Author Archives: rumikern

About rumikern

executive coach, organizational consultant, speaker, writer, board-certified psychiatrist, change activist.

Webinar Mon., April 16, 8pm EDT – “The Perilous Physician Licensing Landscape”

REGISTER: The Perilous Physician Licensing Landscape

Negotiating The Increasingly Perilous Medical Licensing – Peer Review – Physician Health Program Landscape

Learn What You Can – And Must – Do To Protect Your Medical License

Physicians are under siege from a host of forces. Amongst the most career threatening and yet little known assault are those pertaining to the administrative medicolegal arena, i.e. medical licensing boards, physician health programs, and credentialing and peer review committees.

Together with my colleague Michael Langan MD, author of The Disrupted Physician blog (www.DisruptedPhysician.com), we’re offering a groundbreaking informational webinar April 16th, 8pm specifically covering this little understood area. 

Here’s the link to register:

The Perilous Physician Licensing Landscape

We’ve guided scores of physicians through sham peer review proceedings; bogus board investigations of anonymously sourced complaints; unwarranted referrals to Physician Health Programs for allegations of impairment or wrongdoing; falsely being labeled a “disruptive physician;” and many other career-threatening challenges.

These are critically important issues which could derail your career and cost you tens of thousands of dollars in legal struggle and even more in lost income and psychological distress. We’ve seen it first hand; we’ve  traveled the territory.

Incorrectly handling these or simply “handing them off to one’s lawyer” believing they’ll be dispensed with can be the death knell of your career. 

Here again is the link to register:

The Perilous Physician Licensing Landscape

Even if you can’t make it, I’d suggest you sign up to ensure that you receive the link to the replay and handout and the helpful checklists we’re planning to offer. 

Is Your Medical License In Jeopardy?

Before you make another step in dealing with these agencies, we believe it’s vital that you learn what could be the difference between your successfully preserving your license and your being deprived of all that you’ve worked for in your career. In this very concise 30 minute webinar, we’re going to cover a lot of ground. 

I encourage you to pass the invite around to colleagues who might be facing these struggles. Perhaps even especially with those who have already faced these challenges; we’re eager to learn from them about what works and what doesn’t. 

And yes, you can share with your attorney! We’re pleased to have advised multiple attorneys around the country in these complex matters that are unique to the healthcare arena. In fact, we’ve discovered that very few attorneys can sufficiently grasp these administrative challenges which are unique to the healthcare arena without knowledgeable guidance. And we can attest from abundant case wreckage, having an attorney who pretends to represent you without having gotten such guidance is like having a surgeon who’s never opened a belly before. It’s never going to be a pretty outcome.

Michael and I are staunch physician and patient advocates and want to ensure that our medical colleagues receive utmost fairness in these perilous dealings and, where indicated, are referred to the most appropriate, impartial and ethical programs to address any issues of legitimate concern with compassion and respect. We don’t want to see more physicians driven to despair and humiliation by these reckless agencies and be forced to helplessly witness their practices destroyed and their patients’ care needlessly and dangerously disrupted.

Don’t delay! Be sure to register and attend with pen in hand – we’re confident you’ll come away with eyes opened and new ideas on how you might optimally approach these challenges.

Monday, April 16th, 2018, 8pm EDT. 

Register here:

The Perilous Physician Licensing Landscape

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Physicians’ Bill of Rights

Louisiana, my birth state and where I did med school, is taking some advanced measures to aggressively restrict the abusive power of its state medical board, the La. Board of Medical Examiners. Over the past several years, efforts had been made to re-write the law governing the board’s powers to abruptly halt a physician’s practice while it investigated that physician.

We know from experiences of other boards , completely lacking oversight, that corrupt dealings enter the picture and before you know it, you’ve got a malignant complaint against a physician being pushed along – and even generated by – the medcal board, often utilizing the “anonymous complaint” mechanism.

Our continuous efforts to confront these abuses are paying off.

As soon as a colleague informed me of the La. bill, I wrote a letter to the bills sponsors supporting the measures and advocating for both an audit of the medical board and an independent investigation of its proceedings. I promptly heard back from Rep. Jackson acknowledging and thanking me for my correspondence.

Here’s what I wrote:

Wednesday, April 11, 2018

Sen. John Milkovich 

milkovichj@legis.la.gov

and 

Rep. Katrina Jackson

jacksonk@legis.la.gov

 

re: Senate Bill 286 and House Bill 778

Dear Sen. Milkovich and Rep. Jackson:

Your excellent legislative initiatives just came to my attention this morning and I note that Rep. Jackson’s House Bill 778 is being considered in committee today. 

I am the organizer of a private national working group – the Coalition for Physician Advocacy – which has been meeting for nearly five years studying issues of abuse of physicians’ rights by state medical licensing boards (“MLBs”), Physician Health Programs (PHPs) and hospital-based peer review committees conducting sham peer review.

A physician myself, I began coaching physicians around these issues over five years ago as a result of my own Kafkaesque nightmare with the NC Medical Board (NCMB) and the NCPHP.

Over five years, I and my colleagues have reviewed hundreds of cases of what can only be seen as gross abuse of power by medical boards and their associated state PHPs which then order these physicians to costly out of state “preferred programs” for what amounts to extended involuntary hospitalization for non-existent – but newly PHP diagnosed – conditions with no chance of contest or appeal. We have reason to believe that multiple physician suicides have occurred. Even less focused on is the profoundly detrimental effect on patient care. Medical boards and PHPs have shown callous indifference throughout and in fact have refused to investigate complaints about their own procedural abuses.

Many states have Medical Practice Acts which appropriately empower medical licensing boards to remove a physician from clinical practice if sufficient reason exists to believe that that physician has an impairing condition which might harm patient care. However, numerous state medical boards across the country seem to have taken that discretionary power to an extreme, not only abruptly interrupting without sufficient warrant a physician’s career but also causing great jeopardy to that physician’s patients. 

I lost a patient to suicide as a result of this unwarranted intrusion.

Your respective Physicians Bill of Rights bills on first perusal seem exactly on target. 

Allowing MLBs to continue in these privilege-abusing ways will continue to harm physicians and patients and will let the national physician community know that Louisiana (incidentally my home state and where I attended medical school) is a dangerous place for physicians to practice. One should not risk their licensure there as its state laws permit its due process denying medical board to make findings of guilty until proven innocent with resultant irreversible career annihilation and patient harm.

What has been done here is the equivalent of empowering the LA Drivers License Bureau and the entire law enforcement and judicial network to revoke a citizen’s drivers license for a simple yellow light infraction and make their gainful employment impossible while the state engages an enormous investigative apparatus to “study this driver’s habits” and determine whether they’re “safe to drive.” This is prosecutorial abuse taken to extremes. Such power was never envisioned by this or any legislature to enable an occupational licensing board to trample the civil and due process rights of a professional willy nilly just because the law allowed them to use their discretion in determining who they thought might be impaired. 

In fact, I don’t believe the proposed Physicians’ Bill of Rights goes far enough in protecting the rights of physicians and other similarly licensed healthcare providers. Should we speak, I’ll share with you other proposed protections which have emerged from our multi-year study.

Public Citizen’s stance is both a fallacious argument and a ruse. Evidence strongly suggests that they’re little more than a disguised lobbying group for medical boards. Just because a state medical board is investigating a complaint does not connote that patient care is jeopardized. Nor does such concern, even if substantial, justify abuse of constitutional rights, neither that physician’s nor certainly more generally. Their fallacious argument is equivalent to saying that because there might be a drunk driver in a car, and driving cars while drunk is a danger to the public, all cars can be stopped and searched and their drivers licenses removed until they’re cleared. What absurdity! 

It is important to note here that the two national bodies which grandly set policy and invariably weigh in on policy discussions of this nature – The Federation of State Medical Boards and The Federation of State Physician Health Programs – assert that they have no role in oversight of their member organizations. In fact, neither organization provides any means of filing grievance regarding its member organization’s illegal activities. Thus, along with complete lack of state oversight, each physician is forced to fight this abuse on their own in an invariably protracted, costly and ultimately futile manner. 

It also bears noting that there is a class action lawsuit in one state against its medical board and PHP (Michigan); and in another state (Florida), a bill was recently passed prohibiting its PHP from conducting any evaluation or treatment activity. Another state’s judge found its medical board members individually liable for the denial of due process of a physician wrongfully brought before it. 

An additional though insufficiently exposed concern is that state medical boards, certainly in North Carolina, may be operating as free-standing tyrannical governments unto themselves with utterly no active state oversight. The NC State Auditor found as much in her 2014 reports, first of NCPHP and then of all boards and commission in NC. In fact, after complaints of fraudulent diagnosis being conducted by NCPHP, in a year-long Performance Audit, NC Auditor Beth Wood found that NCPHP had violated the due process rights of 1,140 physicians over the preceding decade. It was operating with no oversight by the NCMB as required and that NCMB also had no oversight. A recipe for disaster perhaps? As noted by Auditor Wood, state government has a duty to exercise diligence over its agencies, especially those to whom it has entrusted police powers. I can provide these audit reports to you if desired. 

I urge the committee to either vote in favor of this bill or, perhaps in light of the multiple related bills under consideration, to take the matter under further advisement and seek expert consultation. You may wish to know that our Coalition for Physician Advocacy study group’s membership consists of a major writer-advocate of PHP reform; an MD JD whose focus is on disability law, mental health issues and litigation stress; a former vice chair of psychiatry at a well-recognized academic center; and an established addictions psychiatrist who is multiply boarded and is also a retired brigadier general. All have come together to address what we collectively feel are major abuses of privilege by some state medical boards and PHPs. 

The La. State Board of Medical Examiners in saying that they are conducting themselves to the letter of the law is quite revealing. What they’re trying to convey is that it is precisely because the law permits them to conduct themselves in these abusive ways is the exact reason why modification to the law is urgently needed.

I also write to encourage you to dually engage the state auditor in conducting a performance audit of the La. State Board of Medical Examiners and its adherence to due process protections. In this investigation, specific attention ought to be paid to the assertions by its Executive Director that only 4% of complaint cases are referred for formal investigation. A very close examination of these forty plus cases should be undertaken by independent consultants to determine how these cases were handled, i.e how these complaints were processed, whether due process was honored, and whether continuity of patient care was ensured. I strongly suspect your findings will be alarming.

I also believe that you should impanel an independent task force to examine the actual processes and impact of this Board’s operations. Of course there will be resistance; and that is all the more reason to proceed with haste.

What MLBs do not seem to understand is the profoundly detrimental effect of the complaint investigation process itself. A recent study published in the esteemed British Medical Journal found a 100% increase in depression, anxiety and suicidal ideation in those being “investigated by” their medical board. I’ve had physicians tell me they’d rather have ten malpractice suits than deal with the medical board’s rights abusive process.

Thank you for your advocacy of physicians’ rights and patient wellbeing. I would welcome the opportunity to discuss these matters with you further and serve as an informational resource as you develop these initiatives.

Respectfully,

Kernan Manion, MD

Bill to shield physicians during investigations advances to Louisiana Legislature

La. Legislature considers sweeping changes to investigations of doctors

Milkovich La Senate Bill 286 Physicians Bill of Rights

Guest Post: “The Perilous Physician Licensing Landscape” by Kernan Manion, MD

Disrupted Physician

medico-legal

Over the years, many have visited Michael’s audacious blog as he’s dared open eyes about concealed abuse by medical boards, physician health programs and hospital-based peer review committees. 

Through shared experience, Michael and I have been studying these issues for nearly a decade. We are amongst a handful of physicians nationally who get the big picture and know the career-threatening challenges one faces in responding to and interacting with medical licensing boards, PHPs and related entities.

In fact, we’ve been founding members of a study group loosely referred to as the Coalition for Physician Advocacy (which I’ve cross linked to from here on occasion). Amongst the members of that think tank are a major writer-advocate of PHP reform; an MD JD whose focus is on disability law, mental health issues and litigation stress; a former vice chair of psychiatry at a well-recognized academic center; and an established addictions psychiatrist…

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The Regulatory Capture of American Medicine by the Drug and Alcohol Testing, Assessment and Treatment Industry  by Michael Langan, MD

The Regulatory Capture of American Medicine by the Drug and Alcohol Testing, Assessment and Treatment Industry

Another incisive piece by Dr. Langan on the crucially important concept of “regulatory capture” of a market sector, in this case the Physicians Health Program.  Clearly, Medical Licensing Boards (MLBs) have mastered the art of regulatory capture, essentially writing legislation which includes stipulations that essentially allow them to write their own rules as they see fit. Then, covered by that state’s sovereign immunity, they’re essentially tin-pot dictators. Then, allied with PHPs who are extended the same sovereign immunity with utterly no oversight or accountability and, which in multiple states, are alleged to have neglected (and thwarted) all means of due process, one has a co-conspirator in the regulatory capture. Now two “state agencies” (in quotes because the recent SCOTUS FTC v. NC Dental decision throws their claim of “state agency” into major question) operate in tandem to both capture the regulatory process by which physicians operate and then collude with other states’ MLBs and PHPs to ensure pan-country (and essentially worldwide) total regulatory control over the professional licenses of physicians.

Clearly, this is not what state legislatures had in mind. And clearly,  federal courts have no idea about the concept of “regulatory capture” of what should otherwise be a low-level administrative function. However, MLBs and PHPs have leveraged their power in this arena to such dictatorial levels that they have essentially overthrown from within all means and understandings of justice which a professional licensee is constitutionally entitled to.

There is much to be alarmed about here. While it may have started out as benign and well-intentioned, the slippery slope is extreme, and in the context of utterly no oversight or accountability, the consequences are dire.

Disagree with an approach to treating Lyme disease? Adjust the criteria defining Lyme disease and then find the doc guilty of practicing outside of the regs. (see Jemsek case in NC / 4th Circuit). Disagree with a pesky internal whistleblower who’s calling attention to billing irregularities, get a crony to file an anonymous complaint. Don’t like someone’s stance on pro-choice or including gun violence in the clinical dialog, report anonymously to the MLB. Or, if you’re a board member or staff, simply get the process rolling of your own accord via secret meetings.

Yes, it’s gotten that dangerous.

 

 

The Federation of State Physician Health Programs and the Dead Doctors at Ridgeview-A Harbinger of the Medical Profession’s Current Suicide Epidemic

Deeply distressing story of Talbott’s Ridgeview Rehab program in which a string of suicides was alleged to have been related to the care provided there. And the same abusive model seems to have been replicated in “rehab” programs across the country.

Disrupted Physician

“There is enormous inertia—a tyranny of the status quo—in private and especially governmental arrangements. Only a crisis—actual or perceived—produces real change. When that crisis occurs, the actions that are taken depend on the ideas that are lying around. That, I believe, is our basic function: to develop alternatives to existing policies, to keep them alive and available until the politically impossible becomes politically inevitable.” –Milton Friedman

cropped-hanging_witch_01.jpg

“Gentlemen, it is a disagreeable custom to which one is too easily led by the harshness of the discussions, to assume evil intentions. It is necessary to be gracious as to intentions; one should believe them good, and apparently they are; but we do not have to be gracious at all to inconsistent logic or to absurd reasoning. Bad logicians have committed more involuntary crimes than bad men have done intentionally.”–Pierre S. du Pont (September 25, 1790)

 “It is easier to believe a lie one…

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MD Sues NC Medical Board/Physician Health Program-A Prototypical Case

A most relevant blog piece.

Disrupted Physician

A prototypical case involving PHP and Medical Board. PHPs’ integrity varies state by state depending on:

1. How entrenched the FSPHP is in the state PHP

2. Whether that state’s Medical Board has become a partner in PHP’s crimes.

It is very curious that states who have had a Medical Director who has also been President of the Federation of State Physician Health Programs seem to be the worst of the violators.

Based on over 200 responses I have received on my PHP survey [PHP Survey], North Carolina, Florida, Massachusetts and Washington State are physician career destroyers whereas West Virginia seems relatively unscathed (although I have learned that the FSPHP has been attempting to impose its “PHP-Bluprint” on the Board with some resistance.

What you see here is a classic case. Physicians and med schools urgently need to become aware and take a stance of resistance to…

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Request Medical School Administrators Question PHP Authority to Prevent Future Medical Profession Brain Drain

Another incisive piece by Michael Langan MD on the overreach of PHPs into med schools, essentially hijacking med students’ careers before they’ve even gotten their MD and fleecing them with sham diagnostic evals and out-of-state referrals to their “preferred” centers.

Disrupted Physician

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Physician Health Programs (PHPs) now targeting medical students–More sheep for the slaughter

The attached article entitled “Medical school drug testing is a moral and scientific failure” opposes testing medical students for drugs and alcohol but things are going to get a whole lot worse.

In the past six-months I have been contacted by an increasing number of  medical students searching for help after being  trapped in quagmire of their state physician health program  (PHP).   Each of them had either been referred to a “PHP-approved” assessment center or had already had an evaluation recommending inpatient treatment.

Some of these students were subjected to non-FDA approved laboratory developed tests including hair testing for marijuana metabolites and the  alcohol  biomarker EtG.  These typeof tests can detect substances that were used days, weeks and even months prior to testing.

Medical students and physicians are just as likely to have experimented with illicit substances in their lifetimes as…

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