Doctors on Drugs

[docB]

This is a really interesting situation playing out in Las Vegas. A doctor (optho) was arrested a few years back on drug charges. From the news item:

"In August 2003, police stopped [Dr.] Buzard's car for a traffic violation. According to police, Buzard was wearing only underwear, a sheet and a dog collar, and was clearly intoxicated. About 2.6 grams of cocaine were found in the car, according to police."

Here's the full link: http://www.lasvegassun.com/sunbin/stories/sun/2005/dec/11/519801635.html

The doctor pled guilty to coke possession. To keep his Nevada medical license he had to go into a rehab program. He is now suing the program because they want to force him to admit that he has a drug problem. He denies that he has a problem and states that he only plead guilty to the charges because he thought he couldn't win in court.

So who to root for? Should a doc be forced to admit to a problem even if he denies he has one just to keep his license? It's hard to take seriously the guy who was arrested half naked wearing a dog collar with a batch of coke but what if he's telling the truth? When something this egregious happens should the board provide anything other than summary revocation? Would you let this guy cut your eyes?

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[Febrifuge]

Wow. The only one of those questions I'm comfortable answering off the cuff is the last one. My answer is, I'm afraid, pretty predictable.

 

[Febrifuge]

How about now I take a better shot at those questions...

So who to root for? Sentimentally, the doc. In terms of what's best for everyone (which includes the doc), I have to say that the onus is on him to convince whomever that he doesn't have "a problem"... because the evidence is pretty compelling that he does indeed.

Should a doc be forced to admit to a problem even if he denies he has one just to keep his license? Maybe the issue here is that my definition of "problem" is most certainly brought into being when a guy is arrested. Doubly so when he's pantsless. If he believes that it was his responsible, controlled use of the booze and the coke just happened to make this situation slightly more likely to come to pass, then again, I think it's up to him to convince someone. Because from the outside, it seems pretty clear.

It's hard to take seriously the guy who was arrested half naked wearing a dog collar with a batch of coke but what if he's telling the truth? When something this egregious happens should the board provide anything other than summary revocation? I am far from a conservative in most of my political and social habits and beliefs. But as Vermont-hippie as I can be, I recognize that most of society functions based on assumptions and judgements that, while they can be arbitrary or nonsensical, are at least close to a societal consensus.

So I'll suggest that the rules here should be similar; I'm open to non-traditional ways of living, and challenging the prevailing morality from time to time on its merits. But a guy can't just go snorting coke, driving a car out in public where he might kill someone, and then expect sympathy after the fact. There was a reason he felt he couldn't get a fair trial in court... and yet now he's suggesting that he should benefit from leniency vis-a-vis his license, even though (it sounds like) there's no mechanism for him to argue his point of view with the licensing body, and revoking his licensure is all this board has available to it.

A shorter answer would be yes, it would be good if the board could moderate its response when it deems that would be appropriate -- but there's already a court system, and the doc is availing himself of it. So let's see him make his case.

Would you let this guy cut your eyes? To quote Whitney Houston, hell to the no. But I'm weird about eyes to begin with.

 

[BKN]

This is a really interesting situation playing out in Las Vegas. A doctor (optho) was arrested a few years back on drug charges. From the news item:

"In August 2003, police stopped [Dr.] Buzard's car for a traffic violation. According to police, Buzard was wearing only underwear, a sheet and a dog collar, and was clearly intoxicated. About 2.6 grams of cocaine were found in the car, according to police."

Here's the full link: http://www.lasvegassun.com/sunbin/stories/sun/2005/dec/11/519801635.html

The doctor pled guilty to coke possession. To keep his Nevada medical license he had to go into a rehab program. He is now suing the program because they want to force him to admit that he has a drug problem. He denies that he has a problem and states that he only plead guilty to the charges because he thought he couldn't win in court.

So who to root for? Should a doc be forced to admit to a problem even if he denies he has one just to keep his license? It's hard to take seriously the guy who was arrested half naked wearing a dog collar with a batch of coke but what if he's telling the truth? When something this egregious happens should the board provide anything other than summary revocation? Would you let this guy cut your eyes?

Boring night in the ED?

 

[Creightonite]

my answer isd simle... If he is taking coke --> addicted --> has a problem. It seems like he cannot admit his addiction... thats like step #1 of the AA

 

[trustwomen]

This is a really interesting situation playing out in Las Vegas. A doctor (optho) was arrested a few years back on drug charges. From the news item:

"In August 2003, police stopped [Dr.] Buzard's car for a traffic violation. According to police, Buzard was wearing only underwear, a sheet and a dog collar, and was clearly intoxicated. About 2.6 grams of cocaine were found in the car, according to police."

Here's the full link: http://www.lasvegassun.com/sunbin/stories/sun/2005/dec/11/519801635.html

The doctor pled guilty to coke possession. To keep his Nevada medical license he had to go into a rehab program. He is now suing the program because they want to force him to admit that he has a drug problem. He denies that he has a problem and states that he only plead guilty to the charges because he thought he couldn't win in court.

So who to root for? Should a doc be forced to admit to a problem even if he denies he has one just to keep his license? It's hard to take seriously the guy who was arrested half naked wearing a dog collar with a batch of coke but what if he's telling the truth? When something this egregious happens should the board provide anything other than summary revocation? Would you let this guy cut your eyes?

Just using drugs is one thing; driving under the influence is entirely another. I think it' s pretty clear this guy has a problem. If he denies it, he is in....denial (not so uncommon). I root for the board on this one. The board should revoke his licence and place the burden of proof on him to demonstrate, if and when he cleans up, that he is fit to practice. And since the first step is admitting he has a problem, it seems he's a long way away from fixing it.

Hell no I wouldn't let him cut my eyes.

 

[SomeGuy]

The doctor pled guilty to coke possession. To keep his Nevada medical license he had to go into a rehab program. He is now suing the program because they want to force him to admit that he has a drug problem. He denies that he has a problem and states that he only plead guilty to the charges because he thought he couldn't win in court.

Interesting as he pled "guilty," not "no contest." However, admitting to having possessed cocaine in a court of law shouldn't be construed as admitting to having an addiction anyway.

EDIT: The article itself says that he did plead "no contest". The word "guilty" isn't even in the article.

But I'd agree with the physician (and please, read the article, since it tells a more-detailed story) in that the program is flawed if it requires physicians to admit that they have a drug problem, as it is possible for a person to continue functioning normally even if caught with drugs by law enforcement. However, he doesn't appear to be someone that can handle these drugs.

 

[docB]

Interesting as he pled "guilty," not "no contest." However, admitting to having possessed cocaine in a court of law shouldn't be construed as admitting to having an addiction anyway.

EDIT: The article itself says that he did plead "no contest". The word "guilty" isn't even in the article.

But I'd agree with the physician (and please, read the article, since it tells a more-detailed story) in that the program is flawed if it requires physicians to admit that they have a drug problem, as it is possible for a person to continue functioning normally even if caught with drugs by law enforcement. However, he doesn't appear to be someone that can handle these drugs.

That is true. He went with no contest. I was previously incorrect.

The other point is that while the article notes that the police said he appeared intoxicated his argument is that he was not intoxicated on cocaine and that he does not use illegal drugs and that therefore he doesn't have a problem. He also was not DUI because he was not driving the car. All of these things make the case murkier. So let's say that he was intoxicated but not on cocaine. He was found in the state he was but not driving. There was cocaine in the car but not his and he plead no contest because he was advised that he'd never beat the rap because the coke was found in his car. If all of that is true does it sway anyone to his side?

 

[docB]

Boring night in the ED?

Yeah, were holding a ton and gridlocked. As you can imagine this story always gives us a chuckle so I thought I'd put it up for discussion.

 

[trustwomen]

the police said he appeared intoxicated his argument is that he was not intoxicated on cocaine and that he does not use illegal drugs and that therefore he doesn't have a problem. He also was not DUI because he was not driving the car. All of these things make the case murkier. So let's say that he was intoxicated but not on cocaine. He was found in the state he was but not driving. There was cocaine in the car but not his and he plead no contest because he was advised that he'd never beat the rap because the coke was found in his car. If all of that is true does it sway anyone to his side?

It kind of sways me to his side (knew I should've read the article first!). 😡
I don't think using drugs automatically means abusing drugs. Was the driver intoxicated? (I ask because letting somebody else drive intoxicated, let alone geting in their car yourself, is also a serious flaw in judgment.)

So, I revise my opinion. However, this incident might lead me to review his history for any evidence that this may have carried over into his professional life (ask more questions of anyone that may have sued him, for instance) because some drug users merely hide the fact that they are really drug abusers.

 

[McDoctor]

my answer isd simle... If he is taking coke --> addicted --> has a problem. It seems like he cannot admit his addiction... thats like step #1 of the AA

I have to respond to this only because I think we have way too much faith in A.A. and 12-step programs as a whole as a blanket method of treatment for substance abuse. I can't think of any other treatment modality that is so pervasive while having so little evidence of benefit and so little basis in science. My experience has been that most people who get better through 12 step programs were in pretty dire situations and quite desperate (a group that arguably the naked dog collared ophthalmologist belongs) and thus maybe it is not a good option for somebody with moderate substance abuse problems (a category that most abusers fall under).

I think that the recovery movement is far too pervasive in Addiction Medicine and perhaps we need to re-examine the requirement to subscribe to A.A. dogma in order to retain a medical license for substance abusers in medicine. Most addiction specialists are active in 12-step programs themselves and thus I wonder if their own experience clouds their ability to think objectively. I recognize the value of A.A. for some, so I hope nobody takes offense or interprets my comments as A.A.-bashing. I just think it is too lazy to dismiss all substance abusers to 12 step treatment without thinking outside of the box a little bit.

 

[sdn1977]

This makes me think about a situation in a hospital I worked at about 15 yrs ago....One of our psychiatrists was arrested in a motel room. The arresting officers found him naked tied to the bed & covered in Hershey's chocolate syrup (it was on the bedside table). The young woman who was also taken into custody was partially nude and covered with chocolate syrup (presumably Hershey's). Both later tested positive for ETOH, cocaine among others.

I don't know what happened with his license, but since the young woman was less than 18 & since his practice was predominately adolescents, the publicity effectively destroyed his practice. He moved out of state, so I have no idea if he is still practicing medicine at all. This was before the registered sex offender stuff. It did give us all a chuckle & I have to admit for years after I couldn't eat a chocolate sundae without a smile!

 

[trustwomen]

I have to respond to this only because I think we have way too much faith in A.A. and 12-step programs as a whole as a blanket method of treatment for substance abuse. I can't think of any other treatment modality that is so pervasive while having so little evidence of benefit and so little basis in science. My experience has been that most people who get better through 12 step programs were in pretty dire situations and quite desperate (a group that arguably the naked dog collared ophthalmologist belongs) and thus maybe it is not a good option for somebody with moderate substance abuse problems (a category that most abusers fall under).

I think that the recovery movement is far too pervasive in Addiction Medicine and perhaps we need to re-examine the requirement to subscribe to A.A. dogma in order to retain a medical license for substance abusers in medicine. Most addiction specialists are active in 12-step programs themselves and thus I wonder if their own experience clouds their ability to think objectively. I recognize the value of A.A. for some, so I hope nobody takes offense or interprets my comments as A.A.-bashing. I just think it is too lazy to dismiss all substance abusers to 12 step treatment without thinking outside of the box a little bit.

Hi,

I'm not sure there is such a creature as a moderate substance abuser - if one has passed from drug use (controlled) to drug abuse (out of control), I'm not sure moderation has much to do with it.

As I am neither a user nor an abuser my personal experience is limited to my job. I work in a homeless shelter for young women, the slight majority of which abuse hard drugs (cocaine, crack, and heroin mostly - although crystal meth is just starting to hit here). Now, they are not necessarily representative of all drug users, but I've gotten really skeptical of all standard therapies except AA. It doesn't work for most, true, and they do need to be ROCK bottom for it to have a chance, but for a few it does seem to "catch" and boy, when it catches... Mainly because to quit the drugs, it seems to me that they need to be able to just slip another addiction into that "hole" - and constant meetings, proselytizing, borderline-unhealthy codependence on other members, and (often) religious conversion seems to do the trick. AA people do seem to me to be "unbalanced" (by our standards), but it does seem to keep them from using. Whereas traditional therapies don't fill that dysfunctional hole and work for about two weeks or until they get back to their usual lives. I sometimes think that a benevolent tyrant of a boyfriend would do the trick also - someone who will control every aspect of their lives without being abusive, with well-hidden unselfishness, and without ever making them feel entirely secure (ah, if only such a beast existed!).

But the coddling therapies produce unrealistic expectations for the outside world, and the harsh therapies destroy their self-esteem and never quite get to the "rebuilding it" part...

It's possible that good old cognitive-behavioural approaches would work for those who just take their partying a bit too far. That's not my client population, so I couldn't say. However, I look at the success rates for cognitive-behavioural approaches for simpler things like smoking and weight loss, and most people just can't seem to change their habits on a permanent basis...

 

[McDoctor]

Hi,


As I am neither a user nor an abuser my personal experience is limited to my job. I work in a homeless shelter for young women, the slight majority of which abuse hard drugs (cocaine, crack, and heroin mostly - although crystal meth is just starting to hit here). Now, they are not necessarily representative of all drug users, but I've gotten really skeptical of all standard therapies except AA. It doesn't work for most, true, and they do need to be ROCK bottom for it to have a chance, but for a few it does seem to "catch" and boy, when it catches... Mainly because to quit the drugs, it seems to me that they need to be able to just slip another addiction into that "hole" - and constant meetings, proselytizing, borderline-unhealthy codependence on other members, and (often) religious conversion seems to do the trick. AA people do seem to me to be "unbalanced" (by our standards), but it does seem to keep them from using. Whereas traditional therapies don't fill that dysfunctional hole and work for about two weeks or until they get back to their usual lives.But the coddling therapies produce unrealistic expectations for the outside world, and the harsh therapies destroy their self-esteem and never quite get to the "rebuilding it" part...

I'm impressed with this insight and I would probably be less skeptical of A.A. if more people who advocate it at least acknowledged the "borderline-unhealthy codependence" that is fostered. Good post.

I should probably use the term functional substance abuse instead of "moderate" (which I'll agree is nebulous terminology). I'm not convinced that AA is a good option for alot of these people. The problem I have is that most, if not all states, will mandate an impaired physician to AA meetings as a condition to keeping their license. There is no evidence that this is in any way beneficial and seems mostly to be a punitive measure disguised as "treatment". The program is strongly based on Christian beliefs and that in and of itself creates a problem with mandating it for physicians or any other multicultural group of individuals. I don't have a problem with state licensing boards issuing punitive measures, I just want them to call a spade a spade. The courts mandate AA meetings all the time, it is called punishment.

I think in the case of this doctor, he clearly had an aversion to 12 step philosophy he encountered in rehab. I think the interesting question lies within why this rigid philosophy is enforced on all physicians who encounter drug problems. To state that drug addicition is an illness demands an approach that requires evidence of benefit for a universally recommended treatment, something that 12 step group attendance currently lacks.
If we want to consider drug addiction as purely a behavioral problem that demands punitive measures and possibly revocation of license for physicians such as in this example then we need to completely revise our philosophy and approach to substance abuse.

This is an interesting thread. I'd like to see where others come down on this issue. Personally, I can accept the point of view of somebody who won't "admit their disease" based on the 12 step dogma that seems to be enforced in rehab as I understand it.

 

[McDoctor]

Its interesting that the psychiatrist who heads the rehab program stated that there are many studies to show the effectiveness of his program, because I can't find anything to back this up. If anyone else can locate something credible to support 12 step groups please post a link. Thanks.

 

[trustwomen]

This is an interesting thread. I'd like to see where others come down on this issue. Personally, I can accept the point of view of somebody who won't "admit their disease" based on the 12 step dogma that seems to be enforced in rehab as I understand it.

I don't know if I consider addiction a disease per se. A marginally treatable mental or personality disorder, maybe. Like borderline disorder (oh, those borderlines - phew). I know the goal is to reduce stigma, etc.. but maybe the stigma helped people not try these things in the first place? We know stigma doesn't work to prevent premarital sex, but there is no strong adolescent hormonal urge to do drugs AFAIK...

I guess the question is - if the person is functional, what business is it of ours how they spend their free time? If it is proven to affect their brain (long-term coke use, fr'instance), then pull their license the same way you would for a surgeon with Parkinson's. Problem solved. (Wow, I sound like a heartless biatch, don't I).

And to reassure docB, no, I don't consider obesity a disease either. 😉

 

[McDoctor]

I don't know if I consider addiction a disease per se. A marginally treatable mental or personality disorder, maybe. Like borderline disorder (oh, those borderlines - phew). I know the goal is to reduce stigma, etc.. but maybe the stigma helped people not try these things in the first place? We know stigma doesn't work to prevent premarital sex, but there is no strong adolescent hormonal urge to do drugs AFAIK...

I guess the question is - if the person is functional, what business is it of ours how they spend their free time? If it is proven to affect their brain (long-term coke use, fr'instance), then pull their license the same way you would for a surgeon with Parkinson's. Problem solved. (Wow, I sound like a heartless biatch, don't I).

And to reassure docB, no, I don't consider obesity a disease either. 😉

I agree there are some fundamental differences between addiction and most other diseases, the main one being that the spectre of punishment actually does seem to have some benefit in curbing abuse. The same wouldn't hold true if we threatened punishment to prevent recurrence of cancer for instance. Even staying in the realm of behavioral medicine, we can't threaten punishment as a method to improve one's mood in depression or ease one's delusions in psychosis because beyond the obvious ethical problems, it just wouldn't work.

I can't think of a better activity to stigmatize than someone driving around Vegas half naked, wearing a dog collar, with several grams of coke.
Except, maybe, reality TV contestants. 😉

 

[QuikClot]

Having pled no contest, the doc had to know the medical board would be interested. He says he pled because he couldn't "win in court," but why couldn't he win in court, aside from being guilty as sin? If he were some high school dropout pinched in the projects, I'd give a lot of credence to the "I'm innocent but I had to plead out." But as we know, wealthy people in our society can serve up double homicides and win in court. So when he says he couldn't win, I tend to think that is because they had him dead to rights.

Now he gets diversion -- rehab. Fine. There are conditions to rehab -- one of them is admitting you have a problem. If he doesn't like it, he shouldn't have gone for diversion in the first place. Surrender your license and find a new career.

I can't find any empathy for this doc in my heart. He's an addict in denial, using the legal system against the people trying to help him. He couldn't weasel out of the drug conviction, so now he's trying to weasel out of the consequences.

 

[xanthines]

Sure they had him "dead to rights", but "guilty as sin?" I'm not so sure about that. He wasn't the driver but it was his car, therefore his options in a possession case were probably pretty limited. Most people would call this a technicality, although I'm sure a shiver is running down Law2Doc's spine as I type this. This is technically his first violation, so rehab may not be necessary for this guy.

If that were all there were to the story, I'd say this guy has every right to sue and he should. But...

This isn't his first arrest. He's had two arrests, one resulting in a "no lo." That's highly suspect. Based on that, I'd say he might have a problem. So in the end, I'd have to say he's idiot for initiating a lawsuit when he'll still get to keep his medical license but I'm not as willing to crucify him as others might be. In the OP, one of the questions implied this was egregious. What's that really based on? Being naked with a dog collar is pretty unsightly, but it really doesn't have anything to do with anything unless you're some kind of prude. He was covering himself with a sheet after all. Maybe he's gay and got drunk and some wild Vegas leather party. Who knows? Who cares? He plead no lo to one possession where he wasn't the driver but because he was the owner, the case was pretty open and shut. That's pretty much all the medical board really has. This is, as far as we know, his first violation (ie conviction) and bringing in his nakedness is probably a prejudice against his lifestyle (if that's what he wants to claim, anyway).

There's reason to suspect addiction, but not really anything too concrete. At least from a legal perspective (from a non-lawyer! 😛)

That's my story and I'm stickin' to it.

-X

PS There's no way I'd let this guy touch my eyes!

Having pled no contest, the doc had to know the medical board would be interested. He says he pled because he couldn't "win in court," but why couldn't he win in court, aside from being guilty as sin? If he were some high school dropout pinched in the projects, I'd give a lot of credence to the "I'm innocent but I had to plead out." But as we know, wealthy people in our society can serve up double homicides and win in court. So when he says he couldn't win, I tend to think that is because they had him dead to rights.

Now he gets diversion -- rehab. Fine. There are conditions to rehab -- one of them is admitting you have a problem. If he doesn't like it, he shouldn't have gone for diversion in the first place. Surrender your license and find a new career.

I can't find any empathy for this doc in my heart. He's an addict in denial, using the legal system against the people trying to help him. He couldn't weasel out of the drug conviction, so now he's trying to weasel out of the consequences.