As the oldest medical society in the United States the Massachusetts Medical Society can count some of the greatest minds in the history of American medicine as members.  My how far we have fallen.  This same author has previously unintelligibly compared the field of medicine to Barbra Streisand’s face and shamelessly and opportunistically blamed the Boston Marathon bombing on “marijuana withdrawal.” 

The sophomoric mnemonics are neither clever nor illuminating.  Unworthy of  Readers Digest circa 1957, this dumbing down of doctors needs to end.  The very soul and practice  of medicine is being castrated and lobotomized by the same dull and very very blunt instrument. 

How does one reconcile the fact that the very same medical society that publishes the New England Journal of Medicine is allowing this type of tripe and rabble to get past editorial review?  In 1969, through an act of the state legislature, the Massachusetts Medical Society updated its mission to read:

“The purposes of the Massachusetts Medical Society shall be to do all things as may be necessary and appropriate to advance medical knowledge, to develop and maintain the highest professional and ethical standards of medical practice and health care, and to promote medical institutions formed on liberal principles for the health, benefit and welfare of citizens of the commonwealth.”

With a foundation and history built and based on of scholarship and critical thought we need to support the highest levels of science, fact, intelligence and reason.  Stupidity tries but it should not win.  Before the Boston Society for the Diffusion of Useful Knowledge in 1842, Dr. Oliver Wendell Holmes delivered two long lectures entitled “Homeopathy and Its Kindred Delusions.” He characterized one of its popular practitioners, Dr. Robert Wesselhoeft, as one of those:  

“Emperics [quacks], ignorant barbers, and men of that sort…who announce themselves ready to relinquish all the accumulated treasure of our art, to trifle with life upon the strength of these fantastic theories.” That “pretended science” as Holmes called it, was “a mingled mass of perverse ingenuity, of tinsel erudition, of imbecile credulity, and artful misrepresentation, too often mingled in practice…with heartless and shameless imposition.”

And Holmes words are as apt and appropriate today as they were in mid 19th Century Boston!   Probably more so. History has recurrently proved that false constructs and groundless concepts allow for endless error. The Massachusetts Medical Society and all of its members need to come to the realization that Physician Health Services (PHS) has paradoxically become a reservoir of bad medicine beset by corruption. The documentary evidence of  professional, ethical and legal misconduct must be specifically and precisely addressed.

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Accountability. Answerability and Justification Required. 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 called 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 doctors of academic integrity and moral compass.  Those not conforming to groupthink were threatened with litigation if they breached “peer-review” statutes or confidentiality agreements and this has effectively silenced many from reporting misconduct, abuse or even crimes they may have witnessed.

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Massachusetts PHP engaging in Procedural, Ethical and Criminal Misconduct 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.  Of course “tailoring” a diagnosis to support anything other than the real diagnosis is fraud.    The “PHP-approved” assessment centers are willing to fabricate and misrepresent neuropsychological and cognitive testing to support “denial” and “cognitive-impairment.”   Detailed examples can be seen here and here.  The evidence is clear that past medical director Dr. Luis Sanchez and Director of operations Linda Bresnahan have engaged in not only unethical but criminal activity. Egregious misconduct including forensic fraud and political abuse of psychiatry can be seen in detail here, here and here. This type of inverse morality is antithetical to the history and organizational purpose of not only the MMS but the entire Profession of Medicine.  Institutional injustice can have grave and far reaching consequences.   Increasing reports suggest that programs just like PHS are contributing to the suicide epidemic in doctors.  The patterns are the same and the same scaffold is being used.  PHPs are colluding with the same drug-testing companies and “PHP-approved” assessment facilities.  It is, in fact, a rigged game.

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Sunshine is the best disinfectant. Very few doctors are speaking out. Most are vey afraid and remain silent.Few have obtained documentary evidence of misconduct. I have. To ignore the problem or suggest that it does not exist will only cause more damage to other doctors. The suicides will continue.  Nothing will change.  The majority of Massachusetts Medical Society members (as are the majority of doctors) are honest, thoughtful and responsible. Most are completely unaware of the ethical and criminal allegations concerning PHS. This is, after all, a system that depends on secrecy and silence. Most doctors are also probably unaware that the MMS has no regulatory, supervisory or investigatory oversight of PHS.  They have removed themselves from scrutiny by design.  The only avenue of complaint, I have been told, is by filing an ethical complaint with the MMS grievance committee and that any investigation is private, non-disciplinary, and final.   This is irrespective of the severity and scope of the complaint.   What this means is that any complaint against a member of PHS is behind closed doors, if the complaint is substantiated it results in “education” not “discipline,” and the decision cannot be further addressed, appealed or revisited.

Moreover, I have been hearing that ethics and grievance committees in many states have been intentionally populated by PHP apologists, supporters and friends.  As with the other “point-people” they have positioned at medical boards, public health departments and law enforcement, these friends of like-mind are used to deflect, block, delay, suppress and minimize valid complaints.   I do not know if this is the case in Massachusetts.   However, the bottom line is that only two results are possible from any complaint 1) complaint dismissed–final answer, or 2) complaint substantiated–member educated on matter-final answer.  Although this system  may be applicable to some of the common ethical conundrums encountered in the medical profession it is not applicable to criminal activity and fraud.

The character of those involved in PHS can be seen in my post “Integrity and Accountability the Declining State of Physician Health and the Urgent  Need for Ethical and Evidence Based Leadership.”    Wayne Gavryck’s moral compass and adherence to professional and ethical standards can be seen here.  My request is simple, straightforward and should be easy to answer.   So to any of the  apologists, supporters or defenders of PHS I have a simple request.  Just answer the questions here.   No reframing the question, moving the goalpost or redirecting the focus.  Just register and respond. Simple request and litmus test.  Ascertain or refute what you see.  Can the actions of actions of Dr. Luis Sanchez, Dr. Wayne Gavryck or Linda Bresnahan procedurally, ethically or legally.  Yes or No.

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Accountability Requires Answerability and Justification for Actions. Accountability necessitates both the provision of information and justification for actions; what was done and why?    The other defining factor of accountability is the ability of outside actors to punish and sanction those who commit misconduct or wrongdoing.    Without these constraints corruption is inevitable.  State PHPs such as PHS have not only removed answerability and justification but have taken steps to prevent any interference by outside actors including medical societies, medical boards, law enforcement and departments of public health. The most crucial step in solving any problem is admitting it exists. This exists.  There is a solution to this.  Sunshine is the best disinfectant.    If the actions of Sanchez, Gavryck and Bresnahan cannot be justified or defended then it must be concluded that these individuals have violated procedure, ethics and the law.  And if that is the case it is the responsibility of the MMS to acknowledge the individual and specific issues as well as the reality that there is no current avenue to address these issues.   That, in and of itself, is a problem. The documents show significant and severe wrongdoing that constitute crimes committed within the walls of MMS.   How far down would the moral compass have to go before the significance of this is recognized?   This necessitates acknowledging the  problem exists, defining the problem and addressing it directly.

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Zero-Tolerance for Forensic Fraud and Political Abuse of Psychiatry Necessary. Any and all forensic fraud should be met with Zero-tolerance. State PHPs are colluding  with commercial drug testing labs and “PHP-approved” assessment and treatment centers this same scaffold is being used in many states. Doctors are dying because of it.  State Physician Health Programs (PHPs) are organized under the Federation of State Physician Health Programs (FSPHP). The FSPHP arose from the American Society of Addiction Medicine and the history can be seen here.

Dr. Luis Sanchez is past President and Linda Bresnahan is the current Secretary.   The FSPHP does not represent doctors but the multibillion dollar drug and alcohol testing, assessment and treatment industry.  This will all come out in due time.   The states of North Carolina and Michigan have taken the lead in starting to expose this. Others will follow.   State Auditor Suzanne Bump is currently looking into a Massachusetts Audit of PHS.  But because of the scope and severity of the forensic and rehab fraud it is morally imperative that the MMS address this.   Those engaging in forensic fraud must be removed.  This needs to be done state by state and I am providing Massachusetts with documentary proof.of forensic fraud.  This is not isolated but systemic.  There are plenty of doctors of intellectual and moral integrity to take the place of those who do not. The criminal and ethical violations shown do not comport with any codes of conduct including those of the medical society.    It is paradoxical here that in my battle against PHS that I am the one supporting truth and fact,medical and  professional ethics, evidence-based medicine and physician rights.   It is I who am fighting for the preservation of and adherence to historical ideals and moral codes of the medical profession.   This is easily seen by looking at rhetoric versus actions and deeds. Those of Sanchez, Gavryck and Bresnahan are irreconcilable.  As the oldest medical society in the United States whose stated purpose is to “…do all things as may be necessary and appropriate to advance medical knowledge, to develop and maintain the highest professional and ethical standards of medical practice and health care, and to promote medical institutions formed on liberal principles for the health, benefit and welfare of citizens of the commonwealth” it is morally imperative that the  Massachusetts Medical Society address this urgently, directly and with full-measure.  Massachusetts needs to take the lead in exposing this national problem.

-Michael Langan, M..D.