Top 10 things you need to know about PHPs

Reprinted from Kernan Manion, MD @ Center for Physician Rights (CPR)

For those who are not yet aware of what PHPs (Physician Health Programs) do, they’re the agency that the state medical licensing board (MLB) contracts with to do its compulsory “fitness for duty” assessments when any concern is raised that the physician may have some significant impairment impacting their clinical performance. That issue is generally brought forth to the MLB (medical licensing board) via a complaint and the MLB orders the physician to go to the PHP for that evaluation.

Problem is a flood of reports have come to CPR’s attention revealing that there is an avalanche of concerns about this process:

1. The MLB (Medical Licensing Boards) may not have sufficient basis in the first place to “regard as disabled” and compel the physician to report for such a mental evaluation; thus the referral is flawed, punitive and irreparably damaging. Worse, it’s prone to turn into a psychiatric witch hunt. Close study with ADA legal experts suggests that such baseless “regarding as disabled” referrals without thorough and clearly documented case analysis by the MLB is likely illegal under ADA. 

2. The PHP itself may receive major funding from the MLB and from “preferred” evaluation and treatment programs that receive its lucrative stream of referrals.

3. The PHP may not even be licensed as a legitimate medical organization licensed or even trained to conduct such specialized fitness-for-duty exams. Many operate with literally no malpractice insurance. Some don’t even have a physician on their staff, much less a board certified addictions psychiatrist.

4. The PHP conducting these exams may refuse to give the physician a copy of their evaluation or consider independently obtained qualified professional evaluations that may challenge the PHP’s concealed findings. Most provide no opportunity for grievance. In a forensic fitness-for-duty evaluation such as this which carries such immense weight, a grievance process is the only means of obtaining legally comparable due process.

5. The PHP may make an unfounded diagnosis on an already unwarranted referral, utilize SAMHSA-prohibited drug tests known for their false positive findings, and compiling this package, insist on the physician’s “voluntary” referral to one of its costly out-of-state in-network “preferred” programs where it may subject the physician to interrogation via polygraph examination. This 4 day evaluation may cost as much as $10,000 cash, no insurance accepted.

6. If the PHP-evaluated physician balks at this and refuses to cooperate, the PHP then reports the allegedly impaired and now newly “PHP-diagnosed” physician to the ordering medical licensing board as non-compliant and a danger to the public. The physician’s objection to this extortionary threat of reporting is further framed as defiance and evidence of their denial of their illness.

7. The MLB then invariably orders the physician to comply with EVERYTHING the PHP orders, including forced hospitalization for 3 months and then five years of intensive monitoring – the equivalent of probation and home arrest. 

8. The “preferred programs” the PHP uses (apparently jointly selected by the MLB) are private and don’t accept one’s health insurance. Costs just for the three month forced hospitalization can easily exceed $50,000. Again, out of pocket.

9. The shocked and distraught physician may seek representation from a so-called professional license defense attorney, a self-designated specialty, and too often be informed after paying a hefty retainer that they have to do everything the MLB and PHP says. 

10. Throughout this process, there is no escape. Physicians are fleeced, humiliated and lose their jobs and careers. And they never have a chance to contest the proceedings which all too strikingly resemble Soviet abuse of psychiatry. Profound moral injury and new psychiatric illness are the necessary result. An untold number are driven to suicide. (Our colleague Pamela Wible MD, another truly courageous physician calling out physician abuse, shares a particularly poignant case here.)

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NOTE: Does this mean that ALL MLBs and PHPs are as abusively corrupt? Certainly not. Uh, let me rephrase that. Hopefully not. But without state and national oversight, you just don’t know. And you have to admit, that’s a hell of a quandary for a physician. (Note to ethical leaders of MLBs and PHPs: your Federations’ and your state’s lack of oversight and unwillingness to confront abuses is compromising your reputation, the good work of your ethical program and physicians’ willingness to trust you. It’s also worth noting – your lack of state oversight and lack of internal controls increases your liability immensely while simultaneously removing your state-granted immunity protection from suit. One would think this would be worthwhile checking on.)

Dr. Wes Boyd, a former state PHP assistant director himself, witnessed firsthand this corrupt physician trafficking and spoke out about it. He parted ways with that state PHP and became an outspoken critic. As you might imagine, it takes courage and commitment to do that; PHPs and MLBs are powerful entities who can easily abuse their power to aggressively act on “anonymous complaints.” Please read his latest article: Doctors Pay Up or Else Don’t Work.

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