Doctors fear PHPs—why physicians won’t ask for help

Doctors fear controversial program made to help them

Reposted from NBC affiliate KSDK in St Louis, Missouri. Author: Investigative Reporter: PJ Randhawa, Erin Richey
 
Many say a controversial program designed to help doctors with mental health issues is out of control, destroying careers and causing some doctors to commit suicide.

 
Dr. Gary Hammen admits that he was tired on the job.
 
In 2017, he had a newborn at home and a packed schedule as an anesthesiology resident, on top of a sleep disorder stemming from an injury he got serving our country as a soldier overseas.

But to him, the questions his supervisors asked crossed a line.

“They asked me, is this a drug problem? Are you sure you’re not using drugs?” he recalled. “I was floored.”

The questions came after months of exhaustion for Hammen.

Hammen says repeated, 24-hour shifts were taking their toll on his mental and physical health. Most weeks, he worked more than ninety hours and slept no more than four hours a night.

More than a year earlier, he met with his supervisors to tell them about his sleep disability, and offer them schedule recommendations from his sleep doctor.

He says supervisors promised, but failed to make any accommodation to his schedule or his sleep disability.

Weeks after his supervisors asked him about drugs, he got a call that made him think they didn’t believe him.

An organization called a Missouri Physician’s Health Program wanted him to fly to an addiction recovery center in another state, to be checked out.

Hammen couldn’t believe what was happening. “I had a bad feeling about it,” he said. “The whole thing just felt wrong.”

But he had no choice; colleagues warned him that if he didn’t follow the PHP’s requirements, he could lose his license and his career.

PHPs, or Physician’s Health Programs, are meant to help doctors with addiction or other psychological problems. But some, including Hammen, claim that doctors are sometimes falsely accused and getting help that they don’t need. They say the result drains their savings, endangers their licenses, and has even led some young doctors to take their own lives.

Nearly every state has a PHP. Some states have more than one. They started in the 1980s, often with close ties to the state’s medical boards or hospital associations. Medical industry professionals told 5 On Your Side’s I-Team that now big money is involved, and the lack of regulation turned a well-meaning measure into something that doctors fear even when they need help.

Dr. Wes Boyd of Harvard University is one of the skeptics. He used to work for a state PHP. Now he and others have raised concerns about these programs in the American Medical Association’s Journal of Ethics and in other respected publications.

“The physician is basically at the mercy of the PHP,” said Boyd. “There is no one outside the program looking at them, monitoring their practices and making sure that they’re really acting in a benevolent way.”

Boyd told us that when a PHP gets a tip about a supposed problem doctor, there is usually no way for the physician to appeal or dispute it. Instead, he or she must go to a “preferred” treatment center for evaluation. That center has complete authority to decide which doctors need treatment and how much.

Hammen made the flight to a treatment center, where evaluators made an unusual diagnosis. They said he had “provisional alcohol disorder,” something Hammen never heard of before.

“They hadn’t even talked to my wife to see if I drink. Most people wouldn’t make that sort of diagnosis without talking to some sort of outside person beside the patient,” said Hammen.

That diagnosis, Hammen thought, came from the fact that he told evaluators he and his wife shared a bottle of wine over the course of several dinners that week. It’s the only thing listed in the part of his evaluation describing his alcohol use.

Many of the treatment centers that PHPs refer doctors to are for-profit and specialize in addiction, even though doctors enter PHP monitoring because of stress and depression as well.

The I Team found many of the “preferred” treatment centers also donate money to the PHP trade organization: the Federation of State Physician Health Programs (FSPHP). Newsletters on the FSPHP website show several treatment centers are donors and exhibitors at FSPHP events.

Boyd told the I-Team that the bottom line motivates the centers to push doctors into treatment regardless of whether it’s really needed.

“Even in cases where there was no substance dependence, these centers come back and say, ‘You need to stay for 30 or 90 days of treatment,’” he said. “It is very hard not to think that financial motivations were behind the misdiagnoses.”

That can mean weeks of being unable to work, attending a treatment center that might not even offer services that doctors really need, with no way to get a second opinion or to choose their own care.

Even doctors who need help find the system difficult to navigate, with a high price to them and their community. Karen Miday once hoped that her son would get to help the community as a Cancer Specialist, but now he’ll never get that chance.

The words he left behind in a suicide note are so painful that she never took it out of the police department’s evidence envelope. But she read them to KSDK’s PJ Randhawa to show what he was feeling at the end of his life.

“That ‘I love you’ line stays with me,” she said.

“This is just the end of the line for my particular train,” Dr. Greg Miday wrote. “Earth wasn’t a great place for me.”

Dr. Greg Miday was 29 years old when he finished his residency in St. Louis in 2012. Friends and colleagues described him as bright, talented, and gentle. Under the surface, he also battled a drinking problem.

Miday’s last phone call was to the Missouri PHP. Karen Miday believes they had a chance to help him.

“I think all they needed to do was say, get yourself to a place of safety, you know, we’re behind you. That was all they needed to do,” she said.

Dr. Miday had been to one of the program’s approved out-of-state treatment centers before, where he followed the PHP’s requirements exactly. Then, just as he was about to start a new fellowship, he had a relapse.

Karen told the I-Team that he knew he needed help, but he also didn’t want to lose his new job. He suggested to the PHP that he could go to the outpatient program at a recovery center in St. Louis. This would let him keep his job and get treatment.

When Dr. Miday called the Missouri PHP, they said he must go to one of their “preferred” centers outside of the state. If he didn’t, the organization said, they would report Dr. Miday to the medical board.

“I think he thought there was no way out,” Karen said. “They have dual agency. It’s like being a policeman and a therapist at the same time.”

The list of approved facilities for Missouri physicians to get treatment includes just one in the state of Missouri. The nearest out-of-state option is in Lawrence, Kan.

“There’s no legitimate reason why they should have that handful of centers around the country that they prefer to use,” said Boyd.

“You start thinking after a while if there’s some diagnosing for dollars going on because now it’s not just substance use disorders, but now the “disruptive physician” and they’re talking about aging physicians,” said Miday.

Many doctors told the I-Team that the same lack of options that Dr. Miday felt is the reason that they fear contacting their local PHP when they really need help. That could put you at risk.

“If they’re afraid to ask for help, the chance that you’re going to get a doctor who shouldn’t be taking care of patients that day, goes up. And you won’t even be able to know what the chances that that’ll happen. Because nobody will say anything,” said Hammen.

The I-Team reached out to the Missouri Physician’s Health Program with questions, and even went to the home of program director Bob Bondurant, RN, to ask them. He declined to talk about the doctors’ concerns, as did the Missouri Medical Association, and the Missouri Board of Healing Arts.

The National Federation of State PHPs declined to answer any of our specific questions about how their programs work. Instead, they issued this statement:

“Physician Health Programs (PHPs) across the United States and Canada provide physicians and other health care professionals a resource to ensure they are healthy, can practice their craft and at the same time ensure public safety. Today’s physicians often suffer from stress and burnout. A smaller number develop substance use disorders and depression. We are a ready resource to physicians with such untreated conditions who would otherwise be at risk to the public an/or face loss of licensure by their state medical board. PHPs lessen the significant barriers that stand in the way of physicians asking for help.

Treatment is necessarily different for those in safety-sensitive professions, such as pilots and physicians; PHPs help physicians access care specifically designed to their needs. Our goal is to restore physicians’ lives and safely return them to patient care. Research as shown that the PHP care model has unmatched long-term consequences for substance use disorders. Additional research demonstrates successful graduates of PHP’s have a lower risk of malpractice.”

A few PHP nightmares published in my book: Physician Suicide Letters—Answered (free download):

Chapter 33—Adam

Dear Pamela, As a physician who struggles with suicidal thoughts, I appreciate what you do. Two years ago, I did a stint in a psych outpatient program due to depression, with great success. Since then I’ve moved to a new state and I find that I need support again. My medical director suggested I self-refer to the physician health program here. So I called (and didn’t give my name) and was shocked by how unhelpful they were. They described the process, which would delay returning to work. I’d be forced to comply with years of monitoring and pay for multiple evaluations and random drug screens. (Even though I don’t have a substance problem.) I may be mentally ill, but I’m not crazy! It seemed punitive and geared toward addicted docs with nothing to offer everybody else. I don’t think preventing suicide is on their radar at all. I would love to do more to advocate on this issue, but honestly I’m just trying to stay alive. ~ Adam

Chapter 34—Amy

Dear Pamela, I’m amazed at the punitive terms I’ve had to face in recovering professionally from a depressive episode for which I was hospitalized last year. One of my requirements is to be urine tested for substance abuse, despite multiple demeaning assessments that have rendered the clear verdict that I don’t have a substance use problem. I’ve had to attend costly treatments for “professionals” in which I am the only female in a group of male physicians who have had sex with their patients or have become assaultive with staff. Any efforts on my part to point out that I don’t quite “fit” are taken as further evidence of my pathology. I’m a single parent as well, so that each of these “treatments” I’m required to attend takes me away from my two children for extended periods of time. Throughout all of this, nobody has told me how common my feelings are—that a large number of doctors feel depressed and suicidal at times. Rather, I’ve been told that my actions are unheard of for someone in mental health and may preclude me from ever providing therapy again since “we tell patients to never give up hope, but you did.” Hopefully, in the near future this won’t be a taboo subject, and there will be places for those like me to seek responsible and confidential care. ~ Sincerely, Amy

Chapter 36—Susan

Hi Pamela, My ex-husband, also a physician, committed suicide one-and-a-half years ago. I have had my own episodes of depression with little support at work. (After taking three months off for a major depressive episode and to look after my grieving children, one of which was threatening suicide herself, I was told that I wasn’t carrying my share of the load at work and had a “boutique practice.” I’m a surgeon.) It is a long overdue conversation that I am trying to start here in Canada as well. We, too, have a physician health program which is in conflict of interest as it pertains to licensing and physician support. To this point, they have focused mostly on physician substance abuse and disruptive behavior. These seem to me to be late stages of physician mental health problems. I would like them to deal with issues before they get to those stages. But it is hard to do until we “re-humanize” physicians. Any resources I can use to break down the silence and annihilate the taboo are appreciated. ~ Susan

If you’ve been harmed by a PHP please leave (even anonymous) comment below. Free upcoming retreat for suicidal physicians (and those who have been suicidal). Contact Dr. Wible if you wish to attend.

Tagged with: , ,
Add your comment below or scroll down to read 42 comments

Leave a Comment

Your email address will not be published. Required fields are marked *

*

42 comments on “Doctors fear PHPs—why physicians won’t ask for help
  1. Mark Ibsen MD says:

    I lived through the montana professional assistance program.
    Only approved “out of state” $1,000/ day programs.
    They diagnosed me as “narcissistic personality disorder”
    Then wanted me to go for 10 weeks of “treatment”
    No harm ever for any patient.
    I was going through a divorce
    My soon to be ex referred me to
    Mpap.
    I had no rights at all
    Like trip to the gulag.
    Still have ptsd over it.
    And
    The state board used the Mpap as evidence against me later, violated my privacy rights, terrible.

    • Jim Whitlock says:

      Sorry to hear you going through this.
      Hang in there.

    • Katherine Murray Leisure MD says:

      Thanks for sharing. See more information on Sham Peer Reviews, Whistleblowers in hospitals, etc., increased since 1986 (HCQA “Patient Safety” Act, Sen Henry Waxman) gave unlimited hospital authority over physicians and our hospital patients. Physicians lost the ability to pursue due process and most of our civil rights since 1986. TIME TO PETITION ORGANIZED MEDICINE to work to reverse this legislation which destroys physicians right to have voice and work in hospitals.

    • Susan T. Haney, MD says:

      Dr. Ibsen,

      Your post reads like a sad but familiar Haiku to me.

      I’ve noticed that males often get labelled with “narcissistic personality disorder”, and females get labelled with “borderline personality disorder”, when they object to abuse and exploitation by PHP’s and medical licensing boards. I find it interesting that these “diagnoses” are not infrequently assigned, justified, and/or disseminated by various non-medical staff of PHP’s and medical licensing boards (attorneys, investigators, compliance officers, “agreement” monitors, management, consultants, etc.). And of course, ALL physicians (both male and female) are clearly either addicts or in denial of being addicts. Don’t ever admit to PTSD from this traumatizing experience; you’ll get sentenced to another 5+ years of PHP “monitoring”. To drum up more business, these programs are starting to order their victims into “career-long monitoring” for the “lifelong disease” of being a physician and having any assets whatsoever left to plunder. I feel your pain.

  2. Rick Fermelia says:

    Dr Wible,
    I had a progressing toxic relationship with my hospital. I was there for 23 years, leader, had developed a trauma and bariatric program. I became an employee thinking I was in line with leadership. Leadership changed, pulled support for my programs and began a smear campaign labeling me a “disruptive physician”. I had a complication, which is occasionally happens to a busy surgeon. They used it as a fulcrum to destroy me. They would not defend the case, because they had “consent”, power to settle. They demanded I go to one of these out of state “professional rehab” centers, where I was in treatement with substance abusers, sex offenders and people who simply cheated on their wives. They pretty much told me if I didn’t go, they would destroy me. They destroyed me anyway. I had to undergo “treatment” $650 a day out of my pocket plus room and board. Their scheme is to not let you know when treatment ends. I had to attend virtual “groups” weekly for years to follow and have return visits. The hospital fired me anyway, tried to make unsuccessful attempts at my privileges and reported me fallaciously to the NPDB for “actions against my privileges” and for withdrawing an application which under investigation. I have reversed on of the NPDB charges, and had to put in a second dispute for the “withdrawal” which is pending still 3 years later. I managed to find a hospital to give me chance and I am still rebuilding my life living apart from my family to work. This system and these places that “treat” people are a complete sham. It was a jail sentence. The center said that if I completed treatment, they would support me. They made available a tepid form letter that basically said the dates of treatment. It is so great to see someone shedding the light on this. They ruined me.

    • Katherine Murray Leisure MD says:

      Happens all the time as long as Hospitals have undisputed authority instead of physicians and patients. Thank you, “Patient Safety” Health Care Quality Act of 1986 (Sen Henry Waxman) which initially passed to stop “rogue doctors”.

  3. No thanks says:

    I’ve been destroyed by the South Carolina medical board,the president of the board, Stephen Gardner, MD, actually decides treatment for the docs who succumb and go the the SC RPP.

    Glad to see that voices are being heard.

    Thank God for the internet.

  4. PHP Scam says:

    TX PHP railroads docs into one of four centers in the country. It’s the ultimate nepotistic bullshit that should be illegal but cotinuea unabated because those of us who survive their draconian mandates want nothing to ever do with them again and those who can’t navigate don’t practice again and many will die of their addiction or suicide. They are killing more than they save. It’s a scam. Nationwide and insidiously ruining good doctors every day. You don’t go for evaluation without them finding some pseudo diagnosis to keep you. Your a paying captive. It’s insane that this is the best we have in 2019.

    • Pamela Wible MD says:

      If anyone is ever interested in sharing their story in more detail and taking down corruption there are many attorneys and docs now involved. Investigations ongoing now.

      • Vee says:

        i’m currently being monitored by TX medical board. I got a DUI in 2009 and completed a PHP monitoring program in another state. I then applied for a TX medical license and I self referred to the TX PHP to let them know I already completed a PHP contract in another state. The TX PHP then told me I had to sign a 5 year monitoring contract with them or else they would tell the board I was non-compliant. How can I help further investigations?

  5. Dr. Julie says:

    I was referred to one of these centers because I was struggling with an undiagnosed medical issue, Crohn’s disease. I had bloody diarrhea for several months and was told by a residency physician that I was just stressed out and depressed. I was put on antidepressants and told I was impaired. It wasn’t until I passed out at work from severe anemia, that they finally realized I wasn’t depressed.

    • Katherine Murray Leisure MD says:

      PHP groups while helping some physicians are run by high revenue psychiatrists, so they will miss MEDICAL diagnoses like Crohn’s. Your case illustrates how we physicians MUST CARE FOR OURSELVES first. That is, take no alcohol, no extra drugs, and see a CONFIDENTIAL high quality medical primary care doctor or provider regularly. “The doctor who treats him(her) self is a fool”. The doctor who sees any PHP before having private care is also a fool!!! The public has a right to treatments from healthy doctors, but don’t get entangled w PHPs and their huge COI’s in order to achieve fitness. Thank you, TV 5 and the courageous Comments witnesses here.

      • Pamela Wible MD says:

        Actually not even run by doctors but by those in recovery who are RNs, social workers etc . . . NO PHYSICIAN OVERSIGHT when caring for vulnerable physicians. HUGE RED FLAG!!

        • Susan T. Haney, MD says:

          Interestingly, the Executive Director of Oregon’s PHP uses the title “Dr.” in his correspondence, is addressed as “Dr.” by his staff, is called “Dr.” in PHP publications, and is introduced as “Dr.” when lobbying the Oregon healthcare licensing boards and the Oregon legislature in public meetings. His credentials are NOT medical, NOT psychiatric, NOT even “addictionology”. He has a PhD in education and a masters degree in public administration. I am NOT making this up. The “Medical Director” went to medical school in the Dominican Republic, and was hired just four months after completing a Family Medicine residency — followed by a one-year “fellowship” in addiction medicine while he somehow simultaneously served as addiction medicine faculty at two other hospitals associated with addiction treatment programs. His online LinkedIn profile says that he is now simultaneously working five different jobs — including Medical Staff for inpatient addiction treatment and detox at two different private hospitals; “Treatment Advocate & Speaker” for Indivior (pharmaceutical giant who markets patented buprenorphine products for maintenance of opioid addiction); Medical Director for an expensive private outpatient addiction treatment center; and as the Medical Director of Oregon’s PHP (the Health Professionals’ Services Program, or HPSP) — where he is the sole physician on staff. Oregon’s PHP clearly has effectively NO medical oversight. I understand that many other states are similarly situated.

  6. K M Leisure says:

    Excellent TV 5. If you feel you need help, get it privately first. Find a business health COACH first. Then your private psychiatry evaluation first, even if to obtain an independent clean bill of mental health. Of course, go 100% abstinent and stay off ALL drugs. The LAST place to go if entirely sober and off drugs is to your PHP due to their peculiar, undeclared conflicts of interest: $5K down for psychology evaluations, send-aways when equivalent local care available, unusual long term monitors for more cash, the usual “prisoner’s dilemnas”. You are guilty with your medical license at stake until proven innocent, $10K – $50 K needed. Soviet refusenik doctors were sent to similar re-education camps out in the Gulag or remote Siberia. Wake up America! [Publish as Anonymous or Do Not Publish].

  7. Patricia says:

    I confided to my program director that I was dx with bipolar disorder. Got reported. Was doing random (expensive) drug screens when I never had a substance dx. At the end of my 5 years, I somehow had a positive alcohol test. It was proven false positive with a hair test, but it didnt matter. I had to do a 3 day inpt eval. Wait weeks for outcome and told I needed to fo to rehab for 3 weeks! I haven’t drank in years because I couldnt because of my contract. Yet I had to pay $12k for rehab. Between the initial eval for the false positive test and all the waiting for psychologists to have their conclusions I spent $20k and was unable to practice for 4 months! Now when I was close to finishing my additional year they decided I needed to be off my klonopin for a year before they release me. It feels like it’s never going to end…

    • Pamela Wible MD says:

      What a nightmare!!!! These one-size-fits-all 12-step-programs for doctors who DON’T use drugs or alcohol has got to be the most BIZARRE and OUTRAGEOUS thing I have ever ever heard in my life! As a treatment for doctors who have occupationally induced mental health issues – PTSD, depression, suicidal—FORCE them to do random urine dips for drugs and bleed out their bank accounts while preventing them from working. Beyond PHYSICIAN BULLYING. I’m so upset about this.

      • Lee Marie says:

        Sadly, my husband still isn’t ready to speak up, even anonymously. Shame. Fortunately, the professionals knew he wasn’t on drugs or alcohol – – – numerous tests b/c he was suicidal and called 911 and was inpatient. My husband self-reported (required state statute) that he became depressed, suicidal and was an inpatient getting treatment for Major Depression.

        The state medical board’s attorney harassed him while he was an unstable psychiatric inpatient (is this even legal?), he threatened my husband (I have enough evidence to suspend your license!), and a few days after my husband was released (after having contact AGAIN, that day) with the attorney for the state, he almost ended his life early the next morning. Thank goodness I figured out what was going on, I was able to locate him, and I was able to stop his attempt. He was a few minutes from death according to the first responders.

        For closure (for myself – I need that), I am going to report this attorney to the state’s bar association. His actions pushed my husband over the edge. I developed PTSD myself from intervening in my husband’s bloody, horrid attempt on ending his life. Thankfully, he’s alive.

        The attorney, and the state medical board need to know their actions are not ethical and they impact many people (including me)! I am not a person to stay silent. I use my voice and I advocate for people; I’ve done that all of my life.

        My husband’s licensure hearing is in a month, so I am not going to make waves right now. But a storm is coming after that hearing. We no longer live in that state, either, but the current state is ridiculous, too.

        • Pamela Wible MD says:

          I’ll contact your privately as I have some resources and strategy that may help you and your husband as you prepare for the licensure hearing.

    • The positive EtG test as the contract is about to end is automatic. These are not false positives they are intentional falsely created positives as these tests have no FDA oversight. Easy money to start the cycle over again and zero chance of getting caught. In the scores of cases I have suicides I been made aware of this is also the point when many say fuck it and kill themselves. These are more murder than suicide.

      • Pamela Wible MD says:

        Can you please clarify “These are more murder than suicide.” Wrongful death homicides?

        To quote Greg Miday, “They killed me. I just finished the job.”

        Does that sum it up?

        • When they get another positive test just as they are about to end the 5-year contract they feel hopeless, helpless and defeated. The tests are deliberate – that’s more murder than suicide

  8. When you consider the whole of medicine and other healthcare, you are looking at a LOT of money – coveted money – enough that it is well worth it to establish a system of organized crime around it. I am not going to say it IS organized crime, but in my tenure as a watchdog over the Oregon Board of Psychology and then as Co-Founder and Executive Co-Director of the Healthcare Alliance for Regulatory Board Reform, I have seen a LOT of ducks – and if it walks like a duck and quacks like a duck, we must consider the possibility that it is a duck.

    We’re not having it. Of all the places where corruption resides, it’s residence in healthcare must not be tolerated. Patients lose their doctors and patients collectively lose their choices. Doctors are losing their careers and their lives are becoming so wrecked that many turn to suicide. All of healthcare becomes affected, and as hard as they struggle to figure it out, Americans cannot figure out why healthcare is so expensive and why it is inadequate or inaccessible for so many. We have looked in all the obvious places. It may be that we need to look in places we haven’t looked before. I suggest the reader join those of us already on this, start looking at the PHPs and their “business arrangements” with their “business associates.” Greed and arrogance lead to sloppiness and stupidity. Seek the information and ye SHALL find it behind surprisingly thin veils. HARBR-USA(dot)org WILL help you and we will connect you with others who will help you too. Thanks TONS to Emmy Award-Winning investigative reporter PJ Randhawa (and St. Louis, MO NBC for breaking this story, and thank you too, to Dr. Pamela Wible for getting the story out here on here site. Thank you to Dr. Wesley Boyd for his expertise, and thank you to Center for Physician Rights (CPR) for the PHP information they provided to Ms. Randhawa. CPR has special knowledge of PHP matters. They can be contacted at PhysicianRights(dot)net.

  9. Pablo says:

    Thank God for Dr. Wible. I have been beyond impressed by her love and care for providers ever since I met her. Her tireless efforts to help providers even if it means keeping just one from suicide is a godsend. It is beyond time that everyone everywhere speak up and against and do everything they can to stop the destruction of lives that the PHPs and boards propogate. Dr Wible is a pioneer in all she has done and proactively created a workspace in which she and others can thrive. Kudos to her and her staff!

  10. Tom Horiagon MD MOccH says:

    I want to mention to posters on this page that you can do more than vent your feelings and re-count your abuse. All US PHP’s follow the same model promulgated by the Federation of State Physician Health Programs. This year the FSPHP flagship operation, the Colorado Physician Health Program (CPHP) will be reviewed as part of the state contract renewal cycle and posting of a new RFP for physician peer assistance services and as part of the sunset review of the Colorado Medical Practice Act. Various legislative committees will have to hear public testimony about CPHP and similar programs if requested. If a committee hearing is jam-packed, testimony will be limited to 2-3 minutes per witness. The schedule of hearings is still being determined but, if you wish to end this abuse, spend a day in Denver and testify. Contact me and I’ll keep any interested party updated on opportunities to testify. @chestmedicine

  11. Ann Cordum says:

    Unbelievable. This needs to get out to the public in all 50 states and Canada. Thanks Pamela for your boldness and fearlessness in disclosing the truth in our industry. I am happy to do completely confidential visits in Boise, ID for docs in need.

    • Pamela Wible MD says:

      Thank you Ann!! I do believe there are so may doctors who would do the same. Please don’t suffer in silence and NEVER sign away your rights!

  12. Steven Greer says:

    Thank you Dr. Wible. I can relate to the situation Dr. Miday was in prior to him taking his own life. What is going on inside most states is unconscionable. I am currently in an active legal process with the NM Medical Board and the PHP that was once supportive of me. I too was going through a divorce, and began weekend drinking, never drank and went to work. My former boss and Dr. William Miller (of Motivational Interviewing fame) are backing me 100% and will testify to the fact that the relapse was not severe nor resulted in patient safety issues. I think that because I got them involved, it made my situation worse, it bruised the PHP medical director’s ego. I had several addiction-boarded providers assess me as only needing intensive outpatient treatment. Because I did not go to the $40k a month “physician” catering treatment center he wanted me to go to, the PHP medical director decided to work with the Board to end my career. I am a veteran, and I went to the local VA hospital and got into a top-notch, evidence-based intensive outpatient program. I have done a little more than 6 months of treatment there (much more than the 30-day for-profit, and financially ruinous option), including DBT, and individuals with my psychiatrist and psychologist. However, at my Board hearing this past Friday, the PHP medical director testified that I went against his demands (which is not true), and upon questioning by me (because I cannot afford an attorney, and have to handle the case myself) about whether there are any RCT (gold-standard) studies showing that these expensive for-profits are better than outpatient treatment, he lied and said there is research (but he just could not recall it at the moment, but that there was a statement on the ASAM website touting the effectiveness of these programs compared to other programs). He also testified my last treatment at an outpatient treatment program failed, because I had a brief relapse 2.5 years after completing that treatment.

    This past Friday, I thought the nightmare would be over. However, we spent all day with the Board attorney putting on her case. We now have to set a date for me to present my case. I’m just hoping that putting Dr. Miller (one of the most cited researchers (AUD and MI) in the world, and a Project MATCH PI) on the stand and having him testify to how ridiculous this physician catering treatment is, will have an effect on the Hearing Officer.

    I drank, and I was on a stipulation. Therefore, I expect their to be consequences. However, I did not expect them to attempt to take my license forever just because I did not follow the PHPs direction. They gave me an “offer” early on, last year, and the offer was that I permanently surrender my license or face contemplated action to have them take my license forever. I would not call those options or offers.

    Another railroaded physician with a chronic disease,

    Steven

  13. Abel A. Garibaldi says:

    It is not only the PHP’s, state medical boards direct physicians to be evaluated at outfits like CPEP, whether there is a reason or not. Any kind of complaint against a physician will be used by state medical boards to refer you to CPEP, at the physician’s cost (thousands of dollars). The problem is that HQIA and the FSMBs has provided state medical boards with a very efficient net to catch fish. But only the large fish (bad physicians) should be kept and the small ones (good physicians) returned to the pond. But the medical boards receive accolades, money, and political advances for the total amount of fish they catch. There is a mechanism of supervision to ensure that the small fish are released. But this mechanism is faulty because of different reasons (fear, lack of interest, etc.). As a result, small fish are part of the catch and sent to market. A multi-million dollar market and, most likely, money is exchanging hands. I am suspicious that the FSMB’s and CPEP are running a racket buy taking medical licenses hostage and demanding money for them to be returned. It should be an easy RICO case.

  14. Medical Board Torture says:

    IT IS WORSE THAN ANYONE IMAGINES. The viciousness and lawlessness of the medical boards no longer require complicity with PHPs and the centers that purport to evaluate physician fitness for duty. A doctor I did not know accused me of substance abuse. No matter that I never had any history of either substance abuse or mental illness and had successfully practiced 28 years.

    The main “evidence” claimed by this physician was a UDS that was allegedly mine. HOWEVER, I do not recall being asked to submit this sample, nor do I recall providing this sample, nor did I sign any consent for this sample, nor did anyone ever produce a copy of a signed consent for this sample. As an employed physician, I have been subjected to numerous UDS over the years, all of which I passed, and I am well aware of procedure. Forensic UDS require informed consent, unless there is a court order to the contrary, and nobody ever alleged that this happened.

    Moreover, this UDS report with my name on it, specifically indicated that results were “unconfirmed” AND that the specimen should NOT be used forensic purposes, a legal requirement which the Board chose to overlook. No reports were ever found to show that confirmatory tests were subsequently done, as required by law for forensic samples that are positive. But the Board ignored all this, just as they continued to ignore all the exculpatory evidence for eight long and miserable months, including negative urine and hair tests. This illegal misuse of a UDS report, which may have belonged to anyone, further contravenes AMA policy on drug testing, although the Board hypocritically purports to embrace AMA ethical codes.

    I endured eight months of torture, multiple forced evaluations, including two different comprehensive evaluations for substance abuse. Evaluators found no evidence for Board claims.The Board obtained pharmacy and medical records without my knowledge or consent. Subsequent urine and hair samples were negative. And there was a lot more before it was over. After permanently derailing my career and breaking me financially, ruining my personal and professional reputation, invading my privacy and destroying my peace of mind, the Board’s only “evidence” was ONLY the initial unconfirmed UDS without any documentation of chain of custody or consent. the Board begrudgingly and belatedly dismissed all charges. They sent me a letter of dismissal, adding insult to injury, even claiming that the doctor who made the report had done so “in good faith.”

    The board broke my financially, ruined my reputation, destroyed my peace of mind, and took my career and purpose in life. There is nothing in life to live for BUT suicide is not an option for me or any physician, because 1 ) Suicide does nothing but provide the Board with “evidence” that there really was something wrong with the physician-victim (i.e., it allows the Board to assert their actions were reasonable) and 2) suicide confirms the Board’s belief in their own omnipotence, which encourages further sadistic acts against other physicians. As long as you remain alive, even if you suffer miserably, you prevent the Board and its agencies from the uncontested win that they so desperately want.

    • Pamela Wible MD says:

      Wow. Overwhelming how physicians can be cannibalized by a system that is eager to punish and hesitant to offer real help. Unreal the depth of suffering among doctors who are then thrown to the wolves.

  15. Michael Servetus says:

    If a professional finds themselves in one of these circumstances:
    1. Work with or find a personal physician, best if established before the troubles begin, but don’t procrastinate.
    2. Immediately find an experienced lawyer!
    3. Do not self treat!
    Pay for the best help you can find. Here, a penny saved will lose a license.
    While a license is a state given privilege, you do have some rights.

  16. Another PHP Victim says:

    Hi Pamela, I’ll share my PHP experience with you. I told you about the whole experience doing locums work in various state. Well, it’s almost resolved. I had to hire a lawyer who is a member of the Oregon BAR. So, that cost me about $50K, more or less. In the end, they decided that I should be drug tested for 6 months. I said, “Ok.”, even though I had not done anything. I didn’t have enough money to fight them anymore, and I was afraid that if I didn’t do what they said, they would suspend my privileges, and I would have to report it on a licensing/credentialing application. In the end, they decided to have me contact a PHP, who recommended an “assessment”, which cost an additional $3K. As mentioned in the article, there were 6 centers that were approved by the PHP nationwide, with one located about 90 miles away. I finally did this unilateral assessment because I was afraid of the consequences of not doing it. They diagnosed me with a “mild substance use disorder”, even though the meds I was taking for anxiety had been prescribed by my psychiatrist for the past 10 years. They decided that I needed to go for an “intensive outpatient program” at (you guessed it), another approved center. I had to pay another $4000K. This brings us to the present, and I have gone through all of my retirement plan, all of my savings, put my house up for sale, and moved back to California with my parents because my house in Oregon has not sold. I was afraid to apply for any work until this insanity was over with Oregon, but I decided that if I didn’t find work, I would soon run out of money. All of the places to which I sent my CV noticed the temporal gap in my work, and, based solely on that, are inclined not to hire me—let alone me explaining the absence. In short, this racket with the PHP and their associated centers for evaluation and treatment cost me everything. I have no money left, so I feel as though I must do what they say. I believe that everyone has profited off of my misfortune, yet I am powerless to fight anymore. I’m pretty sure that once I finish, regardless of whether or not I must report it, I will have been gone from clinical practice for long enough that it will be tough to find work. I can clearly see how some would think that this would be the “end of the line”, but I will not let them destroy me. I would gladly do something outside of medicine if I was qualified, and I’ll have to just wait and see how this plays out. I’m happier than when I was working, but I’m also really stressed because I cannot find a job. Several friends of mine also expressed thoughts of leaving medicine if they could, but they feel trapped as well. Sorry to be lengthy, but thanks for listening.

    • Janice says:

      I don’t know any other career in which there are so many ways for them to derail it. They really can (more or less) force you to do whatever they want.

  17. I just sent this letter to FSPHP:
    Christian Wolff, MA
    [Independent] Psychologist Associate, Voluntarily Inactive (Oregon)
    Executive Co-Director & Co-Founder
    Healthcare Alliance for Regulatory Board Reform (HARBR)
    HARBR-USA.org
    christianwolff@harbr-usa.org

    February 21, 2019

    Linda Bresnahan, MS, Executive Director
    Federation of State Physician’s Health Programs
    668 Main Street, Suite 8, #295
    Wilmington, MA 01886
    lbresnahan@fsphp.org
    347-0600

    Re: FSPHP statement made to NBC affiliate, KSDK I-Team in article entitled “Is your doctor afraid to ask for help?” – February 14, 2019: I-Team investigative reporters: PJ Randhawa, Erin Richey

    Dear Ms. Linda Bresnahan of FSPHP:

    I am writing on behalf a large group of physicians and others who are concerned about the operation of your organization. According to an investigative report by the Channel 5 I-Team in St. Louis, FSPHP refused to answer specific questions asked of them by the I-Team. Why is that? Anticipating that you will not explain yourselves meaningfully, I am prepared to declare your forfeiture of the opportunity given you to answer specific questions meaningfully for yourselves.

    I say “forfeiture” because secrets are often indicators of lies and we are prepared to regard, by default, your future statements to be some manner of calculated falsehood. Nevertheless, we will always accept your candid disclosers if you wish to counter the meaningful and specific assertions we will make in your stead.

    FSPHP offered the investigative reporters from NBC affiliate KSDK’s I-Team a boilerplate statement. Boilerplate assertions without support are devoid of meaningful information. Our people are extremely familiar with such dismissives. It is difficult to quantify the extent to which dismissives such as yours leave us unimpressed.

    We will be pressing this matter.

    For the moment, I will work with what you have given us.

    In the dismissive you provided the I-Team, FSPHP wrote:

    “Physician Health Programs (PHPs) across the United States and Canada provide physicians and other health care professionals a resource to ensure they are healthy, can practice their craft and at the same time ensure public safety.”

    We see you more as a “Gulag Archipelago.” Though our people* have described, in detail, their horrible experiences with PHPs and PHPs’ “preferred” treatment and assessment programs, we have seen only a few reports which might be regarded as “positive.” In examining those reports, there is nothing which would indicate that there was anything “special” about about about these “special” treatment programs.

    In the FSPHP statement above, FSPHP states humbly that it is “a” resource. This has not been our experience. Our experience has been that your Federation of State Physician Health Programs has been “the” resource for the majority of clients seen in PHP-preferred treatment and assessment programs who are forced to go to PHP-preferred facilities against the threat of damage to, or loss of their license to practice their profession earn their livelihood.

    The reports made to us indicate that PHP-preferred facilities are substandard, unprofessional, unethical, without meaningful independent supervision or audit, and if anything, an exacerbation of any difficulties a physician-client may have already had. Generally, physicians‘ well-being is worse after a PHP experience than before any PHP experience. And not by just a small amount. By a large amount.

    State PHP-related programs seem to be uniformly, extra-expensive. Physician-clients are more often than not, forced to go to treatment programs which are a half-continent away when other, proven, more transparent, and local bonafide treatment programs are available everywhere.

    Uniformly, we have found that PHP-related programs will not accept a physician’s health insurance. Payment is cash-in-advance-only, and it is for treatment of pre-determined length. Why is this? For many of us, this reeks of organized crime. We have never heard of any physician who, having completed a PHP program, went back to a happy, full practice. We have never heard of any physician who has graduated one of these programs early for any reason. We know, however, of many physicians who never fully “graduate” but are two-steps away from bureaucratic set-back against their license in perpetuity.

    We believe that were it not for ransoming physician’s licenses to practice, PHP-preferred treatment facilities, PHPs and the FSPHP would go out of business. Why? High price, low quality. That is, the PHP system is non-competitive. In a free market, no person in need would choose them.

    Let’s look at the claim in your boilerplate which implies that PHP’s are part of a system which “protects the public.” Emphatically, we believe that PHP’s do not protect the public. With equal emphasis, we assert that PHPs are part of a system which puts the public at an inexcusable level of risk. What is the nature of the risk? The biggest risk to patients and to the public is lack of transparency. As with licensing boards, PHPs claim to be a part of public protection, and sadly, the public tends to believe it. We believe along with licensing boards, certain hospital review committees, and other would-be authorities, the FSPHP is knowingly misleading the public. Is it for assured profit? Power? This question can be put to the test and “our people” will be testing it.

    As it is, the discerning public cannot tell a good physician from a bad one nor a competent one from an incompetent one because of PHP and licensing board opacity. Patients (and the public who care about them) trust that the “bad” healthcare professionals are being caught and disciplined or rehabilitated. Yet, because of the system-embraced opacity of the PHP-associated entities, the fact is, even the most discerning person would be incapable of being assured that well-connected friends of the authority-entities aren’t allowing truly dangerous physicians to practice, profit, and prosper at the expense of patients.

    The I-Team states in its story of February 14, 2019 entitled, “Is your doctor afraid to ask for help?”:

    “The I-Team reached out to the Missouri Physician’s Health Program with questions, and even went to the home of program director Bob Bondurant, RN, to ask them. He declined to talk about the doctors’ concerns, as did the Missouri Medical Association, and the Missouri Board of Healing Arts.” [emphasis added]

    This is consistent with my experience. In 2017, I wrote a very ordinary letter of inquiry to the Center for Personalized Education for Physicians (CPEP, in Colorado). They declined to provide any response whatsoever. See my report at http://harbr-usa.org/harbr-declares-cpep-unaccredited/. I then tried another facility set called the Acumen Institute & Acumen Assessments. Each of these inquiries were prompted by the report of professional colleagues being forced to these specific facilities at the risk of licensure lost. See http://harbr-usa.org/harbr-declares-another-php-unaccredited-acumen/.

    Nobody’s talking. Why is that? We plan to talk and reveal. If these silent despots wish to remain silent, fine. Qui tacet consentire videtur. In Latin, this means, “He who is silent is understood to consent (or agree).” Revisiting my notion of FSPHP’s “forfeiture of their opportunity to tell us truth” in their choice to not answer the I-Teams specific, relevant, and detailed questions, I offer more Latin. Qui tacet consentire videtur, ubi loqui debuit ac potuit means “He who is silent, when he ought to have spoken and was able to, is taken to agree.

    Finally, we find in the FSPHP boilerplate, this statement which is very telling:

    “Research as shown that the PHP care model has unmatched long-term consequences for substance use disorders. Additional research demonstrates successful graduates of PHP’s have a lower risk of malpractice.”

    Let’s just say, we’d like to see some citations and some full content articles supporting FSPHP’s claim. A professional, studied in science and research, especially when trying to maintain a position would never state “Research as [sic] shown …” or “Additional research demonstrates …” without providing citations to such research.

    We want those citations. We want those articles. Until then, we are declaring FSPHP to be illegitimate.

    We challenge to FSPHP to “put up or shut up.” Until then, we will assume FSPHP’s illegitimacy to be a fact and we will carry forward with this fact now in mind.

    Bonus note: Recently, a physician friend wrote to me in correspondence:

    Are these organizations exempt from FOIA requests? Correct me if I’m wrong, but it seems that it was only recently, perhaps 2008 after the housing collapse, that Congress passed laws that would hold the top three C level executives in a company liable for its actions. We have all heard countless stories of a CEO of one giant corporation driving his company into massive failure and bankruptcy, receiving his guaranteed millions nevertheless, and then being offered another CEO position in another Fortune 500 company. It’s mind-boggling. But it is not only in the private sector that this occurs, apparently. A minor government can ignore calls for accountability and transparency and then eventually resign and disappear from view and reemerge unscathed in another parallel government position in a different locale, perhaps. This is VERY different than the type of torts that a physician, say, might be liable towards.

    I think my friends and foes alike should think about this. I know my friends already are.

    Christian Wolff, MA
    [Independent] Psychologist Associate, Voluntarily Inactive (Oregon)
    Executive Co-Director & Co-Founder
    Healthcare Alliance for Regulatory Board Reform (HARBR)
    HARBR-USA.org
    christianwolff@harbr-usa.org

  18. Dear Pamela,
    
So glad you posted P.J. Randhawa’s excellent investigative video piece and article on the MO PHP. Very pleased also that you referenced several stories of PHP abuse in your touching “Physician Suicide Letters – Answered.”

    In the nearly eight years our physician advocacy study group has been meeting, we’ve collectively heard from hundred of physicians across the country who have endured nightmarish experiences with their state medical boards, PHPs and their “preferred” programs. Many had been “referred” to the PHP by their medical board, some by hostile department chairs or group leaders, a significant number via an anonymous complaint whose content the board refused to share with the physician. It could have been from an aggrieved spouse, a jilted lover, a physician competitor, a spiteful patient ….

    As we studied the issues, it took us quite a while to get our heads around the fact of widespread board / PHP / “preferred program” conspiratorial abuse. It seems so disturbingly dystopian and sadistic as to not even be comprehensible. And so too the exact experience of each individual doc caught in this web. About half of us in the study group know the experience painfully well; the other half were initially concerned just on ethical and humanitarian grounds but, through many stories now shared, probably have secondary PTSD themselves.

    Just a few months ago, we decided to create an organization to pool our knowledge and efforts toward confronting abuse of physicians rights by boards and PHPs. CPR – The Center for Physician Rights (www.physicianrights.net) intends to serve as an information resource and offer confidential curbside consultation, peer support and tailored case guidance. We believe that definitive change will come from a combination of informed litigation, legislation and media exposure. We were honored to serve as a resource for PJ Randhawa’s story and are encouraging her and her team to explore the PHP corruption story from a national perspective.

    We’re soon to be publishing an ebook laying out the perilous landscape and sharing five physicians’ stories of their own Kafkaesque nightmares. And we’ll offer a section of Do’s and Don’ts in dealing with boards and PHPs. This will be just the preliminary version of our book as we later intend to publish a wider collection of physicians’ stories and explore in more detail exactly how the malignant process works and what steps one can take to best protect themselves. But we recognize the immense need and we want to get a sufficiently informative book out ASAP. (It’ll be available from the website.)

    One of the main steps is coming together, sharing our stories, supporting and validating one another and joining together to fight this menace.

    If any physicians who follow your excellent posts and presentations would like to learn more, or perhaps share their story for publication (even if under a pseudonym), schedule a curbside consult, be part of a peer support community (whether receiving or providing peer support) or become more active in some other way, just write a note to me at kernan@physicianrights.net. We’re still in the early formative stages and can use all the collaboration offered.

    And for those interested in following CPR and being kept apprised of webinars and other offerings, be sure to sign up on the website for our newsletter.

    As always, thanks for your extraordinary efforts toward protecting physician wellbeing and preserving the soul of medicine.

    Kernan Manion, MD
    Founder & Director, CPR – The Center for Physician Rights

  19. There is a time to think and there is time to talk, a time to confer & console and a time for diplomacy. But if there is no point at which these lead to definitive and unmistakable action then all pre-action is for naught.

    Prudence, indeed, will dictate that Governments long established should not be changed for light and transient causes; and accordingly all experience hath shewn, that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security.

Click here to comment

ARCHIVES

WIBLE WINS NPR AWARD

Copyright © 2011-2019 Pamela Wible MD     All rights reserved worldwide     site design by Pamela Wible MD and afinerweb.com