Pharmacard: A Prescription Drug Monitoring System Designed to Record Drug Histories and Reduce the Incidence of “Drug Misadventuring.”
As a medical student in 1990 I saw a 79 year old woman in the emergency room with intractable nausea and vomiting. Earlier that week she had seen her primary care physician for nausea and a mild cough. Diagnosed with bronchitis, she was given a prescription for erythromycin. Her husband brought in her medications including digoxin which can cause nausea
when blood levels are too high. A markedly high level came back on the blood draw indicating digitalis toxicity. I spoke to her primary care physician who was unaware of her digoxin prescription; completely clueless that she was prescribed the foxglove plant extract by a cardiologist for an irregular heart beat.
Digitalis was first described by William Withering in 1785 for heart conditions and this is considered the beginning of modern therapeutics. Sometime after erythromycin became available in 1952 it was discovered that taking the two drugs together increased digoxin levels. This simplest type of drug interaction is called interference and occurs when one drug either accelerates of slows down the metabolism or excretion of the other.
Based on the progression of symptoms her husband reported and the elevated levels on admission this woman undoubtedly had elevated digitalis levels when she was seen by her doctor earlier in the week. Unaware of the digitalis he inadvertently worsened her condition by giving her a medication that elevated her levels even further. She was lucky.
The Boston Collaborative Drug Surveillance Program found digoxin to be the second most commonly implicated drug in causing death in hospitalized patients and the most commonly implicated drug implicated in hospital admissions (N Engl J Med 291:824–828, 1974).
Digitalis toxicity in those who die outside of the hospital often goes unrecognized as most are elderly and assumed to have died from age related causes.
Seeing several more cases of drug related problems caused by ignorance of current medications and lack of communication prompted an interest in drug misadventures. I also became interested in developing a computerized up to date and accurate record accessible by all health care providers in real time , a closed loop system of “portable” information easily transferred among all health care providers be they primary doctors, pharmacists or emergency room personnel.
Research pharmacologist Dr. Edward Gallaher and I brainstormed over ideas and eventually came up with a computer program using WORM (write-once-read-many) optical technology used in compact disc systems. much like a CD-R but without the spinning disc. The credit-card sized disk could store up to two megabytes of data on an optical layer that could be written once and never changed. An optical card-reader interfaced with any IBM compatible PC. The plan was to place card readers at pharmacies, medical offices and emergency rooms. We called it Pharmacard.
Pharmacard System Developed. ASTI Connections. Vol 4. Eugene, OR: Advanced Science and Technology Institute; 1992.
Although computerized medical records existed in 1992 they were predominantly stand alone with many just replicating the paper record without word search capability. Moreover these programs did not communicate with one another so no information portability existed between the entities involved. Communication of information from pharmacy to doctors to emergency room was not an option. The system was fragmented and the search for information long.
But drug mishaps were a real problem. As with digoxin they could be fatal. Multiple reports of drug induced morbidity and mortality were found in literature searches. An obvious problem existed. . Many were drug interactions such as that with digitalis and erythromycin. From my viewpoint the need for addressing the problems caused by inadequate and and incomplete records was not only self-evident but a priority. Solutions however were few. “Brown-bag” sessions in which patients bring in a paper bag containing all of their meds were held periodically. Little booklets titled “patient medication records” were given to patients to update and record their new and current prescriptions.
In addition to an up to date medication list we decided to put in the bare but essential elements of the medical record that would be needed in an emergency; these consisted of demographics, emergency contacts, a basic problem list, allergies and a baseline EKG.
An available baseline EKG was decided based on its presence making it much easier to detect a problem by looking for differences. A baseline EKG would conceivably facilitate the timing and accuracy of diagnosis. In addition it would save money because without a comparison the default is admission.
We then applied for multiple research grants for funding to do a pilot study. All were rejected and contained comments suggesting we pitch our wares to the computer people not the medical people-this is computer science not medical science.
We received very little interest at an AMA poster presentation in Washington D.C. Few people would even read the poster with most taking a quick glance and redirecting straight ahead as if they were avoiding a street-corner pollster. Those who did read it were either non-plussed, perplexed or cynical.
A research psychopharmacologist M.D.,PhD from France asked permission to give me some advice. He then told me it would not work. He said the idea was great, it would work as intended and probably help prevent drug related problems. But that did not matter because no one
gets it yet.”
Aside from a handful of people intimately involved in the research most everyone else finds this useless as do most people at the conference. This means nothing to them.
They don’t see the problem and they don’t see a need for a solution. Many believe it is the patient’s responsibility to keep track of their medications and that any problem associated with not providing their medication list up to date were self-inflicted.” He said it will be a different story in five or ten years when the problem is acknowledged and accepted by the rank and file.
In 1999 the Institute of Medicine published To Err is Human: Building a Safer Health Care System placing patient safety high on the nation’s health care agenda. Medical errors, adverse drug reactions and interactions were deemed a big problem. Identifying ways to keep track of medications became a priority and multiple business ventures popped up and got their hats in the ring. Suddenly everyone not only recognized the problem but imparted the sense they knew it all along. Seven years had gone by and our project had then fallen by the wayside. In addition our optical platform was obsolete.
As with firefighter arson this illustrates the most crucial step in addressing a problem is admitting the problem exists. Firefighter arson had been documented for over a century but not properly addressed. The extent of the problem was not publicly recognized until a Special Report: Firefighter Arson was done by the Department of Homeland Security, the United States Fire Administration and the National Fire Data Center in 2003. The most crucial step was admitting the problem exists. The second was defining the problem. The third was having zero tolerance for those engaged in the problem. States that have taken this approach have found a marked reduction in firefighter arson.
The problem of not recognizing problems as problems can also be applied to individuals; Bill Cosby comes to mind. So too does FSPHP self-appointed drug-testing expert Dr. Gregory Skipper whose irresponsible introduction of junk-science drug testing into the marketplace through a loophole has undoubtedly caused many more deaths than Dr. Harold Shipman who killed more than 250 patients in the U.K. by injecting them with morphine.
Skipper’s introduction of junk science drug and alcohol testing and use of cutoff points he pulls out of a hat and then moves upward as the problems are exposed is shameful. The fact that he unleashed this on other doctors knowing full well what would happen in a zero tolerance program needs to be revealed.
My survey is revealing many suicides as a direct result of these tests, including those of medical students and residents. And most of those who have died were not even remotely addicts or alcoholics. They were reported anonymously, given one of these tests and asked to be evaluated at a “PHP-approved” assessment center where a diagnosis was confirmed followed by 3-4 months of inpatient treatment. I am finding out most of the doctors referred to PHPs do not have any problems but the PHPs and their affiliates are giving false diagnoses, false drug testing and using threats to control them and there is little they can do about it. Skipper’s complete lack of empathy for his victims as he continues to put coins in his purse is abhorrent. Meanwhile the death count continues to rise.
I get many e-mails, letters and phone calls from doctors, nurses and others who have been abused by “professional health programs” (PHPs).
Most are anonymous. Afraid of being identified and punished by the PHP, very few leave comments on my blog revealing their names or potentially identifiable information.
This is understandable. By simply reporting “noncompliance” to the medical boards a state PHP can end their careers. As it was with the Inquisition this system relies above all else on silence and secrecy. Speaking out can result in “swift and certain consequences.”
They are afraid. Some are undoubtedly suffering from PTSD. Most have developed a “learned-helplessness” Many have reported abuse and even crimes to their medical societies, medical boards, law enforcement, the media and others only to have the door slammed in their faces.-myself included.. They have no advocacy or support and feel no one cares. Their locus of control, identify and self-worth have been suddenly ripped from them without recourse. There is no lifeline.
PHPs are ostensibly Employee Assistance Programs (EAPs) for doctors in both mechanics and mentality. EAPs assist employees with substance abuse, personal problems and other issues. They do not diagnose or treat “patients” but refer to outside professionals who do. The critical difference between EAPs and PHPs is PHPs have mandated all assessment and treatment be done by their own. These “PHP-approved” facilities are economically and ideologically intertwined with the PHP. The conflicts of interest are serious and many.
PHPs also use non-FDA approved junk-science drug and alcohol testing they introduced. The procedural safeguards most EAPs use to protect the donor ( certified labs, FDA-approved validated tests, split-specimen, strict chain-of-custody, MRO review) have been reviewed. Unvalidated “personality” assessments they also introduces are being used in “disruptive” physician evaluations guaranteed to find “character defects” to justify monitoring contracts. They implement polygraphs despite the AMAs previous conclusion they are scientifically unsupportable.
But regulatory agencies have readily adopted policies not only unsupported by science and evidence-based research but outside the normative principles and practice of medicine.
Granting PHPs authority to limit assessments and treatment to their own facilities offends the fundamental rights of the individual.
Informed consent (or refusal) constitutes a basic rule of the lawfulness of medical practice according to national and state medical practice acts governing the profession. It is a basic principle of all published principles of medical ethics.
Involuntary treatment is motivated by either potential harm to others (for the good of society) or by need for treatment and/or potential self harm.
Involuntary treatment should be a confined to those gravely disabled by psychiatric disorders or substance abuse. It necessitates reflection under the ethical principles of autonomy and beneficence.
A single DUI, transient psychological issue such as grief or anxiety, and even sham peer-review can easily land a doctor into forced assessment and involuntary treatment at a “PHP-approved” facility.
Involuntary assessment and treatment involves legal, clinical ethical, and deontological consideration in its demarcation.
The economic and ideological aspects need to be considered here.
How is it this paradoxical assessment and treatment paradigm legitimized and justified within a profession that emphasizes evidenced based decision making and beneficence and autonomy as two of the basic principles of medical ethics?
To sell the “PHP Blueprint” to other EAPs it is necessary to prevent doctors from speaking the truth. Very few want their names, states or other unique identifiers published for fear of consequences and retaliation.
The letters below have only been posted after being approved by their authors-MLL
4/20/15
Dear Michael Langan
I love your writings analysing the power relations and psychopathy that is running rampant in every sphere of life, including sadly, medicine…
Your logo of the the two serpents represents the fight between good and evil, to me…
It was encouraging that you ‘liked’ the post from the blog as writing in relative isolation is very hard.
So thanks a bunch !
Take good care of yourself – truth tellers are precious and rarer than gold dust !
3/5/2015
Comment: I am Board Certified in Internal medicine. I have endured years of emotional, psychological and spiritual abuse at the hands of the Washington Physician’s Health Program. I have suffered through a long list of injustices without recourse. They include, but are not limited to discrimination, abuse of power, breach of contract and repeated and WILLFUL medical negligence.
Because the actions of the WPHP have been SO egregious, I assumed what was happening to me must be extraordinarily rare.
I have nothing to hide. And I have shared my story with any and all who would listen. To date, my voice, my rights and now my life have been dismissed as unimportant. MY LIFE!! It’s apparently better that I die than my tormentors be questioned and compelled to defend their indefensible and evil behavior.
I am meeting with one last attorney tomorrow. I fully expect him to ignore the basic, indisputable and well documented facts of my case. Namely, there is massive and systematic malfeasance being committed by a tax payer funded agency in the State of Washington who act with omnipotence and without oversight. I have no reason to believe he will respond any differently than the others with whom I have met. HE WON’T CARE! HE WILL NOT BE MOVED. He will make statements that suggest I DESERVE this treatment. And that my life, as well as my imminent death, is unworthy of his time or efforts.
Once my assumptions about this last meeting are officially confirmed, I am committed to the only course of action available to me. The only thing which will put an end to this nightmare.
Today I stumbled upon your website. And today, for the first time, I have learned that my case is not rare. I suspect the other physician victims in this matter have occasionally allowed themselves to dream wistfully of justice. Justice which they have seen thwarted at every turn. Perhaps they, like me, have dreamily imagined the relief and joy and LIFE they would experience if the truth were simply presented and the perpetrators held accountable. I have imagined standing up in court and triumphantly affecting justice for myself as well as all of the other current and future victims. I deliver a powerful defense of justice. My ‘dream speech’. I have imagined that I might still live. And then I wake up.
And so today, imagine my shock, when I found my ‘dream speech’ here. My speech. Reasonable. Honest. Consistent. And based firmly in truth, justice and defense of the powerless against the (arbitrarily) powerful. My speech, it seemed, but authored by another.
Thank you, Dr. Langan. You have given a voice to my struggles. Please never stop speaking for me, and people like me, many of whom, I fear, will not survive to see justice.
Despite my intention to die, I actually WANT TO LIVE! And I will live and fight on if I ever believe that there is even a small chance of justice for me and the other innocent victims of PHP’s and the ‘treatment’ centers with whom they contract (Talbott in my case. Purely evil and loathsome human beings, for the record).
So, because I do WANT to live…PLEASE HELP ME, SIR!
Can you refer me to attorneys, individuals or groups who might advocate for me and the other victims? Do you have any specific words of hope or encouragement?
Please note my name. Please add me to the list of innocent victims of these power hungry, narcissistic BULLIES.
I don’t expect to live through this. And in a way, the PHP, Talbott and the addiction ‘experts’ with whom I have been tragically acquainted are correct…My life is worth very little. But this issue is so much larger than I. I can die with some serenity if I believe there will be meaningful justice for others like me. And that those responsible will be held to account.
Thank you Dr. Langan. Thanks to all of those involved in the creation and maintenance of this website. Although your shining beacon is barely perceivable through the darkness of injustice which surrounds and seeks to extinguish it…it is the only glimmer of hope I have found during my slow death by PHP.
3/2/2015
Dr. Langan:
Thank you for your articles and research regarding PHPs and “impaired” physicians. I have become involved in this issue after someone close to me struggled with depression during residency. Sadly, they lacked the resources, support and coping skills and ended up committing a crime with a misdemeanor charge. Despite their treatment and rehabilitation, they were dismissed from residency. Not sure if they will ever get to practice clinical medicine. It is very sad. they are very smart, great doctor and very empathetic towards patients.
After their situation, I started looking on blogs and found that many residents had shared similar instances. Many reported struggling with depression and the stresses of residency put them over the edge– like the perfect storm of stress, fatigue, and loneliness that could exploit anyone’s weaknesses. It seems like during residency, we are emotionally as well as legally vulnerable. Many of these residents have never been able to resume training at their institutions despite their demonstration of clinical competence and emotional maturation. According to that medscape article, that is a huge loss to society, socially and financially.
Sadly, there still so much stigma surrounding mental health, and I think it may be worse in our profession.
I am very concerned regarding the future of our profession. We are becoming robots in a health care factory. Our own personal lives are being compromised as well as quality patient care.
I appreciate all you are doing to shed light on this very important issue.
Thank you for your time and consideration
2/17/2015
Dear Dr. Langan:
Thank you for your insight, eloquence, and concern for all of us. These Boards and other administrative bodies claim that they are “protecting the public,” but healthcare providers are the public too. And they’re killing us.
The problem is not unique to physicians. I am a nurse practitioner, and we share some of the same burdens. Although the numbers are growing, there are so few NPs nobody has studied suicidality among our profession. There is still the same fear of malpractice, professional bullying (nurses “eat their young,”) and the taboo of asking for help.
A trivial, third-party complaint to the State Board didn’t cost me my license, but it did cost me my job and my mental health. The pain I endured: the relentless questions about my personal life… it was jarringly intrusive. All of this was conducted by a bullying investigator: a man who had no medical training. The Board took it upon itself to ask detailed questions about my personal life and relationships, as if they would somehow psychoanalyze me. The investigator started his conversation by advising me that the Board does not honor the Fifth Amendment.
I’ve heard others—physicians—tell me of similarly murky complaints that dragged on. A cardiologist I know was instantly fired and rendered unemployable for year under similar circumstances. He struggled to feed his kids. Nobody died. Nobody got hurt. He didn’t have a substance abuse problem or divert drugs. He practiced within his scope. The case was eventually dismissed, and he’s back in business. But he has never totally recovered.
A simple, free email to the Board can cost a physician or nurse practitioner his or her livelihood in a split second.
All of this detracts from the dangers posed by inept or otherwise dangerous clinicians. We’ve all met them, seen them in practice, seen their charts, or heard stories. I think everyone I know can name a clinician who showed up drunk to work, billed fraudulently, or who was so incompetent that he or she should not be practicing.
It has been ten months. The Board hasn’t had any further questions, but they never dismissed the case, claiming that they have a massive backlog. My health and livelihood are inconsequential to them. I’m still being prescribed scheduled benzos and z-drugs just so I can make it day to day.
I came very close to suicide more than once, but I evaded psychiatric admission because then I’d lose my license without a doubt. Again, “protecting the public?” I deliberately avoided emergent medical care because of the Board.
I chose another path: I left the profession, and I have lost my sense of self. Twelve years of school, $350,000 in tuition, and four degrees were rendered worthless by a single third-party email. Above all, my pride in my clinical acumen, passion for learning, anal retentive charts, sensitivity, and professionalism also went down the drain.
The Board’s notion of “protecting the public” also means kicking good providers out of the business. Our emotional lives are destroyed, our finances wrecked, and we live in fear. There is no “speedy and public trial,” no “jury of our peers.” Although Conrad Murray MD fled to Trinidad, where he is working as a cardiologist (hopefully not prescribing propofol for insomnia), an open complaint renders me ineligible for licensure in all fifty states, all Canadian provinces, the Netherlands, and Australia.
Assuming that the Board dismisses the case, I don’t know if I could ever return to practice. It’s too hard to live in fear of a backstabbing patient or family member, and the ineptitude and glacial pace of a medical board. I want to clobber anyone who says, “and this too shall pass.” It’s not quite like that.
I am trying to re-establish myself in some second career, but that is hard to face. I cringe every time I open my email and mailbox in fear of a letter from the Board. I know I did nothing wrong, but that’s not how the system works.
I still fight the urge to take my own life.
1/17/2015
Great website. Presents an alternate view I have never seen in action and I have had to report a number of MDs to our state’s PHP. Thanks for the insights.
2/8/2015
I am an RN in a monitored program in PA which includes forced AA attendance. I have 22 years as an RN with 10 years of military service which includes a one year deployment to Iraq. I am willing to speak out. Too many are afraid of losing their licenses to practice.
1/14/2015
A review of 14 studies found that the relative risk of suicide in physicians compared with the general population is between 1.1 and 3.4 for men and 2.5 to 5.7 for women, http://www.currentpsychiatry.com/index.php?id=22661&tx_ttnews[tt_news]=175910, furthermore, studies have indicated higher rates of suicide among psychiatrists and anesthesiologists.
There are a variety of theories on why physicians commit suicide. Depression is the most common explanation given. Certainly, there’s a lot of stress involved in our profession. We deal with death and dying. We’re held to impossible standards. Managed/mangled care and the restrictions of government plans/laws/policies on the one hand restrict what we can do for our patients. On the other hand however, are the viscous packs of attorneys waiting to cull the herd. Let’s not forget the State Medical Boards, out there striving to “protect the patients”, generally done in cahoots with the “Physicians Health Programs”. These two entities form a deadly collusion that is inescapable—and of course, linked to the packs of predators circling to ensure that we will suffer the consequences for actions that we may have little if any control over.
I am one of the unfortunates.
I haven’t committed suicide (obviously), nor made an attempt at it. Certainly I’ve had thoughts about it—who among us hasn’t? My strong religious convictions prevent any serious consideration of this “permanent solution to a temporary problem”.
I am also one of the fortunates.
This is largely due to the foundation of faith that I have. Years ago I made what may have been a mistake. I prayed for patience & humility. We tend to be an impatient and yes, at times an arrogant lot. I recognized those character flaws in myself and asked Him for help.
I should have asked for the grace to overcome these shortcomings. Grace is a gift, a “freebie” if you will.
Patience is gained through trials. Humility generally through humiliation.
I have learned that where there is pain in life, there is often a lesson—look for it, learn from it. Running from it merely guarantees that it’ll be presented again, and again and again until it’s learned, often with a few extra presentations after the initial effort to dodge the trial.
The study of theology has lead to the interesting concept that suicide is actually a sin of pride. Yes, depression is involved, but the pride plays it’s role with the thought that; “I don’t deserve this trial so I’m choosing to take myself out of the game”.
My personal belief is that only God has the power to give and take life. The reader is certainly entitled to their own belief. Mine has evolved by study and prayer over decades.
There is a growing movement afoot across all 50 states for attorneys employed by State Medical Boards to direct their investigators to report possible transgressions directly to the attorneys instead of to the physician board members http://woundedhealersnc.net/. The attorneys have thus usurped the role of a professional board; to ensure that we’re held accountable by our peers. These attorneys then draft their own perspective of what happened, often putting “spin” or “slant” to the report to prejudice the board members to carry out the actions that these attorneys deem to be appropriate. The Board Members have unwittingly abdicated their responsibilities. This leaves physicians at the mercy of Board attorneys. These attorneys were initially tasked with ensuring that the Board members didn’t violate any laws in their disciplinary actions against wayward licensees. Board members are busy physicians in their own rights. They have their practices and with the attendant problems associated with them, as do the rest of us. Typically, they go to their state capital for a couple of days a month to do their “official duties”. The attorneys present the information for the “rubber stamp” of the Board’s approval.
Worse still are the “consent orders” drafted by the State Board attorneys. A key part of such an order is the “findings of fact” describing the (alleged) transgressions. The hapless licensee is often coerced to signing these flagrantly fictitious documents with threats that the attorney-derived discipline will be much lighter than what the Board will mete out. It’s actually not uncommon for “defense” attorneys to collude with the Board attorneys, urging the clients that they are supposed to be defending into signing the consent order. Signing the order will have many grave consequences http://woundedhealersnc.net/documents/lip/index.htm. As a hapless victim, I had no concept of such unethical yet commonplace activities.
There is documentation of an extremely arbitrary nature of punishments on www.woundedhealersnc.net ; A physician and his mid-level go out to a dinner presentation by the local pharmaceutical representative. Driving home afterwards, the physician crashes the vehicle. Both are intoxicated. The mid-level spends 2 weeks recuperating in the hospital. The physician/driver gets a “Public Letter of Concern”.
Another physician is out of state on vacation, gets a DUI, truthfully reports it during his annual license renewal and is taken out of practice for four years. Some practitioners NEVER return to practice. Substance abuse issues are treated extremely harshly.
Killed somebody with negligence? Oh, no problem, that will only get you a “Public Letter of Concern” in North Carolina.
You were seduced by a patient? Big problem! There’s to much of a “power imbalance” since you’re a medical practitioner, mid-level or otherwise. You may possibly NEVER practice medicine again. There’s documentation of a psychiatrist who married a patient, the State Board found out about it and took her license away; she was to much of a risk for sexually assaulting other patients. Ultimately she was allowed to have her license back on the condition that she never practice psychiatry again!
I was also unaware that state boards are incentivized to discipline as many physicians as possible, as harshly as possible, for as long as possible.
I was indeed one of the innocents.
Knowledge is indisputably power. The site quoted above provides a wealth of information of the workings of the “system” in North Carolina. The “Great North State” is hardly alone in their approach.
The Physician Health Programs (PHP’s) are another area of concern. It’s a shame that the stated purpose of the PHP’s is to help return impaired practitioners to active practice. These groups throw the very physicians who need help the most the furthest under the bus in full collusion with the Board. They’re typically staffed by psychiatrists who are members of “addiction societies” that aren’t much more than diploma mills. The PHP’s often claim to be performing “peer review” while disregarding the legal requirements for peer review. The PHP’s/Medical Societies/State Boards are parasitic symbionts that prey upon those of us who have been used up and burnt out by the non-system of healthcare that exists.
Does this sound like a pattern is developing? “Disregarding the legal requirements…”
In North Carolina, the complaints were of such a volume that the NCPHP was audited and found to have numerous deficiencies. Next, all 57 of their licensing and professional boards were audited. All of them showed problems—the most common that they did not report to anybody for supervision! These are routine violations of the General Statutes of the state.
Every state has a state auditor whose function is to ensure that state agencies fulfill their assigned duties efficiently and honestly. Most State Medical Boards and PHP’s have NEVER been audited. Anybody can report their concerns to their state auditor.
Attorneys are supposed to uphold the law; isn’t this ironic?
There is ample evidence of collusion among the players; Defense attorneys who should be defending their clients against their Board (sometimes the Boards actually recommend individual attorneys that they “work well together” with to wayward licensees). Board Attorneys are clearly involved as are the PHP’s.
State Medical Societies are also generally in the same bed with the Boards & PHP’s. Governor’s generally rely on the Societies to recommend prospective Board members. It’s not uncommon for the first question at an “investigative hearing” to request information on whether the licensee is a member of the local state society. What would the purpose of such a question be? Simple. It’s well-documented that membership has a “protective” function. It’s not absolute, but exists nonetheless.
In one case, the Board remanded a full mental health evaluation. The result was that the licensee had a mild autism spectrum syndrome (something a good many of us have), an autism spectrum disorder that is characterized by difficulties with social skills and non-verbal communication—but with benefits such as intense interest and expertise in certain areas (like medicine!).
The function of a Board is to maintain scope of practice. Family physicians don’t do craniotomies. Yet, despite the absence of a single mental health professional on the Board, the recommendations of 3 independent professional organizations, all recommending immediate return to practice for the licensee were ignored.
The Board posted the practitioners protected health information, including mental health information on their website. The most basic rights to privacy were clearly violated. The licensee never gave permission for such an intrusion!
The ADA covered disability was dealt with by an indefinite suspension—all with the full collusion of the NCPHP. The ADA requires “reasonable accommodations”. Indefinite suspension is punitive—certainly not a reasonable accommodation! Again, it cannot be over-emphasized that Board attorneys have a strong desire to punish whenever, wherever, for as long as possible.
The licensee signed the contract with the NCPHP. The licensee was held to the terms, but the advocacy mandated by the contract was never delivered; “the Board attorney said he wasn’t interested in anything I have to say in your favor, his mind is made up, there’s nothing I can do to help…” was the limit of advocacy received.
Advocacy?
Collusion is a more accurate description.
The theme song from the hit movie and TV show M*A*S*H* is “Suicide is Painless” by Johnny Mandell. This epidemic is more of an endemic among our profession. We can’t keep “looking the other way”.
There are two major forms of suicide.
Active suicide would best be described as a former colleague who went into the recovery room one Sunday afternoon when it was deserted, took a scalpel and did a full-length carotidotomy on himself. He made a posthumous statement. Another ran out in front of a box truck on the interstate. It took his head off.
Passive suicide is best shown by 5 of the NC Medical Board victims. This Board tends to pursue physicians from their mid-40’s to mid-60’s, the top income-producing time of our careers. They usually have assets to poach. Usually by that age, we’re taking some form of medications for our own health issues. A diabetic who purposely forgoes his insulin… Suicide? It won’t be reported as such. What do YOU think?
We will never eliminate all of our stressors. There will always be the “less fit members of the herd”, which is sad. This is more appropriate for other animals at other positions on the evolutionary tree. Why should the most noble of professions be relegated to those branches of that tree?
We need to reach out to each other. We need to reach out to our state auditors. Another resource that surprised me is a different agency. There is an agency whose primary function is “to deal with corruption in public officials both appointed and elected”.
Does this sound like an appropriate agency to engage against our Boards & PHP’s? It’s the Federal Bureau of Investigation, commonly known as the FBI!
All that it takes for evil to triumph is for good men to do nothing. When we organize we change from individual targets to a formidable force. State Medical Societies, unfortunately, are not the answer. Typically state governor’s turn to them for nominations to staff the boards. In North Carolina, lawsuits have been settled out of court that involve the alliance between the Board, Medical Society & PHP.
Perhaps the best solution would be to revamp the system. Maybe it’s time for a Federal Medical Board. At the very least, State Boards should be restructured so that investigators do not report to the attorneys, but directly to the Board Members. It will mean more work for the Boards, but they’ll at least resume functioning in the manner originally intended.
–Wounded Healer
12/31/2014
This whole lack of accountability and oversight within the PHP’s makes me sick. I was sent to PHP for evaluation and suspicion of drug abuse by my employer hospital. I was only suffering from side effects of Paxil causing a SSRI Discontinuation Syndrome. The diagnosis was completely missed because the PHP sent me to a rehab center in Los Angeles. I am sure you know this one very well.
I was coming there for IDE, Intensive Diagnostic Evaluation not recovery and rehab. After arrival I was forced to enter their rehab program completely against my will. I was on my way out the door and about to call a cab when the program director threatened me with absolute coercion.
He said if I left he would assume I had drugs in my possession and that this would negatively affect my evaluation and would be reported to the PHP and state medical board as a form of noncompliance, and that my career and license would be in jeopardy. How is that possible when I was not sent there by any state board or regulatory agency as I was there voluntarily.
The only incentive to force me into admission rather than having my workup done as an outpatient was purely financial. Employer was paying the bill, so it was in their best financial interest to force me into admission at $1800/day and $1400/urine sample and charge for all the transportation to and from all the outsourced facilities for my “evaluation”.
The facility was run by the most inept, unethical group of charlatans I have ever encountered in any field of service not just healthcare. I could not understand how they were qualified to provide medical evaluations when they are not legally allowed to provide any form of treatment for anything. These people were nothing more than middle-management screw ups. They have to outsource everything. They did not even have a crash cart on site. One of their clients had a tonic-clonic seizure during group therapy as a result of a brilliant PA who decided to withhold the clients chronic benzodiazepine therapy because of her personal beliefs that benzos are horrible medications for anyone. Where is the physician co-signature and oversight on this brilliant therapeutic decision? No one except the doctors in rehab even knew how to react. It was a total fiasco and state of panic for all the rehab employees. Luckily the client didn’t dislocate something, die or worse, suffer anoxic encephalopathy. I was in fear for my life after witnessing this my first day.
What’s even more concerning is that this rehab center is supposedly one of the best and has exclusive referral from every state PHP.
They had me stay with recidivist junkies and participate in 12 step when I had no substance abuse issues at all, in fact my social life was so boring, that my hair test wasn’t even positive for alcohol. I had to recite scriptures in group therapy, admit that I was helpless, and powerless, and a weakling. Admit that I had to submit to a higher power since I was an addict. I had to submit to random urine drug tests which costs $1400 each 3-5 times per week.
Then when I cannot produce a sample on the spot (paruresis) I am threatened to be reported to the State Medical Board for noncompliance. A college dropout working as a technician at a rehab does not even have the authority to make this type of threat. I was also forced to shave in front of a female technician with the bathroom door open; she stated that this was policy and I had to relinquish my razor after every shave because I could use it to inflict harm on myself. I then asked why is there a whole drawer full of sharp cutlery in the kitchen that me and my junkie roommates have access to 24/7???
I saw a psychiatrist and handed him my diagnosis on a silver platter from my history , i.e. Paxil withdrawal yet SSRI Discontinuation Syndrome was not even on his differential. I was in a state of constant agitation, sleep deprivation from insomnia, severe depersonalization. Ended up in the ER at UCLA for intractable Migraine HA, Sleep deprivation, Dehydration, mild AKI and had to be medicated with IV crystalloid, Phenergan to combat emesis and finally induce sleep (going on 4th day of insomnia at that point).
Less than 24 hours after the ER visit I am sent for Neuropsychological testing extensively, which violated just about every code of conduct and ethics under the American Psychological Association in regards to testing validity. I was then labeled “disabled” based on the results. the treatment center was then going to recommend that I stay and additional extended period so they could “rehabilitate” me. They realized now that they did not have my credit card on file because I refused to provide them with it at admission as my employer, was paying for everything for the first month. Next they discover that I do not have disability insurance, and now know that they have just ruined my life. It will take a minimum of 6 months before I can be retested to prove that I have no cognitive impairment and am not disabled. Now my chances of getting disability insurance in the future are ruined.
The treatment center then released me and I returned home to the PHP. I then had to sign a five year contract, enlist in a drug monitoring contact with “RecoveryTrek” which I had to perjure myself and illegally claim that I was a substance abuser and was in “recovery.” I immediately sought legal counsel because of this nonsense. Shortly into my so called recovery I had to take my Maintenance of Certification Board Exam in Internal Medicine. Passed exceptionally and with ease. How could I be cognitively impaired?
Go figure! The neuropsychological test was readministered locally by a different provider as I told the PHP there was no way I would ever consent to going back to the treatment center. The neuropsychologist was pretty pissed off about everyone’s mismanagement of my case starting with my employer. I tested fine, and then the PHP released me from the program and cleared me to return to work. The entire experience has jaded my enthusiasm in medicine. I had to take almost a year off to reflect on how I was used as a pawn in everyone’s game.
I experienced coercion, collusion, fraud, incompetence, and saw a part of evil in this world that I never new existed. I was a prisoner, starting my day by having to call a monitoring center to see if I had to be drug tested for that day, every day of the week. I was not allowed to leave the state; how can a PHP legally restrict my civil rights this way when I was not under a court order, and not even under state medical board referral? I was not allowed to have a sip of alcohol during my monitoring, even though I had tested negative for any evidence of drug use. I had to meet with board of directors every month and discuss my case, which no one had clue about regarding why I was even in a PHP. This violated all of my rights to privacy regarding my medical condition. The contract that I initially had to sign with the PHP had statements within claiming they could report any information about me to any regulatory agency without even substantiating any facts or validity. This is just a clever way of saying they can lie about you and there is nothing you can do about it legally. There is complete lack of due process. Your civil rights are stripped. You are beaten down into despair and desperation. You are told if you don’t comply your license would be in jeopardy and your career will be over. This cost me thousands of dollars in legal fees, thousands of dollars to be retested and prove I was not impaired, hundreds of dollars each month for PHP dues and random urine drug screening.
I put up with this B.S. for six months, and honestly could not have fulfilled a 5 year contract. If I had not been released (since there was no condition to monitor) I would probably be dead today. I would not be surprised that PHPs have actually caused in increase in physician suicide rate. I cannot fathom the degree of humility physicians experience having to do this for five years. And the only reason these rehab centers claim such a high success rate for recovery is that they hold a gun to your head and threaten you to be in compliance with everything they recommend. So yeah, doctors have a lot more to lose. I now understand how these PHP’s are in collusion with rehab centers. What they are doing is a violation of fair trade acts and would fall under the RICO act. The problem is nobody is investigating them for conspiracy and fraud. They all fly under the radar because they believe they are providing a service that ensures public safety. Its a multi-billion dollar scam industry. What’s more sad is that nobody really cares what physicians are subjected to. In fact the public likely finds joy in fact that docs are treated this way. The state of California hates doctors, so the rest of the country probably does too. People probably enjoy knowing doctors are held to higher standards than the rest. That they are usually required to stay 90 days in rehab while all other professionals stay 28 days, that they are financially ruined by rehab centers. That they have been stripped of all their rights while in a PHP monitoring program. That they are more subject to discrimination based on age or coexisting medical problems like diabetes and hypertension. I have actually seen cases of MDs sent to PHPs for monitoring of hypertension and regardless of why you are sent there you must comply with drug monitoring.
The rehab centers are now tapping into other territory that further identify this as a conspiracy. Department of Transportation, Aviation, and Law Enforcement are going to be their next victims. I can’t wait to see how the police officers are going to respond to this nonsense.
This was an eye opening experience. There is no profession that is worth going through this amount of humility. PHP’s will likely remain above the law, continue to have no accountability and oversight, which is a travesty of justice. I hope you will share my experience. My case is rather unique in my opinion. It’s evidence that no physician should ever voluntarily enter a PHP at an employer’s request. You would be much better off to simply quit/resign.
12/27/2014
I know of pharmacist who are forced into the program and held hostage by their license. They are also required to do “inpatient” treatments of at least three months and continued random monitoring for five years as well.
Once they have you by the proverbial ball, they milk you till you are dry. It is nothing but a scam. The funny thing is that for healthcare professionals who relapse while in the program, they are sent back to “rehab”(inpatient) again once more for milking while they feed you the same b.s. they did the first time.
What is becoming even more alarming is that at least in one case, Texas, if you call PHP for help or to inquire about help, even though nothing has been reported at work or to the board, and you identify yourself and spill your guts about your issue/s asking for your options you are automatically signing up for a trip to rehab and five years of monitoring.
If you decided that you are not interested what they have to offer, they will tell you they would report you to the board at that stage (of course at the beginning of the conversation they tell you it is confidential, but it is confidential as long as you voluntarily start their program since you spilled the beans.
I would be very careful calling the state PHPs asking for information. I would do it from a blocked phone and use an alias before talking to them.
Maybe others who information about other states can also shed some light on this.
12/7/2014
It is really tragic that so many valuable doctors are lost without reason. That State Medical Boards can strip a physician of his hard earned license without due process. That there is no oversite of these boards. That boards and PHPs bully and harass physicians, even to the point of suicide. About 400 physician commit suicide every year. That’s a loss of an entire medical school every year! A colleague of mine committed suicide after facing medical board charges that had no signifigance anyway. This is occurring in the face of a physician shortage as baby boomers age.
12/30/2014
Turns out, I am one of those recovering alcoholics (9+ years) with a lot of experience in AA. It was a large part, though not all, of my treatment. I found it personally helped me a lot. And I also agree with your position.
Based on my experience in AA, things I heard at AA meetings and things I read in AA literature:
– the AA message should be spread via “attraction, rather than promotion”
– AA does not claim to be any kind monopoly in the field of addiction treatment
– AA is fully self-supporting, declining outside contributions
– AA is not professional and not organized
And so having a large body of physicians outside of AA promoting AA is, in my opinion, contrary to multiple AA traditions – particularly if this situation creates controversy. I personally find AA needs no extra promotion, and alternative treatment programs ought to be encouraged just as well as further scientific research into the addiction problem.
The whole thing was meant as a very open, welcoming, non-judgemental, informal gathering of alcoholics talking to each other. Extremism, government coercion, public promotion, money – all those things do a lot more harm than good.
At any rate, thanks for your thoughts, Dr. Langan. Best of luck in the future, I’ll keep following along.
12/25/2014
As an airline pilot who made the monumental mistake of believing that the “E” in EAP (Employee Assistance Program) really meant “assistance”, I can only nod my head in sad agreement to everything above. Between “treatment” (indoctrination in AA dogma) and monitoring my decision to ask for assistance in dealing with a series of health and personal issues that I (for the first and so far only time in my life) tried to use alcohol to numb has changed my life forever. I have lost 7 years of my life. My faith in the rule of law in our society is completely gone. The stress and humiliation of having my career depend on my ability to convince people in this program that I have been “converted” (let’s call it what it is: living a lie) have been indescribably painful. It has affected every aspect of my life. My physical and mental health has suffered as has my personal relationships. My only hope is that court decisions like the recent one in the Hazle trial will once and for all end this damaging and unconstitutional practice.
12/1/2014
Comment: Excellent research. What is astounding is that some (if not all) PHPs are using EtGs and EtSs and PEths DESPITE explicit advisories by SAMHSA over a span of 6 years! These advisories noted that a) they were not FDA approved; b) there was insufficient research; c) that there were too many false positives; and d) using such tests in such a setting as the forensic environment where someone’s career and reputation could be put at risk was highly dangerous. Further, as I discovered only recently, NCPHP not only runs these tests on new evaluations it conducts on involuntary (and unsuspecting) physicians who have been ordered (under specious circumstances) to be evaluated by NCPHP, NCPHP adamantly refused to release the results of the tests to the physician, though you can be assured the results were used to “make their case” for a pre-determined diagnosis.
I think it is fair to say that their use of these tests is not simply unethical; it constitutes highly risky human experimentation conducted with neither the subject’s consent nor with approval of an IRB.
One can also presume that PHPs have sold this junk science to their associated medical boards in giving them what appears to be substantial evidence to bolster their case. And one can also presume that medical boards have simply accepted it as though it were valid, essentially doing nothing to challenge the invalidity of the test and the violation of due process and thus virtually rubber-stamping the annihilation of a physician’s career.
When you engage these research epidemiologists in this endeavor (is there yet a group called “Epidemiologists for Social Responsibility?”), you may also ask them to review data form board and PHP actions in which this data was – in any way – involved in the assessment of their case, whether playing a major role or only an incidental one. The introduction of this misleading – and therefore fraudulent – laboratory data into these physicians’ adjudication would seem to serve as a solid basis for invalidating their fraudulent assessment and ensuing “conviction.”
Personally, I believe this is of such immense importance that it ranks up there with the flawed hair and fiber analysis assessments that were done by the FBI which my courageous colleague Dr. Fred Whitehurst called attention to in the late ’90’s (and lost his job over, via a massive campaign of discrediting and innuendo of “mental illness.”) It took nearly 15 years but finally, the DOJ saw the immensity and breadth of the false prosecution based on flawed “evidence” and ordered the FBI to reopen over 21,000 cases of potentially flawed hair and fiber analysis!
I truly believe the same outcome is going to materialize here – it has to! Physicians (and soon many other seemingly well-paid professionals who are judged able to afford the “private addictions treatment for professionals” scam) have been falsely assessed and compelled into costly (and embarrassing) treatment programs and prolonged monitoring (with extra time for balking – i.e. “being disruptive”) by the PHP prison-industrial complex. All with no chance of fair hearing, no chance to challenge the validity of the evidence, and high likelihood of reprisal if one doesn’t “go along.” This pervasive abuse of authority and process must be aggressively confronted.
11/27/2014
Great site! There is so much corruption in medical boards & PHP’s. We need to take it upon ourselves to evaluate what our agencies are doing and turn them into the state auditor of every sight for performance and forensic auditing. Auditors DO listen and DO investigate, but they need to be led to the need for an audit. The best way to do this is for those of us who have been assaulted and battered by these agencies to document what has been done to ourselves and our peers and let the auditors know what is going on!
11/22/2014
I have enjoyed reading your web log. I have empathy for your plight. I am involved in a parallel organization known as the HIMS program (Human Intervention and Motivational Study)
I can’t help but notice that several of the names you have listed under ‘like-minded docs’, are ‘professionals’ I have also encountered. Namely, Joe Garbely who did my initial psychiatric evaluation, Lynn Hankes, a urologist who advises HIMS and the FAA, and William Green, my current psychiatrist. I am told a component of my $1500 dollar meeting with Dr Green (Physical and Psychiatric) will be composed of inquisitions into my involvement in Alcoholics Anonymous and progress in my step work. This is the man who told me I must attend three AA meetings weekly and my aftercare group therapy must involve AA in order to be approved for FAA Special Issuance (the FAA Gold Standard). I was also informed that non compliance would mean a rejection of my application by the Feds. All of this after I informed Dr. Green that there simply was ‘no correlation’ between Alcoholics Anonymous involvement and my sobriety and that I found the program to be psychologically harmful to my well being.
If you have any further information on the three ‘like-minded docs’ I have encountered in my journey kindly point this out to me. I am sure there are more but I must thank you for providing the missing pieces of the puzzle from the medical perspective. Its eye opening to say the least. Have you spoken with the same attorneys the pilots have? I am sympathetic with your plight. The worst mistake I ever made was asking for help and the process of psychological hazing, indoctrination, and coercion did nothing but steepen my situational depression.
Jonathan
Thank you for your earnest work on this subject. We are not alone in this.
I received the email below from Dr. Jesse Cavenar, Jr. regarding legislative changes that would severely infringe on the rights of doctors as licensees of the North Carolina Medical Board and subject them to distinctly non-impartial diagnostic psychiatric evaluations and remove all possibility of due process. These developments could possibly herald the wide-scale abuse of psychiatric evaluation and treatment by two governmental agencies acting in collusion with utterly no oversight or accountability. Namely the Federation of State Physician Health Programs (FSPHP) and the Federation of State Medical Boards (FSMB). As a state Representative who is also a physician told me this morning –“this bill is representative of a prevailing attitude that does not realize what is really happening.”
NC Audit can be seen here: http://www.ncauditor.net/EPSWeb/Reports/Performance/PER-2013-8141.pdf
This is the bill, entitled H453 that is before the NC legislature this session. My reading of the bill is that the bill is a disaster. It seems to be an attempt by the lobbyists and lawyers to remove many existing features of the present law. In particular, I would direct your attention to two features:
1) It appears that all mention of due process has been removed from the law. The NC State Auditor found that the NCPHP had not afforded due process as required by law, so one simply changes the law to remove all mention of due process.
2) There is a clause inserted in the law to immunize the NCPHP against civil liability for the performance of the NCPHP function. In other words, the state statute declares that one cannot bring legal action against the NCPHP because they are immune. This is absurd. These people should be no more immune than any other doctor in the state of North Carolina.
In addition, the proposed statute seems to attempt to haze out whether the NCPHP record is or is not a medical record. As you will see, one would be entitled to a copy of an ³Assessment² but it would appear not the entire medical record. This is contrary to the NC Medical Board position paper on medical records. I would urge everyone to immediately contact his or her appropriate Senator and Representative to register opposition to this bill as written, and to urge that an expert panel of disinterested physicians and attorneys be appointed to write a new bill that would be appropriate.
A colleague of mine who is a medical ethicist has reviewed this and had the following to say: ³Well, well! I think the most interesting thing here is that someone has tried to get the NC Legislature to immunize the existing system against any countering action. This, it seems to me, is tacit admission of culpability.² Well stated, I would say.
I would like to begin this discussion with the 1st reason that made give me inspiration and additional courage to continue with this struggle and made understand that, no matter what happens, I have to continue with the discussion of this matter — Thank you Dr. Langan for giving me that additional inspiration — difficult to find the appropriate words to describe the type of ill-treatment, degradation, and humiliation that defines forced psychiatric treatment — especially when this is used to suppress dissenting ideas questioning the safety and effectiveness…
Trust is confidence in the honesty or integrity of someone or something. It involves a complex mixture of cognitive and emotional beliefs and expectations that create an attitude of optimism about the motives and competence of the person being trusted.
Trust requires the calculation that someone has the knowledge and expertise to do what they are being trusted to do, but it also necessitates believing that whatever they are being trusted to do is done in good faith with honesty, sincerity, and integrity.
Trust presupposes adherence to moral principles, codes of conduct, and ethical standards and requires an implicit conviction that the other person aspires to help and not to harm.
Political abuse of psychiatry is the “misuse of psychiatric diagnosis, detention and treatment for the purposes of obstructing the fundamental human rights of certain groups and individuals in a society.”
It is more often seen under totalitarian rule (the Soviet Union, China) where dissent was disapproved, often punished, and those perceived as threats to the existing political system could be effectively “neutralized with trumped up psychiatric illness. By this stigmatization reputations were ruined, power was diminished, and voices were hushed.
It involves the deliberate action of diagnosing someone with a mental condition that they do not have for political purposes as a means of repression or control.
It is important to recognize that the unique role of discrediting opinion and dehumanizing those with one whom disagrees is not limited to totalitarian regimes. The coercive use of psychiatry represents a violation of basic human rights in all cultures.
“Whistleblowers are often referred to a psychiatrist by the employer. The aim then is to make a finding sufficient to discredit the whistleblower, as having a personality disorder, a pre-existing psychiatric illness, or a neurotic reaction. All too often, the psychiatrist selected by the employer will cooperate in this, relying perhaps on uncorroborated information/allegations supplied by the employer without the whistleblower’s knowledge or consent. If, as not uncommonly happens, the psychiatrist reports that there is no pre-existing problem, and the person’s complaints of malpractice within the organisation should be taken at face value and properly investigated, the employer will usually insist on referral to another psychiatrist; and if that one’s report is no more helpful, to another … until the desired report is achieved. One…
“With one arm around the shoulder of religion and the other around the shoulder of medicine, we might change the world.”—Twelve Steps and Twelve Traditions, AA World Services, Inc (1953).
In 1985 the British sociologist G. V. Stimson wrote:
“The impaired physician movement is characterized by a number of evangelical recovered alcoholic and addict physicians, whose recovery has been accompanied by an involvement in medical society and treatment programs. Their ability to make authoritative pronouncements on physician impairment is based on their own claim to insider’s knowledge.”
The American Society of Addiction Medicine’s mission is to “establish addiction medicine as a specialty recognized by professional organizations, governments, physicians, purchasers, and consumers of health care products, and the general public.”
In this they have succeeded.
And in the year 2014 Stimson’s characterization of the “impaired physician movement” remains as accurate and apt as it was in 1985. But the “number of evangelical recovered alcoholic and addict physicians” has increased dramatically (outnumbering Addiction Psychiatry by 4:1) and their involvement in “ medical society and treatment programs” has been realized and enforced through the state Physician Health Programs and their “PHP-approved’ assessment and treatment centers.
Their“ability to make authoritative pronouncements on physician impairment…based on their own claim to insider’s knowledge”has become public policy and sanctified by Regulatory Medicine -essentially the Word of the Lord.
And the 1953 Alcoholics Anonymous prophecy that “With one arm around the shoulder of religion and the other around the shoulder of medicine, we might change the world” is also coming to pass.
But the world is not changing for the better as that arm around the shoulder of religion has its fingers deep in the pockets of the multi-billion dollar drug and alcohol testing and assessment and treatment industries. And the arm around the shoulder of medicine has its fingers clamped tightly around its throat; a stranglehold in full throttle suffocating the Profession of Medicine with no meaningful opposition I can see.
Good leadership requires correct moral and ethical behavior of both the individual and the organization. . Integrity is necessary for establishing relationships of trust. It requires a true heart and an honest soul. People of integrity instinctively do the “right thing” in any and all circumstances. Adherence to ethical codes of the profession is a universal obligation. It excludes all exceptions. Without ethical integrity, falsity will flourish.
The documents below show fraud. It is intentional. All parties involved knew what they were doing, knew it was wrong but did it anyway. The schism between pious rhetoric and reality is wide.
One measure of integrity is truthfulness to words and deeds. These people claim professionalism, ethics and integrity. The documents show a reality of hypocrisy and sanctimony. But the hypocrisy seen here is also a danger because the careers and lives of doctors are in these peoples hands.
Dr. Clive Body in his book Corporate Psychopaths writes that “Unethical leaders create unethical followers, which in turn create unethical companies and society suffers as a result.” And according to Dr. Robert Hare in Without Conscience “If we can’t spot them, we are doomed to be their victims, both as individuals and as a society. ”
Abuse under the utility of medical coloration is especially egregious. It violates the fundamental ethical principles of Medicine -Autonomy, Beneficence, Nonmaleficence and justice. Intentionally falsifying a laboratory or diagnostic test to refer for an evaluation or support a diagnosis or give unwarranted “treatment” is unconscionable.
Similar fraud is occurring across the country.
This is an example of the institutional injustice that is killing physicians. Finding themselves entrapped with no way out, helpless and hopeless they are feeling themselves bereft of any shade of justice and killing themselves. These are nothing more than bullies and accountability is essential.
Accountability, or answerability, is necessary to prevent abuse and corruption. This requires both the provision of information and justification for actions. What was done and why?
Professional guidelines and standards of care, ethical codes of conduct and the law are all objective benchmarks that can be used to assess the actions and decisions of others. In any free society this necessitates the existence of organizations of truly independent opinion capable of standing in this judgment.
State PHPs are Non-Governmental Organizations (NGOs) over which the state health department has no supervisory oversight. There is no regulation, no transparency and no accountability. There is no public scrutiny and they police themselves.
In Ethical and Managerial Considerations Regarding State Physician Health Programs Drs. John Knight and J. Wesley Boyd call for greater oversight and scrutiny of PHPs by the medical community at large. They recommended periodic auditing, national standards and regulation. They also attempted to convince the Massachusetts Medical Society to implement changes at PHS where they served as Associate Directors with over two decades of collective experience.
These efforts to promote transparency and accountability at both local and national levels, however, fell on deaf ears.
State PHPs have systematically removed those not conforming to groupthink. Threatening them with litigation if they breached “peer-review” statutes and confidentiality agreements has effectively silenced them from reporting any misconduct, abuse or even crimes they may have witnessed.
In Massachusetts John Knight was removed in 2009 and J. Wesley Boyd in 2010. In Ethical and Managerial Considerations Regarding State Physician Health Programs they comment “if a PHP highlights a physician as particularly problematic, the evaluation center might–whether consciously or otherwise—tailor its diagnosis and recommendations in a way that will support the PHP’s impression of that physician.” So too will the clinical laboratories.
How is this any different from the case of Dr. Farid Fata, the Michigan oncologist who intentionally diagnosed healthy patients with cancer so he could charge them for unneeded chemotherapy? The U.S. Attorney called it the “most egregious” case of health care fraud ever. His acts may have contributed to one patient death. The institutional injustice of the PHP system is causing countless deaths of physicians.
To consciously “tailor” a diagnosis is fraud. To tailor a diagnosis of substance use disorder or any other psychiatric diagnosis is the political abuse of psychiatry. Misrepresentation, dishonesty, deception, and distortion play no role in the Profession and Guild of Medicine. To do so violates the basic moral principles of Medical Ethics–Autonomy, Beneficence, Non-Maleficence and Justice.
The “PHP-approved” assessment and treatment centers are all staffed by doctors of “like-mind.” It is a rigged game.
An audit of the North Carolina PHP found essentially no oversight from the Medical Board or Medical Society. The audit found that “abuse could occur without being detected,” and this is by design. By removing and blocking the provision of information necessary for accountability, restricting the liberties and freedoms of physicians, and increasing their power and control they have erected a framework of hidden abuse.
While outspoken in denouncing what they regard as unethical and unprofessional behavior by other doctors, they are resistant to apply even the most minimal standards to their own activities.
To whom are the PHPs accountable? Whom do they represent? There are legitimate concerns.
The Boston Collaborative Drug Surveillance Program found digoxin to be the second most commonly implicated drug in causing death in hospitalized patients and the most commonly implicated drug implicated in hospital admissions (N Engl J Med 291:824–828, 1974).
In addition to an up to date medication list we decided to put in the bare but essential elements of the medical record that would be needed in an emergency; these consisted of demographics, emergency contacts, a basic problem list, allergies and a baseline EKG.
They don’t see the problem and they don’t see a need for a solution. Many believe it is the patient’s responsibility to keep track of their medications and that any problem associated with not providing their medication list up to date were self-inflicted.” He said it will be a different story in five or ten years when the problem is acknowledged and accepted by the rank and file.
The problem of not recognizing problems as problems can also be applied to individuals; Bill Cosby comes to mind. So too does FSPHP self-appointed drug-testing expert Dr. Gregory Skipper whose irresponsible introduction of junk-science drug testing into the marketplace through a loophole has undoubtedly caused many more deaths than Dr. Harold Shipman who killed more than 250 patients in the U.K. by injecting them with morphine.
I get many e-mails, letters and phone calls from doctors, nurses and others who have been abused by “professional health programs” (PHPs).
Trust
Disrupted Physician 