Physician Health Programs

Guest Post: “The Perilous Physician Licensing Landscape” by Kernan Manion, MD

mllangan1 6 Comments

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Over the years, many have visited Michael’s audacious blog as he’s dared open eyes about concealed abuse by medical boards, physician health programs and hospital-based peer review committees. 

Through shared experience, Michael and I have been studying these issues for nearly a decade. We are amongst a handful of physicians nationally who get the big picture and know the career-threatening challenges one faces in responding to and interacting with medical licensing boards, PHPs and related entities.

In fact, we’ve been founding members of a study group loosely referred to as the Coalition for Physician Advocacy (which I’ve cross linked to from here on occasion). Amongst the members of that think tank are a major writer-advocate of PHP reform; an MD JD whose focus is on disability law, mental health issues and litigation stress; a former vice chair of psychiatry at a well-recognized academic center; and an established addictions psychiatrist who is multiply boarded and is also a retired brigadier general. All have come together to address what we collectively feel are major abuses of privilege by a significant number of state medical boards and PHPs. We have observed the remarkable similarity in many of these due process deprived dealings to that of sham peer review. 

You would likely recognize our Coalition members’ names from their prominent articles and comments on many blog pieces over these last several years in Medscape, KevinMD, Medical Economics; Journal of Addiction Medicine; et al. Just look anywhere where Michael or I have posted comments. And with each gathering comment bearing witness to these gross abuses, we are gaining immense strength.

Michael encouraged me to convey through this guest post that we’re offering a free informational webinar “The Perilous Physician Licensing Landscape” on Monday 4/16 at 8pm EDT specifically pertaining to the issues. 

You can register here: http://bit.ly/LicensePeril

Over the years, we have collectively spoken with hundreds of physicians who have shared their stories of abuse at the hands of these agencies and the harm that has ensued to their practices, their careers and their patients. Of course, throughout this ordeal, their personal and family lives have been thrown into turmoil as well.

This concise webinar will provide not only an overview of these key issues and what we’ve learned through hundreds of consultations but also some very practical “do’s and don’ts” in dealing with medical boards and PHPs. And these pertain not only to physicians and all others in healthcare – both with degrees and still in preparation – but to their families and even their counsel. 

We’ve heard many heart-rending stories of immense suffering and injustice meted out by these unregulated entities. Many have been badly traumatized, so much so that they fear retribution and further harm if they dare speak out.

And it’s our goal to use our expertise to help our fellow physicians negotiate their way through these very dangerous waters.

Be sure to join us Monday 4/16 at 8pm EDT for “The Perilous Physician Licensing Landscape.”

Register here: http://bit.ly/LicensePeril

And even if you can’t make it, be sure to register in order to get the replay link and any handouts.

I can’t close without offering tribute to Michael’s perseverance in the face of all adversity. He’s continued to expose these abuses, and suffered greatly for it. I am confident, in significant part due to his relentlessly hard-hitting well researched essays, that national exposure is growing, that journalists are taking note and the powers that have so menacingly operated like demonic Wizards of Oz are now having to examine their vulnerability to their reckless sadism being exposed. 

On behalf of Michael and myself, I hope this finds you well and that you’ll be able to join us for the webinar.

Kernan Manion, MD

p.s. In the event that you know of colleagues who might benefit, please share this invite – just copy the url of this webpage and paste it in an email.

p.p.s. And … if you’re on any social media or physician discussion groups (e.g. Sermo, Doximity, LinkedIn et al.), just copy and paste this link below into your post inviting people to attend. Knowledgeable career-saving help is available. You don’t need to face it alone. Learn what you can and need to do to protect your career in the event that your license is jeopardized by these entities. Here’s the link again: http://bit.ly/LicensePeril

Physician health programs: ‘Diagnosing for dollars’?

mllangan1 12 Comments

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Source:  Clinical Psychiatry News

Please comment.

Publish date: December 5, 2017
By Dinah Miller, MD
As medicine struggles with rising rates of physician burnout, dissatisfaction, depression, and suicide, one solution comes in the form of Physician Health Programs, or PHPs. These organizations were originally started by volunteer physicians, often doctors in recovery, and funded by medical societies, as a way of providing help while maintaining confidentiality. Now, they are run by independent corporations, by medical societies in some states, and sometimes by hospitals or health systems. The services they offer vary by PHP, and they may have relationships with state licensing boards. While they can provide a gateway to help for a troubled doctor, there has also been concern about the services that are being provided.

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Physicians find their way to PHPs in a number of ways. A doctor whose behavior suggests impairment can be referred to the PHP by his employer, or by a licensing board, following a complaint. In these instances, participation often is a condition of employment or of continued licensure, and the PHP serves as an agent of the hospital or the state. Doctors may also be referred to PHPs for monitoring if they ascribed to having a diagnosis of psychiatric illness or substance abuse, either now or in the past, and are with or without obvious impairment. Finally, PHPs serve as a portal to treatment for physicians who self-identify and self-refer in an effort to get help. Their use is encouraged in an effort to prevent bad outcomes from mental health conditions, stress, and substance abuse, in those who are suffering in ways that would not otherwise call attention to their plights. In these situations, the PHP may serve as the agent of the patient or client, but there may remain dual-agency issues if the physician says something that leads the PHP to be concerned about the doctor’s fitness. Compliance with PHP recommendations, including drug screening, might be mandated, and physicians may resent these requirements.Louise Andrew, MD, JD, served as the liaison from the American College of Emergency Physicians (ACEP) to the the Federation of State Medical Boards from 2006 to 2014. In an online forum called Collective Wisdom, Andrew talked about the benefits of Physician Health Programs as entities that are helpful to stuggling doctors and urged her colleagues to use them as a safe alternative to suffering in silence.

More recently, Dr. Andrew has become concerned that PHPs may have taken on the role of what is more akin to “diagnosing for dollars.” In her May, 2016 column in Emergency Physician’s Monthly, Andrew noted, “A decade later, and my convictions have changed dramatically. Horror stories that colleagues related to me while I chaired ACEP’s Personal and Professional WellBeing Committee cannot all be isolated events. For example, physicians who self-referred to the PHP for management of stress and depression were reportedly railroaded into incredibly expensive and inconvenient out-of-state drug and alcohol treatment programs, even when there was no coexisting drug or alcohol problem.”

Dr. Andrew is not the only one voicing concerns about PHPs. In “Physician Health Programs: More harm than good?” (Medscape, Aug. 19, 2015), Pauline Anderson wrote about a several problems that have surfaced. In North Carolina, the state audited the PHPs after complaints that they were mandating physicians to lengthy and expensive inpatient programs. The complaints asserted that the physicians had no recourse and were not able to see their records. “The state auditor’s report found no abuse by North Carolina’s PHP. However, there was a caveat – the report determined that abuse could occur and potentially go undetected.

“It also found that the North Carolina PHP created the appearance of conflicts of interest by allowing the centers to provide both patient evaluation and treatments and that procedures did not ensure that physicians receive quality evaluations and treatment because the PHP had no documented criteria for selecting treatment centers and did not adequately monitor them.”

Finally, in a Florida Fox4News story, “Are FL doctors and nurses being sent to rehab unnecessarily? Accusations: Overdiagnosing; overcharging” (Nov. 16, 2017), reporters Katie Lagrone and Matthew Apthorp wrote about financial incentives for evaluators to refer doctors to inpatient substance abuse facilities.

Dr. Dinah Miller is coauthor with Annette Hanson, MD, of “Committed: The Battle Over Involuntary Psychiatric Care” (Baltimore: Johns Hopkins University Press, 2016)

Dr. Dinah Miller

“Medical professionals who enter the programs must pay for all treatment out-of-pocket, which could add up to thousands of dollars each year. There are also no standards on how much treatment can cost.”The American Psychiatric Association has made it a priority to address physician burnout and mental health. Richard F. Summers, MD, APA Trustee-at-Large noted: “State PHPs are an essential resource for physicians, but there is a tremendous diversity in quality and approach. It is critical that these programs include attention to mental health problems as well as addiction, and that they support individual physicians’ treatment and journey toward well-being. They need to be accessible, private, and high quality, and they should be staffed by excellent psychiatrists and other mental health professionals.”

PHPs provide a much-needed and wanted service. But if the goal is to provide mental health and substance abuse services to physicians who are struggling – to prevent physicians from burning out, leaving medicine, and dying of suicide – then any whiff of corruption and any fear of professional repercussions become a reason not to use these services. If they are to be helpful, physicians must feel safe using them.

Dr. Miller is coauthor with Annette Hanson, MD, of “Committed: The Battle Over Involuntary Psychiatric Care” (Baltimore: Johns Hopkins University Press, 2016).

The “PHP-Approved” Assessment and Treatment Center Gravy Train

mllangan1 4 Comments

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Related:  Monopolies, Self-Referral and Shell Games: The Need for Antitrust Investigation of Physician Health Programs and their “PHP-Approved” Assessment and Treatment Centers

Regulatory capture and the critical need for Federal Trade Commission (FTC) Investigation of Medical Licensing Boards

The Dictatorship of the Federation of State Physician Health Programs (FSPHP)

The Federation of State Medical Boards (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.”  In 2011 The American Society of Addiction Medicine (ASAM)  issued a Public Policy Statement on coordination between physician health programs (PHPs), medical boards and treatment providers recommending  only “PHP approved” treatment centers be used in the assessment and treatment of doctors.   The Federation of State Physician Health Programs (FSPHP)  is an appendage of the American Society of Addiction Medicine (ASAM) that cultivated a relationship with the  Federation of State Medical Boards (FSMB) by offering  “treatment” rather than”punishment and their influence on regulatory medicine can be historically tracked  in the  Journal of Medical Regulation and similar  publications when they began touting grandiose success rates in treating “addicted doctors.” The  Washington  PHP claimed a success rate of  95.4%,  Tennessee   93% and Alabama  90%.   These breathtaking success rates were attributed to specialized treatment centers for doctors such as Ridgeview where they required inpatient stays lasting three times longer than average folks; cash-on-the-barrel and at three times the cost mind you. The truth is the majority of doctors referred for assessments do not meet the diagnostic criteria for problems they are receiving treatment.  It is unneeded. Very few are “addicts.”  Most of those being referred to these programs are like Leonard Masters who was accused of overprescribing and was told by the director of the Florida PHP he could either relinquish his license or have an evaluation. Masters chose the evaluation thinking he would be returning in 4-days.  but was diagnosed as an alcoholic and spent 4-months.  The man didn’t even have a drinking problem!   He successfully sued G. Douglas Talbott and the facility for false imprisonment, malpractice and fraud.

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What objective criteria are used in selecting these “PHP-approved” assessment and treatment centers?    According to a  Performance Audit of the North Carolina Physicians Health Program done by State Auditor Beth A. Wood that’s a good question.

The North Carolina State  Audit specifically noted the predominant use of these out-of-state treatment centers.   In addition to “creating an undue burden on” those being evaluated the audit states that:

 “Program procedures did not ensure that physicians received quality evaluations and treatment because the Program had no documented criteria for selecting treatment centers and did not adequately monitor them”

In fact the audit found no documented policy for selecting treatment centers.  The very organizations demanding documentation of policy for approval and charged with approving the treatment centers could not even give a comprehensible, plausible or even simple explanation for what any of  these things even mean.    

When the NC PHP was asked to define these characteristics they explained that they learned  of “new treatment centers through professional networks and other informal sources” and used the “treatment centers’ reputation as a basis for establishing a referral relationship.”      Staff credentials, quality of care, treatment methods and modalities, patient choice, follow-up data, outcomes and other objective information apparently took a back-seat to what appears to be ill-defined and subjective word-on-the-street.

None of these facilities take insurance.  It is all out-of-pocket with the average cost for a 4-day assessment $5K and another  $80-120K for at least three months of inpatient treatment   Reports of “diagnosis rigging” and unneeded treatment are rampant and if  my survey is an accurate reflection of what is occurring more than 90% of those treated do not even meet the diagnostic criteria for what they are being treated for.

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This  “failure to use FSPHP  recommended criteria to select treatment centers,” the Audit concluded “could cause the Program to enter into referral arrangements with service providers that do not meet quality standards”

Ironically the  NC PHP failed to follow guidelines they themselves introduced and demanded be followed but could produce no documented criteria they existed.    They could not even provide plausible criteria.   Professional networks, reputation and other informal sources are fine for some choices.  That’s how I picked out my first skateboard.     These resources can play in important role in choosing a shirt, new sneakers or even a car but they do not constitute selection criteria for an assessment in which the consequences and recommendations made for the person being assessed are significant, potentially life-altering and possibly permanent!

And to top it off the  Medial Director of the North Carolina PHP,  Dr. Warren Pendergast, was the  President of the FSPHP at the time of the audit.  PHPs are not clinical providers but monitoring agencies.  They meet with, assess and refer doctors for evaluations and and monitor doctors through drug and alcohol testing and the monthly reports of others.     As such the PHP is tasked with two jobs-referring doctors for evaluation and then monitoring them after they have been evaluated.  The fact that they could not produce the facts and reasoning of the very basis for which they exist is incomprehensible.   The President of the FSPHP being unable to define the selection criteria for approved and mandated facilities is like Anthony Bourdain being unable to explain the ingredients of an omelette.

To summarize, doctors in North Carolina were being forced by the PHP  to have evaluations at “PHP-approved” assessment and treatment centers but the PHP was unable to explain anything substantive in defining any of it.  Why?  Because no qualitative objective selection criteria exist and that is the case in every state. This is especially concerning when it is realized that these evaluations are limited to facilities and people  tied financially and ideologically to the groups and individuals who are mandating the referral.

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Please donate!  Need urgent funding!  No donation is too small on GoFundMe!

mllangan1 5 Comments

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Please donate here!

https://www.gofundme.com/PHPReform

Anonymous referrals to state PHPs can result in loss of careers, families and even lives.   I have heard from doctors targeted due to age , religion, sexual preference , nationality, political stance and appearance.  Referred to the  state PHP with an anonymous complaint of “alcohol on breath” or “anger issues,” these good doctors were removed from practice under the guise of protecting the public.   By claiming a doctor has a  “potentially impairing illness” and falsely labelling him or her with a substance use or behavioral disorder they are able to remove due process and remove any doctor from practice. The system is designed to give the appearance of legitimacy.   It is not.  The stories I have heard and continue to hear from doctors  and medical students are as horrific as they are heartbreaking.  I have heard from female doctors who refused to go out on a date with, spurned sexual advances and even been raped by other doctors who then reported them to their state PHP for damage control.   I have heard from many doctors who discovered misconduct such as insurance or Medicare fraud who were promptly reported to their PHP and doctors who were reported by competitors for patients.   I have heard from doctors reported out of jealousy, anger, racism and bigotry.    Some of these storied can be seen on who have thwarted sexual advances and even been raped who were reported to their state “letters from those abused and afraid

My work in physician health reform has resulted in some significant gains.  For example the Medscape article  Physician Health Programs- More Harm Than Good? by Pauline Anderson was the result of  Medscape Editor taking an interest in my tweets about a year earlier and contacting me and taking an interest in my blog.  Physician Health Programs- More Harm Than Good?    broke new ground as it was the first mainstream medical article critical of PHPs. This was read by British Medical Journal Editor Jeanne Lenzer and this led to “Physician health programs under fire.”    In this article published in the BMJ she takes on the financial conflicts of interest, abuse and fraud in PHPs and the FSPHP’s response to direct and specific questions revealed what an irrational and illegitimate authority they are.   They cannot provide direct and simple answers to direct and simple questions and remain tongue tied to this day.

By all counts their days are numbered and the articles mentioned above and more to come are the direct result of bottom-up activism.  So too is a forthcoming audit by Massachusetts state Auditor Suzanne Bump whose office has already interviewed enough abused doctors to warrant an investigation which will hopefully look into the misconduct and fraud being perpetrated by the Massachusetts PHP in collusion with a specific group of attorneys within the medical board that blocks due process and conceals evidence to protect the PHP and harm innocent doctors.

It took 25 years for the FSPHP to rise.  Let’s hope their demise is much quicker.  They need to be named as the enemy and addressed on a state by state basis.  We have dealt some significant blows and I would like to keep throwing some direct punches to the enemy but at this point it is getting difficult due to financial matters and I urgently need funding and support.

 

The need for allies and funding is urgent as time is critical.  We have to expose this group as an illegitimate and irrational authority, expose their fraud and scams and expose the backgrounds of some of the individuals involved.    Physician health programs should not longer be considered the elephant in the room.  All you have to do is look at documentary facts  and evidence to see what is happening and any ignorance at this point would have to be deemed willful ignorance.  You cannot continue to ignore the obvious.  To those within the PHPs and their sympathizers and apologists your silence speaks volumes To save American Medicine it is essential this be exposed, investigated and the perps held accountable.  Silence is no longer an option.

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https://www.gofundme.com/PHPReform

The Federation of State Physician Health Programs (FSPHP) is an unexamined, illegitimate and irrational authority: Let’s drain this swamp in 2017!

mllangan1 2 Comments

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Nosce te ipsum. Nosce inimicum tuum

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.

screen-shot-2017-01-30-at-11-59-14-pmExamining 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.screen-shot-2017-01-30-at-11-59-05-pm

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-amThe 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 game.

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-pmThe 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 Wood 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.

screen-shot-2016-01-13-at-9-52-11-am“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-pmOf 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.

Screen Shot 2017-01-30 at 11.58.54 PM.pngResearch 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. There is zero-accountability. No fines. No repercussions. No risk. What has happened is not only logical but inevitable. It is time to name the enemy.  The enemy is not state physician health programs (PHPs) but those in charge of them. The Federation of State Physician Health Programs (FSPHP) is a heretofore unexamined authority.    Current evidence is revealing the FSPHP is also an irrational authority. It is also quite easy to show by historical documentation of the policy and practice they have pushed that they are an illegitimate authority.   Illegitimate authority when identified and recognized needs to be removed.

Nosce te ipsum. Nosce inimicum tuum. Know thyself, know thy enemy.  The FSPHP is the enemy. They cannot be bargained with. They need to be removed.   In the interim we need to set up advocacy and watchdog groups to help and protect those already caught in this web of manipulation, oppression and fear. Wake up, Stand up and Speak up.  Silence is consent. Let’s drain this swamp in 2017.

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Please donate!  Need urgent funding!  No donation is too small. Come on! https://www.gofundme.com/PHPReform

 

 

Adding 1964 Rolling Stones Decca 7″ 45″Off the Hook” Vinyl signed by Mick Jagger, Keith Richards, Brian Jones, Bill Wyman and Charlie Watts to 25 K in prizes previously offered to the first person who can disprove FSPHP President did not commit multiple felonies!

mllangan1 4 Comments

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It has now been almost two months since I offered over $25 thousand dollars in cool prizes to the first person to disprove past president of the Federations of State Physician Health Programs and Medical Director of Physician Health Services, inc. Dr. Luis “the dirty” Sanchez did not commit multiple felonies.  (December 9, 2016) and as far as I know no one has been knocking at my door.   All of these prizes can be seen in the post below:

I am Offering Over $25,000 in cool prizes to anyone who can show past FSPHP President Sanchez did not commit at least 3 felonies based on documentary evidence alone! I claim the documents show direct evidence of multiple serious crimes –prove me wrong and the whole lot is yours!

Perhaps the booty isn’t good enough so I am adding a 1964 Decca  7″ 45 RPM original pressing of Little Red Rooster  (A) and Off the Hook (B) on vinyl signed by Mick Jagger, Keith Richards, Brian Jones, Bill Wyman and Charlie Watts.  This is in addition to the over 25 K of other prizes previously offered. All you gotta do is show that Sanchez did not commit fewer than three felonies. Simple enough?

Dr. Sanchez machinations and misconduct can be seen here.  It took a formal complaint with the College of American Pathologists to get the truth out.  More of this fiasco can be seen here and here.   What Sanchez  and his co-conspirators did is egregious and ethically reprehensible.  It shows a complete lack of moral compass and personal integrity.  What was done from collection to report to coverup  and everything in-between is in fact indefensible on all levels (procedurally, ethically, and legally).  So too are the actions of Board attorney Deb Stoller (who not only covered it up forensic fraud but was complicit in it) and those of Assistant Attorney General Bryan Bertram (who is continuing to participate in a cover-up of a cover-up) in violation of ethics and professional conduct. In a perfect society Sanchez would have his medical license revoked and the other two would have been disbarred by now.  In a perfect society all three would be held accountable for crimes.  Does Bertram’s superiors know what he is doing? I don’t think so.  They will at some point.

I think everyone would agree that there should be zero-tolerance for forensic fraud and cover-up and cover-ups of cover-ups in positions of power.    Any person of honor and civility would agree. The documentary evidence shows with clarity that this subterfuge and chicanery was not accident or oversight.  It was intentional and purposeful misconduct.  It is indefensible. Attorneys cannot ignore the obvious.

Transparency, regulation, and accountability are necessary for these groups.

To be fair if Sanchez  can give any  procedural, ethical, or legal explanation for his actions then I stand corrected.  Same applies to his apologists, lackeys and  morally challenged counterparts Stoller and Bertram.  Just one will suffice.  I’ll erase my blog and vanish into oblivion.  No questions asked. Into the woodwork.  But If this trio  cannot then this malfeasance needs to be addressed openly and publicly.   It is their agencies responsibility to correct this –however late the hour may be.  My suspicion is that all of this has been blocked from going upstream.

Forensic fraud has grave and far reaching effects and in this case has severely impacted many people and includes patient deaths. Perhaps this trio needs to take a “moral inventory” and see that this this type of behavior causes real damage to real people and put a faces on it.  The increasing comments on Pauline Anderson’s latest Medscape article would be a start.

Perhaps Sanchez, Stoller and Bertram  need to be asked these questions by an  investigative reporter. Direct and simple questions deserve direct and simple answers.  “Not my department” and “no comment” are no longer acceptable.  We need to demand answers.

It is people just like this who are killing physicians across the country.   The body count is vast and multiple. This type of behavior is directly and temporally related to the recent epidemic of suicides in doctors.  They have removed themselves from conventional accountability by withholding information and suppressing facts. No longer.  The sympathizers and apologists who refuse to acknowledge or investigate wrongdoing will be held to account. Sanchez, Stoller and Bertram believe they are beyond reproach; complacent in the belief they are protected from harm and insulated from investigation.   The evidence, however, is not going away. Neither am I. Neither are the growing legion of ethical individuals who want to drain this swamp.

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.

This is corruption plain and simple and  The doctors and patients of Massachusetts and the doctors and patients of this entire country deserve better than this.

As no checks and balances exist I am offering 25K in prizes and now adding a 1964 45″ signed by the Rolling Stones; Mick Jagger, Keith Richards, Brian Jones, Bill Wyman and Charlie Watts.  One of the problems in this system cognitive dissonance and the belief that there must be something more to it.  There isn’t.  Fact is I could offer you my car, everything I own or my very soul and you would still not be able to disprove that Sanchez committed multiple felonies, that Stoller not only  covered it all up but was complicit and that Bertram is engaging in a cover-up of a cover-up by misusing administrative law and is in violation of the rules of professional conduct and basic ethics and morality. So here’s the ticket.  Either come get the prizes or help me get this exposed and dismantled.  Either defend them or help me hold them accountable. Silence is not an option.

 

 
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I am Offering Over $25,000 in cool prizes to anyone who can show past FSPHP President Sanchez did not commit at least 3 felonies based on documentary evidence alone! I claim the documents show direct evidence of multiple serious crimes –prove me wrong and the whole lot is yours!

mllangan1 7 Comments

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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-amThe 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 game.

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-pmThe 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 Wood 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.

screen-shot-2016-01-13-at-9-52-11-am“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-pmOf 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-pmWhat 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-pmIt 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-pmLegitimate 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-pmboard’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

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Medscape Article Now Live! Please comment and tell your stories now!

mllangan1 7 Comments

screen-shot-2017-01-27-at-11-34-00-amLink to Medscape article by Pauline Anderson Here:

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

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

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

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

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

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

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

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

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

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

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

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

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

 He was an inpatient at the Talbott Recovery Center in Georgia for more than 3 months, after which he signed the requisite 5-year contract with the PHS that included regular drug testing.

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

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

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

Lab Fraud?

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

 “They noted no past or present history of alcohol use or abuse and sent me back after a 4-day evaluation,” he said.

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

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

 Among the “many errors in sample collection, processing and transportation,” said Dr Flood, was that the documentation that was received with the specimen did not have a date and time of specimen collection. Moreover, the person who collected the specimen was not properly identified, the signature of the sample donor was missing, and there was no tamper-proof seal affixed to the specimen.

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

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

 In a letter to the Massachusetts Board of Registration in Medicine, Luis T. Sanchez, MD, who at the time was the director of the Massachusetts PHS, said the amended report indicates that the “external chain of custody protocol [for that sample] was not followed per standard protocol.”

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

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

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

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

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

 Medscape Medical News also sought comment on recent developments in Dr Langan’s case from the Massachusetts Attorney General’s Office, which declined to comment.

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

Intentional Delay?

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

 The Board of Registration in Medicine eventually approved an evaluation by Patricia Recupero, MD, from the Law and Behavioral Health Program at the University of Rhode Island.

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

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

 It is “critical to understand” the inadequacies of such tests for physician monitoring for purposes of relapse, she notes. She added that the source of the alcohol in Dr Langan’s test results cannot be determined and that many products – mouthwash and hand sanitizers among them – can create a false-positive test.

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

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

 It was her opinion that, should he require additional treatment and supervision, the PHS should not be involved. A spokesperson for the PHS confirmed that it has not been involved in matters related to Dr Langan for at least 3 years.

Dr Langan said that since it suspended his medical license, the board has “engaged in a persistent pattern of ignoring my every reasonable effort at trying to be reinstated” and has “abused the administrative law process to accomplish this.”

Medscape Medical News contacted the Massachusetts medical board as well as its counsel, Deb Stoller, but received no response.

“Close to Homeless”

A memorandum to the Supreme Judicial Court, filed May 13, 2016, proposed a settlement between Dr Langan and the board. In return for the immediate reinstatement of Dr Langan’s license, he would be monitored for a maximum of 3 months by Dr Recupero and Timothy E. Wilens, MD, codirector of the Center for Addiction Medicine at MGH.

That memorandum was accompanied by letters from Dr Recupero and Dr Wilens agreeing to the terms, but according to Dr Langan, it has been “ignored.”

“The board did not acknowledge or address the proposals in any way,” said Dr Langan.

Dr Langan maintains that he “never ever” had any patient care or malpractice problems during his 15 years at MGH. In fact, his supervisors and colleagues reported that his work performance has been “superlative” on all counts, he said.

Many in the addiction medicine and psychiatric community support Dr Langan. He has letters from high-profile physicians in the field who verify that he is safe to practice medicine.

A first petition was filed in the Supreme Court on October 22, 2014, but the judge dismissed it because it had not been filed within the required 60-day period. Dr Langan’s most recent petition was filed July 3, 2015.

The past few years, he said, have taken a toll on his family. They have lost their home and health insurance because of his inability to practice his profession.

Disheartened by this latest setback, Dr Langan is looking into the possibility of becoming licensed in another state and leaving Massachusetts.

But Dr Langan has renewed hope. Under Massachusetts’ new Public Records Reform Law, which went into effect January 1, 2017, “the board was forced to comply with my request for records within 10 days,” and has done so, he said.

According to Dr Langan, these records show some irregularities that may bolster his case.

“A letter dated December 15, 2011, introducing exculpatory evidence was date-stamped January 17, 2012, almost 1 month after the hearing where it was submitted as evidence. All of the other documents had either illegible or absent date-stamps,” he said.

ASAM Weekly Editorial recommends Physician Health Program (PHP) organizational groups provide addiction treatment advocacy on a national level to guide public policy: A RED FLAG if ever there was one.

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ASAM Weekly is a publication of the American Society of Addiction Medicine (ASAM) circulated by E-mail to “more than 25,00 addiction professionals” every Tuesday.  It provides timely news briefings of top stories related to addiction medicine. The current issue includes a  National Survey on Drug Use and Health study correlating substance use with suicidal ideation;  original research  suggesting a strong link between  alcohol use and”thwarted belonging”  ( wanting and needing to be with others being socially isolated ) with both homicidal and suicidal ideation in a group under community corrections supervision by the criminal justice system; a study of privately billed services looking at the economic impact of the opioid epidemic on the healthcare system (Fair Health White Paper) which found a 1000% increase in opioid related treatment and service costs between 2011 and 2014;  and an article written for the  Huffington Post entitled  “When ‘All or Nothing’ Means Life or Death”  that questions the abstinence based model that currently monopolizes addiction treatment in the United States which the author notes  “is not only harmful and killing people,” but also “defies much of what we know about addiction.”

In his weekly editorial Editor-in-Chief William Haning refers to prescription database finding that the number of opioid prescriptions written in Tennessee last year outnumbered the number of people in Tennessee.  He appropriately notes this should “stun the readership” as it should. He notes several other articles this week “remind us that most of the public is not terribly interested in whether somebody has an addiction”  or the socioeconomic impact of addiction. He states “the public really can’t be expected to care” is someone with a substance use disorder is using substance and may not even be “realistically expected to care very much” about those who recover.

“What they do and rightly care about,” Haning declares,  “is the outcome of substance usage” and the public “is much more impressed by and will react to the consequences, ” As consequences he points to the two articles concerning suicidal and homicidal ideation and a report concerning sexual assault and violence from the University of Wisconsin .  He goes on to state:  “It causes an understandable lack of sympathy when a group of illnesses imparts injury to others.”  He lists crime, trauma in the workplace, spread of infectious disease and impact of childhood development of the disordered family as additional outcomes or consequences.

Haning notes a dilemma for those in recovery–they want to advocate for others but do not want to draw attention to themselves as the attention is far different from a diabetic or parent of a child with muscular dystrophy pushing for increased research or approval of a new medication.  He points out a national organization advocating for the treatment of the mentally ill exists (NAMI) that is comprised largely of those being treated but  “no strong national equivalent exists for substance use disorder yet” with two “organized bodies” as exceptions:    “physicians who have themselves entered recovery (IDAA), and another, smaller body of physicians in recovery who are engaged in the treatment of SUDs” These “organized bodies” have generally been focused on “ensuring identification of and care of their colleagues and patients” but have more recently become involved in the “pursuit of public policy changes.”  

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Propoganda, Truth and Credibility

In   Propaganda: The Formation of Men’s Attitudes  Jacques Ellul discusses the underlying assumptions and ideology that give rise to propaganda and the structures and belief systems needed for propaganda to flourish.  Propagandists  move with an “assortment of soothing and easily digestible notions.”  He discusses how easy it is for most people to accept propaganda as the individual does not want information but only value judgments and preconceived positions.  On the surface Haning’s proposal is rational and seems like a good idea. Who could argue with it?

It is important to recognize what Haning is referring to.    IDAA is an acronym for International Doctors in Alcoholics Anonymous , an AA fellowship of more than 9500 doctors.  The organized body focused on ensuring “identification” of “colleagues” are the state physician health (basically employee assistance programs for doctors).  47 of them are under the management of the  Federation of State Physician Health Programs (FSPHP).  The organized body focused on “care” of “patients is a group called   Like Minded Docs (LMDs). Collectively these groups represent the physician health program model and it is being promoted as “gold standard addiction treatment” based on a 2009 study called the“PHP-blueprint”  that reported remarkable success rates (80%).  The  high success rate is attributed primarily to close linkage with 12-step programs and the use of “residential and outpatient treatment programs that were selected for their excellence.”

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Mechanics and Mentality

The “PHP-blueprint” is abstinence based and 12-step participation is mandatory.   Random frequent drug and alcohol testing is used with zero-tolerance. A positive test results in an out-of-state “PHP-approved” assessment center and concepts such as “potentially impairing illness” and “relapse without use” are accepted.  The core organizational structure includes the state PHP, commercial drug testing labs and a number of  out-of-state “PHP-approved” assessment and treatment centers.  The PHP’s have no regulation or oversight.  The testing, assessments and treatment are out -of-pocket cash only.The assessment and treatment centers have very little oversight and because the  commercial drug-testing labs use non-FDA approved laboratory developed tests (LDTs)  they are not regulated.  No agency exists to provide sanctions for faulty or even fraudulent testing.  No internal or external avenues of complaint exist.  It is essentially a closed system in which no outside opinion is acknowledged let alone addressed.    Transparency and accountability are absent. Due process is absent.   Every “PHP-approved” facility is represented by a Like-Minded Doc and many of the doctors involved in the drug-testing process are also on the list of LMDs.   It is a rigged system and explained  here.    Choice in assessment and treatment is removed and the “PHP-approved” facilities engage in “diagnosis rigging” and are willing to label people with diagnoses when they do not in fact meet the diagnostic criteria for that diagnosis.  Pervasive problems include:

–Labeling normal variations in behavior as pathological

–Failing to receive proper diagnosis and effective treatment in those who need it

–Forcing unneeded evaluations and treatments including forced committment

 

Pervasive and Serious Concerns

Physician Health Programs- More Harm Than Good?  was the first article critical of  PHPs. “Physician health programs under fire” was recently published in the British Medical Journal (BMJ). The lack of accountability and financial and ideological conflicts of interest are addressed.  Complaints include coercion,  threats, “diagnoses rigging,” lab fraud and false diagnoses to  to support unneeded treatment.    The physician health program model is a major factor in the current suicide epidemic in doctors.

Profit Motive and Plans for Expansion

In his Editorial Haning  mentions a “national organization for advocacy of treatment of the mentally ill” called NAMI and this stands for the  National Association of Mental Illness (NAMI). It is considered a pharmaceutically funded front-group founded by Abott Labs, Pfizer, Eli-Lilly and pharmaceutical manufacturers.  They all market drugs for mental illness.    Mother Jones reported  $11+ million over 5 years from Big Pharma, and an Eli Lilly executive directed operations from their headquarters..  A U.S. Senate investigation revealed Big Pharma contributed $23 million in a just two years and until forced by the Senate Finance Committee to identify its corporate donors  had refused to do so. The “Campaign to Stop the Stigma of Mental Illness”  was started by NAMI and the group claims one out of five adults will suffer some form of mental illness in their lifetime.    The system is designed to provide a seemingly altruistic agenda but is in actual fact driven and funded by groups who profit from labelling more people mentally ill.     It is, in fact, the very same business model as what we see here but the primary profiteers are not Big Pharma but Big Rehab -the multi-billion dollar drug and alcohol testing, assessment and treatment industry.images-4

What is planned is explicitly spelled out in the  ASAM White Paper on Drug Testing . This is a Trojan horse for expanding the “PHP-blueprint.”  The business mode is similar to the razor or printer model.  The razor or printer does not generate a profit, the razor and printer cartridge replacements do recurrently.  PHPs are simply employee assistance programs (EAPs). Selling the PHP (i.e replacing an existing EAP) does not turn a profit, the non-FDA approved drug and alcohol testing does (and the referrals to the “approved” assessment and treatment centers.    The New York Times reported that the size of the US drug-screening industry grew from $800 million in 2000 to $2 billion in 2013.

Infrastructure Already in Place 

The drug and alcohol assessment, treatment and testing organizations are already present To replace an EAP with the PHP model  it is only necessary to convince an employer or  administrative agency in charge of professional licensure.   If elected as public policy advocates for addiction treatment they will most assuredly be lobbying and working on state and federal laws and aligning themselves with licensing boards to remove due process and civil liberties by “medicalization”.  This could impact anyone from our elderly, to our military, pregnant women, nursing mothers and school children. It is a testing and treatment  Trojan Horse.   They will be pushing public policy to coerce people into treatment who do not need treatment.

Creating Bogus Risks of Danger

Linking patient harm to “impaired” doctors is one of the primary propaganda techniques used by the FSPHP to forward the assessment, testing and treatment agenda. Be creating fear in hospital administrators, medical boards and the public ( “The Junkie in the O.R.” ) This appeal to  consequences (argumentum ad consequentiam) is suggested by Haning in the editorial. He states the public will react to consequences such as crime, trauma in the workplace, spread of infectious disease and “impact of childhood development of the disordered family “as potential consequences. The PHP system uses a medical license as “leverage” but any other license or benefit provided by the state could be used in the same manner.   This is what is called “contingency management” and how this is done is discussed in the ASAM White Paper on Drug Testing.

FSPHP/FASAM/LMD

 

 

screen-shot-2016-09-29-at-7-11-01-amThe primary architects of this system can be found on a list of Fellows of the American Society of Addiction Medicine. The list can be seen  here and includes  G. Douglas Talbott,  Robert Dupont, and  Paul Earley whose contributions to the current paradigm I have detailed in previous posts.   The list also includes  Greg Skipper  who introduced the first non-FDA approved  laboratory developed test for alcohol and is currently promoting  Soberlink -another junk science gadget that is prominently advertised as the top header in the current issue of   ASAM Weekly.

The list of like-minded docs was taken down from the website several months ago. Below is a screenshot taken the week prior.  On this list are Dupont, Earley, Skipper and the medical director’s of every single “PHP-approved” assessment and treatment center and it must be a small world after all because if you look at this list it has the name “Bill Haning” on it.  You will also find him on the list of ASAM Fellows.

 

 

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PHYSICIAN OR PROFESSIONAL HEALTH PROGRAM (PHP) SURVEY

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PHYSICIAN OR PROFESSIONAL HEALTH PROGRAM (PHP) SURVEY

Professional Health Program (PHP) 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.