Ask Dr. Salvo
July 12, 1994
Editor's Note: Since Dr. Salvo has received no letters of question or comment for weeks, I took the minor liberty of siccing our Serious Investigative Reporter on him. He, or sometimes she, is briefly addressed as S.I.R., or just SIR. -- E.T.
SIR: Doctor Salvo it is good to see your old white head again. I am here seriously to investigate some rumors.
Salvo: Go to it SIS, I mean SIR. There's always rumor at the top.
SIR: In charity I'll let that one pass and come right to the point -- Are you involved in some law suits against MASA?
Salvo: Are you trying to say Ole Marster or Massuh, in the style of Joel Chandler Harris or Stephen Foster? Are you in fact Uncle Remus in mufti sent to spy on doctors by the Board of Censors?
SIR: I mean to say the Medical Association of the State of Alabama, known to yardbirds as MASA. Are you feeling good about it all?
Salvo: It is perhaps premature to announce that "Massas in de cok, col', col' groun'." However it is a matter of public record that our side has two lawsuits going against several agents and agencies of the Board of Censors and Co., one suit in Montgomery, and one in Mobile.
SIR: Whom else are you suing? Or is it who?
Salvo: We would also sue the Licensure Commission if we could find them. They are the adjudicative arm of the Alabama medical profession, and can issue, revoke, suspend and reinstate the licenses of physicians found guilty of professional misconduct. The reason we're not suing them is, the Licensure Commission has no office or place of business, and no employees. Almost invisible, you might say. This hardly seems fair when the fifteen members of the Board of Censors turn out to be also the fifteen members of the Board of Medical Examiners, the investigative and prosecutorial arm of the Alabama Medical profession. When our lawyer expresses displeasure with the misbehavior or arrogance of one of these committees, its spokesman points out that the offense was committed by the other agency. Then no one is responsible and all members enjoy great latitude, even immunity (they thought) no matter how disrespectfully they treat the ordinary citizen.
SIR: Dr. Salvo you're addressing me as though I were a public meeting, and your face is red. Why all the anger? You know resentment is bad for you and -- denial could set in at any time.
Salvo: We had to spend about a year explaining to them that "the 15" were all the same people. In order to keep it simple we didn't even mention that the Board of Censors is also the Board of Health and is the final authority for the Public Health Department of Alabama!
SIR: What about it Doc? Is that improper? Picky, picky, some will say.
Salvo: Perhaps your condition is serious, SIR, but you are not: Consider that the Medical Association of Alabama is a private club of about 5500 (out of 8,000) licensed physicians. The members pay $350.00 per year dues, for which they receive the most dubious benefits. But they are not unimportant, since the Board of Censors, their governing body, has almost limitless authority over public and private health in Alabama. Do you think a small group of doctors, members of a private club, should have all that power over public funds and affairs of health and not a single non-physician on any of their Boards and Committees???
SIR: To the barricades, comrade. An inspiring speech, but I still want to know what these suits are about. Explain the suit in Mobile first.
Salvo: This one has been filed only, and is pending the outcome of the other suit. If we win the latter, the one in Mobile may fall to us without contention. All I can say about it is, it will investigate a money trail that leads from the Impaired Physicians' Committee to the P.R.N. Director to several evaluation and treatment facilities "approved" by PRN.
SIR: More Committees?! What on earth are the PRN and the Impaired Physicians' Committee?
Salvo: The I.P.C. is a non-profit private corporation of physicians contracting with the Board of Medical Examiners to carry out the duty and obligation of that Board to promote the early identification, intervention, treatment and rehabilitation of physicians who may be impaired by reason of the excessive use of alcohol or drugs, or by mental illness, etc., etc. This committee was created in 1989, and nothing much happened until October 1993 when a new contract was entered whereby MASA and the Board of Medical Examiners created the Physicians' Recovery Network as a program to be operated by the Alabama Impaired Physicians Committee.
SIR: Now I've forgotten what the Board of Medical Examiners is, but no matter. I think I understand that the PRN was created to be the active arm of the I.P.C.?
Salvo: That is close to correct. What developed, to the great convenience and satisfaction of the PRN's Director, was a neat arrangement by which each IPC member, conveniently placed around the state, would serve as a bounty hunter/dog catcher, so to speak, to inform on erring physicians and turn them over to the tender mercies of "advocacy" by the PRN. The latter would use threats, coercion, innuendo to persuade the accused physician to do as he's told by the PRN. That meant being shipped off post-haste to a "center" (only if approved and designated by the PRN Director) for evaluation. This evaluation nearly always ended with a strong recommendation for 4 weeks to 4 months of inpatient treatment at a per diem of $800.00. Followed by "aftercare" on into the golden years. All at the subject doctor's own expense, of course. For those of you too young to recall it, the Federal government gave a twenty five year trial to the long term inpatient treatment of substance abuse, at two large centers, at Knoxville and Fort Worth. The retrospective outcome studies showed the results to be somewhat worse than doing nothing at all. The long term centers were closed.
With convenient amnesia for this embarrassing fact, gurus like the execrable Douglass Talbott in Atlanta, and his disciples all over the Southeast are dragooning plane loads of intimidated doctors into such money mills as Talbott's, and scarfing up $800.00 per diem per doctor. And, for up to nine months with 5-year follow-up, aftercare, overkill contracts for the next 10-20 years. The roving and anonymous agents of IPC and PRN then refer promising marks, or cases, to centers where they themselves consult, often flying in in their private planes. Dr. Talbott has become a multimillionaire in his humble mission. And so on -- your turn, SIR?
SIR: It surely sounds attractive, if you like money and aren't burdened with principles. What about the suit in Montgomery?
Salvo: Well that one is not so dirty but perhaps more important. What it speaks to is more profound than the policies of self enriching informers and Brown Shirts.
SIR: Come on, out with it, Dr. Salvo!
Salvo: The suit in Montgomery pleads that:
1) Section 34-24-400 et seq Code of Alabama Act No. 88-536 Ala.Acts 1988 violates the Due Process Clause facially and as applied by the Board of Medical Examiners. (Facially means on the face of it)
2) An unlawful delegation of legislative powers to the Impaired Physicians Committee has occurred.
3) Separation of Powers is violated by the Board of Medical Examiners when it acts as investigative/prosecutorial agent, and then the executive and adjudicative agent.
4) Violation of the Establishment Clause -- It is improper for a state agency to force a citizen to attend religious service, i.e., A.A. meetings. (These have at least two Christian prayers per meeting)
SIR: That suit, as serious as I may be, is too deep. Just tell me: Are you winning?
Salvo: I honestly think the indications are that my side will win on at least one of the four issues. We will probably hear the Judge's conclusions and receive his order sometime this summer. With luck. If we win, then all the unhappy doctors in their paranoid Caduceus clubs, all in the thrall of the neo- Puritan brown shirts and bounty hunters -- all will be emancipated...That is, if they want to be!
Salvo, Canter-Bounty Agent
July 12, 1994