physician suicide

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.

The Medical Profession under Dictatorship–Revisiting Dr. Leo Alexander’s prescient warnings from 1949

mllangan1 6 Comments

“Let it be considered, too, that the present inquiry is not concerning a matter of right, if I may say so, but concerning a matter of fact.”–Adam Smith

“Most men endure the sacrifice of the intellect more easily than the sacrifice of their daydreams.  They cannot bear that their utopias should run aground on the unalterable necessities of human existence”  -Ludwig von Mises

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“Science under dictatorship becomes subordinated to the guiding philosophy of the dictatorship.” So begins Medical Science Under Dictatorship1 written in 1949 by Leo Alexander and published in the New England Journal of Medicine. Alexander acted as consultant to the Secretary of war and the Chief Counsel for the Nuremberg trials.

The guiding philosophic principle is Hegelian or “rational utility” and “corresponding doctrine and planning”, Alexander said “replaced moral, ethical and religious values” and Nazi propaganda was highly effective in perverting public opinion and public conscience. He explains how this expressed itself in a rapid decline in standards of professional ethics in the medical profession.   This all “started from small beginnings” with subtle shifts in the attitudes of physicians to accept the belief that there is such a thing as “a life not worthy to be lived.”

In 1985 the British Sociologist G.V. Stimson wrote of a new form of professional control in the United States that had emerged in the preceding decade whose “success rests on the ability to take certain areas of conduct such as alcoholism and drug abuse (which are formally disciplinary issues) and handle them as diseases.”2

Stimson writes:

“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.”2

Among these authoritative pronouncements was the use of specialized treatment centers. Many professionals were critical of these programs including Assistant Surgeon General John C. Duffy who criticized the “boot-camp mentality”4 toward doctors and American Society of Addiction Medicine President Leclair Bissel who when asked in a 1997 interview when the field began to see physicians as a specialized treatment population replied “when they started making money..” .” 5

Amid reports of abuse, coercion and control in facilities using a doctor’s medical license as “leverage,” the Atlanta Journal Constitution ran a series of reports in 1987 documenting the multiple suicides of health care practitioners at one of these programs (5 while in the facility and at least 20 after discharge).6   Neither these suicides nor a large settlement against the same facility (finding a non-alcoholic doctor was intentionally misdiagnosed as an alcoholic and forced into months of treatment)  for fraud, malpractice, and false imprisonment involving intentional misdiagnosis7 generated any interest among the medical community at large.

And by 1995 the door had closed as the Federation of State Physician Health Programs ( FSPHP ) relationship with the Federation of State Medical Boards (FSMB), the national organization responsible for the licensing and discipline of doctors,  was forged.  A 1995 issue of The Federal Bulletin: The Journal of Medical Licensure and Discipline, contains articles outlining the high success rates of these programs in 8 states with an editorial comment from the FSMB that concludes:

“cooperation and communication between the medical boards and the physician health programs must occur in an effort to protect the public while assisting impaired physicians in their recovery.”8

The Federation of State Medical Boards (FSMB) has approved any and all policy and regulation put forth by the impaired physician movement  then organized under the Federation of State Physician Health Programs (FSPHP) with no apparent inquiry or opposition.

In 2003 Dr. Gregory Skipper, one of the key players of the impaired physician movement partnered with NMS labs to develop the alcohol metabolite ethyl-glucuronide (EtG) as a laboratory developed test13 14 he proposed be used as a monitoring tool for covert alcohol use in physicians after a pilot study involving just 14 psychiatric inpatients.15

The policy entrepreneurship this group so effectively uses to advance their goals can be seen in the August 25, 2004 Journal of Medical Licensure and Discipline which contains articles both presenting the problem 11 and providing the solution.11   The EtG was then introduced as an accurate and reliable indicator of covert alcohol use and the impact of this cannot be underestimated as it introduce to the market not only unregulated non FDA approved tests for forensic use but tests reaching further back into history then those used by workplace drug-testing programs.

The limitations of any test needs to be understood both in the forensic and clinical context but there is a lot less flexibility in the forensic context when people’s liberties, freedoms or property rights ( as with a medical license) are in jeopardy.

Sensitivity and specificity need to be carefully considered.  The positive predictive value of a test is the true positives over the true positives plus false positives.  If you are going to sanction somebody as a result of a single test that test needs to have 100% sensitivity.

When workplace drug testing was introduced debates over both the accuracy and scope of tests occurred. The employees right to privacy and the employers right to have a drug-free workplace were discussed with the general consensus being testing for impairment was a legitimate concern but preservation of private life should remain.

What was done here dissolves both.

PHP programs require abstinence from all substances including alcohol and strict adherence to 12-step doctrine9 yet many of the physicians monitored by them are neither addicts nor alcoholics. Requiring abstinence from drugs and alcohol while using non-FDA approved Laboratory Developed Tests in monitoring programs is a dangerous combination. The suicides reported by the Atlanta Journal Constitution in 1987 were prior to the introduction of these tests. Adding these tests of unknown validity to an already abusive program of coercion and control would only worsen the situation.

I have been hearing of multiple suicides involving both the fear of results and false results. I have also been hearing of doctors who have killed themselves because they were suffering from depression but did not seek help as their fear of being ensnared into the PHP outweighed the need to get help.

Three decades after G.V. Stimson so accurately defined the impaired physician movement the impaired physician movement defines the professional control of medicine..   Their involvement in medical society physician health programs (PHPs) and treatment programs has evolved into absolute control of both. Pronouncements on physician impairment have evolved from insider’s claims to written edict.   And their reach has extended from impairment due to drugs and alcohol to “potential impairment” and “relapse without use.” Their reach has extended from drug and alcohol impairment to all other aspects of medicine and the impact has been profound.   Medicine has been subordinated to the guiding philosophy of the impaired physician movement and doctors are dying in droves du to institutional injustice.

How does the profession of medicine reconcile the fact that we have allowed an as yet non ABMS recognized “self-certification” specialty full reign over those who are ABMS recognized?  How is it that we allow non-FDA approved Laboratory Developed Tests (LDTs) of unknown validity on doctors coerced into state Physician Health Programs (PHPs)?    A recent debate in Washington calling for regulation of  “clinical”  LDTs just took place and the fact that they are being used for “forensic” purposes in doctors is incomprehensible.   Has anyone noticed it is the same people introducing the tests who are claiming PHPs are the “gold standard,” trying to push them on other EAPs and calling for more widespread use of these tests?

The use of non-FDA approved Laboratory Developed Tests (LDTs) for drug and alcohol testing  is currently limited to PHPs and the criminal justice system. (i.e. monitoring programs in which those doing the testing have power and those being tested have no power). That may soon change. See  Drug Testing and the Future of American Drug Policy and The American Society of Addiction Medicine White Paper on Drug Testing describing the plans for widespread expansion of this drug testing to other groups including kids.

Those involved in the Massachusetts General Hospital Laboratory Medicine, Toxicology and addiction medicine departments looked critically at these tests and decided hands down against using them. Why? Because no evidence base exists and the potential harm far outweighs any perceived benefit.  “Research” has been done on those being monitored by PHPs and the criminal justice system and Drs. J Wesley Boyd, M.D., PhD, and John Knight, M.D. of Harvard Medical School who collectively have over two decades of experience as Associate Directors with the Massachusetts PHP, Physician Health Services, Inc. addressed this research in a 2012 article published in the Journal of the American Society of Addiction Medicine entitle Ethical and Managerial Considerations Regarding State Physician Health Programs.  The allegations that PHPs are engaging in research in violation of the Nuremberg code ( that was a direct result of the Nuremberg trials for which Dr. Alexander acted as consultant ) should have raised some eyebrows.   It hasn’t.

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What do you think will happen when ASAM gets recognized by the ABMS in 2 years as is expected?   These “addiction medicine” specialists will inevitably join hospital formulary , clinical lab, toxicology and ethics panels to do the same thing they have done to get where they are today.   They will do the same thing they have done with state PHPs.  Those with a hidden agenda will be able to outvote those of good conscience and thoughtful intelligence and patient care will then be subordinated to the guiding philosophy of the impaired physicians movement.

This system of institutional injustice is killing doctors by suicide as the medical societies and Departments of Public Health have given PHPs full autonomy and authority and it is poised to impact patient care.

I challenge you to name any other company, organization, group or agency within or related to the profession of medicine and the field of science that is bereft of absolutely all  transparency,  regulation or oversight?  It does not exist.

The PHP scaffold has deliberately  removed themselves from all aspects of accountability including answerability, justification of actions and the ability of outside actors to hold them in judgment of any information provided by answerability.   Heads I win, tails you lose.   That is a big red flag in itself. and those not currently being held accountable they may very well be after you next as their plans include expansion to other groups includes EAPs, the Department of Transportation, athletes, students and even kids!

Doctors are afraid to talk about this for fear of being ensnared themselves.  Those already in these programs will not speak for fear of punishment. This is a legitimate concern and needs to be discussed openly and publicly.  I need allies!

 Help me get the word out –too many doctors are dying.  Three died by suicide in one month alone who were being monitored by the Oklahoma PHP and these suicides did not even make the local papers let alone national news!     They need to.

In The Argument of Fascism Ludwig von Mises wrote:

It cannot be denied that Fascism and similar movements aiming at the establishment of dictatorships are full of the best intentions and that their intervention has, for the moment, saved European civilization. The merit that Fascism has thereby won for itself will live on eternally in history. But though its policy has brought salvation for the moment, it is not of the kind which could promise continued success. Fascism was an emergency makeshift. To view it as something more would be a fatal error.

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Physician Suicide and “Physician Wellness” Programs–It’s time we start talking about the elephant in the room!

mllangan1 2 Comments

Screen Shot 2015-06-11 at 8.17.34 PMPhysician 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 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 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) can be considered an 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 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 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 referrals. Most EAPs were developed with the collaboration of workers unions or some other group supporting the rights and interests of the workers.  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:

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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.”

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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 34 Low 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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27 thoughts on “The Elephant in the Room: Physician Suicide and Physician Health Programs”

  1. Wow! Thank you for this! This article may very well be far beyond its time, and thus, that much more impactful. There is so much to be added to the discussion of the mental and physical state of the modern day physician. It could provide so much more insight not only into the lives of physicians, but also their patients. Much like the police, there is a code of silence among the medical and scientific community; one so static and unwavering, it is much of the cause of the staggering amount of deaths and illnesses abound in our current society. Because by default, everyone is either a patient or a physician, by building the platform for this conversation, pieces of writing like this may prove to be the key to saving every single person in the world. Literally. Again, thank you!

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    • Thanks! The problem is the mainstream medical bloggers will not address the role of physician health programs and physician suicide. In fact many of my comments on these blogs regarding this have been removed as “spam.” This barrier has been very hard to break for various reasons. How do we solve a problem most doctors will not even mention? To address the problem we need to acknowledge it and that is just not happening.

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      • So, so true! Please, just don’t stop what you’re doing. No matter how much blow back and obstacles you face, keep getting this message out there. People are watching and waiting for the courage to join in the conversation. People like you, with the courage to be the first on the dance floor, so to speak, are the reason the party gets started. No matter how long it may seem that you’re dancing alone, you’re not. And right when you last expect it, the whole world will begin acknowledging the significance of physician health and physician suicide, as if it’s been around as long as sliced bread. People like you and I rarely get the credit we deserve, but what’s credit, compared to saving lives. I can’t emphasize enough how important research, data and discussions like this are for the necessity of literally, saving lives. I get it. I really, really do. I’ve personally seen what can and continues to happen as a result of us ignoring what the lacking physician health programs and growing physician suicide. So, yea, just keeping going, please. For the children who may never meet you, but will live longer lives from the sacrifices you’ve made. Much peace, love and blessings be to you always! A’se (and so it is)!

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  2. So is it suicide or accidental overdose? I had a physician who was found dead by his wife, overdosed on a prescription med. It has bothered me all these years, wondering if it was deliberate or an accident. I tell myself it was accidental, because that’s what I want to believe, and yet, you all have so much responsibility weighing on your shoulders. How do you cope?

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    • The 400 figure is an underestimate as death certificates and other traditional sources of information have proven unreliable. In addition most of these deaths are not investigated –especially if there was a PHP involved. Last August 3 doctors died by suicide in a 30 day period who were under monitoring by the state PHP and it did not even make the local news. In many cases it is difficult to determine if death is a result of suicide or an accident and suicides are often underreported to protect the victim or family from stigma or insurance investigations. An insurance company will more easily pay on a claim due to a “drug misadventure” than a suicide.

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    • That’s understandable, but so sad. Everything seems to boil down to insurance now, what they will or will not pay for. From a patient’s point of view, it gets frustrating that we all pay because of the ones who abuse the system, and from your side, it means extra work because some of the patients abuse the system, so all patients must be subjected to the same embarrassing testing. And you suffer because the patients hold you responsible, so it is an uphill battle all the way. I’m glad the COD is not included in obits that are seen in newspapers, and also glad autopsies are not required in every case. I can remember when they were, and how hard it was on families. In the case of my doctor, an autopsy was ordered and it was all over the front page of the local paper. Not a good thing for his family to live with.

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  4. (forgive if this is a redundant entry – left one yesterday but didn’t get posted.)

    Another brilliantly incisive piece, Michael!

    In what is sure to be a seminal work, Tom Bourne and colleagues examined the psychiatric impact of board complaint investigations on physicians in Britain (the GMC there is the equivalent of state licensing boards here) and found a 100% increase from baseline in depression, anxiety and suicidal ideation. Hmmm … any possible link between board “investigations,” PHP sham “diagnoses” and physician suicide?

    (see: Bourne T, et al. BMJ Open 2015;4:e006687. doi:10.1136/bmjopen-2014-006687)

    You would have expected medical boards (consisting of physicians who took an oath, for godsakes!) and PHPs (with their “oh-so-concerned-about-physician-health” mantra) to have shuddered at this finding and rushed out to investigate whether this could possibly be true.

    Now, optimists that you are, brace yourself … not one medical board or PHP member has responded to the Medscape article which announced this, nor apparently countered the finding in any other forum. (As in “oh, board and PHP inquiries are really benign … see all our happy campers … our studies show everybody’s doing well and what great work we’re doing.”

    Have you heard of any investigation by FSPHP or FSMB into whether this finding might be true? Or at least an expression of concern? Nah ….

    Or perhaps the AMA …? Nah.

    Oooh, oooh, maybe the APA which by all rights should be concerned about the illicit activities of unlicensed PHPs operating as “public charities” conducting career and life altering psychiatric and substance abuse evaluations under the sham rubric of “peer review,” referring, under board order based on their pontifical findings (whose report they adamantly refuse to provide to the subject physician), to pre-selected “preferred institutions” with whom there is a prearranged “understanding” of the admission diagnosis and impairment severity and the gross abuse of the field of psychiatry by the denial of due process and ensuing torture these programs commit…? Maybe they’d be concerned, right??? … nah. Multiple parties have emphatically tried to rouse them from their institutional slumber to utterly no avail but an insulting response implying that the complainer is nothing but a personality-disordered whiner who’s unhappy with “the program.” (Yes, the “program.” That’s like telling a Jew in 1940’s Germany that he shouldn’t be complaining about the free train ride the government is offering.)

    As has been explicitly documented by the NC State Auditor in its comprehensive performance evaluation report on the NCPHP (see NCOSA Performance Evaluation of NCPHP April 2014, available online), NCPHP systematically violated the due process rights of over 1,140 physicians over the preceding decade. (Even the writing of the phrase does not convey the extremity of the violation – one has not only been denied justice and screwed by one’s own pathetically impotent lawyers, one has lost one’s career and even personal identity – all in one fell swoop by an agency with no oversight or accountability.)

    Now, answer me this: if you were falsely accused of something, falsely diagnosed, had laboratory data falsified in order to both reinforce the false diagnosis and punish you for your defiant challenge, and had your due process rights violated, and you then were entirely deprived of your career and then so publicly shamed by the published proceedings based on the false but incontestable findings, and your practice was abruptly upended, and you then were forced to witness your patients’ suffering as a result of the disruption of their care with you, and you then were forced to bear the news of one of your patients committing suicide as a direct result of this abusive disruption of care, would you be … upset?

    Keep up the extraordinary work, Michael. While there are innumerable docs who have been utterly obliterated by this combined board / PHP abuse and their manipulation of their privilege – and, yes, some have tragically taken their lives being put in such an impossible bind, there are a few of us who are determined to confront this abuse and demand that protections be put in place so that it never occurs again, without severe consequences ensuing to the offending party.

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  7. (From a resident physician who wishes to remain anonymous)

    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

    Liked by 2 people

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  9. I was sent the letter below by e-mail. Dr. Roop has specifically requested that it be published here with his contact information and I applaud his courage.

    On Mar 5, 2015, at 4:04 PM, Jonathan Crane Roop MD wrote:

    Name: Jonathan Crane Roop MD
    Email: jonathanroop@hotmail.com
    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.

    Jonathan Crane Roop MD

    811 S Cowley St #48
    Spokane WA 99202

    509-710-4641

    Liked by 1 person

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  10. These miscarriages of justice remind one of nothing so much as Victor Hugo’s “Les Miserables”. That was, of course, a mere novel. Sadly, the experiences described here are real. The loss of capable physicians is doubly tragic — not only for the physicians involved, but for society at large. I would add only that God is capable of giving our lives purpose, even after what is most precious to us has been taken. Life can be worth living, despite great loss.

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    • I have been hearing from 2 or 3 every day. Nearly all of them are afraid to leave comments here (even anonymously) for fear the PHP will find out. There is a “learned helplessness” because there is no lifeline. The Medical Boards are complicit, The Medical Societies have no oversight, Law enforcement turns a deaf ear because the perpetrators have convinced them it should be kept within the medical profession. Attempting to report valid crimes are refused and they are often reported back to the Board or PHP and further punished. The media is not interested because they have been labeled “impaired”or “disruptive” and no matter how strong the truth, evidence or facts are they take the PHPs word over theirs. And almost all of the doctors I have talked to are good doctors who are kind hearted and honest. But bad doctors are rarely sanctioned by medical boards; they have to do something so egregious that turning a blind eye would be noticed. And doctors who are bad people who have engaged in terrible behavior often get reinstated by claiming they were “helpless” over that behavior but are now “in recovery.” They go to extremes to protect sexual violators in these programs and also believe they can monitor pedophiles with polygraphs and treat them with 12-step. Just look at the case below. An adolescent psychiatrist gets arrested with child pornography and admits to a longstanding attraction to young boys. The PHP gives him a polygraph test “proving” he’s a looker not a toucher and he is back practicing medicine in no time. The PHP speaks as if he is a Saint. Perhaps they had a slot to fill in the “sexual addiction” department in one of the “PHP-approved” assessment and treatment centers.

      http://www.psychsearch.net/montana-psychiatrist-james-h-peak-convicted-of-child-porn-wants-license-back/

      http://billingsgazette.com/news/local/peak-s-medical-license-reinstated-on-lifetime-probationary-status/article_fab77fef-188c-5f29-8013-4a86c87d32a8.html

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  13. Doctors, I can sympathize with your pain although I am not a physician. I was trained at a university medical facility in laboratory medicine and during my sophomore year it was found that I was suffering from what their psychologist called “delayed grief” from the loss of my mother. Long story short, they pushed me out of school until I could get it together. I am a disabled, Christian and pastor of a small church now and not in laboratory technology practice anymore. My website http://thelivingmessage.com, is my way of bringing the hope of Jesus to those who are searching for answers in a world that seems not to want to hear them. Please feel free to refer any of your friends to my site or even to email me through it. I will be glad to pray with and for any or all of you in your time of pain and suffering. God gave you your talents and abilities so please don’t throw them away if possible.

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  14. The list really touched me….I have been close to just ending it before. I used to think it was something only “other” people experienced. This is so sad !!

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“No matter what people tell you,words and ideas can change the world.”-Robin Williams.

mllangan1 6 Comments

“No matter what people tell you,words and ideas can change the world.”-Robin Williams..

“I stand upon my desk to remind myself that we must constantly look at things in a different way.”

-John Keating (Robin Williams)

Dead Poets Society

Letters From Those Abused and Afraid

mllangan1 5 Comments

Letters From Those Abused and Afraid.

I’m hearing from more and more doctors via my survey, emails and phone calls.  At this point the patterns are becoming crystal clear and they involve the same “physician wellness” actors, the same “PHP-approved” assessment and treatment facilities and the same commercial “forensic” drug testing labs.

It is all the same M.O.  A false accusations  is made followed by misrepresentation of laboratory developed tests (LDTs) or outright forensic fraud.    A referral is then made for an “evaluation” at one of the “PHP-approved” facilities where an “assessment” is “tailored” to fit a pre-determined diagnosis.  The PHP then says do anything and everything we say or we will “end you.”  And all too often that is exactly what they do.   It is Political Abuse of Psychiatry plain and simple.   It does not get any more egregious than this folks.

The Doctors dying from this system of institutional injustice are not dying by suicide.  This is more akin to murder and the murderers have removed themselves from all aspects of accountability including answerability, justification for actions and the ability to be punished by third party actors truly outside the system. It is a rigged game.

the-world-is-a-dangerous-place-to-live-not-because-of-the-people-who-are-evil-but-because-of-the-people-who-don_t-do-anything-about-itThe sociopaths responsible for ordering false assessments and falsified drug and alcohol testing as well as those complying with it in the drug and alcohol testing, assessment and treatment industry need to be held accountable.

Those ordering the falsified tests and assessments are essentially putting guns to the heads of doctors.  The labs and rehab centers complicit in this fraud are pulling the trigger.  Simple as that.

You can see some of these letters here:  Letters From Those Abused and Afraid.

“No matter what people tell you,words and ideas can change the world.”-Robin Williams.

mllangan1 7 Comments

5.0.2

“I stand upon my desk to remind myself that we must constantly look at things in a different way.”

-John Keating (Robin Williams)

Dead Poets Society

dead-poets-society-on-desk-212x300

mllangan1's avatarDisrupted Physician

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Robin Williams Melancholy Suicide—Hopelessness, Helplessness and Defeat

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dead-poets-society2 What we need!

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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.

Slide41

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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Backfire Step 3: REFRAME –Fraudulent Concealment of Fabricated Forensic test correction, False Statements Under Color of Law : Need to hold accountable

mllangan1 4 Comments

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Laboratory developed tests (LDTs) have no FDA or CLIA oversight.  Avoiding regulatory oversight is just one of the ways those involved in the use of these tests avoid accountability.  Without answerability to third parties they have essentially removed themselves from consequences.

College of American Pathologists (CAP) accreditation is the sole avenue for complaint.  CAP does not sanction.  They only have the ability to educate lab to come under compliance with CAP standards under threat of loss of accreditation and it is under this threat that they can force a laboratory to correct both unintentional and intentional errors.  This is what was done in my case.

I filed a complaint with CAP in January of 2012.  The “Litigation packet ” showing forensic fraud was sent to CAP and I was informed that the investigation could take many months.    In October of 2012 I was suddenly reported to the Board of Registration in Medicine for  “noncompliance” with AA meetings (that were the sole and direct result of this test) and action was taken against my medical license which resulted in my suspension.

In December of 2012,  the Chief Investigator for CAP, Amy Daniels  called me to see how I was doing in light of the “amended” test.  She told me that the test had been invalidated on October 4, 2012.   I told her this was news to me as I was in the process of being suspended for “noncompliance” and called the Director of Operations at Physician Health Services (PHS) Linda Bresnahan who predictably told me she was unaware of any revision to the test.

But the very next day a letter was  sent out  signed by PHS Medical Director Dr. Luis Sanchez, M.D. stating that they had just  found out about the amended test on December 10. 2012, the day before when I called them.  Interestingly the letter acknowledged the invalidity of the test but  stated PHS and the BORM would  “continue to disregard” it.  Sanchez also made it a point in the letter to state they were  were not aware of any consequences resulting from it.  They denied any knowledge of an October 4, 2012 revision which would have been 67-days earlier than this acknowledgment and dismissal of the test.

In response to 93-A demand letters from my attorney for fraud, PHS, Quest and USDTL all refused to consider any damages by blaming my suspension on me.   They claimed my suspension was due to my “noncompliance” with attending AA meetings that was officially reported to the Board October 18, 2012.     The claimed the test that was used as a stepping-stone for all subsequent adverse events was completely irrelevant and had nothing to do with anything.    This is what is known as “moving the goalpost.”   What they did not know was that I would eventually be able to get the document proving they knew what they knew and when they knew it.

The response letters revealed important information that was previously only speculative with no way to prove.  Both labs, in defense, claimed that  the test was sent as “clinical” specimen at the request of PHS (an ultra vires out of scope act as they are a 503(B) charity. PHS is not a healthcare provider and is not authorized to practice medicine.

PHS and the labs were apparently unaware of the new HIPAA Privacy rule that requires labs to provide patients with their lab tests without approval from the agency ordering the test.  PHS had previously refused to provide labs by hiding under confidentiality and medical records regulations.

At first they refused but CAP and the DOJ -civil rights division forced USDTL to provide the document below dated October 4, 2012 informing Dr. Luis Sanchez of the amended test he reported in a signed letter to a state agency that he had just found out about December 10, 2012.  The letter undeniably shows Sanchez lied to a state agency in a written letter.  This is also a prima facie crime.  It is just one of many crimes that Board Attorney Deb Stoller has facilitated for PHS as her job is to ignore, suppress, minimize and deflect any criminal acts committed by PHS and protect them.  And this needs to be made public.  PHS needs to be held accountable.  So too do the actions of Ms. Stoller whose job as an agent of the state makes her involvement even more egregious than the perpetrators.

The documents below show a clear violation of M.G.L. 256 (B) Section 69 done under Color of Law.

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Title 18, U.S.C., Section 242
Deprivation of Rights Under Color of Law

This statute makes it a crime for any person acting under color of law, statute, ordinance, regulation, or custom to willfully deprive or cause to be deprived from any person those rights, privileges, or immunities secured or protected by the Constitution and laws of the U.S.

This law further prohibits a person acting under color of law, statute, ordinance, regulation or custom to willfully subject or cause to be subjected any person to different punishments, pains, or penalties, than those prescribed for punishment of citizens on account of such person being an alien or by reason of his/her color or race.

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False Statements Relating to Health Care Matters (18 U.S.C. § 1035) It is a crime to knowingly and willfully falsify or conceal a material fact, make any materially false statement, or use any materially false, fictitious, or fraudulent writing or document in connection with the delivery of or payment for health care benefits, items, or services. 11 Chapter 2 ~ Summary of Fraud and Abuse Laws

Mail and Wire Fraud (18 U.S.C. §§1341 and 1343)  Statutes, which prohibit the use of the mails or the wires to further “schemes” to defraud

Perjury and False Statements

PERJURY BY WRITTEN INSTRUMENT. 

FALSE STATEMENTS (18 U.S.C. § 1001)

This statute prohibits the making of any false, fictitious, or fraudulent statement to the United States or a government agency. This statute is exceedingly broad: It covers any statement or representation made to the government or any of its agents. A statement can be made either orally or in writing, and it can be sworn or unsworn.

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Supression of Dissent: Basic Information

2. The keys to backfire

• “Reveal: expose the injustice, challenge cover-up

• Redeem: validate the target, challenge devaluation

• Reframe: emphasize the injustice, counter reinterpretation

• Redirect: mobilize support, be wary of official channels• Resist: stand up to intimidation and bribery”

via Helpful resources for those abused and afraid — via http://www.bmartin.cc .

An Open Letter to Senator Elizabeth Warren Regarding Laboratory Developed Tests, Physician Health Programs and Institutional Injustice

mllangan1 6 Comments

An Open Letter to Senator Elizabeth Warren Regarding Laboratory Developed Tests, Physician Health Programs and Institutional Injustice.

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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.   But that is what is occurring.   Some of us are trying to expose this corrupt system but barriers exist. As with the Laboratory Developed Tests (LDTs), those involved have intentionally taken steps to remove both answerability and accountability.  Both the tests and the body of individuals administering these tests are notable for their lack of transparency, oversight and regulation.  This renders them a power unto themselves.

Doctors (and others coerced into Professional Health Programs) across the country have reported going to law enforcement and state agencies only to be turned away.   The Federation of State Physician Health Programs (FSPHP)  has convinced these outside agencies that this is a “parochial” issue best handled by the medical profession..   Those reporting crimes are turned back over to the very people committing the crimes.

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Backfire Step 1: Expose the Injustice–Forensic Fraud being committed by PHPs in Collusion with Corrupt Labs

mllangan1 11 Comments

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I will be putting up a survey shortly and want to hear your stories.  One of the recurrent themes I keep hearing from those victimized by PHPs is falsified drug and alcohol tests.   Attached is an example of what they are capable of.

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Quote by Dr. Greg Skipper, MD, FASAM, FSPHP

Remember, this group has essentially removed themselves from accountability in drug and alcohol testing via the use of Laboratory Developed Tests (LDTs), a loophole which avoids FDA approval and oversight.   Whereas most drug testing is transparent and held accountable, the PHPs use testing that is opaque, unregulated and accountable to no one.  Accountability demands both the provision of information and justification for ones actions. PHPs block both.  While most drug-testing requires the immediate provision of information if the test is questioned (as it should be), PHPs have put forth the logical fallacy that doctors have some sort of inherent expertise in toxicology and pharmacology and can “figure out” how to circumvent the testing process if they were to get copies of their lab results.  They block this provision of information.  And even if this information is ultimately provided, as seen below,  no outside organizations exist to hold them to account.  They do not have to justify their actions to anyone.  No safeguards exist to assure integrity and honesty of the sample.   No safeguards exist to assure the integrity and honesty of those ordering the sample either.

The documents below show forensic fraud.  This is undeniable and indefensible. It does not take a toxicologist or Medical Review Officer to understand what “chain-of-custody” is and that “updating” one constitutes misconduct, fraud and (as seen here) criminal activity.   These documents were obtained 5 months after a falsified test was ordered by Linda Bresnahan, Director of Operations at Physician Health Services, Inc. (PHS, inc.) the Massachusetts PHP via fax no less.  The blood test was drawn on July 1, 2011.  On July 19th, 2011 Ms Bresnahan requests (through the PHP secretary Mary Howard) that an already positive test for the alcohol biomarker phosphatidylethanol be “updated” with  ID # 1310 and a “chain-of-custody. (which is an oxymoron-a “chain-of-custody” by definition cannot be “updated.”  Unveleivably the lab does it without hesitation or any apparent compunction.   The documents speak for themselves.  ID # 1310 just happens to be my ID number.  When I complained that no one ever accused me of ever having an alcohol problem she replied:

“You have an Irish last name-good luck finding anyone who will believe you!” 

For a more detailed analysis see here, here and here.  And where was the Medical Review Officer during all of this?  Good question and one he will not answer!  And no one else is holding him to account.   This needs to change.

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A

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B

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C

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1. Supression of Dissent: Basic Information

2. The keys to backfire

• “Reveal: expose the injustice, challenge cover-up

• Redeem: validate the target, challenge devaluation

• Reframe: emphasize the injustice, counter reinterpretation

• Redirect: mobilize support, be wary of official channels• Resist: stand up to intimidation and bribery”

via Helpful resources for those abused and afraid — via www.bmartin.cc .