Michael Langan MD (blog at Disrupted Physician) has been doing some extraordinary research on PHPs and the myriad forces which are contributing to their powerful and unchecked role as virtual wings of the medical boards. In particular, he examines the history of the movement and its virtual hijacking by ASAM and the insistence on PHPs’ exclusive endorsement of and referral to pre-selected 12 step recovery programs.

This post contains the comment I made to his article and examines the dynamics of how medical societies signed over – essentially outsourcing – the function of assessing, referring and treating physicians to PHPs and the naive assumptions they made in doing so.

I believe it is time for organized medicine as well as state legislatures to reexamine the assumptions of benevolence they made in their “outsourcing” of these functions to PHPs.

Organized medicine isn’t likely aware that the “recovery movement” that they endorsed decades ago (on the basis of its original benevolent principles) has been secretly taken over by power-crazed, entrepreneurial thugs masquerading as white-coated squeaky clean rehabilitated physicians espousing the 12 step religion. Sadly also, they doesn’t likely care, certainly not sufficiently to raise their voices and protect their membership from PHPs’ death grip. And this has been accomplished, in part, by PHPs being embraced by the medical societies themselves.

In fact, the NC Medical Society (NCMS) prides itself on declaring that NCPHP is its offspring. However, NCMS was admonished by the NC State Auditor in its recent performance audit of NCPHP for playing no oversight role as it was supposed to have been doing. In fact, it was found that NCPHP has been operating with no oversight at all – not by the medical society, not by the medical board and not even by its own board of directors. (The audit report is available at: http://www.ncauditor.net/EPSWeb/Reports/Performance/PER-2013-8141.pdf)

So, in essence, for medical societies to speak out and take ownership necessarily exposes their own role in PHPs’ pervasive wrongdoing – and therefore ownership for all the consequential damage and financial liability – for its gross violation of civil liberties; anti-competitive practices; operating without a corporate medical license; breaches of privacy; unwarranted interruption of medical practices; and defamation (to name just a few of their egregious violations).

Another key reason why organized medicine has given free rein to PHPs is what could best be compared to the “outsourcing of stinky garbage work.” I think it’s fair to say that the vast majority of physicians don’t have significantly impairing problems with alcohol, drugs, mental illness or disruptive behavior (though with the current climate of healthcare and the lack of supportive resources, such can only be expected to increase). For that minority who do develop these problems, PHPs came on the scene originally as genuinely concerned do-gooders (in the good sense), originating from their inception as “impaired physician” / “wellness” committees of local hospitals and medical societies, to help those who had succumbed to the myriad pressures of a life in medicine and developed significantly problematic illnesses. Organized medicine basically said “well, we don’t want to deal with those problem docs (read: “losers”), and since you benevolent PHP good fellows say you want to take it on, have at it … it’s all yours.” And have at it they most definitely did. (Of course, it does cross one’s mind whether medical societies might be reaping some financial benefit as well from PHPs’ “preferred facility” referrals.)

Organized medicine’s (and governments’ and the general public’s) position has essentially been one of free-market outsourcing. (It’s the same dynamic that has occurred in the justice system – privately owned-and-operated prisons and “rehabilitation centers” – essentially domestic, capitalist-inspired, profit-driven versions of extraordinary rendition.) And the reason why it’s been allowed to flourish is that the attitude of the outsourcing agencies has been a) “it doesn’t affect me but only those ‘unfortunates’”; and b) “surely, there are enough checks and balances in place (e.g. due process, transparency and accountability) to ensure that they won’t mistreat these ‘unfortunates.’” And, voila, as an organization, I emphatically swipe my palms together, ridding myself of this annoying little problem of dealing with the outcasts and happily go about my business. Until, that is, I become one of the “unfortunates.”

It is only then that one realizes, as increasing numbers of physicians (and PAs and many other healthcare professionals) have realized, that the two assumptions were deeply flawed. It doesn’t just affect “unfortunates” because, in a due process-deprived, hidden-from-public-view, government sanctioned system, we’re all liable to be ensnared by the monster (e.g. witness government surveillance). And, in fact, not only are there not enough checks and balances in the outsourced system, there are none! And worse, not only are there none, but there’s no consequence to these power-and-profit-driven enterprises’ limitless abuses. Because this Frankenstein was actually a patchwork of multiple creators, no one is really in charge of it. And, while operating essentially invisibly, it’s essentially been given free rein by each of the state legislatures who naively beknighted it and tied its functions to the also unchecked powers of the regulatory licensing boards, giving it sovereign immunity to boot! (Legislatures too likely share the same operational assumptions about outsourcing the handling of the “unfortunates.”)

I believe it’s important to take a systems perspective on this. No “one” person is driving this, though each of the players is doing their part to work the system to their advantage. If I ran a for-profit long term addictions treatment facility (and one that is entirely above board), you can be assured that I’d do all I could to strengthen my referral pipeline. If I ran a for-profit prison, I’d do all I could to keep it full occupancy, including cozying up to co-owners in the justice system to ensure a steady stream of “referrals.”* Why? Because I can. There’s nothing holding me back. (So much for the idyllic notions of self-restraint and self-motivated organizational integrity.) Personal and organizational integrity? Bah, humbug! What’s that have to do with running a profitable business where I’ve invested a lot in making connections? “Besides,” I say to myself, “I’m not responsible for the way the system works!”

(* There recently was one such case of a judge sentencing juveniles to a facility s/he co-owned.)

Phenomena like this are like hurricane storm systems. They’re created and intensified by multiple atmospheric forces – cool moist air here, warm and dry there, massive fronts themselves influenced by their own multi-causal dynamics. Did any one element cause this hurricane? I believe our challenge is to approach this as a powerful system which is a confluence (perhaps even a “conspiracy”) of forces.* A deranged system not unlike a malignant cancer which operates stealthily for so long until at last it manifests itself and presents itself for intervention. An increasing number of us are, unfortunately, the victims of this invasive cancer, our career and life assaults are its overt manifestations.

(* For these purposes, I believe a confluence becomes a conspiracy or collusion when two forces intentionally unite.)

Toward that end, various physicians across the country have formed organizations devoted to examining this problem of medical licensing board and PHP abuses of authority and violations of physicians’ due process. (For one, see The Center for Physician Advocacy, currently at www.PhysicianRights.wordpress.com . They are hoping to serve as an information and support resource for physicians and their families who are newly ensnared in the board and PHP regulatory web. [Disclaimer: I am on their steering committee.]) And there are numerous others, often single physicians desperately presenting their case to the public. And a stalwart in the battle has been the American Association of Physicians and Surgeons; they’ve been going to battle with various state medical boards over their conduct of sham peer review for a number of years.(http://www.aapsonline.org/index.php/article/sham_peer_review_resources_physicians/) Even they, with their numerous well researched pleading in multiple cases, have encountered remarkable opposition.

It’s going to take all of our efforts to end this nightmare and bring this behemoth under control. And I believe it can be done. Because it has to be done. Because we know that this insane and voracious PHP “professional evaluation and treatment” movement – currently proselytizing AA zealotry and operating in the form of a joint PHP-Medical Board cabal (with full, unquestioned and unchallengeable endorsement by the medical board) – will soon break out of the confines of the healthcare industry and move on to every other profession and regulatory agency and employee assistance program (EAP) in the country where there is profit to be had, posing benevolently as the 12 step empowered answer to their “problematic professionals.” (And keep in mind, in such a concealed, due process-deprived environment, “problematic” doesn’t just mean “ill.” It also includes anyone deemed to be a “problem.”)

Lastly, I’ve closely followed Michael’s case of being ensnared by MA PHS and being a victim of forensic lab fraud, and I’m sorry for what he and his family have had to endure. I truly applaud him for his tireless efforts as he delves into the workings of this rampaging Frankenstein. It has clearly destroyed his career and is ravaging many other physicians’ careers and families and the wellbeing of these physicians’ patients. And it’s only going to be by collaborative action that we will be able to confront it and prevail.

In doing so, we might even restore integrity to the physicians’ wellness movement that has been so thoroughly hijacked by this organized racket.

Please take a moment to visit his blog (Disrupted Physician) and offer comments.