In a recent Medscape piece entitled “How Impaired Physicians Can Be Helped” the author propounds the values of the PHP program, even providing a 29 page listing of all of the state PHPs and their services offered and populations served (a worrisomely broad swath of professionals). I felt compelled to reply.
I believe it is crucially important for Medscape and Mr./Dr. Chesanow to know that the national PHP list (which appears when one goes to print the article) erroneously indicates that PHPs evaluate and treat a wide variety of conditions that they are in fact neither authorized nor trained to conduct.
There are several issues here which require MEdscape’s closer examination:
- A number of PHPs are chartered as non-profit 501c3 public charities. In checking with legal counsel, I was informed that such organizations by definition cannot perform professional evaluation and treatment services while operating as a “public charity.”
- Chartered as such, they are not incorporated as medical corporations. However, they are conducting the same professional activities as a medical corporation.
- “So what?” one might say. What this means is that an organization incorporated as such and performing the wide diversity of activities it does is practicing medicine without a license.
- Further, organized as such, they carry no malpractice insurance. Imagine!
- Additionally, being a “public charity” and not a medical corporation, they can hire any old hack or zealot they want to conduct a physician’s evaluation because, not being a medical corporation, there’s no licensing requirement, is there?
- But get this, in NC, the PHP refuses to give the subject physician a copy of his/her evaluation because they assert that, even though one was interviewed for over two hours by two individually licensed clinicians who wrote up an evaluation report which they submitted to unknown personnel at the licensing board, what they conducted wasn’t a diagnostic psychiatric evaluation at all but rather “peer review.” Peer Review! This certainly gives a new understanding to that activity that is defined as something entirely different under HCQIA, the federal law defining the parameters for peer review.
Now, tell me, how does a PHP evaluate and treat, or even evaluate and refer, all of these conditions if it a) is not licensed to conduct such evaluations; and b) actually denies to the subject physicians (and all other professionals sent to it) that it conducts such evaluations?
Not being a licensed medical corporation, what is to prevent them from hiring Joe Schmoe the retired barber who’s in recovery and who is so grateful to AA to conduct these “evaluations”? Please also explain for me how can PHPs assert that they evaluate and treat this array of conditions given these documented findings?
Remember, in several PHPs, these are non-profit “public charities” which explicitly deny that they conducts diagnostic evaluations. But how can they treat or make referrals if these aren’t diagnostic evaluations? So, what does one call these two hour multi-clinician meetings at which a detailed report is produced but concealed from the subject physician??
Even more basic, isn’t this a fundamental violation of trust? Why would anyone even risk his or her career or mental health to such an evasive, unlicensed identity, one at that which makes life and death decisions over one’s career simply on revelation that one suffers from depression or made the unwise decision to drive after having wine at a party, or on unvetted anonymous allegations which they refuse to share with the subject physician?
But when one combines this deceptive corporate multiple identity disorder * with a) arrival at operational diagnoses that the subject physician can’t scrutinize nor get an independent 2nd opinion on; b) “recommendations” for further evaluation and treatment at pre-arranged “preferred centers,” nearly all of which are connected with FSPHP members or donors and some of which feature polygraph experts (yes, polygraph experts!); c) recommendations which have the weight of law as boards, with whom they are affiliated and which allow them to operate under the same state immunity, promptly act on them with orders to comply under threat of loss of license; and d) “treatment” at cash-only “preferred” centers which exceeds all norms for length of stay and whose diagnosis and treatment plan has already been arranged … what do you have? I believe it’s obvious there is a major problem that requires intensive investigation. With immense power and automatically granted credibility for their advertised mission, but with neither oversight nor accountability, these programs have become exceedingly dangerous. And because their affiliated state boards are loathe to investigate complaints against their symbiotic sibling state agency (in fact they are not state agencies but non-competitively bid state contractors), they operate with complete impunity.
- Although, consciously chosen, its not so much a disorder as a well-crafted legal ruse.
And to think that they are now promoting their expertise and extending their content area to include burnout, anyone who’s on psychotropic medication, any allegation of disruptive behavior (even anonymous), those who fall behind in their charting and some even touting expertise in marital stress ….
You probably don’t know that in NC, as previously in WA and presumably other states, bills have been recently put before the legislature proposing to eliminate all guarantees of due process at PHPs. The lawyers for the boards argue that this is much more expeditious and will serve the public interest. These are hideous developments that should send a chill to every practicing physician and every other professional who comes under PHPs’ purview.
As Pamela Wible MD has eloquently documented, I fear that as we investigate further, we are going to discover the horrific impact some of these abusive programs have had on some physicians who ultimately took their own lives in a state of trapped desperation.
If you doubt the extent of extortion, witness this quote drawn from the FSMB Journal:
“They just don’t have as deep of pockets as the physicians when they get into trouble,” say Warren Pendergast, M.D., medical director of the North Carolina PHP and coauthor of the study. Another contributing factor may be that physicians have more to lose. “For a lot of physicians, if they’re not able to keep their license or get their license back, they don’t have a lot to fall back on,” says Pendergast. “Many of us don’t have other skills. Medicine is really all we’ve done.” The prospect of losing one’s livelihood and identity as a physician is a major motivator.
(see Page 8, Journal of Medical Licensure and Discipline, vol 91, Number 4, 2005)
I am very concerned that Medscape is giving wholesale endorsement to such a program without having done due diligence in critically examining it. As can be seen by the comments, there is considerable concern. As unbelievable as it may seem, I know that there are many physicians who have been so tyrannized and traumatized by their Board-PHP enterprise that they are extremely reticent to post comments for fear of covert retaliation, e.g. lengthening of their monitoring contract, contrived need for reassessment etc., all done without the protection of due process or governmental oversight.
I urge Medscape to review its endorsement and to conduct a thorough inquiry and begin a national dialog about PHPs – their benevolent-sounding PR and the reality.