Anesthesiologist accused of getting high while treating patients

[deleted480308]

What do you think about the systems in place to allow controlled re entry for addicted commercial pilots?

They are similar to PHPs and achieve roughly the same success approaching 90% sustained sobriety at 10 yrs

More (un)surprising lack of empathy from physicians of all people. Do you think all physicians with a psychiatric diagnosis that could theoretically affect judgment should be simultaneously ejected from their profession that they worked so hard for tomorrow?

I’ve seen plenty of dangerous physicians that probably had no psychiatric diagnosis. Life isn’t black and white. On a case by case basis, a good doctor that temporarily succumbs to their disease can return to practice successfully , this has been studied and shown. How do you respond to that? Aside from knee jerk disgust over a disease you obviously don’t understand

There is a difference between off shift addiction issues and showing up for work under the influence. I stand by my opinion

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[fakin' the funk]

Agree that anesthesia providers and opioid addiction is a fairly unique, one chance type situation.

It really is quite scary if you think about that we have access every day to these substances that can destroy one's life. Is that baked into the specialty's compensation? "Hazard pay"?

And yes, addiction is a disease and should be covered by DI - could see how individual companies wouldn't offer it though, or place limits depending on the actuarials etc.

 

[vector2]

I don't like the idea of recovering opioid addicts returning to anesthesia practice, but I can live with it if they're getting a random UDS two or three times a week indefinitely.

 

[T-burglar]

I don't like the idea of recovering opioid addicts returning to anesthesia practice, but I can live with it if they're getting a random UDS two or three times a week indefinitely.

Well developed PHPs mandate usually 4 or more monthly random urine screens and the constant threat of hair testing for a broad spectrum of abusable substances available to anesthesiologists. In addition to NA membership, addiction psychiatry, and additiction therapy. There is usually a workplace monitor that is designated to know all the details about the doctor and monitors his or her practice.

This usually goes on for a minimum of 5 years. Often times more. Opioids and anesthesia are a special case but the vast majority of anesthetists in PHPs are exactly that, opioid addicts. They don’t just “let them go back to work”.

 

[vector2]

Well developed PHPs mandate usually 4 or more monthly random urine screens and the constant threat of hair testing for a broad spectrum of abusable substances available to anesthesiologists. In addition to NA membership, addiction psychiatry, and additiction therapy. There is usually a workplace monitor that is designated to know all the details about the doctor and monitors his or her practice.

This usually goes on for a minimum of 5 years. Often times more. Opioids and anesthesia are a special case but the vast majority of anesthetists in PHPs are exactly that, opioid addicts. They don’t just “let them go back to work”.

Sounds good to me. What I also hope when you say "well developed" though is that most of the country uses this kind of PHP practice and this is more akin to the standard (floor) as opposed to the exception (ceiling).

Also, have you considered mandating that the anesthesiologist return to work in an ACT practice where there's enough personnel (float doc, float resident, float CRNA etc) so that he can practice safely without even needing access to the pyxis?

 

[T-burglar]

I do think that an extra layer of personnel, whether CRNA or Resident between the attending and the drugs would help also

 

[Gern Blansten]

I do think that an extra layer of personnel, whether CRNA or Resident between the attending and the drugs would help also

Maybe you have stated this already, but I would be curious to know what your experience level is. How much experience do you have in this area? Having seen it play out several times and heard hundreds more stories, I am of the opinion that, if you divert and use potent intravenous opioids, you are out after one strike. The relapse rate is high and the first sign of relapse is often being found dead in the call room (two studies reported 25% risk).

You are also proposing a lot of measures that require extra work by that person's colleagues to provide extra monitoring, short notice relief for random drug screens, etc. It is a burden on the colleagues of the person. If a person cannot resist the temptation the first time, they should know that succumbing to it is a career-ender for anesthesiology. Make no mistake, choosing to divert and use IV potent opioids is a decision that a person makes, no matter their genetic make up. That person chose to engage in criminal activity.

I am happy to assist anyone who is addicted and wishes to retrain in a different specialty that does not prescribe, dispense, and administer potent opioids. We are the only specialty that does that.

The worry that the one strike rule will cause people to not self-report and seek help is a fallacy. Absolutely no one self-reports unless they know they have been found out. Occasionally, if they know the jig is up, they will try to self report to ensure a confidential process with their state medical board.

I don't mean to sound jaded, but maybe I am. Just seen this play out too many times and the patients deserve better than this. The addicted physician also deserves better. They just don't have any clue or acceptance of that fact. The addicted physician (or CRNA) will look you straight in the eye and tell you, in a very convincing manner, that you are wrong about them. And you will believe them, because you also do not want it to be true. They are also masterful at beating the system and UDS's.

If someone told you that an elective decision that you had to make had a 25% chance of resulting in the death of an individual versus a near 0% chance if you make the opposing decision, which path would you choose?

Like I said, maybe I am jaded. I have just seen it too often and I refuse to have them or their patients on my conscience when a bad outcome occurs. That does seem harsh to an outside observer, but I know I am not alone in this position.

 

[T-burglar]

That number you quote is an old study that has been debunked. It was based on a survey of program directors , based on the memories of program directors of what happened to their addicted trainees many years after the fact.

25% of addicted anesthesiologists do not end up dead. And someone asked in this thread somewhere how PHP involvement compares to recidivism in the general population. And the answer is it is leaps and bounds superior.

Lots of people in this thread secretly think they are superior human beings.

 

[Gern Blansten]

That number you quote is an old study that has been debunked. It was based on a survey of program directors , based on the memories of program directors of what happened to their addicted trainees many years after the fact.

25% of addicted anesthesiologists do not end up dead. And someone asked in this thread somewhere how PHP involvement compares to recidivism in the general population. And the answer is it is leaps and bounds superior.

Lots of people in this thread secretly think they are superior human beings.

The two studies did not say 25% of addicted will be dead. It stated that, of those that relapse, 25% will have death as the initial symptom/sign. I would not say that has been "debunked." There are just a couple of other studies that show numbers that are alarming, just not quite as alarming.
I am not sure what you mean by the superior human beings comment. If you mean that people think that they can steal potent opioids and face no repercussions or that they can use those drugs without becoming addicted, then I agree.
If you are saying that those who wish to hold people who criminally divert potent opioids accountable think they are better than someone else, I think that is not the point. Whether or not they feel they are superior to another person is irrelevant. There are certain lines that I feel are sacred and should not be allowed to be crossed. Stealing patient's drugs and using them for their own purpose and caring for patients while impaired on those same drugs is one of those lines. You cannot un-ring that bell and be considered trustworthy again in my opinion. I feel the same way about airline pilots that show up for work under the influence, or school bus drivers for that matter. Patients put a trust in us to care for them when they are under our care and unable to speak up for themselves. If that trust is broken, how do you get that back?
I am not trying to pick a fight and I recognize that there will be some (perhaps many as described in a lecture by Fitzsimons, I believe, that showed that this is a very polarizing topic) who disagree with me. I am just stating why I feel as I do. If you wouldn't mind, will you share what your experience is in this area? Do you have some special expertise or experience in the area of addiction? Perhaps a colleague who has gone through the process that you feel was treated unjustly? Just trying to get some context on why you feel the way you do. My backstory is that I know of several who have died that I knew personally and several others that have retrained in other areas.

 

[E. Tillie]

BS. This will cost a fortune. Patients will claim excruciating pain that was inadequately treated because this guy diverted meds and/or was too high to recognize. Nightmares, PTSD...

Won't be necessary.

1. He falsified medical records with fraudulent intent. He overdosed in a bathroom immediately following Lopez' surgery, after injecting himself with the opiate medication he stole and billed to Lopez.

2. The patient cannot claim "Nightmares, PTSD..." The patient is deceased. The only other person suing, is his daughter, on behalf of her deceased father.

He is one of more than 100 defendants named in the suit, including the hospital. The suit also claims the defendants violated numerous state and federal laws in neglecting their duty to inform the patients and correct billing to the patients, the private insurers, and the Dept of Veterans Affairs.

 

[E. Tillie]

He gave up his license years ago from this. Lawyers have been spending all this time searching for people to join in the money grab.

Jan 2017 overdosed in a bathroom following patient Lopez' surgery
Oct 2017 medical board filed accusation and stipulated surrender of his license
Apr 2018 surrendered license
Jun 2018 medical board contacted patient Lopez' daughter in the course of further investigation
Apr 2019 notice of intent to file suit

The patient, Lopez, has been deceased since 2017. The only other plaintiff in the "money grab" is Lopez' daughter (on behalf of her deceased father).
Between April 2019 and when the suit was filed less than a year later, the lawyers were not "searching for people to join." They were conducting depositions. Eight months is a reasonable amount of time.

Over 100 people are being sued in this case, including UC San Diego.

 

[E. Tillie]

Won't be necessary.

1. He falsified medical records with fraudulent intent. He overdosed in a bathroom immediately following Lopez' surgery, after injecting himself with the opiate medication he stole and billed to Lopez.

2. The patient cannot claim "Nightmares, PTSD..." The patient is deceased. The only other person suing, is his daughter, on behalf of her deceased father.

"This guy" is one of more than 100 parties being sued, including the hospital. The suit also claims the defendants violated numerous state and federal laws in neglecting their duty to inform the patients and correct billing to the patients, the private insurers, and the Dept of Veterans Affairs.

 

[GaseousClay]

Won't be necessary.

1. He falsified medical records with fraudulent intent. He overdosed in a bathroom immediately following Lopez' surgery, after injecting himself with the opiate medication he stole and billed to Lopez.

2. The patient cannot claim "Nightmares, PTSD..." The patient is deceased. The only other person suing, is his daughter, on behalf of her deceased father.

He is one of more than 100 defendants named in the suit, including the hospital. The suit also claims the defendants violated numerous state and federal laws in neglecting their duty to inform the patients and correct billing to the patients, the private insurers, and the Dept of Veterans Affairs.

The only other person that is suing is his daughter?

what about the 800+ patients they lawyers are representing?

Lawsuit seeks damages for 800+ UC San Diego patients treated by opioid-using anesthesiologist

A lawsuit representing about 800 surgery patients was filed against UC San Diego Medical Center after former anesthesiologist Bradley Hay, MD, allegedly treated them while he was high on fentanyl, CBS 8 reports.

www.beckersasc.com

 

[We'llBeDoneIn15Minutes]

The ‘decent’ studies on the subject suggest that 75-90% of anesthesiologists with addictions are apparently still sober at 10 years.

This is with involvement in WeLl developed PHPs (which not every state has).

Physicians should be allowed to attempt re entry with a careful plan like in this model PHPs. imagine for a minute you were the one with the cursed genome and craved the experience of drug use. And count yourself as incredibly lucky that you aren’t cursed that way.

Lots of horror stories out there how a false accusation or pretty innocuous event can land you in a treatment facility with the threat of license revocation. After often years in the system and lost finances you could become a "success" statistic though never having a substance abuse issue to begin with. I'm well aware of the personal details of one such case in which php was pushing to take over an issue that had no substance (no pun intended).

Based on the accounts I've read and the story I am very familiar with, I would recommend staying away from php unless you truly have an issue. I would be cautious of the belief that php will quickly exonerate you of a false charge and you'll be on your way.

Doctors fear PHPs—why physicians won't ask for help | Pamela Wible MD

"But he had no choice; colleagues warned him that if he didn’t follow the PHP’s requirements, he could lose his license and his career."

One way to pad your "success" statistics:
"Boyd told the I-Team that the bottom line motivates the centers to push doctors into treatment regardless of whether it’s really needed."

 

[We'llBeDoneIn15Minutes]

Dr. Louise Andrew, a physician/attorney has written extensively on PHPs. Before singing their praises I urge you to read this and other articles and accounts.

Are PHPs Still In Our Corner? | Emergency Physicians Monthly

This will help pad substance abuse "treatment success" rates:
"physicians who self-referred to the PHP for management of stress and depression were reportedly railroaded into incredibly expensive and inconvenient out of state drug and alcohol treatment programs, even when there was no coexisting drug or alcohol problem."

They don't sound like the physician's interests are what is being defended:
"You have everything to lose if you trust that the caller is from the PHP and is “here to help you.” More than one physician has completed suicide in the clutches of some of these PHPs and their “preferred” rehabilitation centers.... Dr. Leon Masters who successfully sued Talbott for false imprisonment and fraudulent diagnosis of alcohol dependence."

 

[We'llBeDoneIn15Minutes]

Physician Suicide, Organizational Injustice and the Urgent Need for Open Discourse

"In May 1999 Talbott stepped down as president of the American Society of Addiction Medicine (ASAM) as a jury awarded Dr. Leonard Masters a judgment of $1.3 million in actual damages and an undisclosed sum in punitive damages for fraud, malpractice, and the novel claim of false imprisonment.42 The fraud finding required a finding that errors in the diagnosis were intentional. After being accused of excessive prescribing of narcotics to his chronic pain patients, Masters was told by the director of the Florida PHP that he could either surrender his medical license until the allegations were disproved or submit to a four-day evaluation. Masters agreed to the latter, thinking he would have an objective and fair evaluation, but was instead diagnosed as “alcohol dependent” and coerced into the Talbott recovery program. He was forced to stay in the program under threat of his medical license as staff would routinely threaten to report any doctor who questioned any aspect of their diagnosis or treatment to their state medical boards “as being an impaired physician, leaving necessary treatment against medical advice”42 which would mean the loss of his licensure. However, Masters was not an alcoholic. According to his attorney, Eric. S. Block, “No one ever accused him of having a problem with alcohol. Not his friends, not his wife, not his seven children, not his fellow doctors, not his employees, not his employers, No one.” 43 He was released 4 months later and forced to sign a five-year “continuing care” contract with the PHP, also under continued threat of his medical license. Talbott faced no professional repercussions and no changes in the treatment protocols were made. Talbott continued to present himself and ASAM as the most qualified advocate for the assessment and treatment of medical professionals for substance abuse and addiction up until his death last year."

Should have died in jail if you ask me.

 

[deleted162650]

No one ever accused him of having a problem with alcohol. Not his friends, not his wife, not his seven children

Seems fishy to me. There’s no way this guy has 7 kids and doesn’t have an alcohol problem.

 

[Iso4ane]

Seems fishy to me. There’s no way this guy has 7 kids and doesn’t have an alcohol problem.

Could be Mormon.

 

[Drangue]

ERAS hocus pocus today

 

[Twiggidy]

I will also post an unpopular opinion similar to the last page. While I don’t think you need to go to jail, you should kiss the privilege to practice medicine goodbye. Get your disease under control and find another way to pay the bills. Why do I feel this way? Well, because there are too many people who ARE doing the right thing and having trouble getting jobs in the fields they want in the area they want. This guy was an attending in academics in San Diego, and while it may not be the most amazing gig, he had a job at a good institution in a wonderful part of the country and a good amount of qualified applicants probably got rejected so he could get the job and steal drugs.

sorry. If you have addiction issues/personality type the anesthesiology isn’t for you.

 

[sevoflurane]

I am catching up on this sdn thread and just want to add a real life comment here. I have a 60+ year old partner that was caught diverting 30 years ago. He went to rehab, cleaned himself up, turned his life around. Has been sober ever since. Is cardiac and peds guy, one of the hardest workers in the group and a fun dude to hang out with outside of work. Hunter, biker, skier, etc. He turned all that energy into positive vibes and I am glad he was given the chance to come back to anesthesia.

 

[chocomorsel]

I don’t know any real life addicts of serious stuff . Just pot.
My question is, do recovering alcoholics who do the whole AA thing or whatever program hang out at bars? Does anyone know of a real life addict that can chime in?
I am just thinking (not based on any research) that being close to the “poison” and handling it everyday is a stupid idea. A temptation that many can’t overcome. And for every successful story such as @sevoflurane, there are probably five failures who relapsed may have died. My chief resident died of heroin when he got let go of his job for diversion which of course he denied.

Anyways I think personality disorder types not only do not belong in anesthesia, but really any field of medicine. Too many sociopaths running around only looking for money and not giving good care to patients.

 

[coffeebythelake]

I don’t know any real life addicts of serious stuff . Just pot.
My question is, do recovering alcoholics who do the whole AA thing or whatever program hang out at bars? Does anyone know of a real life addict that can chime in?
I am just thinking (not based on any research) that being close to the “poison” and handling it everyday is a stupid idea. A temptation that many can’t overcome. And for every successful story such as @sevoflurane, there are probably five failures who relapsed may have died. My chief resident died of heroin when he got let go of his job for diversion which of course he denied.

Anyways I think personality types not only do not belong in anesthesia, but really any field of medicine. Too many sociopaths running around only looking for money and not giving good care to patients.

Over the years I've heard of 3 in our dept that were given a second chance, and they all relapsed. One is now dead.
We also had a CRNA who likely overdosed and died.

 

[Man o War]

I don’t know any real life addicts of serious stuff . Just pot.
My question is, do recovering alcoholics who do the whole AA thing or whatever program hang out at bars? Does anyone know of a real life addict that can chime in?
I am just thinking (not based on any research) that being close to the “poison” and handling it everyday is a stupid idea. A temptation that many can’t overcome. And for every successful story such as @sevoflurane, there are probably five failures who relapsed may have died. My chief resident died of heroin when he got let go of his job for diversion which of course he denied.

Anyways I think personality disorder types not only do not belong in anesthesia, but really any field of medicine. Too many sociopaths running around only looking for money and not giving good care to patients.

I would think it would be almost impossible to stay sober with the access we have to drugs, but I’m happy to hear success stories.
Me personally- I have known 3 anesthesiologist diverters over the years. Two are dead, one had to switch to a different specialty. Two CRNA diverters- both still alive but not practicing CRNAs any longer. I also know an orthopedic surgeon who was diverting and ended up ODing on pills. He was an incredible surgeon and I had no idea he was into that stuff until after he died.
Very sad.

 

[T-burglar]

Over the years I've heard of 3 in our dept that were given a second chance, and they all relapsed. One is now dead.
We also had a CRNA who likely overdosed and died.

I’d be curious to know what their treatments and re entry conditions looked like. Some states apparently don’t have a great system for planning and monitoring Reentry (I don’t know a ton about PHPs in states outside my own, admittedly)