Link to Medscape article by Pauline Anderson Here:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lab Fraud?

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

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

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

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

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

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

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

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

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

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

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

Intentional Delay?

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

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

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

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

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