“Implicit faith belongs to fools, and truth is comprehended by examining principles”-Algernon Sidney (1683)

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The photo above was taken at the 104th Annual Meeting of the Federation of State Medical Boards (FSMB) held in San Diego April 28-30 and tweeted last night in reference to the partnership between the FSMB and the Federation of State Physician Health Programs (FSPHP) with the caption:

“How a healing profession heals itself #FSMB2016 partnerships #FSPHP trust and faith in oversight and system.”

Within the the allotted 140 character twitter limit this succinct observation is nevertheless very revelatory.   Both systems and the oversight of systems demand accountability and answerability to outside and independent agencies.  Trust and Faith are not in the equation.  Why has this lesson not been learned?

Answerability requires the obligation to answer questions regarding decisions and actions. Accountability requires transparency, explanation and justification. What was done and why?  Standards, rules, regulations, codes, laws and other objective benchmarks need to be applied by outside actors.  This is critical. It is the very essence of oversight.

“Trust and faith in oversight and system” is both  oxymoronic and nonsensical. “Faith and trust” in oversight equates with an “absence” of oversight.  “Faith and trust” in systems inevitably results in “systems failure” and therein lies the problem.

Blind faith and deference to authority has led to a systems failure  in the regulation of the medical profession.   Physician health programs (PHP’s) have convinced state medical boards to give them complete deference.  Medical board’s in turn have convinced state attorney generals and law enforcement to give them complete deference.  This has led to a complete systems failure.  No investigatory or oversight body exists.  No one is minding the minders. It is a complete and utter free for all.

Making sound decisions about regulation calls for an understanding of the problem it is intended to solve. Legitimate policy must be based on recognized institutions and experts. Regulatory changes demand methodologically sound science and evidence-based facts arrived at through rigorous peer review and professional oversight. The science must be reliable and unbiased. Legitimate policy must be based on recognized institutions and experts. If the information regulatory agencies rely on to discipline doctors and protect the public is unreliable then serious consequences can occur.

The validity and reliability of opinions lie in their underlying methodology and evidence base. Reliance on the personal authority of any expert or group of experts is the fallacy of appeal to authority and a more apt and accurate twitter caption to the photo above would be Algernon Sidney’s 1683 statement that:

“Implicit Faith belongs to Fools, and Truth is comprehended by examining Principles”

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MD Sues NC Medical Board/Physician Health Program-A Prototypical Case

A prototypical case involving PHP and Medical Board. PHPs’ integrity varies state by state depending on:

1. How entrenched the FSPHP is in the state PHP

2. Whether that state’s Medical Board has become a partner in PHP’s crimes.

It is very curious that states who have had a Medical Director who has also been President of the Federation of State Physician Health Programs seem to be the worst of the violators.

Based on over 200 responses I have received on my PHP survey [PHP Survey], North Carolina, Florida, Massachusetts and Washington State are physician career destroyers whereas West Virginia seems relatively unscathed (although I have learned that the FSPHP has been attempting to impose its “PHP-Bluprint” on the Board with some resistance.

What you see here is a classic case. Physicians and med schools urgently need to become aware and take a stance of resistance to these abuses. Wouldn’t you find this distressing – that only over the past [3 years], I have heard this same story from medical students to doctors in their 80s – through detailed and lengthy conversations – over and over again.

The identical same patterns of PHPs and medical boards acting in collusion emerge. As much as I don’t want to believe it, PHPs, acting in tight collusion with their sibling agencies, the medical licensing boards, have expanded their power and uniformly deprived physicians (and med students!) of their due process rights, against all understandings of appropriate powers with which they were originally vested.

No accountability exists as they have removed due process and freedom of choice.  The PHP controls every aspect of the assessment and monitoring process with absolutely no oversight.  As the North Carolina state PHP audit revealed, there is no oversight from the medical society or medical board.  In addition the assessment and treatment centers and drug-testing labs have no meaningful regulation.  No oversight or regulation of the multiple non-FDA approved laboratory developed tests (LDTs) of unknown validity exist.

As a power accountable to no one, PHPs have become predators who not only stalk and victimize doctors but harm the very public they were supposed to protect!

These PHPs, along with the cozy relationships with medical licensing boards, need to be confronted, as Dr.Manion has done, and dissembled and then rebuilt into accountable organizations state by state.

It seems apparent from my research that the FSPHP is not only an illegitimate but an irrational and opportunistic authority exclusively representing the interests of the medical board and the drug and alcohol testing, assessment and treatment industry.

PHPs are being promoted as a “gold standard”  and replicable model by the American Society of Addiction Medicine (ASASM), a “self designated practice specialty” not recognized by ABMS. The ASAM White Paper on Drug Testing  is recommending widespread application of the PHP model in other populations.  The FSPHP arose from ASAM state chapters and their intimate relationship with the Drug and Alcohol Testing Industry Association (DATIA) is as tight as thieves.

In addition the medical directors of every one of the “PHP-approved” assessment and treatment programs are not only ASAM doctor but belong to a self-described 12-step group called “like-minded docs.”

Like a treatment industry of the Taliban, they play on the dangers of alcohol use. To some of us, they are little more than prohibitionist profiteers and dimwitted “addiction addicts” who have “recovered (even in the sense of the word that would suggest that they have “recovered” [retrieved and had destroyed] and “re-covered” their felonious past) and are now in firm control of the gates to the rehab farm. As evidenced from previous articles, narcissistic and psychopathic personality disorders abound in this PHP movement. Physicians need to wake up and confront and dismantle this Frankenstein the state PHPs have become. PHPs urgently need accountability and answerability, not more immunity and secrecy. Here we are in a time of great physician scarcity and PHPs and Boards are eliminating physicians with utterly no accountability.

Link to complaint obtained via Pacer:  Manion v NC Medical Board and PHP

2016-02-09 DOC 2 Corrected Complaint and Demand for Jury Trial

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A lawsuit filed by a physician against the North Carolina Physicians Health Program (NCPHP) claims loss of significant and potential earnings as well as public humiliation, irreparable harm to his professional reputation, and severe emotional distress.

Kernan Manion, MD, a practicing psychiatrist for some 30 years, is suing the NCPHP as well as the North Carolina Medical Board (NCMB), the North Carolina Medical Society, several past and present medical board officials, and current NCPHP Chief Executive Officer Warren Pendergast, MD.
The suit alleges “arbitrary and unlawful application of summary suspension procedures” resulting from “intentionally and/or negligently abusive practices” and other common law, statutory, and constitutional violations.

In court documents, Dr Manion, who has never before been disciplined by any licensing entity in any state and has never been found liable for malpractice, said he was forced to inactivate his medical license in February 2013 after “wrongful and flawed” diagnoses conducted by the NCPHP and its agents.

He describes the experience with the PHP as “a Kafkaesque nightmare.”

According to events outlined in a statement of facts, Dr Manion, who maintains he has never suffered from mental or emotional health problems or from alcohol, drug, or any other form of substance abuse, was dismissed in September 2009 from his position as a civilian contracted psychiatrist with the Deployment Health Center at Naval Hospital Camp Lejeune.

He had raised concerns, which he described as “whistleblowing,” regarding what he felt was deficient care of active duty service members with posttraumatic stress disorder.
Dr Manion brought claims against his employers, alleging retaliatory discharge, after which he says he was harassed and followed, prompting him to contact local police.

Shortly thereafter, Dr Manion said he was notified by the NCMB that someone at the police department had expressed “concern” about his mental health and that the NCMB had opened an investigation.

Malice?

On his own initiative, Dr Manion obtained a comprehensive psychological evaluation, which, he said, concluded that he did not have a delusional disorder and that recommended that he be permitted to retain his unrestricted medical license. Despite this, says the statement, the NCMB ordered Dr Manion to undergo an assessment by the NCPHP, which he did.

That assessment, carried out by Dr Pendergast, concluded “wrongly and negligently or intentionally and with malice” that Dr Manion was mentally ill and in doing so, “relied upon only the unofficial information provided by the police office, reviewed no clinical records, and failed to interview any collateral sources as is required in such evaluations.”

Dr Pendergast apparently then recommended that Dr Manion complete a comprehensive psychological evaluation at an out-of-state mental facility. Such facilities, says the court document, often charge thousands of dollars and require that physicians incur costs for travel and spend multiple days, if not months, away from their medical practice.

According to the court document, PHPs have been criticized for “rampant fraud and abuse” and that the NCPHP and NCMB are “riddled with conflicts of interest.”

An audit carried out by the North Carolina state auditor, and reported by Medscape Medical News, found no abuse by the NCPHP but did state that there were “multiple conflicts of interest inherent in the relationships between NCPHP and its preferred assessment and treatment centers and an alarming potential for abuse and violations of the process rights by NCPHP.”

The filed court document also states that there was “no reasonable basis” for the NCMB and the NCPHP to conclude that Dr Manion was impaired and unfit to practice medicine, “conclusions that forced him into a Kafkaesque nightmare that ultimately concluded in the loss of his license and his livelihood.”

Dr Manion said he proposed an alternative in-state evaluation, but in January 2012, “based wholly” on its “intentionally flawed diagnosis and recommendation,” the NCPHP again voted to order Dr Manion to undergo evaluation and treatment at an out-of-state facility.

According to the court files, the NCMB brought formal charges against Dr Manion that alleging he failed to cooperate with the NCPHP. Dr Manion claims he submitted to yet another evaluation to assess his mental health status against his will.

This evaluation concluded that he was delusional “based chiefly on information…received from Dr Pendergast about Dr Manion and not based on medical evidence or corroborative fact checking,” according to the statement.

“Frightened and Threatened”

Told to inactivate his license and immediately resign from his position as medical director at a clinic or have felony charges brought against him for practicing without a license, Dr Manion said he was “frightened and threatened” into inactivating his license on February 9, 2013.

In trying to reactivate his license in December 2014, Dr Manion agreed to submit to another evaluation, which concluded that he “is not delusional, that he is fit to practice medicine, and that the prior evaluations conducted by or at the direction of NCPHP…are flawed and incorrect,” says the statement. It adds that the assessor believed that Dr Manion’s “display of anxiety, distress and intensity is proportionate to the circumstances which have occurred.”

Despite this, Dr Manion said the NCMB wanted him to submit to another NCPHP evaluation in order to activate his license, but he objected to undergoing another assessment.

As a result of these events, Dr Manion claims he has suffered, among other things, loss of significant earnings and potential earnings and the burden and cost of defense against unwarranted action, as well as “public humiliation, irreparable harm to professional reputation, and severe emotional distress.” The suit also claims one of his former patients committed suicide because of interruption of highly specialized care.

The broadly applied policies and practices of the NCPHP “draw unimpaired licensees into a Kafkaesque ‘damned if you do, damned if you don’t’ catch-22 scenario that almost always ends in severe and underserved harm,” says the statement.

The document estimates that Dr Manion has suffered and continues to suffer damages “in excess of $75,000.”

The suit was filed February 8 in the US District Court, Eastern District of North Carolina, Western Division.

“Unprofessional Conduct”

Medscape Medical News contacted the NCMB for comment, and spokesperson Jean Fisher Brinkley provided the following statement: “NCMB is aware of Dr Manion’s lawsuit but cannot discuss it as the matter is pending litigation.”

However, Brinkley provided a link to public documents on the NCMB website related to the disciplinary case at issue in the lawsuit, which includes “a detailed account of the Board’s concerns regarding Dr Manion.”

According to the October 10, 2012, Notice of Charges and Allegations, the NCMB outlined two charges against Dr Manion: “failure to respond reasonably to a Board inquiry” and “unprofessional conduct.”

On the first charge, the NCMB claims that in failing to undergo an assessment at Acumen Assessments Inc, which is the recommended out-of-state treatment facility, as required by a Board order issued February 27, 2012, Dr Manion’s conduct “constitutes a failure to respond, within a reasonable period of time and in a reasonable manner,” to inquiries from the Board concerning any matter affecting the license to practice medicine, within the meaning of the state’s general statutes.

On the second charge, the NCMB states that Dr Manion’s failure to undergo an assessment at Acumen, as required by the Board, “constitutes unprofessional conduct, including, but not limited to, departure from, or the failure to conform to, the ethics of the medical profession and is the commission of an act contrary to honesty, justice or good morals” within the meaning of the state’s general statutes.

According to the NCMB, for both charges, there are grounds under the general statutes for the Board “to annul, suspend, revoke, condition or limit Dr Manion’s license” to practice medicine.

In addition, the legal notice describes concerns about Dr Manion from a single police officer who reported them to the NCMB in 2010.

According to the NCMB, the police officer was subsequently interviewed by a Board investigator. According to an account of this interview, the officer alleged that Dr Manion spoke to the Wilmington Police Department chief of police in November 2010 and expressed concerns that he was being followed and that a tracking or listening device had been placed on his car.

According to the NCMB report, the officer outlined other instances that were cause for further concern.

Medscape Medical News contacted the NCPHP. However, Dr Pendergast declined to comment, noting that the “NCPHP cannot comment on this matter as it is pending litigation.”

 

The Aging Physician—Goodbye Dr. Welby!

IMG_8901The methodology is not new–witches are real, witches are dangerous and witches need to be identified and exterminated at all costs. Convince the authorities to assist you in protecting the public from harm and advance the greater good

In this manner the Federation of State Physician Health Programs (FSPHP)  has convinced the Federation of State Medical Boards state medical boards (FSMB)  to adopt and enforce policies that have incrementally and systematically increased their own  autonomy, scope and power.   This began in 1995 when the FSPHP first cultivated a relationship with the FSMB and subsequently took an uninvited seat at the table of power by offering a non-disciplinary “safe harbor” as an alternative to discipline for doctors impaired by drugs or alcohol.IMG_8900

Since then they have increased their scope from the “impaired” to the “disruptive” to everything else. Arising from the “impaired physicians movement” as “addiction specialists” these doctors whose specialty of addiction is not even recognized by the American Board of Medical Specialties have now become the “experts” in all matters related to physician health. Jacks of all trades covering neurology, psychiatry, geriatrics, and occupational medicine.

A 2011 updated FSMB Policy on Physician Impairment states that Medical Boards should recognize the state Physician Heath Program (PHP) as their experts in all matters relating to licensed professionals with “potentially impairing illness,” and these include those potentially impairing maladies that increase as we age.  This has gone too far.  Isn’t it time we take back the profession of medicine from illegitimate and irrational authority?Slide15

Disrupted Physician

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As a specialist in geriatric medicine I have experience in taking care of a number of  doctors who were referred to me for suspected memory problems. Still operating and teaching residents in his 70s, my first was a well-respected surgeon, a pioneer or Maverick who had made advances in his particular subspecialty.  Known for his detailed knowledge of the history of medicine and sharp clinical acumen, he had not seemed himself for a while.  His colleagues noted he appeared slower,  fatigued and forgetful at times (not remembering his keys, having trouble finding the right word).  An internist friend and co-worker who knew him for 50 years curb-sided me and asked if I would see him.  He did not have a primary care physician or even seen a doctor professionally for decades (a common phenomenon in this age cohort of doctors).

I met him the next week and he readily admitted to having difficulty concentrating and having trouble with his short term…

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Urgent Action Needed on Proposed Legislation in North Carolina–Removing Due Process from Doctors a Harbinger of Wide-Scale Political Abuse of Psychiatry

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I received the email below from Dr. Jesse Cavenar, Jr. regarding legislative changes that would severely infringe on the rights of doctors as licensees of the North Carolina Medical Board and subject them to distinctly non-impartial diagnostic psychiatric evaluations and remove all possibility of due process.  These developments could possibly herald the wide-scale abuse of psychiatric evaluation and treatment by two governmental agencies acting in collusion with utterly no oversight or accountability.  Namely the Federation of State Physician Health Programs (FSPHP) and the Federation of State Medical Boards (FSMB).  As a state Representative who is also a physician told me this morning –“this bill is representative of a prevailing attitude that does not realize what is really happening.”


Bill H453 can be seen here:  H543v2 – 04152015[10]

NC Audit can be seen here:  http://www.ncauditor.net/EPSWeb/Reports/Performance/PER-2013-8141.pdf

This is the bill, entitled H453  that is before the NC legislature this session.  My reading of the bill is that the bill is a disaster.  It seems to be an attempt by the lobbyists and lawyers to remove many existing features of the present law. In particular, I would direct your attention to two features:

1) It appears that all mention of due process has been removed from the law. The NC State Auditor found that the NCPHP had not afforded due process as required by law, so one simply changes the law to remove all mention of due process.

2) There is a clause inserted in the law to immunize the NCPHP against civil liability for the performance of the NCPHP function. In other words, the state statute declares that one cannot bring legal action against the NCPHP because they are immune. This is absurd. These people should be no more immune than any other doctor in the state of North Carolina.

In addition, the proposed statute seems to attempt to haze out whether the NCPHP record is or is not a medical record. As you will see, one would be entitled to a copy of an ³Assessment² but it would appear not the entire medical record. This is contrary to the NC Medical Board position paper on medical records. I would urge everyone to immediately contact his or her appropriate Senator and Representative to register opposition to this bill as written, and to urge that an expert panel of disinterested physicians and attorneys be appointed to write a new bill that would be appropriate.

A colleague of mine who is a medical ethicist has reviewed this and had the following to say: ³Well, well!  I think the most interesting thing here is that someone has tried to get the NC Legislature to immunize the existing system against any countering action.  This, it seems to me, is tacit admission of culpability.²  Well stated, I would say.

                 Jesse

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Junk-Science in the Medical Profession: The Resurgence of Polygraph “Lie-Detection” in an age of Evidence-Based Medicine

Disrupted Physician

33755_1527129670651_5081648_n Circa 1995

The article below was published in the now defunct magazine Gray Areas almost twenty years ago. (Vol. 4, No. 1, Spring 1995 pp. 75-77).   Antipolygraph.og founder George Maschke noted in 2008 that article “makes a good introduction to the pseudoscience of polygraphy” and “the criticisms of polygraphy remain valid today.”  They remain valid in 2014.

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The Art of Deception: Polygraph Lie Detection

By Michael Lawrence Langan, M.D.

I’d swear to it on my very soul, If I lie, may I fall down cold.”

– Rubin and Cherise
(Hunter/Garcia)

The accuracy of polygraphic lie detection is slightly above chance. Nevertheless, State and local police departments and law enforcement agencies across the United States are devoted proponents of this unscientific and specious device. In addition, the American public seems to lend an implicit credence to the “lie detector” as evinced by its ubiquitous use on television crime shows and…

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