Almost Addicted

The slippery slope of recreational drug use

Help for Doctors With Substance Use Disorders

Doctors who are unsafe to practice medicine ought to be prevented from doing so, but every doctor who seeks evaluation and/or help--whether voluntarily or otherwise--should be treated respectfully and fairly, monitored appropriately, and have legitimate avenues of appealing decisions about their care. Read More

Fraud, abuse, and physician suicide

State PHPs have been taken over by the FSPHP because there was no protection. The current PHP system is undermining what they were originally started for. Irrational and unqualified authority is now at the helm. These are ASAM Physicians and despite all the marketing and deceptive public relations claiming to be experts they have no expertise and this needs to be addressed directly. The only accepted board certification is addiction psychiatry. WE CANNOT LET THE ASAM ACHIEVE ABMS STATUS--it makes a mockery of real medicine. The ASAM is primarily composed of ex addicts and drunks who had their licenses revoked and only got them back because they pleaded with the boards that they have changed and want a second-chance and most of them feigned this phony 12-step facade.

In contrast to these accepted board credentials, ABAM certification requires only a medical degree, a valid license to practice medicine, completion of a residency training in ANY specialty, and one year‘s full time involvement plus 50 additional hours of medical education in the field of alcoholism and other drug dependencies.

Somewhere there may be doctor with no post-graduate training in surgery wielding a scalpel and calling himself an expert surgeon, but it is difficult to imagine that he is a very good one.
When society gives power of diagnosis and treatment to individual within a group schooled in just one uncompromising model of addiction with the majority attributing their very own sobriety to that model, they will exercise that power to diagnose and treat anyone and everyone according to that model. And unfortunately forcing 12-step ideology and using threats, coercion, and control can kill. The rise of the FSPHP to power corresponds to the increase in physician suicide.

We need to get rid of the FSPHP on the State level. N.C. showed abuse can occur but be hidden. Same system in Massachusetts and there is evidence of the abuse including documented conspiracy to commit fraud with third parties. There should b e zero tolerance for forensic fraud and there are documents showing the operational manager of PHS, inc. is engaging in fraud and the groupthink supports it. Need state AUDITOR Suzanne M. Bump to do an investigation. Let's request this. If the MA PHP has nothing to hide then they should not be worried. An ombudsman system needs to be put in place int the interim to listen to valid complaints. Need oversight, regulation, and transparency. Current system has zero of this.

link goes to groups for professionals

The link in my name will take you to a list of groups that specifically help people in different professions. Doctors, psychologist, clergy, even airline pilots, but I have never found any groups for MDs.

I do know that AA some some professional groups too. Intergroups can probably help a doctor find what they need.

If their groups do not work then they really need something that does. Doctors also may not want to go on record at their hospittal with their problem. If they have a malpractice case open and they admit to being a drunk (even if they were sober and in good shape at the time) it could be devastating.

PHS, inc. audit -expose the ASAM/FSPHP/LMD rehab racket

I just signed this petition - will you join me?

Need state audits of these programs state by state. Let's add Massachusetts to N.C. as there is documented abuse, fraud, civil rights violations, Establishment clause violations, forensic fraud ala Annie Dookhan, and more. Need full measure exposure

http://www.avaaz.org/en/petition/Commonwealth_of_Massachusetts_State_Aud...

PHPs, Boards and the security of your career

As concerning as Dr. Boyd's observations here and in his "PHP Ethical Considerations" article are, I believe he underplays the depth, complexity and urgent gravity of the problem. And as you will see below, this is not just about physicians but all professionals including psychotherapists.

PHPs were initially envisioned to be benevolent outreach programs to physicians (by physicians) who are grappling with substance abuse issues. They then were assigned – or began assuming – new content areas, e.g. evaluating complaints of alleged boundary violations and disruptive behavior. They then began marketing themselves as the one stop remedy for all non-medical maladies that physicians might be encountering, even including garden variety depression, and occupational stress and burnout.

While this expansive outreach may appear benevolent on the surface, the reality is that some if not all PHPs are conducting illicit diagnostic "fitness for duty" evaluations often prompted by an anonymous complaint to the corresponding medical board, the content of which PHP refuses to share with the subject physician. Upon a board order to appear for such a PHP examination, one is subjected to an order for a monitored urine specimen for unclear purpose and with no justifying protocol. The physician is refused feedback about the diagnostic conclusions of the evaluation, refused access to a report of the evaluation and refused access to the laboratory examination results, and even the nature of the tests conducted. Worse, when demanding a copy of one's evaluation record, the physician is told that what was conducted was not really a diagnostic evaluation (despite the evaluation being explicitly ordered as such by the medical board) but was "peer review." However, this is no "peer review" that follows any known and established protocol as defined by federal law, e.g. HCQIA (USC 42-11101 et seq.). in fact, it is not "peer review" at all but more like a rigged assessment conducted by a single PHP employee (sometimes not even an MD) without any legitimate authorization and done in the name of an organization (a "Physicians Health Program") which itself is conducting such professional services under the false rubric of being a non-profit "charitable organization" which receives contributions that are tax deductible to the donor and tax exempt to the receiving organization (i.e. a "501(c)(3)").

This is particularly problematic because a) being organized as such a "public charity" corporate entity, PHPs are eligible to receive contributions from the very programs to which they refer for "independent evaluation" and ""specialized treatment for professionals." (The institutions to which they refer happen, ironically, to be members of FSPHP. Any chance there might be a conflict of interest there?)

And b) as such a "public charity," they maintain no malpractice insurance. None. In fact, they use this very circular argument to deny that they conduct diagnostic evaluations at all. "We're a nonprofit public charity, therefore, we can't possibly have conducted a diagnostic evaluation and treatment referral; therefore, there's no ' patient record' and there can't be any malpractice."

Even more concerning, the medical boards with which they are allied ("joined at the hip" might be more accurate) and with whom they enjoy "sovereign immunity" adamantly refuse to investigate the illegality of such professional healthcare services being delivered under such a false corporate identity. This is certainly most curious, given that most if not all states' Medical Practice Acts indicate that it is a felony to practice medicine – whether individually or as a group – without an appropriate license.

In North Carolina, the state auditor was compelled to undertake a comprehensive performance audit of the NCPHP after receiving multiple physician complaints about markedly abnormal and unfair procedures conducted there. What the auditor found was shocking – over the course of the last 10 years, NCPHP (by its own reporting) has evaluated 1140 physicians. (Other sources indicate that that figure is more likely twice that.) (see: http://www.ncauditor.net/EPSWeb/Reports/Performance/PER-2013-8141.pdf)

In "auditor language," there have been no internal or external controls to ensure provision of due process and prevention of conflicts of interest and severe damage to one's reputation and career. It found that neither the NC Medical Board nor the NC Medical Society which were explicitly charged with oversight of this agency had exercised any such oversight. In normal language, what this means is that NCPHP has likely violated the due process rights of at least 1140 physicians over the study period of the last 10 years and has exercised exclusive and concealed evaluation and referral patterns which have not only contained severe conflicts of interest, these conflicts of interest referrals to NCPHP's "preferred institutions" have resulted in confirmatory diagnoses (of PHP's initial hypothesized diagnosis contained within its sham "peer review") which are inherently biased and which have cost physicians an average of $50,000 per unjustified referral for evaluation and extended treatment. This dollar figure does not even begin to estimate the total financial damage and harm to physicians subjected to this abuse. Consider for example what three months of lost income means. (Not the focus here, but consider the detrimental impact to patient care from such unwarranted interruption of one's practice.) The legal costs of trying to defend against the false allegation are exorbitant, if not bankrupting. The reputational damage is extensive and irreversible. The psychological damage is profound and immeasurable.

Imagine for a moment what it would be like to have no patient or colleague complaint or concern (or reason for such) and suddenly be falsely accused via an "anonymous concern" of having manifestations of some psychiatric malady or addictive disorder and, despite explicit evidence provided by contemporaneous evaluation by independent experts to the contrary, to be utterly powerless to challenge the infallibility of a PHP diagnostic pronouncement, given the Board's imprimatur, yet masquerading itself as a "peer review."

You should find it as alarming as we did upon learning, per the chairman of NCPHP's board, that he was told by one or more NCMB personnel that NCPHP needed to diagnose more physicians. This was told to four senior psychiatrists who were meeting with the chair and vice-chair of NCPHP to apprise them of their grave concerns about NCPHP's reckless behavior.

I believe the abuses manifested here in North Carolina by this Physician's Health Program are of profound severity and are a replica of the Soviet-style abuse of psychiatry we were aghast at learning about during the Cold War.

Lest nonphysicians think that they are safe from this twin-headed Gestapo cabal, PHPs have their eyes on promoting their remarkably effective "rehabilitative methodology" to a wide swath of other professionals. In North Carolina, NCPHP already exercises its virtual police powers over physicians, physician assistants and veterinarians. It uses various trumped-up FSPHP and ASAM authored studies to justify its extraordinary measures of evaluation (such as using out-of-state programs featuring polygraph experts), non-validated laboratory testing (e.g. PEth et al.) and thoroughly medically unjustified lengths of stay (three months!) exclusively at programs on NCPHP's concealed referral list which it adamantly refuses to divulge (which accept "cash only") and punitive monitoring periods (five years! with extra time added if you balk … and you get the label "non-compliant" and "disruptive").

Clearly, with vested interests and potentially lucrative returns (and, of course, targeted physicians pummeled into brokenness and submissive silence), it will be a breeze to outcompete other professional health services programs presently operating outside of the FSPHP web. You can be assured that psychologists, psychotherapists, dentists, nurses, chiropractors, pharmacists, lawyers, teachers, pilots and all other manner of professionals will soon come under their jurisdiction.

Please understand – the above are just my opinions, based exclusively on my personal experience and my intensive study of this organization over the preceding three years. But, I can tell you from speaking extensively with over 20 other physicians here and around the country, this is a very dangerous movement that does not have physician (or any professional) well-being as its core value. (Well, excepting those carefully selected approved "preferred" providers.) As a result of my experience, and already having been coaching physicians on stress, burnout and career redesign, I began coaching other physicians (and their counsel) on the nuanced complexities of effectively and definitively responding to their Board and PHP directives so as to preserve their livelihoods – and their sanity. (Without a well-thought-out approach and fully knowledgeable and assertive counsel, you should plan on walking away $100,000 lighter, at that still with the likelihood of hanging your license up for good, or being held in PHP's "non-advocacy" limbo indefinitely.)

I personally believe that as we investigate this malignant and unchecked movement further, we will see the catastrophic stress impact this joint Medical Board – PHP enterprise has had on physicians subjected to their cruel and illegal harassment. I fully anticipate that we will learn of physician suicides which have been directly related to the inordinate stress of this clearly out-of-control regulatory apparatus. I believe that it is not only in the interest of but the moral duty of every physician to take an active role in examining this movement and seeking to initiate an independent audit by their state auditor of their Physicians Health Program, specifically to evaluate their program's adherence to due process, evaluative independence, internal and external oversight and absence of conflict of interest.

Help Needed for Timid Monitors of the Physician Substance Abuse Program

"Help for Doctors with Substance Abuse Disorders" is a misleading title for this informative article. It seems to imply that all doctors inducted into the PHP program for rehabilitation have substance abuse disorders or near disorders -- only they may not be treated with sufficient respect, or their needs may exploited.

Unfortunately, as many examples attest, doctors with no substance abuse problems whatever have been funneled into this system by parties with ulterior motives. The PHP program is easily turned to the purpose of threatening, discrediting, or disabling whistle blowers and moral dissidents in the medical profession. Especially in this era of economic pressures on physicians to withhold serious diagnoses and timely treatment from combat veterans, the malfunctions of the PHP program can be criminal.

The PHP program needs savvy, independent, courageous monitors with deep and unannounced access.

Massachusetts Irony

It is interesting that Massachusetts, the "medical hub" of the US, has one of the worst PHPs in the Country. It is common knowledge among those in the know at the major hospitals (BI, Brigham, MGH, etc.) NOT to refer doctors with substance abuse problems. If a doctor presents to the department of psychiatry or employee health (providing no issues with patient care, the law, or public safety) they will be told to take a leave of absence and be treated at a facility outside the reach of the PHPs and then be monitored "under the table." Those in the know realize that referring a doctor to PHS is like throwing them to the wolves as it is top-down corruption from the program manager who manages incompetents. Like many in the FSPHP the MRO for PHS is an ex-drunk with a history of major malpractice--a bottom of the barrel doctor who had no power prior to going through the program himself who now is able to wield his power in the program over doctors of real accomplishment and scholarship. It is a joke putting people like this in power. A real joke.

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Wes Boyd is on faculty at Harvard Medical School and is an Attending Psychiatrist at Cambridge Health Alliance and Children’s Hospital Boston.

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