If you’re dealing with a medical licensing board investigation, Physician Health Program assessment or hospital peer review committee hearing, it very well may be!
Physicians’ careers are under siege from a host of forces. Amongst the most career threatening and yet little known are those pertaining to the administrative medicolegal arena, i.e. medical licensing boards, physician health programs, and credentialing and peer review committees.
As a result of guiding scores of physicians, residents and medical students, and drawing on my own protracted experience and study in challenging these entities, I developed a specialized coaching program. It’s geared to consult with physicians and all other healthcare professionals around these critically important challenges which could derail their careers and cost them tens of thousands of dollars in legal struggle, lost practice income and overwhelming psychological stress.
Here are some of the most troubling challenges that physicians face:
- anonymous complaint(s) to the medical board about unprofessional behavior;
- unwarranted allegations of impairment or wrongdoing;
- being labeled a “disruptive physician;”
- being ordered for an involuntary “fitness for duty” forensic psychiatric assessment by the state PHP;
- unwarranted diagnosis of mental illness, substance abuse, or personality or behavioral disorder;
- unwarranted referral to a costly out-of-state “PHP-preferred” 4 day assessment program;
- denial of due process by medical licensing boards;
- denial of “medical due process” (e.g. fundamental patients’ rights) by Physician Health Programs;
- minor infractions (e.g. prescribing an antibiotic for a family member) resulting in “career death penalty” or being sent to the equivalent of “re-education camp;”
- sham peer review;
- biased appraisals of one’s performance by medical or executive staff or even one’s peers;
- … amongst others, all potentially career threatening.
You Don’t Have To Face It Alone
Going through any of these is often a physician’s worst nightmare. And almost invariably, due to not knowing where to turn and feeling some degree of embarrassment, physicians try to privately and discretely deal with this challenge on their own. Some seek a professional license defense lawyer only to learn from highly paid counsel that unfortunately their choices are limited and they have to do whatever the board or PHP says. That crisp legal wisdom often comes at a cost of $10,000 … and the debt only grows from there.
Incorrectly handling these challenges – “winging it,” ignoring it, treating it as a minor nuisance or simply “handing it off to one’s lawyer” believing it’ll be dispensed with, can be the death knell of your career.
∾ ∾ ∾ ∾ ∾ ∾ ∾
Over the course of nearly 20 years of coaching physicians on burnout and essential components of career re-crafting, I’ve witnessed some worrisome challenges, but none as stressful as these. A physician’s life can literally be upended by these. You can lose everything you worked for.
“PHPs: More Harm Than Good?”
Originally intended to serve as an outreach to truly troubled physicians grappling with substance abuse, PHPs emerged as the catch-all organization to which MLBs and MSOs (medical staff organizations at hospitals) and even group practices could refer any issues of concern, whether substance abuse, mental illness, dementia, boundary violation, “disruptive behavior” or what-have-you.
Now, if PHPs were legitimate mental health organizations registered as medical corporations in their state and appropriately staffed by board certified psychiatrists trained to conduct such weighty “fitness for duty” forensic evaluations and held to appropriate standards for the execution of these, that’d be one thing. One might be able to rely upon their expertise and their ethics and, while they don’t apply in the same way as in legal proceedings (and that’s indeed a problem), their due process rights.
However, many don’t know that many PHPs are not medical corporations. They’re not licensed and they’re often run not only without a qualified psychiatrist on staff but without any MD at all. All the time conducting board ordered “fitness for duty” mental evaluations of career and life consequence. And making wildly inaccurate and even fraudulent diagnoses, seemingly intended to both please the board and feed their referral pipeline of “preferred” (read “authorized exclusively”) programs which conduct inherently biased four day evaluations which too often lead to grossly inappropriate extended hospitalization for non-supportable though incontestable PHP diagnoses.
In other words, some PHPs may be systematically engaging in fraud. But this fraud is not only of a economically corrupt type. It results in the destruction of a physician’s career. And the unwarranted interruption of practice may not only cause treatment interruption, it can lead to patient death.
PHPs, generally afforded state agency status and therefore immunity to suit, are supposed to be overseen by a variety of entities. One state’s auditor found that they had operated for years with utterly no oversight. That PHP over the preceding decade had violated the due process rights of 1,140 physicians, at a minimum by denying these physicians access to their “top secret” PHP evaluation report and by refusing them any means of second opinion or grievance.
When a number of physicians finally got their report, it was readily understandable why it was “top secret.” It was fraudulent, laced with false information and a medically unsupportable diagnosis and treatment recommendation. The PHP’s diagnosis, often made by the equivalent of high school guidance counselors who are neither qualified nor legislatively authorized to conduct such diagnostic assessments, is generally considered by the board to be infallible and final. (It’s worth noting that that state auditor also found in a separate audit that that medical board itself operated in a potentially reckless manner with utterly no state oversight.) That PHP even appears to have lied to the state auditor about the existence and operation of a grievance protocol ensuring due process. And of course, the “preferred programs” to which the PHP sent these physicians (a very lucrative referral stream indeed – cash only $ 5,000 – $10,000 for a four day eval; and $50,000 for an entirely unjustifiable three month stay at PHP member-owned programs) is not inclined to disagree with the PHP referring diagnosis.
A Physician’s Kafkaesque Nightmare
What I’ve seen happening is that once thrust into such a Kafkaesque nightmare, the physician’s career is all but annihilated. But it’s a slow death as the physician is immobilized, rendered over to a deeply defective administrative judicial system which itself operates as a lynch mob and has no oversight, and incrementally financially bankrupted and psychologically broken much like a python suffocates its prey with each exhalation.
I’ve had my own experience with these tyrants. And I’ve written about it elsewhere; I’m happy to share it with you if interested. That protracted experience educated me to the extreme dangers of these proceedings and has made me perhaps one of the most intimately knowledgeable physician consultants in the country about this dangerously broken system.
Over the last five or so years, I’ve developed an expertise in consulting to others who have found themselves ensnared in such a nightmare. I’ve had physicians tell me they’d rather face ten malpractice lawsuits than deal with the board, it’s that horrible. At least in a malpractice suit, they get legal representation, the system follows established and enforceable rules of order, and an independent body, the jury, weighs the evidence.
This nightmarish challenge is affecting docs who are alleged to have “mental illness,” substance abuse, or who are said to be “disruptive.” Every whistleblower who exposes fraud, corruption, insider dealing, dangerous conditions (e.g. inadequate staffing) …is, by definition, disruptive. I’m no stranger to that arena, as many know. A search on my name and “Camp Lejeune” will bring up thousands of articles. And it’s pretty readily apparent that that stance rendered me over to the fate of the medical board and its corrupt PHP.
Docs Do Develop Illnesses
Let’s be clear, docs do develop illnesses, both physician and mental. And they do abuse substances and some become addicted. And these illnesses may reach a level of professional impairment.
And let’s also recognize there are some who really are a pain in the ass and rightly earn the label “disruptive.” And all of these need and deserve some form of legitimate assessment, treatment and guidance. But, frighteningly, that’s not what’s being provided in the current system.
Rather, what I’ve witnessed is that the policing authority of the boards and the “fitness for duty” assessment rights of the PHP have been progressively abused. And due to complete lack of oversight as well as state protection of these entities, physicians are easy prey. They’re basically prosecuted in a backroom extra-judicial manner and deprived of their rights.
And the weakling lawyers they hire at exorbitant fees do little more than a well-rehearsed kabuki dance to give the client the appearance of legal protection, while ultimately telling the physician that they “need to do what the board and PHP say, or else.” They thus lead the naive physician into a state endorsed extortion scheme and wash their hands of any further responsibility. Notwithstanding considerations of such unethicality and laziness, it’s also dangerously wrong advice.
What You MUST Do (… And It’s Not What You Think)
I’ve discovered that there are a host of things that physicians can – indeed MUST – do to protect themselves and ensure that they stand a chance of resuming their careers.
Despite the preponderance of recommendations to “lawyer up” at the earliest moment, I argue that this could be one of the most costly, ill advised, and indeed even dangerous things a physician can do, at least at the outset. Speaking with well over a hundred physicians about these very issues, not only are most lawyers ignorant of the administrative judicial system and the MLB’s and PHP’s roles in it, their limited tool set and desire to maintain a “nicey nicey” decorum with the board’s attorneys almost invariably works to the physician’s detriment, markedly eroding away their rights while precious and non-recoverable statute of limitations clock time is consumed. And the legal approach all to often adopts the criminal prosecution system – overstating the charges while seeking a “plea deal.” It’s a grossly unethical application of a prosecution strategy into occupational licensing matters.
And we’re not talking here about an innocuous mishandling which can be easily remedied. We’re talking about life and death career matters. The harm done by these renegade agencies is immense. Inept case handling by one’s attorney can be fatal.
Rather, what you need to do is find the most knowledgeable resource you can, someone who’s not only consulted on many such complex cases but one who has himself traveled the territory. Not someone in a legal representational way. Not yet.
The Professional Life and Licensing Matters Coaching Program
After hearing one nightmarish story after another and reflecting on my own journey into this unchartered territory, I decided to develop a specialized program to consult with physicians (and where appropriate, their counsel) about these issues. They need someone who’s been there, who’s guided others, who really gets the big picture and can help them see the entire landscape and what awaits. Someone who can help them develop their most informed game plan at the earliest moment.
If you get a lawyer involved too early, you may actually cut off learning about and accessing a host of strategies that are potentially life-saving. And if you don’t thoughtfully plan your strategy, you will not only be ensnared for years and progressively bankrupted, you will be at highest risk of losing your career. And it is clear in case after case that from the outset, the pathway you choose will irreversibly limit the choices available to you moving forward. Each strategic pathway is fraught with consequences; it’s best that a physician know their options fully and make the most reasoned decision.
I’m happy to set up a confidential phone call to learn about your situation and share my perspective and recommendations. No fee, no obligation.
After that, if desired, we can do a more thorough consultation in which we pull together the full picture and lay out the variety of likely pathways for which I can offer specific feedback. That consultation can be free-standing or we can then explore the PLLM coaching program to help you negotiate the treacherous landscape and explore your best courses of action.
These can be exceedingly complex matters and there is no one answer. Responding to the challenge requires an active collaborative reasoning process between consultant and client. (And that’s a major reason why “turning it over to a lawyer” and expecting it to get fixed is so ineffective and perilous.)
As if medicine wasn’t difficult enough already, now one has to fight sham peer review, intrusive investigations by lawyer-laden boards and unwarranted and fraudulent fitness-for-duty assessment by non-overseen and unlicensed PHPs to prove one’s innocence.
So if I can be of help in sounding out your challenge, let me know. You can go straight to the contact form from here.
To your professional wellbeing and successfully navigating your way through this !
(To learn more about the details of the Professional Life and Licensing Matters Coaching Program, visit here.)