abuse of power

Physician Suicide and “Physician Wellness” –Time to start talking about the elephant in the room!

mllangan1 9 Comments

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Physician Suicide and the Elephant in the Room

Michael Langan, M.D.

Although no reliable statistics exist, anecdotal reports suggest an alarming upsurge in physician suicide. This necessitates a reappraisal of known predisposing risk factors such as substance abuse and depression but also requires a critical examination of what external forces or vulnerabilities might be unique to doctors and how they might be involved in the descent from suicidal ideation to suicidal planning to completed suicide.

Depression and Substance Abuse Comparable to General Population

Depression and substance abuse are the two biggest risk factors for suicide. The prevalence of depression in physicians is close to that of the general population1,2 and, if one looks critically at the evidence based literature, substance abuse in medical professionals approximates that of the general population.  Controlled studies using DSM diagnostic criteria suggest that physicians have the same rates (8-14%) of substance abuse and dependence as the rest of the population 3 and slightly lower rates compared to other occupations.4,5 Epidemiological surveys reveal the same. Hughes, et al.6 found a lifetime prevalence of drug or alcohol abuse or dependence in physicians of 7.9%, markedly less than the 14.6% prevalence reported in the general population by Kessler.7

State Physician Health Programs

Perhaps it is how physicians are treated differently when they develop a substance abuse or mental health problem.

Physician Health Programs (PHP) may be considered the equivalent to Employee Assistance Programs (EAPs) for other occupations. PHPs meet with, assess and monitor doctors who have been referred to them for substance use or other mental or behavioral health problems. Originally developed as “impaired physician” programs, the PHPs were created to help doctors who developed problems with substance abuse or addiction as an alternative to disciplinary action by State Medical Boards. These programs existed in almost every state by 1980. Often staffed by volunteer physicians and funded by State Medical Societies, “impaired physician” programs served the dual purpose of both helping sick colleagues and protecting the public. Preferring rehabilitation to probation or license revocation (so long as the public was protected from imminent danger)  most medical boards accepted the concept with support and referral.   However, most EAPs were developed with the collaboration of workers unions or some other group supporting the rights and interests of the workers.  Not so with PHPs  as there is no such organization representing doctors.   PHPs developed in the absence of regulation or oversight.    As a consequence there is no meaningful accountability.   

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

“Because PHP practices are unknown to most physicians before becoming a client of the PHP, many PHPs operate out- side the scrutiny of the medical community at large. Physicians referred to PHPs are often compromised to some degree, have very little power, and are, therefore, not in a position to voice what might be legitimate objections to a PHP’s practices.”8

Noting that “for most physicians, participation in a PHP evaluation is coercive, and once a PHP recommends monitoring, physicians have little choice but to cooperate with any and all recommendations if they wish to continue practicing medicine,” Knight and Boyd raise serious ethical and managerial questions about current PHP policies and practice including conflicts of interest in referrals for evaluation and treatment, lack of adherence to standards of care for forensic testing of substances of abuse, violations of ethical guidelines in PHP research, and conflicts of interest with state licensing boards.

Knight and Boyd recommend “that the broader medical community begin to reassess PHP’s as a whole” and that “consideration be given toward the implementation of independent ethical oversight and establish and appeals process for PHP clients who feel they are being treated unfairly.” 8 They also recommend the relationship of PHP’s between the evaluation and treatment centers and licensing boards be transparent and that national organizations review PHP practices and recommend national standards “that can be debated by all physicians, not just those who work within PHPs.”8 Unfortunately this has not happened. Most physicians have no idea that the state physician health programs have been taken over by the “impaired physicians movement.”

In his Psychology Today blog,  Boyd again recommends oversight and regulation of PHPs.   He cites the North Carolina Physicians Health Program Audit released in April of 2014 that reported the below key findings:

As with Knight and Boyd’s paper outlining the ethical and managerial problems in PHPs, the NC PHP audit finding that abuse could occur and not be detected generated little interest from either the medical community or the media.

Although state PHPs present themselves as confidential caring programs of benevolence they are essentially monitoring programs for physicians who can be referred to them for issues such as being behind on chart notes. If the PHP feels a doctor is in need of PHP “services” they must then abide by any and all demands of the PHP or be reported to their medical board under threat of loss of licensure.

State PHP programs require strict adherence to 12-step doctrine9 yet many of the physicians monitored by them are neither addicts nor alcoholics. Some do not even have substance abuse issues and there are reports of “disruptive” physicians being diagnosed with “character defects” at the “PHP-approved” facilities that do these assessments.   PHPs require abstinence from drugs and alcohol yet use  non-FDA approved Laboratory Developed Tests in their monitoring programs. Many of these tests were introduced to commercial labs and promoted by ASAM/FSPHP physicians.10-12

LDTs bypass the FDA approval process and have no meaningful regulatory oversight.   The LDT pathway was not designed for “forensic” tests but clinical tests with low risk.   Some are arguing for regulation and oversight of LDTs due to questionable validity and risk of patient harm.13

These same physicians are claiming a high success rate for PH programs9 and suggesting that they be used for random testing of all physicians.14

As with LDTs, the state PHPs are unregulated, and without oversight. State medical societies and departments of health have no control over state PHPs.

Their opacity is bolstered by peer-review immunity, HIPPA, HCQIA, and confidentiality agreements. The monitored physician is forced to abide by any and all demands of the PHP no matter how unreasonable-all under the coloration of medical utility and without any evidentiary standard or right to appeal.

The ASAM has a certification process for physicians and claim to be “addiction” specialists. This“board certification” is not recognized by the American Board of Medical Specialties and is not a recognized medical specialty. The goal of the ASAM is to be recognized as the experts in addiction medicine with the consensus expert opinion based on the 12-step prohibitionist brain disease model. The ASAM has aligned itself with a number of inpatient drug treatment centers  (Hazelden, Talbott, Marworth, Bradford,etc) and are heavily funded by the drug testing industry.   It is in fact a “rigged game.”

State PHPs are non-profit non-governmental organizations and have been granted quasi-governmental immunity by most State legislatures from legal liability.

By infiltrating “impaired physician” programs they have established themselves in almost every state by joining, gaining power, and removing dissenters. Groupthink and 12-step indoctrination are the goals. By advertising as advocates for doctors who are “caring,” “confidential resources,” “giving help,” and advocating for “colleagues in need” the outward appearance is one of benevolence.

The biggest obstacle is that this system allows them to throw the normal rules of conduct under the imperative of a higher goal assumed to trump all other consideration. Those outside of programs either defend or ignore the reports of ethical and criminal violations, complacent in their trust of these “experts” claiming they are just helping sick doctors and protecting the public.

With no oversight or regulatory body involved this is all done with impunity, immunity, and undercover. They use the accusation of substance abuse as an indication to disregard the claims of the accused. The physician is left without rights, depersonalized, and dehumanized. The imposition of confinement, stigmatization, lack of oversight of the organizations, peer-review protected confidentiality, and lack of procedural protection is a one-way train to hopelessness and despair.

By establishing a system that of coercion, control, secrecy, and misinformation, the FSPHP is claiming an “80% success rate” 15and deeming the “PHP-blueprint” as “the new paradigm in addiction medicine treatment.

The ASAM/FSPHP had a major influence on the DSM-V where drug abuse and dependence are no longer separate entities. They are also working behind the scenes to get legislation to randomly drug test all physicians.

They are now after the “disruptive physician” and the evidentiary criteria are fairly low and red flags include “deviating from workplace norm in dress or conduct” and being tardy for meetings.

They have identified “the aging physician” as a potential problem because “as the population of physicians ages,””cognitive functioning” becomes “a more common threat to the quality of medical care.”

The majority of physicians are unaware that the Federation of State Medical Boards House of Delegates adopted an updated Policy on Physician Impairment in 2011 that uses addiction as an example of a “potentially impairing illness.”  According to the Federation of State Physician Health Programs …”physician illness and impairment exist on a continuum with illness typically predating impairment, often by many years. This is a critically important distinction. Illness is the existence of a disease. Impairment is a functional classification and implies the inability of the person affected by disease to perform specific activities.”

“Process addiction” was added as a potentially impairing illness including compulsive gambling, compulsive spending, compulsive video gaming, and “workaholism.” According to the FSPHP “the presence of a process addiction can be problematic or even impairing in itself, and it can contribute to relapse of a physician in recovery. As such, process addictions should be identified and treated.” They define three levels of relapse including the novel “relapse without use.”

Bullying, Helplessness, Hopelessness and Despair

Perceived helplessness is significantly associated with suicide.16 So too is hopelessness, and the feeling that no matter what you do there is simply no way out17,18 Bullying is known to be a predominant trigger for adolescent suicide19-21 One study found that adolescents in custody who were bullied were 9.22 times more likely to attempt suicide than those were not bullied.22

Heightened perceptions of defeat and entrapment are known to be powerful contributors to suicide.23,24 The “Cry of Pain” model 25,26 specifies that people are particularly prone to suicide when life experiences are interpreted as signaling defeat which is defined as a sense of “failed struggle” or loss of social position and resources.. The person is unable to identify an escape from or resolution to a defeating situation, a sense of entrapment proliferates with the perception of no way out, and this provides the central impetus for ending ones life.

There is also evidence that rescue factors such as social supports may play a role in preventing suicide. These rescue factors act buffers to protect against suicide in the face of varying degrees of life stress.27,28 The study of female physicians revealed meetings to discuss stressful work experiences as a potential protective factor, 29 and support at work when difficulties arose appeared to be a protective factor for the male physicians.30   Research involving Finnish physicians found that control over one’s work and organizational justice were the most important determinants of work-related wellbeing.31,32 Organizational justice is related to fairness and refers to an individuals perception of an organizations behaviors, decisions, and actions and how these influence one’s own attitudes and behaviors and has been identified as a psychosocial predictor of health and wellbeing33 34Low organizational justice has been identified as a notable risk factor for psychological distress and depression.35,36

A recent report indicates that job stress, coupled with inadequate treatment for mental illness may play a role in physician suicide..

Using data from the National Violent Death Reporting System the investigators compared 203 physicians who had committed suicide to more than 31,000 non-physicians and found that having a known mental health disorder or a job problem that contributed to the suicide significantly predicted being a physician.1

Physicians were 3.12 times more likely to have a job problem as a contributing factor. In addition, toxicology testing showed low rates of medication treatment.  The authors concluded that inadequate treatment and increased problems related to job stress are potentially modifiable risk factors to reduce suicidal death among physicians.

They also warned that the database used likely underestimated physician suicides because of “underreporting and even deliberate miscoding because of the stigma attached.”

I can think of nothing more institutionally unjust than an unregulated zero-tolerance monitoring program with no oversight using unregulated drug and alcohol testing of unknown validity.

We have heard of numerous suicides due to these institutionally unjust programs.   Three doctors died by suicide in Oklahoma in a one month period alone (August 2014).   All three were being monitored by the Oklahoma PHP.   I went to an all boys high-school of less than 350 students yet a classmate a couple years ahead of me died by suicide a few months ago. He was being monitored by the Washington PHP. His crime?  A DUI in 2009–a one-off situational mistake that in all likelihood would never have recurred.  But as is often the case with those ensnared by state PHPs he was forced to have a “re-assessment” as his five-year monitoring contract was coming to an end.  These re-assessments are often precipitated by a positive Laboratory Developed Test (LDT) and state medical boards mandate these assessments can only be done at an out-of-state “PHP-approved” facility.    Told he could no longer operate and was unsafe to practice medicine by the PHP and assessment center he then hanged himself.  And at the conclusion of Dr. Pamela Wible’s haunting video below are listed just the known suicides of  doctors; many were being monitored by their state PHPs–including the first name on the list– Dr. Gregory Miday.

None of these deaths were investigated. None were covered in the mainstream media.   These are red flags that need to be acknowledged and addressed!    This anecdotal evidence suggests the oft-used estimate of 400 suicides per year (an entire medical school class) is a vast underestimation of reality—extrapolating just the five deaths above to the entire population of US doctors suggests we are losing at least an entire medical school per year.

As physicians we need to demand transparency, oversight, regulation and auditing by outside groups. This is a public health emergency.

To wit:

They first came after the substance abusers and I did not speak out because I was not a substance abuser.

They then came for those with psychiatric diagnoses and I did not speak out because I was not diagnosed with a psychiatric disorder.

They then came after the “disruptive physician” and I did not speak out because I was not disruptive.

They then came after the aging physician and I did not speak out because I was young.

They then came after me and there was no one else to speak out for me.

  1. Ford DE, Mead LA, Chang PP, Cooper-Patrick L, Wang NY, Klag MJ. Depression is a risk factor for coronary artery disease in men: the precursors study. Archives of internal medicine. Jul 13 1998;158(13):1422-1426.
  2. Frank E, Dingle AD. Self-reported depression and suicide attempts among U.S. women physicians. The American journal of psychiatry. Dec 1999;156(12):1887-1894.
  3. Brewster JM. Prevalence of alcohol and other drug problems among physicians. JAMA : the journal of the American Medical Association. Apr 11 1986;255(14):1913-1920.
  4. Anthony J, Eaton W, Mandell W, al. e. Psychoactive Drug Dependence and abuse: More Common in Some Occupations than in Others? Journal of Employee Assistance Res.1992;1:148-186.
  5. Stinson F, DeBakely S, Steffens R. Prevalence of DSM-III-R Alcohol abuse and/or dependence among selected occupations. Alchohol Health Research World. 1992;16:165-172.
  6. Hughes PH, Brandenburg N, Baldwin DC, Jr., et al. Prevalence of substance use among US physicians. JAMA : the journal of the American Medical Association. May 6 1992;267(17):2333-2339.
  7. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.Archives of general psychiatry.Jun 2005;62(6):593-602.
  8. Boyd JW, Knight JR. Ethical and managerial considerations regarding state physician health programs. Journal of addiction medicine. Dec 2012;6(4):243-246.
  9. DuPont RL, McLellan AT, White WL, Merlo LJ, Gold MS. Setting the standard for recovery: Physicians’ Health Programs. Journal of Medical Regulation. Mar 2010;95(4):10-25.
  10. Skipper GE, Weinmann W, Thierauf A, et al. Ethyl glucuronide: a biomarker to identify alcohol use by health professionals recovering from substance use disorders. Alcohol and alcoholism.Sep-Oct 2004;39(5):445-449.
  11. Skipper GE, Thon N, Dupont RL, Baxter L, Wurst FM. Phosphatidylethanol: the potential role in further evaluating low positive urinary ethyl glucuronide and ethyl sulfate results.Alcoholism, clinical and experimental research. Sep 2013;37(9):1582-1586.
  12. Skipper GE, Thon N, DuPont RL, Campbell MD, Weinmann W, Wurst FM. Cellular photo digital breathalyzer for monitoring alcohol use: a pilot study.European addiction research.2014;20(3):137-142.
  13. Sharfstein J. FDA Regulation of Laboratory-Developed Diagnostic Tests: Protect the Public, Advance the Science. JAMA : the journal of the American Medical Association. Jan 5 2015.
  14. Pham JC, Pronovost PJ, Skipper GE. Identification of physician impairment.JAMA : the journal of the American Medical Association. May 22 2013;309(20):2101-2102.
  15. McLellan AT, Skipper GS, Campbell M, DuPont RL. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. Bmj. 2008;337:a2038.
  16. Rivers I, Noret N. Potential suicide ideation and its association with observing bullying at school.The Journal of adolescent health : official publication of the Society for Adolescent Medicine. Jul 2013;53(1 Suppl):S32-36.
  17. Lester D, Walker RL. Hopelessness, helplessness, and haplessness as predictors of suicidal ideation. Omega. 2007;55(4):321-324.
  18. Beck AT. Hopelessness as a predictor of eventual suicide. Annals of the New York Academy of Sciences. 1986;487:90-96.
  19. Hinduja S, Patchin JW. Bullying, cyberbullying, and suicide. Archives of suicide research : official journal of the International Academy for Suicide Research. 2010;14(3):206-221.
  20. Hertz MF, Donato I, Wright J. Bullying and suicide: a public health approach. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. Jul 2013;53(1 Suppl):S1-3.
  21. Kim YS, Leventhal B. Bullying and suicide. A review. International journal of adolescent medicine and health. Apr-Jun 2008;20(2):133-154.
  22. Kiriakidis SP. Bullying and suicide attempts among adolescents kept in custody.Crisis.2008;29(4):216-218.
  23. Taylor PJ, Gooding P, Wood AM, Tarrier N. The role of defeat and entrapment in depression, anxiety, and suicide. Psychological bulletin. May 2011;137(3):391-420.
  24. Lester D. Defeat and entrapment as predictors of depression and suicidal ideation versus hopelessness and helplessness. Psychological reports. Oct 2012;111(2):498-501.
  25. Williams JMG. Cry of Pain. Harmondsworth: Penguin; 1997.
  26. Williams JMG, Crane C, Barnhofer T, Duggan DS. Psychology and suicidal behavior: elaborating the entrapment model. In: Hawton K, ed. Prevention and treatment of suicidal behavior: from science to practice. Oxford: Oxford University Press; 2005:71-89.
  27. Borowsky IW, Ireland M, Resnick MD. Adolescent suicide attempts: Risks and protectors.Pediatrics. 2001;107(485).
  28. Clum GA, Febbraro GAR. Stress, social support and problem-solving appraisal/skill: Prediction of suicide severity within a college sample.Journal of Psychopathology and Behavioral Assessment. 1994;16:37-46.
  29. Fridner A, Belkic K, Marini M, Minucci D, Pavan L, Schenck-Gustafsson K. Survey on recent suicidal ideation among female university hospital physicians in Sweden and Italy (the HOUPE study): cross-sectional associations with work stressors. Gender medicine. Apr 2009;6(1):314-328.
  30. Fridner A, Belkic K, Minucci D, et al. Work environment and recent suicidal thoughts among male university hospital physicians in Sweden and Italy: the health and organization among university hospital physicians in Europe (HOUPE) study. Gender medicine. Aug 2011;8(4):269-279.
  31. Lindfors PM, Meretoja OA, Toyry SM, Luukkonen RA, Elovainio MJ, Leino TJ. Job satisfaction, work ability and life satisfaction among Finnish anaesthesiologists. Acta anaesthesiologica Scandinavica. Aug 2007;51(7):815-822.
  32. Heponiemi T, Kuusio H, Sinervo T, Elovainio M. Job attitudes and well-being among public vs. private physicians: organizational justice and job control as mediators. European journal of public health. Aug 2011;21(4):520-525.
  33. Elovainio M, Kivimaki M, Vahtera J. Organizational justice: evidence of a new psychosocial predictor of health. Am J Public Health. Jan 2002;92(1):105-108.
  34. Lawson KJ, Noblet AJ, Rodwell JJ. Promoting employee wellbeing: the relevance of work characteristics and organizational justice. Health promotion international. Sep 2009;24(3):223-233.
  35. Hayashi T, Odagiri Y, Ohya Y, Tanaka K, Shimomitsu T. Organizational justice, willingness to work, and psychological distress: results from a private Japanese company. Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine. Feb 2011;53(2):174-181.
  36. Lang J, Bliese PD, Lang JW, Adler AB. Work gets unfair for the depressed: cross-lagged relations between organizational justice perceptions and depressive symptoms. The Journal of applied psychology. May 2011;96(3):602-618.

 

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Michael Langan, M.D.

“Sham Peer Review”–Informative Discussion of the Underhanded Tactics Used by the Morally Disengaged Bullies Who Have Occupied the Medical Profession

mllangan1 17 Comments

Dr.  Lawrence Huntoon lectures on the common tactics used by the enemy forces who have taken an uninvited seat at the table of power in the regulation and control of the noble profession of medicine.  Collectively this band of nitwits and thugs  represent an enemy occupation and the damage has been ruinous to both the science and the art.  Clinical decision making has been reduced to algorithmic pathways and binary options that throw knowledge base and clinical acumen out the window and replaced them with  a heap of feel-good bottom-line poorly constructed dictates. These simple-minded marauders are nothing more than idiots with sticks but they’ve bamboozled the citizenry,  sweetheart-swindled the politicians and Robber barroned  their  morally disengaged  logical  fallacy into bandwagon reality under the rhetoric of cost containment and public welfare.

An enemy force has occupied our turf and it has indeed been ruinous.  Pride, integrity and enlightenment  have been torn out of the medical profession by the acceptance of poisonous ideas and concrete thinking and this disease  has  viruntly spread  from regulatory agencies to hospital administrators to those charged with governing academic medicine.

I recently spoke with a medical resident who yelled at a nurse as she was about to fatally inject  an anti-arrythmic medication at 10x the dose into a patient’s IV.   Had he not intervened the patient would in all probability have died and he undoubtedly saved  the patient’s life.  This fact is irrelevant in the current climate as the nurse he yelled at reported him for it and instead of seeing this as an acute human emotional response in a tense situation where a patient’s life was in danger,  the powers that be interpreted it as a red flag and recommended he be assessed for anger issues.  The evaluators suggested an inpatient evaluation and the assessing facility recommened treatment in their cash-only facility which, as a resident physician,  he did not have the means to pay.  Without the treatment he could not return to his residency program.  The nurse who almost killed this patient was cleared ( it was deemed a systems error) of any wrongdoing while the doctor who saved the patients  life has potentially lost  his career because he exhibited an understandable human response to a crises situation –  Apparently he should have said “pretty please” or whispered “just don’t let this happen again”

I heard of another case in which  a patient had  had multiple colonoscopies, endoscopies and batteries of lab tests for an undiagnosed gastrointestinal ailment for which no one could come up with a diagnosis.  The patient subsequently consulted with an independent astute diagnostician and who came up with an accurate yet unusual diagnosis; a so called zebra among the horses and he was able to treat the condition and the.symptoms abated within a week.  Coming up with the correct diagnosis when others have failed is an accomplishment that has historically generated the praise of one’s colleagues; met with respect, admiration, a toast and round of applause. But those days are long gone and instead of accolades this astute diagnostician and finder of the cause and cure of a difficult diagnosis got a raft of shit and sneers as the sniveling sheeple dong repeated colonoscopies without a clue felt disrespected.  He made them look bad.  He failed to communicate with them and they reported him to hospital administration for being “unprofessional” An investigation ensued that took on a life of its own.  Mobbing and sham peer review followed and he ended up dying by suicide– A death sentence for making a brilliant and correct diagnosis.

Medical Urban Legend–The Legacy of the 4 MDs and why B.S. Needs to be Identified from the Get-Go!

mllangan1 20 Comments
photo

“Because I can Biotches! That’s right..because I can!”

According to G. Douglas Talbott, rehabilitation programs that evaluate and treat the rest of the population for substance abuse issues are incapable of doing so in doctors as they are unlike any other inhabitants of our society.   Physicians are unique. Unique because of their incredibly high denial”, and this genetically inherent denial is part of what he calls the “four MDs.” Used to justify the thrice lengthier length of stay in physicians the “four-MDs” are as follows: “M-Deity”, “Massive Denial” “Militant Defensiveness” and “More Drugs.”

He states that “Impaired doctors must first acknowledge their addiction and overcome their ‘terminal uniqueness’ before they can deal with a drug or alcohol problem.”
Now some  doctors are arrogant undisciplined egotists but narcissistic personalities exist in any profession and expanding traits that may apply to a small percentage of doctors to include all doctors as a universal truth contradicts reality. Applying a stereotypical paternalistic length of treatment in doctors three times as long as non-doctors to force a “one-size” fits all treatment on them has no evidence base.

tumblr_kuwuugSEmN1qz6z0no1_500This dicto simpliciter argument can, in fact, be refuted simply by pointing it out! Sadly, no one ever did so the ASAM front-group hasbeen able to establish this caricature of the arrogant paternalistic know it all needing 3 months or more of treatment as standard of care for our profession. They did this by getting medical boards and the FSMB to accept fantasy as fact by relying on board members tendency to accept expert evidence at face value–which they always do and that is a personality characteristic that I would argue is not dicto simpliciter.

Physicians are unique only insofar as the unique elements required of the profession to become and be a physician such as going to medical school and completing the required board examinations.

Any and all doctors referred to a PHP for assessment will spend at least 3 months in treatment if the facility feels it is indicated. It is inevitable. No one has challenged a patently absurd generalization that has absolutely no evidence base or plausible scientific or medical explanation. Of course those sentenced to the 3 or more months have complained but by that time they are de-legitimized and stigmatized. No one to complain to.  After all, these are just redeemed altruistic non-profit  good guys protecting the public and helping colleagues forge a path to salvation!
All the ASAM/FSPHP quacks have to do at that point to deflect legitimate concerns is point out the one doing the complaining is an “addict” who is “in denial” and it is part of his “disease.”  The mere accusation of substance abuse is used to disregard the claims of the accused.
Authoritative opinion entrenched. Someone should have called B.S. long ago.  But no one did and if they had we would not be in the current situation which is only going to go from bad to worse as the ASAM plan for universal contingency-management and urine usury unfolds-–A “golden age.” And the 4MDs Talbott attributes to doctors are all wrong. There is only one MD and it is “medical license.” On second thought that may not be entirely true.  “More money” may be another. And I am not talking about a doctor’s income. I am referring to insurance and the specter of depleting home and hearth.   Fiscal annihilation. Your license or your life.   And the only true  and plausible answer that Talbott could give to justify the lengthy stay is “Because I can biotches!” And “contingency-management” sounds better than extortion doesn’t it?  And  using your medical license as “leverage” sounds a helluva lot better than holding it for ransom.
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The ‘A’ Word: Are Doctors Arrogant?
Leslie Kane
June 17, 2014
Good Doctors Have Some Bad MomentsDoctors’ personalities have become a hot topic, not only because warmth and pleasantness count toward patient satisfaction, but also because positive patient interactions have a role in better outcomes.Physicians’ personalities are under the microscope as patients post reviews of doctors on numerous Websites. In some reviews, the word “arrogant” has shown up. But calling doctors arrogant is nothing new.Are there really so many arrogant doctors? No doubt, some physicians deserve the label, but it seems to be a stereotype that has blossomed and taken on its own life.”Arrogance among doctors is not the norm”, says Marion Stuart, PhD, co-author of The 15 Minute Hour: Therapeutic Talk in Primary Care, and Professor Emeritus in the Department of Family Medicine at UMDNJ-Robert Wood Johnson Medical School. “Someone who has done the hard work and has gone into medicine because they care about people, and are interested in helping peoples’ lives and making the world a better place, is not going to be arrogant.”So how did the arrogant doctor epithet arise?In the past, doctors were considered authorities who told compliant patients what to do and treated them with a paternalistic attitude. Some doctors may retain those behaviors today.Another possibility is overgeneralizing. A patient sees a doctor who has a difficult personality and assumes that the trait is more widespread within the profession than it really is.Arrogance or Self-confidence?

“Arrogance is totally different from self-confidence,” says Dr. Stuart. “When you’re confident, that’s your assessment of your own competence. You have the experience and the wisdom, you know what you can do, and your confidence says that. It’s your relationship to yourself and your own expertise,” she says.

Arrogance is a different ballgame. “This has to do with your judging that other people are inferior,” she says. “It has more to do with not seeing other people as being up to your standards.”

Could the confidence that comes with being accomplished and successful make someone arrogant? Typically no, says Dr. Stuart. The trait of arrogance develops or resides within a person at a much earlier stage, arising from one of two paths:

“I am indeed better.” Someone who has always lived a privileged life, feels entitled to all of the finer things, or has always been looked up to may take it as a given that he or she is better than others. “People who had a sheltered, protected existence with no perception of what the real world is like for other people may consider themselves an elite group, entitled to feel superior,” says Dr. Stuart.

“I made it, so why can’t you?” By contrast, a person who was deprived as a child and worked very hard to pull himself up by the bootstraps may then look down on others who don’t have the same perseverance or initiative to take charge of their life and create similar success.

Doctors Are Harried and Pressured; Patients Are More Demanding

Some doctors have admitted that at times it’s hard to maintain their patience, and frustration triggers a snappish response. Throw into the mix the fact that doctors may have less time to see each patient and answer questions, and you have the ingredients for a negative interaction.

“I’ve had eight years of medical education and I’ve been trying to get my patient to make healthy lifestyle changes, and he comes in with a page ripped out of a tabloid, convinced that the information is right…there’s a limit to how much time I can spend ‘educating’ or convincing them that their ‘cure’ has no scientific basis,” one physician told me.

People have come to expect the stance of “the customer is always right” and get annoyed if doctors don’t accede to all of their requests. But because of new medical practice guidelines, a doctor may not readily give the patient the test or medication they ask for. “Now, with healthcare insurers and companies setting limits on doctors, many times the patient feels that the doctor is not so much on their side, and this could be perceived as arrogant,” says Dr. Stuart.

Is There an Outbreak of Rudeness?

Barry Silverman, MD, a cardiologist and coauthor with pediatrician Saul Adler, MD, of Your Doctors’ Manners Matter: Better Health Through Civility in the Doctor’s Office and in the Hospital, says, “While most doctors are appreciated and respected by their patients, there’s a general perception that professionalism has declined.

“Patients are often more informed, ask detailed questions, and demand a high level of service, while demands on the doctor’s time increase and reimbursements fall,” says Dr. Silverman. “What patients interpret as arrogance is many times a rushed and harried doctor, not an uncaring one. Medicine can be mentally and physically exhausting, but the bottom line is that the doctor must listen and communicate with the patient to deliver quality medical care.”

Still, remaining pleasant and calm is easier for some doctors than for others. There’s no uniform physician personality; many doctors have a natural “people person” inclination, while others are more stoic.

Are doctors expected to smile and be nice in every circumstance, no matter what?

“Professionalism is not about putting on a happy face or being someone you are not; it is about providing quality care for the patient,” says Dr. Adler. “Patients are more informed and have access to more information than ever before. Much of that information is incorrect and sometimes harmful. That means that part of the professional duty is to teach as well as treat.

“Patients understand that doctors have significant restraints on their time, and it is not unreasonable for doctors to use preprinted written materials, educational resources outside the doctor’s personal office, and honest and informative Websites,” says Dr. Adler. “However, under no circumstances should the doctor be rude or abrupt; a smile and kind, considerate behavior is always appropriate.”

It would be naive to say that there aren’t arrogant doctors. But there are far more doctors trying to do their best for patients and relate to them.

Medscape Business of Medicine © 2014 WebMD, LLC

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The “Impaired Physician Movement” takeover of state Physician Health Programs (PHPs).

mllangan1 6 Comments

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“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.”–G.V. Stimson  (1)

Forget what you see; Some things they just change invisibly–Elliott Smith (Between the Bars)

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Physician Impairment

The Sick Physician: Impairment by Psychiatric Disorders, Including Alcoholism and Drug Dependence, published by the American Medical Association’s (AMA) Council on Mental Health in The Journal of the American Medical Association in 1973, (2)  recommended that physicians do a better job of helping colleagues impaired by mental illness, alcoholism or drug dependence. The AMA defined an “impaired physician” as “a physician who is unable to practice medicine with reasonable skill and safety to patients because of mental illness or excessive use or abuse of drugs, including alcohol.”

Recognition of physician impairment in the 1970s by both the medical community and the general public led to the development of “impaired physician” programs with the purpose of both helping impaired doctors and protecting the public from them.

IMG_1010The 1975 media coverage of the deaths of Drs. Stewart and Cyril Marcus brought the problem of impaired physicians into the public eye. IMG_0940Leading experts in the field of Infertility Medicine, the twin gynecologists were found dead in their Upper East Side apartment from drug withdrawal that New York Hospital was aware of but did nothing about. Performing surgery with trembling hands and barely able to stand, an investigation revealed that nothing had been done to help the Marcus brothers with their addiction or protect patients. They were 45 –years old.

Top: Twin Gynecologists Stewart and Cyril Marcus Bottom: The Movie

Top: Twin Gynecologists Stewart and Cyril Marcus
Bottom: The Movie “Dead Ringers” starring Jeremy Irons based on the Marcus twins

Although the New York State Medical Society had set up its own voluntary program for impaired physicians three years earlier, the Marcus case prompted the state legislature to pass a law that doctors had to report any colleague suspected of misconduct to the state medical board and those who didn’t would face misconduct charges themselves.

Physician Health Programs

Physician health programs (PHPs)  existed in almost every state by 1980. Often staffed by volunteer physicians and funded by State Medical Societies, these programs served the dual purpose of helping sick colleagues and protecting the public. Preferring rehabilitation to probation or license revocation so long as the public was protected from imminent danger, most medical boards accepted the concept with support and referral.

As an alternative to discipline the introduction of PHPs created a perception of medical boards as “enforcers” whose job was to sanction and discipline whereas PHPs were perceived as “rehabilitators” whose job was to help sick physicians recover. One of many false dichotomies this group uses and it is perhaps this perceived benevolence that created an absence of the need to guard.

Employee Assistance Programs for Doctors

Physician Health Programs (PHPs) are the equivalent of Employee Assistance Programs (EAPs) for other occupations. PHPs meet with, assess, and monitor doctors who have been referred to them for substance use or other mental or behavioral health problems.

Most EAPs, however, were developed with the collaboration of workers unions or some other group supporting the rights and best interests of the employees. PHPs were created and evolved without any oversight or regulation.

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The American Society of Addiction Medicine can trace its roots to the 1954 founding of theNew York City Medical Society on Alcoholism (NYCMSA) by Ruth Fox, M.D whose husband died from alcoholism.

The society, numbering about 100 members, established itself as a national organization in1967, the American Medical Society on Alcoholism (AMSA).

By 1970 membership was nearly 500.

In 1973 AMSA became a component of the National Council on Alcoholism (NCA) in a medical advisory capacity until 1983.

But by the mid 1980’s ASAM’s membership became so large that they no longer needed to remain under the NCADD umbrella.

In 1985 ASAM’s first certification exam was announced. According to Dr. Bean-Bayog, chair of the Credentialing Committee, “a lot of people in the alcoholism field have long wanted physicians in the field to have a high level of skills and scientific credibility and for this body of knowledge to be accredited” (3).   And in 1986 662 physicians took the first ASAM Certification Exam.

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By 1988 membership was over 2,800 with 1,275 of these physicians “certified” as “having demonstrated knowledge and expertise in alcoholism and other drug dependencies commensurate with the standards set forth by the society.” (4)  The formation of State Chapters began with California, Florida, Georgia, and Maryland submitting requests.(5)

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In 1988 the AMA House of Delegates voted to admit ASAM to the House. According to ASAM News this “legitimizes the society within the halls of organized medicine. (3)
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By 1993 ASAM had a membership of 3,500 with a total of 2,619 certifications in Addiction Medicine. The Membership Campaign Task Force sets a goal to double its membership of 3,500 to 7,000 by the year 2000 to assure “the future of treatment for patients with chemicals. It represents a blueprint for establishing addiction medicine as a viable entity.” (6)

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Many of these physicians joined state PHPs and over time have taken over under the umbrella of the FSPHP.

Others became medical directors of treatment centers such as Hazelden, Marworth and Talbott.

1. Stimson GV. Recent developments in professional control: the impaired physician movement in the USA. Sociology of health & illness. Jul 1985;7(2):141-166.

2. The sick physician. Impairment by psychiatric disorders, including alcoholism and drug dependence. JAMA : the journal of the American Medical Association. Feb 5 1973;223(6):684-687.

3. Four Decades of ASAM. ASAM News. March-April 1994, 1994.

4. American Medical Society on Alcoholism & Other Drug Dependencies Newsletter. Vol III. New York, NY: AMSAODD; 1988:12.

5. AMSAODD News. Vol III. New York, NY: American Medical Society on Alcoholism & Other Drug Dependencies; 1988.

6. Membership Campaign Update. ASAM News. Vol VIII: American Society of Addiction Medicine; 1993:11.

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

mllangan1 6 Comments

On the above list can be found the Medical Directors of a number of drug and alcohol rehabilitation facilities. I did not make up this list. An updated version can be seen right here on the “like-minded doc” website.

Talbott, Marworth, Hazelden, Promises, and another two-dozen or so “PHP-approved” assessment and treatment centers are represented on this list. State Physician Health Programs (PHPs) refer doctors to these facilities for evaluations. PHPs are non-profit tax-exempt organizations. They do not evaluate or treat patients. If a physician is referred to a PHP for a suspected problem the assessment must be done at an outside facility which will invariably be linked to a name on the list of Like-Minded Docs.

What most people do not know, however, is that this is an exclusive arrangement. Evaluations are constrained to one of these facilities. It is mandated. No bargaining. No compromises. No choice. In other words it is a coercion.

Disrupted Physician

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Three shells and a pea–ASAM, FSPHP, and LMD.

“PHP-Approved” Assessment and Treatment Centers

On the above list  can be found the Medical Directors of a number of drug and alcohol rehabilitation facilities.  I did not make up this list.  An updated version can be seen right here on the “like-minded doc” website.

Talbott, Marworth, Hazelden, Promises, and another two-dozen or so “PHP-approved”  assessment and treatment centers are represented on this list.    State Physician Health Programs (PHPs) refer doctors to these facilities for evaluations.  PHPs are non-profit tax-exempt organizations.  They do not evaluate or treat patients.   If a physician is referred to a PHP for a suspected problem the assessment must be done at an outside facility which will invariably be linked to a name on the list of Like-Minded Docs.

What most people do not know, however, is that this is an exclusive arrangement.    Evaluations are constrained to one of these facilities…

View original post 95 more words

Physician Suicide, Organizational Justice and the “Cry of pain” Model: Hopelessness, Helplessness and Defeat

mllangan1 2 Comments

tireddoctorAccording to Talbott, “impaired doctors must first acknowledge their addiction and overcome their ‘terminal uniqueness’ before they can deal with a drug or alcohol problem.” “Terminal uniqueness “ is a phrase Talbott uses to describe doctors’ tendency to think they can heal themselves. “M-Deity” refers to doctors “being trained to think they’re God,” an unfounded generalization considering the vast diversity of individuals that make up our profession. This attitude, according to some critics, stems from the personal histories of the treatment staff, including Talbott, who are recovering alcoholics and addicts themselves. One such critic was Assistant Surgeon General under C. Everett Koop John C. Duffy who said that Ridgeview suffered from a “boot-camp mentality” toward physicians under their care and “assume every physician suffering from substance abuse is the same lying, stealing, cheating, manipulating individual they were when they had the illness. Certainly some physicians are manipulative, but it’s naïve to label all physicians with these problems.”

Disrupted Physician

They can be a terror to your mind and show you how to hold your tongue
They got mystery written all over their forehead
They kill babies in the crib and say only the good die young
They don’t believe in mercy
Judgement on them is something that you’ll never see
They can exalt you up or bring you down main route
Turn you into anything that they want you to be–Bob Dylan, Foot of Pride


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Although no reliable statistics yet exist, anecdotal reports suggest a marked rise in physician suicide in recent years. From the reports I am receiving it is a lot more than the oft cited “medical school class” of 400 per year.

This necessitates an evaluation of predisposing risk factors such as substance abuse and depression, but also requires a critical examination of what external forces may be involved in the descent from suicidal ideation to suicidal…

View original post 4,152 more words

In Mechanics and Mentality the Physician Health Program “Blueprint” is Essentially Straight, Inc. for Doctors.

mllangan1 10 Comments

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In 2012 former Nixon Drug Czar Robert Dupont, MD delivered the keynote speech at the Drug and Alcohol Testing Industry Association (DATIA) annual conference and described a “new paradigm” for addiction and substance abuse treatment. He advocated zero tolerance for alcohol and drug use enforced by monitoring with frequent random drug and alcohol tests. Detection of any substances is met with “swift and certain consequences.”

And then he proposed expansion of this paradigm to other populations including workplace, healthcare, and schools.

Robert Dupont was a key figure in launching the “war on drugs” — now widely viewed as the failed policy that has turned the US into the largest jailer in the world.

Screen Shot 2014-02-23 at 8.06.56 PMIn the 1970s, Dupont administered the experimental drug rehab program called “The Seed” – that was later deemed by congress to use methods similar to those used on American POW’s in North Korea. He would later go on to consult for “Straight, Inc”, a rehab program that treated troubled teens as “addicts”, often for minor infractions or normal teenage behavior.

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Deemed the “family oriented treatment program,” Dupont encouraged organization and expansion. Targeting the children of wealthy white families parents fears were used to refer their kids to the programs. Signs of hidden drug use such as use of Visine, altered sleep patterns, and changes in clothing style were used as indications for referral. Any child who arrived would be considered an addict in need of their services. Coercion, confrontation, command and control were the guiding principles. Submit or face the consequences. We know what’s right. The idea was to strip the child of all self-esteem and then build him back up again in the straight image. Abused, dehumanized, delegitimized and stigmatized-the imposition of guilt, shame, and helplessness was used for ego deflation to facilitate canned and condensed 12-step as a preparatory step on the path of lifelong spiritual recovery.

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Children were coaxed or terrorized into signing confessions, berated, and told they were in “denial.” Inaccurate and false diagnoses were given to wield greater control. Reports and witness accounts now indicate that many of the kids did not even have drug problems but by creating a “moral panic” about teenage drug use they exploited parents fears for profit. Straight, Inc. became the biggest juvenile rehabilitation center in the world for rehabilitation and treatment of addiction.

12 year old girl admitted to inpatient addiction rehabilitation for sniffing a “magic marker”–Once!

A Deficiency Correction Order was issued by the Executive Office of Human Services, Office of Children, Commonwealth of Massachusetts Services to Straight, Boston in 1990 that read in part:

“Although Straight’s statement of services states that Straight serves chemically dependent adolescents, a review of records and interviews with staff demonstrate that Straight admits children who are not chemically dependent. For example, one twelve-year-old girl was admitted to the program although the only information in the file regarding use of chemicals was her admission that she had sniffed a magic marker.”

Straight was always making outlandish claims of success but there was no scientific evidence based data to support it. In September 1986 USA TODAY ran an article headlined:  DRUGS:  Teen abusers start by age 12 which opened with:  “Almost half of the USA’s teen drug abusers got involved before age 12…”Screen Shot 2015-05-15 at 12.51.23 AM

The article was based on a study conducted by Straight, Inc.

Many former patients of Straight were so devastated by the abuse that they took their own lives. Since then, Dupont has been a key figure in the proliferation of workplace drug testing programs, and once advocated for drug testing anyone in the workplace under the age of 40.1,2Screen Shot 2015-05-15 at 1.47.15 AM

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The Physician Health Program (PHP)  blueprint is essentially Straight, Inc. for Doctors in both Mechanics and Mentality

The “new paradigm” Dupont speaks of before the Drug and Alcohol Testing Industry Association is modeled after state physician health programs (PHPs) and as was done with Straight, “remarkable” claims of success are being made.3-6 Promoted as “Setting the standard for recovery” PHPs are now being pitched to other populations7

0 Dupont and Dr. Greg Skipper proclaim the “need to reach more of the 1.5 million Americans who annually enter substance abuse treatment, which now is all too often a revolving door.”8 They conclude:

This model of care management for substance use disorders has been pioneered by a small and innovative group of the nation’s physicians in their determination to help other physicians save their careers and families while also protecting their patients from the harmful consequences of continued substance abuse. In fulfilling the professional admonition “physician: first heal thyself,” these physicians have created a model with wide applicability and great promise.8

In “Six lessons from state physician health programs to promote long-term recovery” Dupont and Skipper attribute this success rate to the following factors:8

(1) Zero tolerance for any use of alcohol and other drugs;

(2) Thorough evaluation and patient-focused care;

(3) Prolonged, frequent random testing for both alcohol and other drugs;

(4) Effective use of leverage;

(5) Defining and managing relapses; and

(6) The goal of lifelong recovery rooted in the 12-Step fellowships.8

Slide27As with Straight, the majority of those admitted to PHPs are not even addicts.  The Federation of State Physician Health Programs (FSPHP) was able to convince Federation of State Medical Boards, to adopt the notion of “potentially impairing” illness and “relapse without use” to promote early intervention using the same false logic as Straight, Inc. and the 12-year old with the magic marker.  ( i.e. teen drug abuse starts by age 12 and that any sign or symptom inexorably progresses to impairment justifying  “treatment”).

Signals for “impairment” can be as benign as not having “complete, accurate, and up-to-date patient medical records.”  according to Physician Health services, the Massachusetts Physician Health Program and subsidiary of the Massachusetts Medical Society.

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Despite the overwhelming amount of paperwork physicians now have, incomplete or illegible records could be construed as a red flag, since, as Associate Director of PHS Judith Eaton notes “when something so necessary is not getting done, it is prudent to explore what else might be going on.”

 It is a false premise “feel-good fallacy” with faulty conclusions.  And because it is being perpetrated on doctors (and those in the criminal-justice system) no one seems to care.   But this is merely a wedge for a grander plan.

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Dupont has  been heavily involved in studies using non-FDA approved laboratory developed tests and other devices of unknown validity on doctors in PHPS and promoting the use of these tests for forensic monitoring.9,10   

And they want to bring these tests to you. Propaganda and misinformation has been designed to sway public opinion.

A Medscape article from   “Drug abuse among Doctors: Easy, Tempting, and Not Uncommon” is a prototypical example of the propaganda and misinformation being used to sway public policy and opinion.  Focusing on a small study  ( n =55) done by Lisa Merlo (Director of Research for the Florida PHP). Dr.Marvin Seppala  states in the article that impaired  doctors are:

“….often described as the best workers in the hospital,” he says. “They’ll overwork to compensate for other ways in which they may be falling short, and to protect their supply. They’ll sign up for extra call and show up for rounds they don’t have to do.” Physicians are intelligent and skilled at hiding their addictions, he says. Few, no matter how desperate, seek help of their own accord.”

There is no evidence base for a hidden cadre of drug-impaired doctors causing medical error. A critical review of the literature reveals no evidence base exists.  Moreover, this blather does not even comport with reality.  It defies reason and even basic common sense.

Screen Shot 2014-03-15 at 5.09.11 PMBut through misinformation and deceptive propaganda similar to that used by Straight these groups have created “moral panics” aimed at physicians designed to separate them from everyone else.

To be sure, doctors who are practicing impaired due to substance abuse need to be removed from practice both to get the help they need and to protect the public. But that is not what is happening.   Instead, what is occurring is that doctors can get caught up in this system for any number of reason. Indeed, some of these physicians have no history of drug-addiction—they are the equivalents of the 12-year-old girl caught sniffing a magic marker.

And this is how the scam works.

When doctors monitored by their PHP test positive they are forced to have an evaluation at a “PHP-approved” treatment center.  In 2011 the American Society of Addiction Medicine (ASAM) issued a Public Policy Statement recommending physicians in need of assessment and treatment be referred only to “PHP approved” facilities.  The medical directors of the “PHP-approved” facilities can be found on this list of “Like-Minded Docs”.

In 2011, The organization that oversees the licensing for all medical doctors, the Federation of State Medical Boards, adopted a new policy and approved the concept of “potentially impairing illness.” and the Orwellian notion of drug “relapse without use.” 

This implies that they will be able to ruin any doctor who does not comply or who is found guilty, even if fraudulently.

The question might be, “Why?” As with anything, we have to think about who profits.

Indeed, Dupont has remained a vocal and influential spokesman for drug and alcohol testing. But he along with former DEA head Peter Bensinger run a corporate drug-testing business. Their employee-assistance company, Bensinger-Dupont is the sixth largest in the nation.

Now, they also want to extend these tests to drivers.11,12 and Federal Workplace Drug Testing Programs.

They would like to replace the current system used in pilots, bus drivers, and Federal Employees with “comprehensive drug and alcohol testing.”13 AND THEY ARE promoting hair testing, 14Their goal is 24/7 sobriety with complete abstinence 15, and zero tolerance.16

Their claims of success are based on a single retrospective cohort study looking at the outcomes of 904 physicians monitored by 16 different State PHPs.17

An 80% success rate is claimed but 102 of the 904 participants were “lost to follow up” and of the remaining 802, 155 failed to complete the contract.

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So what happened to the 24 of who “left care with no apparent referral,” the 85 who “voluntarily stopped or retired,” and the 48 who “involuntarily stopped” or had their “license revoked.”  Whether you leave a PHP voluntarily, involuntarily, or with no apparent referral it is the end.. The plug is pulled. Game over.   Comparing this to other populations where the consequences are not as terminal is like comparing apples to oranges.

But the bigger question is what happened to the 157 physicians who left or stopped? How many of those killed themselves. The study reports 6 suicides, 22 deaths, and another 157 who are no longer doctors.   How many of the 22 deaths were suicides and what happened to the 157 who stopped for no apparent reason?   Using the last recorded clerical status as an endpoint obfuscates the true endpoints.  Where are they now?  Alive or dead?

Propaganda and misinformation is  designed to sway public opinion and it is all hidden from public view and scrutiny. Absolutely no oversight or regulation from outside agencies exists for PHPs and very little exists for the “PHP-approved” up-front cash only assessment and rehabilitation facilities.  The commercial drug-testing labs using non-FDA approved LDTs have no accountability either.  No agencies exist to hold them accountable for errors or even intentional misconduct.  The College of American Pathologists (CAP)  is the only avenue for complaint and CAP is an accreditation agency that can only “educate” not “discipline.”  It is a system that fosters and fuels misconduct as no consequences exist for wrongdoing and they built it that way.

The American Society of Addiction Medicine erected this scaffold state-by-state. And that is how it must be removed. It is a system of coercion, control, and fear. Crimes like the ones being committed here in Massachusetts must be investigated as crimes. The perpetrators must be held accountable.

It is a system of institutional injustice that is killing physicians by driving them to hopelessness, helplessness, and despair. The general medical community needs to awaken to the reality of the danger to expose and dismantle it at the State level.  And many of the doctors caught in this maw do not even have an addiction or substance abuse issue –equivalent to the 12-year old girl in referred to Straight for sniffing a magic marker.  On the other hand many of those in charge of the administration of these programs have engaged in egregious even horrific misconduct and have a history of manipulating the system.

Secondly, all of the so-called “research” must be subject to evidence base review. It is not there.

And thirdly, the numerous, intertwined and myriad conflicts of interest must be addressed – because it’s money that is the big driver of this “benevolent” interest in whether or not you are sober.

With over 20 years experience as Associate Directors of the Massachusetts PHP, Physician Health Services, Inc. (PHS,inc.), Dr.’s J Wesley Boyd, MD, PhD and John R. Knight of Harvard Medical School published an Ethical and Managerial Considerations Regarding State Physician Health Programs pointing out serious conflicts of interest and ethical issues involving PHP programs and the need “to review PHP practices and recommend national standards that can be debated by all physicians, not just those who work within PHPs.”

They recommend ethical oversight of PHPs, a formal appeals process for physicians, periodic auditing, a national system for licensing, and recommend “the broader medical community begin to reassess PHPs as a whole in an objective and thoughtful manner.” Unfortunately, this has not occurred.  It urgently needs to.  Because the Physician Health Program “Blueprint” is essentially Straight inc. in both mechanics and mentality. and those killing themselves are the equivalent of the 12-year old girl caught sniffing a magic marker.

Unlike Straight, inc.,  no FaceBook site dedicated to the  “memory of those gone” yet exists for the many many doctors killed and being killed  by the “PHP-blueprint.”   It should and someday, believe me, it will.

  1. Engs RC. Mandatory random testing needs to be undertaken at the worksite. Controversies in the Addiction Field. Vol 1. Dubuque, IA: Kendall/Hunt; 1990:105-111.
  2. Dupont RL. Never trust anyone under 40: What employers should know about Molly Kellogg in the workplace. Policy Review. Spring 1989:52-57.
  3. DuPont RL, McLellan AT, Carr G, Gendel M, Skipper GE. How are addicted physicians treated? A national survey of Physician Health Programs. Journal of substance abuse treatment. Jul 2009;37(1):1-7.
  4. White WL, Dupont RL, Skipper GE. Physicians health programs: What counselors can learn from these remarkable programs. Counselor. 2007;8(2):42-47.
  5. Skipper GE, Campbell MD, Dupont RL. Anesthesiologists with substance use disorders: a 5-year outcome study from 16 state physician health programs. Anesthesia and analgesia. Sep 2009;109(3):891-896.
  6. Yellowlees PM, Campbell MD, Rose JS, et al. Psychiatrists With Substance Use Disorders: Positive Treatment Outcomes From Physician Health Programs. Psychiatric services. Oct 1 2014.
  7. DuPont RL, McLellan AT, White WL, Merlo LJ, Gold MS. Setting the standard for recovery: Physicians’ Health Programs. Journal of Medical Regulation. Mar 2010;95(4):10-25.
  8. Dupont RL, Skipper GE. Six lessons from state physician health programs to promote long-term recovery. Journal of psychoactive drugs. Jan-Mar 2012;44(1):72-78.
  9. Skipper GE, Thon N, Dupont RL, Baxter L, Wurst FM. Phosphatidylethanol: the potential role in further evaluating low positive urinary ethyl glucuronide and ethyl sulfate results. Alcoholism, clinical and experimental research. Sep 2013;37(9):1582-1586.
  10. Skipper GE, Thon N, DuPont RL, Campbell MD, Weinmann W, Wurst FM. Cellular photo digital breathalyzer for monitoring alcohol use: a pilot study. European addiction research. 2014;20(3):137-142.
  11. Voas RB, DuPont RL, Talpins SK, Shea CL. Towards a national model for managing impaired driving offenders. Addiction. Jul 2011;106(7):1221-1227.
  12. DuPont RL, Voas RB, Walsh JM, Shea C, Talpins SK, Neil MM. The need for drugged driving per se laws: a commentary. Traffic injury prevention. 2012;13(1):31-42.
  13. Reisfield GM, Shults T, Demery J, Dupont R. A protocol to evaluate drug-related workplace impairment. Journal of pain & palliative care pharmacotherapy. Mar 2013;27(1):43-48.
  14. DuPont RL, Baumgartner WA. Drug testing by urine and hair analysis: complementary features and scientific issues. Forensic science international. Jan 5 1995;70(1-3):63-76.
  15. Caulkins JP, Dupont RL. Is 24/7 sobriety a good goal for repeat driving under the influence (DUI) offenders? Addiction. Apr 2010;105(4):575-577.
  16. DuPont RL, Griffin DW, Siskin BR, Shiraki S, Katze E. Random drug tests at work: the probability of identifying frequent and infrequent users of illicit drugs. Journal of addictive diseases. 1995;14(3):1-17.
  17. McLellan AT, Skipper GS, Campbell M, DuPont RL. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. Bmj. 2008;337:a2038.Screen Shot 2014-02-25 at 1.06.55 PM

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Letters from those Abused and Afraid

mllangan1 4 Comments

Screen Shot 2015-03-27 at 1.24.08 AMLetters From Those Abused and Afraid

images-2I get many e-mails, letters and phone calls from doctors, nurses and others who have been abused by  “professional health programs” (PHPs).

Most are anonymous.  Afraid of being identified and punished by the PHP, very few leave comments on my blog revealing their names or potentially identifiable information.

This is understandable.   By simply reporting “noncompliance” to the medical boards a state PHP can end their careers. As it was with the Inquisition this system relies above all else on silence and secrecy.   Speaking out can result in “swift and certain consequences.”

They are afraid.  Some are undoubtedly suffering from PTSD.  Most have developed a “learned-helplessness”   Many have reported abuse and even crimes to their medical societies, medical boards, law enforcement, the media and others only to have the door slammed in their faces.-myself included..   They have no advocacy or support and feel no one cares.   Their locus of control, identify and self-worth have been suddenly ripped from them without recourse. There is no lifeline.

PHPs are ostensibly  Employee Assistance Programs (EAPs) for doctors in both mechanics and mentality.   EAPs assist employees with substance abuse, personal problems and other issues.    They do not diagnose or treat “patients” but refer to outside professionals who do.  The critical difference between EAPs and PHPs is PHPs have mandated all assessment and treatment be done by their own.  These “PHP-approved” facilities are economically and ideologically intertwined with the PHP.  The conflicts of interest are serious and many.

PHPs also use non-FDA approved junk-science drug and alcohol testing they introduced.  The procedural safeguards most EAPs use to  protect the donor ( certified labs, FDA-approved validated tests, split-specimen, strict chain-of-custody, MRO review) have been reviewed.  Unvalidated “personality” assessments they also introduces are being used in “disruptive” physician evaluations guaranteed to find “character defects” to justify monitoring contracts. They implement polygraphs despite the AMAs previous conclusion they are scientifically unsupportable.

It is an institutionally unjust system of coercion, control and abuse that is unregulated, opaque and protected.  There is no answerability and they are accountable to no one.

But regulatory agencies have readily adopted policies not only unsupported by science and evidence-based research but outside the normative principles and practice of medicine.

Granting PHPs authority to limit assessments and treatment to their own facilities  offends the fundamental rights of the individual.

Informed consent (or refusal)  constitutes a basic rule of the lawfulness of medical practice according to national and state medical practice acts governing the profession.  It is a basic principle  of all published principles of medical ethics.

Involuntary treatment is motivated by either potential harm to others (for the good of society) or by need for treatment and/or potential self harm.

Involuntary treatment should be a confined to those gravely disabled by psychiatric disorders or substance abuse.  It necessitates reflection under the ethical principles of autonomy and beneficence.

A single DUI,  transient psychological issue such as grief or anxiety, and even sham peer-review can easily land a doctor into forced assessment and involuntary treatment at a “PHP-approved” facility.

Involuntary assessment and treatment involves legal, clinical ethical, and deontological consideration in its demarcation.

The economic and ideological aspects need to be considered here.

How is it this paradoxical assessment and treatment paradigm legitimized and justified within a profession that emphasizes evidenced based decision making and beneficence and autonomy as two of the basic principles of medical ethics?

  To sell the “PHP Blueprint” to other EAPs it is necessary to prevent doctors from speaking the truth.  Very few want their names, states or other unique identifiers published for fear of  consequences and retaliation.

The letters below have only been posted after being approved by their  authors-MLL

4/20/15

Dear Michael Langan

I love your writings analysing the power relations and psychopathy that is running rampant in every sphere of life, including sadly, medicine…

Your logo of the the two serpents represents the fight between good and evil, to me…

It was encouraging that you ‘liked’ the post from the blog as writing in relative isolation is very hard.

So thanks a bunch !

Take good care of yourself – truth tellers are precious and rarer than gold dust !

3/5/2015

Comment: I am Board Certified in Internal medicine. I have endured years of emotional, psychological and spiritual abuse at the hands of the Washington Physician’s Health Program. I have suffered through a long list of injustices without recourse. They include, but are not limited to discrimination, abuse of power, breach of contract and repeated and WILLFUL medical negligence.

Because the actions of the WPHP have been SO egregious, I assumed what was happening to me must be extraordinarily rare.

I have nothing to hide. And I have shared my story with any and all who would listen. To date, my voice, my rights and now my life have been dismissed as unimportant. MY LIFE!! It’s apparently better that I die than my tormentors be questioned and compelled to defend their indefensible and evil behavior.

I am meeting with one last attorney tomorrow. I fully expect him to ignore the basic, indisputable and well documented facts of my case. Namely, there is massive and systematic malfeasance being committed by a tax payer funded agency in the State of Washington who act with omnipotence and without oversight. I have no reason to believe he will respond any differently than the others with whom I have met. HE WON’T CARE! HE WILL NOT BE MOVED. He will make statements that suggest I DESERVE this treatment. And that my life, as well as my imminent death, is unworthy of his time or efforts.

Once my assumptions about this last meeting are officially confirmed, I am committed to the only course of action available to me. The only thing which will put an end to this nightmare.

Today I stumbled upon your website. And today, for the first time, I have learned that my case is not rare. I suspect the other physician victims in this matter have occasionally allowed themselves to dream wistfully of justice. Justice which they have seen thwarted at every turn. Perhaps they, like me, have dreamily imagined the relief and joy and LIFE they would experience if the truth were simply presented and the perpetrators held accountable. I have imagined standing up in court and triumphantly affecting justice for myself as well as all of the other current and future victims. I deliver a powerful defense of justice. My ‘dream speech’. I have imagined that I might still live. And then I wake up.

And so today, imagine my shock, when I found my ‘dream speech’ here. My speech. Reasonable. Honest. Consistent. And based firmly in truth, justice and defense of the powerless against the (arbitrarily) powerful. My speech, it seemed, but authored by another.

Thank you, Dr. Langan.  You have given a voice to my struggles. Please never stop speaking for me, and people like me, many of whom, I fear, will not survive to see justice.

Despite my intention to die, I actually WANT TO LIVE! And I will live and fight on if I ever believe that there is even a small chance of justice for me and the other innocent victims of PHP’s and the ‘treatment’ centers with whom they contract (Talbott in my case. Purely evil and loathsome human beings, for the record).

So, because I do WANT to live…PLEASE HELP ME, SIR!

Can you refer me to attorneys, individuals or groups who might advocate for me and the other victims? Do you have any specific words of hope or encouragement?

Please note my name. Please add me to the list of innocent victims of these power hungry, narcissistic BULLIES.

I don’t expect to live through this. And in a way, the PHP, Talbott and the addiction ‘experts’ with whom I have been tragically acquainted are correct…My life is worth very little. But this issue is so much larger than I. I can die with some serenity if I believe there will be meaningful justice for others like me. And that those responsible will be held to account.

Thank you Dr. Langan. Thanks to all of those involved in the creation and maintenance of this website. Although your shining beacon is barely perceivable through the darkness of injustice which surrounds and seeks to extinguish it…it is the only glimmer of hope I have found during my slow death by PHP.

3/2/2015

Dr. Langan:

Thank you for your articles and research regarding PHPs and “impaired” physicians.  I have become involved in this issue after someone close to me struggled with depression during residency.  Sadly, they lacked the resources, support and coping skills and ended up committing a crime with a misdemeanor charge.  Despite their treatment and rehabilitation, they were dismissed from residency.  Not sure if they will ever get to practice clinical medicine.  It is very sad. they are very smart, great doctor and very empathetic towards patients. 

After their situation, I started looking on blogs and found that many residents had shared similar instances.  Many reported struggling with depression and the stresses of residency put them over the edge– like the perfect storm of stress, fatigue, and loneliness that could exploit anyone’s weaknesses.   It seems like during residency, we are emotionally as well as legally vulnerable.  Many of these residents have never been able to resume training at their institutions despite their demonstration of clinical competence and emotional maturation.  According to that medscape article, that is a huge loss to society, socially and financially.

Sadly, there still so much stigma surrounding mental health, and I think it may be worse in our profession. 

I am very concerned regarding the future of our profession.  We are becoming robots in a health care factory.  Our own personal lives are being compromised as well as quality patient care. 

I appreciate all you are doing to shed light on this very important issue.

Thank you for your time and consideration

2/17/2015

Dear Dr. Langan:

Thank you for your insight, eloquence, and concern for all of us. These Boards and other administrative bodies claim that they are “protecting the public,” but healthcare providers are the public too. And they’re killing us. 

The problem is not unique to physicians. I am a nurse practitioner, and we share some of the same burdens. Although the numbers are growing, there are so few NPs nobody has studied suicidality among our profession. There is still the same fear of malpractice, professional bullying (nurses “eat their young,”) and the taboo of asking for help. 

A trivial, third-party complaint to the State Board didn’t cost me my license, but it did cost me my job and my mental health. The pain I endured: the relentless questions about my personal life… it was jarringly intrusive. All of this was conducted by a bullying investigator: a man who had no medical training.  The Board took it upon itself to ask detailed questions about my personal life and relationships, as if they would somehow psychoanalyze me. The investigator started his conversation by advising me that the Board does not honor the Fifth Amendment.

I’ve heard others—physicians—tell me of similarly murky complaints that dragged on. A cardiologist I know was instantly fired and rendered unemployable for year under similar circumstances. He struggled to feed his kids. Nobody died. Nobody got hurt. He didn’t have a substance abuse problem or divert drugs. He practiced within his scope. The case was eventually dismissed, and he’s back in business. But he has never totally recovered.

A simple, free email to the Board can cost a physician or nurse practitioner his or her livelihood in a split second.

All of this detracts from the dangers posed by inept or otherwise dangerous clinicians. We’ve all met them, seen them in practice, seen their charts, or heard stories. I think everyone I know can name a clinician who showed up drunk to work, billed fraudulently, or who was so incompetent that he or she should not be practicing.

It has been ten months. The Board hasn’t had any further questions, but they never dismissed the case, claiming that they have a massive backlog. My health and livelihood are inconsequential to them. I’m still being prescribed scheduled benzos and z-drugs just so I can make it day to day.

I came very close to suicide more than once, but I evaded psychiatric admission because then I’d lose my license without a doubt. Again, “protecting the public?” I deliberately avoided emergent medical care because of the Board.

I chose another path: I left the profession, and I have lost my sense of self. Twelve years of school, $350,000 in tuition, and four degrees were rendered worthless by a single third-party email. Above all, my pride in my  clinical acumen, passion for learning, anal retentive charts, sensitivity, and professionalism also went down the drain.

The Board’s notion of “protecting the public” also means kicking good providers out of the business. Our emotional lives are destroyed, our finances wrecked, and we live in fear. There is no “speedy and public trial,” no “jury of our peers.” Although Conrad Murray MD fled to Trinidad, where he is working as a cardiologist (hopefully not prescribing propofol for insomnia), an open complaint renders me ineligible for licensure in all fifty states, all Canadian provinces, the Netherlands, and Australia. 

Assuming that the Board dismisses the case, I don’t know if I could ever return to practice. It’s too hard to live in fear of a backstabbing patient or family member, and the ineptitude and glacial pace of a medical board. I want to clobber anyone who says, “and this too shall pass.” It’s not quite like that.

I am trying to re-establish myself in some second career, but that is hard to face. I cringe every time I open my email and mailbox in fear of a letter from the Board. I know I did nothing wrong, but that’s not how the system works.  

I still fight the urge to take my own life.

1/17/2015

Great website. Presents an alternate view I have never seen in action and I have had to report a number of MDs to our state’s PHP. Thanks for the insights.

2/8/2015

I am an RN in a monitored program in PA which includes forced AA attendance. I have 22 years as an RN with 10 years of military service which includes a one year deployment to Iraq. I am willing to speak out. Too many are afraid of losing their licenses to practice.

1/14/2015

A review of 14 studies found that the relative risk of suicide in physicians compared with the general population is between 1.1 and 3.4 for men and 2.5 to 5.7 for women,  http://www.currentpsychiatry.com/index.php?id=22661&tx_ttnews[tt_news]=175910, furthermore, studies have indicated higher rates of suicide among psychiatrists and anesthesiologists.

There are a variety of theories on why physicians commit suicide.  Depression is the most common explanation given.  Certainly, there’s a lot of stress involved in our profession.  We deal with death and dying.  We’re held to impossible standards.  Managed/mangled care and the restrictions of government plans/laws/policies on the  one hand restrict what we can do for our patients.  On the other hand however, are the viscous  packs of attorneys waiting to cull the herd.  Let’s not forget the State Medical Boards, out there striving to “protect the patients”, generally done in cahoots with the “Physicians Health Programs”.  These two entities form a deadly collusion that is inescapable—and of course, linked to the packs of predators circling to ensure that we will suffer the consequences for actions that we may have little if any control over.

I am one of the unfortunates.

I haven’t committed suicide (obviously), nor made an attempt at it.  Certainly I’ve had thoughts about it—who among us hasn’t?  My strong religious convictions prevent any serious consideration of this “permanent solution to a temporary problem”.

I am also one of the fortunates.

This is largely due to the foundation of faith that I have.   Years ago I made what may have been a mistake.  I prayed for patience & humility.  We tend to be an impatient and yes, at times an arrogant lot.  I recognized those character flaws in myself and asked Him for help.

 I should have asked for the grace to overcome these shortcomings.  Grace is a gift, a “freebie” if you will.

Patience is gained through trials.  Humility generally through humiliation.

I have learned that where there is pain in life, there is often a lesson—look for it, learn from it.  Running from it merely guarantees that it’ll be presented again, and again and again until it’s learned, often with a few extra presentations after the initial effort to dodge the trial.

The study of theology has lead to the interesting concept that suicide is actually a sin of pride.  Yes, depression is involved, but the pride plays it’s role with the thought that;  “I don’t deserve this trial so I’m choosing to take myself out of the game”.

My personal belief is that only God has the power to give and take life.  The reader is certainly entitled to their own belief.  Mine has evolved by study and prayer over decades.

There is a growing movement afoot across all 50 states for attorneys employed by State Medical Boards to direct their investigators to report possible transgressions directly to the attorneys instead of to the physician board members  http://woundedhealersnc.net/.  The attorneys have thus usurped the role of a professional board; to ensure that we’re held accountable by our peers.  These attorneys then draft their own perspective of what happened, often putting “spin” or “slant” to the report to prejudice the board members to carry out the actions that these attorneys deem to be appropriate.  The Board Members have unwittingly abdicated their responsibilities.  This leaves physicians at the mercy of Board attorneys.  These attorneys were initially tasked with ensuring that the Board members didn’t violate any laws in their disciplinary actions against wayward licensees.  Board members are busy physicians in their own rights.  They have their practices and with the attendant problems associated with them, as do the rest of us.  Typically, they go to their state capital for a couple of days a month to do their “official duties”.  The attorneys present the information for the “rubber stamp” of the Board’s approval.  

Worse still are the “consent orders” drafted by the State Board attorneys.  A key part of such an order is the “findings of fact” describing the (alleged) transgressions.  The hapless licensee is often coerced to signing these flagrantly fictitious documents with threats that the attorney-derived discipline will be much lighter than what the Board will mete out.  It’s actually not uncommon for “defense” attorneys to collude with the Board attorneys, urging the clients that they are supposed to be defending into signing the consent order.  Signing the order will have many grave consequences http://woundedhealersnc.net/documents/lip/index.htm.  As a hapless victim, I had no concept of such unethical yet commonplace activities.  

There is documentation of an extremely arbitrary nature of punishments on www.woundedhealersnc.net ; A physician and his mid-level go out to a dinner presentation by the local pharmaceutical representative.  Driving home afterwards, the physician crashes the vehicle.  Both are intoxicated.  The mid-level spends 2 weeks recuperating in the hospital.  The physician/driver gets a “Public Letter of Concern”.

Another physician is out of state on vacation, gets a DUI, truthfully reports it during his annual license renewal and is taken out of practice for four years.  Some practitioners NEVER return to practice.  Substance abuse issues are treated extremely harshly.

Killed somebody with negligence?  Oh, no problem, that will only get you a “Public Letter of Concern” in North Carolina.

You were seduced by a patient?  Big problem!  There’s to much of a “power imbalance” since you’re a medical practitioner, mid-level or otherwise.  You may possibly NEVER practice medicine again.  There’s documentation of a psychiatrist who married a patient, the State Board found out about it and took her license away; she was to much of a risk for sexually assaulting other patients.  Ultimately she was allowed to have her license back on the condition that she never practice psychiatry again!

I was also unaware that state boards are incentivized to discipline as many physicians as possible, as harshly as possible, for as long as possible.

I was indeed one of the innocents.

Knowledge is indisputably power.  The site quoted above provides a wealth of information of the workings of the “system” in North Carolina.  The “Great North State” is hardly alone in their approach.

The Physician Health Programs (PHP’s) are another area of concern.  It’s a shame that the stated purpose of the PHP’s is to help return impaired practitioners to active practice.  These groups throw the very physicians who need help the most the furthest under the bus in full collusion with the Board.  They’re typically staffed by psychiatrists who are members of “addiction societies” that aren’t much more than diploma mills.  The PHP’s often claim to be performing “peer review” while disregarding the legal requirements for peer review.  The PHP’s/Medical Societies/State Boards are parasitic symbionts that prey upon those of us who have been used up and burnt out by the non-system of healthcare that exists.

 Does this sound like a pattern is developing? “Disregarding the legal requirements…”

In North Carolina, the complaints were of such a volume that the NCPHP was audited and found to have numerous deficiencies.  Next, all 57 of their licensing and professional boards were audited.  All of them showed problems—the most common that they did not report to anybody for supervision!  These are routine violations of the General Statutes of the state.

Every state has a state auditor whose function is to ensure that state agencies fulfill their assigned duties efficiently and honestly.  Most State Medical Boards and PHP’s have NEVER been audited.  Anybody can report their concerns to their state auditor.

Attorneys are supposed to uphold the law; isn’t this ironic?

There is ample evidence of collusion among the players; Defense attorneys who should be defending their clients against their Board (sometimes the Boards actually recommend individual attorneys that they “work well together” with to wayward licensees).  Board Attorneys are clearly involved as are the PHP’s.

State Medical Societies are also generally in the same bed with the Boards & PHP’s.  Governor’s generally rely on the Societies to recommend prospective Board members.  It’s not uncommon for the first question at an “investigative hearing” to request information on whether the licensee is a member of the local state society.  What would the purpose of such a question be?  Simple.  It’s well-documented that membership has a “protective” function.  It’s not absolute, but exists nonetheless.

In one case, the Board remanded a full mental health evaluation.   The result was that the licensee had a mild autism spectrum syndrome (something a good many of us have), an autism spectrum disorder that is characterized by difficulties with social skills and non-verbal communication—but with benefits such as intense interest and expertise in certain areas (like medicine!).  

 The function of a Board is to maintain scope of practice.  Family physicians don’t do craniotomies.  Yet, despite the absence of a single mental health professional on the Board, the recommendations of 3 independent professional organizations, all recommending immediate return to practice for the licensee were ignored.

The Board posted the practitioners protected health information, including mental health information on their website.  The most basic rights to privacy were clearly violated.  The licensee never gave permission for such an intrusion!

The ADA covered disability was dealt with by an indefinite suspension—all with the full collusion of the NCPHP.  The ADA requires “reasonable accommodations”.  Indefinite suspension is punitive—certainly not a reasonable accommodation!  Again, it cannot be over-emphasized that Board attorneys have a strong desire to punish whenever, wherever, for as long as possible.

The licensee signed the contract with the NCPHP.  The licensee was held to the terms, but the advocacy mandated by the contract was never delivered; “the Board attorney said he wasn’t interested in anything I have to say in your favor, his mind is made up, there’s nothing I can do to help…” was the limit of advocacy received.

 Advocacy?

Collusion is a more accurate description.

The theme song from the hit movie and TV show M*A*S*H* is “Suicide is Painless” by Johnny Mandell.  This epidemic is more of an endemic among our profession.  We can’t keep “looking the other way”.  

 There are two major forms of suicide.

Active suicide would best be described as a former colleague who went into the recovery room one Sunday afternoon when it was deserted, took a scalpel and did a full-length carotidotomy on himself.  He made a posthumous statement.  Another ran out in front of a box truck on the interstate.  It took his head off.

Passive suicide is best shown by 5 of the NC Medical Board victims.  This Board tends to pursue physicians from their mid-40’s to mid-60’s, the top income-producing time of our careers.  They usually have assets to poach.  Usually by that age, we’re taking some form of medications for our own health issues.  A diabetic who purposely forgoes his insulin…   Suicide?  It won’t be reported as such.  What do YOU think?

We will never eliminate all of our stressors.  There will always be the “less fit members of the herd”, which is sad.  This is more appropriate for other animals at other positions on the evolutionary tree.  Why should the most noble of professions be relegated to those branches of that tree?

We need to reach out to each other.  We need to reach out to our state auditors.  Another resource that surprised me is a different agency.  There is an agency whose primary function is “to deal with corruption in public officials both appointed and elected”.

Does this sound like an appropriate agency to engage against our Boards & PHP’s?  It’s the Federal Bureau of Investigation, commonly known as the FBI!

All that it takes for evil to triumph is for good men to do nothing.  When we organize we change from individual targets to a formidable force.  State Medical Societies, unfortunately, are not the answer.  Typically state governor’s turn to them for nominations to staff the boards.  In North Carolina, lawsuits have been settled out of court that involve the alliance between the Board, Medical Society & PHP.

 Perhaps the best solution would be to revamp the system.  Maybe it’s time for a Federal Medical Board.  At the very least, State Boards should be restructured so that investigators do not report to the attorneys, but directly to the Board Members.  It will mean more work for the Boards, but they’ll at least resume functioning in the manner originally intended.

–Wounded Healer

12/31/2014

This whole lack of accountability and oversight within the PHP’s makes me sick. I was sent to PHP for evaluation and suspicion of drug abuse by my employer hospital. I was only suffering from side effects of Paxil causing a SSRI Discontinuation Syndrome. The diagnosis was completely missed because the PHP sent me to a rehab center in Los Angeles. I am sure you know this one very well.  

I was coming there for IDE, Intensive Diagnostic Evaluation not recovery and rehab. After arrival I was forced to enter their rehab program completely against my will. I was on my way out the door and about to call a cab when the program director threatened me with absolute coercion.

He said if I left he would assume I had drugs in my possession and that this would negatively affect my evaluation and would be reported to the PHP and state medical board as a form of noncompliance, and that my career and license would be in jeopardy. How is that possible when I was not sent there by any state board or regulatory agency as I was there voluntarily.

The only incentive to force me into admission rather than having my workup done as an outpatient was purely financial. Employer was paying the bill, so it was in their best financial interest to force me into admission at $1800/day and $1400/urine sample and charge for all the transportation to and from all the outsourced facilities for my “evaluation”.

The facility was run by the most inept, unethical group of charlatans I have ever encountered in any field of service not just healthcare. I could not understand how they were qualified to provide medical evaluations when they are not legally allowed to provide any form of treatment for anything. These people were nothing more than middle-management screw ups. They have to outsource everything. They did not even have a crash cart on site.  One of their clients had a tonic-clonic seizure during group therapy as a result of a brilliant PA who decided to withhold the clients chronic benzodiazepine therapy because of her personal beliefs that benzos are horrible medications for anyone.  Where is the physician co-signature and oversight on this brilliant therapeutic decision? No one except the doctors in rehab even knew how to react. It was a total fiasco and state of panic for all the rehab employees. Luckily the client didn’t dislocate something, die or worse, suffer anoxic encephalopathy. I was in fear for my life after witnessing this my first day.

What’s even more concerning is that this rehab center is supposedly one of the best and has exclusive referral from every state PHP.

They had me stay with recidivist junkies and participate in 12 step when I had no substance abuse issues at all, in fact my social life was so boring, that my hair test wasn’t even positive for alcohol. I had to recite scriptures in group therapy, admit that I was helpless, and powerless, and a weakling. Admit that I had to submit to a higher power since I was an addict. I had to submit to random urine drug tests which costs $1400 each 3-5 times per week.

Then when I cannot produce a sample on the spot (paruresis) I am threatened to be reported to the State Medical Board for noncompliance.  A college dropout working as a technician at a rehab does not even have the authority to make this type of threat. I was also forced to shave in front of a female technician with the bathroom door open; she stated that this was policy and I had to relinquish my razor after every shave because I could use it to inflict harm on myself. I then asked why is there a whole drawer full of sharp cutlery in the kitchen that me and my junkie roommates have access to 24/7??? 

I saw a psychiatrist and handed him my diagnosis on a silver platter from my history , i.e. Paxil withdrawal yet SSRI Discontinuation Syndrome was not even on his differential. I was in a state of constant agitation, sleep deprivation from insomnia, severe depersonalization. Ended up in the ER at UCLA for intractable Migraine HA, Sleep deprivation, Dehydration, mild AKI and had to be medicated with IV crystalloid, Phenergan to combat emesis and finally induce sleep (going on 4th day of insomnia at that point). 

Less than 24 hours after the ER visit I am sent for Neuropsychological testing extensively, which violated just about every code of conduct and ethics under the American Psychological Association in regards to testing validity. I was then labeled “disabled” based on the results. the treatment center was then going to recommend that I stay and additional extended period so they could “rehabilitate” me. They realized now that they did not have my credit card on file because I refused to provide them with it at admission as my employer, was paying for everything for the first month. Next they discover that I do not have disability insurance, and now know that they have just ruined my life.  It will take a minimum of 6 months before I can be retested to prove that I have no cognitive impairment and am not disabled. Now my chances of getting disability insurance in the future are ruined.

The treatment center then released me and I returned home to the PHP.  I then had to sign a five year contract, enlist in a drug monitoring contact with “RecoveryTrek” which I had to perjure myself and illegally claim that I was a substance abuser and was in “recovery.” I immediately sought legal counsel because of this nonsense. Shortly into my so called recovery I had to take my Maintenance of Certification Board Exam in Internal Medicine. Passed exceptionally and with ease. How could I be cognitively impaired?

Go figure! The neuropsychological test was readministered locally by a different provider as I told the PHP there was no way I would ever consent to going back to the treatment center.  The neuropsychologist was pretty pissed off about everyone’s mismanagement of my case starting with my employer.  I tested fine, and then the PHP released me from the program and cleared me to return to work. The entire experience has jaded my enthusiasm in medicine. I had to take almost a year off to reflect on how I was used as a pawn in everyone’s game.

I experienced coercion, collusion, fraud, incompetence, and saw a part of evil in this world that I never new existed. I was a prisoner, starting my day by having to call a monitoring center to see if I had to be drug tested for that day, every  day of the week.  I was not allowed to leave the state; how can a PHP legally restrict my civil rights this way when I was not under a court order, and not even under state medical board referral? I was not allowed to have a sip of alcohol during my monitoring, even though I had tested negative for any evidence of drug use. I had to meet with board of directors every month and discuss my case, which no one had clue about regarding why I was even in a PHP.  This violated all of my rights to privacy regarding my medical condition. The contract that I initially had to sign with the PHP had statements within claiming they could report any information about me to any regulatory agency without even substantiating any facts or validity. This is just a clever way of saying they can lie about you and there is nothing you can do about it legally.  There is complete lack of due process. Your civil rights are stripped. You are beaten down into despair and desperation. You are told if you don’t comply your license would be in jeopardy and your career will be over. This cost me thousands of dollars in legal fees, thousands of dollars to be retested and prove I was not impaired, hundreds of dollars each month for PHP dues and random urine drug screening.

I put up with this B.S. for six months, and honestly could not have fulfilled a 5 year contract. If I had not been released (since there was no condition to monitor) I would probably be dead today. I would not be surprised that PHPs have actually caused in increase in physician suicide rate.  I cannot fathom the degree of humility physicians experience having to do this for five years. And the only reason these rehab centers claim such a high success rate for recovery is that they hold a gun to your head and threaten you to be in compliance with everything they recommend. So yeah, doctors have a lot more to lose.  I now understand how these PHP’s are in collusion with rehab centers. What they are doing is a violation of fair trade acts and would fall under the RICO act. The problem is nobody is investigating them for conspiracy and fraud. They all fly under the radar because they believe they are providing a service that ensures public safety. Its a multi-billion dollar scam industry. What’s more sad is that nobody really cares what physicians are subjected to. In fact the public likely finds joy in fact that docs are treated this way. The state of California hates doctors, so the rest of the country probably does too. People probably enjoy knowing doctors are held to higher standards than the rest. That they are usually required to stay 90 days in rehab while all other professionals stay 28 days, that they are financially ruined by rehab centers. That they have been stripped of all their rights while in a PHP monitoring program. That they are more subject to discrimination based on age or coexisting medical problems like diabetes and hypertension. I have actually seen cases of MDs sent to PHPs for monitoring of hypertension and regardless of why you are sent there you must comply with drug monitoring.

The rehab centers are now tapping into other territory that further identify this as a conspiracy. Department of Transportation, Aviation, and Law Enforcement are going to be their next victims. I can’t wait to see how the police officers are going to respond to this nonsense.

This was an eye opening experience. There is no profession that is worth going through this amount of humility. PHP’s will likely remain above the law, continue to have no accountability and oversight, which is a travesty of justice.  I hope you will share my experience.  My case is rather unique in my opinion.  It’s evidence that no physician should ever voluntarily enter a PHP at an employer’s request. You would be much better off to simply quit/resign.

12/27/2014

I know of pharmacist who are forced into the program and held hostage by their license. They are also required to do “inpatient” treatments of at least three months and continued random monitoring for five years as well.

Once they have you by the proverbial ball, they milk you till you are dry. It is nothing but a scam. The funny thing is that for healthcare professionals who relapse while in the program, they are sent back to “rehab”(inpatient) again once more for milking while they feed you the same b.s. they did the first time.

What is becoming even more alarming is that at least in one case, Texas, if you call PHP for help or to inquire about help, even though nothing has been reported at work or to the board, and you identify yourself and spill your guts about your issue/s asking for your options you are automatically signing up for a trip to rehab and five years of monitoring.

If you decided that you are not interested what they have to offer, they will tell you they would report you to the board at that stage (of course at the beginning of the conversation they tell you it is confidential, but it is confidential as long as you voluntarily start their program since you spilled the beans.

I would be very careful calling the state PHPs asking for information. I would do it from a blocked phone and use an alias before talking to them.

Maybe others who information about other states can also shed some light on this.

12/7/2014

It is really tragic that so many valuable doctors are lost without reason.  That State Medical Boards can strip a physician of his hard earned license without due process. That there is no oversite of these boards. That boards and PHPs bully and harass physicians, even to the point of suicide. About 400 physician commit suicide every year. That’s a loss of an entire medical school every year! A colleague of mine committed suicide after facing medical board charges that had no signifigance anyway. This is occurring in the face of a physician shortage as baby boomers age.

12/30/2014

Turns out, I am one of those recovering alcoholics (9+ years) with a lot of experience in AA. It was a large part, though not all, of my treatment. I found it personally helped me a lot. And I also agree with your position.

Based on my experience in AA, things I heard at AA meetings and things I read in AA literature:

– the AA message should be spread via “attraction, rather than promotion”

– AA does not claim to be any kind monopoly in the field of addiction treatment

– AA is fully self-supporting, declining outside contributions

– AA is not professional and not organized

And so having a large body of physicians outside of AA promoting AA is, in my opinion, contrary to multiple AA traditions – particularly if this situation creates controversy. I personally find AA needs no extra promotion, and alternative treatment programs ought to be encouraged just as well as further scientific research into the addiction problem.

The whole thing was meant as a very open, welcoming, non-judgemental, informal gathering of alcoholics talking to each other. Extremism, government coercion, public promotion, money – all those things do a lot more harm than good.

At any rate, thanks for your thoughts, Dr. Langan. Best of luck in the future, I’ll keep following along.

12/25/2014

As an airline pilot who made the monumental mistake of believing that the “E” in EAP (Employee Assistance Program) really meant “assistance”, I can only nod my head in sad agreement to everything above. Between “treatment” (indoctrination in AA dogma) and monitoring my decision to ask for assistance in dealing with a series of health and personal issues that I (for the first and so far only time in my life) tried to use alcohol to numb has changed my life forever. I have lost 7 years of my life. My faith in the rule of law in our society is completely gone. The stress and humiliation of having my career depend on my ability to convince people in this program that I have been “converted” (let’s call it what it is: living a lie) have been indescribably painful. It has affected every aspect of my life. My physical and mental health has suffered as has my personal relationships. My only hope is that court decisions like the recent one in the Hazle trial will once and for all end this damaging and unconstitutional practice.

12/1/2014

Comment: Excellent research. What is astounding is that some (if not all) PHPs are using EtGs and EtSs and PEths DESPITE explicit advisories by SAMHSA over a span of 6 years! These advisories noted that a) they were not FDA approved; b) there was insufficient research; c) that there were too many false positives; and d) using such tests in such a setting as the forensic environment where someone’s career and reputation could be put at risk was highly dangerous. Further, as I discovered only recently, NCPHP not only runs these tests on new evaluations it conducts on involuntary (and unsuspecting) physicians who have been ordered (under specious circumstances) to be evaluated by NCPHP, NCPHP adamantly refused to release the results of the tests to the physician, though you can be assured the results were used to “make their case” for a pre-determined diagnosis.

I think it is fair to say that their use of these tests is not simply unethical; it constitutes highly risky human experimentation conducted with neither the subject’s consent nor with approval of an IRB.

One can also presume that PHPs have sold this junk science to their associated medical boards in giving them what appears to be substantial evidence to bolster their case. And one can also presume that medical boards have simply accepted it as though it were valid, essentially doing nothing to challenge the invalidity of the test and the violation of due process and thus virtually rubber-stamping the annihilation of a physician’s career.

When you engage these research epidemiologists in this endeavor (is there yet a group called “Epidemiologists for Social Responsibility?”), you may also ask them to review data form board and PHP actions in which this data was – in any way – involved in the assessment of their case, whether playing a major role or only an incidental one. The introduction of this misleading – and therefore fraudulent – laboratory data into these physicians’ adjudication would seem to serve as a solid basis for invalidating their fraudulent assessment and ensuing “conviction.”

Personally, I believe this is of such immense importance that it ranks up there with the flawed hair and fiber analysis assessments that were done by the FBI which my courageous colleague Dr. Fred Whitehurst called attention to in the late ’90’s (and lost his job over, via a massive campaign of discrediting and innuendo of “mental illness.”) It took nearly 15 years but finally, the DOJ saw the immensity and breadth of the false prosecution based on flawed “evidence” and ordered the FBI to reopen over 21,000 cases of potentially flawed hair and fiber analysis!

I truly believe the same outcome is going to materialize here – it has to! Physicians (and soon many other seemingly well-paid professionals who are judged able to afford the “private addictions treatment for professionals” scam) have been falsely assessed and compelled into costly (and embarrassing) treatment programs and prolonged monitoring (with extra time for balking – i.e. “being disruptive”) by the PHP prison-industrial complex. All with no chance of fair hearing, no chance to challenge the validity of the evidence, and high likelihood of reprisal if one doesn’t “go along.” This pervasive abuse of authority and process must be aggressively confronted.

11/27/2014

Great site!  There is so much corruption in medical boards & PHP’s.  We need to take it upon ourselves to evaluate what our agencies are doing and turn them into the state auditor of every sight for performance and forensic auditing.  Auditors DO listen and DO investigate, but they need to be led to the need for an audit.  The best way to do this is for those of us who have been assaulted and battered by these agencies to document what has been done to ourselves and our peers and let the auditors know what is going on!

11/22/2014

I have enjoyed reading your web log.  I have empathy for your plight.  I am involved in a parallel organization known as the HIMS program (Human Intervention and Motivational Study)  

I can’t help but notice that several of the names you have listed under ‘like-minded docs’, are ‘professionals’ I have also encountered.  Namely, Joe Garbely who did my initial psychiatric evaluation, Lynn Hankes, a urologist who advises HIMS and the FAA, and William Green, my current psychiatrist.  I am told a component of my $1500 dollar meeting with Dr Green (Physical and Psychiatric) will be composed of inquisitions into my involvement in Alcoholics Anonymous and progress in my step work. This is the man who told me I must attend three AA meetings weekly and my aftercare group therapy must involve AA in order to be approved for FAA Special Issuance (the FAA Gold Standard). I was also informed that non compliance would mean a rejection of my application by the Feds. All of this after I informed Dr. Green that there simply was ‘no correlation’ between Alcoholics Anonymous involvement and my sobriety and that I found the program to be psychologically harmful to my well being.

If you have any further information on the three ‘like-minded docs’ I have encountered in my journey kindly point this out to me.  I am sure there are more but I must thank you for providing the missing pieces of the puzzle from the medical perspective. Its eye opening to say the least. Have you spoken with the same attorneys the pilots have? I am sympathetic with your plight.  The worst mistake I ever made was asking for help and the process of psychological hazing, indoctrination, and coercion did nothing but steepen my situational depression.

Jonathan

Thank you for your earnest work on this subject.  We are not alone in this.

Jonathan


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Physician Suicide, Organizational Justice and the “Cry of pain” Model: Hopelessness, Helplessness and Defeat

mllangan1 85 Comments

They can be a terror to your mind and show you how to hold your tongue
They got mystery written all over their forehead
They kill babies in the crib and say only the good die young
They don’t believe in mercy
Judgement on them is something that you’ll never see
They can exalt you up or bring you down main route
Turn you into anything that they want you to be–Bob Dylan, Foot of Pride


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Although no reliable statistics yet exist, anecdotal reports suggest a marked rise in physician suicide in recent years. From the reports I am receiving it is a lot more than the oft cited “medical school class” of 400 per year.

This necessitates an evaluation of predisposing risk factors such as substance abuse and depression, but also requires a critical examination of what external forces may be involved in the descent from suicidal ideation to suicidal planning to completed suicide.  What are the cumulative situational and psychosocial factors in physicians that make suicide a potential option and what acute events precipitate the final act?

Depression and Substance Abuse no Different from General Population

The prevalence of depression in physicians is close to that of the general population 1,2 and, if one looks critically at the evidence based literature, substance abuse in medical professionals approximates that of the general population.  Controlled studies using DSM diagnostic criteria indicate that physicians have the same rates (8-14%) of substance abuse and dependence as the general population,3 and slightly lower rates compared to other occupations.4,5 Epidemiological surveys reveal the same. Hughes, et al.6 reported a lifetime prevalence of drug or alcohol abuse or dependence in physicians of 7.9%, markedly less than the 14.6% prevalence reported in the general population by Kessler.7

Job Stress and Untreated Mental Illness Risk Factors

Job stress coupled with inadequate treatment for mental illness may be factors contributing to physician suicide according to one recent study. Using data from the National Violent Death Reporting System, Gold, Sen, & Schwenk, 2013 8 compared 203 physicians who had committed suicide to more than 31,000 non-physicians and found that having a known mental health disorder or a job problem that contributed to the suicide significantly predicted being a physician. Physicians were 3.12 times more likely to have a job problem as a contributing factor. In addition, toxicology testing showed low rates of medication treatment.  The authors concluded that inadequate treatment and increased problems related to job stress are potentially modifiable risk factors to reduce suicidal death among physicians. They also warned that the database used likely underestimated physician suicides because of “underreporting and even deliberate miscoding because of the stigma attached.”8

Few studies have evaluated the psychosocial stressors surrounding physician suicide but there is no reason to believe they are any different from the rest of the population. Although the triggering life events and specific stressors may vary outside, the inner psyche and undercurrent of thoughts and feelings should remains the same.   Perhaps the same drivers of suicide identified in other populations are contributing to physician suicide.

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Perceived Helplessness, Hopelessness, Bullying and Defeat

Perceived helplessness is significantly associated with suicide as is9 Hopelessness10,11 Bullying is known to be a predominant trigger for adolescent suicide12-14 One study found that adolescents in custody who were bullied were 9.22 times more likely to attempt suicide than those were not bullied.15

Heightened perceptions of defeat and entrapment are known to be powerful contributors to suicide.16,17 The “Cry of Pain” model 18,19 specifies that people are particularly prone to suicide when life experiences are interpreted as signaling defeat which is defined as a sense of “failed struggle” or loss of social position and resources.. The person is unable to identify an escape from or resolution to a defeating situation, a sense of entrapment proliferates with the perception of no way out, and this provides the central impetus for ending ones life. There is a helplessness and hopelessness that precipitates the descent from ideation, to planning, and then to finality.

Organizational Justice Important Protective Factor

In a study on Italian and Swedish female physicians, degrading experiences and harassment at work were found to be the most powerful independent variables contributing to suicidal thoughts.20 Degrading work experiences harassment, and lack of control over working conditions were found to be associated with suicidal thoughts among Italian and Swedish male university physicians.21

Evidence exists for the role of rescue factors (i.e. social support) as buffers against suicide in the face of varying degrees of life stress.22,23 The study of female physicians revealed meetings to discuss stressful work experiences as a potential protective factor, 20 and support at work when difficulties arose appeared to be a protective factor for the male physicians.21   In line with this, studies of Finnish physicians found that control over one’s work and organizational justice were the most important determinants of work-related wellbeing.24,25 Organizational justice has been identified as a psychosocial predictor of health and wellbeing26 27 Low organizational justice has been identified as a notable risk factor for psychological distress and depression.28,29

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Historical Precedent-the Suicides at Ridgeview

Could these factors be playing a role in physician suicide?   They evidently did at the Ridgeview Institute, a drug and alcohol treatment program for impaired physicians in Metropolitan Atlanta created by G. Douglas Talbott. Talbott helped organize and served as past president of the American Society of Addiction Medicine (ASAM) and was a formative figure in the American Medical Association’s (AMA’s) Impaired Physician Program. He has owned and directed a number of treatment facilities for impaired professionals, most recently the Talbott Recovery Campus in Atlanta, one of the preferred referrals for physicians ordered into evaluation and treatment by licensing boards.

After creating the DeKalb County Impaired Physicians Committee for the Medical Association of Georgia, Talbott founded the Georgia Disabled Doctors Program in 1975 in part because “traditional one-month treatment programs are inadequate for disabled doctors.” According to Talbott, rehabilitation programs that evaluate and treat the rest of the population for substance abuse issues are incapable of doing so in doctors as they are unlike others. He bases this uniqueness on “incredibly high denial”, and what he calls the “four MDs,” “M-Deity”, “Massive Denial” “Militant Defensiveness”, and “More Drugs.”30

Contingency Management = Extortion Using Medical License

According to Talbott, “impaired doctors must first acknowledge their addiction and overcome their ‘terminal uniqueness’ before they can deal with a drug or alcohol problem.” “Terminal uniqueness “ is a phrase Talbott uses to describe doctors’ tendency to think they can heal themselves. “M-Deity” refers to doctors “being trained to think they’re God,”31 an unfounded generalization considering the vast diversity of individuals that make up our profession. This attitude, according to some critics, stems from the personal histories of the treatment staff, including Talbott, who are recovering alcoholics and addicts themselves. One such critic was Assistant Surgeon General under C. Everett Koop John C. Duffy who said that Ridgeview suffered from a “boot-camp mentality” toward physicians under their care and “assume every physician suffering from substance abuse is the same lying, stealing, cheating, manipulating individual they were when they had the illness. Certainly some physicians are manipulative, but it’s naïve to label all physicians with these problems.”32

American Society of Addiction Medicine (ASAM) President (1981-1983) LeClair Bissell was also highly critical of Talbott’s approach. Bissell, co-author of the first textbook of ethics for addiction professionals33 when asked if there was any justification to the claim that doctors are sicker than other people and more vulnerable to addiction replied:

“Well, based on my treatment experience, I think they are less sick and much easier to treat than many other groups. I think one reason for that is that in order to become a physician…one has to have jumped over a great many hurdles. One must pass the exams, survive the screening tests and the interviews, be able to organize oneself well enough to do examinations and so on, and be observed by a good many colleagues along the way. Therefore I think the more grossly psychotic, or sicker, are frequently screened out along the way. The ones we get in treatment are usually people who are less brain-damaged, are still quite capable of learning, are reasonably bright. Not only that, but they are quite well motivated in most cases to hang on to their licenses, the threat of the loss of which is frequently what puts them in treatment in the first place. So are they hard to treat? No! Are they easy patients? Yes! Are they more likely to be addicted than other groups? We don’t know.”34

“I’m not much for the bullying that goes along with some of these programs,” Bissell commented to the Atlanta Journal and Constitution in 1987.31   The constitution did a series of reports after five inpatients committed suicide during a four-year period at Ridgeview.35 In addition there were at least 20 more who had killed themselves over the preceding 12 years after leaving the treatment center.32

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Bissell, the recipient of the 1997 Elizabeth Blackwell Award for outstanding contributions to the cause of women and medicine remarked: “When you’ve got them by the license, that’s pretty strong leverage. You shouldn’t have to pound on them so much. You could be asking for trouble.”31 According to Bissell: “There’s a lot of debate in the field over whether treatment imposed by threats is worthwhile…To a large degree a person has to seek the treatment on his own accord before it will work for him.”31

A jury awarded $1.3 million to the widow of one of the deceased physicians against Ridgeview,36 and other lawsuits initiated on behalf of suicides were settled out of court.35

The Constitution reported that doctors entered the program under threats of loss of licensure “even when they would prefer treatment that is cheaper and closer to home.” 37 The paper also noted that Ridgeview “enjoys unparalleled connections with many local and state medical societies that work with troubled doctors,” “licensing boards often seek recommendations from such groups in devising an approved treatment plan,” and those in charge are often “physicians who themselves have successfully completed Ridgeview’s program.”37

The cost of a 28-day program for nonprofessionals at Ridgeview in 1987 was $10,000 while the cost was “higher for those going through impaired-health professionals program,” which lasted months rather than 28 days.32

In 1997 William L. White interviewed Bissell whom he called “one of the pioneers in the treatment of impaired professionals.” The interview was not published until after hear death in 2008 per her request.   Noting her book Alcoholism in the Professions38 “remains one of the classics in the field”, White asked her when those in the field began to see physicians and other professionals as a special treatment population. She replied:

“When they started making money in alcoholism. As soon as insurance started covering treatment, suddenly you heard that residential treatment was necessary for almost everybody. And since alcoholic docs had tons of money compared to the rest of the public, they not only needed residential treatment, they needed residential treatment in a special treatment facility for many months as opposed to the shorter periods of time that other people needed.”39

Talbott claimed a “92.3 percent recovery rate, according to information compiled from a five-year follow-up survey based on complete abstinence and other treatment.”40

“There is nothing special about a doctor’s alcoholism,” said Bissel

“these special facilities will tell you that they come up with really wonderful recovery rates. They do. And the reason they do is that any time you can grab a professional person by the license and compel him or her into treatment and force them to cooperate with that treatment and then monitor them for years, you’ll get good outcomes—in the high 80s or low 90s in recovery rates—no matter what else you do.”39

“The ones I think are really the best ones were not specialized. There were other well-known specialty clinics that claimed all the docs they treated got well, which is sheer rot. They harmed a great many people, keeping them for long, unnecessary treatments and seeing to it that they hit their financial bottom for sure: kids being yanked out of college, being forced to sell homes to pay for treatment, and otherwise being blackmailed on the grounds that your husband has a fatal disease. It’s ugly.”39

Stanton Peele’s “In the Belly of the American Society of Addiction Medicine Beast” describes the coercion, bullying, threats and indoctrination that are standard operating procedure in Talbott’s facilities.41 Uncooperative patients, “and this covers a range of sins of commission or omission including offering one’s opinion about one’s treatment,” are “threatened with expulsion and with not being certified-or advocated for with their Boards.”41 The cornerstone of treatment is 12-step spiritual recovery. All new patients are indoctrinated into A.A. and coerced to confess they are addicts or alcoholics. Failure to participate in A.A. and 12-step spirituality means expulsion from the program with the anticipated result being loss of one’s medical license.

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From a talk given by FSPHP

Fraud, Malpractice, False Diagnoses and False imprisonment

In May 1999 Talbott stepped down as president of the American Society of Addiction Medicine (ASAM) as a jury awarded Dr. Leonard Masters a judgment of $1.3 million in actual damages and an undisclosed sum in punitive damages for fraud, malpractice, and the novel claim of false imprisonment.42 The fraud finding required a finding that errors in the diagnosis were intentional. After being accused of excessive prescribing of narcotics to his chronic pain patients, Masters was told by the director of the Florida PHP that he could either surrender his medical license until the allegations were disproved or submit to a four-day evaluation. Masters agreed to the latter, thinking he would have an objective and fair evaluation, but was instead diagnosed as “alcohol dependent” and coerced into the Talbott recovery program. He was forced to stay in the program under threat of his medical license as staff would routinely threaten to report any doctor who questioned any aspect of their diagnosis or treatment to their state medical boards “as being an impaired physician, leaving necessary treatment against medical advice”42  which would mean the loss of his licensure. However, Masters was not an alcoholic. According to his attorney, Eric. S. Block,  “No one ever accused him of having a problem with alcohol. Not his friends, not his wife, not his seven children, not his fellow doctors, not his employees, not his employers, No one.” 43  He was released 4 months later and forced to sign a five-year “continuing care” contract with the PHP, also under continued threat of his medical license. Talbott faced no professional repercussions and no changes in the treatment protocols were made. Talbott continued to present himself and ASAM as the most qualified advocate for the assessment and treatment of medical professionals for substance abuse and addiction up until his death last year.44

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Same System Imposed on Doctors Today—Institutional Injustice Worse due to Laboratory Developed Tests. Fortified Scaffold and Tightened the Noose.

In almost all states today any physician referred for an assessment for substance abuse will be mandated to do so in a facility just like Ridgeview. There is no choice. There is one difference however.   When the Ridgeview suicides occurred the plethora of laboratory developed tests were not yet introduced. A decade ago Dr. Gregory Skipper introduced the first laboratory developed test for forensic testing and used it on doctors in physician health programs.   These non-FDA approved tests of unknown validity presented a new unpredictable variable into the mix with a positive test necessitating another assessment at an out of state treatment facility—a “PHP-approved” assessment facility. The addition of this laboratory Russian Roulette renders the current system much worse than it was at the time of the Ridgeview suicides.

And if a positive test occurs there are no safeguards protecting the donor. LDTs are unregulated by the FDA. There is no oversight and no one to file a complaint with.

In addition the PHPs have no oversight by the medical boards, departments of health or medical societies. They police themselves. The PHPs have convinced law enforcement that when it comes to doctors it is a “parochial issue” best handled by the medical community. I have been hearing from doctors all over the country who have tried to report crimes to the local police, the state Attorney General and other law enforcement agencies only to be turned back over to the very perpetrators of the crimes. “He’s a sick doctor, we’ll take care of him.” The “swift and certain consequences” of this are an effective means of keeping the rest of the inmates silent.   Likewise doctors have been going to the media only to have the door slammed in their faces because the media has generally bought in to the “impaired” and “disruptive” physician construct these same people developed through propaganda, misinformation and moral panics and crusades.

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Urgent Need to Admit to the Problem

There has been an increase in physician suicide in the past decade.   By my estimate the numbers are going to be far higher than the oft-cited 400 per year. The speculation as to cause has been unenlightening and in fact frustrating.   Knowledge of anatomy, access to dangerous drugs, increased workload and even student loans have been proposed as contributing factors. Although there has been some tangential mention of physician health programs it has been indirect. Direct and defined discussion is necessary and state PHPs need to be named as a possible contributor to suicide.  Admitting the possibility there is a problem is the first crucial step in defining and addressing the problem.    The 1980s historical precedent is correlated with physician suicide.  The current system is not only based on Ridgeview but has been fortified in scope and power.  The physician health movement has effectively removed due process from doctors while removing answerability and accountability from themselves. And they have not only fortified the scaffold but widened it from substance abusing doctors to all doctors. “Potential impairment” and “relapse without use” were introduced without any meaningful resistance and they are now using a panoply of non-FDA approved laboratory developed tests of unknown validity to test for substances of abuse in a zero-tolerance abstinence based monitoring program.  With no regulatory oversight the stage is set not only for error but misuse as witch-pricking devices for punishment and control.  Doctors across the country are complaining of the very same abuses Leonard Masters did–false diagnoses, misdiagnosis, unneeded treatment and fraud.

In summary, any doctor who is referred to their state PHP today is required to have any assessment and treatment at a “PHP-approved” facility based on Ridgeview.  It is mandated.  There is no choice.  Coercion, control and abuse at Ridgeview was associated with multiple suicides in doctors in the 1980s.  The use of non-FDA approved tests of unknown validity worsens the abuse and fits the “cry of pain” model of hopelessness, helplessness and despair. Locus of control is  lost.  Organizational justice is absent.

The temporal relationship is clear.

Why is this still the elephant in the room?

This needs to be named, defined and openly discussed and debated.  How many more must die before we speak up?

Please help me get the conversation going.

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  1. Ford DE, Mead LA, Chang PP, Cooper-Patrick L, Wang NY, Klag MJ. Depression is a risk factor for coronary artery disease in men: the precursors study. Archives of internal medicine. Jul 13 1998;158(13):1422-1426.
  2. Frank E, Dingle AD. Self-reported depression and suicide attempts among U.S. women physicians. The American journal of psychiatry. Dec 1999;156(12):1887-1894.
  3. Brewster JM. Prevalence of alcohol and other drug problems among physicians. JAMA : the journal of the American Medical Association. Apr 11 1986;255(14):1913-1920.
  4. Anthony J, Eaton W, Mandell W, al. e. Psychoactive Drug Dependence and abuse: More Common in Some Occupations than in Others? Journal of Employee Assistance Res. 1992;1:148-186.
  5. Stinson F, DeBakely S, Steffens R. Prevalence of DSM-III-R Alcohol abuse and/or dependence among selected occupations. Alchohol Health Research World. 1992;16:165-172.
  6. Hughes PH, Brandenburg N, Baldwin DC, Jr., et al. Prevalence of substance use among US physicians. JAMA : the journal of the American Medical Association. May 6 1992;267(17):2333-2339.
  7. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry. Jun 2005;62(6):593-602.
  8. Gold KJ, Sen A, Schwenk TL. Details on suicide among US physicians: data from the National Violent Death Reporting System. General hospital psychiatry. Jan-Feb 2013;35(1):45-49.
  9. Rivers I, Noret N. Potential suicide ideation and its association with observing bullying at school. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. Jul 2013;53(1 Suppl):S32-36.
  10. Lester D, Walker RL. Hopelessness, helplessness, and haplessness as predictors of suicidal ideation. Omega. 2007;55(4):321-324.
  11. Beck AT. Hopelessness as a predictor of eventual suicide. Annals of the New York Academy of Sciences. 1986;487:90-96.
  12. Hinduja S, Patchin JW. Bullying, cyberbullying, and suicide. Archives of suicide research : official journal of the International Academy for Suicide Research. 2010;14(3):206-221.
  13. Hertz MF, Donato I, Wright J. Bullying and suicide: a public health approach. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. Jul 2013;53(1 Suppl):S1-3.
  14. Kim YS, Leventhal B. Bullying and suicide. A review. International journal of adolescent medicine and health. Apr-Jun 2008;20(2):133-154.
  15. Kiriakidis SP. Bullying and suicide attempts among adolescents kept in custody. Crisis. 2008;29(4):216-218.
  16. Taylor PJ, Gooding P, Wood AM, Tarrier N. The role of defeat and entrapment in depression, anxiety, and suicide. Psychological bulletin. May 2011;137(3):391-420.
  17. Lester D. Defeat and entrapment as predictors of depression and suicidal ideation versus hopelessness and helplessness. Psychological reports. Oct 2012;111(2):498-501.
  18. Williams JMG. Cry of Pain. Harmondsworth: Penguin; 1997.
  19. Williams JMG, Crane C, Barnhofer T, Duggan DS. Psychology and suicidal behavior: elaborating the entrapment model. In: Hawton K, ed. Prevention and treatment of suicidal behavior: from science to practice. Oxford: Oxford University Press; 2005:71-89.
  20. Fridner A, Belkic K, Marini M, Minucci D, Pavan L, Schenck-Gustafsson K. Survey on recent suicidal ideation among female university hospital physicians in Sweden and Italy (the HOUPE study): cross-sectional associations with work stressors. Gender medicine. Apr 2009;6(1):314-328.
  21. Fridner A, Belkic K, Minucci D, et al. Work environment and recent suicidal thoughts among male university hospital physicians in Sweden and Italy: the health and organization among university hospital physicians in Europe (HOUPE) study. Gender medicine. Aug 2011;8(4):269-279.
  22. Borowsky IW, Ireland M, Resnick MD. Adolescent suicide attempts: Risks and protectors. Pediatrics. 2001;107(485).
  23. Clum GA, Febbraro GAR. Stress, social support and problem-solving appraisal/skill: Prediction of suicide severity within a college sample. Journal of Psychopathology and Behavioral Assessment. 1994;16:37-46.
  24. Lindfors PM, Meretoja OA, Toyry SM, Luukkonen RA, Elovainio MJ, Leino TJ. Job satisfaction, work ability and life satisfaction among Finnish anaesthesiologists. Acta anaesthesiologica Scandinavica. Aug 2007;51(7):815-822.
  25. Heponiemi T, Kuusio H, Sinervo T, Elovainio M. Job attitudes and well-being among public vs. private physicians: organizational justice and job control as mediators. European journal of public health. Aug 2011;21(4):520-525.
  26. Elovainio M, Kivimaki M, Vahtera J. Organizational justice: evidence of a new psychosocial predictor of health. Am J Public Health. Jan 2002;92(1):105-108.
  27. Lawson KJ, Noblet AJ, Rodwell JJ. Promoting employee wellbeing: the relevance of work characteristics and organizational justice. Health promotion international. Sep 2009;24(3):223-233.
  28. Hayashi T, Odagiri Y, Ohya Y, Tanaka K, Shimomitsu T. Organizational justice, willingness to work, and psychological distress: results from a private Japanese company. Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine. Feb 2011;53(2):174-181.
  29. Lang J, Bliese PD, Lang JW, Adler AB. Work gets unfair for the depressed: cross-lagged relations between organizational justice perceptions and depressive symptoms. The Journal of applied psychology. May 2011;96(3):602-618.
  30. Gonzales L. When Doctors are Addicts: For physicians getting Molly Kellogg is easy. Getting help is not. Chicago Reader. July 28, 1988, 1988.
  31. King M, Durcanin C. The suicides at Ridgeview Institute: A Doctor’s treatment program may be too tough, some say. Atlanta Journal and Constitution. December 18, 1987a, 1987: A12.
  32. Durcanin C, King M. The suicides at Ridgeview Institute: Suicides mar success at Ridgeview with troubled professionals. Atlanta Journal and Constitution. December 18, 1987, 1987: A13.
  33. Bissell L, Royce JE. Ethics for Addiction Professionals. Center City, Minnesota: Hazelden; 1987.
  34. Addiction Scientists from the USA: LeClair Bissell. In: Edwards G, ed. Addiction: Evolution of a Specialist Field. 1 ed: Wiley, John & Sons, Incorporated; 2002:408.
  35. Durcanin C. The suicides at Ridgeview Institute: Staff members didn’t believe Michigan doctor was suicidal. Atlanta Journal and Constitution. December 18, 1987, 1987: A8.
  36. Ricks WS. Ridgeview Institute loses $1.3 million in suit over suicide. Atlanta Journal and Constitution. October 11, 1987, 1987: A1.
  37. King M, Durcanin C. The suicides at Ridgeview Institute: Many drug-using doctors driven to Ridgeview by fear of losing licenses. Atlanta Journal and Constitution. December 18, 1987b, 1987: A1.
  38. Bissell L, Haberman PW. Alcoholism in the Professions. Oxford University Press; 1984.
  39. White W. Reflections of an addiction treatment pioneer. An Interview with LeClair Bissell, MD (1928-2008), conducted January 22, 1997. Posted at http://www.williamwhitepapers.com. 2011.
  40. Williams c. Health care field chemical dependency threat cited. The Tuscaloosa News. January 16, 1988, 1988: 16.
  41. Peele S. In the Belly of the American Society of Addiction Medicine Beast. The Stanton Peele Addiction Website (accessed March 28, 2014) http://web.archive.org/web/20080514153437/http://www.peele.net/debate/talbott.html.
  42. Ursery S. $1.3M verdict coaxes a deal for doctor’s coerced rehab. Fulton County Daily Report. May 12, 1999b 1999.
  43. Ursery S. I was wrongly held in alcohol center, doctor charges. Fulton Count y Daily Report. April 27, 1999a 1999.
  44. Parker J. George Talbott’s Abuse of Dr. Leon Masters MD ( http://medicalwhistleblowernetwork.jigsy.com/george-talbott-s-abuse-of-leon-masters ). Medical Whistelblower Advocacy Network.

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Backdraft: How Firefighter Arson was Reduced by Admitting, Defining and having Zero-Tolerance for the Problem–A Lesson for the Medical Profession

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Firefighter Arson

In his book “Fire Lover: A True Story,” Joseph Wamnaugh profiles Fire Captain and  Senior Arson Investigator for the Glendale California  Fire Department John Orr.  Known for his uncanny instincts in solving arson cases, Orr often astounded other investigators with his seemingly brilliant deductions in determining the causes of incendiary crime.

As it turns out, neither instinct nor brilliance played any role.   Orr solved many of these cases by first-hand  knowledge. He actually started many of the infernos he fought.  Burning down businesses and homes for over a decade, investigators suspect Orr may have intentionally set as many as 2000 fires.

John Orr

John Orr

One involved a large Pasadena hardware store that killed four people including a 3-year old toddler and his grandmother. Orr is now serving a life-sentence at Lompoc Penitentiary.  Details of his arsonist acts are described in chilling detail in his own book,  “Points of Origin…playing with fire.”

The problem of arsonist firefighters is not new. In Firesetting Firefighters: Reconsidering a Persistent Problem–Firefighter Arson Research, Matt Hinds-Aldrich reconsiders historical context by drawing upon an original dataset of 1,213 firefighters arrested for arson dating back to the early nineteenth century.   Screen Shot 2015-04-27 at 3.55.38 PM

These cases have generally been attributed to “bad apples,” and prevention has hence been focused on identification by screening of candidates in the same manner as police departments–methods that may successfully identify and weed out criminals turned cops but not cops turned criminals.

This type of screening is unlikely to isolate those with inverted perceptions of morality for whom the normal rules do not apply.   There is no test to identify individuals joining the police force  “who might get so caught  up in making things right or getting their guy that they would push procedural, legal or ethical boundaries.”  There is no test that would have identified John Orr.

The 1991 film Backdraft illustrates this type of warped morality in portraying a firefighter turned arsonist who attempts to make a moral political statement about the dangers of reducing firefighter staffing by setting a series of explosive fires to prove the social value of firefighters.  Hinds-Aldrich describes an ends-justifies-the-means occupational overzealousness in which these individuals in their efforts to do what they think is right take matters into their own hands and begin freelancing.
 Occupational socialization and commitment go awry and firefighter arsonists may attempt to downplay their acts and believe the risks are manageable or even justified and necessary.  They may believe they are truly providing the community a valuable service by eliminating dilapidated and crime-ridden properties-noble corruption all done for the greater good. 
  In a large number of cases studied by Hinds-Aldrich, at least two firefighters at the same department were involved in the fire-setting. They worked together. In Louisiana, authorities discovered that several firefighters from two rural districts were setting dozens of fires each year, mostly grassland but eventually buildings.
The majority of firefighters are individuals of integrity, good-heart and moral compass.  But an estimated 100 firefighters are arrested for arson each year.  Many others have avoided detection due to a confluence of factors.  Hinds-Aldrich notes some have even returned to work as firefighters at a later date. Some have been let go by their department without formal investigation under the rationalization that the threat was removed.  The desire to keep this behind closed-doors is understandable as the arsonist, as a firefighter, puts a stain on a noble profession.   How many of these returned to their old habits is unknown.  Historically no methods have been in place to detect, investigate and hold accountable those who are engaging in behavior that is the antithesis of their public responsibility and trust.
But this behavior has consequences that are sometimes grave and permanent.   As Wamnaugh notes:  “The damage they do in one fire can be enormous. I mean it can be a calamity, just one crime.”
 Backdraft was loosely based on firefighter Ray Norton Jr who was in 1985 was convicted of conspiring with seven other “sparkies” to set 219 blazes in and around Boston during a 14-month arson spree.  The group was motivated by the mistaken belief that the fires would force local governments to hire more firefighters after widespread layoffs in the 1980s. The group started with trash bins and vacant buildings but this soon escalated to burned houses, churches, factories, restaurants, a Marine Corps barracks and the Massachusetts Fire Academy.   More than 300 people were injured and $22 million in property was destroyed.  This illustrates the concept of so called “noble corruption” and the power of “groupthink.”
What are the motivational factors involve?   Some experts previously hypothesized arsonist firefighters may have been motivated by situational factors, boredom or wanting to participate in the job they were tasked with doing –putting out fires.   Others have theorized that becoming a firefighter was a direct consequence of being a firebug; a deliberate volitional choice similar to a foot fetishist becoming a shoe salesman.
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This seems plausible on the surface.  It makes sense in the same vein of logic as Willie Sutton’s explanation as to why he robbed banks–“that’s where the money is.”   If firefighter arsonists are the product of a pyromaniacs wish fulfillment in choosing a vocation that supports and a fire fetish then screening to identify this pathology makes perfect sense.  Identify and remove the threat before the damage occurs.   If Florsheims wanted to extirpate all foot fetishists a screening system identifying any unusual proclivity for toes could be developed.  The underlying reliability and validity of that screen, however, depends on multiple factors including the truthfulness of the potential shoe salesman.  It’s much more complicated.  It is a safe assumption that selling shoes does not create a fetish for feet. Some foot fetishists become shoe salesmen but I would guess few shoe salesmen become foot fetishists.
In the case of arsonist firefighters evidence suggests that it is much more complicated.  Arsonist firefighters are not the simple product of a firebug choosing a vocation that provides an  increased incidence of engaging in and a closer proximity to their avocation.  Joining the profession does not appear to be deliberate machination to acquire an unmolested backstage pass to start fires.    The personality profiles of firefighters who engage in arson seems to involve an interplay between insecurity and power.  Therefore the usual screening procedures are ineffective as this type of personality predisposes these individuals to evolve into arsonists over time.  It is an evolution fostered by the reinforcement of power and control.   Such was the case with Orr.
According to Joseph Waughnaugh:  “It’s power and control. They’ve not only created a living thing, they’ve created a living thing that is the object of massive attention.”
A Special Report: Firefighter Arson was done by the Department of Homeland Security, the United States Fire Administration and the National Fire Data Center in 2003.
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One of the primary motives for firefighters who commit arson was found to be the desire to be seen as a hero.  Those with deep-seated insecurities and feelings of powerlessness, such as Orr, are provided with a feeling of empowerment over society.    These individuals are suddenly given attention, recognition and validity they never had.  Retaliation for some grievance, real or imagined, may also sometimes play a role.
“They may be the first to call in a fire, the first on the scene, and one of the most eager, excited, and enthusiastic members of the response team. Their main reason for lighting the fire is so they can appear as a hero, either by being the first to spot the flames, or by rescuing people and saving property. Extreme cases of firefighter arson involve fires set in occupied structures. When a firefighter sets fire to an occupied structure, the potential for being a life-saving hero is even greater. In North Carolina, one firefighter would set fire to an occupied house, and then return to the scene and rescue the family. His need for excitement, being worshiped, and getting attention predominated over any concern about the terrible danger to which he exposed the occupants”
Some researchers believe that firefighter arsonists undergo a mental process referred to as RPM: the arsonist rationalizes the crime, projects blame, and minimizes the consequences.
The impact of firefighter arson can be severe. People die or are seriously injured, including fellow firefighters. Homes are destroyed. An arsonist from within the fire department can disgrace the whole department, and his actions diminish public trust.  Several states that have experienced the crime of firefighter arson have developed new legislation that directly impacts the prosecution of firefighters accused of arson.
The most crucial step was admitting that the problem exists.  The second was defining the problem. The third was having zero tolerance for those engaged in the problem.    States that have taken this approach have found a marked reduction in firefighter arson.
Physician Wellness Suicides and Medical Review Officer Forensic Fraud 

Multiple parallels exist between firefighter arsonists and physician wellness experts.   Misuse of entrusted power 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.

The firefighter who commits arson is an example of this phenomenon.   So too would be a program that ostensibly promotes the health of doctors but is in reality driving them to suicide or a Medical Review Officer (MRO) ( whose sole job is to prevent the donor of a drug or alcohol test from being falsely accused of drug or alcohol use) falsely accuse a donor of drug or alcohol use by engaging in fraud.

Some of the same psychodynamics and sociocultural factors are probably involved.  A disproportionate number of arsonist firefighters are volunteer firefighters (75%) who offered to help fight fires and ended up doing the opposite..   A large majority of  physician wellness experts were doctors who had had their licenses revoked and were only able to practice medicine again by becoming “addiction medicine” specialists and offering to help other doctors.  As a result these programs self-select for doctors who did something severe enough to lose their licenses and getting their licenses back does not necessarily mean they have changed. Many used the “salvation” card to get their licenses back.  “I’ve changed.”  “I want to help others.”  “I’ve been redeemed.”

Designed with the dual purpose of helping sick doctors and protecting the public, many of the current state Physician Health Programs (PHPs) do neither.  Paradoxically they have become reservoirs of bad medicine and institutional injustice.  Part of the problem is the PHPs have removed themselves from answerability and accountability.  Accountability necessitates both the provision of information and justification for actions;  what was done and why?   The other defining factor of accountability is the ability of outside actors to punish and sanction those who commit misconduct or wrongdoing.    Without these constraints corruption is inevitable.  As we have seen, much of this is by intentional design.  PHPs have no oversight or outside regulation.    No avenue exists to file a complaint let alone investigate one.  In addition those who do file complaints are targeted for retaliation and retribution via “swift and certain consequences” that can be irreversible.    Because of this, few ensnared by these programs speak out and those outside dare not speak up out of fear of being targeted themselves.  This provides the necessary secrecy and silence they need in order to operate.

As with firefighter arson, few people are pointing their fingers at PHPs and claiming any problems with them.  Any suggestion of misconduct or wrongdoing is inevitably ignored, delayed, blocked, rationalized or justified.

Most worrisome is the fact that outside agencies who should and could be doing something about ethical violations, procedural irregularities and even crimes are doing nothing.  As a result  inverted systems of morality involving procedural, ethical and criminal violations against doctors are able to not only exist but thrive.

This needs to change. Everyone in the medical profession must be and should be prepared to admit that there are ethical, procedural and legal breaches being committed by State PHPs and that precise, firm methods are needed to combat the situation.  To ignore the problem or suggest that it doesn’t exist will only increase the damage caused by the impaired physician movement as well as destroy the morale of good and honest doctors.  We must talk to all doctors about forensic fraud, neuropsychological fraud and physician suicide.  We must investigate, charge and convict the perpetrators of these crimes.   No exceptions.  The most crucial step in exposing firefighter arsonist was admitting the problem exists.  The most crucial step in exposing physician wellness corruption is admitting the problem exists.  Although we have made some gains this has not yet happened.

Defend the Medical Review Officer (MRO)

It is now over five months and no one has been able to procedurally, ethically or legally justify the actions of Dr. Wayne Gavryck and the Massachusetts PHP, Physician Health Services, Inc.  I had previously offered 100 volumes of the Classics in Medicine Library to anyone who could do so.  (see prior blog below).  No one has.

Therefore I am going to lower the bar and increase the prizes.  If anyone can think of anything that would hypothetically justify the actions of Gavryck and PHS procedurally, ethically or legally then they win my complete collection of the Classics in Medicine Library. On top of that I will add my collection of Cocoanut Grove artifacts as seen below.  Just one will do.

 Cocoanut Grove Artifacts including menu, wine list, and matchbook

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The Cocoanut Grove was a popular nightclub and restaurant lo located at 17 Piedmont Street in Downtown Boston. On Saturday November 28, 1942 it was the scene of  a tragic and deadly fire that killed 492 people and injured many more.  Fourteen hospitals received the injured and the dead: Beth Israel, Boston City, Cambridge (MT Auburn St.), Cambridge City, Carney, Chelsea Naval,  Faulkner, image012

image010Massachusetts General, Massachusetts Memorial, Peter Bent Brigham, St. Elizabeth’s, St. Margaret’s, and U.S. Marine. Boston City Hospital took the majority of patients (134) and Massachusetts General Hospital took 39.

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Boston City Hospital merged with the Boston University Medical Center Hospital and unfortunately the majority of its records and archives have been lost. Fortunately, we know more about the practices and techniques used at Mass General as a result their excellent archives and due to the June, 1943 Annals of Surgery, which was dedicated to the Symposium on the Management of the Cocoanut Grove Burns at the MGH.

While innovations in burn treatment were a major focus, burns were not the only medical problem. Upon arrival at the hospitals, it was obvious that a large number of patients had severe respiratory distress. Some patients image014showed evidence of obstruction to the air passages. Non-burn specialists were quickly called to the scene to perform laryngoscopes, tracheal suction and tracheotomies. Such a large number of respiratory patients at one time enabled doctors and researchers to better understand the impact of various treatments, leading to many advances in the field.

img018image002See https://www.flickr.com/photos/boston_public_library/sets/72157631071090782/ http://www.cocoanutgrovefire.org/ 

Previously blogged:

As the Medical Review Officer (MRO)  for the Massachusetts state Physician Health Program (PHP), Physician Health Services, Inc. (PHS, inc.), Dr. Wayne Gavryck’s responsibility is an important one.   His job is to verify that the chain-of-custody in any and all drug and alcohol testing is intact before reporting a test as positive.

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Note Dr Gavryck is: 1. Certified by ASAM; 2. A .Certified Medical Review Officer (MRO) who “serves PHS in this capacity.” Although Dr. Gavryck serves PHS I would beg to differ on the MRO function. Accessed from PHS Website 1/15/2015 http://www.massmed.org/Physician_Health_Services/About/PHS_Associate_Directors/#.VM1dZlXF-hY

Dr. Gavryck evidently did not do that here.  In fact for more than a year he helped cover up an alcohol test that was intentionally fabricated at the behest of PHS Director of Operations Linda Bresnahan (who told me when I confronted her with the fact that I have never had or ever even been suspected of having an alcohol problem “you have an Irish last name–good luck finding anyone who will believe you!”

It took a formal complaint with the College of American Pathologists to get the truth out.  The whole fiasco can be seen here and here.

What Gavryck 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 indefensible on all levels (procedurally, ethically, and legally).

The documentary evidence shows with clarity that this was not accident or oversight.  It was intentional and purposeful misconduct.  I think everyone would agree that there should be zero-tolerance for forensic fraud in positions of power.    Any person of honor and civility would agree.

Transparency, regulation, and accountability are necessary for these groups.   It is an issue that needs to be acknowledged and addressed not ignored and covered up.

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

Perhaps Dr. Gavryck needs to see some of the damage he has caused in order to take this responsibility. Known as a “bag man” who simply rubber stamps positive tests at the request of Sanchez and Bresnahan (much like Annie Dookhan)  he does not see the damage that is caused. Forensic fraud has grave and far reaching effects and in this case has severely impacted many people and include patient deaths.

Perhaps Dr. Gavryck needs to take a “moral inventory” and see that this this type of behavior causes real damage to real people and put a face on it.

It is people just like this who are killing physicians across the country.   The body count is vast and multiple.  And those who are caught doing dirty deeds such as this need to be held accountable.

Please help me get this exposed, corrected, and rectified.  The doctors of Massachusetts and the doctors of this entire country deserve better than this.

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

DECEMBER 5, 201413 COMMENTSEDIT
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Integrity and Accountability—The Declining State of Physician Health and the Urgent Need for Ethical and Evidence-Based Leadership.

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Sabin and Salk Autographs

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

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

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Sabin, Salk and the Classics in Medicine Library

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

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

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

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

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Background

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

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

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

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

Accountability

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

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

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

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Contest Rules

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

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

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

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

  1. Procedurally;IMG_0580

  2. Ethically; 

  3. or Legally;IMG_0577 - Version 2 

You win all of the prizes! Simple as that!

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

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

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

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

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

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

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

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

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

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

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

Accountability is necessary to prevent corruption and necessitates both the provision of information and justification for actions;  what was done and why?   The other defining factor of accountability is the ability of outside actors to punish and sanction those who commit misconduct or wrongdoing.    Without these constraints corruption is inevitable.

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

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

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

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

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

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

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

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