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.
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.
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.
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.”
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
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,
Massachusetts 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.
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 showed 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.
See https://www.flickr.com/photos/boston_public_library/sets/72157631071090782/ http://www.cocoanutgrovefire.org/
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.
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!.
Integrity and Accountability—The Declining State of Physician Health and the Urgent Need for Ethical and Evidence-Based Leadership.
- 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
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. But 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.
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).
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.
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.
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):
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.
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:
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.”
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.
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.”
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.
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.