Ethical Issues in State Physician Health Programs

In our Journal of Addiction Medicine piece just published online, co-author John R. Knight MD and myself discuss ethical and managerial considerations regarding state physician health programs (PHPs).  These are programs that work with physicians who have various kinds of health related issues, including substance use disorders and mental health issues.  As we note, “For most physicians, participation in a PHP evaluation is coercive, and once a PHP recommends monitoring, physicians have little choice but to cooperate with any and all recommendations if they wish to continue practicing medicine.”  As we note, the fact that they have high success rates does not obviate the need for scrutiny of PHPs and does not excuse abusive practices when they exist.  Such an argument is a weak utilitarian argument.  Separately, to argue by analogy to airline pilots does nothing to alter the facts that some PHP practices are abusive and ethically indefensible.  (See http://www.asam.org/publications/president’s-blog/asam-president’s-blog/2012/10/16/how-to-achieve-an-80-percent-recovery-rate)

What are some examples?

For one, as we point out in our essay, some PHPs report physicians for positive test results when the PHP knows that these test results do not indicate relapse or ANY problematic behavior by physicians.  What’s the big deal?  Well, getting reported to one’s board of medicine is almost uniformly terrifying and can require retaining legal help to address the issue, coming out of practice while the “false positive” test is being investigated, and significant psychological distress.  One physician told me that one of these days a physician is going to commit suicide after one of these reports.

In addition, as we point out in our piece, PHPs often have complicated, financially intertwined relationships with the programs they send physicians to for evaluation and treatment.  And these are just a couple of the problematic issues about PHPs.

As we conclude in our Journal of Addiction Medicine piece, “Since PHP practices are unknown to most physicians prior to becoming a client of the PHP, many PHPs operate outside the scrutiny of the medical community at large. Physicians referred to PHPs are often compromised to some degree, have very little power, and are therefore not in a position to voice what might be legitimate objections to a PHP’s practices.”  Because of this, to argue as some have that we can just let the legal system deal with any potential abuses of PHPs is either naïve or an attempt to allow some unethical practices to continue without scrutiny.  We conclude our piece by recommending that the broader medical community begin to reassess PHPs.

The time for action is upon us.

Here is a PDF of our piece:

file://localhost/Users/jwboyd/Documents/PHS/Ethical_and_Managerial_Considerations_Regarding_PHPs.pdf

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57 Responses to Ethical Issues in State Physician Health Programs

  1. Kent England MD says:

    I just came across your article on PHP’s and their medical ethics. I am going through a nightmare with the South Carolina RPP for for a false positive drug screen on 5/6/11. My medical license has been suspended since then I’ve been evicted from my home lost my medical-practice my reputation my finances. The only option the SCRPP will give me is minimum 90 day residential treatment but there is no such thing for an indigent person as I am after multiple illnesses; it would be 6 to 12 months. Followed by 90 days outpatient monitoring then petition SC medical board for license reinstatement it would easily be one and a half to two years before I can practice again. I fought for seven months this year to finally get an MRO to review my test and he felt the results were all inaccurate with the exception of minimal ETS which can be explained by incidental exposure and multiple other health issues. I am devastated going through administrative appeals with ? chance of success my life is being ruined after five years of uninterrupted solid recovery. Kent England M.D.

    • Terpsichore says:

      Dear Dr. England,
      I am so sorry you have had such horrible experiences. Please keep very accurate records. I am new to all this, but I do not see how deliberately unreliable information can be at all legal. I see the possibility of some strong class-action charges around the corner. If you have not yet gone to the ACLU, perhaps you should. None of us in the medical professions thought we or any of our colleagues would ever need to report to the American Civil Liberties Union as so many of us are very conservative. Sometimes you have to swim in unfamiliar waters to keep afloat. The PHPs may proclaim they cannot be sued. If so, why are they required to have legal counsel listed? After looking into a few cases, I see a pattern of alleged collusion with certain testing labs. Please look at the False Claims Act under RICO. I should mention that I am not under any state PHP, but I fear that any of us could be next and this system currently looks just plain diabolical.

  2. Anonymous says:

    Still trying to get your article, so I don’t know if you address misdiagnosis or not. Some physicians in PHP programs do not believe themselves to be addict/alcoholics. They are perhaps suffering from denial (common in addiction). They of course could also be right, that they have been misdiagnosed (they are doctors after all, with medical knowledge of what addiction). Regardless of what they, their families, or their own physician’s think, they are forced to do 90 days of treatment at a PHP approved facility + 5 year contract with PHP (paying lots of money to both). They have to do this to keep their job, there is no avenue to argue against there diagnosis, even if other addictionologists disagree with it. Is it any wonder that there is an 80% success rate when some of the members are not even addicts. Not to hard to stay away from a drink if you are not truly powerless…..

  3. PHP program staff provide “monitoring” programs for nurses, doctors, dentists, pharmacists, veterinarians, and chiropractors. When a medical doctor is in need of medical treatment for whatever reason, they still have rights as patients and also as human beings. Those in the healing professions have the right to compassionate medical care. The fact that a person has a medical degree does not diminish their rights under the US Constitution. However, in many states, the PHP programs act with color of law governmental authority because they are subcontractors to the state department of health. Under the laws governing such state subcontractors they have been granted quasi-governmental immunity. This means that they believe that they have cart blanch to do whatever they want to a targeted doctor. This means that doctors when they are their most vulnerable are potentially victims of abuse – behind the locked doors of the PHP and their agents. Fearful for the loss of their medical license and knowing the governmental power extended to the PHP, they often acquiesce to the PHP demands, and thus loose their civil rights and often their privacy rights as patients. There is no system for accounting for the actions or behaviors of the PHP agents. There is no transparency of their financial accounts and no auditing by the state department of health of their clinical practices. Questionable practices have been alleged including payment of kickbacks by the labs doing the urine testing of PHP clients, falsifying of test results, and abusive confrontations, humiliating and degrading treatment. I have found that the PHP programs in many states have not only violated civil rights of doctors who are patients/clients in their programs, but that they are also violating basic human rights.

    • Suzanne Giles-Martinez says:

      Dear Dr. Parker,

      I just typed you a lengthy reply, but it flew off the page. Also, I have been experiencing strange events with my emails. Very recently, I received an alert that the security on one of my email accounts has been compromised and specific emails (or copies) have been extracted. God knows where these emails have gone. I have changed passwords on both accounts, but I would like to make everyone aware of this. The hacked account corresponds with other things that have recently taken place. Please protect your backs. This world needs you.
      Dr. Parker, you have absolutely hit the nail on the head. PHPs feed their physician-clients to specific high-end recovery facilities, even those docs only needing IMEs. Evidence from several individuals has been brought to my attention supporting my opinion. Based on reported experiences, it is my opinion that these clinics have a systematic routine of initial testing that justifies further testing. As some medical and psychological testing is contracted out to independent specialists to provide “objective” data, the treatment facility can then cull the data, skewing it wherever possible, with (in my opinion) the intent to issue a summary report to the PHP that states that the physician is currently “unfit to return to practice.” At this point, the clinic offers to use the physician’s disability insurance and/or personal assets to cover the costs of an extended stay to help the physician “get back to normal.” While PHPs and the associated referral clinics fly under the radar with their assumed immunity to civil law, they cannot escape the umbrella of criminal law. And I do feel criminal violations abound. Any citizen has the right to report suspicion of criminal acts. The FBI has a special department to handle health care crimes. The RICO Act also defines criminal activities involving the falsification of data for financial gain. There is an FBI web site with a complaint reporting page. Also, citizens are encouraged to report suspected health care and insurance fraud crimes to district and state AGs. No individual, organization or facility has the right to get away with illegal acts. The cover of immunity under the guise and cloak of protecting public safety can be penetrated. No thinking or caring person would ever want the public to be endangered or innocent patients to be placed at risk. But the good concept has turned into a self-oiling machine of secrecy that collects millions. Enough is enough. Suzanne

  4. Warren Mullaney says:

    Physicians Health Programs are in almost every state and governed by the FSPHP.
    (http://www.fsphp.org). They give the outward appearance of helping physicians who have drug and alcohol problems and protecting the public but they do neither. They have figured out that by gaining control of individual doctors licenses that they can effectively control organized medicine. They did this by aligning themselves with state boards of medicine in each state by offering to help “impaired physicians” get help from drug and alcohol problems. They encourage confidential informants to report colleagues. They have the ability to target and remove any doctor they feel is against them in any State. They have successfully done this to doctors in Boston with ease and with little effort or evidence and despite protests from colleagues nothing could be done. It is this power that has created a culture of fear, coercion, absolute power, and silence. No one speaks out against them because of fear that they will be targeted by them.

    The organization is a false front for the 12-step residential treatment facility drug testing ASAM PFDFA just say no fundamentalists who are trying to 1. Eliminate physicians who use drugs from the field of medicine as they feel that the noble profession needs to be purged of “character defects.” 2.Establish 12-step philosophy, strict prohibition, abstinence, routine drug testing as the one and only treatment for addiction. 3 .Establish themselves as a model for addiction medicine treatment to be applied to other populations outside of medicine.
    Dr. Adelman’s reefer madness bong-bomb hypothesis gives a glimpse of the monster under the mask.
    They are below the radar, expanding scope, and gaining political power. Giving an organization police-like power and complete opacity allows them to do whatever they want. There is no oversight, accountability, or transparency involved. They are now trying to expand beyond the allegations of substance abuse and have started a campaign to expand to the “disruptive physician.”
    They are also claiming that this mutant model of recovery should be the standard of care for other organizations and claim an 80% success rate.
    They are working to get certain bills passed under the radar that will decrease individual rights and give them more protection and power, they have infiltrated the AMA, and have rode the “war on drugs” bandwagon to increase support. It is amazing that they have been able to successfully accomplish goals as seen in the upcoming DSM-V diagnoses of substance abuse disorder where any drug or alcohol use falls under the same umbrella as addiction.
    Unseen, the FSPHP is probably the biggest threat to ending the “war on drugs. They are under the same roof as the PFDFA with the same ideology of zero tolerance, prohibition, abstinence, uniformity, and punishment, but the organizational design provides power and secrecy. The close ties with the commercial drug testing industry, rehab facilities, oversight boards, and the 12-step players threaten all of us in eroding civil rights, due process, and individual liberty. This band of individuals is strung together by political ideology and are not experts in addiction medicine as they claim to be and many of them are recovering addicts themselves who, steeped in 12-step philosophy, believe what is good for the goose is good for the gander.
    Individual doctors are afraid of them and they have successfully snowed state agencies and medical societies into believing they are altruistic helpers.

    “Every time we turn our heads the other way when we see the law flouted, when we tolerate what we know to be wrong, when we close our eyes and ears to the corrupt because we are too busy or too frightened, when we fail to speak up and speak out, we strike a blow against freedom and decency and justice.”
    ― Robert F. Kennedy

    http://www.asam.org/publications/president's-blog/asam-president's-blog/2012/10/16/how-to-achieve-an-80-percent-recovery-rate#comments

    http://www.opednews.com/articles/Insurance-Company-Financin-by-MedicalWhistleblow-090926-111.html

  5. Warren Mullaney says:

    “The greatest trick the devil ever played was convincing the world that he did not exist.”

    ― Charles Baudelaire

    Physicians Health Programs are in almost every state and governed by the FSPHP.
    (http://www.fsphp.org). They give the outward appearance of helping physicians who have drug and alcohol problems and protecting the public but they do neither. They have figured out that by gaining control of individual doctors licenses that they can effectively control organized medicine. They did this by aligning themselves with state boards of medicine in each state by offering to help “impaired physicians” get help from drug and alcohol problems. They encourage confidential informants to report colleagues. They have the ability to target and remove any doctor they feel is against them in any State. They have successfully done this to doctors in Boston with ease and with little effort or evidence and despite protests from colleagues nothing could be done. It is this power that has created a culture of fear, coercion, absolute power, and silence. No one speaks out against them because of fear that they will be targeted by them.

    The organization is a false front for the 12-step residential treatment facility drug testing ASAM PFDFA just say no fundamentalists who are trying to 1. Eliminate physicians who use drugs from the field of medicine as they feel that the noble profession needs to be purged of “character defects.” 2.Establish 12-step philosophy, strict prohibition, abstinence, routine drug testing as the one and only treatment for addiction. 3 .Establish themselves as a model for addiction medicine treatment to be applied to other populations outside of medicine.
    Dr. Adelman’s recent reefer madness bong-bomb rant, now removed, gives a glimpse of the monster under the mask.
    They are below the radar, expanding scope, and gaining political power. Giving an organization police-like power and complete opacity allows them to do whatever they want. There is no oversight, accountability, or transparency involved. They are now trying to expand beyond the allegations of substance abuse and have started a campaign to expand to the “disruptive physician.”
    They are also claiming that this mutant model of recovery should be the standard of care for other organizations and claim an 80% success rate.
    They are working to get certain bills passed under the radar that will decrease individual rights and give them more protection and power, they have infiltrated the AMA, and have rode the “war on drugs” bandwagon to increase support. It is amazing that they have been able to successfully accomplish goals as seen in the upcoming DSM-V diagnoses of substance abuse disorder where any drug or alcohol use falls under the same umbrella as addiction.
    Unseen, the FSPHP is probably the biggest threat to ending the “war on drugs. They are under the same roof as the PFDFA with the same ideology of zero tolerance, prohibition, abstinence, uniformity, and punishment, but the organizational design provides power and secrecy. The close ties with the commercial drug testing industry, rehab facilities, oversight boards, and the 12-step players threaten all of us in eroding civil rights, due process, and individual liberty. This band of individuals is strung together by political ideology and are not experts in addiction medicine as they claim to be and many of them are recovering addicts themselves who, steeped in 12-step philosophy, believe what is good for the goose is good for the gander.
    Individual doctors are afraid of them and they have successfully snowed state agencies and medical societies into believing they are altruistic helpers.

    “Every time we turn our heads the other way when we see the law flouted, when we tolerate what we know to be wrong, when we close our eyes and ears to the corrupt because we are too busy or too frightened, when we fail to speak up and speak out, we strike a blow against freedom and decency and justice.”
    ― Robert F. Kennedy

    http://www.asam.org/publications/president's-blog/asam-president's-blog/2012/10/16/how-to-achieve-an-80-percent-recovery-rate#comments

    http://www.opednews.com/articles/Insurance-Company-Financin-by-MedicalWhistleblow-090926-111.html

  6. Concerned Spouse says:

    It is truly appalling how PHP programs and their treatment centers are operating across the country. They simply divide families. They blatantly commit fraud, they do not want to accurately diagnosis professionals as this may lend to a patient seeking medical care at a hospital v. one of their established rehab centers. Spouses are bullied beyond belief by recovering addict doctors in charge of these programs. Both Betty Ford & Promises missed a major neurological diagnosis on my loved one. My spouse was denied the care he truly needed and was left seizing his days away at both places as they had ignored what our family had indicated to them. Staff intentionally omit information from charts if that information would be indicative of a diagnosis other than an addiction.
    As Dr. Janet Parker has clearly indicated they are violating these professional’s civil rights.

  7. Suzanne Giles-Martinez says:

    Is there any national law firm or attorney who would take the case of a good physician whose every rights–civil, mental health, medical, employee, personal–have been blatantly violated? Why are accused physicians not allowed to face their accusers? How do you combat retaliatory remarks? How do targeted physicians protect themselves when they have done no wrong? Some doctors have been illegally forced into these programs just to justify the existence of the PHP programs. Also, recovery programs need to be investigated. They deliberately skew test results to render the physician “disabled” and then tap into the physician’s disability insurance. Fraud abounds in these programs. Please advise. Thank you. Suzanne

    • EB says:

      Suzanne,
      Hopefully there will be some light shed on these wolves-in-sheeps-clothing soon. They cannot get away with what they are doing for much longer. The reason they have been able to operate in the way they have (unethically, way outside standards-of-care, and in some cases criminally) is because they have set up an unregulated system of complete opacity and unaccountability by using existing health care confidentiality and quality improvement statutes and laws as self-serving barriers under a cloak of perceived benevolence. They are essentially a “front-group” for the 12-step inpatient rehab drug testing industry and the prime directive is to make 12-step and AA the one and only treatment for drug and alcohol abuse and addiction. This ideology trumps everything and they don’t care who they step on along the way.

      The ASAM, FSPHP, and State Physician Health Programs over the past 40 years have gradually and covertly gained political power to redefine addiction medicine in the US to conform to 12-step ideology and doctrine, have a stranglehold on organized and regulatory medicine, pose a threat to individual doctors life and liberty, and have grand plans of expansion for domination and control of addiction research and treatment.

      Fact checking is easily verified as far as the organizations, architects, ideology, and future plans but the psychosocial and political climate (“war on drugs” crusade, public perception of AA as benign) have dissuaded public exposure and attack. Those who have tried to question the logic are met with ad hominem attacks and harassment.

      The ASAM and FSPHP are political front groups for AA and the 12-step drug testing industry. Well funded financially and in numbers, the “prime-directive” is to take make the “Hazelden model” of 12-step prohibitionist spiritual recovery the one and only treatment for addiction. This has been the goal for the past several decades, but with evidence-based medicine, critical thought, and scientific reasoning precluding this goal–what they could not take by persuasion they are now taking by force.

      By infiltrating “impaired physicians” programs in all 50 states and gaining control under the organization of the FSPHP they are in charge of the PHP programs, shaping public policy, creating the myth of hidden cadres of drug addicted doctors protected by a medical conspiracy of silence to promote random MD drug testing, helped shape the DSM-V, and are now promoting the PHP model of rehab as the “gold-standard” of addiction treatment based on a methodologically flawed retrospective cohort study which is misleading and biased. The ABAM certification amounts to little more than a diploma mill. The PHP’s are now targeting the “aging” physician, going after the nebulous “disruptive physician,” and have convinced regulatory boards and public policy makers that they are indeed experts. The marked rise in physician suicide is directly due to these programs as there is no way out, no appeal process, and no evidentiary standard. They have created a culture of fear. All you have to do is refer a doctor to them and they can ruin them if they so choose. No one is paying any attention to this and it is imperative they be exposed, regulated, and controlled

      The infrastructure is in place and they now plan to roll it out to the general public. Claiming the PHP model the “gold standard” and paradigm of addiction medicine they have sites on EAP’s, DOT, criminal justice system, and students (one positive drug test = no federal loans). And by drug test this includes the EtG and PEth junk science biomarkers the introduced, tested on physicians, and marketed to drug testing companies. It will be a nightmare.
      ASAM= AA, they are a fraud. None of the research is in the evidence base.

      There is even more egregious information out there. Skipper, the master showman, who is also interestingly a staunch anti-circumcision nut-bag is one of the key players behind the movement to drug test all physicians randomly. He is also part of the movement (along with Reagan Drug war czar and geriatric whack job drug-test-em-all-let god-sort-em out Robert Dupont and a host of others of the same ilk). They also want to bring the Hazelden “carrot-and-stick” 12-step indoctrination with frequent drug testing and immediate consequences (including EtG-and PEth) to you. They are currently wooing the right people in DOT and other EAP drug testing programs to accept this “wonderful” “amazing” PHP as the “gold-standard.” Having only a hammer and seeing everyone as a fucking nail they want global prohibition and everyone goose-stepping in time to to the twelve steps of salvation.

      There needs to be more public exposure of this. Once people realize that they too may be at risk of being under the thumb of an incompetent and unethical herd of zealots we may get some leverage. Hopefully soon-but eventually a certainty.

      http://t.co/zFhUc8cY8H

      http://bit.ly/19YeDFX

      • Suzanne Giles-Martinez says:

        Dear EB,

        Thank you for your beautifully written reply. Agencies need to investigate the money trail. Who has routinely done what. These clinics have put their lies in writing. There are specific patterns. Also, it seems as though there is a deliberate effort to leave out important medical information in the summary reports because the medical information would negate specific statements in the summary to make the physician “unfit.” Any client who has experienced this possibility should write directly to the evaluating physician for a copy of his/her complete record. I have heard so many reports from others that their medical evals were deliberately omitted from their summaries and the clinics have refused to produced the medical records in spite of several requests from clients, insurance providers, and state PHP directors. Isn’t this against the law? S.

    • Suzanne Giles-Martinez says:

      To All of You Who are Trying to Make Things Better,

      I have had to alert law enforcement because I have received a veiled threat to my safety and that of my family. From now on, I will be posting under another name. I have informed the FBI of specific individuals who may take out their anger at my comments on me or a member of my family. I hope the people who are responsible will understand that the FBI knows who you are. Please do not mess with me or my family in any way, however small. You will be investigated. Suzanne Giles-Martinez

  8. EB says:

    Threats and intimidation are an essential part of the organizational mechanics of this petty tyranny and also reflect the arrested development of the majority of its current members. Intelligent and thoughtful physicians with noble intentions guided by reason and moral compass have been gradually replaced with self-righteous self exalted delusional bullies on ego trips. Losing site of the original purpose of “impaired physician” programs they are beyond redemption and neither protect the public nor help doctors in need. Imposing ignorance on knowledge they can only do this by force–threats, coercion, and control. Their own sense of self worth is based on power and proving right to others their simple minded arrogant and irrational agenda as the overseers of medical morality with strict adherence to their arrogant vision of “professionalism.”

    To keep this monstrosity afloat they need power and opacity. The imbalance of power that exists between PHP members and doctors is enormous—a differential even greater than that between prison warden and prisoner as even they are guaranteed some semblance of civil rights, human rights, and due process. Prisons are regulated. There are checks-and-balances that afford accountability. Transparency is present.

    This is not so in the PHP system. The physician turned over to them be it voluntary or coerced loses all rights. There is no one to appeal to, no complaint system in place, and no one to turn to. He is alone. The first step is indoctrination into the 12-steps, the forced acceptance of helplessness, ego destruction, and psychological trauma. The physician is isolated, dehumanized, marginalized, and humiliated to the point of learned helplessness and impotence. Do as I say and if you question it their will be consequences. Physicians who have complained to the appropriate authorities (Boards, Departments of Public Health, law enforcement are disregarded and ignored convinced that the complaints are simply the product of a sick doctor in denial these organizations refuse to acknowledge, investigate, and protect–convinced that the PHP is acting out of benevolence and competence. This creates a culture of fear. Those who do report injustice and abuse are punished for doing so–and this does not go unrecognized by others both current victims and other doctors who could potentially be victims.

    To keep this monstrosity afloat they need opacity and power but in addition they need the sustained complacency and ignorance of the outside world. Threats and intimidation keep things in check for them and they rely on keeping things hidden. Because if anyone actually took an interest in investigating this operation it would be the beginning of the end.

    We need to make sure that happens. It is important that every abuse, standard of care violation, instance of fraud and misconduct, civil rights breach, and lie be reported to the authorities and that it be communicated and documented. Although the media have unfortunately turned a blind eye to this we can still get it out there in she social media—facebook, Twitter, Instagram– anywhere it can. I heat the same patterns of misconduct over and over (reporting drug tests below accepted cutoff values, reporting positive drug tests for prescribed medications, fabrication of drug tests and alcohol biomarkers, falsification of diagnoses by ASAM collaborators, etc. These are not very imaginative people and the patterns are clear–once we have enough of them in enough states the mosaic will appear. Public concern needs to be generated and as soon as enough people take interest and it reaches the right people there will be change. Remaining silent ensures defeat. Many of the offenses are indefensible. Report abuse and misconduct, specify the names of the perpetrators in public, and force them to respond. They most likely will not respond because threats and intimidation do not work as well in the open–and although the imbalance of power is completely on the PHP side–logic, reason, justice, and truth reside on ours.

  9. Terpsichore says:

    I agree about reporting any kind of fraud to the authorities, but go to the top. I, too, went to the FBI website and they do have a tips email reporting page. If all the victims of FSPHP or any type of recovery center would just fill out the FBI tips form. Specific crimes identification would not be too difficult as the insurance fraud issue seems to be widespread. The FBI is asking the public to report SUSPICION of fraud. Every abused physician and every family member of the poor physician needs to put in a complaint–but make sure it is stated in the form of suspicion of a crime, and this usually involves false claims resulting in financial enrichment. If the FBI starts to get involved, the IRS will soon follow. Oh, I was told always to remember to state comments as an opinion or feeling because you cannot be sued for an opinion. If the FBI were to receive 100 tips, I feel this would be significant. I agree with EB. We all have to start reporting these crimes. Remember, a crime is a crime is a crime. This has nothing to do with the FSPHP proclamation that they are above civil law.

  10. CM says:

    Unfortunately, valid complaints by doctors of ethical violations, misconduct, and even crimes are frequently denied, dismissed, and deflected.
    I have heard from many physicians in many states that indefensible and severe civil rights violations are ignored by authorities and agencies that should be concerned. The ASAM and FSPHP is a front group for the 12-step drug testing industry that has infiltrated State Medical Societies and taken over the “impaired physician” programs and are expanding in scope and power. They are responsible for the marked increase in physician suicide in the past decade.

    This convoluted web that has been put in place that needs to be looked at through a critical lens using of critical thought and skepticism based on real science and reasoning to see this system as it really is. This is the problem. People seldom look behind the veil and see only a patina of benevolence and good will.

    The multiple and severe civil rights violations that are occurring are not isolated. It is occurring in almost every state. A fundamentalist sub-group of the ASAM consisting of 12-step zealots who fear that addiction medicine is losing site of their core 12-step dogma have set up a scaffold of coercion, control, and abuse. State Physician Health Program Medical Directors and their medical review officers come from this group and so too do the Medical Directors of the referral facilities that physicians are sent to for “independent evaluation” under threat of loss of licensure. Any physician referred to a PHP program is referred to one of their own. By claiming and convincing regulatory boards that only a subset of rehabilitation facilities have expertise and experience ” in the evaluation and treatment of health care professionals” they have cornered the market. There is an appearance of choice because multiple facilities are listed and the physician has no choice under threat of loss of licensure to pick one of the offered facilities. Like a rigged deck of cards it does not matter which one is picked. The end result will always be an evaluation by another “like minded doc” who places ideology and the cause before all else and will gladly sacrifice an innocent physician to do so. This physician will be evaluated by another of like mind who is willing to engage in “confirmatory distortion” false diagnoses, false imprisonment, civil rights violations, harassment, retaliation, and psychological abuse. The groupthink of these dinosaurs of the FSPHP and the referral centers they use form a scaffold that is unregulated, opaque, and accountable to one. Forming relationships with other organizations and individuals that would be unthinkable anywhere else as the “conflict of interest” alarms would be immediate and severe the ASAM, FSHPH system has been able to take advantage of a perfect storm of factors to cultivate a network of aiders, abetters, co-conspirators, defenders, and apologists who both facilitate the corruption and prevent its exposure. Using the euphemisms “contingency management” for the unethical and sometimes illegal acts they commit and “point person” for those they conspire with to commit them they rely on a hidden network of individuals with the same ends-justifies-the-means philosophy who will gladly partake in falsifying and misrepresenting evidence and impeding investigation and inquiry. . Bereft of professional competence and morality, a physician is confronted with a system of coercion and control that places ideology over the individual and tramples due process, fairness, civil and human rights, freedom of religion, as well as basic truth and justice. With no oversight or transparency and without regulation this “lord of the flies” incubated system of absolute power has has evolved into what history has shown us time and again to be inevitable under these circumstances. Like the lobotomy, history will reveal this dark cloud in time.

    The PHPs are trying to expand to DOT, employee assistance programs, and students (drug test all students who have federal loans. + test = removal of funds) With AA and the 12-step drug testing industry behind them they have a lot of money, are successful lobbyists, and are unopposed.

    Doing nothing about these injustices is all it will take to keep it going and with plans of expansion it won’t be just doctors under their crooked thumbs.

    Being the “medical hub” of the country it would be nice if MA could play a role in exposing this system of corruption and misguided power. This is a National problem, we know who is behind it and all it will take to dismantle them is a little sunlight and exposing the Oz behind the curtain.

  11. AW says:

    The strategy of distraction, the ASAM and FSPHP
    by August West (not verified), May 15, 2013, 10:43am
    The various pro “drug war” groups absolutist public persona is merely a ruse to distract. While attacking the hortatory absolutist nonsense of these groups of negligible influence, and believing that reason, logic, and progress would prevail, the drug warriors have successfully and silently designed a complex web that has both power and protection. By strategy of distraction, the noise of groups with the power to hector but not enforced has enabled other groups with common goals to gain power while remaining silent. By creating organizations that pretend to unrelated and benign groups they opportunistically inserted themselves into medicine at all levels, in each state, and in such a way that they have absolute control over almost every doctor in ways that are mind boggling. The ASAM (American Society of Addiction Medicine) and the Federation of State Physician Health Programs (FSPHP) are the factions of the drug war that have gained power and protection. They have put up an impenetrable fortress that cannot be dismantled easily. As the brainchild of Robert DuPont, as a way to stranglehold medicine and advance the 12-step institutional rehab drug testing agenda, they have already regressed medicine by decades. The upcoming DSM-V controversial diagnosis of “substance abuse” is part of this legacy. By making it easier to diagnose substance abuse and muscle forward the testing and rehab industry to further their goals they eventually plan on using the abusive “physician health program”, FSPHP model on other populations. This needs to be recognized, exposed, and dismantled on a state level.

    http://www.asam.org

    http://www.opednews.com/articles/Insurance-Company-Financin-by-MedicalWh

    http://www.fsphp.org

    http://blog.massmed.org/index.php/2013/05/is-there-a-marathon-marijuana-

    http://www.youtube.com/watch?v=HbNuuKJEwEA

    reply

  12. matthew James says:

    Doctor Boyd,

    I cant tell you how much I appreciate your article on PHP’s. I have one DUI to the slightest degree on my record. I got this on vacation from my practice in Alaska in the state of Arizona. My Father is dying. I left Alaska to come home to Seattle to be with him and help my Mother. During reciprocity of my license, after being fourth-coming with the DUI a year prior, I was referred to the WPHP. They have financially destroyed my family. I have not been allowed to work. My wife and child are on food stamps and social services. The WPHP threatens to initiate the same process should I attempt to resume practice in Alaska. My only choice is to attend a 90 day inpatient program, out of state, at extraordinary cost. I cannot find an attorney. I have independent alcohol evaluations stating I have no specific problem, hair and nail drug tests that are negative, psych reports that say there is little to none evidence of substance abuse…none of this objective information seems to matter. I came home to be with my Father before he passes and now I am financially ruined with a 20 year marriage hanging by a thread.

    I have been referred to the commission by the WPHP for non-compliance. I have attached a letter to them that would provide you with details of my experience. If you have any resources that can be of any help I would be genuinely grateful.

    • RK says:

      Dear Matthew,
      I’m very sad to hear of your plight and can well identify. As you may have discovered in your research, this is becoming a national epidemic. I’m pleased to report that a number of us are gathering our efforts. Please check out the link below to the Federation of State Physician Advocacy Programs. Eventually, various of us are going to post our own stories of the grossly unethical and illegal treatment administered by medical boards and their affiliated PHPs.

      please see:
      http://www.fspag.org/15.html

      We are in the process of starting a virtual support group for us afflicted docs. The PHP / Board thugs who masterminded this treatment by extortion scheme and career homicide never envisioned that the afflicted lepers might find a way to connect.

      I’m also pleased to report that the NC office of the state auditor is now completing a comprehensive investigation of NCPHP’s practices; by the end of it, more than 125 physicians, along with former board members and staff will have been interviewed. We anticipate the report, to be released in Jan 2014, will confirm the breadth of these violations. And we are hopeful that it will lead not only to immediate procedural change but further investigation.

      Feel free to contact me and we can find a time to connect by phone:
      info@worklifedesign.us

      • matthew James says:

        Thank you so much for your reply;it means a lot. Tomorrow Im going to Betty Ford for another 5 day evaluation. This despite the fact that the evaluation at Hazelden said I was good after a 3 day (6k) evaluation. This is a 4k evaluation. My parents had to loan me the money and put up my family as we lost our house. The WPHP acted as the commision and had me removed from my job at seattle indian health board based on an ETG spike. I was being monitored for 5 mos after Hazelden and all tests were negative. I had two oral surgeries in November and provided the WPHP with a note from my physician stating that I would be using an EtOH based rinse. I took no pain killers only ibuprofen. I used nyquil to sleep at night and hand sanitizer at work as I thought the ETG would be expected. They state the value was so high I must be drinking. I provided literature that concludes ETG cannot differentiate between exposure and consumption. The WPHP said, “I dont care about the literature” I dont feel I should have been monitored in the first place as all I have is one first time DUI with a BAC of 0.11%. I made a mistake and would not minimize it but, this was on vacation. It had nothing to do with my work. I dont feel that my career, family stability, and financial security should have been destroyed. Another disturbing thing is that when Hazelden reported “no specific problem” the WPHP refused to accept it. They demanded the facility make more collaborative calls. The final draft states, “not enough evidence for substance abuse” however, the state that I must have PTSD as I was formally a NYC paramedic for 10 years and worked in body recovery at Ground Zero for 8 mos. Sure, it was not easy but I acceted the fact that everything happens for a reason and went back to school to become a PA. Thats why I work in Indian Health; because I have come to realize life as a serious matter and strive to do something meaningful. My medical director supported me with the WPHP and reported colleague and patient satisfaction with no suspect of substance abuse. This was ignored by the WPHP. The commission refuses to speak with me on legal advice. They state there has been no report to them, my license is clear, and offered me to file a complaint against the WPHP. I asked if the commission provided any oversight. They stated no, the WPHP are the experts. What kind of a world is this becoming?! Im so scared Betty Ford has already been instructed to keep me. I dont know how I would pay for it. I dont know how my family will come out the other side. I leave tomorrow. At this point, prayer is all I have.

        • Threatened Whistleblower II says:

          Be very careful at Betty Ford. Do not let them have your credit card. Betty Ford and Promises apparently operate with the same mindset: Get the money up front and let the patient deal with insurance. I have heard of many examples of this. If the Office of Inspector General would make these places open their books, the penalties alone would make up for the costs of Obamacare; and, the investigation may alleviate the possibility that new insurance initiatives would enrich these places even more as state and federally endorsed insurance programs create opportunities for average people to enroll in facilities such as Betty Ford and Promises.

  13. Hapa HaoleaoleTerpsichore says:

    After reading the last post, I guess we should be grateful that Hawaii’s PHP seems to be much better than so many of the others. Hapa Haole

  14. Al Shuster says:

    The current incarnation of Physician Health Programs undermines the foundations on which they were built. An abusive system of coercion and control is hidden behind feigned sanctimony and make-believe scholarship this hypocritical tyranny is buggering medicine with propaganda, disinformation, and obfuscation. They are killing doctors, ruining lives, and wantonly destroying our art and profession. It’s time to draw back the curtain and reveal what’s underneath. Take off the blinkers. It does not take that much investigation to show the studies they are parading as “gold standards” are internally incoherent puff pieces with no evidence base and no substance. Speak up because you could be next.

    But see, amid the mimic rout
    A crawling shape intrude!
    A blood-red thing that writhes from out
    The scenic solitude!
    It writhes!–it writhes!–with mortal pangs
    The mimes become its food,
    And the angels sob at vermin fangs
    In human gore imbued.
    –Edgar Allan Poe

  15. RK says:

    I left a more detailed message in reply to Matthew above.

    Please check out the link below to the Federation of State Physician Advocacy Programs. Eventually, various of us are going to post our own stories of the grossly unethical and illegal treatment administered by medical boards and their affiliated PHPs. We’re also preparing a contact form so we can serve as a supportive resource to others docs.

    please see:
    http://www.fspag.org/15.html

    As I mentioned, I’m also pleased to report that the NC Office of the State Auditor is now completing a comprehensive investigation of NCPHP’s (and, to some extent NCMB’s) practices; by the end of it, more than 125 physicians, along with former board members and staff will have been interviewed. We anticipate the report, to be released in Jan 2014, will confirm the breadth of these violations. And we are hopeful that it will lead not only to immediate procedural change but further investigation.

    Feel free to contact me about these developments and, if desired, we can find a time to connect by phone:
    info@worklifedesign.us

    My apologies for the relative anonymity but the grossly retaliatory behavior of these agencies make such necessary for now. But not for long.

  16. Medical Whistleblower says:

    Please go to your local FBI field office and report your concerns/experiences at your earliest convenience. I have been assured that the FBI WILL take us seriously. There is a massive amount of healthcare fraud going on here with the FSPHP & their affliated treatment centers. I have recently provided the FBI with a list of all of the treatment centers & labs connected to FSPHP.

    • JL says:

      Are you sure the FBI will take this seriously. The MA FBI and the AGO has ignored several reports that I am aware of and there is also prima facie evidence documentary evidence that the MA PHP is committing crimes all over the internet while the perpetrators of those crimes still hold their positions at PHS, Inc. It is business as usual. One would think there would be zero-tolerance for forensic fraud but this is apparently not the case

  17. Using the fallacious argument from authority and credentialism, PHPs have convinced medical boards that physicians need to be “evaluated at a facility experienced in the assessment and treatment of health care professionals.” Sounds reasonable on the surface but a true authoritative argument necessitates legitimate expertise and expert consensus Here it is a logical fallacy because the facility the doctor ends up at has neither. Parading themselves as “the voice of addiction medicine” the ASAM physicians are not experts and ABAM “board certification” reflects neither training nor expertise. Unrecognized by the ABMS it is a self-designated specialty group and the accolade of certification amounts to nothing more than a diploma mill–all you need is an MD, $2200.00, some past experience in addiction medicine (usually being “in recovery” and 12-step involvement make the grade), and successful completion of an easy test that is mostly on 12-step ideology.
    Over the past 10 years the ASAM has grown to over 3000 physicians. Within this group there is a subset of hard core fundamentalist zealots who are to the ASAM what the teabaggers are to the GOP. 12-step fanatics who believe they are on a mission from God and saving souls. Control has replaced conduct and ideology has trumped science and reason. These are the Inquisitors who have spread out and taken over the “impaired physicians” programs. By removing dissenters this groupthink has successfully taken over under the umbrella of the FSHP. All one has to do is look at the credentials of the physicians who staff the PHPs to see there has been a dumbing down of those involved. Scholarship and expertise has been replaced by incompetence.

    From this same pool comes the medical directors of the preferred (i.e. mandated under threat of loss of licensure) “assessment” facilities. So they are essentially referring to themselves. This has created a “Lord of the Flies” type environment where the rules are made up as they go along. Fabricated diagnoses, falsification of tests, alterations of records, false imprisonment, political abuse of psychiatry are all seen as standard operating procedure. Who cares about truth when were saving souls.

    Of course the 12-step zealots are just willing gulls in the for profit 12-step rehab drug testing machine. But be it greed or misguided bat-shit zealotry its time to shut the mother down.

    http://twicsy.com/i/6RwKje

  18. EB says:

    What we need to do is expose them and hold them accountable for what they are doing. Sunshine is the best disinfectant!

    The Medical Board and Medical Society need to realize that turning a blind eye to criminal activity is not going to be beneficial in the long run for anyone. The Massachusetts PHP cannot even find any associate directors. I know a couple people who were asked and they refused because of the corruption.

    The perpetrators of the crimes must be removed and procedural safeguards must be put in place to protect physicians. Once the cancer is removed there will be no shortage of qualified and dedicated physicians to take over.

    Bottom line is the problem needs to be addressed and dealt with.

    One person who should be held accountable is the Medical Review Officers who are rubber stamping tests as positive and reporting them to the Board with no regard to standards of care. They are reporting positive tests well below cutoff levels and for metabolites from medications that are legally prescribed and medically necessary. The MRO in Massachusetts reports everything as a positive. But in Massachusetts they are also engaging in forensic fraud. There should be zero-tolerance for forensic fraud.

    It is time to turn the heat up a little bit. I have documents that show an indefensible fraud and coverup. What the documents show is procedurally, ethically, and legally indefensible.

    I have provided the MRO of record with these documents and asked him to address them directly and have asked ” Is it not also your responsibility to ‘promptly admit’ when you are wrong and ‘make amends?’ Or is it simply doublethink that allows you to sanctimoniously preach one thing while engaging in the opposite ? Perhaps it’s time for a moral inventory?”

    Of course we know how it works with “contingency management” where they have “point people” who are willing to assist them in committing fraud by suppressing, diverting, and blocking valid complaints.

    What people do not know is that the medical directors of the facilities they use as well as many of the MROs and directors of PHPs are all smart of a small subset of the ASAM who are to the ASAM what the Tea Party is to the GOP. These are all doctors in recovery themselves who think they are saving souls and do not care if they violate ethics, civil rights, and human rights in the process. It is time to identify them and get their names out in the public. Sunshine is the best disinfectant and it is time to shine a little light in this dark dank corner of medicine.

  19. Threatened Whistleblower II says:

    My family and I are experiencing veiled retaliation and subtle backstabbing that may clearly endanger a loved one’s medical career and maybe even our lives. When organizations commit illegal and immoral acts, they will do anything to avoid exposure by closing ranks and disabling any potential threats. We have tried to protect ourselves as much as possible, but we have no guarantee of our safety. In the meantime, there are more important things I must report.
    I recently learned that once specific (unregulated) recovery/treatment facilities authorized by the FSPHP have released their PHP-referred patients after mandated stays, the patients return home only to be faced with credit card statements indicating questionable, inflated charges resulting in thousands of dollars being overpaid to the recovery facilities and billed to the bankcard holders. How does this happen? As a registration requirement, these facilities demand that PHP-referred patients submit personal credit cards up front. This allows the facility to up bill, misrepresent, and falsely submit claims of thousands of dollars, thereby getting its money up front without communication with or supervision by the patients’ insurance carriers or the patients themselves. Often, this is after the facilities have assured patients beforehand that they will make normal good-faith efforts to work with patients’ and their insurance companies. Later, when patients contact their insurance companies for reimbursement, they discover how the recovery facilities had been using evasive tactics to avoid submitting the required documentation. Often this takes weeks to months of consistent contact and runaround as patients continue to be caught between the facilities who have already been paid and insurance companies who refuse to reimburse, citing lack of required documentation and/or evidence that precertification requirements were satisfied. Patients cannot precert themselves even they caution the PHP or treatment facility before they register, so this is clearly a failing of the system to provide any decent good-faith service. It also provides the opportunity for facilities to enrich themselves under the cover of confidentiality, color of law, and secrecy.
    Fortunately, patients and their families are starting to fight back. They are contacting their banks and challenging these outrageous charges, and the banks are starting to take notice. Banks and credit card companies are acknowledging patterns of suspicious charges as more and more victims are alerting them.
    This is how you can fight back. First notify your credit card company or bank concerning your bill and explain why you suspect health-care fraud. Gently remind banks that they are required to report suspicions of patterns of fraud to federal law enforcement agents. Notify your insurance companies or employers as well. Then you should notify the health-care fraud departments of Health and Human Services, FBI, and other federal enforcement agencies. Be sure to name the facilities, and report the directors and others with whom you have had to interact. Provide names, titles, addresses and phone numbers and how each person may be involved. No one can sue you over your suspicions; these are your opinions and you are allowed to have them. Also, you may be provided with some protection because you are reporting patterns that will likely fall under the Rico Act. Also report if you have encountered resistance from facilities about insurance matters or their failure to provide records. Mention if the facilities have evaded your requests for records of diagnoses by medical consultants. Again, include names, titles, reasons for consults and any other information that will facilitate investigations.
    As for your credit card companies, I believe they will go before court once they have received enough complaints from card holders. After the Office of Inspector General audits in 2012 of major banks involved in unlawful foreclosures, the banks were required to sign a statement promising to alert law enforcement of suspected fraud. This was in exchange for negotiation rights involving hundreds of millions of dollars in penalties against the major bank corporations. Most credit card companies are in some way connected to the banking industry. I guess the recovery facilities were so greedy and arrogant that they thought they had complete immunity when they insisted patients surrender their credit cards up front. Inflating charges on patients’ credit cards is just one more pattern of violations under the RICO Act.
    For so many years, doctors who have been abused by PHPs and treatment facilities have endured unspeakable hardships and assaults to their identities, feelings of self worth, families, and assets. Finally, the time for exposure and investigation is here. There is no going backward. Too much has happened, evil practices and people have been allowed to have unsupervised control over often innocent physicians; and, those objecting to the abuse have been cut down by threats of professional and financial ruin. At last, it is time the citizens of this country are allowed to see the truth. Organizations involved in systematic healthcare fraud should be reported, exposed, investigated, indicted, and punished.

  20. Bruce L says:

    The biggest challenge to dismantling this system, which is essentially front-group for the 12-step drug testing rehab profiteers engaged in organized crime operating under a veil of benevolence, is not the perpetrators themselves but the rest of us. A culture of silence has developed around PHPs. If someone is in one then the prevailing attitude is they must have done something. The organizations that should be helping are not. Complaints are simply ignored, dismissed, or tabled. This is unacceptable and the organizations need to be held responsible for their actions. There is evidence that the Massachusetts PHP is involved in criminal activity including forensic fraud, political abuse of psychiatry (i.e conspiring with a third party to falsify nonexistent diagnoses -they send you to one of their friends who is willing to fabricate data and give false diagnoses and then recommend a lengthy inpatient stay under threat of loss of licensure), and other crimes. The evidence is incontrovertible and the documentation shows indefensible fraud with clear malicious intent. It shows two separate incidents of collusion with a third party to commit fraud. In both cases a complaint was filed against the third party involved, the fraud was validated, an investigation ensued, and the third party was reprimanded. The physician who obtained these documents did so at great cost, harassment, and abuse in the process. He paid dearly for it hoping for change but was met with a community of silence and disinterest. BORM, Mass Medical Society, DPH, DOJ, AGO, were all provided with evidence showing a public health emergency and threat to the doctors of massachusetts. When the organizations who are supposed to protect and help us are ignoring the truth and allowing injustice to thrive without accountability and transparency there is a problem. We need to find out where the roadblocks are and remove them. It is incomprehensible that it is business as usual.

    • Threatened Whistleblower II says:

      A member of each of these organizations should be subjected to the same devastation and scams as current and past victims of state PHPs have been. Wait until one of their kids gets targeted.

  21. EB says:

    I have a modest proposal. 1. Take a look at the following documents. http://bit.ly/JKStBp What they show is a crime committed by the Massachusetts PHP (PHS, Inc.). A collection date and an ID # are added to an already positive specimen to report it as a positive test. It is procedurally and ethically reprehensible and it is against the law. The perpetrators of this have not had to answer to it simply because they do not have to. Where is the Massachusetts DPH? What about the Board of Registration in Medicine? The AGO, The Mass Medical Society, Governor Patrick’s office.

    My modest proposal is that someone from each of these agencies answer a simple question. Do you or do you not support what you see on this document? And if you do, then how do you justify it procedurally, ethically, and legally. What it shows is forensic fraud clear and simple. The perpetrators of this forensic fraud are still in their positions at PHS. The Medical Review Officer of PHS needs to answer to this. Either he supports it or he does not and if he does he should be able to justify it. If he does not then he needs to explain. And this would apply to any of the other sympathizers and apologists who believe that the rules, laws, and conduct of others just don’t apply to them.

    This shows a crime. It cannot be met with silence and deflection as it has so far. Just answer the question. If you can justify this gross misconduct then do it. If not then you need to do your goddamned job already!

    http://twicsy.com/i/6RwKje 2.

    • Au secours says:

      Dear EB,

      I so agree with your last statement. It should be possible to execute a writ of mandamus. I do believe Mass. has some provisions for this. Some states provide for this under Interstate Commerce Commission or Model State Administrative Procedures Act (Model State APA), but the names and procedures may be specific to each state.

  22. Threatened Whistleblower II says:

    Dear EB and Others,

    Please keep all your records. We are trying to organize for a Congressional hearing. I wish there were some safe way in which we could all get together with solid documentation. We need to go to the top. I guess appealing to local agencies and offices has been disappointing.
    Every person who has been damaged by the PHPs and the totalitarian mindset of the FSPHP needs to rally friends, family members, Representatives, and anyone else who will listen. Please report the financial crimes to your banks and the FBI. Report kickbacks, collusion, conspiracy, and other crimes as well. Have everyone call representatives and complain, offering to show evidence. We need to get a strong movement organized to hit these monsters from all sides. Most of all, we need to make sure somehow they are charged with crimes and investigated. I know of two investigative reporters for television documentaries. I will try to reach them both. But, the most important thing is to make top federal law enforcement agencies aware that the government can recover geometric penalties from violations under the RICO Act. Anyone can engage in racketeering. I believe treatment facilities such as Promises and Betty Ford are routinely using collusion, conspiracy, and falsification of data to acquire millions. This is a national disgrace. Let’s face it. Nobody cares about doctors and violations of their civil rights. Only the people who have been hurt by this evil empire are impassioned to expose these criminals. Other people either do not care or they do not want to hear about it because it does not affect them. But, if enough people report crimes involving money to the central FBI office, the FBI may finally take notice seeing as how the recovery from penalties would be in the millions. We are trying. It is so difficult to talk with all of you because of the safety issue. I wish I knew the answer to that one.

  23. Warren says:

    I have documents that reveal crimes confirmed by third party. Both involve collusion with a third party and in both cases te third party was reported to an oversight agency for misconduct, an investigation was done confirming the misconduct, the colluding party was sanctioned by the oversight agency, and forced to retract what PHS, inc asked them to falsify/fabricate. The first involves neuropsychological misconduct. PHS requested a neuropsychologist fabricate psychometric testing results to show impairment when there was none. Normal MMPI and Cognitive testing was reported as abnormal to show “denial” and cognitive impairment. Raw data obtained by MGH and found MMPI well within normal limits and cognitive testing well within normal limits (superior to very superior). Ethics Committee of Psycholigical Association investigated and forced him to “correct,” results. Neuropsychologist sanctioned. PHS unscathed however as unregulated and unaccountable. Told BORM the tests did not factor in the diagnosis ( they were the only basis of the diagnosis!)

    Second involves forensic fraud and fabrication of a confirmatory positive test that was used as a stepping stone to report to BORM and request an evaluation. Colluded with USDTL. Litigation packet shows fax from PHS to USDTL asking that my PHS Id# and a chain of custody be added to an already positive test 19 days after it was drawn. Again obtained original documents ( with much difficulty and retaliatory punishment), filed complaint with College of American Pathologists (CAP), 6 month investigation done. USDTL forced to make changes under threat of loss of CAP accreditation and forced to “correct” test. Since lab testing in PHS is not transparent and they have set it up so that physicians can have no direct communication with the lab ( under the ruse that it could “compromise” testing if doctors saw what they were testing for). Test was reversed October 4th 2012. Instead of revealing the correction PHS just didn’t tell anyone ( apparently hoping no one would ever find out), and reported me to the BORM for “noncompliance” with AA meetings ( I was forced to go to 3 aa meetings per week and provide PHS with the names and phone numbers of fellow attendees at anonymous meetings!). I found out about the retracted test in December when the Chief investigator for CAP called wanting to make sure I got a copy. I had not- instead I got suspended. PHS then said the had just found our about the retracted test and issued a letter saying they would “continue to disregard it.” Again – it was the sole basis for everything. This goes beyond criminal -it is egregious misconduct that is psychopathic , intrinsically evil, as cruel. No wonder so many doctors are killing themselves. I have proof of conspiracy to defraud x 2 that has already been investigated and confirmed plus a whole lot more– this is insurance fraud also–so why is it so hard to report a crime of this magnitude??? It is incomprehensible. These Witchprickers are a rank wart on the face of the Mass Medical Society. Throw the bumble out.

    • Au secours says:

      I just discovered that anyone who has experienced false billing, up billing, contrived diagnoses for additional financial gain,, etc., can file a complaint with the Joint Commission naming the offenders. I just learned that one of these major FSPHP-mandated recovery facilities is squirming under the scrutiny of the Joint Commission based on a physician patient complaint. We need to use every legitimate opportunity to turn the tables on these places. Work with your credit card company if you suspect inflated or false charges. Do not be intimidated by threats from the recovery facility because your contact with the credit card company encourages you report suspicions. Use the Tips Page available on the FBI web site. Now, you can even report suspected up billing to the Joint Commission as the FSPHP guidelines have promulgated the use of fair and competitive compensation recommendations, and these facilities are the FSPHP’s mandated choices. Another thing, why can’t the FSPHP be reported for violations of the Fair Trade laws? The FSPHP is directly affecting the commercial survival of facilities outside those specified by the FSPHP.
      How do they get away with these violations when other people and businesses get called up by the DOJ?

  24. Medical Whistleblower says:

    We can get change implemented by making complaints to Joint Commission as well as other agencies responsible for investigating healthcare fraud (FBI, DOJ and Health & Human Services). Anyone who is then threatened by one of these facilities can then turn around and make a complaint with the Federal Trade Commission. Business as usual is coming to an end!

    • I would like to provide some helpful hint to the newbies in our fellowship. Some pearls of wisdom to streamline our mission if I may for the assessment of physicians who by the Grace of God have been referred to our fold. If we feel a physician would benefit from our services then we must do everything in our power to make sure that that opportunity comes to fruition as we know the inevitable consequences all too well. To give the physician what could be his only lifeline to salvation I advise the following true and tested advice to you my friends on the assessment of doctors who must be assessed and treated differently from the layperson. 1. Obtain a positive drug or alcohol test and report it to the board of medicine (even if it is due to a valid prescription or below accepted cutoff levels. (cutoff levels are for amateurs–I mean it is either there or it’s not). If that’s not possible then just order an EtG and ask your friends at the lab to let the sample sit out overnight and then test it. (don’t worry the board will never second guess you. If the board does have any questions remind them that we ASAM doctors are the experts. We have esoteric knowledge other physicians do not). 2.Mandate an evaluation at “a facility experienced in the assessment and treatment of health care professionals” and give them a choice (Marworth, Hazelden, Promises, Talbott, etc.). REMINDER-NO EXCEPTIONS. 3.Obtain information to support the diagnoses. As far as collateral information it is not necessary to speak to anyone outside the circle. These doctors are experts at hiding their addictions (remember these addicts are often seen as stellar physicians as they overcompensate for their addictions. They often fool others into believing they are model physicians and hard workers (it is all just a show as staying late at the office often allows them to obtain more drugs. They often have reputations as being kind and caring physicians with good “bedside manner” but it is really a ruse to gain the confidence of patients so they can get them to bring in their prescription. Don’t forget they are master manipulators. Those they don’t fool with their fancy showmanship will just cover for them. It is a conspiracy of silence out there. Also no need to talk to family members or friends (it is safe to exclude anyone they specifically ask you to talk to) as they are inevitably biased (drinking buddies, co-dependents, partners in prescription drug diversion). So in the interest of saving time all history should be obtained from sources we trust (PHP, board members, “point people,” brothers in recovery). One pearl to keep in mind is to focus on information that supports the diagnoses and disregard anything that does not. Elaborate on the pertinent information that supports the case and dismiss, or at least minimize, the irrelevant. Tailor the physical examination and neuropsychological assessment to fit the diagnoses. Appearances can be deceiving as addicted doctors know how to hide the physical signs of drug and alcohol use (visine, breath mints, steroids, growth hormone, botox, etc). Focus on how they act-they will often appear anxious and tremulous. Above all remember the golden rule–the degree of denial of drug or alcohol use is directly proportional to the degree of use. They will throw everything at you they can to rationalize the monkey on their back and the more they fight the more guilty they are. As far as neuropyschological assessment focus on the diagnoses. Numbers don’t really matter as these smart alecs have most likely prepped themselves for the tests. To save time in this realm elaborate on the denial and give a diagnoses of cognitive impairment. Everything is subjective. Here is another pearl. Ask them to recite the 12-steps of the Big Book. If they cannot do it verbatim then label them as “cognitively impaired.” I have some templates you can use for this to justify it for billing purposes but no one never looks and they would need a court order to do so as confidentiality to protect the records of our physicians is paramount:). In order to get them help they need give as many ancillary diagnoses as possible. If LFTs are slightly elevated give them an ICD-9 of hepatitis, if they have ever experimented with drugs (no matter how remote) give them diagnoses of substance abuse. If they have ever felt sad then “major depression.” It all adds up. Once this is done be sure to put cognitive impairment and denial in the conclusions and diagnose them with SUD/Relapse. State that they cannot practice medicine and recommend inpatient treatment. Simple as that. We are saving lives. Who cares about their medical license when we are saving their souls!
      Some exciting developments over the past year. Our task force was successful in altering the DSM-V criteria so that all substance abuse is rolled into one so it is much easier now to validate the diagnosis. I’d like to thank Bob, Greg and the IBH for putting out the word on these hidden junkie physicians and the need to drug test all these doctors. Oh and thanks Greg for coming up with that PEth idea-this will hopefully bring back the EtG and enable widespread testing. The “impaired physician” program is up and running. Kudos to our two facilities in Lawrence Kansas-they are running at full capacity. The polygraph program has been very successful in rooting out these poor souls. Ours is a replicable model. Let’s expand and with Bob’s help (both W. and D. :) we will get our message to the masses one day at a time! Bless you all.

  25. One of the problems with the current PHP system is the dearth of doctors who will speak up against the abuse. Those from within have been psychologically abused to the point of “learned helplessness” or succumb to 12-step philosophy. If anyone dare speak out against the program it will fall on deaf ears and most likely result in punishment. This sends a clear message and keeps the herd in line. Those outside either buy the lie that these programs are benevolent organizations that protect the public and protect society or afraid of being brought into the fold themselves. It is a culture of silent obedience and fear. Drs Boyd and Knight mention in their article that PHS reports any and all drug tests to the Board. They report metabolites of prescribed medications, don’t believe in the concept of cutoff limits, and even fabricate tests. MROs are supposed to have integrity and follow protocol, guidelines, and the law. But with the MA PHP the “MRO” Wayne Gavryck simply rubber stamps everything across his desk. A “recovering alcoholic” one PBR away from another malpractice case he feels everyone is powerless over alcohol like he is. Being in ex-drunk who has found God does not give you the right to make your own rules. This guy should have his license pulled and be criminally charged. He is a menace to the profession–the current PHP in Massachusetts is a reservoir of bad medicine and mediocrity. It attracts bullies who are lower echelon physicians of mediocre accomplishment who feel better about themselves when they have power over real physicians from real hospitals. It empowers them to take down Doctors who they can’t hold a candle to academically or professionally. Losers with a badge

    The major goal of the ASAM is expansion and control. In addition to drug testing physicians randomly they want to expand the referral base. Currently any physician diagnosed with (or alleged to have ) a psychiatric or substance abuse disorder can be mandated to PHS monitoring. The “disruptive physician” is a current target of referral, and they are starting to promote “the aging physician and “physician burnout” as reasons for confidential referral to them to “help a colleague.”

    What I find fascinating is that no epidemiologist or evidence based medicine proponents have written criticisms of the useless propaganda they are using to promote the program as the “gold standard” in addiction treatment.

    The major campaign, as it is with all cults, is more power and control and they have plans to expand beyond physicians and gain control of other drug testing industries such as the department of transportation and federal aviation, etc. by proclaiming superiority of the PHP model. Federal Drug Testing Guidelines require strict protocol that comply with at least some evidence base, forensic protocol, chain of custody, MRO review, strict cutoff levels, rights to split sample, independent exam, etc. They want to usurp these programs by proclaiming results that just are not there. They will most likely be successful in gaining control of these organizations.

    Much like the physician drug testing propaganda, the claims for success of the PHP programs are without any basis. They took one flawed study, wrote a bunch of meritless papers about it, and misrepresented the results. What is maddening is the blind acceptance of the propoganda.

    http://www.fsphp.org/Hambleton%20et%20al%20Blue%20Print%20Study%20Handout.pdf

    They are claiming an 80% success rate but if you look at the endpoints, unlike the comparison populations, the 1 in 5 doctors who did not finish the programs lost their careers and many of them their lives.

    The ASAM, FSPHP rise to power is amazing and incomprehensible. All one has to do is look at the evolutionary history of the group (AA ideology not science), the major involved (former “drug war dinosaurs, ex-convicts who reinvented themselves, prohibitionists), the creation of the ASAM “board certification” as a sham specialty (reflects neither training nor experience) to see that this is a group with a political not scientific agenda. They are not experts in addiction medicine.
    Secondly, all one has to do is look at the primary sources of their claims to see that they are low tier opinion pieces methodologically flawed and meaningless. The alcohol biomarkers they introduced are junk science. It’s all smoke and mirrors. There is no science and no evidence base for any of it.

    • Au secours says:

      My God, what has the state of Mass. come to? I thought this state had one of the highest intellectual, educated populations in the nation. I may be mistaken, but something keeps coming across my thoughts. Was the initial PHP system started with good intentions by good people, and as the money thing came into play and ex-addicts slithered in, did the born-again sobriety of the newbies along with their atavistic, group-think subconscious criminality take over and did they rally to nudge out the good guys? Am I dreaming? What part of this whole system makes any sense at all? Why has this system not been evaluated by the best legal minds in the U.S.? Coercion absolutely negates the definition of a contract. Extortion, threats, and seizure of personal assets and freedom are all against the law. Why is anyone in the U.S. even thinking of putting up with this crap? I am ready to rally everyone into a march and demonstration against these places, especially the kickback kings associated with Promises and these ridiculous testing labs. Remember how the banks and mortgage industries managed to get away with bundling mortgages and notes into securities until three judges in this country stood up to the trend and recognized that none of this was legal? The average penalty of a banking corporation under investigation by Office of Inspector General was 340 million dollars. Just think what they could do with all the FSPHP-mandated private, high-end, “recovery” facilities. I am ready. Just tell me where I need to be.

  26. WM says:

    Agreed. The financial conflicts of interest are mind-boggling. Transparency, accountability, and regulation are urgently needed. A culture of silence has developed—the problems are not mentioned, discussed, or acknowledged. If someone is referred to a PHP the underlying assumption is that they must have done something to deserve it.

    Accountability is not simply about compliance with laws and industry standards but rooted in organizational purpose and public trust. The best available evidence provides little support for the alarmist misinformation about the plague of hidden junky physicians contributing to medical error and other mayhem necessitating widespread drug testing of all doctors. It is simply unfounded. Pronouncements masquerade as science in misleading public relations campaigns.

    Antithetical to the rules of science which require the free exchange of information and opinion in pursuit of truth, these organizations have increased opacity and successfully deflected scrutiny and oversight. They answer to no one. They use the addict or disruptive physician label as a means to disregard the claims of the accused. Delegitimize one’s opponent to avoid addressing the substance of the argument.

    There is also a dismissal and distortion of data and disregard for evidence based medicine and science in favor of positions dictated by religion and spiritual “recovery. And what is most concerning is how readily those both inside and outside of medicine have accepted this. Torture and torment are a small price to pay when it comes to protecting the public and saving souls. Proof by anecdote. All justified by creating a moral crusade or moral panic, the communal good has been assailed. Fervent proclamations Under the guise of scholarship in order to increase the grand-scale of the hunt.

    Drug testing and substance abuse evaluation requires professional competency and professional ethics. It should be based on science and critical reasoning. If I am a bus driver for the MBTA and am referred to employee health and given drug test rules and protocol are followed. Cutoff limits, MRO review, and procedure and protocol are maintained. In addition the drug testing is based on sound science and established testing. There is transparency and predictability. In addition, if I am an MBTA bus driver and do have a substance abuse problem I have a choice in my assessment and treatment.

    If I am a physician, however, and am referred to a PHP I have no choice. There is no one to enforce cutoff limits and procedure and protocol and they can test me for anything they want. Hell, they can throw me in the Charles to see if I float if they wanted to. They can use the junk science tests they introduced, proselytized, and marketed. and no one will bat an eye. No transparency. Everything filtered through the PHP including the lab results. They can disregard standards of care altogether if they want. And if there is a substance abuse issue then they dictate where I go and it is inevitably one of a short list of 12 step facilities they choose for me. No exceptions. Lifelong monitoring, prohibition, and 12-step indoctrination.

    They are also claiming an 80% success rate of the PHP program and parading it as a “replicable model” of “sustained recovery,” based on another non -blinded methodologically flawed study with false endpoints. Parade and swagger. By using termination from the PHP and similar outcomes as endpoints in the 20% who didn’t complete the 5 year program they were able to effectively hide all of the suicides that occurred. Forced indoctrination and bullying kills. Time to wake up.

    “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).

  27. Aldous Huxley said that the “surest way to work up a crusade in favor of some good cause is to promise people they will have a chance of maltreating someone. To be able to destroy with good conscience, to be able to behave badly and call your bad behavior ‘righteous indignation’—this is the height of psychological luxury, the most delicious of moral treats.” (Chrome Yellow 1921).

    There is a recent medscape article entitled “Drug Abuse Among Doctors; Easy, Tempting, and Not Uncommon”
    The writer is a freelancer who is paid by corporations to write articles that promote what they are selling. This is copywriting, folks, not investigative journalism. Marketing disguised as journalism. ASAM FSPHP propaganda to sell the “new paradigm” of addiction medicine as described here by Robert Dupont to DATIA (Drug & Alcohol Testing Industry Association) http://bit.ly/1eCO7U7 to rally the troops to war. Oratory propaganda worthy of 1930s Berlin.

    Likewise, the puff piece in medscape is mere shill in the witch hunt. The junkies in the OR are here, they are hidden, and they are dangerous. They are everywhere.

    The small study ( n =55) they mention in the article was done by Lisa Merlo who is the Director of Research for the Florida PHP and all of the physicians interviewed are all part of the inner circle of ASAM like-minded docs (Seppala chief medical director Hazelden, Fogarty Minn Medical Board, etc). Addiction is a serious and devastating disease and needs to be treated as such. Doctors need to be evaluated by competent, caring, and unbiased professionals not witch hunters and profiteers with an agenda.

    “They’re often described as the best workers in the hospital,” he says. “They’ll overwork to compensate for other ways in which they may be falling short, and to protect their supply. They’ll sign up for extra call and show up for rounds they don’t have to do.” Physicians are intelligent and skilled at hiding their addictions, he says. Few, no matter how desperate, seek help of their own accord”

    “My God they look just like us”. “We had no idea.” .Problem is a large number of doctors referred to these programs are not even addicts. A “one-off,” situational factor, DUI, false allegations, jealousy, competition, sham peer review–any number of variables can bring you to being reported to a PHP (the guaranteed immunity and confidentiality provide no disincentives for those so inclined). And if a doctor bullied into one of these programs ends up killing himself because he has no help combatting the injustice it is attributed to the “disease” he never had in the first place. Bullied into hopelessness with no voice and left with no shred of hope this is occurring all over the the country. It’s has occurred in medical students and doctors nearing retirement and it is inevitably swept under the rug by the medical community–attributed usually to suffering in silence with depression, not seeking help, “burnout,” or some other unidentified unknowable melancholy. But it is never never attributed to the actual cause–bullied helplessness by the band of PHP zealots who loaded the gun and pulled the trigger. How much longer must this go on. The writing is on the wall. All one has to do is look at who they are and what they are claiming to see the emperor has absolutely no clothes and it is a pack of lies.

    Robert Dupont (White House drug chief, 1973–1977, ASAM, FSPHP) is one of the primary architects of the Physician Health Program system. He and other ASAM FSPHP physicians claim this as a “replicable model” and “paradigm” for treatment of addictions.
    Dupont and Peter Bensinger (DEA chief, 1976–1981) run a corporate drug-testing business. Their employee-assistance company, Bensinger, DuPont & Associates, the sixth largest in the nation and they plan to to improve this status.

    Introducing and promoting junk science and proselytizing the 12-steps he and his associates produce a plethora of pulp fiction and publish methodologically flawed opinion pieces masquerading as science that they then use as stepping stones to support successive self-serving positions.

    A recent artice published in an ASAM incubated journal Alcoholism: Clinical and Experimental Research, promoting the PEth test to confirm drinking in physicians being monitored by the Alabama Physician Health Program who tested positive for EtG/EtS alcohol biomarkers is co-authored by Dupont, Greg Skipper, and Friedrich Wurst. Skipper introduced and proselytized the EtG as he is now doing with the PEth test and Wurst has a patent for EtG/EtS testing.

    If you google these programs all you find is praise. But where is the evidence? There really is none and all of the studies are small, flawed, biased, non-blinded opinion pieces like the one mentioned here. Why no Cochrane review? Why no IOM conflict of interest scrutiny? The studies are knee slapping laughable. Lord of Flies feral children pretending to be doctors. Laissez -faire reservoirs of bad medicine with an all access pass who say and do whatever they like without opposition. It is a swaggering parade of propaganda, misinformation, and logical fallacy. http://bit.ly/MViJdF

    If the studiers involved beta blockers or statins they would be be ripped to shreds the next day in every way possible. The drug testing industry and inpatient rehabilitation racket are multi-billion dollar businesses also. Perhaps someone should contact Marcia Angell and see if she is looking for ideas for a new book.

    But no one dares cast any doubt here. The ASAM gives them a pass as do the State Medical Societies. Is it any wonder that State Medical Society Membership is on the decline. These societies are supposed to represent physicians not special interest groups. In Massachusetts I know of many members who have not renewed in the State Medical Society specifically because of Physician Health Services, Inc. They are a wart on the face of an otherwise exemplary and historically significant institution. It is very sad that these incompetent marauders are not only destroying physicians but pillaging the institutions representing the professions revered and sacred ideals of compassion and excellence. When the PHS Medical director, Steve Adelman, revealed what was underneath the public patina and opined that “marijuana withdrawal” contributed to the Boston marathon bombing it should have raised some red flags. There goes this years medical student and resident membership enrollment campaign. An embarrassing indiscretion that revealed the distorted groupthink behind this non-tranparent, unregulated, unaccountable band of misguided prohibitionist zealots.

    PHS was once an organization of benevolence and critical thinking when it was staffed by the likes of John Fromson, John Knight, and Wes Boyd. Perhaps this is why the MMS has not acknowledged the problem. They see it for what it was. Self-deception. Perhaps they have been bamboozled by the staff of PHS and actually believe that PHS is serving the Commonwealth of Massachusetts by protecting the public and helping sick doctors.
    Or perhaps they have gradually accepted some of the groupthink of PHS and accepted so called noble corruption as a worthy cause. Maybe they have been swayed by the propaganda and misinformation campaigns promoting the PHP model and believe the hidden cadre of drunks and druggies in smocks are contributing to medical malpractice and mayhem and that the “disruptive” physician epidemic is disrupting our profession. Desperate times require desperate measures.

    But zealots with absolute power are never satisfied. They substance abusing and disruptive physicians are just part of the grand scale of the hunt. The ASAM/FSPHP is behind the move to randomly drug test all doctors. Skipper, the pied piper of EtG who has created a cottage industry out of junk science, was co-author on the JAMA article supporting this nonsensical idea that should it come to fruition will stifle both the art and science of medicine. The FSPHP will be in control in a scaffold beset by corruption.

    Modern medicine will be run by admonitory and prohibitive few. Doctors will be easily removed for political views, speaking out, independent thought or resisting authority. There will be accelerated abuse of the disruptive physician clause and increasing use of sham peer review.

    The next target for the FSPHP is the “aging physician” http://www.fsphp.org/Aging%20Physicians%20V5.pptx

    So a word to the wise. The time to act is now because before you know it it will be too late. Any dissenters in a few years will be subject to the same stigmatization, humiliation, and injustices as todays alleged addicts and disruptors based on age alone–vulnerable to the same corrupt testing and assessment. Delegitimized. Political abuse of psychiatry. Psikhushka. Ignoble career ender at twilight.

    The Massachusetts Medical Society has always been based on a foundation of the highest professional and ethical standards. Its mission to advance medical knowledge and promote the best healthcare possible has been accomplished for over two centuries by physicians of competence, care, scholarship, and honor.

    As the oldest medical society in the United States the MMS can count some of the greatest medical minds in history as members such as Dr Oliver Wendell Holmes.

    Before the Boston Society for the Diffusion of Useful Knowledge in 1842, Dr. Holmes delivered two long lectures entitled “Homeopathy and Its Kindred Delusions.” He characterized one of its popular practitioners, Dr. Robert Wesselhoeft, as one of those “Emperics [quacks], ignorant barbers, and men of that sort…who announce themselves ready to relinquish all the accumulated treasure of our art, to trifle with life upon the strength of these fantastic theories.” That “pretended science” as Holmes called it, was “a mingled mass of perverse ingenuity, of tinsel erudition, of imbecile credulity, and artful misrepresentation, too often mingled in practice…with heartless and shameless imposition.”

    He may have well been describing the current incarnation of PHS, inc. All one has to do is look at the career accomplishments, teaching, publications, research, and reputations of Fromson, Knight, and Boyd and contrast it to that of today’s roster to see that this once grand organization has morphed into decay. It is a dishonorable bastion of incompetent power and paternalism. A petty tyranny. Many physicians dare not speak the truth for fear they will be targeted. It is a culture of silence and fear.

    But if we don’t individually speak up and collectively demand the same level of ethics and professionalism we do for everything else this will certainly come to fruition. It is time we work together to advance systemic changes before that door closes for good.

    • Au secours says:

      Topic of interest: Google “Soberlink alcohol monitoring system” and “Dr. Greg Skipper.” The same old gang is promoting a new breathalyzer system with the same old pseudoscience in clinical trials, etc. I just heard that Dr. Skipper gave a patient at Promises a business card for Soberlink. The name on the card was that of Dr. Skipper’s daughter. Skipper told the patient to give her a call and she would set him up. Conflicts of interest continue to be business as usual.
      If this should happen to you, please turn these people in.

    • Au secours says:

      By the way, are not Drs. Skipper and DuPont aging physicians? How do we know that they themselves are not victims of age-related dementia?

      • EB says:

        Senile dementia with megalomania delusion in Dupont-:) But more likely possibly sociopathic personality disorder. He seems to have no contrition over all of the deaths of teenagers in the Straight, inc. abusive teen rehab programs he was praising in the 1980s in the same manner as the PHPs today. As with PHPs many of them were not even addicts but kids caught with a bong or some other typical teenage occurrence. He rationalizes any drug use warrants barbaric brainwashing.

        Skipper–definitely sociopathic personality disorder. He has no compunction or regrets about introducing the EtG and pulling his arbitrary cutoff level of 100 out of a hat and deeming it proof of drinking. Any forensic test development needs thoughtful consideration of pharmacokinetics, pharmacogenetics, cross-reactivity, specificity individual metabolic variations, etc. But this guy just pitches an idea and markets it to a drug testing lab and starts using it. In vivo studies are not even required for these types of tests. The cutoff rises 250, then 500, then 1000, ….1500. How much devastation did he leave in his wake –ruined careers and lives because he was able to get to market junk-science as forensics. It’s like claiming an elevated Hemoglobin A1c is proof of cotton candy or an elevated LDL proves fried beef liver. He never apologized or tried to make amends to the EtG victims. He just moved on and turned it into a cottage industry testifying for whoever would pay him. And now he is doing the same thing with the PEth test. No evidence based science. Small studies that just show there is a relationship between drinking and PEth without consideration of all they myriad variables that could also play into phospholipid metabolism. He is also an anti-circumcision nut on par with Heidi Fleiss’ dad for some reason.?? But check out his bio below–he takes no responsibility. In 1990 “little was known about treating chronic pain.” ??? He States there was no physician health program but Oregon did have one during that time. He blames his criminal charges “an overly zealous Chief of Police.” He seems to take no responsibility for any of his actions at all which is quite revealing.

        “Straight, Inc. is the best drug abuse treatment program I have seen, anywhere. Lest there be any doubt that this is an accolade I have bestowed easily or casually, I can tell you that I have not said that about any other program.”
        The above quotation is excerpted from a presentation by Robert L Dupont, M.D., President of the American Council on Marijuana, Inc., given at the First Annual Awareness Banquet, Straight, Inc. Atlanta, October 17, 1981.”

        http://survivingstraightinc.com/FloridaGovernmentDocuments/StraightPropaganda/Epidemic-No1-Straight-newsletter-Denial-page1_Combine.pdf

        http://bit.ly/1e5DIAr

        Greg Skipper, MD
        Fellow, American Society of Addiction Medicine
        Medical Director, Alabama Physician Health Program

        Substance Abuse History
        Because of a leg fracture in 1980 and because of ongoing knee pain following surgery Greg Skipper became dependent on pain meds. He was eventually confronted and went to treatment for substance abuse. Because of ongoing problems he had further trouble taking pain meds and in 1990 he was confronted about using pain meds from his office and the hospital. In those days, little was known about treating chronic pain and there were no Physician Health Programs therefore Dr. Skipper was disciplined by the Oregon Board of Medical Examiners and his license was temporarily revoked. Because of an overly zealous chief of police charges were filed and he eventually pled guilty to a class C felony of possession of a controlled substance. After three years of probation the felony conviction was set aside. The Oregon Board allowed Dr. Skipper to return to the practice of cardiology. Dr. Skipper worked partime in indegent clinics in the USA and Central American. He also volunteered and spent time working as a volunteer physician in Africa. Dr. Skipper eventually went into the field of chemical dependence treatment. He believes in accurate diagnosis for substance abuse and dependence, proper treatment of chronic pain, and accountability.
        Dr. Skipper has devoted his life and talents to attempting to make things better for pain patients and for those with addictions. He was selected by the Oregon Board of Medical Examiners to help develop the guildelines for the first professional “Diversion Program” in Oregon. Dr. Skipper worked with the Psychiatry Department in Oregon and developed the first Addiction Fellowship at the Oregon Health Sciences University. He has volunteered to work with the FDA, and the Center for Substance Abuse Treatment in Washington DC. Dr. Skipper has brought fairness and consistency to the Physician Health Program in Alabama.

  28. Kimberly says:

    I am a registered nurse, and I am caught up in the same predicament as all of you. I was reported to the board of nursing for a blood alcohol level of 0.02 upon arriving at work (1 hour before my shift was to start). Since that time I have had to do a 90 day treatment, and I am tested randomly 3-4 times a month. This will go on for 5 years. I am about to lose my house. I have already lost my car. Alcohol is not illegal, but I cannot even have a drink on my day off, or more time will be added to my “sentence”. I feel completely for all of you. I am also one of the “lepers”.

    • Au secours says:

      Kimberly,

      I am so sorry you are facing this. Someone was apparently out to get you to pull you off service by testing you one hour before your shift.
      I have heard of too many cases of retaliation and false charges. I have also learned that the physician wellness “suits” occupying cushy hospital admin jobs as opposed to doing clinic in the trenches will tend to pick on the professionals who cannot fight back and who do not have the political or financial clout to object. They apparently need to send someone to the PHP to justify the continuation of their admin jobs. I am almost certain they will never send their hospitals’ high-income-producing docs or those who have had time to know where the bodies are buried. I am amazed how often the younger or non-political professionals are singled out. I have learned of many cases in which the targeted physician was a patient advocate; also reported were cases in which a medical error resulted from incompetence and blame was falsely attributed to the doc who actually saved the day. As long as someone else has something to gain at another professional’s expense and admin refuses to investigate false claims, respectable but non-political professionals will be conveniently shuffled off to state PHPs just to keep everyone happy.
      By the way, if they tested you for alcohol did they also test every medical professional on staff during your shift? I wonder if the hospital ever thinks to test the “physician and medical personnel wellness” director? He or she, too, can pee in the jar.

  29. Essentially unknown to the general public and most of the medical community, the current Physician Health Program model is a paradigm of profit, profit, and prohibition. Built on propaganda, misinformation, and pretense, these programs are run by corporate front-groups for the drug testing 12-step rehabilitation industry and have become reservoirs of bad medicine and groupthink. Control has usurped conduct and 12-step indoctrination has replaced critical reasoning, science, and common sense. Strategic lobbying and loopholes in existing laws and regulations have provided them a cover of immunity and impunity. Irrational authority with absolute power they rely on secrecy and deflect scrutiny.. They are opaque, accountable to no one, and unregulated. Reports of ethical violations, coercion, threats, false diagnoses, forensic fraud, and criminal activity are occurring across the country. These anti-science inquisitors and self-appointed experts embrace junk science and pseudoscience if it furthers an agenda and maintain a pervasive climate of fear. Disregard for professional guidelines, standards of care, and diagnostic criteria are standard operating procedure. The conflicts of interest in this new paradigm are staggering. But even more staggering is the fact that this was all done without any meaningful opposition and how readily cooperating political authorities, administrators, bureaucrats, and board members have accepted each successive position used to erect the scaffold, shape orthodoxy, and set the standards. Willing gulls they have been swayed by logical fallacy.

    The next target is the “aging physician.” I just hope some of the old toilets in administration and regulation who turned a blind eye to the complaints of the “impaired” and “disruptive” physicians thinking “those hippies deserve it” get their comeuppance. In a couple years they will be able to pull any doctor in over 60 for a “cognitive assessment” and deem them demented. Let’s hope they do as the old farts deserve it!

  30. Roger Rodriguez says:

    I just read a really good book on hysterical drug policy by Dr. Carl Hart of Columbia University. (HIGH PRICE) These folks have America brainwashed and this isn’t the first time they’ve used the same old playbook to get rid of folks wise enough to say WHOOOA PARTNER! If you get rid of all the Old doctors all you’re left with are the one’s so deeply in student loan debt that they are afraid to speak up. I’m so fed up with hysterical responses to this faked threat, “drugs are destroying America”, my butt! The massive amounts of money being spent on the war on drugs is pervasive corrupting researchers, physicians, law enforcement and politicians. THANK YOU speaking up. (I’M NOT affiliated in any way with Dr. Hart btw his book is cogent to this discussion and it’s FACT Based.)

  31. UD says:

    I was sent to the NCPHP for evaluation of Anger Management. They test my urine for alcohol and decided I have an alcohol problem. I refused to sign their draconian contract and have temporarily had my privileges suspended. I am awaiting my final fate at this time.

  32. anonymous says:

    I am having problems too. I have been sober for years, no relapses. No false positive tests, nothing to indicate a relapse. However, my PHP is keeping me out of work because they have concerns. Very difficult times, but I will prevail.

  33. Help says:

    I am now succumbing to the power and fear that the PHP has over physicians. I am not even board certified yet. I have finished my internship and moved to PA to finish my second and third year of a FM residency. I actually planned on coming here much sooner for residency but they wanted legal documents regarding a felony for falsifying a police report. Long story short I was a victim of an armed robbery and shot. The detective on my case had a personality conflict with me and found anything he could charge me with so he found discrepancies in my story. Granted I was interviewed in the ER after being shot with pain medications on board. No telling what I said. After much legal advice, it was decided to wait until the charge had been expunged in order to proceed. After the expungement, I reapplied checking NO to the box that states have I ever been convicted, etc of a crime. They worked off of my old application. I had already committed to a program so I sent them the letter stating that the charge had been expunged. On that letter it stated that I was originally charged with possession of a handgun while under the influence which was dropped in court secondary to lack of evidence. They now have made me go and have an evaluation for substance abuse. I have now had 2 urine tests that were negative but they decided to do a Peth test which I am sure will be positive because of the literature I have read. Just 7 ETOH drinks in one week will create a positive result. I am now in limbo awaiting my fate from this evaluation. Has anyone had any success stories fighting these giants or will I just have to kneel and take the lashes?

  34. Natural cynic says:

    I had an evaluation with a PHP last week because of a 6 year old DUI that I got before even going to medical school. I got sent for a 3 day evaluation at one of those “approved centers”, draining my pocket of all my savings. I haven’t had a single alcohol related problem since the DUI and they couldn’t find any evidence of dependence or abuse despite calling my friends, family, employer. I was shocked when they recommended treatment! The treatment center had a very long discussion with the PHP immediately before calling me in to hear my sentence, and I suspect that the PHP was pushing for hard time and some funny shit went down behind closed doors.
    I told them No Deal, and brought all of my issues with the process to the table. They didn’t budge, so I checked out… at that point I thought I was going to have to leave medicine.
    To my surprise, they later called me offering a year long monitoring contract instead of treatment. I have no clue what changed their minds. Maybe it was how emphatic I was when I told them I don’t have a substance abuse problem; some of the other DRs I met during the process started to agree when the clinicians insisted they were addicts. The DSM 5 criteria for a substance use disorder is not at all strict… pretty much any single overuse at any point in your life will earn you a diagnosis, and then they can stretch that to justify “treatment”. But then again, I don’t know if continuing to insist you don’t have a problem helps, because I also got told I was in denial and that they felt like I was hiding things from them!
    The lack of oversight and the lack of evidence for efficacy with these programs is very troubling. Perhaps even worse, there seemed to be a general opinion that physicians shouldn’t use even legal substances recreationally. They seemed to feel justified in monitoring what we do in our leisure time. It’s a violation of civil liberties and basic human rights… we are not public property.
    I feel very deeply for those of you who are going through this or facing this. I am telling everyone I know about what I went through… no shame. This is straight gangster behavior, it needs to be stopped, and transparency is the only way to do it. Email me at mnm.msm at Gmail dot com if anyone knows of any action around this, because I want in.

  35. anon says:

    I have a question regarding a recent evaluation initiated after applying for a medical license. I have had 2 DWIs in the distant past-over 7 years ago. I have not drank since then. I was evaluated by a PHP prescribed SAP and had the appropriate blood and urine collected. I know the labs will be negative. As long as the evaluation was okay will they require further involvement in the program?

  36. J W Boyd says:

    Hopefully they will not require anything more but you never know. I wish I could be more positive.

  37. Jonathan says:

    The 12 step zealots have also infiltrated the FAA and Human Intervention and Motivational Study (HIMS) for commercial airline pilots. One DUI, or even self disclosure, is a coercion gateway into twelve step coercion and extortion. An affected pilot is referred by means of a peer monitor (12 step ideologue) to one of several treatment centers with PHP medical directors that report directly to the FAA and peer 12 step monitors. Therapy consists of forced participation in 12 step meetings billed to insurance and step work counseling sessions with AA therapists who bully, threaten, and suppress any dissent. If the efficacy, appropriateness, or patently ludicrous dogma of the therapy is questioned, a patient is assigned the pathology of denial, delusion, self will, anger, and intellectual pride. This is harmful to an individual struggling with depression and detrimental to the psychological well being of a person seeking legitimate help. Operating under the cloak of anonymity and benevolence, these ‘professionals’ have your credentials in their hands. Fail to attend meetings, walk the walk, or talk the talk and your medical credentials are in jeopardy. An affected pilot is told three AA meetings weekly or the FAA will deny your application for medical re-issuance.

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