Doctors fear controversial program made to help them | Feb. 14, 2019

Doctors fear controversial program made to help them | Feb. 14, 2019

https://www.idealmedicalcare.org/doctors-fear-phps-why-doctors-will-not-ask-for-help/
Many say a controversial program designed to help doctors with mental health issues is out of control, destroying careers and causing some doctors to commit suicide.
 

In 2017, he had a newborn at home and a packed schedule as an anesthesiology resident, on top of a sleep disorder stemming from an injury he got serving our country as a soldier overseas.

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

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

The questions came after months of exhaustion for Hammen.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Doctor left destitute after seeking help from PHP | May 21, 2019

Doctor left destitute after seeking help from PHP | May 21, 2019

A program designed to help depressed and addicted doctors has been blamed for ruining lives, and even driving some physicians to suicide.

You may think doctors have it all: education, status, money.

But now they have something else: the highest suicide rate of any profession.

For months, the I-Team has been exposing a state health program that’s supposed to help addicted or depressed doctors.

But what the I-Team found out about that program has many doctors questioning if it’s doing more harm than good.

For thirty years, Bob was a small town Missouri doctor. He asked the I-Team not to use his full name to protect his family.

“All I ever did in my life was play hockey and practice medicine,” said Bob.

Yet, while he was busy healing others, Bob admits he struggled to heal himself.

“My father I knew, I always knew had depression. I think I inherited some of that.”

For decades, his fight was a private one. Bob managed pill by pill with anti-anxiety medication.

“It was a low dose Benzodiazepine. I never took more than the prescribed amount. I found that helped me more than anything.”

One day, Bob’s supervisors at the small hospital where he worked offered him a lifeline: confidential treatment for his problems. 

“They wanted me to speak to the gentleman in charge of the physicians health program in Missouri.”

The idea behind the Physician Health Program (PHP) is to help doctors with addiction or mental health issues get well and return to practice.

But here’s the catch: once you seek help from the PHP, you are no longer in control. The PHP decides where you get treatment, no matter the cost or distance. The Missouri PHP contracts with “preferred centers” around the country. The I-Team found many of those centers are also significant donors to the PHP industry group.

Former PHP leaders and whistleblowers have expressed concern that the “preferred” centers have no special qualifications to handle the doctors that are often forced into their care. 

Perhaps most concerning about the program is the overwhelming control the PHP has over the doctors in the program.

If you fail to follow the PHP’s recommendations, the Missouri Board of Healing Arts can choose to suspend or even revoke your medical license.

But Bob had never heard of the PHP, and he said he certainly wasn’t worried about it.

“I thought, well, sure, why not? I mean, what do I have to hide?”

Bob was told to report a “PHP-preferred treatment center” in Lawrence, Kansas, to be evaluated. The center advertises its expertise in dealing with professional burnout.

But the problems began before he even arrived.

“At that point, they wouldn’t let you take your medicine. So I started to withdraw from the Benzos.”

Addiction experts say trying to kick a drug habit cold turkey can be dangerous. Bob said he experienced seizures, sweats, and said he felt like he was going to die.

“They didn’t seem to have any idea what to do with me. Finally, I said, ‘I need help or I’m going to die.'” said Bob.

He said the other doctors at the facility then drove him to get help.

From there, a nurse from the center escorted him on a plane to Atlanta, where he was put in yet another “PHP-preferred center”.

Bob was no longer in control of his own life.

So why didn’t Bob just go home?

“I thought I had to do it. I was afraid I would lose my license,” said Bob.

Bob said all that PHP-mandated treatment cost him his life savings, around $50,000 and a wasted five months.

He said the program did nothing to treat his biggest problem: depression.

“Being off the benzos exposed more of the depression. And that was OK. But they never changed the treatment. They did a lot of group therapy. They asked you, ‘Hey Bob, how are you feeling?’ And I just said ‘Terrible. I feeI terrible. I don’t feel well.’ And they’d say ‘OK, well thanks for sharing.'” said Bob.

Bob did everything the PHP demanded.

Released with a clean bill of health, he said he still wasn’t allowed to practice medicine. In fact, Bob said the PHP required him to sign up for five years of monitoring.

“[The Executive Director] just said, ‘Well, here’s the agreement. You got to sign it and you’ll be going to meetings, you have drug screens and on and on and on.’ I had no idea about the cost,” said Bob.

At roughly $1200 a month, Bob quickly learned he couldn’t afford it.

“If I was working, it would’ve been chump change, but I slowly descended into a state of poverty. All my savings were used up paying for all these things. I lost my farm, home.”

The very program that pledges to return physicians to “healthy, professional, functioning” didn’t want to help Bob if he couldn’t pay.

And because he couldn’t afford the mandatory drug screenings and doctors visits, he was in violation of his PHP contract. So, Missouri’s board of healing arts revoked his medical license.

“My life was ruined.”

“The PHP is not a life preserver for a physician,” said Mark, a former attorney with the Kansas medical board. He once worked side-by-side with the PHP.  Now he helps doctors who find themselves stuck in the program.

Mark agreed to speak with us without revealing his identity.

“[Doctors] lose their money, their investments. They spend their retirements. And sometimes it comes at a cost of losing their house. Sometimes even a greater cost of losing their family.”

Mark said he even knows of doctors who have committed suicide after getting treatment from the PHP.

In February, the I-Team detailed the story of Dr. Greg Miday — a St. Louis doctor at Barnes Hospital who committed suicide in 2012. Miday’s family said last call before committing suicide was to the PHP. Miday’s mother said PHP staff refused to allow Miday to check into a rehab of his own choosing. 

The I-Team traveled to Jefferson city to share Bob’s ordeal with State Senator Jim Neely. Neely is one of only two doctors in the Missouri legislature.

“Now I think maybe it’s gotten out of control. I guess I’d be curious about an audit of this particular area,” said Dr. Neely.
I-Team: is that something that you would feel comfortable championing?
“I will, I will look at this. I need to talk to Dr. Direnna.”

Neely’s friend, Dr. Jim DiRenna, sits on the board of the PHP, and the state medical board. In early April, we caught up with him in Jefferson City.

First, he agreed to speak with us.

But then he stopped answering our calls.

And to our surprise, State Senator Neely had suddenly changed his mind about looking into the PHP, saying that he was “focusing on legislation” instead. This is Dr. Neely’s last year in the legislature.

DiRenna and Neely are just the latest state leaders to avoid questions about the program.

A few months ago, after repeated requests for an interview, we tracked down Bob Bondurant, the executive director of the PHP, outside of his home.

I-Team: why are doctors so afraid of the PHP?
Bondurant: “Hey, call Pat Mills, he’s my boss.”
I-Team: we’ve spoken to Mr. Mills and he hasn’t answered our questions.
Bondurant: “This is embarrassing! I’m calling the police.”
I-Team: why don’t you give doctors a choice about where they can get treatment?

Bondurant did not answer any of our questions, and neither has his boss, Pat Mills. Mills is the Executive Vice President-Elect of the Missouri State Medical Association, the non-profit that runs the PHP.

These days Bob survives on social security.

“All my savings were used up paying for all these things. Um, I lost my farm, home.”

Forced to live in squalor in a small, borrowed and non-functioning RV with several pets.

“There really isn’t any running water. I have to use a chemical toilet outside.”

A career dedicated to caring for others is gone for good.

“I think if it weren’t for my faith as a Christian, I think I would have committed suicide. It’s just such a dehumanizing program,” said Bob.

Bob said he eventually did find great treatment for his depression but he had to do it on his own after the PHP dropped him. Bob is currently looking for work at Walmart and other retail shops.

Since our first investigation into this program, several states have taken action to install more oversight over their PHPs.

Massachusetts is planning an audit of its program, and Louisiana and Colorado have been also been discussing changes in the legislature.
Efforts are also underway in Missouri to start a class-action lawsuit against the program and some of their “preferred” centers.

Any physicians seeking help should contact the Center For Physician Rights.

 
NC doctors, patients still don’t trust medical watchdog | May 17, 2019

NC doctors, patients still don’t trust medical watchdog | May 17, 2019

Medical watchdog under fire from doctors
 

CHAPEL HILL, N.C. (WTVD) — A group of North Carolina doctors and their patients are claiming the state’s leading non-profit medical watchdog is not fulfilling its mission and instead unfairly treating physicians and the people relying on their care.

The complaints are directed at the North Carolina Physicians Health Program, whose website says the organization “assists health care providers with substance use disorders, mental health issues, burnout, communication problems and other issues that may affect their ability to deliver optimal care and services to their patients.”

 

The NCPHP, whose financial supporters include the NC Medical Board, assessed nearly 1,000 patients between 2014 and 2018.

‘This can’t be real’

Ginny Dudek, a Chapel Hill resident battling Lyme Disease, tells ABC11 the NCPHP right now is assessing her physician and the process has prevented the doctor from seeing patients.

“I’m a retired nurse and I’ve seen lots and lots of doctors in my life,” Dudek says. “She’s irreplaceable. This can’t be real, this can’t be happening. She’s a good doctor.

ABC11 has spoken with the physician and is choosing not to name her.

 

“Never once was there an indication that she wasn’t really sharp,” Dudek adds. “I’m being denied access to my healthcare, to the healthcare that I need and to the healthcare that has returned me to that state of health.”

According to the physician, the NCPHP received an anonymous complaint against her, and assessors are now accusing her of being an alcoholic and that she puts herself in dangerous situations. The physician adds that she was ordered to attend a four day treatment program at a drug rehab center in Virginia – on her own dime – and then a 28 day program followed by monitoring.

The physician, who is rejecting the diagnosis and has not completed the 28 treatment, says she is being “strongly advised” by the NCPHP and NC Medical Board “not to practice” medicine until further notice (ABC11 cannot verify those claims because NCPHP cases are confidential.)

Complaints lead to state audit of NCPHP

Dudek’s doctor is one of several physicians reaching out to the I-Team expressing concerns about the NCPHP and detailing prior engagements with them. Two physicians, who spoke on condition of anonymity, tell ABC11 they chose to relocate to another state to practice medicine instead of following the NCPHP’s recommendations for treatment.

“They told me that I would lose my license,” a physician recalls. “They refused to accept my clean bill of health.”

Dr. Jesse Cavenar, a former Duke professor and Chief Medical Review Officer for the U.S. Army, says he’s been working with “dozens” of physicians who are trying to navigate the NCPHP process.

“Radiologists, anesthesiologists, internal medicine, surgeons, you name it,” Cavenar says in an interview with ABC11. “There are some physicians who deserve to lose their license, and I’m not contesting that for a minute, but if there’s a diagnosis being made that doesn’t meet muster and the guy loses his license about that, that’s something else. I think that’s very wrong.”

Cavenar’s accusations of false diagnoses helped lead to investigation by the North Carolina State Auditor’s Office. In a performance audit released in 2014, NC Auditor Beth. A Wood reported no evidence of abuse of financial impropriety, but NCPHP’s rules and regulations “did not provide reasonable assurance that an abuse of authority would be prevented or timely detected if it occurred.”

In other words, investigators couldn’t prove something nefarious was going on, but at the same time there was no definitive way to negate the accusations either.

 

Among its many findings, the audit would go on to report the NCPHP “did not have objective, impartial due process procedures for physicians who disputed the Program’s evaluations and directives,” and there was not any “reasonable assurance that physicians received objective and quality evaluations without experiencing any undue burden.”

“If a doctor is practicing and loses his license, all of his patient load is without a doctor,” Cavenar warns. “I’m just raising questions with them about how do you do what you’re doing.”

Positive follow-up report

The 2014 report’s conclusion also listed five specific recommendations, and in February of this year the auditor’s office released a short follow-up report that judged the following:

  • The Program should ensure physicians have access to objective, independent due process procedures.
  • The Medical Board and Medical Society should develop and implement plans for better oversight of the Program.
  • The Program should not allow treatment centers to fund its retreats and should stop directly paying scholarships to the centers.
  • The Program should make it clear in writing that the physician may choose separate evaluation and treatment providers. It should also develop procedures for selecting and monitoring treatment centers.
  • The Program should continue its effort to identify qualified in-state treatment centers.

In her letter to the NCPHP, the state auditor writes the program “took appropriate corrective action” and complimented the “courtesy and cooperation” of NCPHP staff during the investigation.

Dudek’s future treatment in limbo

Despite the positive report, Ginny Dudek and her physician still find themselves at odds with the NCPHP.

“Where’s the evidence? Where did they come up with the evidence?”

Left without her physician, Dudek says she’s having a tough time finding another primary care physician whom she can feel comfortable with and build a new relationship.

“I went from doctor to doctor to doctor to doctor until I found her,” she recalls. “I don’t think there’s another person like her out there.”

As for Dudek’s physician being assessed by the NCPHP, she tells ABC11 the impasse will continue without her agreeing to out-of-state treatment.

NCPHP Responds to ABC11

Dr. Joseph Jordan, CEO of the NCPHP, would not agree to an on-camera interview. Instead, we sent him several questions related to Ginny Dudek’s concerns, Dr. Cavenar’s allegations, and the two state audits among other things:

We’ve heard from patients of doctors frustrated that they can’t see their doctors because of issues related to NCPHP. These patients think their doctor is being unfairly investigated and their health care is being denied. What is your message to them

We understand this may be a confusing and upsetting situation for patients, which is compounded by the confidential nature of the process. We ask patients to understand that NCPHP and the NC Medical Board each have an obligation to ensure that medical professionals are safe to practice. NCPHP’s role is to help determine whether a medical professional is safe to practice and, if needed, help that medical professional get better so he or she can safely return to practice.

Can you offer more specifics please on the changes to ensure “independent due process” as mentioned in the state audits?

All medical professionals evaluated by NCPHP have the option to request that any recommendation be reviewed by a panel of outside experts. This review process ensures that NCPHP does not have unchecked authority to refer someone for a more comprehensive assessment or directly to treatment.

NCPHP has a very strong track record of making the right call. The 2014 audit conducted by the NC Office of the State Auditor used outside psychiatric and addiction experts to review a random selection of 10 percent of NCPHP’s referrals over a 10-year period. They determined that NCPHP made appropriate recommendations in 100 percent of cases reviewed. Out of 110 cases reviewed, there was not a single instance where the reviewers found NCPHP referred someone for assessment or treatment without cause.

What is the nature of the relationships between the NCPHP and certain treatment centers like Acumen Institute in Kansas and the Farley Center in Williamsburg, VA? Of the treatment or diagnostic centers offered to Doctors, how many are in North Carolina? Why not more?

NCPHP provides a comprehensive list of inpatient assessment and treatment centers for medical professionals to choose from. Most inpatient centers are in neighboring states, although two are located in NC. As part of a multi-state consortium of physician health programs, NCPHP uses an outside expert to evaluate centers and make sure that medical professionals are getting the best assessment and treatment so they can get back to treating patients. As more NC centers demonstrate that they meet quality criteria established by the physician health programs, they will be added to our provider list. We recognize the value of offering a wider range of NC-based options. For the record, NCPHP also refers to numerous outpatient treatment and assessment providers, all of whom are in North Carolina. NCPHP receives no direct or indirect benefit for making referrals.

Even with the state’s follow up audit, ABC11 has heard from several physicians accusing the NCPHP of “abusing its power” and pushing “unfounded” and “unsubstantiated” allegations and diagnoses of physicians. What is your response?

Just like most people, it’s common for medical professionals referred to NCPHP to believe they don’t have a problem and look for alternate explanations if our team finds evidence of something that needs further assessment or treatment. As life-long helping professionals, we understand that response.

 

The bottom line is that there is just no evidence that NCPHP has ever made a referral without sufficient cause and, in fact, there is compelling evidence that NCPHP’s judgment is incredibly sound when making referrals, as documented by the 2014 State Auditor’s findings.

The 2014 auditor’s report found no evidence of abuse by NCPHP. Between the additional protections implemented since then, and the increased oversight provided by the NC Medical Board and NC Medical Society, NCPHP has made a good program even better. Indeed, a follow-up report by the NC Office of State Auditor released in March 2019 documented no findings, indicating NCPHP has successfully implemented all recommended policies and protections to ensure that medical professionals are treated fairly.