Botched Surgeries Blamed On Addicted Docs

Confidential Programs Let Addicted Doctors Practice While In Rehab; Calif. Ends Its Program

(AP)  Troubling cases in which doctors were accused of botching operations while undergoing treatment for drugs or alcohol have led to criticism of rehab programs that allow thousands of U.S. physicians to keep their addictions hidden from their patients.

Nearly all states have confidential rehab programs that let doctors continue practicing as long as they stick with the treatment regimen. Nationwide, as many as 8,000 doctors may be in such programs, by one estimate.

These arrangements largely escaped public scrutiny until last summer, when California's medical board outraged physicians across the country by abolishing its 27-year-old program. A review concluded that the system failed to protect patients or help addicted doctors get better.

Opponents of such programs say the medical establishment uses confidential treatment to protect dangerous physicians.

"Patients have no way to protect themselves from these doctors," said Julie Fellmeth, who heads the University of San Diego's Center for Public Interest Law and led the opposition to California's so-called diversion program.

Most addiction specialists favor allowing doctors to continue practicing while in confidential treatment, as does the American Medical Association.

Supporters of such programs say that cases in which patients are harmed by doctors in treatment are extremely rare, and would pale next to the havoc that could result if physicians had no such option.

"If you don't have confidential participation, you don't get people into the program," said Sandra Bressler, the California Medical Association's senior director for medical board affairs.

California's program ends June 30. If no alternative program is adopted, the rules could revert back to the zero-tolerance policy in place before 1980, when doctors who were found by the medical board to have drug or alcohol problems were immediately stripped of their licenses.

No other state has followed California's lead. But the president of California's medical board, Dr. Richard Fantozzi, said that behind the scenes, regulators nationwide share his ambivalence toward such programs.

"To hide something from consumers, something so blatant ... it's unconscionable today," Fantozzi said.

Between 10 percent and 15 percent of physicians nationwide will have a substance abuse problem at some point in their lives, a rate similar to that of the general population, according to widespread estimates. An estimated 7,500 to 8,000 practicing doctors are probably in confidential treatment, or about 1 percent of all physicians practicing in the U.S., said Dr. Greg Skipper, head of Alabama's program and a leader of an upcoming study on the issue.

Opponents of such programs are unable to cite any documented cases in which doctors who were confidentially undergoing treatment botched operations while drunk or high. But they say the very secrecy of the programs makes it hard to assess the risks.

Nevertheless, some doctors have been accused of harming patients while they were in treatment.

In Montana, a patient accused a doctor enrolled in the state's treatment program of not following up on her abnormal test results, delaying her cancer diagnosis by more than a year. Montana revoked Dr. Robert Schure's license last year after he flunked out of treatment six times since 1994, according to board documents. The patient's suit was settled for an undisclosed sum.

A North Carolina surgeon enrolled in the state's program for alcoholism charged patients for one type of gastric bypass and then performed a shortcut procedure that led to serious complications, including stomach ulcers and vomiting, according to patients and a medical board investigation.

It wasn't until Dr. Steven Olchowski lost his license in 2005, years after many of the incidents occurred, that his participation in North Carolina's program became publicly known.

Opponents of California's program have focused on the case of Dr. Brian West, a Long Beach plastic surgeon who has been accused of negligence by the state medical board and is fighting to keep his license.

In 1999, West performed a double mastectomy and breast reconstruction surgery on Becky Anderson. The procedure left her with gaping, infected wounds that wouldn't close and, ultimately, a grotesque lump the size of a melon caused by organs spilling through an unhealed hole in her abdomen.

Weeks before performing his final, futile procedure on her, West was arrested for a drunken-driving accident.

After his conviction, West entered the diversion program for alcoholism. A year later he performed a tummy tuck on a 37-year-old woman that also healed poorly.

West ultimately flunked out of the treatment program after investigators uncovered a pattern of relapses, binge drinking and doctored urine tests that "demonstrate that he is a physician who has been long and chronically impaired by alcohol," according to a 2005 medical board complaint.

West's supporters say he has been made a scapegoat, asserting that he is not to blame for his patients' complications and that the severity of his drinking problem has been exaggerated by investigators. "I have no information from any of my investigations that Dr. West has ever cared for patients while under the influence of alcohol," said his attorney, Dominique Pollara.

West admitted no fault in settling Anderson's malpractice lawsuit for $250,000, Pollara said. The tummy-tuck patient lost her malpractice case.

Without the assurance of confidentiality, some say, addicted doctors will go underground and continue to practice without getting any treatment at all.

Jim Conway, a Venice, Calif., drug and alcohol counselor, said that before confidential treatment programs, doctors would do whatever they could to hide their addiction for fear they would lose their licenses.

At a Pomona hospital where Conway worked, an alcoholic obstetrician came to work and delivered a baby while "dead drunk," he said. In the process, the doctor severed the newborn's spine.

"And that's how it will be if they just do a punitive approach," Conway said.

Dr. Jason Giles, a Malibu physician, completed California's program in 2004 after five years in treatment for alcoholism and addiction to prescription drugs.

"I was never intoxicated taking care of patients. It didn't get to that - but would have if I didn't avail myself of that rope dropped from the helicopter," he said.

His experience in rehab was so transformative, he said, that he quit practicing anesthesiology and opened the drug treatment center he now runs.

Giles said allowing physicians to continue to practice while in rehabilitation is crucial to the success of the treatment.

"Working actually helps them get better," he said.

[jenifar]

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[jenifar]

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[jenifar]

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[sassey4]

I would like to know why there is complete silence from the California Diversion Program? Why isn''t the Diversion Program standing up to defend your program and it''s participants? Since Diversion released this doctor''s "confidental" Diversion file, I''m confused why they haven''t released all the other doctors files? If they already broke this doctors confidentiality in the program, why aren''t they publically speaking about him? What''s there excuse? If he''s the only failure, that sounds like a pretty good program. If there are other failures, why aren''t there names posted all over the newspapers and news stations? Why is this doctor so "special"? There must be something else......

[the_hollow]

Part 2

The general public is protected by HIPPA. Your medical information is protected. As a physician, your medical information is not protected. Licensing boards will post all of a physicians medical information on the web if a license becomes probated. Unlike popular belief, a probated license do not equal a patient harm.

I would propose that the press become more educated about recovery prior to making inflammatory statements. The public should no that physicians in a monitoring program public or not are safer than most. With most programs requiring monitoring physicians at work, urine screens 1 to 8 times per month, weekly meetings with a counseling group, and direct communications with a the monitoring group or medical board, I propose to you that it is not the known recovering physician in a monitoring program that should worry you (1%); it is the actively using physician that is unknown(9%).

[the_hollow]

Part 1
A interesting figure that is posted in this article is that about 1% of physicians are enrolled in impaired physician programs, yet the incidence in no different than the normal population, 10%. Therefore, 9% are not in monitoring programs. Although held to a higher standard, physicians are human first. As a human, physicians are susceptible to all the disease processes as other humans. The physician in not a god.

Many lay people and medical professionals view addiction as a character flaw. Yet it meets all the criteria for a disease and accepted by multiple medical organizations including the World Health Organization (WHO). I will not go through all the reasons. Here is the Wiki reference (http://en.wikipedia.org/wiki/Alcoholism).

[sundancers1]

Diversion is a MONITORING PROGRAM.

[sundancers1]

Doctors are NOT practicing medicine or seeing patients while in "rehab." Of course doctors in %u201Crehab%u201D shouldn%u2019t be seeing patients. The program of discussion is %u201CDiversion%u201D, a monitoring program for Physicians run by the Medical Board. The use of %u201Crehab%u201D in the title of this article is misleading. Diversion does not let the doctor go back to practicing medicine/seeing patients until they are safe to return to work. When they first enter Diversion, they are sent to rehab usually for 60 to 90 days depending on the situation. Once they complete rehab, they enter "Diversion" run by the Medical Board. In California, Diversion is a 5 year program. The doctors have to meet twice a week facilitated by a drug and alcohol counselor, receive random drug tests several times a month, and have to attend AA or NA meetings. The doctors in Diversion are watched very closely. The doctors are usually not allowed to return to work full time (40 hours a week) until after one year of success in the Diversion program. If they test positive at any time, they are immediately taken out of work until they meet with the DEC (Drug Evaluation Committee). The DEC often requires that the Physician go back to rehab. They often are required to sign a new 5 year contract and start all over again in Diversion. These doctors are very safe.

[drbehavior-2009]

I''m outraged at the notion that physicians should be allowed to practice while undergoing rehabilitative therapy for drugs and/or alcohol. Patients are not some sort of experimental test subjects and deserve to be treated by a doctor that''s absolutely sober and having sound judgment. Heaven knows that there''s enough doctors in practice that even when stone cold sober have sufficient difficulty in making a proper assessment of a patient''s ills given the 15 minute window allotted to them by the insurance companies. Doctors need to be given a leave of absence during there drug treatment program and then reassessed as to ''worthiness'' and ''readiness'' once they''re done. The notion that working while undergoing treatment is helpful to the doctor is a specious concept at best. This is not ''all'' about the doctor - rather - this is all about the patient''s life!

[runningralph]

I don''t believe in rehab. I''m not saying it can''t work, but I believe there are more backsliders than recoveries. Even after years of rehab these people refer to themselves as "recovering alcoholics" or "recovering addicts". They''re just one drink away from going off the deep end. And it''s not a disease, it''s a character flaw.

[rf35]

I agree that the physician''s license should be suspended until successful completion of the rehab program. The reason for the suspension can remain confidential, but they should not be allowed to practice until they have proven their addiction has been treated and they are no longer a danger to their patients.

[hologram5]

Defective Doctors being permitted to practice sounds more like the programs didn''''t have tough enough controls like DRUG / ALCOHOL SCREENS. Also What about DEFECTIVE LAWYERS / PLAINTIFFS WHO sue for thousands of dollars over nothing like dry cleaned pants...ISN"T THIS UNCONSCIONABLE TOO???? WHY AREN"T THEY STRIPPED OF THEIR RIGHT TO PRACTICE LAW???


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Posted by apple2pie at 09:59 AM : Dec 19, 2007

In case you didn''t read the news, that Judge was stripped of his bench.

[tibu987]

Uh, simply put, shouldn''t the patient have some rights and certainly, the right to know that their surgeon is sane and sober.
Something that is becoming forgotten is the Hippocratic oath to "first do no harm".
This is scary.

[house015]

I suspect if you start revoking these people''s licenses, then they will, in turn, sue based on the premise that there is no proof they are under the influence while at work. The lawsuits from the poor victims hinge on this fact as well, ironically, so I''m just suggesting that something, anything be done to provide documentation. Fine, take away the anonymity if necessary, I have no problem with it. At the very least their supervisor should be aware of their situation, and they could set up random tests with any old lab tech and a de-identified sample. I work in medical research, and know for certain THAT can be done.

[connapa]

There needs to be some type of happy medium whereby both the public is protected and the affected physician is able to maintain some type of gainful employment so that they don''t lose everything they have (home, family, etc) and have further reasons to drink. Many physicians do have disability insurance, some of which have riders which list chemical dependency (which is recognized as a disease) included so that they can maintain their income while undergoing treatment. States should require all physicians to have that type of coverage just as they also need to maintain malpractice coverage. During the period of treatment, their license should be suspended. Upon completion of treatment, the license should be reinstated, but with restrictions. There needs to be some type of increased supervision of the physician''s practice. Also, some type of restrictions as to requiring an assisting physician in the OR. If there is any suspicion of impairment, breatholyzer or drug screen should be done immediately, and if positive, license suspension on the spot. It is also not just up to regulatory agencies such as medical examiner''s boards. The Hospitals themselves need to get involved. They are the ones that allow physicians the privelege of using their hospital and OR (physicians already undergo priveleging and repriveleging on a regular basis.) As the Hippocratic Oath states in its first line, "First, do no harm." This should apply to all parties involved.

[rowdytexan2]

Posted by house015 at 09:04 AM : Dec 19, 2007

But if it''s confidential, who''s going to administer and read the test and approve him going to work? Him/herself?

The whole thing is backwards...they should be suspended from working until they can prove they can maintain a alcohol/drug free life.

As the other poster said, they jerk your driver''s license just for having a social drink.

Relly different story isn''t it when you have medical associations behind ya.

[allunknowing]

ago5675, the reason that happens is not because the Doc forgot, it''s because the PA, nurse, or intern forgot. The Doc does the actual surgery and leaves the sewing up to the PA, RN, or Resident. And if one of them screws up, the Doc gets sued for malpractice. If the Doc didn''t have to babysit the other people, we might not have as much stupid "newsworthy" entertainment at 6:30 every night.

[house015]

Wait a minute, if I get caught drinking and driving they take away my license to drive, but these people can keep performing surgery based on the assurance that they''re keeping their addiction to their "off hours"? Uh, NO. Perhaps they can still keep it confidential, but they should be required to take a drug test at the beginning of each work day before risking another human''s life. Period. If you''re going to tell me that addiction is a disease, then that means it''s a 24 hr problem that needs to be dealt with accordingly.

[rowdytexan2]

Working while they are rehabilitating??? I guess the value of the patient is just written off in comparison to these bozo''s losing their careers? What kind of conscrewed up thinking is that?

[pollroller1]

Like I''ve said before. This so called "war on drugs" is a multi billion dollar business. No way that John Q Public will ever be able to stop it.