treated like an alcoholic or drug addict; it felt more like an interrogation than a conversation.
He told me I had to sign papers, which basically stated that I would agree to do whatever they recommended.
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9/15/2015 Physician Health Programs: More Harm Than Good?
When I asked about the possible recommendations, the social worker said there was a greater than 90% chance they would recommend a oneweek inpatient evaluation, which would cost $5000 cash. Usually, that would be followed by 3 months of inpatient treatment (~$40,000), sometimes longer; and then 35 years of outpatient treatment. “But first you need to take a drug test!”
I felt like this must be some kind of mistake. I said I didn’t feel comfortable signing anything until I spoke with my lawyer.
The social worker became angry and I was sent back to the waiting room and 5 minutes later the medical director came out and asked me what the problem was and why I was refusing to take the drug test.
I tried to explain why I felt uncomfortable, and that I was there only because he had a history of depression and didn’t feel comfortable signing their paperwork, given what I was told about the process.
I politely asked for an explanation. Instead, the director explained that from his perspective I was refusing to take a drug test, which meant that I must have something to hide; so whatever the original reason for my referral, I was now also there under suspicion of having a drug addiction problem. I couldn’t believe it! I wasn’t able to get in touch with my lawyer so I rescheduled and left. Now, I’m glad I did!
I didn’t want them to think I left because of the drug test so the next day I called to ask them where I could go to do a drug test and the director basically said he wouldn’t help me. He said that doing the test a day later would mean nothing and he wouldn’t tell my PCP what test to order because that was top secret information. I did a drug test through my PCP anyway.
Before going back, I spoke with multiple lawyers and they all said if I went back I would still have to sign the papers, which basically would forfeit all of my rights, and they would probably try to punish me for not cooperating during my first visit.
The lawyers in NC said any representation would cost at least $30,000 and may not do any good. I did my own research and found out about the audit and also read many complaints, some of which described unethical relationships between lawyers for PHP and lawyers defending physicians.
I decided that a medical license in NC was not worth it and didn’t go back to NCPHP. After reading the recent Medscape article, I am so glad I never went back!
Dr. K M | Psychiatry/Mental Health
13 likes Unlike Reply Aug 26, 2015
One physician who’s terribly afraid of reprisal wrote me and said he really wanted to submit a comment but “My attitude now is that I am just soooo grateful to have a purpose and a job again, I don’t want to upset the present status quo with any possible negative memories or negative thinking about the entire several year ordeal. I fear ruffling any feathers in the offices of the PHP, medical board, [field] monitors etc…I fear any criticism of the [actually] experienced process will be viewed as a “Relapse Red Flag” in thinking. … [T]he truth is that I was over diagnosed and overly treated and permanently tattooed with many exaggerations to my personal problems. My case and many others were given the cookie cutter approach of ‘You have a substance diagnosis and you are in denial’, ‘you must go to a 3 month inpatient rehab center and then a 1/2 way house’ and maybe you get your license back in a year or two if you do what you are told, so drink the lemonaide buddy and do and say what we think if you want to be a doctor again!'” (brackets and emphasis mine)
Fair to say, this physician is so traumatized and so fearful of reprisal (being retraumatized) that s/he cannot even speak for fear of being “outted” and then punished. This is not just PTSD, it’s back alley bullying with threat of resumption of punishment.
If a psychiatric patient or a nursing home patient came to you and shared this with you in your consulting room, you’d be right to immediately contact the DHHS to open an investigation into patient abuse and endangerment. And you can bet that an investigation would be opened immediately. If found to be a pattern, the facility would likely be closed. The place would be nicknamed “Shutter Island” and become front page news.
The abuses reported here are abhorrent and antithetical to the fundamental principles of medical care.
Why are we not doing the same for our physician colleagues as we would for our patients in demanding a prompt and thorough investigation?
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Dr. Anthony Blanford | Psychiatry/Mental Health
My encounter with the system was nearly catastrophe, and I too, am grateful to have survived. Your
colleague hit the problem squarely on the head. There is no appeal once labeled, however poorly or
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Physician Health Programs: More Harm Than Good?
selfserving the evaluation. To protest is to bring about a heap of recriminations, accusations of denial, and unwanted suspicion. I would like to say more but I don’t want to be accused of having a victim mentality, or harboring poisonous resentment, and who is there to appeal to anyway?
Dr. Kernan Manion | Psychiatry/Mental Health
9 likes Unlike Reply Sep 1, 2015
@Dr. Anthony Blanford Thank you Dr. Blanford. I believe that the largest burden of addressing this systematic atrocity lies with those of us in psychiatry and related mental health fields. It is we who are directly witnessing the profoundly adverse impact of these PHPs operating as protected state regulatory agencies and posing as legitimate psychiatric / mental health entities. They are most definitely not and need to be called out and confronted. By allowing them to continue this powerandzealotbased terror, we are allowing them to fundamentally violate the principles of medical and psychiatric ethics. And, as a result, the integrity of all mental health services will be called into question.
Please write to the APA and stress your concerns. Two of us in NC have already written (this after our extensive and detailed ethics complaints were derailed and dismissed in a most unethical manner).
Further, I would encourage every physician who has been so adversely affected by these entities to urgently write the APA President Renee Binder MD to indicate your request for their prompt investigation of these abuses.
I will be compelling a list of action steps that can be taken and will post on http://www.physicianrights.wordpress.com.
Dr. Jesse Cavenar | Psychiatry/Mental Health
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11 days ago
@Dr. K M I happen to know that the doctor mentioned became bankrupt, lost a home, ended up living in a car, supported by his grown children to purchase food. I had thought I would never see a homeless, destitute physician but there it was.
Darby Penney | Health Business/Administration
1 like Like Reply Aug 26, 2015
I found this article fascinating and disturbing. While I have great empathy for the doctors and other health professionals abused by the PHP system, what was described sounds pretty much like what happens to all people who get caught up in the mental health system. Perhaps this obvious injustice might alert physicians to the much broader problems with the mental health system.
Dr. Eric Dover | Family Medicine @Darby Penney
Dr. l k | Neonatal/Perinatal Medicine
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Aug 25, 2015
We are put on a pedestal by the public and authorities when we physicians are also humans prone to make mistakes just like other educated people. It does not mean vast majority of the time, we are a threat to public but anytime you step away from the imaginary line that separates physicians who are “perfect” people from other people, you will be punished financially and much more than that psychologically, and guess what there is no going back , it is going to haunt you for the rest of your professional life. I strongly believe physicians when a mishap happens in life are treated way unfairly for the degree of the mishap than any other profession including lawyers, judges, politicians, presidents of USA and even priests… What is going to happen is eventually people with great potentials for becoming wonderful physicians will walk away or won’t even come close to this art I call “medicine”, and it will become a profession for people who will do it just for the financial gains of the job. I tell my daughter who is a very successful student and passionate person to not think twice but ten times before she is willing to live her life under a microscope by a governing body who claims to have the responsibility to protect the public from so called impaired physicians. When was the last last time anybody heard a physician hurt any patient intentionally or by being impaired? I can’t even count more than a couple (one a medical student who should not even have graduated and would not be noticed by state licensing boards and second an oncologist again who would not be identified by state licensing boards) even though hundreds if not thousands of physicians have to go through cruel processes that are themselves more traumatic than their actual feelings of letting down their ideal, goals, patients and people who trusted them to be perfect… On the other hand I much more frequently see patients hurting from physicians who don’t show the compassion to take care of them or educate themselves to provide good care and I see hospitals throwing things under the carpet to protect themselves and those physicians… In my opinion state medical boards are just people trying to cover themselves without any respect to the wellbeing of any physician who is identified unfairly/or not as impaired because of some rule that does not take into account that person’s qualifications or personality… The time to change the way states approach “impaired” physicians have been long overdue and our own governing bodies who are supposed to be our advocates have failed us… It is an unspoken problem of the profession of medicine in this country, and I want to
9/15/2015 Physician Health Programs: More Harm Than Good?
thank the people who bring this topic for further discussion… How many more physicians have to go bankrupt, leave the profession or go into major depression before this process improves?
Dr. harvey kohn | Orthopaedic Surgery
11 likes Unlike Reply Aug 25, 2015
It’s incomprehensible to me that a state PHP would be supervised by the legal system with the state examining board offering no oversight Certainly this is reassuring that this situation is being corrected. Also shouldn’t a physician accused of misconduct by an “anonymous source” be allowed due process w/r to a hearing before his peers?
Dr. Jesse Cavenar | Psychiatry/Mental Health
11 likes Unlike Reply 11 days ago
@Dr. harvey kohn Please refer to the NC State Auditor’s report in which she notes the inadequate supervision and oversight of the NCPHP, and in fact a lack of supervision of the NCPHP. Of course, any physician accused of misconduct by an “anonymous source” should be allowed due process; the federal Health Care Quality Improvement Act clearly states that due process should take place.
However, it is not taking place.
Dr. s n | Physician
2 likes Like Reply Aug 25, 2015
As always, thank you for enlightening us, Dr. Cavenar. Thank you for sharing the details of your strong efforts. It is important for people to see that trying to enact change from the inside, though noble, is rarely successful and/or extremely slow.
**That is why I strongly believe the fastest way to draw attention and force change is via HIGHPROFILE national media attention. Does anybody have such contacts? We need to pool our stories.
Dr. s n | Physician
8 likes Unlike Reply Aug 25, 2015
Another option worth exploring is a NATIONAL classaction lawsuit. I’m wondering if the FSPHP would be the target?? Yes, lawsuits are brutal, but we ought to explore. If people are interested, I know a kind lawyer with classaction experience, but I make no promises.
Dr. Jesse Cavenar | Psychiatry/Mental Health
14 likes Unlike Reply Aug 25, 2015
Dr. K.M. raised the question “what needs to be done to bring this issue to fullest light and prompt change and accountability?” While I cannot answer the question, I would note that I filed an extensive twenty pages plus complaint with the NC Psychiatric Association (NCPA), which is a necessary precursor to filing an American Psychiatric Association (APA) complaint. Subsequently, I found that a colleague had also filed a complaint of over two hundred pages with the NCPA. Our complaints were both received on a Wednesday afternoon and on the following Monday, some 96 hours later, there was a conference call of the NCPA Ethics Committee and the finding was “no ethical violation” with either my complaint or my colleague’s complaint. Later, I found that a complaint to the APA or to a state branch can be assigned to one individual to read, and that person can then report via telephone to the rest of the committee. Thus, only one personif one personmay have read a complaint prior to action being taken on the complaint. This is appalling and unbelievable. It appears to some observers to be a system designed to “bury” complaints rapidly and make them go away. An appeal to the APA Ethics Chair revealed that he had no concern about the action of the NCPA committee. I have been a member of the APA for fifty years, and I am incredulous.
I filed an extensive twenty pages plus complaint with the American Society of Addiction Medicine (ASAM) addressed to the then President and sent it to the headquarters of ASAM. After no response for months, I inquired only to be told that the President did not get mail at that address and the complaint could not be found. Another copy was sent to the President at his office address. The response was that ASAM had no code of ethical standards. The President was informed that indeed ASAM had a code of ethical standards, and I directed him to the ethical standards of the organization of which he was President on the Internet. This was apparently news to him, and his response was that these ethical standards were suggestions and could not be enforced by ASAM.
He noted that ASAM had no investigative ability and directed me to the AMA, but I found that the AMA does not take complaints of ethical violations. Case closed.
I filed an extensive twenty pages plus complaint with the Federation of State Physicians Health Programs (FSPHP). I never received acknowledgement of receipt of the complaint, and never any other information. Case closed.
A complaint was filed with the North Carolina Medical Society (NCMS), and a colleague and I met with the President and Executive Director of that organization. There was extensive discussion of my complaints, and the decision was reached that since I was not a member of the NCMS I could not file a complaint against a member.
9/15/2015 Physician Health Programs: More Harm Than Good?
Case closed.
Many different complaints were filed with the NC Medical Board (NCMB). The response I received was that the NCMB “voted to take no further action” on my complaints. There was never any statement that my complaints had been investigated and found to be without merit, or that my facts were in error, or any such statement. My requests to meet with the NCMB or President were all denied. Further, I was told that the decision of the NCMB was not appealable.
Subsequently, I filed another complaint with the NCMB which is allegedly being investigated. I have met with investigators from the NCMB for one and one half hours, and am aware that they are interviewing other people in regard to the complaints.
A complaint was filed with the NC Attorney General’s office, only to be told that they don’t investigate complaints concerning state agencies. (The AG apparently considers the PHP a state agency. I would not agree). Case closed.
Dr. K.M.’s question is the question of the hour, namely what can be done and what needs to be done. It seems apparent to me and my colleagues that professional societies, medical societies, medical boards and even the Board of Directors of at least one PHP have no interest in tackling the issues.
Dr. Mark Ibsen MD | Emergency Medicine
13 likes Unlike Reply Aug 25, 2015
Something similar occurred for me in 2006 in montana. There is clearly a lack of due process in our state. I was accused of substance abuse by a soon to be exwife, in collusion with former medical partners. I was required to go to a psych eval across the country, cleared of the substance abuse issue, diagnosed with axis II ,
Given the opportunity to have a 10 week in patient treatment for a so called personality disorder. When I returned home
The wife was gone
The furniture gone
The kids gone with her. It took 2 years to sort through all the repercussions.
The professional assistance program, operated by an mSW would not give me any relief. I was definitely suicidal part of that time.
Sick
Sick system.
Kind of a Gulag experience. I wish it on no one except those who did it to me.
Dr. K M | Psychiatry/Mental Health
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Aug 25, 2015
@Dr. Mark Ibsen MD I’m glad you had enough resiliency to survive. I hope you’re back in practice and rebuilding your life. And I hope you’ve been able to reflect on this nightmare and take some positive action out of it. In fact, I think that’s the challenge for all of us who’ve been mauled. How do I not live in bitterness; how do I regroup; what can I learn from this; what can I do to confront this injustice and change this awful system; what can I do to reach out to others who’ve been beaten up ….
Dr. R B | Physician
@Dr. Mark Ibsen MD similar experience,ongoing.
Dr. k s | Emergency Medicine
We’re fighting back Come over to SERMO and tell your story we’re organizing.
Dr. Gail Hirschfield | Family Medicine
@Dr. k s What is SERMO? I would like to look at it
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Dr. Gail Hirschfield | Family Medicine
@Dr. k s Can you supply a link? I went to SERMO and don’t see what you mean, where this might
be. I tried but failed to log on…can’t remember my p.w. and asked them to send me the link to reset but
12 days ago
9/15/2015 Physician Health Programs: More Harm Than Good?
haven’t gotten it yet. Gail
1 like Like Reply Dr. D R | Psychiatry/Mental Health Aug 23, 2015
The PHP in Georgia is one such PHP that is coercive, micromanaged, shame based, lacking in empathy, and essentially under the control of one physician with an extremely Narcissistic and sociopathic personality. The harm and devastation (including suicides) caused by this PHP and its Director to professionals and their respective families is a deplorable travesty. The GA PHP is in dire need of an unbiased investigation by an organization who has the authority to intervene.
Dr. Roy Blackburn | Physician @Dr. D R
Dr. K M | Psychiatry/Mental Health
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Aug 23, 2015
Many may not know that Drs. Wes Boyd and John Knight published an incisive article in 2012 “Ethical and Managerial Considerations Regarding PHPs” highlighting crucial concerns regarding the philosophy and operation of PHPs. They succinctly described the awesome nature of a PHP evaluation and its potential for abuse.
http://www.jwesleyboyd.com/?p=280
The commentary there also reveals another stream of horror stories.
Dr. Boyd indicated that he expects publication about this topic in a soon to be released issue of the AMA Journal of Ethics.
Discussions with several have raised the question “what needs to be done to bring this issue to fullest light and prompt change and accountability?” AMA / APA investigative task force? FSPHP investigative task force? File complaints to state medical board and compel investigation of state PHP’s practices? FSMB complaint and investigation? Urge state audits like in NC (and perhaps soon beginning in another state)? Gather a group and go to Governor or Attorney General? Legislators? Compel state medical society investigation?
Where does one go when one has been mistreated by a PHP and put through the ringer with the authority of the Board? What does one do when one is told that they can’t obtain their PHP record and neither the PHP nor Board offer any due process to evaluate these complaints?
a b | Medical Student a
Dr. Gail Hirschfield | Family Medicine
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@Dr. K M We need to unionize, to keep going to the press, especially investigative reports on MSM, request state audits (done better en masse), put a video on YOUTUBE about the injustices we face, maybe on TEDtalks about physician suicide and the role PHP plays in the lives of the unfortunate victims of its hateful crimes against humanity.
PHYSICIAN’S LIVES MATTER
Dr. Michael Brog | Psychiatry/Mental Health
2 likes Like Reply Aug 23, 2015
As Lord Acton so famously said, “Power tends to corrupt, and absolute power corrupts absolutely.” While Lord Acton never encountered any PHP’s in his lifetime, it’s fair to say he would not be surprised by the previous comments. Want a recipe for exploitation? Grant an organization absolute power over the lives of others, slip some profit motive into the mix, affix shame inducing labels upon its critics, ban structured oversight, banish opportunities for second opinions or independent evaluations, and see what happens. PHPs undoubtedly have helped many, have saved lives, have been served honorably by many dedicated professionals with the best of intentions. But we all know how the road to hell is paved, and the stories on this page are convincing and condemning to the extreme.
Whatever good these organizations do is besmirched by a system ripe for corruption. There is no rational or sane argument against the implementation of administrative oversight,due process, independent opinion options, open access to all financial arrangements with outside treatment centers, open access to costs for all mandated treatments, clear criteria for mandated treatments, instate treatment options, access to medical records etc. I’ve seen some good people helped, and some good people (patients, and personal friends) severely aggrieved and undoubtedly harmed by a system they experienced as overly punitive, controlling, shaming and exploitative. The North Carolina experience is instructive. They are changing not of their own initiative, but because they were audited. Other states would do well to follow suit. Independent audits are needed as a first step towards restoring confidence, it’s just that simple. These outfits ought to be following some sort of national guidelines and standards
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just like the rest of us.
Dr. Gail Hirschfield | Family Medicine
@Dr. Michael Brog Yes, that quote came to my mind too…good post
Dr. karen miday | Psychiatry/Mental Health
Does anyone know why California does not have a PHP? No impaired physicians there?
C Z | Other Healthcare Provider
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@Dr. karen miday To the best of my recollection, California was audited several times to determine the efficacy of their PHP. Each audit produced the same results: that fewer than 1% of all physicians were selfreports because of much of what has been identified in this thread. Who would seek treatment when they run the risk of losing their medical license and the “minimum term” for a mental health issue is three (3) years and five (5) years for substance abuse?
C Z | Other Healthcare Provider
10 likes Like Reply Aug 23, 2015
Dr. Michael Myers “Many of these same physicians, when well, look back at their attitude toward the PHP initially and can see that they no longer feel the same negativity about how they were evaluated, advised, and monitored.” Really doctor? As a therapist who has been providing both mental health and substance abuse services to physicians for years, would you care to hear what those who are no longer under the supervision of the PHP have to say? Those who view their experience as helpful are in a small minority. The vast majority have used words like “Draconian,” Demeaning,” “Punitive,” “Cottage industry,” “The darkest patch of my life” to describe their experience. Any physician who is foolish enough to question treatment recommendations is labeled as anything ranging from resistant or noncompliant to having an antisocial or narcissistic personality disorder. Any time my own recommendations to the PHP have been for a higher or more intense level of treatment, I have been complimented for being astute. However, I cannot recall a single time when I have recommended a less intensive treatment or, heaven forbid, determined that the physician did not suffer from addiction I was cautioned to not be ‘taken in” by their “manipulative behavior and dishonesty.” For persons who do not have firsthand experience with this deeply flawed system, I suggest they watch “Good Night and Good Luck” as this system is as close to McCarthyism as one can get.
Dr. karen miday | Psychiatry/Mental Health
14 likes Like Reply Aug 23, 2015
My son is literally a “dead duck.” Shouldn’t we at least demand a body count? How many physicians who are and/or have been monitored by the PHP’s have died by suicide? The loss of licensure is a very real crisis, not to mention the humiliation of being yanked from one’s residency or practice. Again, anyone with any mental or emotional vulnerabilty is likely not to fare well. Additionally, their treatment paradigm appears totally stuck in the abstinenece only, 12 step, AA approach to addiction. Shouldn’t they at least consider a “harm reduction”” model in some cases. AA is a spiritual rather than evidencebased model. Strange to think that physicians, people of science, are mandated to what is essentially a religion. We talk repeatedly about practicing “evidencebased” medicine, yet, when it comes to our fellow physicians, we mandate them to a model that is 35 yrs old, and never scientifically studied. Worse yet, if they fail that treatment, they are mandated to return to the very same treatment. Where else in medicine do we do that? Isn’t it possible that there is something wrong with the treating paradigm rather than those who are not helped by it.
This “blame the victim” mentality of substance use treatment must stop. Let’s start by treating our fellow physicians with compassion and offer them treatment by physician specialists rather than by chemical dependency counselors whose main credentials is having been addicts themselves. And, please, let’s not threaten loss of licensure in cases (most) where patients have never been put at risk. A relapsse over the weekend, or while on vacation, is not the same as substance use in the hospital or office. In my son’s mind, his relapse on vacaation, at the very least, would mean 5 more years of monitoring (at his own expense), at worst, license suspension. He was not due to see the first patient of his fellowship for over a week.
His PHP essentially cut off his only hope of saving himself from this. He had made a plan, on his own, with his own private psychiatrist to address the issue. Why interfere with this? I am not jaded enough to believe that money was at the heart of this interference, and yet, this is how PHP’s keep themselves in existence.
The system cannot be changed until we know, with complete transparency, how it operates. Sad to think that we will have to do this 50 times over to have any real answers. Shouldn’t this be the work of the FSPHP? Let’s call upon them to do this.
Dr. R B | Physician
19 likes Like Reply Aug 23, 2015
@Dr. karen miday Please broaden the scope of the body count to include physicians who have died due to abuse of power by state medical boards. Not only include suicides but also “accidental” deaths as one may find that the “accidental death” rate is above the general population. I know of one physician who had their license restricted, finally found a job working as a CNA and after three years of working as a CNA walked in front of a speeding car. All who knew him knew it was suicide. However,
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the official reported cause of death is “accidental”.
8 likes Like Reply Dr. Gail Hirschfield | Family Medicine 12 days ago
@Dr. R B @Dr. karen miday And the mortality and morbidity of all the patients these talented and caring doctors serve.
j c | Medical Student
@Dr. karen miday Dear Dr. Midday,
2 likes Like Reply Aug 27, 2015
I am both saddened and enraged at your loss. I was also coerced and illegitimately forced into in a very bad position by a PHP. I am grateful to have found strong supporters and I got out of it. These unethical actions and bullying by PHPs are unforgivable. I hope you will find justice and closure in court.
Dr. Gail Hirschfield | Family Medicine
5 likes Like Reply Aug 31, 2015
@Dr. karen miday Yes, this is what I say as well! Let’s demand an accountability by finding out and posting how many physicians were harassed and hounded into suicides by these socalled PHP programs? Here in the US! not in the USSR, not in Hitler’s Germany. Look, inquisition should be held up for what it really is.
Euphemistically named, these programs harm and kill our healers. Who will stop this injustice? As a group, maybe our voice will be heard.
Sign me up. Gail Hirschfield M.D.
Dr. karen miday | Psychiatry/Mental Health
2 likes Like Reply Aug 23, 2015
My son is literally a “dead duck.” Shouldn’t we at least demand a body count? How many physicians who are and/or have been monitored by the PHP’s have died by suicide? The loss of licensure is a very real crisis, not to mention the humiliation engendered by being yanked from one’s residency
Dr. s n | Physician
8 likes Like Reply Aug 22, 2015
The corruption must end now!Thank God for this article.The situation is MUCH worse than people know. Many people across the country have had their entire LIVES ruined by Physician Health Programs (PHPs) and their collaborators. We need to band together and fight. We physicians are notorious for not banding together and protecting our rights. Dr. Michael Langan’s website says it beautifully: “the need for revolt…”
Once you are referred to a PHP, you are a dead duck. You are not told why you are referred. You are not allowed to see the documentation. Literally ANYBODY can make a ridiculous allegation(s), and the PHP will take it as gospel. They have every (financial) incentive in the world to keep you in their grips. They do not allow you to get an independent second opinion. If you try to defend yourself or provide objective evidence or witnesses, you are labelled as cognitively impaired / in denial / defensive / disruptive / narcissistic, etc.
They further intimidate you by saying that if you resist, they will report you to the medical board. They even go out of the way to add false information to your file to justify their (outofstate) referral.
Such centers are also corrupt. In fact, Pine Grove says that ~LESS THAN 5% of people who get referred there leave with a clean bill of health. The eval center will undoubtedly conjure up diagnoses, recommend unwarranted/arbitrary/absurd treatment which guess what they just so happen to offer. It costs a fortune and must be paid in cash. Even if you are Gandhi or Mother Theresa, they will most likely recommend long term monitoring by a PHP which is inhumane, but the PHP gets to charge you money so who cares about your basic rights. Why do you think PHPs force you to go to their handpicked centers and nowhere else?
How many INNOCENT people’s lives have been destroyed! Drs. Boyd and Cavenar are right.
I’m a (former) intern who had matched into an (excellent) ophtho residency, but my racist program director (PD) who has a history of psych problems and was also undergoing a divorce for my PGY1 Transitional Year in WA destroyed my ENTIRE career by making a malicious, absurd (substance abuse) referral to Washington PHP (WPHP).
I have never abused substances of any kind. I do not even USE substances of any kind. Neither my family nor I have any psych history whatsoever.
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Without hesitation, WPHP obliged my PD and refused to even CONSIDER I was telling the truth. Even though all substance testing was negative and WPHP said to my face “You are a likable guy,” they documented the complete opposite. They couldn’t diagnose me with anything, but they were still hell bent on conjuring up some sort of psych diagnosis by forcing me to go to 1 of 3 obscure, outofstate eval centers.
WPHP had already called the outofstate people to make a tentative appointment for me BEFORE I ever stepped foot into WPHP. Regardless of what would happen at the “outside eval,” WPHP said they’d be monitoring me and charging me money. PHPs and their collaborators/cronies need to be brought to justice.
I’ve been forced to fight ungodly painful, expensive legal battles for the past 4 years. Over the years, I’ve applied to ~400 jobs in MULTIPLE SECTORS, including outside of healthcare, but I can’t even get interviews. WA Dept of Health issued PRESS RELEASES making horrible allegations about me. Press releases are at the top of Google so when anybody or a potential employer Googles my name, the first things they see are press releases.
Trainees need extra protections! Even if, miraculously, a PHP clears a trainee in 2 days, your next residency program can rescind your spot if the PHP and/or your PGY1 program delays your reporting to your next program by EVEN ONE DAY. A trainee being referred to a PHP and/or labeled as XYZ is DISASTROUS BEYOND IMAGINATION. Residency programs don’t want to touch you with a 10 ft pole – innocent or not. Getting even a trainee license is impossible. Trainees do not have the means to fight legal battles. If a trainee wins legal battle (can easily take 7+ years), residency programs still don’t want you. Even if a trainee’s named wasn’t publicly smeared, without a PGY1, s/he would need a miracle to gain employment.
If anybody can help me in any way, I’d really appreciate it. If you are a trainee who is reading this, and you have been referred to a PHP, you should probably lawyer up right away regardless of how good or bad of a trainee you are.
Disability rights advocates and non profits, physicians need your help also! Under the pretense of “protecting the public,” how can gov’t organizations issue PRESS RELEASES accusing people with physical and/or mental health problems? [Physicians, see ADA “regarded as disabled” and “improper testing.” Beware of statutes of limitations.]
There is no light at the end of the tunnel for me. My family’s lives have also been shattered.
If anybody else was harmed by WPHP, we should band together. We should explore our options including a class action lawsuit. I heard WPHP drove at least one person to suicide. I doubt PHPs should even exist because they seem beyond saving. At the MINIMUM, PHPs need to be audited, etc., and there must be TRANSPARENCY and STRONG, lightningfast checks & balances.
I don’t know what defines a crime racket, but the current state of affairs sure seems like a diabolical one white collar crime. IMHO, the people involved probably belong in prison.
Dr. k s | Emergency Medicine
20 likes Like Reply Aug 23, 2015
@Dr. s n Even nontrainees can exhaust their resources trying to fight the PHP. I had the full support of my own therapist, who was a professor of psychiatry, boardcertified in addiction psychiatry, neurology, and psychiatry, to return to work. I had an independent evaluation by a forensic psychiatrist who trained at a top university and felt I was in no way impaired (I wasn’t) but the PHP insisted that only one of their, as you aptly put it, “obscure treatment centers” could make an evaluation. I fought this battle for eight years. The PHP approved evaluations were a farce.
Among other things, I was given some Axis II diagnosis at one evaluation after an hour with a doctor who specialized in family medicine and directed the facility. I asked my own doctor of 5 years if he felt I had this personality disorder (narcissism that’s a favorite of these places.) He said absolutely not. In what world does a former addict turned addiction specialist get to slap derogatory labels on patients they don’t even know?
The “psychological testing” performed at these places is frequently a series of largely discredited maneuvers, like Rorsasch testing. I’ve taken the MMPI so many times and I answer the questions the same way, so imagine my surprise when the last time I took it, I was told my answers were invalid because of a lack of internal consistency? Of course, I was never allowed to see the report.
The Metro Atlanta Recovery Residences is another “approved facility.” At that evaluation, which was supposed to last three days, I saw a psychologist, only later to find that he was not licensed to practice. He told me one thing during our interview and then, of course, wrote something consistent with what the PHP wanted. At that facility, at the end of three days, they had not been able to come up with a diagnosis so they insisted I stay additional time. The facility was horrendous. People were diagnosed with “love addiction.” It was disgusting and shocking. When I refused to stay for additional days of evaluation, the PHP reported me to the board as “noncompliant.” The board threatened revocation of
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my license unless I went for another evaluation. I did. BTW, many of these evaluations end up with the evaluee placed in a confrontational situation. If you don’t “admit you have a problem” you are, as you noted, “in denial.” Or the assumption is that you are lying.
The last evaluation I had was at Vanderbilt University. I had been there an hour when I was interviewed by the director of that program, who told me right off the bat that “of course, you know you have to go away for three months. All doctors do.” Whoever is saying otherwise is disingenuous. At this “special center with a special doctor program” I quickly learned that unless I played the game, I would not “pass.” After undergoing “treatment” which cost nearly 50,000 dollars, So, in a very real sense, it was useless. How good can therapy be when you can’t be candid about your doubts, particularly about the idea of “surrendering to a Higher Power.”
The treatment that was supposed to be so uniquely geared to doctors wasn’t very special we were mainstreamed with a lot of heroin addicted kids and people who had been in and out of treatment centers 9 times and more. Doctors get to listen to the same lectures at least 3 times, sometimes 12 times, since the programs are run on a 28 day cycle for everyone else. The lectures are on a sixth grade level. Frankly, the 24 hour surveillance with cameras everywhere was degrading. All of the health care professionals were on edge, for fear something they said would inadvertently delay their release. People are encouraged to report “relapse behavior” by their peers, which can be something as innocuous as questioning the existence of god. It all had a chilling effect that destroys much of the
potential for therapeutic benefit.
After discharge, I had to sign a contract to be monitored and drug tested 72 times annually. Probably the worst part was the forced participation in AA. I consciously left Christianity behind many years ago. I don’t believe in a god who intervenes. There are many other options, but physicians are not allowed to choose. AA is not a good option for many people. What other “disease” do we treat with prayer? The PHP had to be informed every time I went out of town. I couldn’t live with the cognitive dissonance I was experiencing through this forced participation in what is essentially a religious program. I’m happy for those people who have been able to solve their problems that way, but AA (and the PHP) is a setup for failure for many.
It is unbelievable that the use of lie detector tests in these places is tolerated. I know of one doctor who went to Pine Grove and ended up staying 6 months. He told me about the lie detector tests. I know another doctor who was diagnosed with sex addiction while in treatment and was forced to disclose his sexual history to a group. The diagnosis was made by a masters level counselor. It’s not even in the DSM V, yet Pine Grove in particular has created a good cash flow from treating sex addiction.
The medical licensure board posted my name after my resignation. Since the Board has a .gov site, it ranks high in search results after many years. It has negatively impacted my career in a significant way. It was a nondisciplinary action, but the board vindictively published it and continues to do so.
When you become involved with the PHP, you have no due process or recourse. Doctors in this situation are extremely vulnerable. Part of this vulnerability comes from the assumption that an agency like the medical board and, subsequently, the PHP, must be right. Their appeal to authority is flawed. If you don’t comply, you are immediately suspended or revoked and it becomes a public record that is highly visible. It’s like a scarlet letter and initiating legal proceedings opens your entire life to scrutiny, including medical records, psychiatric history, marital counseling, etc. There is a huge psychological and emotional toll.
I was contacted by a journalist who is researching this topic and asked me if I could refer her to other doctors who were willing to discuss their PHP experiences, whether on or off the record. If you are willing to do this, let me know.
Dr. karen miday | Psychiatry/Mental Health
15 likes Like Reply Aug 23, 2015
Yes, Dr. K s, I would be willing to speak on my deceased son’s behalf. So much of what you have said rings so true and captures much of my son’s experience as related by him to me. Certainly true that those who make it through try to “play the game.” When he tried, with legitimate psychiatric assistance, to make his own plan for treatment in a less restrictive, less costly, local, public inpatient setting, the PHP urged him to see them instead. They esssentially undermined his attempt to seek the treatment he and his psychiatrist had arranged. He clearly was not in a state of mind to accept their interference. He should have been encouraged to immediately seek a place of safety. Although they have no real accountability, their actions appear to have precipitated a suicidal crisis. My email address is karenmiday@aol.com. Would be happy to hear from you and anyone else who has had a negative experience. My son cannot speak for himself, but I do hope that some of you will be
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brave enough to reveal yourselves and help me speak on his behalf, and in honor of his memory.
Dr. s n | Physician
11 likes Like Reply Aug 23, 2015
@Dr. k s @Dr. s n Thanks for the reply and your kindness, Dr. KS. You are ABSOLUTELY right. I’m so very sorry to hear your story. Thanks for sharing and sharing the NAMES and details of other sham facilities.
I thought about sharing so many details, e.g. Pine Grove lost JCAHO accreditation, but was worried my post was already long. You are right about the eval centers. The personnel are very shady, (former?) addicts, unqualified, and the psych testing is a sham just like the whole process from start to finish. I got independent evals and passed EVERYTHING “with flying colors,” but that didn’t matter. I continue to learn a lot about the many sham processes and collaborators.
It is abundantly clear to me that the second you are referred to, or even selfreport to a PHP, you impaired or not are a dead duck. Apparently, California figured that out.
I’d love to connect with your journalist contact. For the sake of everyone on this forum, do you think s/he can pool a number of our stories and draw national media attention? While I’m grateful for Medscape and Drs. Boyd, Langan, Cavenar, and everyone else, I’m thinking that the fastest way to force change is via highprofile national media attention. The PHP corruption, etc., is a NATIONAL epidemic. This story is worthy of frontpage and headline news in the HIGHEST profile national media outlets.
8 likes Like Reply Aug 23, 2015
Dr. R B | Physician
@Dr. k s @Dr. s n If these facilities were treating the general public there would be an
uproar!
Dr. s n | Physician Indeed.
9 likes Like Reply Aug 24, 2015
The public often doesn’t care about physicians. That’s why it is up to us to band together and fight. It’s not too late to fight. Let’s fight to protect the future generations; to honor our fallen brothers and sisters; and so much more.
Dr. K M | Psychiatry/Mental Health
9 likes Like Reply Aug 25, 2015
@Dr. s n I understand the thrust of your comment but disagree with the general sense that the public doesn’t care. The “public” are our collective patients. And many do care deeply about their physician’s wellbeing. They will care more when they learn that their doc could be whisked away on false charges and they could be left without medical care. They should care because their confidential record could be unscrupulously apprehended by a state agency and all confidentiality cold be lost.
What is important is that, while others likely do care to whatever extent it is our responsibility as physicians to confront this beast and fix this problem ourselves. Too many physicians (in general) get stuck in a victim mentality about all of the awful stresses being imposed. There ARE awful things happening. Writing our hands and cursing is not going to get us anywhere. (That said, there are also GOOD things happening in healthcare. And there are good things happening in re: confronting tyrannical boards and gestpo PHPs this article and comment section for one!
Dr. R B | Physician
@Dr. s n It.is social envy and indifference of the majority.
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Dr. s n | Physician
Thanks for the reply and your kindness, Dr. KS. You are ABSOLUTELY right. I’m so very
sorry to hear your story. Thanks for sharing and sharing the NAMES and details of other
Aug 24, 2015
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sham facilities.
I thought about sharing so many details, e.g. Pine Grove lost JCAHO accreditation, but was worried my post was already long. You are right about the eval centers. The personnel are very shady, (former?) addicts, unqualified, and the psych testing is a sham just like the whole process from start to finish. I got independent evals and passed EVERYTHING “with flying colors,” but that didn’t matter. I continue to learn a lot about the many sham processes and collaborators.
It is abundantly clear to me that the second you are referred to, or even selfreport to a PHP, you impaired or not are a dead duck. Apparently, California figured that out.
I’d love to connect with your journalist contact. For the sake of everyone on this forum, do you think she can pool a number of our stories and draw highprofile national media attention? While I’m grateful for Medscape and Drs. Boyd, Langan, Cavenar, and everyone else, I’m thinking that the fastest way to force change is via highprofile national media attention. The PHP corruption, etc., is a NATIONAL epidemic. This story is worthy of front page and headline news in the HIGHEST profile national media outlets. (Sorry if this post appears twice. Medscape not working.)
Dr. Mark Ibsen MD | Emergency Medicine
My story is as arcane as the rest. And nearly as destructive.
Still recovering 9 years later. Markmusheribsen@gmail.com
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Dr. R B | Physician
@Dr. s n It is too late for many. Many have already died and their families have been devastated.
There is a ripple effect of this evil….shattered homes, with children.
Dr. R Oenbrink | Family Medicine
Aug 23, 2015
8 likes Like Reply Aug 22, 2015
I was put through the FL PRN 17 years ago for “Alcohol Dependence” that never was. I spent 4 months in a God forsaken treatment plant that couldn’t figure out what was wrong with me. I was voted most likely to relapse when I “chipped out” of that facility.
By God’s grace I have 1 sobriety date and a diagnosis of Asperger’s Syndrome that was completely missed.
Most recently I’ve spent 2 years out of practice due to the arrogance of the North Carolina Medical Board. A group which countermanded the treatment plant I was sent to for >$20K out of pocket and despite the recommendation that I immediately return to practice.
The advocacy of the NCPHP? “Just do as the NCMB tells you to do”.
Advocacy? I had no due process from the Board, no semblance of advocacy from the PHP or the FL PRN (the FBOME never knew of my issue, it was handled entirely through the FL PRN as I had selfreferred.
When I attempted to contact the groups for clarification of one point or another, callback’s were promised. When they never happened. I complained When I complained about lousy care, being ignored etc, I was told that I would relapse because I “didn’t have good acceptance”.
I would never wish a PHP on my worst enemy (coincidentally enough, the “professionals” of the NCMB & NCPHP). These organizations are more professional thuggery than professional
RJ Oenbrink DO
Family Medicine, Addiction Medicine
Dr. karen miday | Psychiatry/Mental Health
I am an Ohio licensed psychiatrist whose 29 y.o. physician son took his own life while being monitored by the Missouri PHP. He was referred to the PHP by a colleague in 2009 and was sent to a treatment facility in Chicago (no facilties locally or in state were offered) for a 90 day residential treatment program prior to any psychiatric and/or addictionolgist evaluation.
Following a relapse, while vacationing in Puerto Rico, he saw his private psychiatrist and arranged for inpatient treatment at a public local facility. (He contacted that facility from his psychiatrist’s office.) When he called the PHP to inform them of his plan, they strongly advised against his treatment choice and encouraged him to instead come in to speak with them about other options. His calls to several members of the PHP were the last calls he made. He was found dead the next morning.
I talked with him the night prior to his visit to see his psychiatrist. He was panicstricken at what he considered the likelihood that he would either lose his medical license and/or be mandated to another course of inpatient treatment. He was one week away from beginning an oncology fellowship at Washington University/Barnes Jewish.
His feelings about the PHP were anything but positive. He considered them a policing rather than a helping
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agency. Never once did they ask for any information from his treating psychiatrist. I know better than to blame any particular person or agency for my son’s completed suicide. I do, however, believe that had the “professionals” at the Missouri PHP supported the plan made in consultation with his personal physician, he would still be alive today.
My son was a brilliant and compassionate physician who deserved the best evaluation and treatment of his depression, anxiety, and substance use disorders. Instead, he suffered fear, alienation, and humiliation at the hands of his PHP. The “therapy” group he was forced to attend, only reiniforced his fears, as he heard stories about the loss of licensure as well as professional and personal esteem suffered by many in attendance.
We cannot expect physicians to turn for help if their medical license, and consequently all they have worked so hard to earn, are threatened based on input solely by the PHP and is “select” treatment centers.
We must shed light on this, or wel will lose many more talented physicians to suicide.
PHP’s cannot continue to act as both treating and policing agencies. This is an inherent conflict of interest. My thanks, especially, to Michael Langen and his tireless effort to bring this issue to the light of day.
Dr. s n | Physician
@Dr. karen miday So very sorry for your loss
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Dr. k s | Emergency Medicine
@Dr. karen miday Dr. Miday, Many of us have read your son’s story. I am so sorry.
Dr. R B | Physician
@Dr. karen miday Your son was murdered via proxy by a corrupt system.
j c | Medical Student
@Dr. karen miday Dear Dr. Midday,
I am both saddened and enraged at your loss. I was also coerced and illegitimately forced into in a very bad position by a PHP. I am grateful to have found strong supporters and I got out of it. These unethical actions and bullying by PHPs are unforgivable. I hope you will find justice and closure in court.
Dr. Jesse Cavenar | Psychiatry/Mental Health
5 likes Like Reply Aug 22, 2015
I am compelled to comment on Dr. Michael Myers comments below. He states that many of the “unhappy campers” who took issue with the PHPs process were unhappy because they had untreated illness that affected their judgment and insight, and notes that “many of these physicians, when well, look back at their attitude toward the PHP initially and can see that they no longer feel the same negativity about how they were evaluated, advised and monitored”.
Over the past six years, I have talked with a large and growing number of physicians who have completed their respective PHP assessment and compulsory treatment and are now free of the PHP. I have not encountered one person who no longer feels the same negativity about how they were evaluated, advised, or monitored. Instead, I have encountered a group of physicians who strongly believe they were misdiagnosedand some believe intentionally misdiagnosedwho remain extremely bitter and even enraged about the treatment they received at the PHP. They have been traumatized by this process and rendered powerless. To write this off with the standard verbiage of many substance abuse specialists that these disgruntled physicians are just ill and still “in denial” is itself a conceptual blindspot, its own form of denial if you will. Many of these physicians have come to my attention via their treating physicians who concur with the fact of their misdiagnosis. These physicians continue to believe they were misdiagnosed, treated disrespectfully and deprived throughout of their fundamental rights to due process and honest evaluation. They maintain that they were coerced and threatened if they did not fully comply with PHP’s demands and that they were sent for unnecessary and extremely costly evaluation and/or inpatient treatment at inherently biased “preferred” programs. They continue to be enraged regarding these perceived violations.
Many have told me that they cannot even come forward in a forum such as this for fear of retaliation by PHP and the Medical Board. In some cases, they have allegedly been threatened with being labeled as noncompliant or disruptive and “losing the endorsement” of the PHP in advocating for the restoration of their license. Some have allegedly been threatened with extension of their monitoring contract.
Dr. Phyllis Henderson notes below”….I would recommend that someone who thinks they have a mental or addiction problem consult privately rather than go to the PHP”. My experience leads me to conclude there is much
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merit in her statement and I agree with her. Let me note that I was either Chairman or a member of the Impaired Providers Committee (later called the Professionals Health Committee) for some thirty years at major medical centers. Never did I refer a patient to the PHP. Instead, if I had a patient who needed treatment, I arranged for the patient what I and others believed was appropriate. Several times I cancelled my schedule for the day and drove a physician colleague to another city for immediate prearranged emergent hospitalization, or drove a physician patient for an emergency outpatient evaluation. Many times I arranged for hospitalization at worldclass facilities in other states for physician patients.
I would not and will not refer a physician patient to a PHP when:
1) the physician patient cannot obtain a copy of his complete PHP medical record on request and is continually denied access to his own medical record, and prevented from obtaining timely independent consultation
2) the PHP clinical director and medical director refuse to respond to legitimate, reasonable correspondence from the patient and the patient’s representative regarding their diagnosis of the physician patient and the clinical grounds on which the diagnosis was made
3) the PHP has a pattern of disregarding the findings of multiple substance abuse experts and instead makes its own diagnosis but refuses to discuss how that diagnosis was made
4) the PHP denies that it is conducting a clinical or forensic diagnostic psychiatric evaluation which carries immense weight and rather asserts that what they are doing when they evaluate a physician patient is “peer review”, which somehow therefore justifies denying the physician a copy of one’s medical record
5) a physician patient who is to go to a “preferred facility” for evaluation is allegedly told by a cleric person at that facility that he or she will be hospitalized for ninety days prior to the physician patient going to the facility for the “evaluation”
Given what I have witnessed, and other physicians have alleged, why would I ever refer a physician patient to such an organization as the PHP? Who needs it? I can assist my patient in obtaining quality care thru any number of high quality, firstrate evaluation and treatment facilities.
Dr. R B | Physician
@Dr. Jesse Cavenar . Licensed professionals have NO civil rights in the U.S.
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Dr. R B | Physician
@Dr. Jesse Cavenar . PHP programs, CPEP programs are nothing more than legalized extortion and
bullying.
Dr. James Weber | Pediatrics, General
Just like the “disruptive physician ” label once applied , valid or not you are “toast ” .
Dr. Robert Sands | Psychiatry/Mental Health
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I believe the core problem is with the addiction paradigm itself, which can see “underlying pathology” that needs corrective intervention in intensive programs.This pathology may be sub diagnostic such as some anxiety based on trauma or mood issues, quite separate from substance dependence or addiction. It is analogous to my years in psychoanalytic work where “character issues” deserved to be engaged under the idea of “personality reconstruction” or “character analysis”. This approach was long ago abandoned for a variety of reasons, replaced by methods more symptom related and offering evidence based responses, leaving the “underlying” issues alone, unless raised by patients.
There is also the problem that the addiction paradigm interprets medically related symptoms that are of complex causation as deriving from substance withdrawal, even when such a conclusion is absurd given the substance use history and dose consumed. The addiction paradigm is a world unto itself and frequently antagonistic to alternative clinical interpretations. .
So physicians who have minor prescription drug use, (prescribed by their physician), are vulnerable to be “captured” by the “maybe this is dependence/addiction so we need a residential assessment” approach. Benzos are a class in disfavor with the addiction community, even if used in low dose for reasonable indications in low monitored doses.
The larger and non clinical problem is the legalistic structure of the PHP programs that exclude due process, leaving physicians powerless to rebut or question so they submit to the legally prescribed structure or loose their
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license. This must be corrected by lawyers or State Health Boards. This topic is very important and I am pleased to see it put forth so clearly. Perhaps a lawyer could weigh in on how some oversight and due process might be achieved. Via a Health Board?? Legal Bar?? what path??
Dr. R B | Physician
13 likes Like Reply Aug 22, 2015
@Dr. Robert Sands . Dr. Sands. Physicians are being referred to these programs who have no addiction or alcohol issues. It is also being done on a strictly punitive basis. I know a physician, who is not an alcoholic, is not known to be an alcoholic by anyone in the community or her family, who was randomly accused by the Oregon Medical Board, as though some quota of allegations needed to be fulfilled for that year, for being an alcoholic. No patient or patient’s family complained against her. The complaint apparently was generated by the Oregon Medical Board. The Gestapo Nazi Oregon Medical Board then forced this physician to pay about 8000$ to go to an inpatient alcohol treatment center of their choice (no possible corruption there, eh?) at whcih point after three days the attending in this facility said “we don’t know why you are here, you are not an alcoholic.” This physician had no elevated LFT’s or any stigmata of alcoho use, had no history of DUI, etc.
And there are countless other stories of how these tyrants and sophists are being paid to destroy the lives and families of many decent, law abiding physicians. The system wreaks of corruption.
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Dr. Gail Hirschfield | Family Medicine
@Dr. R B @Dr. Robert Sands Yes, it is about numbers. or quotas. Wow! just Wow!
PHYSICIAN’S LIVES MATTER
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j c | Medical Student Aug 27, 2015 @Dr. Robert Sands Hi Dr. Sands,
My experience with a PHP involved no history of substance abuse or any issues at all. During my experience I did not perceive any medical reasoning or diagnostic criteria being used by the PHP at all. Just an insistence that I was ‘impaired’ and I must go to an expensive and out of state ‘treatment center.’ I was given no reason, offered no recourse, and was, frankly, intimidated by the PHP to pay up and play by their terms. I thought their ‘diagnosis’ was ludicrous. Luckily, my institution agreed with me. I’d be happy to share more details of my experience with you if you are interested. I will be seeking thousands of dollars in unnecessary costs occurred by the PHP.
Dr. Phyllis Henderson | Psychiatry/Mental Health
5 likes Like Reply Aug 21, 2015
Such horror stories. I am a recovering alcoholic for whom the monitoring and board process was very helpful, but I was aware of punitive elements. I worked both in California and Washington first as a client and then as a facilitator. I can see that addiction medicine suffers from its own grandiosity and circular reasoning. As stated, we need a balance of transparency and approachability with protection of the public. After reading these stories I would recommend that someone who thinks they have a mental or addiction problem consult privately rather than go to the PHP. One could add contingency contracting with a trusted colleague or therapist that if improvement is not noted that further steps would be considered.
Addiction is a disorder that is hard to admit you have, but we want to have a safe place to get well. No one wants to be a drunk or addicted physician. I would be dead if I had perceived that it was possible to have the outcomes described in Iowa and North Carolina.
Dr. R B | Physician
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@Dr. Phyllis Henderson . Times have changed since your treatment. I have no addiction/alcohol issues yet I was treated like a criminal. Let me clarify that. A criminal has more civil rights than a licensed physician. Also, a criminal when found guilty is given free housing, free food, free medical care and free dental care. Whereas a middle aged physician with a restricted license (for doing nothing wrong) is left without any means of survival except begging. The liability setting…i.e. too many attorneys chasing to few bucks…is making the employment of recovered physicians to high risk.
Dr. Daniel Anderson | Physician
10 likes Like Reply Aug 21, 2015
I no longer practice medicine as a result of selfreporting to a PHP. I sought help from the Iowa PHP in 2005 for professional burnout. This triggered what would ultimately become a very expensive and dehumanizing ordeal that caused me to leave medicine altogether in 2010.
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Fortunately, I have never suffered from a psychiatric condition, including addiction. I had practiced medicine for 16 years with zero disciplinary actions and zero malpractice suits. Once in the PHP system, however, I was rubber stamped as needing 5 years of counseling, abstinence, and drugtesting by people I had never even met. When I refused to comply, on the grounds that the recommended plan did not fit my circumstances and would be of little or no help to me, the matter was turned over to the Iowa Board of Medicine. They sent an Investigator out with a urine cup and a pad to take my story. I happily provided both, thinking I would be exonerated.
I didn’t hear from the Board again for about 6 months, at which time their mode of communication to me was a letter from the Iowa Department of Justice threatening suspension of my medical license, along with a $5,000 civil penalty for being noncompliant. Outraged, I hired a lawyer. He charged me $3,000 to tell me that I would need a $30,000 “war chest” to fight for my innocence. He also told me that I would probably lose, because the Iowa Board of Medicine was not subject to the same due process and constitutional compliance that courts were, that they essentially “owned” my license and could yank it whenever they felt like it. Already having spent about $10,000, I decided to comply with a 5year monitoring contract at my own additional expense, which I did for 2 years before leaving medicine altogether.
Even though I fully complied with all of the Board’s requirements, and paid my $5,000 fine for disagreeing with the Iowa PHP, I ended up with an unflattering permanent entry in the National Practitioner Data Bank. Also, there were press releases that damaged my reputation, and insurance companies dropped me until my 5year probation was over.
I realize that there are many physicians in great need of counseling and treatment for depression and substance abuse, and that some of these physicians endanger their patients. This justifies a need for PHPs. That said, I echo the concerns of other contributors here that PHPs desperately need better implementation and oversight. They should have balanced membership as well, not drawing disproportionally from psychiatry and the legal profession.
I would advise anyone unlucky enough to get in the jaws of today’s PHP to hire the best lawyer you can find immediately, and to agree to nothing without legal counsel. PHPs operate under the guise of public safety, but I believe they are poorly implemented and dangerously unchecked. My experience with a PHP taught me to fear them as a robotic bureaucracy with little more than a superficial regard for due process or for the wellbeing of their clients.
Dr. K M | Psychiatry/Mental Health
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@Dr. Daniel Anderson I am so sorry that you were treated so abusively. Truly a Kafkaesque nightmare. I’m not sure that any lawyer can be effective in an administrative justice system that empowers boards and PHPs to flaunt their abuse of authority and due process so blatantly and provide utterly no recourse to the physician. Rather, the legal profession itself needs to call out and take a vigorous stand against such anticonstitutional abuse.
What then is the answer (asking rhetorically)? It seems clear that oversight and accountability are so grossly absent that some medical boards and PHPs have become governments unto themselves, deaf to multiple physicians’ urgent concerns and impervious to consideration of any reasonable modification to their approach. Those are characteristics which define despots.
One can understand why the recently filed Michigan class action lawsuit against both the board and PHP portends to have such power. In that suit, both the board and PHP are being sued collectively and in their personal capacities. Perhaps that might be the only way.
On a different note, what did you do after you left medicine? Was there anybody there to help you negotiate this ordeal? Perhaps we can find a way to connect offline.
Thank you for sharing your story, and I hope you are finding some healing.
Dr. Daniel Anderson | Physician
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@Dr. K M @Dr. Daniel Anderson I asked for help. What I got was excommunication. I was surprised at the impersonal nature of the PHP, who never once asked to meet with me in person. I was dismayed by the inability of the PHP to offer any real help. They initially advised me to see a psychiatrist, without being able to recommend any specific one with experience relevant to my situation. That psychiatrist felt I had no treatable condition and agreed with my taking time away from practice.
I enjoyed my respite; I explored other practice opportunities, as well as nonclinical career options. After several months I decided to return to practice in the same town but with a more limited engagement, protecting myself from burnout.
Colleagues, administrators, associates, and patients distanced themselves from me, as if whatever was wrong with me might be contagious. Then, after hearing nothing from the PHP for months, they suddenly demanded that I travel 300 miles for a 2day evaluation, despite my clean bill from psychiatry. That program required $5,000 in cash up front and turned out to be one of the poorest decisions I made. I had hoped, naively, for help. I thought they might at least allay any concerns colleagues had about me. Despite normal physical, psychiatric,
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blood, and urine testing, the best they could do is recommend that I should be monitored. It was if they only had 2 categories of patients: doctors with drug problems and doctors who denied it. So now this “official” communication from a respected institution created a cloud of suspicion from which there was no escape.
Again, I have never had a drug or alcohol problem and never tested positive for anything, including results from random SSlike raids on my medical practice, where Board Investigators went into my bathroom to watch me pee. Yet the PHP still demanded that I enter into a 5year monitoring contract with extensive boilerplate recommendations, including daily drug testing and AA. AA?? It was ridiculous. So I refused. That’s when the whole thing went public and I really became a pariah.
Kafka indeed. Fortunately, my metamorphosis was not into a giant insect but instead into CEO of a software company. I am grieved that many of us are not so lucky, and I feel strongly that the system needs change.
Dr. karen miday | Psychiatry/Mental Health
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I am glad that you are alive, healthy, and successful. My physician son was not so lucky. My husband and I actually encouraged him to consider leaving medicine after his experience with the Missouri PHP became so negative. He lived in mortal fear of his license being yanked. It is sad to think that had he chosen any other profession he would likely still be alive.
Dr. R B | Physician
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@Dr. karen miday These and such stories must be told to all young and naive students with any intent of entering into this previously noble but now destroyed profession.
Dr. k s | Emergency Medicine
@Dr. Daniel Anderson @Dr. K M Dr. Anderson,
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The capricious demands made by your PHP and board are typical. Everything you note is absolutely consistent with every doctor I’ve met who has had any interaction with the PHP.
One of my former attendings was referred for evaluation of stress or burnout, after his promotion to associate dean of the medical school. The PHP director, a family practitioner whose qualification was his addiction and membership in AA, insisted Dr. M travel to an approved evaluation in Lawrence, Kansas. There, he was informed that he would have to attend outpatient therapy at one of these facilities for a period of three months. They would not allow him to undergo therapy at home, although we have a whole state full of qualified and licensed professionals. Dr. M was deeply ashamed. As you pointed out, leaving practice for several months immediately places a physician under suspicion. Dr. M was staying in a motel in Lawrence and he became so distraught that he killed himself just before Christmas, while in treatment. He shot himself in the mouth and left behind a wife and children. There was never any question of substance abuse.
My neighbor was a respected cardiologist who was experiencing some marital problems and subsequent depression. He was afraid to see a doctor for treatment of the depression and ended up killing himself one Sunday morning. He also left behind three sons.
Dr. Midday’s story was tragic. Before I made the decision to move forward with my life and leave the PHP behind, I was considering suicide by car.
Dr. karen miday | Psychiatry/Mental Health
9 likes Like Reply Aug 23, 2015
Dr K s, Are relatives of the physicians who died by suicide willing to talk about their loved one’s experience with the PHP? I would so much appreciate you putting them in touch with me (karenmiday@aol.com) The assoication of their deaths with involvement with a PHP needsto be made public. The PHP’s clearly do not want to talk about this. The Missouri PHP made no attempt to conduct any kind of reivew of my son’s death and was not required to make an incident report to any regulatory agency. This is shameful.
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Dr. karen shackelford | Emergency Medicine 7 days ago Dr. Midday, I only know of Dr. M’s story through a fluke I don’t know his family
but have been thinking of writing to his widow.
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Dr. R B | Physician Aug 28, 2015 @Dr. k s @Dr. Daniel Anderson @Dr. K M downtrodden due to abuse of power
by medical boards should be a diagnosis nowadays.
Dr. R B | Physician
3 likes Like Reply Aug 22, 2015
@Dr. K M @Dr. Daniel Anderson . Unfortunately, much of what is the driving force behind the expansion of the Totalitarian Administrative state is too many attorneys seeking too few bucks. Notice how many executive directors who actually run the state medical boards are becoming more and more attorneys who are appointed, without term limits no less, to these high paying positions.
Dr. R B | Physician
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@Dr. Daniel Anderson . And what I hear from you Dr. Anderson is that another decent human being has left medicine to the abuse by these monsters. It is the Totalitarian Administrative State. It is growing in both its scope and the depravity of its abuse. If the Red Army landed on U.S. shores, I am sure that Americans would shoot them and fight back. This increasingly insidious, stealth nation within the U.S. is a clear and present domestic danger to the Liberty that was once revered in this country. The first sign of decay is when an attorney is appointed to run the medical board. Funny, I know of no state bar associations that are run by a physician (unless that physician is also a JD). Regarding the Totalitarian Administrative State, no one elects them, no one can legally get rid of them and they do not have to answer, beyond mere lip service, to the public or the lawmakers. These individuals, interestingly enough, right the laws that grant them impunity. Remember, everything Hitler did was legal. It was immoral and unethical but all legal. And that is what we are facing today. Authority based primarily upon power and not reason. It is discretionary. It is abusive. It will smash any professional who dare questions the actions of these tyrants. It absolutely amazes me that such behavior is legal and institutionalized in the U.S. Basically, you can do anything you want to someone as long as it is legal…it doesn’t matter if it is unethical or immoral….it doesn’t matter if the kangaroo court proceedings of the medical board inquisitions are done in private and would not meet standards that are upheld in civil and criminal courts. It doesn’t matter if you didn’t do anything wrong. It doesn’t matter if none of your patients or families never complained against you. They rule. They write the rules. They earn a living and you are the food.
j c | Medical Student
@Dr. Daniel Anderson Dr Anderson,
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Your highly negative experience with PHPs seems be be unfortunately common. Some professionals are responding to PHP’s coercion with lawsuits
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Dr. Jesse Cavenar | Psychiatry/Mental Health
I was pleased to see Ms. Anderson’s piece calling attention to the previously unaddressed problems that have
emerged with multiple physicians expressing immense dissatisfaction with their evaluation and handling by PHPs.
I am a certified psychoanalyst and boardcertified psychiatrist who was the “doctor’s doctor” at Duke for some thirty years. Subsequently, I was the Senior Medical Review Officer for the U.S. Army Substance Abuse Program, Europe, for eleven years. I believe I have some knowledge about which I speak.
In my attempts over the course of several years to assist a young colleague who was accused of alcohol abuse, I obtained a power of attorney for him and attempted to talk with personnel at the NCPHP who had conducted a diagnostic evaluation on the basis of an anonymous complaint of the man smelling of alcohol. His challenge of the complaint and recounting his professional behavior and absence of a substance abuse problem was overtly rejected. I pointed out to NCPHP personnel in writing that this man did not meet the DSM diagnostic criteria for alcohol abuseor anything else, for that matterand that five substance abuse specialists had all stated that this man did not meet the DSM diagnostic criteria for alcohol abuse. The young colleague had requested a blood alcohol or Breathalyzer to prove his innocence; that had been denied. All of his colleagues at the hospital where
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he worked stated he had never smelled of alcohol, and his girl friend and parents stated that he had no alcohol problem. Yet, NCPHP personnel stated that the diagnosis was alcohol abuse and threatened to report him to the NC Medical Board (NCMB) if he did not sign a contract with the NCPHP for monitoring.
NCPHP personnel refused to meet with me, or to answer my correspondence with them, despite my power of attorney and releases from the patient.
The accused physician asked NCPHP personnel in writing to be told in writing why and on what basis he was being detained in the NCPHP upon threat of report to the NCMB, when in fact he did not meet the diagnostic criteria for the alleged alcohol abuse. NCPHP personnel refused to respond to his request.
NCPHP personnel refused then and for a prolonged period subsequently to give the physician patient a copy of his own record and refused me a copy of the patient’s record, even with the power of attorney that I held.
I posed the question to both the NCPHP and NCMB: “How does one make a diagnosis of a disorder when the patient has none of the required diagnostic signs or symptoms of that disorder?” Not surprisingly, no one would answer that question. My insistence on diagnostic integrity and program accountability was ignored and I, as a reasonable and knowledgeable medical professional in the very same field, was repeatedly shunned.
Over the next several years, I spoke with many other physicians who believed that they had been subject to diagnostic abuse and inappropriate multiday evaluation,and prolonged treatment and invasive monitoring based on what appeared to them to be incorrect diagnoses. Some of the physicians believed that the diagnoses were contrived and unsupportable.
Convinced that I had an ethical responsibility to confront this, I filed a lengthy complaint with the NCMB, alleging violations of constitutional rights, federal statutes, state statutes, and ethical standards of various professional organizations. To my dismay, I received a response that the NCMB “voted to take no further action” on my complaints. Such was an oxymoron, as no “action” had been taken, so no “further” action was impossible. Never was I told that my complaints were not valid, or they had been investigated and not substantiated. In my opinion, I was simply given the “bums rush” with the hope I would go away. Recently, I was informed that the NCMB as well as an additional licensing board has opened bona fide investigations into certain of those complaints.
I have been a practicing physician for fiftytwo years, have an exemplary record and reputation and have never been in any difficulty with a PHP or medical board. I have been shocked as to what I have observed and learned over these past six years. I will go on record as stating that my encounters with the NCPHP are the most outrageous, egregious and unbelievable series of events I have experienced in my years of practice.
For any physician, getting ensnared in NCPHP, especially on an alleged incorrect diagnosis, is a Kafkaesque nightmare. How have we come to this point where a statefunded diagnostic psychiatric program can allegedly routinely engage in a pattern of such reckless diagnostic inaccuracy and yet affected physicians are rendered powerless and their professional societies ignore such alleged flagrant abuse?
Have PHPs become unstoppable organizations that can wreck physicians’ careers? Why has there been no oversight and accountability? Do PHPs and Medical Boards want to look “tough”?
This alleged abusive behavior must be confronted and this alleged outofcontrol unaccountable pattern of alleged psychiatric misdiagnosis and mandatory referral to private treatment facilities halted. I strongly believe that organized medicine and psychiatry must bring their authority to halt this alleged pattern and urgently work to restore a program that operates with professional integrity and compassion in its appropriate outreach to physicians with real mental health and substance abuse issues.
It seems clear that at present no one is watching the regulators and their state psychiatric evaluators. And that is very dangerous. Physicians and other medical professionals, and their respective patients, are allegedly being harmed. And it must stop.
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Dr. R B | Physician
@Dr. Jesse Cavenar . The witch hunts are on. And boy, do the witch hunters like and need their
jobs…to be productive…no matter how many innocent lives and families are destroyed.
Dr. s n | Physician
@Dr. Jesse Cavenar Thank you for your efforts. You are a hero.
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6 likes Like Reply Dr. Gail Hirschfield | Family Medicine 6 days ago
@Dr. Jesse Cavenar Dr. Wible thinks it will be stopped in time. I am going to work my heart out to see that it does. I and many others of us of a like mind. We are getting in touch with one another and are working on plans. Please feel free to get in touch with me (and any of you here who would like toask Dr. Wible to give you my cell no. or work no…and I trust her to do so, OR I can post my email here if you wish…trying to maintain some privacy! )
Thanks for this fine post, Doctor.
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Dr. Michael Myers | Psychiatry/Mental Health Aug 21, 2015
I am quoted by Ms Anderson, referring to the PHP of NY state, with the statement “…..there have also been ‘a lot of unhappy campers’ who took issue with the program’s process”. What is missing is the context of that statement. What I intended is that much of this unhappiness is due to untreated illness in the physician that affects judgment and insight. Many of these same physicians, when well, look back at their attitude toward the PHP initially and can see that they no longer feel the same negativity about how they were evaluated, advised, and monitored. Thank you.
Dr. Eliza Blackwell | Internal Medicine Dr Michael MyersWould you
4 likes Like Reply Aug 21, 2015
Please disclose your relationship to the state PHPs and FSPHP? The article does not mention this conflict of interest. You are a longstanding supporter, advocate and some might argue apologist for physical health programs. There is also a financial conflict of interest.
Your retraction here is interesting. It does not comport with reality on any level. It is implausible as anyone here knows this scenario you describe is ludicrous.
Dr. B W | Neurology
10 likes Like Reply Aug 23, 2015
Actually whar Dr Myers said happens a lot. I have seen it many times over. I might just add “feel less negatively.” The problem is the addict and the innocent act similarly early on. The PHPers, primarily familiar with addicts, assume all are guilty. It’s a tough situation. Lives can be ruined by this but the PHPers charter is “to protect the public” so guess what happens, addict or not. I have no answer. I dont want to see anyone treated unfairly nor do I want an intoxicated provider.
Dr. Jesse Cavenar | Psychiatry/Mental Health
4 likes Like Reply 11 days ago
@Dr. B W This is where the confusion is because the PHPs charter is not to “protect the public”. The PHPs charter is to try to assist physicians and to advocate for physicians. The purpose of the state medical board is to “protect the public”. Unfortunately, the PHPs have identified with the aggressor to the point that they seem to believe that their role is to “protect the public”. That is a large part of the problem. Add that in with a cottage industry that produces billions of dollars and you have a real problem.
Dr. karen miday | Psychiatry/Mental Health
1 like Like Reply Aug 22, 2015
Unless they, like my son, die by suicide first. It seems most reasonable to assume that anyone with a legitimate psychiatric illness might be especially vulnerable to the threat of loss of licensure and hard won career. My son certainly was. In fact, he was panicstricken. He had heard too many horror stories by other physicians in the treatment settings he was mandated to. Why not allow physicians the same options available to our patients. Certainly, they should be allowed no, in fact, encouraged to seek an independent psychiatric or addiction specialist evaluation. The treating physician can then, if necessary, be called upon by the Medical Board for an opinion and treatment recommendation.
My son trusted his private psychiatrist. They were, in fact, working well together on his “issues.” Too bad the Missouri PHP seemed to have no real interest in this and no real interest in input from my son’s doctor.
Mike, I know your heart is in the right place, but the reality is that all PHP’s are not the same. The Clinical Director of my son’s PHP was an RN. Still not certain what credentials he had to make treatment recommendations for my son (residential treatment in Chicago) prior to an evaluation. The absurdity of this should be apparent.
My hope is that you will join this effort to require that PHP’s have some real transparency and accountability. I strongly suspect that my son is not their first victim.
9/15/2015 Physician Health Programs: More Harm Than Good?
8 likes Like Reply Dr. john robertson | Psychiatry/Mental Health Aug 20, 2015
Amen! As a board certified addiction psychiatrist I’ve witnessed these abuses for years. Unfortunately these programs are usually lorded over by wellintentioned previously addicted physicians from specialties outside of psychiatry who have no business practicing psychiatry. Any disagreement of the findings by the alleged impaired physician is treated as denial requiring cultlike intervention. Consideration of less invasive intervention such as outpatient psychiatric treatment are rarely considered.
Dr. Eliza Blackwell | Internal Medicine
26 likes Unlike Reply Aug 20, 2015
Precisely, and they have duped state medical boards ( and FSMB) into believing they are the only “experts” and that anyone outside the shell game cannot be trusted as they 1. Don’t have the “knowledge” they have and 2. Are part of the “conspiracy of silence” protecting impaired colleagues. Although some are recovery zealots the 12step is more frequently used as a facade to 1, get “”like minded” MDs licenses back ( they blame any and all behaviori on drugs and alcohol and take no personal responsibility and 2. Call doctors who don’t agree with their draconian abide “noncompliant.” It sculpture of fear and threats wrapped in a patina of “recovery.”
Dr. karen miday | Psychiatry/Mental Health
20 likes Unlike Reply Aug 23, 2015
Would really love for the American Psychiatric Association to take up this issue. It seems that many PHP’s (Missouri, for one) have no psychiatric oversight or consulation. This is a very sad state of affairs. Organized psychiatry should take more interest in how physicians with psychiatric conditions are treated.
Dr. Pamela Wible | Family Medicine
@Dr. karen miday Why do you suspect the APA has not done that?
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Aug 23, 2015
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Dr. R B | Physician
@Dr. Pamela Wible @Dr. karen miday Fear of another more powerful authority
that is not based on reason.
Aug 24, 2015
Much like the branding of men who were accused of deserting in the old west !
Lee Rivers | Other Healthcare Provider
Now you know how many of your patients feel. Not pleasant, is it?
Dr. James Weber | Pediatrics, General
@Lee Rivers Inane and inappropriate comment !
Aren Aaron | Other Healthcare Provider
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Aug 20, 2015
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Aug 21, 2015
4 likes Like Reply Aug 20, 2015
Dr. James Weber | Pediatrics, General
Simply put admit a problem , seek help for your problem then pay for it for the rest of your life [ career ] .
@Dr. James Weber @Lee Rivers I must beg to differ. The article describes experiences, burdens and struggles extremely comparable to those contended with especially by low income patients with chronic illness and access only to extremely limited healthcare. The similarity is, in fact, astounding, if one reads patient literature as well as professional medical literature.
I would suggest that it’s a basis for patients and practitioners to recognize common ground and join in the effort for better quality healthcare for everyone, so that segregated care for physicians ceases to be desired or needed by physicians and thereby ceases to provide opportunity for abuses.
Dr. Eliza Blackwell | Internal Medicine
Yes it is blanket prejudices like this that keep injustices such as this afloat. If you are going to make a
comment address the substantive points directly. As with any other population most doctors are kind.
8 likes Like Reply Aug 20, 2015
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Physician Health Programs: More Harm Than Good?
Decent and well intentioned ands injustice to anyone is an injustice to everyone. Those witches/savages/hippies deserve it! Is that your thinking?
Aren Aaron | Other Healthcare Provider
5 likes Unlike Reply Aug 21, 2015
@Dr. Eliza Blackwell Injustice to any group is indeed injustice to tall. Please read my reply to Dr. Weber just above. (Though I must admit your reference to witches/savages/hippies is a bit puzzling.)
Dr. Eliza Blackwell | Internal Medicine
1 like Like Reply Aug 21, 2015
Excellent comment you hit the nail on the head. Doctors are I different from anyone else but this same group had duped politicians, boards and the public into this false belief. Time to shut this nonsense down.
Micah Price | Psychologist
3 likes Like Reply Aug 21, 2015
@Lee Rivers Being a healthcare provider would suggest you would want to improve the healthcare system and provide the best care possible to patients. Do you think you achieved it with that statement? Just curious
Aren Aaron | Other Healthcare Provider
2 likes Like Reply Aug 21, 2015
@Micah Price @Lee Rivers Lee Rivers’ comment appears to be a valid criticism of the article’s viewpoint, and such criticism is indeed necessary for improving healthcare for all. Please have a look at my reply at Dr. Weber’s response, if you would. Thank you.
Micah Price | Psychologist
2 likes Like Reply Aug 21, 2015
@Aren Aaron @Micah Price @Lee Rivers Do you feel that the way is was stated was received by others as a valid critique of disparities in healthcare (which I agree exist) or a jab at others?
Dr. Jessica W | Psychiatry/Mental Health
3 likes Like Reply Aug 20, 2015
As a psychiatrist specializing in physicianintraining mental health, I completely agree with Dr. Manion’s comments. These programs drive physicians deeper into secrecy for fear of being trapped in a no win situation with a PHP. Though my state’s PHP was comparatively fair and reasonable, residents who had sought treatment on their own and had established relationships with a psychiatrist and therapist, then in good faith reported having a mental illness on their license renewal, were still forced to enter the PHP or risk losing their licenses in a public hearing before the board of medicine. Most of these residents had depression wellmanaged with meds and therapy and had never been a danger to patients.
25% of residents develop a major depressive episode during residency. How can we expect our residents to take good care of their mental health, if they experience shame and an invasion of privacy for admitting to seeking help? Meetings with the PHP were overwhelmingly perceived as adversarial by residents, who reported they were asked very personal questions which I can see no reason for. The culture of medicine requires a system to encourage physicians to seek mental health care when needed. The current PHP system in most states needs a massive overhaul to help physicians, instead of shame and persecute those with psychiatric and substance abuse problems.
Micah Price | Psychologist @Dr. Jessica W Amen!
28 likes Unlike Reply Aug 21, 2015
Being a medical psychologist (and hopefully soon med student) and working alongside of/training physicians, students, and residents both in and outside of the hospital environment quite a few are
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afraid to seek help. Partly because of the culture of medicine itself but also because of the fear over career ruining negative consequences. Most docs I know do not start off with addiction issues, but those that do develop unhealthy patterns over time often as a way of selfmedicating.
What many physicians don’t realize is that if they seek help early and are not a danger to themselves or others (also not a decision that is made lightly), independent psychologists are not going to report them to anyone. I don’t know of any state that requires immediate reporting of a medical practitioner seeking mental help, can’t say there aren’t but don’t know of any. Cash pay also means that no one would know except for the physician and psychologist. We need to promote a culture of preventative care in medicine, as blind punishment only makes systemic problems worse.
Dr. K M | Psychiatry/Mental Health
10 likes Like Reply Aug 22, 2015
@Micah Price @Dr. Jessica W I know of no state or federal law requiring mandatory reporting of any person to his /her employer or professional board. If you believe otherwise, I would suggest you best put such into your treatment agreement regarding exceptions to patient confidentiality.
And I would argue that, unless there were a clear danger to your physician patient or one of their patients from that person’s illness, then reporting that to anyone is not only a major breach of confidentiality but a violation of one’s professional ethics.
In the absence of such protections of inviolate confidentiality, why would any person place their trust in a therapist?
This principle is the same as the priest’s / minister’s / rabbi’s commitment to absolute confidentiality in the confessional. And some have died to maintain that oath. It is certainly one of the durable oaths carried forward from the Hippocratic tradition.
3 likes Like Reply Aug 23, 2015
Dr. Pamela Wible | Family Medicine
@Dr. Jessica W And if we continue to shame and publicly humiliate our doctors, how our we to care for
patients? Is this the standard of care that we hope to perpetuate on our most vulnerable?
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Aug 20, 2015
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Dr. Kernan Manion | Psychiatry/Mental Health
I appreciate this preliminary examination of PHPs that Medscape has undertaken. As serious as the concerns are,
I believe the real picture is even more grave.
Please know that I write this with some trepidation as I am one who has gotten ensnared in a labyrinth of abuses of process and dishonest assessment by a PHP (acting in conjunction with the board) and, as many have expressed elsewhere, fear retaliation as I attempt to extricate myself and return to practice. But, unwise as it may be, I feel that I must speak about these issues as it is the only way that this abusive system will be confronted and corrected. I hope that others who have felt mistreated by their PHP will feel empowered to come forward.
The article begs the question of what exactly is the nature of the “assessments” that PHP’s perform. In fact, they conduct Boardordered evaluations of physicians for concerns about alleged substance abuse and mental illness. .By necessity, these are diagnostic psychiatric evaluations, even if they are only preliminary screening consultations. In that they are compulsory “fitness for duty” evaluations conducted at the behest of a state medical board, they are essentially involuntary forensic psychiatric evaluations done under threat of loss of one’s license for noncompliance. However, in certain cases, the Board has ordered the physician to a PHP without offering any rationale and the physician has been told he will lose his license if he doesn’t not promptly comply. This certainly has all of the feel of government abuse of psychiatry by a state agency. But, in this case, we have psychiatry’s willing complicity.
Worse, PHPs have repeatedly claimed that the “assessments” it conducts are not diagnostic evaluations but instead are “peer review” and that the physician has no right to see the alleged peer review finding. However, peer review standards were articulated under the Health Care Quality Improvement Act (HCQIA) which spelled out explicit parameters for legitimate peer review. One of course is the right to have the concerns causing the peer review to be undertaken to be explicitly stated to the reviewed physician. Another is the right of the physician to receive the report of the peer review process and to contest its findings. It would certainly appear that PHPs alleging such “peer review” standing in their nonrelease of their record have been in overt violation of HCQIA.
Operating as 501c3 educational public charities, with no established criteria, oversight or accountability for the quality and careeraltering implications of the diagnostic evaluations they perform, they conduct specialized
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Dr. Jorge Ramirez | Physician Related discussion (doc2doc.bmj.com):
It is time to break the silence on physician suicide.
Aug 19, 2015
9/15/2015 Physician Health Programs: More Harm Than Good?
diagnostic procedures by order by the Board. These types of diagnostic psychiatric evaluations are rightfully in the exclusive domain of medical practice. Yet curiously, PHPs carry no malpractice insurance and are afforded full state immunity for their nonoverseen and potentially reckless evaluations through their exclusive association with the state medical board. (In North Carolina, the medical board was supposed to have overseen it, along with the medical society. They didn’t, as documented by the auditor.) By this arrangement, they are inherently a biased entity, and this bias is made worse by the physician having virtually no recourse to either contest the referral to the PHP in the first place (e.g. having been referred on highly suspect grounds) or to contest the substance of the evaluation and recommendations themselves.
For those interested in reading the NC State Auditor’s narrative report on NCPHP, you can obtain it here: http://www.ncauditor.net/EPSWeb/Reports/performance/per20138141.pdf
To suggest that the auditor did not find evidence of wrongdoing is distinctly incorrect. In the preceding decade, the auditor found that 1,140 NC physicians were denied due process in being refused access to their NCPHP evaluation and “recommendations” of mandatory submission to inherently biased evaluations and treatment and therefore being denied reasonable and timely right to contest such and seek second opinion. They were compelled to comply with NCPHP’s infallible findings and the ensuing Board orders for extended evaluation, prolonged treatment at its “preferred programs” and prolonged “monitoring” often for 5 years duration. (One might rightfully ask where was each physician’s counsel in this pervasive abuse of process, but that might best be explored in a subsequent comment.) When one realizes that PHPs are now pushing for mandatory assessment and “monitoring” of physicians and other healthcare professionals who are taking prescribed psychotropics for everyday emotional syndromes (like anxiety, depression and ADHD), and for docs who are alleged to be “disruptive” or who are “burning out,” one ought to be alarmed about the immense potential for abuse, especially in the context of systematic denial of due process, absence of oversight and utterly no legal accountability.
I am not opposed to PHPs’ mission. The original vision was right on target and there is definitely a need for such a specialized and compassionate resource. However, its mission and implementation have become hijacked and in some cases it has taken on a gestapo identity for its sibling regulatory agency.
To return to its original vision, its role must be delineated, its entire range of activities overseen and it must be held legally accountable for ensuring utmost professionalism in the integrity of its evaluations as the adverse consequences of its erroneous diagnoses and recommendations, backed by threat of severe practice restriction and even loss of career in all states, can be catastrophic and irreversible.
Dr. karen miday | Psychiatry/Mental Health
36 likes Unlike Reply Aug 22, 2015
Interesting that you mention “government abuse of psychiatry” in your thoughtufl (and, I believe, right on) commentary. I only wish that a legitimate psychiatric evaluation of my now deceased son had been conducted by the Missouri PHP. In 2009 he was mandated to a 90 day, highly restrictive (no leave without supervison) program without any such evaluation being conducted. I do not doubt that the final triggering event of his suicide in 2012 was fear of being pulled from his fellowship training for a “repeat course” at a similar unit. His plan to attend a local inpatient program was discouraged by the PHP. Had they been legitimate clinicians (which they are not) they would have encouraged him to follow his psychiatrist’s advice and to seek a place of safety.
Interestingly enough, when asked by my husband what sort of review would be conducted following his death, we were told that nothing of the sort was planned, that there was no protocol for such. In 30 years as a practicing psychiatrist, I have yet to work for any legitimate mental health agency that did not require a thorough review of a patient suicide.
Let’s join together to demand both transparency and accountabilty by the state PHP’s. Why not ask the Federation of PHP’s for some basic data? How many physicians are being monitored in each state. What are the demographics? Age, gender, race? What specialities do they represent? What are the diagnoses they are being treated for? How many suicides have occured under their watch?
How does California manage withoutl a PHP? Why don’t they have one? What happens to impaired phsycians in California? I suspect that such basic data would shine some light on the operation of the various PHP’s. And, let’s not forget, the financial incentives to keep physicians under their watch. There are conflicts of interest galore.
7 likes Like Reply Aug 23, 2015
Dr. Pamela Wible | Family Medicine
@Dr. karen miday Excellent initiatives that should be pursued immediately before we lose
any more of our colleagues.
2 likes Like Reply 6 days ago
Dr. Gail Hirschfield | Family Medicine
@Dr. Kernan Manion Great post…I think that most of us agree with the idea or mission of a PHP. But
that is not what we have. Yes, it is totalitarian and brutal…a killer. PHYSICIAN’S LIVES MATTER
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Dr. J M | Physician Aug 19, 2015 So if this is how they treat physicians, imagine how they treat the poor, courtordered people. The one size fits all,
let’s make money mentality has to go. Where did compassion go?
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34 likes Unlike Reply R P | Other Healthcare Provider Aug 21, 2015
@Dr. J M My thoughts exactly, having worked in both the substance abuse and mental health treatment fields. In addition, I have witnessed similar treatment for teachers in similar circumstances. It would seem that the mental health and substance abuse fields are riddled with presuppositions and rigid protocols that fail to take individual circumstances into consideration. However, you may get similar complaints from certain patients, i.e., chronic pain patients or those with mental health issues, concerning the medical delivery system as well. In other words, these physicians may be experiencing the same or similar treatment as their own patients with compromising diagnoses.
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