Excerpted from Disrupted Physician, a blog on life-wrecking rehabilitation programs for doctors in several US states. Lucrative for those who run them and about as health-enhancing as a stint in Sing-Sing, these programs drive some doctors to end their careers or their lives. This doctor’s troubles began with paroxetine. Original is here.
This whole lack of accountability and oversight within the PHP’s makes me sick. I was sent to PHP for evaluation and suspicion of drug abuse by my employer hospital. I was only suffering from side effects of Paxil causing a SSRI Discontinuation Syndrome. The diagnosis was completely missed because the PHP sent me to a rehab center in Los Angeles. I am sure you know this one very well.
I was coming there for IDE, Intensive Diagnostic Evaluation, not recovery and rehab. After arrival I was forced to enter their rehab program completely against my will. I was on my way out the door and about to call a cab when the program director threatened me with absolute coercion.
He said if I left he would assume I had drugs in my possession and that this would negatively affect my evaluation and would be reported to the PHP and state medical board as a form of noncompliance, and that my career and license would be in jeopardy. How is that possible when I was not sent there by any state board or regulatory agency as I was there voluntarily.
The only incentive to force me into admission rather than having my workup done as an outpatient was purely financial. Employer was paying the bill, so it was in their best financial interest to force me into admission at $1800/day and $1400/urine sample and charge for all the transportation to and from all the outsourced facilities for my “evaluation”.
The facility was run by the most inept, unethical group of charlatans I have ever encountered in any field of service not just healthcare. I could not understand how they were qualified to provide medical evaluations when they are not legally allowed to provide any form of treatment for anything. These people were nothing more than middle-management screw ups. They have to outsource everything. They did not even have a crash cart on site. One of their clients had a tonic-clonic seizure during group therapy as a result of a brilliant PA who decided to withhold the clients chronic benzodiazepine therapy because of her personal beliefs that benzos are horrible medications for anyone. Where is the physician co-signature and oversight on this brilliant therapeutic decision? No one except the doctors in rehab even knew how to react. It was a total fiasco and state of panic for all the rehab employees. Luckily the client didn’t dislocate something, die or worse, suffer anoxic encephalopathy. I was in fear for my life after witnessing this my first day.
What’s even more concerning is that this rehab center is supposedly one of the best and has exclusive referral from every state PHP.
They had me stay with recidivist junkies and participate in 12 step when I had no substance abuse issues at all, in fact my social life was so boring, that my hair test wasn’t even positive for alcohol. I had to recite scriptures in group therapy, admit that I was helpless, and powerless, and a weakling. Admit that I had to submit to a higher power since I was an addict. I had to submit to random urine drug tests which costs $1400 each 3-5 times per week.
Then when I cannot produce a sample on the spot (paruresis) I am threatened to be reported to the State Medical Board for noncompliance. A college dropout working as a technician at a rehab does not even have the authority to make this type of threat. I was also forced to shave in front of a female technician with the bathroom door open; she stated that this was policy and I had to relinquish my razor after every shave because I could use it to inflict harm on myself. I then asked why is there a whole drawer full of sharp cutlery in the kitchen that me and my junkie roommates have access to 24/7???
[Ed.: paruresis is “shy bladder,” a not uncommon inability to urinate in certain contexts, especially unexpected social ones.]
I saw a psychiatrist and handed him my diagnosis on a silver platter from my history, i.e., Paxil withdrawal, yet SSRI Discontinuation Syndrome was not even on his differential. I was in a state of constant agitation, sleep deprivation from insomnia, severe depersonalization. Ended up in the ER at UCLA for intractable Migraine HA, Sleep deprivation, Dehydration, mild AKI and had to be medicated with IV crystalloid, Phenergan to combat emesis and finally induce sleep (going on 4th day of insomnia at that point).
[Ed.: AKI normally stands for acute kidney injury.]
Less than 24 hours after the ER visit I am sent for Neuropsychological testing extensively, which violated just about every code of conduct and ethics under the American Psychological Association in regards to testing validity. I was then labeled “disabled” based on the results. the treatment center was then going to recommend that I stay and additional extended period so they could “rehabilitate” me. They realized now that they did not have my credit card on file because I refused to provide them with it at admission as my employer was paying for everything for the first month. Next they discover that I do not have disability insurance, and now know that they have just ruined my life. It will take a minimum of 6 months before I can be retested to prove that I have no cognitive impairment and am not disabled. Now my chances of getting disability insurance in the future are ruined.
The treatment center then released me and I returned home to the PHP. I then had to sign a five year contract, enlist in a drug monitoring contact with “RecoveryTrek” which I had to perjure myself and illegally claim that I was a substance abuser and was in “recovery.” I immediately sought legal counsel because of this nonsense. Shortly into my so called recovery I had to take my Maintenance of Certification Board Exam in Internal Medicine. Passed exceptionally and with ease. How could I be cognitively impaired?
Go figure! The neuropsychological test was readministered locally by a different provider as I told the PHP there was no way I would ever consent to going back to the treatment center. The neuropsychologist was pretty pissed off about everyone’s mismanagement of my case starting with my employer. I tested fine, and then the PHP released me from the program and cleared me to return to work. The entire experience has jaded my enthusiasm in medicine. I had to take almost a year off to reflect on how I was used as a pawn in everyone’s game.
I experienced coercion, collusion, fraud, incompetence, and saw a part of evil in this world that I never new existed. I was a prisoner, starting my day by having to call a monitoring center to see if I had to be drug tested for that day, every day of the week. I was not allowed to leave the state; how can a PHP legally restrict my civil rights this way when I was not under a court order, and not even under state medical board referral? I was not allowed to have a sip of alcohol during my monitoring, even though I had tested negative for any evidence of drug use. I had to meet with board of directors every month and discuss my case, which no one had clue about regarding why I was even in a PHP. This violated all of my rights to privacy regarding my medical condition. The contract that I initially had to sign with the PHP had statements within claiming they could report any information about me to any regulatory agency without even substantiating any facts or validity. This is just a clever way of saying they can lie about you and there is nothing you can do about it legally. There is complete lack of due process. Your civil rights are stripped. You are beaten down into despair and desperation. You are told if you don’t comply your license would be in jeopardy and your career will be over. This cost me thousands of dollars in legal fees, thousands of dollars to be retested and prove I was not impaired, hundreds of dollars each month for PHP dues and random urine drug screening.
I put up with this B.S. for six months, and honestly could not have fulfilled a 5 year contract. If I had not been released (since there was no condition to monitor) I would probably be dead today. I would not be surprised that PHPs have actually caused in increase in physician suicide rate. I cannot fathom the degree of humility physicians experience having to do this for five years. And the only reason these rehab centers claim such a high success rate for recovery is that they hold a gun to your head and threaten you to be in compliance with everything they recommend. So yeah, doctors have a lot more to lose.
I now understand how these PHP’s are in collusion with rehab centers. What they are doing is a violation of fair trade acts and would fall under the RICO act. The problem is nobody is investigating them for conspiracy and fraud. They all fly under the radar because they believe they are providing a service that ensures public safety. Its a multi-billion dollar scam industry. What’s more sad is that nobody really cares what physicians are subjected to. In fact the public likely finds joy in fact that docs are treated this way. The state of California hates doctors, so the rest of the country probably does too.
People probably enjoy knowing doctors are held to higher standards than the rest.
- That they are usually required to stay 90 days in rehab while all other professionals stay 28 days, that they are financially ruined by rehab centers.
- That they have been stripped of all their rights while in a PHP monitoring program.
- That they are more subject to discrimination based on age or coexisting medical problems like diabetes and hypertension.
I have actually seen cases of MDs sent to PHPs for monitoring of hypertension and regardless of why you are sent there you must comply with drug monitoring.
The rehab centers are now tapping into other territory that further identify this as a conspiracy. Department of Transportation, Aviation, and Law Enforcement are going to be their next victims. I can’t wait to see how the police officers are going to respond to this nonsense.
This was an eye opening experience. There is no profession that is worth going through this amount of humility. PHP’s will likely remain above the law, continue to have no accountability and oversight, which is a travesty of justice. I hope you will share my experience. My case is rather unique in my opinion. It’s evidence that no physician should ever voluntarily enter a PHP at an employer’s request. You would be much better off to simply quit/resign.