12-step Coercion

Disrupted Physician 101.1: The “Impaired Physician Movement” and the History of the American Society of Addiction Medicine (ASAM).

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Disrupted Physician 101.1: The “Impaired Physician Movement” and the History of the American Society of Addiction Medicine (ASAM).

Henry David Thoreau

“With one arm around the shoulder of religion and the other around the shoulder of medicine, we might change the world.”—Twelve Steps and Twelve Traditions, AA World Services, Inc (1953).

In 1985 the British sociologist G. V. Stimson wrote:

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

The American Society of Addiction Medicine’s mission is to “establish addiction medicine as a specialty recognized by professional organizations, governments, physicians, purchasers, and consumers of health care products, and the general public.”  

In this they have succeeded.images-4

And in the year 2014 Stimson’s characterization of the “impaired physician movement” remains as accurate and apt as it was in 1985. But the “number of evangelical recovered alcoholic and addict physicians” has increased dramatically  (outnumbering Addiction Psychiatry by 4:1)  and their involvement in “ medical society and treatment programs” has been realized and enforced through the state Physician Health Programs and their “PHP-approved’ assessment and treatment centers.

Their “ability to make authoritative pronouncements on physician impairment…based on their own claim to insider’s knowledge”  has become public policy and sanctified by Regulatory Medicine.

And the 1953 Alcoholics Anonymous prophecy that “With one arm around the shoulder of religion and the other around the shoulder of medicine, we might change the world” is also coming to pass.

But the world is not changing for the better as that arm around the shoulder of religion has its fingers deep in the pockets of the multi-billion dollar drug and alcohol testing and assessment and treatment industries.  And the arm around the shoulder of medicine has its fingers clamped tightly around its throat; a stranglehold in full throttle suffocating the Profession of Medicine with no meaningful opposition I can see.

American Doctors Are Killing Themselves and No One Is Talking About It–By Gabrielle Glaser via the Daily Beast

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Screen Shot 2015-03-23 at 7.31.40 PMVia the Daily Beast:   http://www.thedailybeast.com/articles/2015/03/23/american-doctors-are-killing-themselves-and-no-one-is-talking-about-it.html

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Excerpt:

“Doctors who acknowledge problems with substances or mental health are typically referred to a physicians health program, or PHP. These organizations evaluate, monitor, and treat physicians. Established initially in the 1970s, PHPs, which exist in almost every state, were intended to divert physicians suffering from alcohol or drug problems from censure from their state medical boards. PHPs are incorporated as nonprofits and have autonomy from the boards. But some PHPs breach confidentiality if they fear a doctor is a danger to the public. And some state medical boards also fund their PHPs. Since the boards hold the keys to licensure, many say this is a conflict of interest.

There are growing concerns about whether PHPs have the right approach to the job. They typically send doctors to rehab programs rooted in the faith-and-abstinence principles of Alcoholics Anonymous. While AA’s 12 steps might work for some with alcohol-use disorders, critics say most PHP recommendations are ill suited for patients with mental health problems.

J. Wesley Boyd, a Harvard psychiatrist who left his post as assistant director of the Massachusetts PHP over a disagreement about practices there, says PHPs routinely intimidate their clients. In an article he co-wrote for the Journal of Addictions Medicine in 2012, Boyd noted that many doctors who seek or are referred by colleagues for treatment are mandated to attend pre-selected rehabilitation facilities for 60 to 90 days. Afterward, they must agree to monitoring and drug testing, typically at their own cost. When doctors resist PHP recommendations, they risk losing their livelihood and their licenses.”

For full article see:  http://www.thedailybeast.com/articles/2015/03/23/american-doctors-are-killing-themselves-and-no-one-is-talking-about-it.html

Physician Suicide

mllangan1 45 Comments

Physician Suicide.

Physician Suicide 101:  Secrets, lies and solutions by Dr. Pamela Wible, M.D., is now featured on KevinMD.com.  Please read and comment!   We need to use this as a stepping stone to start discussing the Elephant in the room; state Physician Health Programs (PHPs) organized under the Federation of State Physician Health Programs.  These programs once served the dual purpose of helping sick doctors and protecting the public from harm.

Taken over by the “impaired physician” movement the current manifestation is one of absolute power and unrestrained managerial authority with no meaningful oversight, regulation or accountability.  It is a culture of institutional injustice that is preventing doctors from seeking help for fear of being ensnared and monitored by them.  Those being monitored by them are subject to bullying, abuse and forced 12-step indoctrination under threat of loss of licensure.  Many of these doctors do not even have an addiction or substance use disorder.   Situational factors, a “one-off” or even a false accusation can result in monitoring by these programs that encourage confidential referral for things such as being behind on medical charts.  Sham peer-review is rampant.32-640x472

Moreover, the authority bestowed on this group is both illegitimate and irrational. The mechanics and mentality of the Federation of State Physician Health Programs conforms to that of the American Society of Addiction Medicine (ASAM). Although there are some Addiction Psychiatrists involved, the vast majority are  “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.

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Dr. Gregory H. Miday (1982-2012) A Doctor who would have made this world a better place.

In fact, 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 related to 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.

A note from Dr. Karen Miday whose son Greg died by suicide after having a Corona in Peurto Rico while on vacation:

Dr. Gregory H. Miday ( 1982-2012) My physician son died of suicide 2 years ago while being monitored by the Missouri PHP. When he called to notify them of his relapse (while vacationing in Puerto Rico) and his intent to admit himself to a local public treatment center (decision made in consultation with his psychiatrist during an office visit that morning) the PHP said they did not approve of the plan. They told him to come speak with them instead. He chose otherwise. His phone calls to the PHP were the last ones he ever made. Clearly, he did not see them as benevolent. I sincerely doubt that he is their only casualty. Yet, where are the statistics? How many others have died under their watch. Strangely, the clinical director ( an RN, and likely recovering addict) told my husband that no internal review of my son’s case was planned. Such reviews after a suicide are mandatory at every public mental health facility I have practiced at. Our best and our brightest are being subjected to substandard care without any oversight or accountability. I can’t bring my son back. I do hope, however, that others will join me in an effort to pull the curtain back on these programs and perhaps save other lives. Karen Miday, MD, Cincinnati, OH

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.

These individuals have been granted unrestrained managerial prerogative and absolute power over 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?  Why would anyone be against procedural fairness and transparency in any situation? These are legitimate questions.

State Medical Societies, Departments of Public Health, the American Medical Association, the American Council on Graduate Medical Education, the Institute of Medicine and other Accreditation and Professional Organizations need to start addressing this.

This is a Public Health Emergency that is not going away.  It needs to be addressed directly and with urgency; not with kid gloves and temporization.

Accountability is without exception.  It requires both the provision of information and justification for actions.   Accountability also requires consequences for actions if they breach standards-of-care, ethics and the law.

 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.

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

Physician Suicide, the “Impaired Physician Movement” and ASAM:  The Dead Doctors at Ridgeview Institute under G. Douglas Talbott, by Michael Langan, M.D.

Disrupted Physician 101.1: The “Impaired Physician Movement” and the History of the American Society of Addiction Medicine (ASAM)

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Disrupted Physician 101.1: The “Impaired Physician Movement” and the History of the American Society of Addiction Medicine (ASAM).

Henry David Thoreau

“With one arm around the shoulder of religion and the other around the shoulder of medicine, we might change the world.”—Twelve Steps and Twelve Traditions, AA World Services, Inc (1953).

In 1985 the British sociologist G. V. Stimson wrote:

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

The American Society of Addiction Medicine’s mission is to “establish addiction medicine as a specialty recognized by professional organizations, governments, physicians, purchasers, and consumers of health care products, and the general public.”  

In this they have succeeded.images-4

And in the year 2014 Stimson’s characterization of the “impaired physician movement” remains as accurate and apt as it was in 1985. But the “number of evangelical recovered alcoholic and addict physicians” has increased dramatically  (outnumbering Addiction Psychiatry by 4:1)  and their involvement in “ medical society and treatment programs” has been realized and enforced through the state Physician Health Programs and their “PHP-approved’ assessment and treatment centers.

Their “ability to make authoritative pronouncements on physician impairment…based on their own claim to insider’s knowledge”  has become public policy and sanctified by Regulatory Medicine -essentially the Word of the Lord.

And the 1953 Alcoholics Anonymous prophecy that “With one arm around the shoulder of religion and the other around the shoulder of medicine, we might change the world” is also coming to pass.

But the world is not changing for the better as that arm around the shoulder of religion has its fingers deep in the pockets of the multi-billion dollar drug and alcohol testing and assessment and treatment industries.  And the arm around the shoulder of medicine has its fingers clamped tightly around its throat; a stranglehold in full throttle suffocating the Profession of Medicine with no meaningful opposition I can see.

Utilizing the Medical Profession as a Urine Collection Agency–The ASAM White Paper on Drug-Testing

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“The rights of every man are diminished when the rights of one man are threatened.” ― John F. Kennedy

Before the  2012 Drug and Alcohol Testing Industry Association (DATIA) annual conference, Dr. Robert Dupont delivered a speech entitled “Drug Testing and the Future of American Drug Policy.”    He describes a “New Paradigm” for substance abuse treatment that enforces “zero tolerance for alcohol and drug use”  that is enforced by monitoring with frequent random drug and alcohol tests in which positive tests are “met with swift, certain, but not draconian, consequences.” The paradigm is based on the current Physician Health Programs blueprint.  Dupont states:

“…physician health programs , have set the standard for effective use of drug testing. These pioneering state programs provide services to health care professionals with substance use disorders. The programs are run by physicians, some of whom in recovery themselves. PHPs feature relatively brief but highly focused treatment followed by active lifelong participation in the 12-step fellowships of Alcoholics Anonymous and Narcotics Anonymous. The key to the success of the PHP system of care management is the enforcement of the standard of zero tolerance for any alcohol or other drug use by intensive long-term random testing for both alcohol and drugs with swift and certain consequences for even a single use of alcohol or any other drugs of abuse. PHPs use drug panels of 20 or more drugs. The PHPs commonly use EtG and EtS tests to detect recent alcohol use. Similar comprehensive programs have been developed for commercial pilots and attorneys. These innovative programs of care management produce unprecedented long-term, outcomes.”

Physician Health Programs use a doctor’s medical license as “leverage” in what they call “contingency management.”   What this means is that a doctor who is being monitored by a PHP must comply with any and all demands of the PHP under threat of being reported to the state Medical Board and loss of licensure. Dupont wants to extend the PHP model to other populations including kids.

The 2013 American Society of Addiction Medicine White Paper on Drug Testing describes the organizational structure of the “New Paradigm” which includes utilization of the medical profession as a urine collection agency for their drug and alcohol testing. When a doctor-patient relationship exists the testing is rendered “clinical” rather than “forensic.” Thus the consequences of a positive test can be deemed “treatment” rather than punishment. This bypasses the strict chain-of-custody and Medical Review Officer requirements designed to ensure accuracy and minimize false-positives.  Forensic drug testing is tightly regulated because the results a positive test can be grave and far reaching.  Erroneous results are unacceptable.

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The ASAM paper describes mandated drug-testing for patients in a number of specialties including adolescent medicine, psychiatry, obstetrics, and geriatrics.  Contingency management will involve “the potential for loss of current or desired employment, or threatened loss of or restrictions on a professional or commercial license, or legal and forensic necessity.”
“This White Paper encourages wider and “smarter” use of drug testing within the practice of medicine and, beyond that,broadly within American society. Smarter drug testing means increased use of random testing* rather than the more common scheduled testing,* and it means testing not only urine but also other matrices such as blood, oral fluid (saliva), hair, nails, sweat and breath when those matrices match the intended assessment process. In addition, smarter testing means testing based upon clinical indication for a broad and rotating panel of drugs rather than only testing for the traditional five-drug panel.”

As onerous, unwarranted and unjust as this future dystopia sounds it may very well come to fruition.    Across the country doctors have been going to the media, law enforcement, and the ACLU complaining of ethical breaches, civil rights violations, abuse and criminal activity only to be turned a deaf ear.   The Federation of State Physician Health Programs has been able to construct this scaffold with no meaningful opposition and below the public radar. They have done this by removing accountability at all levels.  By preventing access to information and erecting a system without oversight no consequences exist to deter misconduct and abuse.  The same tactics and strategies will be used as they expand this to other populations.

American Society of Addiction Medicine, The Federation of State Physician Health Programs, and Like-Minded Docs 

“With one arm around the shoulder of religion and the other around the shoulder of medicine, we’d resolve their differences. Having learned to live so happily, we’d show everybody else how. Why, we thought, our Society of Alcoholics Anonymous might prove to be the spearhead of a new spiritual advance! We might transform the world”.–Twelve Steps and Twelve Traditions 1953  A.A. World Services

The American Society of Addiction Medicine exists to trump the 12-step chronic relapsing brain disease model of addiction as defined by A.A.   The authoritarian view necessitates the authority maintain authority so everything is engineered around that goal.

The American philosopher Eric Hoffer noted:

“The only way to predict the future is to have power to shape the future. Those in possession of absolute power can not only prophesy and make their prophecies come true, but they can also lie and make their lies come true.” 

The PHP model is built on the very foundation Hoffer describes.

“Addiction Medicine” not a recognized medical specialty.

This begins with the ASAM itself.  “Addiction Medicine” and ABAM “board certification” is not recognized by the American Board of Medical Specialties.  The requirements for this self-certification are not commensurate with ABMS certifications and only requires a medical license and board certification in ANY specialty.

Dubious Drug Testing-Not FDA approved, Conflicts-of-Interest

Federal workplace drug testing is done in accordance with mandatory guidelines. This testing is regulated using FDA approved tests with established sensitivity, specificity, and cutoff levels.  FDA approval requires rigorous research and proven validity.    The FDA requires valid scientific evidence (with both clinical and analytical validation)     The  FSPHP has introduced non-FDA drug testing via a loophole that removes accountability.  The EtG, EtS, and PEth tests were introduced as  Laboratory Developed Tests (LDTs) with little evidence base.  The LDT pathway was developed for “clinical” tests of low market potential that would not otherwise make it to market as the FDA approval process would be prohibitive.  An LDT  does not even require in vivo testing or proof that the test actually tests for what it s claimed to test.   Without FDA oversight, however, the labs can claim anything they want with no accountability.   After getting the labs to develop the tests the FSPHP then convinced the Medical Boards they were both necessary and accurate and began using them on doctors in PHP programs.

Changing Public Policy and Regulatory Authority to Increase Power and avoid Accountability

The 2011 FSMB Policy on Physician Impairment identifies, defines, and essentially legitimizes “potential impairment” and “relapse without use.”

A PHP Should be empowered to conduct an intervention based on clinical reasons suggestive of potential impairment.  Unlike the Board which must build a case capable of withstanding
legal challenge, a PHP can quickly intervene based on reasonable concern."

“Empowered” to conduct an “Intervention” for reasons “suggestive” of “potential” impairment means a doctor can be pulled out of practice for anything.  It essentially gives them carte blanche authority. The disregard for physician rights, due process and validity is self-evident.

in 2011 The ASAM issued a Public Policy Statement on coordination between PHPs, regulatory agencies, and treatment providers recommending  that  only “PHP approved” treatment centers be used in the assessment and treatment of doctors.  A recent audit of the  North Carolina PHP found financial conflicts of interest and no  documented criteria for selecting the out of state treatment centers they used.  The common denominator the audit missed was that the 19  “PHP-approved” centers were all ASAM facilities whose medical directors can be seen on this list.

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.”

According to the FSPHP, physician illness and impairment exist on a continuum with illness typically predating impairment, often by many years.”

The policy extends PHP authority to cover physical illnesses affecting cognitive, motor, or perceptive skills, disruptive physician behavior, and “process addiction” (compulsive gambling, compulsive spending, video gaming, and “workaholism”). It also defines “relapse without use” as “behavior without chemical use that is suggestive of impending relapse.”

G. Douglas Talbott defines  “relapse without use”  as  “emotional behavioral abnormalities” that often precede relapse or “in A A language –stinking thinking.”  AA language has entered the Medical Profession and no one even blinked.  It will get worse.

The ASAM has  monopolized addiction treatment in the United States.   It has imposed  it on doctors through the FSPHP.  The FSPHP political apparatus exerts a monopoly of force. It selects who will be monitored and dictates every aspect of what that entails.  It is a, in fact, a  rigged game.

The Need for Regulation, Oversight, and Accountability

Accountability is necessary to prevent corruption and requires both the provision of information and justification for actions. What was done and why?   Accountability also necessitates consequences-the ability of outside actors to punish and sanction those who commit the misconduct.  Without these constraints corruption is inevitable.

In  2012 Drs. John Knight and Wes Boyd recommended the medical community outside of PHPS provide oversight and demand accountability.  As with the NC PHP audit,   Ethical and Managerial Considerations Regarding State Physician Health Programs  generated little interest from the medical community at large.

Because addiction is currently defined as a disease, addicts must be “treated” (which in the United States is more often coercive than voluntary), and “cured” (which is defined as remaining abstinent). When the disease concept is not strictly reserve for medical conditions but is expanded to any and all drug and alcohol use.

And this is how the ASAM “New Paradigm” will encroach upon others.  This is why the ACLU needs to get involved. This is not just about doctors but about the future of society.

The ASAM white paper contains the following quote minimizing the critical role of the MRO in drug testing.   They feel clinical testing is good enough.   And unless you want mandated random drug and alcohol testing at your physician visits using non-FDA approved testing with swift and certain consequences you will need to speak up.   This occurred in the medical profession rapidly and with little notice. And that is how it will occur in other venues.

Unlike forensic drug testing where the test results must be able to meet rules of evidence in administrative, civil or criminal proceedings, clinical drug testing* is part of a patient examination performed by a clinician with whom the patient is in a therapeutic relationship. The testing is used for the purposes of diagnosis, treatment, and the promotion of long-term recovery. Clinical drug test results must meet the established standards of medical practice and benefit the therapeutic relationship, rather than meeting the formal legal requirements of forensic testing. Drug testing in medicine employs the same sound procedures, safeguards, and systems of information management that are used for all other health-related laboratory tests, tests on which life-and death medical decisions are commonly made.

State Physician Health Programs have no meaningful oversight or accountability.  Across the country doctors are reporting ethical and civil rights abuses and even criminal activity to law enforcement, the ACLU and the media.  With the exception of North Carolina their complaints were patently ignored.  Feeling hopeless, helpless, defeated and entrapped many are killing themselves.   Institutional justice is a protective factor for preventing suicides.  None exists here.  The North Carolina PHP audit  revealed conflicts-of-interest and no oversight by the state medical society or board.   The audit also found that abuse could occur undetected because of this lack of accountability.

There seems to be a willful ignorance or apathy regarding PHPs.  Perhaps most take the side of the PHPs complacent that these are just helping sick doctors and protecting the public the complaints are nothing more than “bellyaching.”       In reality the misconduct and abuse perpetrated by the PHPs is commensurate with the behavior of Dr. Farid Fata,  the Detroit Oncologist who intentionally misdiagnosed patients with cancer so he could make money off unnecessary chemotherapy treatment.  Dr. Fata’s egregious betrayal of trust and unconscionable acts generated a flurry of comments.  His vile acts resulted in an appropriate response.

The exact same misconduct is being perpetrated by PHPs but being overlooked, justified or otherwise ignored.  Dr. Fata intentionally misdiagnosed patients with cancer who did not have cancer so he could give them chemotherapy to make money.   PHPs are intentionally misdiagnosing substance abuse and behavioral disorders in physicians who do not have them in order to give them unneeded treatment and force them into monitoring contracts to both make money and gain control.

It undermines the very integrity of the profession.  It is particularly vile when the betrayal of trust involves doing the opposite of what was entrusted.   Abuse of positions of power, trust and influence in the field of medicine need to be both prevented, recognized and addressed.    Oversight, regulation and accountability are essential  if this is going to be accomplished.  There are no exceptions.   Policies and procedures must be enforced in a consistent manner.

The medical boards, medical societies, and departments of health have given the state PHPs carte blanche control and absolute power.  They will not even investigate misconduct or even crimes.

And the PHPs have convinced law enforcement that this is a parochial matter.  Doctors reporting crimes are often turned back over to the PHP.

This refusal to investigate  or even acknowledge valid and factual complaints of professional misconduct has not only prevented the exposure of  wrongdoing and corruption but deepened it.    How does wrongdoing and corruption serve the best interests of the public or promote public health?  It doesn’t.    How could  a culture that protects the perpetrators of unethical and indefensible misconduct yet turns a deaf ear to their victims possibly contribute to the common good? It can’t.  And giving  an oppressive, illegitimate and irrational tyranny absolute power and granting them unrestrained managerial prerogative over doctors is fallacy.

“Every time we turn our heads the other way when we see the law flouted, when we tolerate what we know to be wrong, when we close our eyes and ears to the corrupt because we are too busy or too frightened, when we fail to speak up and speak out, we strike a blow against freedom and decency and justice.”
― Robert F. Kennedy

 

aaadrugtest

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Robin Williams Melancholy Suicide–Hopelessness, Helplessness, and Defeat

mllangan1 1 Comment

Disrupted Physician

 
 
There’s something in his soul
O’er which his melancholy sits on brood,
And I do doubt the hatch and the disclose
Will be some danger—which for to prevent,
I have in quick determination……..
It shall be so.    Madness in great ones must not unwatched go.
—Hamlet Act III, Scene 1
According to Radar Online Robin Williams is looking “grim and focused.”  Grim? Yes. Focused? No.  His visage is one of entrapment, despair, and dread.
In  F. Scott Fitzgerald’s  The Great Gatsby, Nick Carraway observes that “the loneliest moment in someone’s life is when they are watching their whole world fall apart, and all they can do is stare blankly”   This is not focus but melancholia–hopelessness, helplessness, and defeat.
In 1896 Émile Durkheim described “melancholy suicide” as being “connected with a general state of extreme depression and exaggerated sadness, causing the patient no longer to realize sanely the…

View original post 2,366 more words

State Mandated 12-step –Establishment Clause Violations Run Amok- (Anonymity and Moral Inventories Optional)

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V0011377 A quack doctor selling remedies from his caravan; satirizing

“The surest way to work up a crusade in favor of some good cause is to promise people they will have a chance of maltreating someone. To be able to destroy with good conscience, to be able to behave badly and call your bad behavior ‘righteous indignation’—this is the height of psychological luxury, the most delicious of moral treats.” Aldous Huxley -Chrome Yellow 1921

A letter of agreement with the BORM, drafted at the behest of Physicians Health Service Inc., and signed by me 1/20/12 under threat of loss of my medical license specifically mandates participation “in a minimum of three 12-step meetings per week” and submit proof to PHS, “develop an “active 12-step sponsor relationship with someone who is not a healthcare professional.”

These requirements were made because I requested an independent evaluation at a non-biased  non-12-step assessment center not affiliated with the ASAM.    The choices PHS gave me were all 12-step facilities with Medical Directors who can be seen on this list.   My request for an independent evaluation was justified as the MRO for PHS is on the same list.  The same MRO who allowed PHS to misrepresent the positive EtG tests and fabricate a confirmatory positive PEth.

The PHS monitoring contract states that positive laboratory reports will be reported to the Board “with the exception of those medications that have been properly prescribed for a legitimate medical purpose and of which PHS has been informed in advance or of which PHS has approved” and that positive drug results are reportable to the Board “unless PHS is provided with advance verification of such medications.”

PHS claimed that I had been told to discontinue medications used to control and treat lifelong asthma.   I had not.   I provided the Board with multiple documents contradicting PHS claims.

An August 24, 2009 from Dr. Luis Sanchez, M.D. to the Board states:

“Dr. Langan has informed PHS that he is being prescribed two asthma inhalers. By FDA mandate, the inhaler manufacturers changed to ethyl alcohol propellants in January of this year. Dr. Langan has provided documentation of this medication. Physician Health Services (PHS) will be working with Dr. Langan to determine whether there are alternative options for asthma treatment that do not utilize ethanol as a propellant. Meanwhile, PHS has advised him to continue to use this medication as needed and as directed by his treatment providers.”

After discussing alternative options with my PHS associate director, John Knight, M.D., it was decided to continue them as prescribed. This decision was based on the history and severity of my asthma and the good control and treatment these mediations provided. As a child and young adult I had multiple emergency room visits and was hospitalized several times for asthma, but the medications had prevented any serious asthma attacks for the previous 10 years.

A letter dated January 1, 2010 from Louis Sanchez acknowledges continued use of the asthma inhalers. He writes: “Dr. Langan has provided PHS documentation of this medication. PHS has concluded that there was no evidence of relapse at this time.”

The documentary evidence shows that PHS acknowledged the prescribed medications, considered me compliant, and advised I continue to use them.

A February 10 2010 letter to my Chief, Dr. Kenneth Minaker, M.D. acknowledges the relationship between the medication and the alcohol biomarker Etg and affirms compliance with my PHS contract:

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No EtG tests were done until June 20 and June 30, 2011. PHS reported these as “positive” by claiming I was told to discontinue my asthma medications. I provided the Board with multiple documents that contradict this claim and suggested that Dr. Knight be contacted to verify this was untrue.   I also requested written documentation to support PHS claim. The Board ignored the contradictory documentation, did not contact John Knight, and neither PHS nor the Board could provide any documentation to support the claim that I was told to discontinue the medication.  They still haven’t.

Reporting a positive test to the Board for a prescribed and acknowledged medication would be in violation of the PHS monitoring contract. Claiming the medications were discontinued allowed PHS to report these tests as true positives and also do a “confirmatory” test. The Etg was used as a stepping-stone to order a blood being used by Physician Health Programs to differentiate “incidental” exposure from drinking.

They were aware of the medications, aware they contained ethanol, and aware that they caused positive Etg levels but reported it anyway under the pretext that I was told to discontinue the medication.   This misrepresentation was then “confirmed” by fraud.

There is no known cutoff level for Etg to differentiate incidental exposure from drinking. It should be noted that the use of ethanol containing metered dose inhalers is not “incidental” exposure but “direct” exposure and reporting them as positive violates all established protocols and guidelines.  PHS then used forensic fraud for confirmation.

On July 1st, 2011, Dr. Gary Chinman of PHS informed me that I had positive EtG tests on June 20th, and June 30th, 2011. I was told to go to Quest Laboratories to obtain a confirmatory blood test.   On July 19th, 2011 I was informed that the test was positive at a markedly high level of 365. The cutoff level of PEth is 20 and a level of 365 suggests heavy sustained alcohol use. Common sense would have dictated this to be erroneous at this point based on my appearance, work performance, and all collateral information.

I immediately requested evaluations from my PCP and the Chief of Addiction Medicine at MGH. They both did full evaluations (including speaking with my supervisors and colleagues,  physical exams, and laboratory tests ) and wrote letters to the Board contradicting PHS claim. The Board was well aware that no other pretext existed to suggest alcohol use except for these tests. The Board ignored all outside information and continued to support PHS.

Suspecting the test was fabricated I requested the “litigation packet.” PHS initially refused. I persisted in obtaining the results and PHS finally agreed but threatened me with “unintended consequences.”   I received the “litigation packet” in December of 2011 and it revealed fraud. A fax dated July 19, 2011 from PHS to USDTL requested that my ID # (1310) and a chain-of-custody be added to an already positive specimen 19 days after it was collected.

This evidence of fraud was provided to the Board in December of 2011. This was followed by a letter from the Chief of Toxicology at MGH opining that the positive test was an intentional and purposeful act by PHS to misrepresent an invalid test as valid.11:5:12-Dr. Flood Letter–Ignored by PHS:USDTL:BORM

The test has since been invalidated as a result of a complaint filed with the College of American Pathologists (CAP), an accrediting agency for the labs.

To sum this up I knew that the test was fabricated at the time and  it was subsequently verified as fabricated ),  I simply wanted a fair and objective evaluation from an assessment facility with no conflicts of interest.  Marworth, Hazelden, or Bradford were the three choices given–all heavily indoctrinated ASAM facilities with close ties to the state Physician Health Programs.

Both PHS and the Board denied this request in violation of the Establishment Clause of the 1st Amendment.   The Board’s Complaint Committee found I was in violation of my Letter of Agreement because I did not immediately enter into one of the three programs offered.  On December 21st, 2011 the Board concurred that I was in violation of my LOA and chose to  “resolve the matter” by extending my contract by two years and “fortifying certain provisions” including

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BORM 12:22:2011

Interestingly, PHS had mandated thrice weekly 12-step meetings for a duration of three months.   The Board took it upon themselves to extend it from three months to 2-years–an ultra vires act outside the scope and power of the Board and an obvious Establishment Clause violation.     The Board also gave PHS carte blanche managerial prerogative to “submit proof of said participation” at the thrice weekly 12-step meetings.     PHS chose names and telephone numbers of fellow attendees at anonymous meetings as the burden of proof!    I informed the Board that obtaining unique identifiers such as names and telephone numbers to provide to a State substance abuse monitoring agency would be a tall order as “anonymous” is half its name.   They did not take this into consideration.  PHS also mandated under threat of my license that I could no longer use the asthma inhalers that had been controlling my asthma for the past decade.

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PHS Letter 12:6:11-phone numbers:claims lab will support test

PHS Letter March 2012 Requesting Signatures

But the requirement that I humiliate myself by attending meetings at which I don’t belong and try to convince anonymous attendees to breach their anonymity wasn’t enough.   I had to do it while wheezing.    The Board forbade me from any of my asthma MDIs and essentially all of the propellants were replaced with ethanol by Federal mandate to protect the Ozone.   Dr. Knight and I looked into alternatives previously and decided that due to the severity of my asthma and the control achieved by my current medications I would continue them as prescribed.  As cold and exercise were two major contributors to asthma attacks I had to stop going to the gym and I had 19 major asthma attacks during that winter.  My PCP documented the wheezing and shortness of breath at my checkups.

And to kick a wheezing fellow asking inappropriate requests at A.A. while he’s down, the  Board extended PHS requirement of thrice weekly mandated AA meetings from 3 months to 2 years on their own accord.   This is an inappropriate ultra vires act by the Board.  It is outside the scope of their authority and an obvious Establishment Clause violation.

PHS had fun with the phone numbers.  This is all documented in multiple e-mails such as these:Screen Shot 2014-10-14 at 1.31.49 PMScreen Shot 2014-10-14 at 1.29.20 PM Screen Shot 2014-10-14 at 1.27.34 PM

It soon became apparent that my attorney was doing nothing.   At a meeting with PHS I told them that getting names and phone numbers at 12-step meetings was inappropriate and that Dr. Chinman was asking personal questions.  My attorney turned to me and said “Well they have to ask questions. They need to make sure you’re not just paying somebody to say you were at a meeting?    It then dawned on me that he had insisted on blaming the positive PEth test on my asthma inhalers and never even contacted the labs.    He also refused to call Hazelden to verify that they had not made the request for phone numbers.   I was told that this is the case  with most PHPs.  They refer you to a few attorneys who they know well and give a lot of business who will not bite the hand that feeds them.    Another component of this rigged game.

On October 9th I received the following e-mail from my attorney:Screen Shot 2014-10-14 at 1.44.23 PM

And on October 23, 2012 PHS formally reported my “noncompliance” with 12-step meetings to the Board

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It has now become clear why this occurred at this time.  Nevertheless the Board has outlined the decision making process from beginning to end right here in the February 6th, Board Order.

The modified Letter of Agreement specifically states that I must attend 3 “12-step” meetings per week and obtain a “sponsor.” No alternatives were offered and it is well established that mandated AA or 12-step by the State is in violation of the 1st Amendment.   The Board then suspended me for allegedly not complying with the 12-step requirement.   My suspension was, in fact, an Establishment Clause violation.

On April 8th, 2013, Attorney William Burgess of the Appignani Legal Center wrote a letter to PHS and The Board identifying the Establishment Clause violations and requested written response in how they would be remedied.  This can be seen here:Secular_substance_abuse_treatment_options_for_MA_doctors

Board attorney Barbara replied on April 19th, 2013 with “the physician who you named in your letter currently has an open matter with the Board and, therefore it would be inappropriate for the Board members to receive your letter.   Additionally, as you are not the attorney of record for the physician, I am unable to comment on the assertions you have made regarding the physician and his interaction with the Board and PHS.”  The letter can be seen here:  boardresponse5:1:13

This non-response is unacceptable.   The Establishment Clause violations have been pointed out to the Board. Whether or not I have an open matter with the Board is irrelevant. Who identifies the violation is irrelevant as the law is clear on this matter.

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The Proof PHS required was the name and phone number of a fellow attendee who they could call to verify my attendance.   PHS mandated thrice weekly 12-step meetings per week for 3 months then once per week. The Board then again violated the Establishment Clause by taking it upon themselves to lengthen my sentence. and extended it from 3 months to 2 years.

A “12-step” program is a set of guiding or “spiritual principles” outlining a course of action for recovery from addiction, compulsion, or other behavioral problems. Originally proposed by Alcoholics Anonymous (AA) as a method of recovery from alcoholism.1 The Twelve Steps were first published in the book Alcoholics Anonymous: The Story of How More than One Hundred Men Have Recovered from Alcoholism in 1939.2 The 12-step ideology has been adopted by other groups such as Narcotics Anonymous and Overeaters Anonymous and that, except for the identified problem source, are carbon copies of one another

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The proof of attendance at 12-step groups, as documented in the attached letters from PHS, mandated that I “provide PHS with the phone number of a consenting meeting participant” which is against the “suggested Alcoholics Anonymous (AA) policy regarding “cooperation with the courts.” The suggested AA policy is to sign “first name only to a card,” and even this “is not always accepted.”

According to Alcoholics Anonymous General Services3 “while most meetings will sign your court card, some will not. It is up to each individual group to decide. Since AA is not allied with the court system, AA is not required to do the courts work. We are not court employees.   If a meeting chairperson or group member offers to sign your court card they will probably just sign their first name or initials. We are personally anonymous,” and “regardless of an A.A. member’s vocation, reporting on the “progress” of another A.A. member is strictly outside the scope of what A.A. does.”

The act of obtaining phone numbers at anonymous meetings not only violates the rights of the person being forced to do it but the rights of the other attendees. The basic tenet of AA is that it is for people who desire to be there and the spiritual foundation of is anonymity. Anonymity, by definition, refers to an individual’s personal identity, or personally identifiable information, being unknown. Signing a first name to a card provides anonymity. Providing a first name and a telephone number most assuredly does not as it is a unique identifier, not unlike a social security number or driver’s license number, and can easily be used to uniquely identify that person. Consequently, trolling for phone numbers to be given to an unfamiliar non-governmental state affiliated agency from anonymous members of a categorically anonymous group that considers anonymity as the spiritual core of its existence, presents a tall order.

Nevertheless, despite being half of its name, the BORM accepted the statement from PHS that obtaining names and phone numbers at 12-step meetings was accepted without question and I was not allowed to challenge or question the decision before the BORM.

Difficult as it was, I was able to provide them with phone numbers despite PHS’ attempts to make it as difficult as possible as documented in the attached e-mails and letters that include my concern that this Sisyphean task was merely designed as a failsafe to deem me noncompliant with the BORM should the need arise. It was.

In addition to coercion PHS continued to engage in threats, intimidation, and “torture” (an act committed by a person acting under the color of law specifically intended to inflict severe physical pain or suffering upon another person within his custody or physical control).

On 11/8/2012 the BORM found I was in violation of this agreement and referred the case to the full Board for sanction based on alleged “noncompliance” with the ordered attendance.

The First Amendment states in the “Establishment Clause that “Congress shall make no law respecting an establishment of religion.”  Acts of direct coercion, threats backed by legal sanctions, are barred by the Establishment Clause.

Legally, Alcoholics Anonymous is established as a religious organization.  And so is Narcotics Anonymous.  This is well established and as far as United States courts are concerned AA and NA are, beyond a doubt, organizations that engage in religious activities and their meetings qualify as religious services.

Applying a standard three-part test to determine whether my constitutional rights have been violated

  1. Has the state acted?
  2. Was there coercion?
  3. Was the object of the coercion religious rather than secular?

As to point one the answer is clearly affirmative.  PHS’ recommendations to the BORM were that I do the following:

  • Participate in a minimum of (3) PHS approved 12 step meetings per week for the next 3 months including at least 1 physician meeting a week and document your participation with the signature of a consenting attendee and a phone number for the consenting attendee.  After 3 months you must attend at least 1 PHS approved support meeting a week and 1 physician meeting a month
  • Develop an active sponsor relationship and provide consent for this sponsor to confirm twice a year with PHS that he/she is your sponsor.

The Board wrote this up in the letter of agreement without offering any other options.

Coercion-point two—also is clearly present by force of law and threat of penalty.   The elements of coercion are 1. A forced choice,  2. Threat of sanction, 3. Coercive ijntent.

The BORM states if I attempt to negotiate or dispute PHS’ recommendation I will be “immediately suspended.”  Your money or your life.

Point three is now well established. (see notes below)

Mandating phone numbers as proof of attendance makes this particularly egregious as they inappropriately demanded I engage in a religious based program and violate the basic principles of the program (anonymity).

Moreover, the request for mandated 12-step attendance was not made out of “good faith” or beneficence. It was a retaliatory act designed to punish me because I questioned the results of a drug test that was done on July 1st, 2011 and reported as a confirmatory positive for alcohol use.

As a result of this test PHS requested an evaluation at a facility of their choosing. They were all -12-step facilities with medical directors they knew well. All ASAM/LMD and in 12-step recovery themselves

Because PHS had previously (2008) misrepresented the results of a drug test to justify sending me to an out of state facility for an evaluation where the facility fabricated neuropsychological testing to support “denial and cognitive impairment” resulting in forced inpatient rehabilitation I requested that the BORM allow an evaluation at an independent facility that did not have a referral relationship with PHS (and the inherent conflicts of interest that exist).4   The BORM would not consider the requests, said I had to go to one of the choices I was given, and added to more years to my contract because I had the audacity to request an alternative.

I also requested the laboratory (USDTL) “litigation packet.” Considered a legal document, this record is generated in any forensic (as opposed to clinical) laboratory -testing, and records the collection, shipping, handling, and testing of the sample. It is done to document that a drug test was done correctly on the person it was supposed to done on. It follows a specific protocol that involves strict chain of custody followed by MRO review.

PHS was resistant to my request for the “litigation packet,” but I eventually got it and, as Dr. Flood’s opinion letter shows, the test was fabricated. Chain of custody was nonexistent. The BORM refused to look at it. I filed a complaint with the College of American Pathologists (CAP) and an investigation was done which showed that the test was manipulated. Although the lab was sanctioned under threat of losing accreditation by CAP, as a non-governmental organization with no regulations and accountable to no one, PHS continued to support the validity of the test.

On December 4th, 2012 I got the following e-mail documenting that the laboratory issued an amended report mandated by CAP that showed the external chain of custody was not followed and thus making it an invalid test.

The amended report was issued on October 4th, 2012. I called Linda Bresnehan at PHS to ask for a copy of the amended report. She said she just got the report that day and issued a letter to the BORM December 11, 2012 stating that they just received the revision to the lab test but they “did not make a determination of relapse following the positive test,” they were not “aware of any action taken” by the BORM, and that they would continue to “disregard it.”

The BORM did not consider the logic that the very basis for my forced attendance at AA meetings and all of the other negative consequences thrown at me was this very test. Nor did they take into consideration the fact that the amended report was issued in October and the temporal relationship to them finding me out of compliance with AA meetings.

Instead, the BORM found me out of compliance with PHS which is essentially a lie (noncompliance) based upon a lie (saying that Hazelden recommended 3x per week AA meetings with phone numbers) based upon a lie (a fabricated test).

But the forensic fraud,  “color of law” abuse, Civil rights violations, harassment, intimidation, and abuse qualifying as criminal harassment  under 42 U.S.C. § 1983 -subject to a systematic scheme of harassment and intimidation   Personal humiliation, embarrassment and mental distress) and arguably a violation of the Bill of Rights under cruel and unusual punishment are irrelevant. So too is the arrogant over-the-top bizarrely inappropriate request for phone numbers. Even without these factors entering the picture the Establishment Clause violations are clear.    And the fact that they ignored the request to remedy a Civil rights violation is indefensibly unconscionable.    They acted with malice, willfulness, and callous and reckless indifference to the safety and rights of my family and me.  The “Right to be secure in one’s person” is an aspect of liberty protected by the due process clauses of both the Fifth and Fourteenth Amendments.  And “Liberty” is Constitutionally protected by both the Fifth and Fourteenth Amendments, and also a protectable deprivation of due process. The liberty interest is violated and actionable by any conduct of persons acting under color of law that “shocks the conscience” (Massachusetts Civil Rights Act is M.G.L. c. 12 § 11I).  

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Notes:

The First Amendment states in the “Establishment Clause that “Congress shall make no law respecting an establishment of religion.” Acts of direct coercion—threats backed by legal sanctions—are barred by the Establishment Clause.

Three federal courts have held that coerced participation in 12-step programs like AA and NA violates the First Amendment. In Kerr v. Ferry, 95 F.3d 472 (7th Cir 1996), the Seventh Circuit held that requiring an inmate to attend NA meetings or risk suffering adverse effects for parole eligibility violated the Establishment Clause. The Second Circuit reached a similar conclusion in Warner v. Orange County Department of Probation, 115 F.3d 1068 (2d Cir. 1997), striking a probation condition requiring attendance at AA meetings.

In 2007 the Ninth Circuit Court of Appeals held that a parole officer’s demand that a convicted drug offender attend Narcotics Anonymous violated the First Amendment rights of the offender who claimed to be a Buddhist (Inouye v. Kemna, 504 F.3d 705 (9th Cir. 2007)).

Moreover, the case ruled that “any coercing authority” can be held individually, civilly liable for the First Amendment constitutional rights violation that they perpetrate on people unwillingly and involuntarily forced to go to 12-step programs and the offender was free to sue the parole officer for damages, even though state officials are often immune form such suits.

In both the Warner and Inouye cases, the courts found the law sufficiently clearly established to abrogate the officer’s qualified immunity. Qualified immunity shields government officials from liability for civil damages “insofar as their conduct does not violate clearly established statutory or constitutional rights of which a reasonable person would have known. (Harlow v. Fitzgerald 4567 U.S.C. 1983)

Warner and Inouye were able to go forward with lawsuits against their officers for damages for violation of their constitutional rights under 42 U.S.C. 1983. (Civil action for deprivation of rights). Numerous federal and district courts and state supreme courts have reached the same conclusion.

What this means is that you can sue a judge, a prison warden, a parole officer, a “counselor, a medical board member, or anyone else in a position of authority who forces you to go to AA meetings.

In cases like this the courts found that the government had forced the person to attend AA or NA. In other cases, where state of local officials simply made participation in AA one option for substance abusers, courts have no found any Establishment Clause violation.

[29] “For the government to coerce someone to participate in religious activities strikes at the core of the Establishment Clause of the First Amendment, whatever else the Clause may bar.” Inouye v. Kemna, 504 F.3d 705, 712 (9th Cir. 2007). The Ninth Circuit articulated the following test in Inouye v. Kemna “with regard to determining whether [Plaintiff] was [subject to] governmental coercion of religious activity . . . : ‘first, has the state acted; second, does the action amount to coercion; and third, is the object of the coercion religious rather than secular?’” Id. at 713. “First, [Crofoot] acted in his official state capacity as a parole officer to order [Plaintiff into a 12-step program that contained religious components]. That the state did not run the program itself is ‘of no moment.’” Id. (quoting Kerr v. Farrey, 95 F.3d 472, 479 (7th Cir. 1996)). It is undisputed that Crofoot, Wilding, and Jallins were acting in their official state capacities when they required Plaintiff to participate in the 12-step drug treatment program as a condition of his parole, and subsequently removed and incarcerated him for not participating in the program.

[30] Further, the Parole Defendants’ “action was clearly coercive: [Plaintiff] could be imprisoned if he did not attend and he was, in fact, ultimately returned to prison in part because of his refusal to participate in the program.” Inouye, 504 F.3d at 713 (emphasis added). The Parole Defendants argue Plaintiff was returned to prison because he was “disruptive” in the program. This argument rings hollow in light of the undisputed facts showing Plaintiff was only “disruptive” in the program “‘in a congenial way’” and “was ‘sort of passive aggressive.’” (Partial Mot. SUF ¶¶ 12, 13.) It is also undisputed that Plaintiff communicated his objection to participation in the Empire program and that Crofoot told Plaintiff he “should continue to participate in the Empire Program or he would be returned to prison.” (Id. ¶ 10.) It is further undisputed that Crofoot and Wilding concluded that “the right thing to do” was to refer Plaintiff to the Board of Parole Hearings “on a parole violation for failing to participate in the BPH-ordered program.” (Id. ¶ 15.) It is also undisputed that Deputy Commissioner Jallins authorized Plaintiff to be returned to prison because of Plaintiff’s failure to participate in the program. (Id. ¶¶ 18-19, 24.)

[31] “The final element requires somewhat more discussion.” Kerr, 95 F.3d at 479. It is undisputed that “Empire used a 12-step program that included references to God and a ‘higher power.’” (Partial Mot. SUF ¶ 3.) Further, Plaintiff’s following averments in his declaration have not been controverted:

[32] Shortly after arriving at Empire, I discovered that Empire used a “12-step” recovery program based [on] the principles of Alcoholics Anonymous (“AA”) and Narcotics Anonymous (“NA”), which contains religious components. Among other features, the “12-step” method used by Empire made references to God, involved acknowledgment of a “higher power,” and included prayer. [¶] I am an atheist, and was one in 2007. The substantial religious components to the “12-step” program administered by Empire conflicted with my beliefs. Prior to my release on parole, I had notified correctional authorities of my Atheism, and requested placement in a treatment facility that did not contain religious components.

[33] (Hazle Decl. ¶¶ 2, 3.) The Parole Defendants do not dispute that the Empire’s 12-step program contained religious components. “As such, on this summary judgment record and given the lack of dispute between the parties in question, . . . the third prong of [Plaintiff’s] Establishment Clause test has been met as well.” Inouye, 504 F.3d at 713-14. Therefore, “the program runs afoul of the prohibition against the state’s favoring religion in general over non-religion,” because of the program’s use of a religious concept of a Higher Power through references to God and prayer. Kerr, 95 F.3d at 480. Accordingly, Plaintiff’s partial motion for summary judgment against the Parole Defendants is granted.

[34] B. Plaintiff and Westcare’s cross motions for summary judgment on Plaintiff’s Establishment Clause claim

It is beyond dispute that, at a minimum, the Constitution guarantees that government may not coerce anyone to support or participate in a religion or its exercise (Lee v Weisman 505 U.S)

Legally, Alcoholics Anonymous is established as a religious organization. And so is Narcotics Anonymous. This is well established and as far as United States courts are concerned AA and NA are, beyond a doubt, organizations that engage in religious activities and their meetings qualify as religious services.

Applying a standard three-part test to determine whether my constitutional rights have been violate

  1. Has the state acted?
  2. Was there coercion?
  3. Was the object of the coercion religious rather than secular?

As to point one the answer is clearly affirmative. PHS’ recommendations following my evaluation at Hazelden (See PHS letter dated 10/27/2011) include:

  • Participate in a minimum of (3) PHS approved 12 step meetings per week for the next 3 months including at least 1 physician meeting a week and document your participation with the signature of a consenting attendee and a phone number for the consenting attendee. After 3 months you must attend at least 1 PHS approved support meeting a week and 1 physician meeting a month
  • Develop an active sponsor relationship and provide consent for this sponsor to confirm twice a year with PHS that he/she is your sponsor.

Coercion-point two—also is clearly present by force of law and threat of penalty.   The elements of coercion are 1. A forced choice, 2. Threat of sanction, 3. Coercive intent.

Motion to Take Judicial Notice of Adjudicative Facts Pertaining to Violation of the Establishment Clause of the First Amendment

Motion to Take Judicial Notice of Adjudicative Facts

Motion to Take Judicial Notice of Law

BORM 11:8:2012 12:4:12-BORM Letter 12:21:11-BORM Board Order 12:22:11-BORM Violation LOA 12:27:2011-BORM LOA American Humanist Letter to BORM boardresponse5:1:13 BORM 12:22:2011 BORM Agreement Emergency Petition to Return to Practice.011013 letter re secular substance abuse treatment options for MA doctors (reply to PHS) v2-1 Liebert Letter to BORM 11:14:2011– Ltr JLH to Harvey.122812.01 Secular_substance_abuse_treatment_options_for_MA_doctors  EMAILSLIEBERT