Accountability Needed for Criminal Fraud Committed by Physician Health Programs

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If we’re looking for the source of our troubles we shouldn’t test people for drugs, we should test them for stupidity, ignorance, greed and love of power.” –P.J. O’ Rourke

Fraud is distinguished from negligence, ignorance, and error by virtue of the fact that it is Intentional; involving some level of calculation.1 Negligence is: “the failure to use such care as a reasonably prudent and careful person would use under similar circumstances,”  and characterized chiefly by “inadvertence, thoughtlessness, inattention, and the like.”2.  Fraud, in contrast, is not accidental in nature, nor is it unplanned.2-4 Those who commit fraud know what they are doing and are deliberate in their efforts. They are also aware that it is unethical, illegal, or otherwise improper.

Fraudulent intent  can be established by examining the documentation of decisions and behaviors associated with those involved. As explained in Coenen: “Manipulation of documents and evidence is often indicative of such intent. Innocent parties don’t normally alter documents and conceal or destroy evidence.”5

A chain of custody is generated in real time. It cannot be done retroactively. To do so constitutes fraud.   What is remarkable is with what apparent ease this was done.  There is no compunction, concern or inquiry from top to bottom at either of these agencies and documents a Machiavellian egocentricity. The acts are those of morally disengaged bullies who lack compassion and integrity.

One would assume that the state of Massachusetts would have a low tolerance for forensic fraud in the wake of the Annie Dookhan lab scandal,  especially when the perpetrators are contractors with the Department of Public Health (DPH) and work within the walls of the Massachusetts Medical Society (MMS).

The problem is Physician Health Programs (PHPs) have set up procedural barriers designed to bloc, ignore, marginalize and bury.  Truth is misrepresented, censored and suppressed.  The DPH and MMS have no oversight or regulation over Physician Health Services (PHS) and PHPs have convinced law enforcement that doctors police themselves.

Accountability needs to be rooted in organizational purpose and public trust.  When an organization operating within or contracting with an institution is committing  serious misconduct and fraud, then it becomes the institutions responsibility to investigate and correct it.  How low must the moral compass go before the MMS and DPH recognize what is self-evident to everyone else?   This would not have happened 20 years ago. What is happening to the profession of medicine when the institutions that are supposed to represent physicians and the public health allow individuals who are obviously and inexcusably engaging  in behavior antithetical to their own expressed ideals and purpose?

Corrupt individuals cannot be hired or retained by an employer without some level of institutional negligence, apathy or even encouragement.

Rationalization involves either self-delusion regarding the acceptability of fraud related to behavior under “special circumstances” or a disregard for the law as unjust or somehow inapplicable.5 Coenen explains that rationalization is the process by which someone   “determines that the fraudulent behavior is “okay” in her or his mind. For those with deficient moral codes the process of rationalization is easy. For those with higher moral standards it may not be quite so easy; they may have to convince themselves that a fraud is okay by creating “excuses” in their minds.

There is a diffusion of responsibility when verification is required and repercussions warranted.  This system of institutional injustice and forensic fraud between state Physician Health Programs and these corrupt labs is occurring across the country. I have spoken to the spouses and parents of multiple doctors who have killed themselves because this same thing was done to them.  Their deaths are being caused by people just like this and accountability is needed.

 

  1. Albrecht WS, Albrecht CO. Fraud Examination and Prevention. Mason, Ohio: South-Western Educational Publishing; 2003.
  2. Black HC. Black’s Law Dictionary. 6th ed. St. Paul, Minnesota: West Group; 1990.
  3. Albrecht WS, Albrecht CO, Albrecht CC, Zimbelman MF. Fraud Examination. 4th ed. Mason, Ohio: South Western Cengage Learning; 2011.
  4. O’ Lord A. The Prevalence of Fraud . What should we as academics be doing to address the problem? Accounting and Management Information Systems. 2010;9(1):4-21.
  5. Coenen T. Essentials of Corporate Fraud. Hoboken, NJ: John Wiley & Sons, Inc.; 2008.

 

 

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mllangan1's avatarDisrupted Physician


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“A body of men holding themselves accountable to nobody ought not to be trusted by anybody.”

― Thomas Paine 

USDTL drug testing laboratory claims to advance the”Gold Standard in Forensic Toxicology.”  “Integrity: Results that you can trust, based on solid science” is listed as a corporate value. “Unlike other laboratories, our drug and alcohol testing begins and ends with strict chain of custody.” “When people’s lives are on the line, we don’t skip steps.”  Joseph Jones, Vice President of Laboratory Operations explains the importance of chain-of-custody in this USDLT video presentation.

Dr. Luis Sanchez, M.D. recently published an article entitled Disruptive Behaviors Among Physicians in the Journal of the American Medical Association discussing the importance of  of a “medical culture of safety” with “clear expectations and standards.”  Stressing the importance of values and codes-of-conduct in the practice of medicine, he calls on physician leaders  “commit to professional behavior.”

Sanchez is Past President of…

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Please Sign Petition and Call (617-727-6200) MA State Auditor Suzanne Bump to Demand Audit of Corrupt Physician Health Services and the MA BORM Physician Health and Compliance Unit

Please Sign Petition and Call (617-727-6200) MA State Auditor Suzanne Bump to Demand Audit of Corrupt Physician Health Services and the MA BORM Physician Health and Compliance UnitThe Petition can be found here.  Or better yet, sign the petition and call her.  The evidence that Physician Health Services, Inc. (PHS) is committing crimes has been free-floating for the past two years.   It has been posted on Reddit, Twitter, Facebook, Linkedin, blogged, faxed, and phoned.  The response?  Absolute silence.

The procedural, ethical and criminal violations are clear and many.     The incontrovertible evidence has been directly delivered to individuals who should address this but for some reason do not.  This is not a matter of opinion folks but a matter of fact.    Time and time again we hear of  egregious misconduct hidden for decades because of  cognitive dissonance and blinkered apathy.

What evidentiary standard is required for action?   Over the past three years and under a lot of duress I have obtained indefensible documentary prima facie  proof of  crimes committed by individuals that should elicit immediate action but produced nothing but silence.

The crimes are many and they are of significance.  Accountability necessitates both the provision of information and justification for one’s actions.   This group has effectively blocked both of these. With much effort and under threat I have obtained proof of criminal activity with the expectation that the provision of this information would  result in those who should and could do something about it would.   They have not.

The documentary evidence of crimes is self-evident.  It is indefensible.    It is inexcusable that criminal activity is taking place within the walls of the Massachusetts Medical Society.   The fact that PHS is unregulated and without any meaningful accountability is irrelevant.  They are engaging in criminal activity within the walls of an institution whose very foundation is the antithesis of this groups actions and it must be addressed. Either support what the documents show or do something about it.

So please sign this petition and call  Massachusetts State Auditor Suzanne Bump at 617-727-6200

Institutional injustice just like that being committed by Luis Sanchez, Linda Bresnahan and the corrupt MRO Wayne Gavryck is killing doctors across the country.  They need to be held accountable.  Help me hold them accountable.

You do not need to be from Massachusetts to sign this petition. It is to raise public awareness–hopefully enough to elicit more exposure of this problem to prompt audits not only in Massachusetts but in other states as was recently done in North Carolina. The N.C. state auditor conducted an investigation and found poor oversight of the state PHP by both the state Medical Society and the state Medical Board, a lack of due process for physician’s who disputed the PHP’s evaluations and requirements, and multiple instances of potential conflicts-of-interest.

Dr. J. Wesley Boyd, who was previously an Associate Director at Physician Health Services, inc., the Massachusetts PHP is recommending that state government agencies audit their PHPs as well to “ensure that their vast power is wielded judiciously and with oversight.”  He adds that “doctors who are unsafe to practice medicine ought to be prevented from doing so. But every doctor who enters any kind of treatment or monitoring program should be treated respectfully and fairly, monitored appropriately, and have legitimate avenues of appealing decisions about their care.”

The Massachusetts PHP is engaging in unconscionable conduct including forensic fraud and self-evident criminal activity that is indefensible from within the walls of the Massachusetts Medical Society. Most are not aware of this. They need to be. This rigged game is a national problem and how the racket works in Massachusetts can be seen here.

 Please help me expose this and put a stop to it!

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Disrupted Physician 101.2: “Addiction Medicine” is a Self-Designated Practice Specialty Unrecognized by the American Board of Medical Specialties–(An AMA Census Term Indicating Neither Training nor Competence)

Disrupted Physician 101.2: “Addiction Medicine” is a Self-Designated Practice Specialty Unrecognized by the American Board of Medical Specialties–(An AMA Census Term Indicating Neither Training nor Competence)B1A19yWIMAAQf7EThe fraudulent Addiction Medicine drug-testing, assessment and treatment complex is a  charade of prohibitionists and profiteers.  It is time that this be identified and addressed. Addiction Medicine has evolved in a Lord-of-the-Flies manner without regulatory scrutiny or oversight and an absence of the need to guard. They are the Robber barons of Science and Medicine who have bought and boondoggled their way into the Medical Profession and Society  and are poised to ruin both. It is time to take aim at these unsupervised pundits of authoritative opinion with facts, evidence base, and the scientific method. The immense and unconscionable conflicts of interest  must also be addressed. And the blinkered apathy of the masses and willful ignorance of organized medicine needs to end now!   If not the ASAM White Paper on Drug Testing  will come to pass and we will be  faced with a future Police State run by unqualified, illegitimate and irrational zealots and profiteers.

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Abuse Hidden Under a Veil of Benevolence: Bill Cosby, Physician Health Programs and Cognitive Dissonance

Fake ASAM ‘Doctors’ Push AA Cult For Profit.

The blue slides below are from a  presentation at the 2014 FSPHP spring meeting in Denver, Colorado and can be seen here.   The presentation was given by past FSPHP President Gary Carr, MD, Current FSPHP President Warren Prendergast, MD, West Virginia PHP Director Brad Hall, MD and Montana PHP Director Mike Ramirez, MS.

 

This needs to be seen as a "to-do" list.

This needs to be seen as a “to-do” list.

A.A. = ASAM = FSPHP 

The quote is from Alcoholics Anonymous and the full passage is as follows:

“We are convinced that a spiritual mode of living is a most powerful health restorative. We, who have recovered from serious drinking, are miracles of mental health. But we have seen remarkable transformations in our bodies. Hardly one of our crowd now shows any mark of dissipation.
      But this does not mean that we disregard human health measures. God has abundantly supplied this world with fine doctors, psychologists, and practitioners of various kinds. Do not hesitate to take your health problems to such persons. Most of them give freely of themselves, that their fellows may enjoy sound minds and bodies. Try to remember that though God has wrought miracles among us, we should never belittle a good doctor or psychiatrist. Their services are often indispensable in treating a newcomer and in following his case afterward.”–Alcoholics Anonymous, 4th Edition,  The Family Afterward

Federation of State Physician Health Program (FSPHP) physicians often quote A.A. because they are defined by A.A. in both mechanics and mentality.  The “impaired physician” movement began with evangelical recovered addict and alcoholic physicians whose recovery was based on 12- step spirituality.  As this group molded into the American Society of Addiction Medicine (ASAM) many of them found employment at 12-step rehabilitation facilities and others joined their state Physician Health Programs and organized under the FSPHP.   Their ability to make authoritative pronouncements on physician impairment is  based on their own claim to insiders knowledge of recovery as brandished in this A.A. passage which I find condescending toward the medical profession and oddly narcissistic.

This special knowledge, of course, was based on the chronic relapsing brain disease model with lifelong abstinence and participation in 12-step recovery.

These “miracles of mental health” joined their state PHPs and those who did not agree with their rigid inflexible views were removed.   Those with access to special secret knowledge were eventually able to outvote those with intelligence and open minds as this groupthink infested and eventually monopolized  PHPs.


 

It is important to understand that the ideology of  A.A. is the ideology of the ASAM is the ideology of the FSPHP 

Like all “front-groups” the ASAM purports to serve one agenda while in reality serving another.  The ASAM claims to be a “physician society with a focus on addiction and its treatment” According to their website their mission is to

  • increase access to and improve the quality of addiction treatment;
  • to educate physicians (including medical and osteopathic students), other health care providers and the public;
  • to support research and prevention;
  • to promote the appropriate role of the physician in the care of patients with addiction;
  • and to establish addiction medicine as a specialty recognized by professional organizations, governments, physicians, purchasers and consumers of health care services, and the general public

In order to accomplish this the  American Board of Addiction Medicine certifies doctors  to “provide assurance to the American public that Addiction Medicine physicians have the knowledge and skills to prevent, recognize and treat addiction.”

Ostensibly these are laudable goals that are almost universally endorsed.   The perceived organizational purpose and public persona are altruistic and humanitarian.  Treating addiction not only saves individual lives but improves the community.  It is for the common good.


 

Abuse Hidden Under Benevolence and Torture as Treatment

History reveals that all manner of abuse can lie underneath a patina of benevolence.   In the past few months alone we have both Bill Cosby and the  British Parliamentary pedophile ring as prototypical examples.  Both cases reveal a decades long coverup of allegations in which the abusers escaped little or no investigation into their alleged crimes. Abuse of power with a large gap between the power of the abuser and the powerlessness of the abused is a common denominator.  If the abuser endorses our own beliefs systems it creates a discord that promotes disbelief.  It does not fit.   Accusations are dismissed, deflected or otherwise suppressed.   Power effectively extinguishes the truth.  Disbelieved and delegitimized, information is suppressed, charges are not filed and law enforcement and the media turn a blinkered eye for decades. Indifference, disbelief, rationalization and cognitive dissonance prevent exposure and accountability. Hidden in plain site the truth was there and easy to find.  The problem was no one was looking. Most did not want to look.

It does not take much sleuthing to uncover what is beneath the veil of the American Society of Addiction Medicine.  The history, mentality and mechanics are well documented and reveal where they came from,  how they evolved and what they have planned.    It is a complicated web and hard to explain but once the pieces of the puzzle are fit together it is clear.  But it involves assembling a complex puzzle by finding the individual pieces scattered in disparate areas including the regulatory, clinical, administrative and professional niches of the medical profession,  Alcoholics Anonymous and 12-step related organization, public policy, all levels of the political arena and other areas. Once put together the portrait is clear.

In reality the ASAM is a political action group or special interest group that is designed to cement the chronic relapsing brain disease model with lifelong abstinence and spiritual recovery as the one and only treatment for addiction.   A.A. is used as the energy source of the operation.  By labeling addiction a “disease” requiring “treatment” in which someone is helpless they are able to dictate all aspects by coercion and control.  But in my opinion the A.A. ideology is just used as a ruse to support the multi-billion dollar drug and alcohol testing, assessment and treatment industry.  The zero-tolerance mindset of the “treaters” combined with the “helplessness” of the diseased enables them to erect a revolving door of testing, assessment and treatment that provides them with both control and a steady stream of money.

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The FSPHP mandates 12-step ideology on all doctors in a zero-tolerance system of abuse and control while at the same time putting out misinformation that the PHP programs are the “new paradigm.”  The page below is from the book Drug-Impaired Professionals by Robert Holman Coombs.

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This is they type of propaganda these groups have propagated.   What is described above is absurd and unrealistic but it is reported, reproduced and repeated to the point that it is accepted as the truth.

The majority of physicians referred to these programs are not even addicts. These programs of Zero-tolerance and 12-step indoctrination are based on coercion and control.  They are causing many doctors to die by suicide as they are feeling hopeless, helpless and defeated.    This portrayal of a group of blissful 12-stepping doctors over the moon because they found spirituality is nonsense.

But you will not find many doctors speaking out against them for fear of “contingency management.”  Disagreeing or even questioning PHP practices including the validity of 12-step can literally cost you your license.

I have spoken to multiple physicians and nurses and have encouraged them to tell their stories here but they are afraid of retribution and “unintended consequences.”  And who can blame them?

They can send you back to one of the “PHP-approved” facilities for “stinkin thinkin.”

Unfortunately the ASAM and FSPHP have successfully bamboozled others into believing they are true experts with noble intent.  They have bamboozled the Federation of State Medical Boards (FSMB) to the point where they have gained autonomy and unrestrained managerial prerogative.    They essentially use the state Boards to impose sanction on doctors who they report doctors for “noncompliance” which includes disagreeing with or questioning mandated A.A  or refusing to admit you have a chronic relapsing brain disease when you in fact do not.    They are in fact imposing A.A. on doctors and forcing them to accept their thinking under threat of loss of licensure.  This  violates the Establishment Clause and is a very serious problem that is being ignored.  It is a slippery slope we are on.

The FSMB House of Delegates adopted an updated Policy on Physician Impairment at their 2011 annual meeting distinguishing “impairment” and “illness”  stating that Regulatory Agencies should recognize the PHP as their expert in all matters relating to licensed professionals with “potentially impairing illness” that predates impairment often by many years.”  

It also defines “relapse without use” as “behavior without chemical use that is suggestive of impending relapse.”Screen shot 2013-05-13 at 1.30.29 PM

G. Douglas Talbott defines  “relapse without use”  as  “emotional behavioral abnormalities” that often precede relapse or “in A. A. language –stinking thinking.”

The ASAM has  monopolized addiction treatment in the United States.  But what the FSPHP arm has done is far more sinister.   A.A. has effectively taken over regulatory medicine and the private lives of doctors as a form of social control.  A doctor can be referred to a PHP for virtually anything and if the PHP believes he or she is in need of an assessment it will be done by a “PHP-approved” facility which means it will be done by a 12-step facility.  The PHP selects who will be monitored and dictates every aspect of what that entails and the entire process is done within the confines of A.A. ideology.  It is a, in fact, a  rigged game as the medical directors of the PHP approved facilities can all be seen on this list of like-minded docs who refer to theselves as “trusted servants” and “believe that evidence from extensive, well-designed studies demonstrates the great benefits of Twelve-Step recovery modalities including Twelve Step Facilitation in promoting long-term recovery.”

A.A. is imposed  on doctors through the FSPHP.  The FSPHP political apparatus exerts a monopoly of force.    And the bottom line is that A.A. has taken over all aspects of “physician health” and is forcing doctors to accept doctrine that is perhaps helpful to a few, useless or unneeded for many, and harmful and sometimes lethal to others.  This is unacceptable and it needs to be recognized.


 

“New Paradigm” of Zero-Tolerance and 12-step Spirituality Based on “success” of PHP to Move to Other Occupations and Kids.

To move this “new paradigm” to other populations they had to gain control of the doctors first.  They have not only created a monopoly but buffered themselves from physicians who may disagree with what they are doing to others.  This current system essentially stifles them.

The power, immunity and impunity this group yields over doctors was done silently and with no opposition. It was done by sequential public-policy steps.  This is why anyone interested in civil liberties and human rights should recognize the menace this presents to society.   The scaffold is in place and they are just adding more nooses.  Just ask the airline pilots.  They plan to impose similar systems on teachers, students and athletes.

And this is all spelled out in the ASAM White Paper on Drug Testing.   What people need to realized is what is described therein is just a few public policy steps away from them.  The only organization they have to convince is the organization that regulates any type of professional license, employment or benefit.

Gaining regulatory sway in the medical field and control over individual doctors was necessary to move this model to other populations.  It is merely a stepping stone for things to come.  It is only a few public policy steps from us to you.

This impacts us all.   It enables control of research, public policy and public health.   It is a system that suppresses dissent and shapes conformity.  The FSPHP  encourages the confidential referral of outliers.

The ASAM is pro-drug war and anti-medical marijuana.  This essentially silences most doctors for fear of being recognized and being brought in.  I know many doctors who will not even talk about it in public.

This is fixed doctrine and will not change.

That is why the ACLU and other groups who promote civil rights, those who are against the drug war and anyone involved in Medical Marijuana need to step in.    These  groups need to recognize the reality of who these people are, what they have planned and understand why they need to be stopped.   They are currently not even in the public eye and by outward appearances they appear to be benign.   In truth they are malignant and rapidly metastasizing without any symptoms.

In Order to Stop This the Following Must be Done

1) get a team of epidemiologists/statisticians to attack the “evidence-base” and “research” that the ASAM/FSPHP has used to support their claims (junk science, pseudoscience, success of 12-step, etc) and do a Cochrane type meta-analysis that will show there is little to no basis for it.

2) Demand accountability of the PHPs. Assign accountability to the Medical Societies and Departments of Public Health. Demand they be accountable for state-contractors with the Medical Boards (many of whom are complicit–in Massachusetts the Board of Registration in Medicine is simply an extension of the state PHP-i.e. Like-minds.

3) Demand that the criminal activity taking place within these PHPs be addressed by law enforcement.

4) Demand the Attorney General enforce the rampant Establishment Clause Violations occurring with mass 12-step coercion.

5) Identify and expose the  backgrounds of many of the individuals involved including felons and double felons who reinvented themselves as “addiction medicine” doctors. Many of these individuals are repeat offenders with a history of manipulating the system who should have never had their licenses returned.  In my opinion the ASAM/FSPHP/LMD rigged system is an example of corporate psychopathy.  While corporate level psychopathy is estimated at around 3% the numbers here appear to be much higher if one looks at the moral disengagement, unethical decision making, lack of empathy and externalization of blame evident in their personal histories.

6) Correctly identify that this system of institutional injustice is responsible for the astronomical suicide rate in physicians. This is due to the fact that doctors who need help are not getting it for fear of being ensnared by the state PHP and those already ensnared are being subject to coercion, abuse, institutional injustice, degradation, dehumanization, delegitimization and civil and human rights abuses and that this is a public health emergency that needs to be addressed.

7) reveal the scam set up between the PHPs, rogue labs, and “PHP-preferred” assessment and treatment gulags.

8) show how this is only a few public policy steps from Doctors to Pilots to Teachers to students to kids. etc. etc.

This necessitates that we get the conversation going before it is too late.

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Integrity and Accountability—Defend the MRO Procedurally, Ethically or Legally and win 100 Volumes of the Classics in Medicine Library and Salk and Sabin Autographs!

Screen Shot 2015-06-18 at 11.46.50 PMIntegrity and Accountability—The Declining State of Physician Health and the Urgent Need for Ethical and Evidence-Based Leadership.

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Sabin and Salk Autographs

“The incompetent or unprincipled physician, licensed to practice medicine by a too complaisant State, is the greatest menace to scientific medicine – as great a menace as all the cultists put together.”  —Dr. Morris Fishbein  (The Medical Follies.  New York:  Boni Liverlight, 1925 p. 71)

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


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Sabin, Salk and the Classics in Medicine Library

Polio is nearly a thing of the past thanks to to Dr. Jonas Salk and Albert Sabin. In 1952 Salk discovered and developed the first successful vaccine for polio and combined with Albert Sabin’s 1961 oral vaccination the duo effectively obliterated the contagious polio virus.  Once a deadly threat to our  country and future there were 93,000 cases of polio reported in the U.S. Between 1952 and 1953 alone. ElaineBurnsBut thanks to Sabin and Salk the last case of naturally occurring polio in the U.S. occurred in 1979.

 
full body respirator or “iron lung” needed to treat patients whose respiratory muscles became paralyzed by polio

October 23, 2014 was the centenary of Jonas Salk’s birth and in honor of his 100th birthday I am sponsoring a contest to win framed autographs of both Jonas Salk and Albert Sabin as seen above.  In addition,  you will receive 100 volumes of the Classics in Medicine Library published by Gryphon Editions whose “mission is the preservation of the literary and intellectual heritage of the noble professions that we serve”

These are exact facsimiles of the original classics bound in leather and include works by William Osler, Harvey Cushing and Paul Dudley White.

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Background

According to British sociologist G. V. Stimson the  “impaired physician movement” is characterized by a “number of evangelical recovered alcoholic and addict physicians, whose recovery has been accompanied by involvement in medical society and treatment programs.” Their “authoritative pronouncements on physician impairment is based on their own claim to insider’s knowledge.”

In this regard Dr. Wayne Gavryck, M.D. is a prototypical example.

An ex-alcoholic with a history of malpractice, Gavryck quit drinking through Alcoholics Anonymous, became “board certified” in “Addiction Medicine” and became involved with the Massachusetts PHP,  Physician Health Services, Inc. (PHS) where he has been an Associate Director since 1988.  He serves as their Medical Review Officer (MRO).

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The “impaired physician movement” has gained tremendous sway through the American Society of Addiction Medicine and the Federation of State Physician Health Programs.  The ASAM is not a valid medical specialty but a “special interest group” that represents the chronic relapsing brain disease with lifelong abstinence and 12-step recovery model of addiction and the companies that profit from it financially ( drug and alcohol testing labs,  12-step inpatient assessment and treatment centers) and politically  (Drug War advocates,  Anti -Medical Marijuana advocates).   The impaired physician movement gained a seat at the table of power in medicine by bamboozling regulatory and administrative medicine.   This illegitimate and irrational authority is in charge of almost every state PHP in the United States.     ASAM physicians joined their state PHPs, gained power, and then removed those who did not agree with the groupthink and doublethink.  Blind obedience and control  are favored over fairness, truth and evidence-base.   As with other states under the FSPHP, blindly obedient doctors are kept on while those who  question the science  and ethics of the groupthink are removed.  The  PHP-Drug Testing Laboratory and  “PHP approved” assessment and treatment center industrial complex requires a Medical Review Officer of blind faith who places the goals of the FSPHP above all other considerations including the Hippocratic Oath.  The system requires doctors who are willing to participate in “moral disengagement” of wrongdoing including professional, ethical and legal violations.    To erect this scaffold they have put in place barriers to exposure and accountability. By declaring themselves “experts” they have used logical fallacy to temporize  deflect and otherwise stifle accountability. With no oversight or regulation they are, in fact, accountable to no one.   The appeal to authority and esoteric knowledge is an effective means of  extinguishing valid concerns.  Complacent that this is a group of benevolent organizational purpose those who should know better and could do something about it rationalize their apathy and indifference.   A necessary step in exposing and addressing this  problem is imposing accountability.    If an organization is able to  engage in conduct that is the antithesis of accepted professional guidelines and standards of care,  in violation of professional and societal mores and codes-of-conduct and  is illegal then there is a systemic problem.  This problem can fortuitously be addressed by examining standards of care, conduct and criminal codes for breaches.   If a breach is found then it needs to be explained and justified.  One of the tactics of the FSPHP is to deflect criticism under the logical fallacy of appeal to authority.  We are the experts. We know better.  That is where it usually ends.   But accountability requires both the provision of information and justification of actions.  My hypothesis is that this group is committing fraud, violating ethics and flouting the law in an irrefutable manner.  If this is not true then my hypothesis should be able to be refuted.  It cannot.  And for that reason I am putting my money where my mouth is.


Accountability

In all fairness,  If Gavryck can justify his actions either procedurally, ethically or  legally and back it up by any written protocol, guideline or standard then he wins and I will refrain from any more criticisms.  In addition I will hand deliver to him the Salk and Sabin autographs and 100 volumes of the classics in medicine, apologize and remove this entire blog.

Accountability requires both the provision of information and justification of actions.  One way of examining this is to look at the body professional and ethical standards and state and federal law.   The FSPHP has blocked the provision of information regarding drug-testing.  Although it has taken over three years I have obtained the all of the information pertaining to a July 1, 2011  test that should have immediately been rejected by the MRO. It is an invalid test.

Dr. Gavryck violated every conceivable procedural guideline and standard-of-care there is for an MRO,  the Medical Review Officer Certification Council’s Codes of Ethical Conduct and both State and Federal Law.   This can be ascertained by looking at the documentation.  I have done this and found hundreds of documents that support the accusation that as an MRO Wayne Gavryck breached protocol, engaged in unethical behavior and broke the law.  Prove me otherwise with just one credible source and  the prizes are yours.

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Contest Rules

Your job is to review the documentary evidence and records from PHS, Quest Diagnostics and USDTL and assess the actions and decisions made by the MRO.S)

If you can show that  these decisions were the result of  legitimate reasoning based on published guidelines or protocol, ethically defensible or did not break any laws and cite one credible source that concurs with this point of view then you have won.

If you can show that these decisions were the product of legitimate and thoughtful reasoning in accordance with established guideline, ethical codes then I will hand-deliver the items to you.

 If you can justify, support or defend the actions of the Medical Review Officer (MRO):

  1. Procedurally;IMG_0580

  2. Ethically; 

  3. or Legally;IMG_0577 - Version 2 

You win all of the prizes! Simple as that!

In fact, If you can support  just one of these the entire lot is yours.

If you can show Dr. Gavryck did not breach any and all published Standards-of-Care and Professional Protocols and Guidelines regarding drugs-of-abuse testing, OR that he did not violate any and all Codes of Conduct and Ethical Guidelines of the Medical Profession from Hippocrates to the American Medical Association OR that he did not violate multiple State and Federal Laws you win Salk and Sabin autographs and all of the books.

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All of the documents and details regarding the forensic fraud, concealment, coverup and deliberate misrepresentation to a state agency under color of law can be seen here:

Integrity and Accountability—The Declining State of Physician Health and the Urgent Need for Ethical and Evidence-Based Leadership.

To Review:   Any and all drug testing requires chain-of-custody.   “Forensic” drug testing differs from “clinical”drug testing because the consequences of a falsely positive test can be grave and far reaching.  Because the results of  a positive test can result in the loss of rights and liberties of the person taking the test it is essential that it be done correctly.  False-positive tests are unacceptable so strict chain-of-custody procedure and MRO review assure specimen integrity.    This provides accountability and the custody

The custody-and-control form records chain-of-custody and is given the status of a legal document as it has the ability to invalidate a test that lacks complete information.  The job of the MRO is to invalidate specimens without intact chain-of-custody.

The MRO job is fairly simple.  If a lab reports a positive test for any substance the MRO must check that the signatures, dates, times and other information on the custody-and-control form are correct and per protocol.  Chain-of-custody must be accurate and complete.   The MRO looks for “fatal flaws” on the chain-of-custody form.  If a “fatal flaw is present then the test is invalidated and the test is not reported as “positive” but “invalid.”

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The sole  job of the MRO is to ensure that the drug testing process and chain-of-custody procedure is followed to the letter.  The MRO reviews the Custody and Control form for accuracy and completeness.  The MRO also rules out any other possible explanations for a positive test (such as legitimately prescribed medications).  Only then is a test reported as positive.

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The legal issues involved in forensic testing mandate MRO review. According to The Medical Review Officer Manual for Federal Workplace Drug Testing Programs

“the sole responsibility of the MRO is to”ensure that his or her involvement in the review and interpretation of results is consistent with the regulations and will be forensically and scientifically supportable.”

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Corruption is misuse of entrusted power.  It occurs when those who have been given authority to carry out expected goals instead use their position and power to benefit themselves and others close to them. Abuse of power is particularly egregious when that person is doing the opposite of what he or she is supposed to do.

Accountability is necessary to prevent corruption and 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.

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Although Gavryck may serve PHS, it is not in the capacity of a certified medical review officer; by my count  the documentary evidence alone shows that he violated four of the seven Medical Review Officer Certification Council Codes of Ethical Conduct.  In addition to violating the MRO  Ethical Conduct he violated every other code I can think of from the Hippocratic Oath to the AMA Code of Ethics. and everything in between.

As the MRO for PHS Gavryck’s responsibility is simple.  He is supposed to verify that the chain-of-custody  of the sample was intact before reporting a test as positive.

This is indefensible on all levels (procedurally, ethically and legally). The documents show with clarity that this was not accident or oversight, but intentional and purposeful misconduct

There should be zero-tolerance for forensic fraud of this sort.   Those of integrity and moral compass would agree.     Transparency, regulation, and accountability are necessary.  It is an issue that needs to be acknowledged and addressed not ignored and covered up.

If Dr. Gavryck can give a procedural, ethical, or legal explanation of what was done then I stand corrected. Just one will suffice. If he cannot then this needs to be addressed openly and publicly.   And whether he was involved in the original fraud or not is irrelevant. As the MRO for PHS it is his responsibility to correct it–however late the hour may be.

Perhaps Dr. Gavryck needs to see some of the damage he has caused in order to take this responsibility. Known as a “bag man” who simply rubber stamps positive tests at the request of Linda Bresnahan, much like Annie Dookhan, he does not see the damage that is caused. Forensic fraud has grave and far reaching effects and in this case has severely impacted many people and include patient deaths. Perhaps Dr. Gavryck needs to take a “moral inventory” and see that this this type of behavior causes real damage to real people and put a face on it.

Please help me get this exposed, corrected, and rectified. The physicians of Massachusetts deserve better than this.

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Article by Pamela Wible, M.D. discussing physician suicide and addressing the role of Physician Health Programs (PHPs)

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Physician Suicide–What to do When Your Doctor Dies Suddenly by Pamela Wible, M.D.

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Physician Suicide 101: Secrets, Lies & Solutions by Dr. Pamela Wible, M.D

Physician Suicide 101:  Secrets, Lies & Solutions  By Dr. Pamela Wible, M.D. will hopefully serve as a stepping-stone to start discussing Physician Health Programs (PHPs) and their relationship to physician suicide.    (click on photo above to access article).

The current state-of-affairs is one of unrestrained  managerial authority and absolute power with no meaningful oversight, regulation or accountability.    Moreover, the authority bestowed on this group is both illegitimate and irrational.  The Federation of State Physician Health Programs is composed of American Society of Addiction Medicine “specialists” in “Addiction Medicine.”    The ASAM is not even recognized by the American Board of Medical Specialties as a bona fide specialty.  It is a Self-Designated-Medical-Specialty;  an AMA  term used to keep track of what any group of doctors is calling themselves.    American  Board of Addiction Medicine (ABMS) “board certification” is little more than a diploma mill.   Yet these “specialists” are now in charge of ALL things in PHYSICIAN HEALTH.    Many of the physicians running these programs had their licenses revoked and got them back by claiming salvation through the good graces of Alcoholics Anonymous and other 12-step methodology.  Many have felony convictions.  Some have double felonies.

At best we have unqualified zealots.   But one major problem I have heard over and over again from physicians forced into these programs is an absolute lack of justice, empathy and even civility by those in charge.  Misconduct, fraud, and even crimes are being reported.   Perhaps the 12-step salvation is just a ruse for some of them; a convenient cloak under which to hide all manner of abuse with impunity and immunity.

The majority of physicians would never do many of the things those now in charge have done no matter how inebriated, intoxicated or otherwise “impaired.”

Most doctors would never think of selling the “date-rape” drug to DEA agents or pilfering IV narcotics from cancer patients who need them.    But if you do a search of some of the doctors who run these PHP programs you’ll find this type of repugnant behavior is all represented.  “i’ve changed.”  “Give me a second chance.”     History will eventually look upon this like the lobotomy.  What the hell were they thinking.  Some of these people should never have gotten their licenses back.   They not only did but were put in charge. Brilliant!

And these are the individuals who have been granted unrestrained managerial prerogative and absolute power over all of doctors.  They decide not only who to monitor but how that monitoring proceeds in every last detail.  Our fates, literally, lie in the hands of this group.   No more physicians should die by this system of institutional injustice, bullying and pseudoscience.  The conflicts-of-interest are abhorrent and would be incomprehensible in any other venue.  Isn’t it time we take charge?  And the solution is fairly simple.  Oversight, regulation,  and auditing by OUTSIDE groups. That is how it’s done everywhere else.  Why do these guys get a pass?     Accountability is a rule not an exception.    Hopefully this article will succeed in framing certain questions for the medical profession; questions that we all need to think about now before the door closes for good.

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