How Public Records Law can force transparency and hopefully bring accountability. Root out the rats!

March 10, 2017November 28, 2017mllangan1 2 Comments

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This Sunday marks the beginning of Sunshine Week, a national celebration started in Florida 15 years ago to promote open government. Transparency is about shedding light. Transparency brings accountability, and, often, meaningful reform.

On June 3, 2016 Governor Charlie Baker signed into law the first update to Massachusetts public records law since 1973. House Bill 4333 imposes shorter time frames for agencies to respond to records requests. Most agencies need to respond within 10-days but can be granted a 20-day extension provided they show good cause for it. Those who believe a state agency has violated its legal obligations can petition the Supervisor of Records and agencies are also subject to punitive damages for failure to comply with the requirements.

Massachusetts has historically ranked at the bottom of the barrel in terms of giving its citizens access to public records. A 2015 assessment by a non-profit investigative news organization gave the state a grade of F and ranked it below Mississippi and Arkansas in the category of public records access (40th in the nation).

Under the new law documents previously provided with missing or illegible date-stamps were requested from the board. The sole reason for this request was to determine if these documents were submitted as evidence and forwarded to the tribunal for consideration at the hearing for which they were considered to be heard a, heretofore impossible task due to toothless public records law in Massachusetts. This matter should be a given. If I mail a letter I do not question or fret over whether or not it was received by the person I sent it to and the same dynamic applies here. It is a given assumption that documents submitted as evidence for at hearing reaches those individuals who are supposed to hear that evidence at that hearing. That is how the system is supposed to work and, like a lost letter, exceptions should be rare as there are safeguards in place to assure it. Here we have a group that has removed those safeguards. The Physician Health and Compliance Unit (PHCU) is part of the medical board but independent of the medical board and exist as a self-contained unit with no oversight, auditing of or accountability. The PHCU was created to serve as a liaison between the state PHP and medical board to handle board cases involving doctors being monitored under PHP contract. Ostensibly they are an objective go-between and these individuals are assumed to seek, follow and tell the truth. Their job is to review the evidence and let the chips fall where they may. They do not. Given the power to act as their own hearing officers and present cases to the board they hold all the chips. All evidence supporting any doctors case before the board in a physician health case must be submitted to the PHCU, not directly to the board and if that evidence contradicts the PHP then it never ever gets to the board. This has been suspected for years but when these documents are later requested to see if they had been reviewed board has been able to delay, withhold and censor them. There has previously been no way to determine these matters and they could get away with whatever they wanted by gaming the system under toothless laws.

Not anymore (hopefully).

The Commonwealth of Massachusetts Public Records Division has been a breath of fresh air. Those I have interacted with have integrity and empathy as well as zeal. Although limited in scope they can hold agencies to account by demanding the provision of complete, legible and accurate records and not backing down.

Pam Wilmot, executive director of Common Cause Massachusetts stated:

“As the cradle of liberty, Massachusetts should lead the way on openness and transparency, not lag behind the rest of the nation. The law Governor Baker just signed will help us catch up and begin to take our rightful place among those states that highly value and promote transparency.”

Document Submitted as Evidence for Hearings Date-Stamped Long After

In response to a June 2016 request the board provided just one with a legible date-stamp; a December 15, 2011 letter requesting an attached “litigation packet”be considered at an upcoming December 21, 2011 hearing . The documents are all date-stamped January 17 2012 (nearly one month after ).. All of the other documents where illegible or missing dates rendering it impossible to determine if and when they were entered into evidence as required by law under M.G.L. c. 30A§ 11(4) which states:

All evidence, including any records, investigation reports, and documents in the possession of the agency of which it desires to avail itself as evidence in making a decision, shall be offered and made a part of the record in the proceeding, and no other factual information or evidence shall be considered, except as provided in paragraph (5) of this section. Documentary evidence may be received in evidence in the form of copies or excerpts, or by incorporation by reference.

Board Defense counsel Bryan Bertram dismissed the date-stamp as irrelevant and claimed it did reflect when it was entered into evidence but when it was scanned into the Document Imaging Unit (DIU) . He claimed this occurs after hearings not before. See logical fallacy and lies. . We filed a Motion to Produce Documents (SJC-2015-0267, # 44) with legible dates which Bertram opposed in his Response to Motion to Produce Documents

Bertram claimed “board staff” had reviewed its records and minutes and retrieved from “off-site storage” those “materials before the Board in December 2011.” The documents I claimed were suppressed, he claims , “are in fact there.” and provides footnotes:

1 The Board’s staff has reviewed its records and confirmed this to be the case.

2 To be sure, and to put this matter to rest for the Court once and for all, the Board has retrieved from offsite storage those materials before the Board in December 2011. The documents that Dr. Langan claims were “suppressed” are in fact there—and this should not be surprising given the Board’s many orders since that time, all of which have disclaimed any reliance on the July 2011 PEth test.

3 The Board’s staff has confirmed this by reviewing its minutes.

He claimed my request was :

“……nothing more than an attempt to impose upon the Board a duty–absent from any statute, regulation or rule to search for and produce documents to him that are outside of that record. Dr. Langan’s Motion tellingly directs this Court to no authority to support such a request. Because it is devoid any basis in the law, the Motion should be denied.”

As of January 1, 2o17 my request for legible documents does have a basis in the law. Authority does now exist to support such a request.

I filed a Public Records Request under the new law on January 9, 2017. I received a response from Board counsel Robert Harvey ( January 20, 2017 documents provided by board). Most are still illegible or missing dates. The same document date-stamped nearly one -month after the hearing for which it was submitted was provided. One other had legible dates. A document written June 6, 2013 is stamped both electronically and by hand with dates sometime in 2012, before it was ever written.

And in response to an Order from the Supervisor of Records I was provided the very same document date-stamped January 17, 2012. But it is not a copy but original as indicated by the “blue-ink. This original document precludes the existence of any others date-stamped earlier than January 17, 2012. This documents no earlier dated copies could have been submitted as evidence before the hearing. This document was never admitted into evidence and may not be relied upon by the board in its decision M.G.L. c. 30A, § 11(4).

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The records, minutes, and materials reviewed and retrieved by “board staff” constitute public records. I requested them. I also requested the board “reports” that would have resulted from “board staff” confirming it was before the board in 2012.

“ABA Model Rule 3.3, Candor Toward The Tribunal, declares that ‘a lawyer shall not knowingly make a false statement of fact or law to a tribunal or fail to correct a false statement of material fact or law previously made to the tribunal by the lawyer.’ If a lawyer ‘has offered material evidence and the lawyer comes to know of its falsity, the lawyer shall take reasonable remedial measures, including, if necessary, disclosure to the tribunal.’

An attorney must have a factual basis for alluding to, offering, or relying on evidence at trial. That factual basis may not be wishful thinking. There are two requirements for a factual basis — an attorney’s subjective belief, and objective evidence to support that belief.

But none exist. Not one document, reference, record, or any other materials exist that are chronologically consistent with the documents being before the board in 2012. The only document that exists is the litigation packet date-stamped a month after the hearing.

I asked Bertram to either provide the factual basis or admit to the false statements. He’s been ignoring me and will not answer.

The whole picture depicts the respondent as an attorney who, when it serves his advantage, is willing to violate clear norms of professional responsibility and to engage in purposeful deceit which harms others.

“The privilege of practicing law does not come without the concomitant responsibility of truth, candor, and honesty. Because no single transgression reflects more negatively on the legal profession than a lie, attorney misconduct involving dishonesty justifies disbarment.” Id. (quoting In re Young’s Case, 913 A.2d 727 (N.H. 2006)).

No matter what it takes I am going to make sure that is a certainty in this case.

Make Medicine Great Again! Please Donate and Help Drain this Swamp!

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MA Board Attorney Deb Stoller’s Fraud Upon the Court

Defending MA BORM Deb Stoller’s Five-Year Concealment of Fraud–Nothing left but logical fallacy and lies

I am Offering Over $25,000 in cool prizes to anyone who can prove fewer than 3 felonies were committed by past FSPHP President Sanchez as shown by documentary evidence alone! I claim I can detect multiple very serious crimes in these documents–prove me wrong and the whole lot is yours!

December 9, 2016July 4, 2017mllangan1 6 Comments

Federation of State Physician Health Programs (FSPHP) removed from accountability with low risk of suffering consequences for misconduct

According to Erich Fromm rational authority is based on competence, experience, and mutual respect. Irrational authority is often disguised as benevolent paternalism and is designed to perpetuate or intensify conditions of inequality through the use or threat of force, deceptiveness, and secretiveness.

The Federation of State Physician Health Programs (FSPHP) has has operated as an unexamined authority for the past 25-years . They have pushed practice and policy unquestioned and without opposition that has gravely harmed individual doctors, the medical profession itself and the public at large. Everything they have done has been done to benefit themselves and their drug and alcohol assessment, testing and treatment affiliates in the provision of protections, power and profits.

Examining the specific practice and policy pushed reveals a body of false-claims making designed to facilitate the systemic use of coercion and threats, remove all due process protections and fundamental rights from physicians and prevent, block and eliminate the evidence. This practice and policy collective has created a culture of impunity, immunity and deference that is able to successfully conceal ethical violations and crimes. Uncovering their wrongdoing is a nearly impenetrable gauntlet. It is a system of institutional injustice that is undoubtedly a major contributor to the suicide epidemic in the profession. They have been able to conceal the truth, avoid investigation and prevent punishment for years by removing themselves from all accountability and outside inquiry. Direct and specific questioning appears to be their Achille’s heel as the recent spat of articles critical of these programs is showing just how much of an illegitimate authority they really are.

In her rebuttal to Pauline Anderson’s article “Physician Health Programs: More Harm Than Good?” FSPHP President Doris Gunderson dismissed the accusations of fraud and abuse in one fell swoop as “allegations rather than facts” and second hand anecdotes. Countering allegations of an absence of oversight and regulation she states:

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“In fact, we operate under a microscope, answering to individual practitioners, medical boards, malpractice carriers, defense attorneys, state attorneys, medical societies, hospitals, medical schools and residency training programs. We are also accountable to patient safety entities and a Board of Directors.”

Untrue. Accountability demands both provision of information and justification for actions to outside entities capable of punishing misconduct. . What was done and why? No such entity exists and no pathway for appeal or grievance redressal exists either. Zero accountability. Ditto for the “PHP-approved” assessment and treatment centers. As cash only out-of-pocket facility they remove themselves from the prying eyes of insurers.

screen-shot-2016-01-13-at-9-55-47-am The North Carolina PHP Audit found the past FSPHP President and NC PHP director Warren Pendergast could not identify the qualitative or quantitative indicators used for “approving” PHP-approved facilities. The best he could come up with is “reputation” and “word of mouth” yet state medical boards mandate evaluations of doctors at these facilities and specifically exclude non-“PHP-approved” facilities.This is enforced by the Federation of State Medical Boards Policy on Physician Impairment. Each state managed by the FSPHP utilizes the same dozen or so facilities and each state medical board mandates it under threat of disciplinary action. It is in fact a rigged gam

Denying accusations of coercion Gunderson states in her rebuttal to Anderson’s article:

“The detractors of PHPs interviewed for the article maintain that PHPs are coercive. Yet the report fails to mention that PHPs have no authority to mandate treatment and monitoring, suspend or revoke licensure, or otherwise discipline physicians.”

screen-shot-2015-10-07-at-7-11-18-pm The report fails to mention it because it is more either/or logical fallacy based on the false dichotomy between “treatment” and “punishment” that is often used to promote the FSPHP mythology. Although PHPs do not have the legal authority to mandate, suspend or revoke a license they have the functional authority to do so. This is also dictated by public policy. (ASAM Policy on Coordination Between Treatment Providers, Professionals Health Programs, and Regulatory Agencies).

Legitimate authority articulates ethical, evidence-based, or internally consistent arguments when challenged. Legitimate authority does not simply delegitimize one’s opponent and use logical fallacy and obfuscation to avoid addressing the substance of an argument. In her rebuttal Gunderson claims the NC Audit was favorable to them because no evidence of abuse was found. This is akin to a serial killer claiming victory because no bodies were found in his dungeon replete with torture devices and restraints. State auditor Beth Woods set this straight when she told the BMJ in Physician Health Programs Under Fire that the holes were big enough in the program “you could drive a truck through them” and it would be “difficult, if not impossible, to defend” oneself against an incorrect assessment” as no ability to “appeal a diagnosis or assessment” existed.

“Compounding the problem, said Wood, was that “the chief executive and medical director were in total control of entire process.” They assessed allegedly impaired doctors, but when those assessments were contested, they were responsible for presenting complaints to the state medical board. The doctors concerned were not allowed to be present and were not allowed to see the programs’ medical reports on them.”

Multiple Barriers Removing Accountability at Multiple Levels

The inability to obtain one’s own medical records or lab reports is the first obstacle one must overcome. The second barrier is that even if documents are obtained there is no one to give them to. The third is the existence of “point people” who deflect, block and otherwise dismiss valid complaints. The only oversight provided to the involved labs is an an accreditation agency, the College of American Pathologists (CAP) They can investigate and correct but do not have the ability to sanction.

screen-shot-2016-12-09-at-1-13-29-pm Of the many hundreds of doctors I have spoken to and who have taken my survey not one has been able to obtain evidence of abuse. It was either refused, censored or doctored. I have obtained documentary evidence that is specific, detailed and unequivocal.

It is therefore critical it be recognized for what it shows and it is morally imperative that those involved be held to account as the documents illustrate clearly and undeniably a collusion between a state PHP and its drug testing lab to fabricate evidence. The corruption is top-down as it involves another former FSPHP President Luis Sanchez and the VP of Laboratory operations at USDTL Joseph Jones. As explicit and detailed as it is in revealing unequivocal black and white crimes it has been ignored by the usual channels.

Research on street criminals suggests the certainty of punishment has the strongest deterrent effect (basically will I be caught) and the more people think they will be arrested for a crime the less likely they are to commit it. Criminals weigh their actions against possible gains and consequences and the risk of consequences in this system have been essentially zero. Diagnosis rigging, coercion, threats and abuse are rampant because they have no fear of punishment. The Chairman of the commission that examined the causes of the 2008 financial collapse compared the relatively small fines paid by corporations to “someone who robs a 7-Eleven, takes $1,000 and being able to settle for $25 and no admission of wrongdoing.” He added,“Will they do it again? Absolutely, because it pays.” This is like someone who robs a 7-Eleven, takes $1,000 and never gets caught so he goes to the next 7-Eleven and takes $2000 then hits as many 7-Elevens as he can for as much as he can.

Multiple Crimes, Multiple Felonies and Egregious Misconduct. Fabrication, Falsification, Concealment and Perjured Evidence. Color-of-Law Abuse, Civil Rights Violations

In June of 2011 I signed a patent-license agreement with a company to bring an epinephrine auto-injector to FDA approval within three years. It was recently mentioned in an NBC news article in the wake of Mylan’s Epipen price hike and the patent documents can be seen here and a slideshare overview here. This was successfully derailed the following month when I was asked by the state PHP to have an alcohol test. This was for no apparent reason. I have never been accused of having an alcohol problem and my work performance at MGH was reported as “impeccable.” There were no issues in any arena. The events are described in detail here, here, and here.

The blood test was reported positive to the medical board on July 19, 2011 as seen here: positive-peth-july-19-2011 I requested records but PHS refused but relented in December 2011 and I obtained the USDTL Litigation Packet which contained a faxed request from PHS to the lab requesting my unique identification number and a “chain-of-custody” be added to an already positive report See key docs here.:12:3:2011 Litigation Packet (Selected)

The records showed falsely created and fabricated evidence. Clear fraud. I filed a complaint with the College of American Pathologists CAPLetter. They investigated and forced USDTL to correct the test as reported in an October 4, 2012 letter from the lab to Sanchez. Instead of revealing the correction the two concealed the revision and reported “non-compliance” two weeks later and board took disciplinary action against my license. In December 2012 CAP contacted me to followup on the outcome of the revised test which I was unaware of. I informed them they did not tell me and confronted PHS but they claimed no knowledge of it.. On December 11, 2012 Sanchez reports to the board that he just found out that the test was revised but it had nothing to do with the disciplinary action taken by the board.. Sanchez and Jones deny there was any correction 67-days earlier and stand by their guns.

In August of 2014 I was able to obtain the complete USDTL documents under new HIPPA-Privacy Rule for labs which removed PHS approval. Full docs can be seen here: August 6, 2014 to Langan with health materials. The October 4, 2012 correction from USDTL to Sanchez contradicting Sanchez claim of not finding out about the correction until December is included.Note the language used in the Letter claiming Sanchez was informed of the revised test 67-days after he actually was.

Recently obtained documents under records reform act – Langan PDF copy They show documents entered as evidence date-stamped and entered into the administrative record after the hearings at which they were to be heard. Multiple others missing and never addressed. It is now clear that Stoller concealed all documents relating to PHS misconduct since December of 2011.

Specific and detailed evidence of criminal activity was provided to Board Attorney Deb Stoller over the course of more than five-years. This showed clear collusion between the state physician health program and one of their preferred national drug testing labs. It is important to recognize the gravity of what this means. I provided a state officer with evidence of crimes similar to Annie Dookhan–clear fabrication and collusion to fabricate evidence. She suppressed it. This is much much worse than Annie Dookhan as the lab is used by state physician health programs across the country and over the past five-years their have been multiple suicides of doctors who have allegedly been given fabricated drug and alcohol tests just like mine. Many of these doctors were given positive tests right before they were to complete a 5-year contract and this is a pattern that seems to be occurring as the rule rather than the exception. Facing five more years of abuse some doctors have chosen to end their lives rather than continue with the PHP.

Specific and detailed evidence of the fraud was given to Deb Stoller over the course of five-years and she did nothing about it to protect Sanchez. The impact of this is much greater and the consequences much more severe than what occurred with Dookhan. As The documents clearly showed felony crimes this is egregious and indefensible.

screen-shot-2016-12-09-at-1-14-00-pm What is chilling is that this request to falsify evidence was done by fax and the lab complied with full knowledge that the positive-test would result in grave and possibly permanent consequences for someone. The moral detachment of Jones is incomprehensible to me. If I was offered a million dollars at this moment to fabricate a drug test on some stranger I would not do it. I would not for any amount of money and I don not believe the majority of my friends would either.I also contacted Jones ( August 6, 2014 to Langan with health materials ) and told him of the severe consequences this was having for my family but he did not respond. Had it not been for the new HIPAA -Privacy rule I would never have obtained these documents and without the record reforms act I would never have obtained the evidence implicating Stoller ( Langan PDF copy )

screen-shot-2016-12-09-at-1-13-52-pm It is now time to enter phase two of exposing the corruption of PHPs. It is now necessary to necessary to relentlessly contradict the lies and falsehoods and and present the evidence with logic and clarity. It is necessary to name names, point fingers and demand that direct and specific answers to direct and specific questions. It is time to shine a bright light on the specific unethical and illegal acts detailed here. They are the rule not the exception and the diagnostic rigging and forensic fraud make these more murders than suicides. This is a public health emergency. By my estimates over 80% of those being monitored by PHPs do not even meet the diagnostic criteria for substance use disorder or any other psychiatric disorder. It is political abuse of psychiatry.

screen-shot-2016-04-26-at-10-58-19-pm Legitimate authority has a responsibility to be truthful to one’s words and deeds and policies need to be enforced in a consistent manner. State PHPs are engaging in fraud in collusion with their preferred drug and alcohol assessment, testing and treatment centers. They are giving diagnoses to individuals who do not meet the diagnostic criteria for a given diagnosis to provided unneeded treatment. They are financially exploiting doctors under threat of disciplinary action against there medical licenses.

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The Board claims no crimes were committed because no one has been charged with any crimes. No, Dr. Sanchez has committed very serious crimes including multiple felonies. This can no longer be ignored. These crimes can be determined by the documentary evidence alone. They are self-evident.

To settle the matter once and for all I am offering over $25,000.00 in cool prizes to the first person who can disprove my claim that Dr. Sanchez committed multiple felonies. My claim is that by simply looking at the dates and documents multiple felonies are clear. They are not equivocal. The first person to disprove this assertion may collect each and every item pictured below. You can even write up a legally binding contract and I will sign it. There is something for everyone and if anyone has any questions about any of it feel free to ask. screen-shot-2016-09-09-at-7-26-42-pm

To summarize, I can find multiple clear felonies in the documents that need no further inquiry. They are black letter law and involve fraud, concealment, perjury and other crimes. Policies and laws need to be enforced equally. The Board cannot play favorites and give allowances to its friends when it comes to criminal activity. Sanchez is licensed by the medical board just as I am and the screen-shot-2016-09-09-at-9-08-18-pm board’s position on the fraudulent practice of medicine is quite clear.

One felony would be demand the board address what is seen here. Multiple felonies make it inexcusable to ignore and if it is ignored it will be relentlessly addressed again and again and again. As it is so difficult to obtain evidence it is necessary that this be addressed with full measure as a precedent. People just like this are harming good doctors across the country and unless you are profiting from the drug and alcohol testing and treatment racket you should be disgusted at what is seen here. The fact that Sanchez pontificates on the behavior of others makes this particularly egregious. Moreover, Jones also tests newborns and other groups with these same tests. If he is this unethical who knows what amount of damage has occurred. Anyone of integrity and conscience should be outraged by what is seen here. As it is one of the clearest and most specific examples of laboratory fraud I am going to be asking for help getting this out–it should be used to show how this type of drug and alcohol testing can be abused.

Direct and specific questions deserve direct and specific answers. This will need to be addressed directly as it is not going away and neither am I. If cannot disprove fewer than three felonies than they need to be addressed. Suspect similar point-people in other agencies protecting them.

If multiple felonies were not committed then you would think at this very moment there should be people knocking on the door trying to get my attention so they can collect these prizes. I don’t hear anybody knocking, do you?

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Prizes as Below

“Implicit faith belongs to fools, and truth is comprehended by examining principles”-Algernon Sidney (1683)

May 2, 2016October 4, 2016mllangan1 5 Comments

The photo above was taken at the 104th Annual Meeting of the Federation of State Medical Boards (FSMB) held in San Diego April 28-30 and tweeted last night in reference to the partnership between the FSMB and the Federation of State Physician Health Programs (FSPHP) with the caption:

“How a healing profession heals itself #FSMB2016 partnerships #FSPHP trust and faith in oversight and system.”

Within the the allotted 140 character twitter limit this succinct observation is nevertheless very revelatory. Both systems and the oversight of systems demand accountability and answerability to outside and independent agencies. Trust and Faith are not in the equation. Why has this lesson not been learned?

Answerability requires the obligation to answer questions regarding decisions and actions. Accountability requires transparency, explanation and justification. What was done and why? Standards, rules, regulations, codes, laws and other objective benchmarks need to be applied by outside actors. This is critical. It is the very essence of oversight.

“Trust and faith in oversight and system” is both oxymoronic and nonsensical. “Faith and trust” in oversight equates with an “absence” of oversight. “Faith and trust” in systems inevitably results in “systems failure” and therein lies the problem.

Blind faith and deference to authority has led to a systems failure in the regulation of the medical profession. Physician health programs (PHP’s) have convinced state medical boards to give them complete deference. Medical board’s in turn have convinced state attorney generals and law enforcement to give them complete deference. This has led to a complete systems failure. No investigatory or oversight body exists. No one is minding the minders. It is a complete and utter free for all.

Making sound decisions about regulation calls for an understanding of the problem it is intended to solve. Legitimate policy must be based on recognized institutions and experts. Regulatory changes demand methodologically sound science and evidence-based facts arrived at through rigorous peer review and professional oversight. The science must be reliable and unbiased. Legitimate policy must be based on recognized institutions and experts. If the information regulatory agencies rely on to discipline doctors and protect the public is unreliable then serious consequences can occur.

The validity and reliability of opinions lie in their underlying methodology and evidence base. Reliance on the personal authority of any expert or group of experts is the fallacy of appeal to authority and a more apt and accurate twitter caption to the photo above would be Algernon Sidney’s 1683 statement that:

“Implicit Faith belongs to Fools, and Truth is comprehended by examining Principles”

Physician Health Programs: The Need for Transparency and Accountability

February 4, 2016February 4, 2016mllangan1 8 Comments

Accountability, or answerability, is necessary to prevent abuse and corruption. This requires both the provision of information and justification for actions. What was done and why?

Professional guidelines and standards of care, ethical codes of conduct and the law are all objective benchmarks that can be used to assess the actions and decisions of others. In any free society this necessitates the existence of organizations of truly independent opinion capable of standing in this judgment.

State PHPs are Non-Governmental Organizations (NGOs) over which the state health department has no supervisory oversight. There is no regulation, no transparency and no accountability. There is no public scrutiny and they police themselves.

In Ethical and Managerial Considerations Regarding State Physician Health Programs Drs. John Knight and J. Wesley Boyd call for greater oversight and scrutiny of PHPs by the medical community at large. They recommended periodic auditing, national standards and regulation. They also attempted to convince the Massachusetts Medical Society to implement changes at PHS where they served as Associate Directors with over two decades of collective experience.

These efforts to promote transparency and accountability at both local and national levels, however, fell on deaf ears.

State PHPs have systematically removed those not conforming to groupthink. Threatening them with litigation if they breached “peer-review” statutes and confidentiality agreements has effectively silenced them from reporting any misconduct, abuse or even crimes they may have witnessed.

In Massachusetts John Knight was removed in 2009 and J. Wesley Boyd in 2010. In Ethical and Managerial Considerations Regarding State Physician Health Programs they comment “if a PHP highlights a physician as particularly problematic, the evaluation center might–whether consciously or otherwise—tailor its diagnosis and recommendations in a way that will support the PHP’s impression of that physician.” So too will the clinical laboratories.

How is this any different from the case of Dr. Farid Fata, the Michigan oncologist who intentionally diagnosed healthy patients with cancer so he could charge them for unneeded chemotherapy? The U.S. Attorney called it the “most egregious” case of health care fraud ever. His acts may have contributed to one patient death. The institutional injustice of the PHP system is causing countless deaths of physicians.

To consciously “tailor” a diagnosis is fraud. To tailor a diagnosis of substance use disorder or any other psychiatric diagnosis is the political abuse of psychiatry. Misrepresentation, dishonesty, deception, and distortion play no role in the Profession and Guild of Medicine. To do so violates the basic moral principles of Medical Ethics–Autonomy, Beneficence, Non-Maleficence and Justice.

The “PHP-approved” assessment and treatment centers are all staffed by doctors of “like-mind.” It is a rigged game.

An audit of the North Carolina PHP found essentially no oversight from the Medical Board or Medical Society. The audit found that “abuse could occur without being detected,” and this is by design. By removing and blocking the provision of information necessary for accountability, restricting the liberties and freedoms of physicians, and increasing their power and control they have erected a framework of hidden abuse.

The situation in North Carolina is standard operating procedure for PHPs under the Federation of State Physician Health Programs (FSPHP). It is not the exception but the rule.

While outspoken in denouncing what they regard as unethical and unprofessional behavior by other doctors, they are resistant to apply even the most minimal standards to their own activities.

To whom are the PHPs accountable? Whom do they represent? These are legitimate concerns.

PHYSICIAN OR PROFESSIONAL HEALTH PROGRAM SURVEY

Please click on the link below and complete the following survey if you have been monitored or are being monitored by a PHP.

Professional Health Program (PHP) Survey

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 G-mail address), then use the alias email address as your “name” for future correlation.

Transparency and Legitimacy Needed in Addiction Medicine—Answerability and Accountability Absent in Current Paradigm

October 5, 2015mllangan1 Leave a comment

The Medical Profession, Moral Entrepreneurship, Moral Panics, and Social Control.

“Few, no matter how desperate, seek help of their own accord.” says Dr. Marv Seppala, M.D., Chief Medical Officer at Hazelden, one of the “PHP-approved” drug and alcohol assessment and treatment centers located in Center City, Minnesota. “Physicians are intelligent and skilled at hiding their addictions.”

“They’re often described as the best workers in the hospital,” he says. “They’ll overwork to compensate for other ways in which they may be falling short, and to protect their supply. They’ll sign up for extra call and show up for rounds they don’t have to do.”

In reality this is ludicrous–knee slapping absurd. If the results of this authoritative opinion were not so dire these statements would, in fact, be comical. Such is not the case, however, and opinions like Seppala’s have been taken at face value and, as a result, the aftermath has been and continues to be tragedy.

Addiction, alcoholism and substance abuse to any significant degree produce both physiological and behavioral manifestations in the user. It is cause and effect. Pathophysiology conforms to law of nature and not the whims of the impaired physician movement.

What anomalous aspect of intelligence or special skill set would enable a doctor to hide an addiction?

The ASAM definition of addiction is characterized by cognitive, behavioral and emotional changes which include “impaired control” so how would intelligence rein it in? Furthermore, what unique logical, rational, analytical, factual, abstract, intuitive or objective aspect of intelligence is responsible for this preternatural fortitude?

How is the intelligence of a doctor any different from the intelligence of any other human being? And what prodigious abilities do doctors have that enable them them to cloak the behavioral manifestations and stave off the physical consequences chemical addiction to such a degree that they are able to maintain the facade of being “described as the best workers in the hospital?” Is it an innate inborn endowment or an esoteric knack acquired during medical training?

What ability and artistry would allow a profession to weave such a web of fortitude that they can convincingly shroud the myriad signs and symptoms of drug and alcohol abuse unlike the regular folk? Perhaps access to ophthalmic vasoconstrictors and beta blockers to temper the pupillary dilation and tremulousness associated with stimulants or botox and a testosterone patch to mask the skin changes and maintain lean muscle mass in the throes of alcoholism?

How does overworking “protect their supply” and why would they keep it at the hospital? These people have prescription pads and last I checked there were no cocktails shakers or bottles of Jameson in the doctors lounge.

And for the life of me I cannot comprehend why an alcoholic or addict doctor would sign up for extra call and show up for rounds on his day off. What would be the point?

In reality a doctor with a drug or alcohol problem would be erratic with call and show up late for rounds.

This is just another example of authoritative opinion with no substantive value. It is moral entrepreneurship at its finest; the fallacy of appeal to authority and secret knowledge.

If Seppala were asked to provide the evidence-base and rationality of these statements he would be hard pressed to do so. The question would be met with deflection, logical fallacy, references to the opinions of like minds and thought-stopping memes. “You need a check-up from the neck up,” your best thinking got you here,” there is no “I” in “team,” “denial isn’t just a river in Egypt.” Oh, yeah? well “Rogue” isn’t just a river in Oregon and, while we are at it, “Boring” isn’t just a town!

It is this type of misinformation and propaganda that allows the “impaired physician movement” to drag away the “best worker in the hospital” and deem him “in denial.”

“We were so surprised. We didn’t even know he had a problem” say the nurses, patients and colleagues left behind.

Well the truth is he probably didn’t!

Blind-faith and unquestioning allegiance to expert authority deflects scrutiny and analysis. Few red flags are raised as this type of moral preening promotes misguided plausibility and complacency in the belief that these are indeed experts with good intentions. This needs to be addressed.

But if you look at any of the current “moral panics” that are being used to suggest random suspicion-less drug testing of doctors or promoting the Physician Health Programs as successful and replicable models, you will inevitably find a doctor on this list behind it. It is a given.

And the invitation goes out to Seppala to debate this in a public forum on a level playing field. Not gonna happen because it would be impossible for him to address and answer the questions rationally, directly and with any tiny scrap of evidence based data. This is being shown clearly on Medscape as both the Federation of State Physician Health Programs (FSPHP) and the American Society of Addiction Medicine (ASAM) remain silent despite the mounting horror stories from doctors diagnosed with pathology when none existed who were forced into treatment they did not need. Diagnosis rigging, forensic fraud, lack of due process and all manner of abuse are being reported but as an organization with power maintained by by lack of accountability and secrecy they will not and cannot answer. It is time we identify these groups as illegitimate and irrational authority and demand transparency and legitimacy.

Physician Health Programs (PHPs) are not above the law: They have simply manufactured a “culture of impunity” by removing themselves from all aspects of accountability

June 14, 2015June 14, 2015mllangan1 13 Comments

Physician Health Programs are not Above the Law

Are Physician Health Programs (PHPs) above the law?

Unable to get law enforcement to take cognizance of reported abuse, many doctors I have spoken with believe that the actors involved are impervious to criminal liability. Complaints of fabrication and fraud involving PHPs and their affiliates to the police, the Attorney General and other law enforcement agencies have been given no credence, tabled or dismissed with little investigation.

Believing these agencies are deliberately ignoring credible complaints and the documentary evidence placed before them, some have concluded that state PHPs have been given the power to commit crimes with impunity and immunity.

PHPs are not above the law. It is by removing themselves from and blocking the usual routes of accountability and absolute operational control of the testing, assessment and treatment process that has enabled misconduct to remain hidden, unrecognized or excused. The crimes exist but they remain undetected, unnoticed and unpunished.

Removing Accountability

The essence of accountability is answerability which means having the obligation to answer questions regarding decisions and actions. This requires the transmission of information when it is requested. The accountable actor provides the information to the overseeing actors in a transparent manner.

Accountability also requires explanation and justification for the information provided. What was done and why? Standards, rules, regulations, codes, laws and other benchmarks are then applied by the overseeing actor to determine if the information provided was appropriate or inappropriate.

The availability and application of sanctions for illegal or inappropriate actions uncovered through answerability is also a necessary component of accountability. This is necessary to impose restraint on authority and power. Lack of enforcement of sanctions contribute to the creation of a culture of impunity.

The usual mechanisms that exist to impose restraint and create incentives for appropriate behavior and actions are absent. No outside oversight exists to limit their power or subject them to a set of rules. No regulation exists to curb abuse.

A Culture of Impunity

The authority accorded PHPs and the power they exercise exist in a culture of impunity.

The key findings of the2014 North Carolina PHP Audit are below:.

No indications of abuse were found, a point brandished by the PHP as redeeming and proving no abuse was occurring. In actual fact it is an ominous finding that also relates to their apparent ability to violate the law.

The audit found no indications of abuse but that abuse could occur and not be detected because of an absence of due process for the complainant, excessive control of the complaint process by the PHP and absence of oversight by either the medical board or medical society. What this means is that a doctor with no power is making a complaint against an unsupervised agency with enough power to influence the investigation of a complaint against itself. The reason no indications of abuse were found is because the system is specifically designed to hide abuse. That is the intent.

Absence of transparency, regulation and oversight coupled with control of information enables both censorship and doctoring of records. Strict Confidentiality is enforced by HIPAA, peer review protection, and drug and alcohol confidentiality law.

PHPs are able to suppress and conceal criminal activity but they are also able to manufacture information designed to hide misconduct.

The North Carolina Audit found no objective selection criteria for the out of state assessment and treatment centers because none exist other than ideological mindset and monetary gain. The same facilities are used by most state PHPS. They are, in fact, mandated as they are the “PHP-preferred” facilities.

In 2011 The American Society of Addiction Medicine (ASAM) issued a public policy statement on coordination between PHPs, regulatory agencies, and treatment providers. recommending only “PHP-approved” treatment centers be used and the statement specifically excludes ‘non-PHP” recognized facilities.

What the Audit diid not discover is the medical directors of all of the “PHP-approved” facilities can all be seen on this list of Like-Minded Docs. It is a rigged game Every aspect of drug-testing, assessment and treatment is kept hidden and secret and within control of the PHP.

It is a rigged game in which they have removed themselves from all aspects of accountability. They have, in effect, manufactured a culture of impunity at our expense.

Moving the Goalpost–Criminal Violations of HIPAA by PHS, Quest and USDTL

May 7, 2015May 8, 2015mllangan1 16 Comments

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Information obtained under HIPAA Privacy Rule

1.August 6, 2014 to Langan with health materials 2. Quest-Clinical

The elements of a criminal offense under HIPAA are fairly straightforward. To commit a “criminal offense” under HIPAA, a person must knowingly and in violation of the HIPAA rules do one (or more) of the following three things.: use or cause to be used a unique health identifier, obtain individually identifiable health information relating to an individual or disclose individually identifiable health information to another person. Criminal penalties under HIPAA, tiered in accordance with the seriousness of the offense, range from a fine of up to $50,000 and/or imprisonment up to a year for a simple violation to a fine up to $100,000 and/or imprisonment up to five years for an offense committed under a false pretense and a fine up to $250000 and/or imprisonment up to ten years for an offense committed with intent to sell, transfer, or use individually identifiable health information for commercial advantage , personal gain, or malicious harm.

One of the ways physician health programs are engaging in forensic fraud using laboratory developed tests (LDTs) is by changing them from “forensic” to “clinical” samples in order to bypass chain-of-custody. As there is no regulation or oversight of the entire testing process it is easy to do. PHPs have no oversight or regulation. Neither do the commercial drug testing labs using these tests. They are non-FDA approved and CLIA exempt so the only avenue of complaint is the College of American Pathologists (CAP) which is an accreditation agency that does not have the power to sanction.

In terms of criminal penalties I would aim for the $25000 and 10 year mark as the cumulative documentation of HIPAA breaches committed by PHS, Quest and USDTL under false pretense are many and severe.

The Department of Health and Human Services Office for Civil Rights confirmed that my blood test from July 1, 2011 was intentionally changed to a clinical specimen and sent to USDTL with specific instructions to process it as a clinical specimen. Under the updated HIPAA-Privacy Rule “patients’ have the right to request their records directly from labs without authorization of the ordering provider.

It is important to recognize that all three parties had misrepresented this test as “forensic” since 2011. I have been requesting the “external chain-of-custody” from Quest since December of 2011 and the “appended test” from V.P. of Laboratory Operations Joseph Jones since December of 2012 when I was informed that it was changed from positive to invalid on October 4, 2012.

The new documents provided by USDTL include the October 4, 2012 revised test contradicting Dr. Luis Sanchez letter that he “just found out about” the revised test 67-days later.

The importance of this cannot be overstated as I filed a complaint with the College of American Pathologists in January of 2012. The investigation confirmed my suspicion that the test was fraudulent and as a result CAP mandated that USDTL revise the test.

USDTL did so and reported it to Dr. Sanchez but both concealed it and Sanchez took action against my license the following week.

“Moving the Goalpost” is a frequent tactic of PHPs whereby they make a new allegation and disregard the original. By controlling the information that is provided they are able to suppress and conceal whatever they want by misusing existing health care confidentiality law.

The October 19, 2012 report for noncompliance with my contract was done under “color of law” and resulted in suspension of my medical license. The new documentation shows that all three parties were involved in the fraud and the coverup.

The information USDTL provided even contains an email from me to Joseph Jones from December of 2012 requesting that he provide a copy of the October 4, 2012 revision which he ignored.

In response to demand letters from my attorney all three defended themselves by claiming the July 1, 2011 test had absolutely nothing to do with my suspension and blamed it on my non-compliance. The new documentation shows that I was reported for noncompliance after Dr. Sanchez was made aware of the revised test.

As the three parties colluded to produce PHI and used it with malice in a conspiracy to commit fraud and I am therefore requesting that charges be filed against these parties under the HIPAA criminal statute:

The HIPAA criminal statute, 42 U.S.C.A. § 1320d-6, reads in pertinent part:  ”A person who knowingly and in violation of this part—  • uses or causes to be used a unique health identifier; • obtains individually identifiable health information relating to an individual; or discloses individual identifiable health information to another person, shall be punished as provided in subsection (b) of this section.”   ”Whoever willfully causes an act to be done which if directly performed by him or another would be an offense against the United States, is punishable as a principal.” 18 U.S.C. § 2(b).

All three parties knew this was intentionally changed from a forensic to a clinical sample and PHI. Instead of correcting an error both Quest and USDTL took steps to conceal this information. In fact, the complicity of the three parties, cover-up and extent of damages caused by it make this the worst HIPAA-criminal violation to date. I can find nothing comparable and the damages have still not been corrected.

Luis Sanchez was notified of the invalidity of the test on October 4, 2012 but suppressed it for 67-days. This was a result of my complaint to the College of American Pathologists (CAP) that launched an investigation which revealed no external chain-of-custody existed for the specimen rendering it invalid. This was revealed to PHS on October 4th, 2012 but instead of disclosing this and correcting things Dr. Luis Sanchez reported me to the Board for “noncompliance” less than 2 weeks after it was revealed to him that the test was invalid. He then wrote a letter on December 11, 2012 stating that he “just found out” about the invalid test.

Sanchez violates M.G.L. (B) Section 69 on 3 separate occasions 1. July 28, 2011 when he reports the fabricated test to the Board of Registration in Medicine (BORM) 2. October 19, 2012 when he reports non-compliance with my contract leading to my suspension. 3. December 11, 2012 when he reports PHS was made aware of the invalidity of the test the day prior when it was actually 67-days prior (and 2 weeks prior to the report of non-compliance). His attempt at “moving the goal-post” was made clear with the August 2014 provision of the October 4, 2012 report from USDTL to Sanchez. Both USDTL and Sanchez suppressed this information to conceal the crime.

The additional evidence was provided in December of 2011 with the litigation packet. Since that time Ms. Stoller has received exculpatory evidence that undeniably refutes the test including an investigation by the College of American Pathologists. In addition Ms. Stoller has been made aware point by point the crimes involved. She is aware that this is not only “invalid” but the product of forensic fraud. Her stance has been to ignore each and every point and support PHS regardless of facts and truth while professing to serve the public interest.

Letter from USDTL to Sanchez reporting the absence of external chain-of-custody and invalidating the positive test. This was concealed until August of 2014.

While concealing the October 4th test correction Sanchez reports “non-compliance” with A.A. meetings. The positive test was the sole justification for the A.A. meetings.

Sanchez claims that he just found out about the revised test 67-days after he actually did. Note he makes it a point to state that the test did not cause any consequences confident that the October 4, 2012 document will remain concealed.

A Request to Inspect and Copy Protected Health Information and Authorization for Use or Disclosure of Patient’s Protected Health Information was sent to USDTL in July and August of 2014.

The July 1, 2011 PEth test was drawn as a forensic specimen and subsequently changed to “clinical” (rendering it PHI) at the request of Quest’s client, PHS, Inc on July 7th, 2011. USDTL sent the materials within the 30 day deadline.

Quest Diagnostics, however, refused to comply with my request for the authorization and release of information forms required for them to draw a clinical specimen (which I knew did not exist) as well as any documentation related to the request by PHS that Quest (in violation of all regulations, professional standards, and clinical laboratory law) changed a “forensic” to a “clinical” specimen. The Quest attorney insisted that I sign a “release” from PHS.

PHS and the colluding labs were apparently unaware of the updated HIPAA regulations removing the need to obtain a signed release from a “provider” to obtain PHI.

I only received it because the DOJ-OCR agreed that this was PHI and forced Quest to send it.

PHS manipulated the test, set up a system in which they could claim me non-compliant , then did so immediately after the test was amended and hoped I would never find out.

On 10/4/2012 USDTL amended the test noting “external chain of custody was not followed per standard protocol” invalidating the test (this was the result of the initial CAP investigation under the assumption it was a forensic test). This was faxed to PHS but they withheld this information from me and the Board of Registration in Medicine.

The very next week they deemed me “non-compliant.”

PHS then officially reported me to the BORM as “noncompliant” on 10/19/2012.

On 12/10/2012 I found out from Amy Daniels of CAP that the test had been amended. I then called PHS and they issued a letter the very next day 12/11/2012 stating “Yesterday, December 10, 2012 Physician Health Services (PHS) received a revision to a laboratory test” referring to the July 1, 2011 PEthstat. They then try to cover themselves by claiming they were not aware of any action taken by the board as a result of this test.

The documents reveal that PHS is violating multiple state and federal criminal laws including clinical laboratory laws. It not only involves forensic manipulation but sending laboratory specimens as “clinical” samples when they are not authorized to do so and misrepresenting them as “forensic.”

Joseph Jones goes on record as a strict advocate of quality control and chain-of-custody with his “Defense in Depth Strategy” video and multiple written documents proclaiming how USDTL follows strict and rigid protocol. Well the ” litigation packet” contradicts and even negates this. How can any of USDTLs testing be trusted in light of what is seen here.

There is nothing that correlates that test with me and for all intents and purposes it could be a positive template used specifically for this type of misconduct. They pointed out that it does not pass the common sense factor (i.e. what would an average person think under normal circumstances about this?)

What it shows is that Mary Howard of PHS changed a test that was drawn as a “forensic” test to “clinical.” She is listed as the ordering “physician.” None of the required information exists to obtain a clinical sample. There are no authorization forms signed by me or to whom the information can be disclosed–clear violations of “Prohibited Activities” under Massachusetts law governing clinical laboratories.

Quest and USDTL representation has already clarified that PHS requested this test be sent by Quest to USDTL as a “clinical sample” with specific instructions to process it as a “clinical” sample. PHS is a monitoring agency not a treatment provider.

A “clinical” laboratory specimen is defined (CLIA, DPH, HHS, state laboratory law, essentially everyone) by its use in the diagnosis and treatment of a patient in a doctor-patient relationship. It necessitates patient “care” which PHS is unable to legally provide as a “non-profit” charitable organization.

As this is both “bad-faith” and ultra vires “confidentiality agreements” and “peer review” protection should no longer be an issue. Just one removes it.

PHS is an agency that utilizes drug and alcohol screens to detect if doctors are using substances they are prohibited to use. It is not a clinical provider. I am sure Bresnahan has spun some sort of logical-fallacy argument to say it is, but the documentary facts negate this. Organizational purpose is clear. As a monitoring agency their drug and alcohol testing is forensic. This brings in to question their “charitable organization” non-profit status.

Accountability requires both the provision of information and justification for actions

Accountability also requires consequences for violations of professional standards-of-care, ethical codes of conduct and the law

PHS is able to do what they do by both blocking information and relying on others to overlook, table or otherwise dismiss valid complaints–complacent that these are good people helping doctors and protecting the public. The current incarnation does neither

There should be zero tolerance. PHS has been unaccountable for this type of behavior but this needs to be addressed.

Accountability requires both answerability, justification and consequences. There is no conceivable procedural, ethical or legal justification for what is shown here. The compounding of crimes over time is self-evident and therefore it is the responsibility of the state to hold him accountable for his crimes. The fact that he pontificates on professionalism and stands in judgment of others makes it even more important. There are no exceptions to the rules or the law..

And we now know why Quest was so reluctant to provide the records. Quest was complicit in this and obtained and processed a known forensic sample as “clinical” without any of the required documents. The test lists “ordering physician” as Mary Howard (who is a secretary at PHS). There are no signed release of information forms or authorization forms indicating who my PHI could be distributed to.

This is in violation of the HIPAA criminal statute. As a business associate It is my understanding PHS can be tied to it by the conspiracy statute.

There should be zero-tolerance for this type of criminal activity. There is no excuse for forensic manipulation and this must be addressed. The people who are engaging in this should be in jail yet they remain unscathed. This is a systemic problem that is best met with head on and in real time. It makes Annie Dookhan look like a girl scout.

7/1/2011—PHS requests blood test at Quest Diagnostics. No outside factors are involved in PHP requesting this. There is no outside complaint or concern behind it. I provide blood sample using my PHS unique identifier #1310

7/28/2011—verbal report that test was positive to the Board of Registration in medicine and requests I have a “reevaluation.”

I request test results in form of “litigation packet” but PHS tries to dissuade me and eventually threatens me with “unintended consequences.”

11/29/2011—PHS agrees to provide “litigation packet. Check dated 11/29/2011 is given for payment.

12/5/2011—Receive USDTL Litigation Packet Sole document from Quest is a fax that is time stamped and arrived 3 hours after the specimen was collected when I was in clinic at MGH rendering this impossible. In addition it is not my signature:

Signature on Quest document

A fax from PHS to USDTL is also included requesting that my ID # 1310 and a “chain-of-custody” be added to an already positive specimen with no unique identifier connecting it to me.

PHS asking that my ID # 1310 be added to this sample and “chain-of-custody” be updated

A report dated 7/20/11 from USDTL “revised report per clients request” and “corrected donor ID from 46130 to 1310 and “corrected collection date to 7/1/2011”

USDTL adds my ID # 1310 to an already positive sample and adds collection date of July 1, 2011

Note this backdating of chain of custody and addition of my ID # is on 7/20/11 (one day after Dr. Luis Sanchez reported the test as positive to the Board of Registration in Medicine. )

Joseph Jones certifies that the specimen was processed with laboratory SOP. This is signed on 12/3/2011

Note that Dr. Luis Sanchez “explained that the testing laboratory is willing to support the test results and provide the litigation packet’ December 5, 2011

Note- the “PHP-referred” attorneys are an essential part of this racket. Although ostensibly representing your interests they are also serving the PHP as they will not go beyond certain boundaries. They will not address the forensic fraud facilitated by the labs or the “tailoring” of assessments to fit the diagnosis. Their other job is 12-step facilitation. They enforce mandated 12-step and essentially threaten you that the medical board will suspend you if you do not show them you accept it. My attorney would not even contact the labs involved. Although discovery of the fraud would have been exculpatory my attorney felt a better approach would be to blame the positive test on my asthma inhalers and referred me to an “expert witness” who for $3000..00 would write a letter supporting this. I even write a letter for him to USDTL. He will not contact the labs but offers to do so if Linda Bresnahan “wants him to.” The deferential almost sycophantic exchange is seen below.

12/14/2011—Bresnahan replies that the one page document with my forged signature is sufficient external chain of custody.

12/19/2011–I try to do everything I can to get my attorney to address the lab issue. In any other profession this would have been immediately resolved. The lab fraud would have been exculpatory. but in this rigged system it is avoided. The fact that the attorney who is supposedly working for you is actually working against you is a very significant breach of trust It is an essential part of the racket.

12/29/12—As I am determined to get the truth about the test I request that when that happens the board allow me to repetition for reconsideration. Confident that the College of American Pathologists will confirm the fraud this letter is written to Board Attorney Deb Stoller.

Letter to Board Attorney Deborah Stoller. My contract with PHS was extended for 2 years because I asked for an evaluation at an independent facility not affiliated with PHS and the Like-minded docs. This letter is important as it shows the import of the PEth test which PHS will later say is irrelevant as they “move the goalpost.

1/12/2012—I send “litigation packet” to the College of American Pathologists (an accreditation agency that does not have power to sanction but can investigate and force lab to correct errors under threat of loss of accreditation)

3/22/2012 – Quest New England Compliance Manager, Nina Tobin in response to my persistence in obtaining the absent Quest “chain-of-custody” provides letter documenting all of the errors in collection and process in a letter that seems to try to give the impression some sort of protocol was followed. She notes it was “ logged as a clinical sample.” Note no indication of the validity of the sample and that this was processed as a clinical sample.

10/8 2012 –I am called by my attorney and told PHS is deeming me “noncompliant’ with my contract.

10/19/2012—I am verbally reported to the Board of Registration in Medicine for noncompliance with my contract. This is followed by a written letter: 10:23:12 PHS Letter to BORM-noncompliance

11/5/2012—n appears to be “a purposeful and intentional act by PHS to show MLL’s 7/1/11 test as valid when in reality this test was invalid, and involved both fatal laboratory errors and lack of adequate MRO review of results. Anything based on MLL’s 7/1/11 test as a confirmatory positive should be reversed, rectified and remediated.” This letter remains unacknowledged by Board Attorney Deborah Stoller.

12/5/2012 – Contacted by Amy Daniels (investigator for CAP) to follow up on the “appended lab.” She tells me that the July 1, 2011 lab was amended on 10/4/2012 and reported to PHS. I contact PHS and they deny it.

12/11/2012– Dr. Sanchez issues a letter stating “Yesterday, December 10, 2012 Physician Health Services (PHS) received a revision to a laboratory test” referring to the July 1, 2011 test. He claims the test had no consequences.

2/6/2013—I am suspended by Board of Registration in Medicine for the “non-compliance” reported by Dr. Luis Sanchez.

6/23/2014-Letter from PHS attorney Paul W. Shaw claiming PHS immune from damages and documenting that the lab draw was performed by PHS ‘in its capacity as a charitable corporation.” He states “you should be aware that the suspension of Dr. Langan’s license had absolutely nothing to do with the blood test referenced in your letter or any actions on the part of PHS, as detailed in the Board of Registration in Medicine’s {Board Order} dated February 6, 2011” referring to my suspension for the “noncompliance reported by Dr. Luis Sanchez.

6/27/2014—Letter from USDTL attorney William F. Burke stating that “the blood sample was tested clinically at the request of Quest Diagnostics” and that “Dr. Langan’s blood sample was provided to USDTL by Quest Diagnostics on behalf of Physician Health Services as part of medical treatment..” He states “Dr. Langan’s suspension was the result of his inability to comply with the terms of his contract.”

8/6/2014—in response to my request for PHI USDTL provides record. This includes documentation that Dr. Luis Sanchez was made aware of the revised test on 10/4/2012. Note the very next week on 10/8/12 my attorney informed me that he was reporting me to the Board of Registration in Medicine for “noncompliance’ and officially did so on 10/19/12.

Also included in the record is an e-mail from me to Dr. Jones December 10, 2012 with subject “please provide amended lab report.” I request a copy of the amended lab report ASAP specifically to “clarify the truth about this test as explicitly as possible before this goes any further.” I state “PHS has used this test to cause, and continue to cause, a significant amount of harm.” He does not respond to this request for what is now documented PHI. I am suspended 2 months later for non-compliance.

Joseph Jones had already corrected the test 10/4/2012 but both he and PHS concealed it while PHS “moved the goalpost” by deeming me non-compliant.

10/9/14—Receive documents from Quest Attorney Fay Caldwell. No release of information forms or other HIPAA required documentation is found.

Ordering Physician is listed as Mary Howard. (secretary at PHS). Documents reveal no custody and control form information only that it was changed to a clinical specimen by Ms. Howard on July 5, 2011 and sent to USDTL on July 7,2011.

An Open Letter to Senator Elizabeth Warren Regarding Laboratory Developed Tests, Physician Health Programs and Institutional Injustice

April 17, 2015April 18, 2015mllangan1 12 Comments

An Open Letter to Senator Elizabeth Warren Regarding Laboratory Developed Tests, Physician Health Programs and Institutional Injustice.

I can think of nothing more institutionally unjust than an unregulated zero-tolerance monitoring program with no oversight using unregulated drug and alcohol testing of unknown validity. But that is what is occurring. Some of us are trying to expose this corrupt system but barriers exist. As with the Laboratory Developed Tests (LDTs), those involved have intentionally taken steps to remove both answerability and accountability. Both the tests and the body of individuals administering these tests are notable for their lack of transparency, oversight and regulation. This renders them a power unto themselves.

Doctors (and others coerced into Professional Health Programs) across the country have reported going to law enforcement and state agencies only to be turned away. The Federation of State Physician Health Programs (FSPHP) has convinced these outside agencies that this is a “parochial” issue best handled by the medical profession.. Those reporting crimes are turned back over to the very people committing the crimes.

—There is no place in science for consensus or opinion, only evidence.-Claude Bernard

Dear Senator Warren,

Thank you for your reply regarding laboratory developed tests (LDTs) and the need for regulatory oversight. As you mention, LDTs are developed without FDA approval—a pathway in which is not even necessary to prove validity of a test (that it is actually testing what it claims to be testing for) to bring it to market. With no FDA oversight or regulation a commercial lab can claim any validity they want in marketing these tests. The regulation debate has focused on the reliability and validity of a number of clinical tests marketed with unverified claims of accuracy such as prenatal screening and Lyme disease and this lack of oversight is a direct threat to patient safety.

I am sure you would agree with me that the importance of tests diagnostic accuracy is directly proportional to its potential to cause patient harm if reported inaccurately. Sensitivity and specificity are important components of any diagnostic test as there are consequences associated with both false-positive and false negative results.

A test falsely indicating the absence of a condition in someone who truly has it can delay or prevent needed treatment wile a test falsely indicating the presence of a condition in someone who does not truly have it can result in unnecessary testing and treatment.

Incorrect treatment and false labeling of patients can also occur. Therefore diagnostic accuracy is paramount if a test is being used as the basis for further tests and treatment. Any test being used as a basis for further tests or treatment needs to be accurate. It needs to be reliable and valid. Moreover, if the consequences of a test can result in significant patient harm (such as unneeded chemotherapy) it needs to be either 100% accurate or be combined with other tests to confirm the true diagnosis.

“Forensic” vs. “Clinical” Laboratory Testing

“Forensic” testing differs from “clinical” testing because of the consequences and the process is tightly controlled because false-positive results are unacceptable as the consequences can be grave, far-reaching and even permanent.

Forensic testing demands special handling and safeguards to protect the donor such as validated tests, certified labs, strict chain-of-custody procedures and MRO (Medical Review Officer) review. These safeguards of quality control assure the validity and integrity of the specimen. The LDT pathway was not designed for forensic tests.

Forensic Laboratory Developed Tests (LDTs)

Paradoxically, laboratory developed tests with the potential to cause life-changing and possibly irreparable harm have been absent from the regulatory debate; LDT drug and alcohol tests used for “forensic” monitoring purposes.

A panoply of tests using urine, blood, hair, fingernails breath and saliva have been developed and brought to market since 2003 when the first one was introduced by Gregory Skipper, then Medical Director of the Alabama Physicians Health Program, who “convinced the initial lab in the USA, NMS near Philadelphia to start performing EtG testing.” 1

Developed as an LDT, Skipper and NMS then claimed the alcohol biomarker (which was discovered in the 1950s) “appeared to be 100 percent specific” in detecting covert use of alcohol based on a study he coauthored that involved a mere 35 forensic psychiatric inpatients in Germany, all male. 2 With this “evidence-base” and a not yet published paper in the pipeline,3 Skipper then pitched the test to the Federation of State Medical Boards (FSMB) as an accurate and reliable tool detect covert alcohol use in health care professionals.

Policy Entrepreneurship

In “Agendas, Alternatives, and Public Policies,”4 John W. Kingdon describes the problem, policy and political streams involved in public policy making. When these three streams come together a specific problem becomes important on the agenda, policies matching the problem get attention, and then policy change becomes possible.

Kingdon also describes “policy entrepreneurs’ who use their knowledge of the process to further their own policy ends. They ‘lie in wait… with their solutions at hand, waiting for problems to float by to which they can attach their solutions, waiting for a development in the political stream they can use to their advantage.”4

And due to a perfect confluence of streams ( Institute of Medicine report that 44,000 people die each year due to medical error,5 media reports of “impaired physicians,” the the war-on-drugs, etc.) the FSMB was swayed into accepting not just the validity but the necessity of using an alcohol biomarker of unknown reliability and validity on doctors referred to or monitored by state Physician Health Programs (PHPs) .

As the national organization that gives guidance to state medical boards through public policy development and recommendations, the individual state medical boards adopted use of the test without critical appraisal and no meaningful opposition.

Shortly after its founding in 1912, the FSMB began publishing a journal called the Quarterly of the Federation of State Boards of the United States. Now known as the Journal of Medical Regulation, the publication has archived all issues with full articles dating back to 1967 and, as the official journal of the national organization involved in medical licensing and regulation this facilitates an unskewed and impartial examination of how and when specific issues and problems were presented and who presented them and, in doing so, the “policy entrepreneurship” Kingdon describes can be seen quite clearly. For example a 1995 issue containing articles written by the program directors of PHPs in 8 different states contains an FSMB editorial acknowledging the reported 90% success rate claimed of these programs (in part attributed to the 90-day inpatient treatment programs) that concludes:

“Cooperation and communication between the medical boards and the physician health programs must occur in an effort to protect the public while assisting impaired physicians in their recovery.” 6

No one bothered to examine the methodology of these reports to discern the validity of the claims and it is this acceptance of faith without objective assessment that has allowed the passage of flawed public policy in medical regulation.

Nowhere is “policy entrepreneurship” more glaringly displayed as it is in a 2004 issue promoting the use of EtG in monitoring doctors as under the same cover is an article identifying both the need7 for such a test and an article providing the solution.8

“Detection of Alcohol Use in Monitored Aftercare Programs: A National Survey of State Physician Health Programs,” a survey of state Physician Health Programs (PHPs) concludes that “surreptitious alcohol use” is a significant concern” for PHPs, there is no current “best method” for detection, but a promising new test with “exceptional specificity (100 percent) and sensitivity” in detecting small amounts of alcohol for up to 18 hours has recently become available.7

This same issue contains an article authored by Skipper about a new marker “not detectable unless alcohol has been consumed” recently introduced in the United States and now commercially available.”8

Notably absent from both of these articles is Skipper’s role in the commercial availability of the test. This conflict-of-interest is nowhere mentioned in this display of “creating a market then filling it.”

This “regulatory sanctification” of the test implied its tacit approval by the medical profession (i.e. “if they are using it on doctors it must be valid”) and facilitated its marketing to other monitoring agencies (nurses, airline pilots) as well as Courts and Probation Departments where those doing the monitoring had absolute power while those being monitored had no voice.

Bent Science

In Bending Science: How Special Interests Corrupt Public Health Research9, Thomas McGarity and Wendy Wagner describe how special interest groups scheme to advance their own economic or ideological goals by using carefully crafted distorted or “bent” science to influence legal, regulatory and public health policy. The authors describe how those making these decisions often assume the information that reaches them has been sufficiently vetted by the scientific community as it flows through a pipeline of rigorous peer-review and professional oversight and that the final product that exits the pipeline is unbiased and produced in accordance with the norms and procedures of science.

McGarity and Wagner note the serious and sometimes horrific consequences of bent science and provide examples involving Tobacco and Big Pharma . The authors call for:

“..immediate action to reduce the role that bent science plays in regulatory and judicial decision making” and the need for the scientific community to be involved in “designing and implementing reform.”

“Shedding even a little light on how advocates bend policy -relevant science could go a long way toward remedying these problems. Indeed, precisely because the advocates have overtaken the law in this area, heightened attention to the social costs of bending science could itself precipitate significant change.”

In the case of EtG this shedding of light is not very hard as no “carefully crafted” studies bending science were used to sway opinion. None existed. The only items in the pipeline were directly related to Skipper. If anyone dare to look, the Emperor has no clothes.

Lack of Answerability and Accountability

There are difficulties in challenging bent science including a general lack of recognition of the problem and an absence of counter-studies to oppose deliberately manufactured ends-oriented research. This has proven true with the myriad LDTs introduced into the marketplace as no counter-forces or competing economic interests producing counter-studies exist.

Multiple lawsuits, including a class-action, have been decided in favor of the labs who have taken a stand-your-ground approach supported by a body of industry-related “research” they or their affiliates produced to support the validity and reliability of the tests.

Those affected by these tests either have no power or have had their power removed. Most do not have the resources to mount a defense let alone produce counter-studies questioning the reliability and validity of the tests.

Most employee drug testing follows Department of Health and Human Services (DHHS) guidelines using FDA-approved tests that have specific cutoff levels defining a positive-result in an effort to eliminate false-positive results.10 Procedural safeguards are in place in these programs to protect the donor. Forensic testing programs using LDTs provide no such safeguards as the testing is unregulated and there is no oversight from outside actors.

Unlike clinical LDTs “forensic” LDTs are even exempt from CLIA oversight. The only avenue for complaint is through the College of American Pathologists (CAP) and, as an accrediting agency, they can only address problems by ensuring compliance with CAP guidelines. If an investigation concludes lab error or misconduct CAP can mandate the lab correct the test result and come into compliance with their guidelines under threat of loss of accreditation but no other consequences exist. Accountability has been removed yet the consequences to those harmed by these are significant and without remedy.

State Physician Health Programs

As is the case with the LDTs they introduced, Physician Health Programs have no oversight or regulation. A 2013 Audit of the North Carolina PHP 11 prompted by complaints from doctors and performed by State Auditor Beth Woods found absolutely no oversight of the program by either the state medical board or medical society and that “abuse could occur without being detected.”

The Audit also found that doctors were predominantly referred to the same “PHP-approved” out-of-state facilities to which they in part attribute their high success rates in treatment. Interestingly the PHP could not identify what quality indicators or quantitative measurements were used by the PHP to “approve” the “PHP-approved” facilities.

In January of 2015 a Federal class action lawsuit was filed in the Eastern District of Michigan against the state PHP program and found health care providers were subject to the same referral system using these out-of-state facilities. The suit alleges constitutional violations related to the forced medical treatment of health care professionals and the “callous and reckless termination of professional licenses without due process.” 12

As with North Carolina, the Michigan PHP will be unable to provide what quality indicators and quantitative measurements are being used to “qualify” and “approve these facilities. None exist. The sole indicators for approving these assessment centers are ideological and economic. In fact, the medical directors of most, if not all, of these facilities can be seen on this list of “like-minded docs.”

Institutional Injustice

You once said “People feel like the system is rigged against them. And here’s the painful part: they’re right. The system is rigged.”

So too is this system.

As the Michigan lawsuit notes: “Unfortunately, a once well-meaning program has turned into a highly punitive and involuntary program where health professionals are forced into extensive and unnecessary substance abuse/dependence treatment under the threat of the arbitrary application of pre-hearing deprivations.”

This has become the rule not the exception. The Federation of State Physician Health Programs (FSPHP), the same group to which Dr. Skipper belongs, has systematically taken over these programs state by state by removing competent and caring doctors not agreeing with the groupthink and silenced them under threat of litigation if they violate their confidentiality agreements and “peer review” statutes.

The same system of coercion, control and abuse exists in Massachusetts. In the past week alone I have heard from a medical student, a resident and two doctors who complained of misconduct misconduct involving fraudulent testing and falsified diagnoses.

In “Ethical and Managerial Considerations Regarding State Physician Health Programs,” published in the Journal of Addiction Medicine in 2012, Drs. John Knight, M.D. and J. Wesley Boyd, M.D., PhD who collectively have more than 20 years experience with the Massachusetts Physician Health Program (PHP) state that:

“Because PHP practices are unknown to most physicians before becoming a client of the PHP, many PHPs operate out- side the scrutiny of the medical community at large. Physicians referred to PHPs are often compromised to some degree, have very little power, and are, therefore, not in a position to voice what might be legitimate objections to a PHP’s practices.”13

Noting that “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,” Knight and Boyd raise serious ethical and managerial questions about current PHP policies and practice including conflicts of interest in referrals for evaluation and treatment, lack of adherence to standards of care for forensic testing of substances of abuse, violations of ethical guidelines in PHP research, and conflicts of interest with state licensing boards.

Knight and Boyd recommend “the broader medical community begin to reassess PHP’s as a whole” and that “consideration be given toward the implementation of independent ethical oversight and establish and appeals process for PHP clients who feel they are being treated unfairly.” 13

They recommend the relationship between PHP’s and the evaluation and treatment centers and licensing boards be transparent and that national standards be developed “that can be debated by all physicians, not just those who work within PHPs.”13

Accountability, or answerability, is necessary to prevent corruption. This requires both the provision of information and justification for actions. What was done and why? Accountability also requires that consequences be imposed on those who engage in misconduct.

In discussing the financial conflicts-of-interest between PHPs and “PHP-approved” assessment centers Knight and Boyd state:

“..if a PHP highlights a physician as particularly problematic, the evaluation center might–whether consciously or otherwise–tailor its diagnosis and recommendations in a way that will support the PHP’s impression of that physician.”

To “consciously tailor a diagnosis” is fraud. It is political abuse of psychiatry. And it is not only the assessment and treatment centers willing to “tailor” a diagnosis; so too are the labs involved.

Physician Suicide

The Massachusetts Medical Society and Massachusetts DPH claim no oversight of the Massachusetts PHP, PHS.inc. The Massachusetts Board of Registration in Medicine (BORM) will not address ethical or even criminal complaints about the doctors involved in the PHP and there is good evidence that some members of the BORM are in fact complicit in unethical and even criminal behavior. As the Massachusetts AGO represents the BORM they defer issues back to them and dig no deeper.

Drs. Knight and Boyd have suggested State Audits and we are hoping that MA State Auditor Suzanne Bump will investigate the MA PHP and the Board of Registration in Medicine’s Physician Health and Compliance Unit shortly.

One major problem is that barriers have been put in place to prevent information from getting to the right people.

The majority of people at medical societies, boards, departments of public health and other organizations are individuals of integrity and honesty but the system has been erected so that valid complaints are deflected, delayed, dismissed or otherwise tabled by sympathizers, apologists and those complicity. The criminal activity the Massachusetts PHP is engaging in is undeniable and indefensible but who is going to hold them to account?

It is going to take a while to reform this system of institutional abuse and it has to be done state by state. Please take a look at the facts and documentary evidence and help me hold them accountable. This needs to be exposed, acknowledged and addressed. Doctors are dying from this system of institutional abuse. It is a public health emergency no one is talking about. Yet those behind the PHP programs are claiming this system of coercion, abuse and control is the “gold standard” of addiction treatment and, using another loophole, they want to expand this system to mainstream healthcare.

Sincerely,

Michael L. Langan, M.D.

Skipper G. Exploring the Reliability, Frequency, and Methods of Drug Testing: What is Enough to Ensure Compliance?: Alcohol Markers and Devices. 2013; http://www.fsphp.org/Skipper, Exploring the Reliability Frequency and Methods 2 Presentation.pdf.
Wurst FM, Vogel R, Jachau K, et al. Ethyl glucuronide discloses recent covert alcohol use not detected by standard testing in forensic psychiatric inpatients. Alcoholism, clinical and experimental research. Mar 2003;27(3):471-476.
Skipper GE, Weinmann W, Thierauf A, et al. Ethyl glucuronide: a biomarker to identify alcohol use by health professionals recovering from substance use disorders. Alcohol Alcohol. Sep-Oct 2004;39(5):445-449.
Kingdon JW. Agendas, alternatives, and public policies. Updated 2nd ed. Boston: Longman; 2011.
Leape LL. Institute of Medicine medical error figures are not exaggerated. JAMA : the journal of the American Medical Association. Jul 5 2000;284(1):95-97.
Schneidman B. The Philosophy of Rehabilitation for Impaired Physicians. The Federal Bulletin: The Journal of Medical Licensure and Discipline. 1995;82(3):125-127.
Jansen M, Bell LB, Sucher MA, Stoehr JD. Detection of Alcohol Use in Monitored Aftercare Programs: A National Survey of State Physician Health Programs. Journal of Medical Licensure and Discipline. 2004;90(2):8-13
Skipper G, Weinmann W, Wurst F. Ethylglucuronide (EtG): A New Marker to Detect Alcohol Use in Recovering Physicians. Journal of Medical Licensure and Discipline. 2004;90(2):14-17.
McGarity TO, Wagner WE. Bending Science: How Special Interests Corrupt Public Health Research. Cambridge, MA: Harvard University Press; 2008.
US Department of Health and Human Services. Mandatory guidelines and proposed revisions to mandatory guidelines for federal workplace drug testing programs: notices.Federal Register. April 13, 2004;69(71):19659-19660.
Wood B. State of North Carolina Performance Audit North Carolina Physicians Health Program. . http://www.ncauditor.net/EPSWeb/Reports/Performance/PER-2013-8141.pdf. Accessed March 17, 2015.
U.S. District Court Eastern District of Michigan, Case No: 2:15-cv-10337-AJT-RSW (2015). Carole Lucas, R.N., Tara Vialpandno, R.N., Scott Sanders, R.N., Kelly Schultz, P.A., and all other similarly situated health professionals v. Michigan Department of Licensing and Regulatory Affairs, Carole Engel, J.D.Former Director of Michigan Bureau of Health Professions, Ulliance, Inc. (State Contractor), Carolyn Batchelor (HPRP Contract Administrator), Stephen Batchelor (HPRP Contract Administrator), and Nikki Jones, LMSW. Filed January 30, 2015.
Boyd JW, Knight JR. Ethical and managerial considerations regarding state physician health programs. Journal of addiction medicine. Dec 2012;6(4):243-246.

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Backfire Step 1: Expose the Injustice–Forensic Fraud being committed by PHPs in Collusion with Corrupt Labs

March 23, 2015April 7, 2015mllangan1 11 Comments

I will be putting up a survey shortly and want to hear your stories. One of the recurrent themes I keep hearing from those victimized by PHPs is falsified drug and alcohol tests. Attached is an example of what they are capable of.

Quote by Dr. Greg Skipper, MD, FASAM, FSPHP

Remember, this group has essentially removed themselves from accountability in drug and alcohol testing via the use of Laboratory Developed Tests (LDTs), a loophole which avoids FDA approval and oversight. Whereas most drug testing is transparent and held accountable, the PHPs use testing that is opaque, unregulated and accountable to no one. Accountability demands both the provision of information and justification for ones actions. PHPs block both. While most drug-testing requires the immediate provision of information if the test is questioned (as it should be), PHPs have put forth the logical fallacy that doctors have some sort of inherent expertise in toxicology and pharmacology and can “figure out” how to circumvent the testing process if they were to get copies of their lab results. They block this provision of information. And even if this information is ultimately provided, as seen below, no outside organizations exist to hold them to account. They do not have to justify their actions to anyone. No safeguards exist to assure integrity and honesty of the sample. No safeguards exist to assure the integrity and honesty of those ordering the sample either.

The documents below show forensic fraud. This is undeniable and indefensible. It does not take a toxicologist or Medical Review Officer to understand what “chain-of-custody” is and that “updating” one constitutes misconduct, fraud and (as seen here) criminal activity. These documents were obtained 5 months after a falsified test was ordered by Linda Bresnahan, Director of Operations at Physician Health Services, Inc. (PHS, inc.) the Massachusetts PHP via fax no less. The blood test was drawn on July 1, 2011. On July 19th, 2011 Ms Bresnahan requests (through the PHP secretary Mary Howard) that an already positive test for the alcohol biomarker phosphatidylethanol be “updated” with ID # 1310 and a “chain-of-custody. (which is an oxymoron-a “chain-of-custody” by definition cannot be “updated.” Unveleivably the lab does it without hesitation or any apparent compunction. The documents speak for themselves. ID # 1310 just happens to be my ID number. When I complained that no one ever accused me of ever having an alcohol problem she replied:

“You have an Irish last name-good luck finding anyone who will believe you!”

For a more detailed analysis see here, here and here. And where was the Medical Review Officer during all of this? Good question and one he will not answer! And no one else is holding him to account. This needs to change.

1. Supression of Dissent: Basic Information

2. The keys to backfire

• “Reveal: expose the injustice, challenge cover-up

• Redeem: validate the target, challenge devaluation

• Reframe: emphasize the injustice, counter reinterpretation

• Redirect: mobilize support, be wary of official channels• Resist: stand up to intimidation and bribery”

via Helpful resources for those abused and afraid — via www.bmartin.cc .

Backfire Basics: http://www.bmartin.cc/pubs/bf/bfbasics.pdf
More materials on Backfire: http://www.bmartin.cc/pubs/backfire.html

An Open Letter to Senator Elizabeth Warren Regarding Laboratory Developed Tests, Physician Health Programs and Institutional Injustice

March 17, 2015December 5, 2016mllangan1 10 Comments

—There is no place in science for consensus or opinion, only evidence.-Claude Bernard

Dear Senator Warren,

I am sure you would agree with me that the importance of tests diagnostic accuracy is directly proportional to that tests potential to cause patient harm if reported inaccurately.

Sensitivity and specificity are important components of any diagnostic test because there are consequences associated with both false-positive and false negative results.

“Forensic” vs. “Clinical” Laboratory Testing

Forensic Laboratory Developed Tests (LDTs)

Developed as an LDT, Skipper and NMS then claimed the alcohol biomarker (which was discovered in the 1950s) “appeared to be 100 percent specific” in detecting covert use of alcohol based on a study he coauthored that involved a mere 35 forensic psychiatric inpatients in Germany, all male. ² With this “evidence-base” and a not yet published paper in the pipeline,³ Skipper then pitched the test to the Federation of State Medical Boards (FSMB) as an accurate and reliable tool detect covert alcohol use in health care professionals.

Policy Entrepreneurship

In “Agendas, Alternatives, and Public Policies,”⁴ John W. Kingdon describes the problem, policy and political streams involved in public policy making. When these three streams come together a specific problem becomes important on the agenda, policies matching the problem get attention, and then policy change becomes possible.

And due to a perfect confluence of streams ( Institute of Medicine report that 44,000 people die each year due to medical error,⁵ media reports of “impaired physicians,” the the war-on-drugs, etc.) the FSMB was swayed into accepting not just the validity but the necessity of using an alcohol biomarker of unknown reliability and validity on doctors referred to or monitored by state Physician Health Programs (PHPs) .

“Cooperation and communication between the medical boards and the physician health programs must occur in an effort to protect the public while assisting impaired physicians in their recovery.” ⁶

Nowhere is “policy entrepreneurship” more glaringly displayed as it is in a 2004 issue promoting the use of EtG in monitoring doctors as under the same cover is an article identifying both the need⁷ for such a test and an article providing the solution.⁸

Bent Science

In Bending Science: How Special Interests Corrupt Public Health Research⁹, Thomas McGarity and Wendy Wagner describe how special interest groups scheme to advance their own economic or ideological goals by using carefully crafted distorted or “bent” science to influence legal, regulatory and public health policy. The authors describe how those making these decisions often assume the information that reaches them has been sufficiently vetted by the scientific community as it flows through a pipeline of rigorous peer-review and professional oversight and that the final product that exits the pipeline is unbiased and produced in accordance with the norms and procedures of science.

McGarity and Wagner note the serious and sometimes horrific consequences of bent science and provide examples involving Tobacco and Big Pharma . The authors call for:

Lack of Answerability and Accountability

Most employee drug testing follows Department of Health and Human Services (DHHS) guidelines using FDA-approved tests that have specific cutoff levels defining a positive-result in an effort to eliminate false-positive results.¹⁰ Procedural safeguards are in place in these programs to protect the donor. Forensic testing programs using LDTs provide no such safeguards as the testing is unregulated and there is no oversight from outside actors.

State Physician Health Programs

As is the case with the LDTs they introduced, Physician Health Programs have no oversight or regulation. A 2013 Audit of the North Carolina PHP ¹¹ prompted by complaints from doctors and performed by State Auditor Beth Woods found absolutely no oversight of the program by either the state medical board or medical society and that “abuse could occur without being detected.”

Institutional Injustice

You once said “People feel like the system is rigged against them. And here’s the painful part: they’re right. The system is rigged.”

So too is this system.

In discussing the financial conflicts-of-interest between PHPs and “PHP-approved” assessment centers Knight and Boyd state:

Physician Suicide

One major problem is that barriers have been put in place to prevent information from getting to the right people.

Sincerely,

Michael L. Langan, M.D.

Skipper G. Exploring the Reliability, Frequency, and Methods of Drug Testing: What is Enough to Ensure Compliance?: Alcohol Markers and Devices. 2013; http://www.fsphp.org/Skipper, Exploring the Reliability Frequency and Methods 2 Presentation.pdf.
Wurst FM, Vogel R, Jachau K, et al. Ethyl glucuronide discloses recent covert alcohol use not detected by standard testing in forensic psychiatric inpatients. Alcoholism, clinical and experimental research. Mar 2003;27(3):471-476.
Skipper GE, Weinmann W, Thierauf A, et al. Ethyl glucuronide: a biomarker to identify alcohol use by health professionals recovering from substance use disorders. Alcohol Alcohol. Sep-Oct 2004;39(5):445-449.
Kingdon JW. Agendas, alternatives, and public policies. Updated 2nd ed. Boston: Longman; 2011.
Leape LL. Institute of Medicine medical error figures are not exaggerated. JAMA : the journal of the American Medical Association. Jul 5 2000;284(1):95-97.
Schneidman B. The Philosophy of Rehabilitation for Impaired Physicians. The Federal Bulletin: The Journal of Medical Licensure and Discipline. 1995;82(3):125-127.
Jansen M, Bell LB, Sucher MA, Stoehr JD. Detection of Alcohol Use in Monitored Aftercare Programs: A National Survey of State Physician Health Programs. Journal of Medical Licensure and Discipline. 2004;90(2):8-13
Skipper G, Weinmann W, Wurst F. Ethylglucuronide (EtG): A New Marker to Detect Alcohol Use in Recovering Physicians. Journal of Medical Licensure and Discipline. 2004;90(2):14-17.
McGarity TO, Wagner WE. Bending Science: How Special Interests Corrupt Public Health Research. Cambridge, MA: Harvard University Press; 2008.
US Department of Health and Human Services. Mandatory guidelines and proposed revisions to mandatory guidelines for federal workplace drug testing programs: notices. Federal Register. April 13, 2004;69(71):19659-19660.
Wood B. State of North Carolina Performance Audit North Carolina Physicians Health Program. . http://www.ncauditor.net/EPSWeb/Reports/Performance/PER-2013-8141.pdf. Accessed March 17, 2015.
U.S. District Court Eastern District of Michigan, Case No: 2:15-cv-10337-AJT-RSW (2015). Carole Lucas, R.N., Tara Vialpandno, R.N., Scott Sanders, R.N., Kelly Schultz, P.A., and all other similarly situated health professionals v. Michigan Department of Licensing and Regulatory Affairs, Carole Engel, J.D.Former Director of Michigan Bureau of Health Professions, Ulliance, Inc. (State Contractor), Carolyn Batchelor (HPRP Contract Administrator), Stephen Batchelor (HPRP Contract Administrator), and Nikki Jones, LMSW. Filed January 30, 2015.
Boyd JW, Knight JR. Ethical and managerial considerations regarding state physician health programs. Journal of addiction medicine. Dec 2012;6(4):243-246.

Screen Shot 2014-07-28 at 12.40.13 PM Screen Shot 2014-08-06 at 4.50.02 PM

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Disrupted Physician

The Physician Wellness Movement and Illegitimate Authority: The Need for Revolt and Reconstruction

Accountability

How Public Records Law can force transparency and hopefully bring accountability. Root out the rats!

Make Medicine Great Again! Please Donate and Help Drain this Swamp!

https://www.gofundme.com/PHPReform

I am Offering Over $25,000 in cool prizes to anyone who can prove fewer than 3 felonies were committed by past FSPHP President Sanchez as shown by documentary evidence alone! I claim I can detect multiple very serious crimes in these documents–prove me wrong and the whole lot is yours!

“Implicit faith belongs to fools, and truth is comprehended by examining principles”-Algernon Sidney (1683)

Physician Health Programs: The Need for Transparency and Accountability

PHYSICIAN OR PROFESSIONAL HEALTH PROGRAM SURVEY

Transparency and Legitimacy Needed in Addiction Medicine—Answerability and Accountability Absent in Current Paradigm

Physician Health Programs (PHPs) are not above the law: They have simply manufactured a “culture of impunity” by removing themselves from all aspects of accountability

Moving the Goalpost–Criminal Violations of HIPAA by PHS, Quest and USDTL

An Open Letter to Senator Elizabeth Warren Regarding Laboratory Developed Tests, Physician Health Programs and Institutional Injustice

Backfire Step 1: Expose the Injustice–Forensic Fraud being committed by PHPs in Collusion with Corrupt Labs

An Open Letter to Senator Elizabeth Warren Regarding Laboratory Developed Tests, Physician Health Programs and Institutional Injustice

Make Medicine Great Again! Please Donate and Help Drain this Swamp!

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