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Ask Dr. Salvo

August 9, 1994

Dr. Salvo and Tim

Ask Dr. Salvo

Dear Dr. Salvo,

A while back you gave us a column about the Physician Recovery Network and its nefarious tactics with physicians at USA and elsewhere in Alabama. Your comments included the observation that "nothing much happened" for a while after the Impaired Physicians Committee and its brown-shirt arm, the Physician's Recovery Network (P.R.N.), were established by legislative action, said acts being sponsored by M.A.S.A. (Medical Association of the State of Alabama) through its Board of Censors.

My question, Doctor, is when did things start happening, what sorts of things, and why? It seems to me you have promised us some earthshaking revelations, perhaps a scandal amongst the minions of M.A.S.A. No tremors have registered on my seismograph thus far. My nose for scandal has not twitched appreciably, and I remain,

Your humble and skeptical servant

Dr. Bilbo

Dear Dr. Bilbo,

You curiosity is commendable. The vast majority of physicians in Alabama have shown no awareness of what M.A.S.A. is doing to them already, much less any curiosity as to what new insults to their autonomy this revered body may have for the future. And, their liability insurance:

Only last week a physician I know called to tell me that a lady highly placed in the Mutual Assurance Company had called to tell him that he was no longer insurable (for medical liability) unless he renewed his "contract" with P.R.N. His five year contract with P.R.N. had been completed over a year ago. This means, in effect, that any M.D. who is ever involved with P.R.N. (for treatment of practically anything) will remain tied to and labeled by P.R.N. as "impaired" for the rest of his professional life.

Of course he can leave Mutual Assurance and obtain his liability insurance elsewhere. Most likely this will be at a higher rate than the one he would have paid to Mutual Assurance. Isn't it likely that Mutual had already raised his rate, because of his past involvement with P.R.N.?

To return to your question: The first reason "nothing much happened" is that the diverse governing committees of M.A.S.A. still felt it was reasonable to wait till trouble came to them, rather than going forth looking for trouble, or even making trouble where none had been before. That is, they assumed that the Ethics Committee of each chapter of M.A.S.A. would deal with all MD's who were clearly impaired in their ability to practice medicine in a responsible and reasonably safe manner. Further, they expected a small number of cases every year in which the M.D. did not respond to local persuasion. These cases would appear before the Board of Medical Examiners and/or the Board of Medical Licensure (these and several other small groups and committees are actually comprised of the same little bunch of people).

The second reason nothing much was happening at first was the absence of now director of P.R.N. It was his selfless devotion and tireless industry that soon filled the ranks of P.R.N. with scores of "impaired physicians," all presumably eager for the salvation offered by him and ready to sign 5 year contracts for "follow-up care" for life. At their own expense of course. And only at the hands of treatment centers designated by the director of P.R.N. himself.

How did he do it? Marketing, my dear friend, marketing: First he sent out a flyer, later to be repeated in various ways, describing a new piece of legislation for Alabama physicians. This law, which had been passed without publicity, and without the knowledge or consent of 90 percent of Alabama physicians, told them who should be reported to P.R.N. (Read "denounced.") The person lodging a complaint was assured confidentiality and anonymity. That is, the target of the informer would not be allowed to face his accuser. The accuser could comfort himself with the thought that the statute legally obliged him to report colleagues who were depressed, withdrawn, eccentric, made rounds at strange hours, tried to romance the nurses, rejoiced too much at public festivals, were seen inebriated or intoxicated under any circumstances (i.e., not necessarily at work). Impairment of professional functions was not specified, nor described, but would be assumed.

All of this pernicious nonsense interests me keenly: The best teachers I ever knew in medicine tended to be eccentric, often pessimistic or depressed, sometimes withdrawn. And on the bright side, they loved to romance the nurses -- several even married nurses and were happy; and they loved to celebrate regardless of what wimps were watching them. They made rounds when they could.

However, this director of P.R.N. had just enough walking around sense to realize he would have to recruit his victims from a much more vulnerable and obvious group than physicians at large: the alcoholics and/or drug abusers. This he did, and does, and plans to do even though he is about to be desquatulated by a constitutional lawsuit. (That word above means "unseated.") He cleverly noted that vulnerability and availability of a concentration of potential subjects beckoned from the medical schools. So that is where he and his subaltern have been flexing their power in Mobile for several years. (We, the Rebribution Committee have not yet heard from UAB in B'ham -- but soon, we hope!)

Besides his "proactive stance" toward identifying offenders, i.e., impaired physicians, the head of P.R.N. brought to the situation a very effective technique of marketing. He held several workshops to acquaint the medical faculty of USA with the benefits they could expect by joining up with P.R.N. as informers. After each workshop/seminar, a rash of unverifiable complaints came in from USAMC.

It would seem he was more persuasive than he had a right to expect. After just a couple of years of G.S.'s effort, the following score was run up:

1) Department of Pathology - one professor and one resident. One suit has come of this, and another possible.

2) Department of Psychiatry - one associate professor, one clinical associate professor, one resident. Two suits out of this, and two beginning.

3) Neurology - One professor, who sent them packing.

4) Anesthesiology - Several victims.

Odd happenings occurred in some of these cases, according to the U.S.A.M.C. gossip: There was no verification in the first case, and the accused had to sue the department/university to obtain redress.

In Case 3, again, there were no grounds to pursue the accusation, and the P.R.N. were told and run off!

In Case 4, there were too many problems in the work itself for the P.R.N. to be fair or accurate in its assessments. P.R.N.'s usual response was to recommend more and more months of inpatient treatment. [At Lexington, KY, and Forth Worth, TX, long-term inpatient drug abuse treatment was thoroughly discredited after 25 years and discontinued.]

As to Case 2, Department of Psychiatry, the latest case is beyond belief, especially since P.R.N. was already under heavy attack in court in Mobile and Montgomery when these events happened.

It began with the resident reporting for work one morning, and pausing on his way into the hospital to sit down and observe a therapist working with a child patient in play therapy. Two women walked by, perhaps staff, but unknown to the resident.

Very shortly thereafter, he was summoned by his chief to appear before the hospital administrator. The latter informed him that there had just been a complaint against him. Two staff members had smelled alcohol on his breath. The accused, who never indulged except at night, (off duty, moderately) knew with certainty that nobody could have smelt whiskey on his breath. He conceded he'd had a cough lozenge in his mouth. With a superkeen proboscis and a paranoid/suspicious personality, someone could have mistaken this scent for alcohol.

(The P.R.N. and the I.P.C., it seems, are recruiting people just like this! Could they be training them to sniff out narcotics in overseas baggage? To hunt quail on weekends?)

Anyway, our resident was ordered to submit to a urine screen for drugs. He demurred -- but was told his residency was at stake. Having no help from his chief or a lawyer -- he went along. Naturally no trace of alcohol was found. However, a small trace of cannabis was found. This could have been in his system for weeks following a small dose -- one or two puffs. A real pot-head's urine or blood sample would have been loaded with cannabis, because he'd be smoking daily.

On the grounds of this feeble and inappropriate evidence (of impairment, remember, not just use of a substance) the resident was coerced into seeing a psychiatrist, and the latter (plus the good offices of the director of P.R.N.) ordered him into 20 hours of after care treatment at Parkside on Dauphin Street. It was never made clear whether he was to be saved from alcohol, on no evidence, or cannabis on almost no evidence. There were never any instances of impaired function mentioned, since there were none. Nobody from the hospital, the D.O.P., or the P.R.N. even consulted Searcy Hospital about the qualities and performances of this resident, who had spent the entire past year working there. The chief administrator there told Salvo that everybody in the hospital respected and liked this resident. Nobody had a word to say against him; and he smelled just fine!

What are we to say about this travesty of medical education and academic freedom, the wholesale trampling on the civil liberties of this resident by the hospital administrator, the psychiatrist, and subsequent ignoramuses at Parkside who said his "attitude was so bad" he needed prolonged in-patient care?! Anyone recall the Gulag Archipelago?

Our plucky resident rejected follow up and in-patient care on the grounds that no diagnosis had ever been made, and there was nothing to treat! For this piece of clear thinking he was fired. He had engaged a lawyer, who wrote some fairly intimidating letters about the case to the hospital administration, the president of USA, and the apparently innocent lady lawyer (who to date seem to have no idea what she has put her foot in, or what to say in reply -- so she doesn't reply). Very soon, I expect, the chickens will come home to roost and the enemy, the director of P.R.N. and his supporters, and the lawyer will all be covered with it.


P.S. At least we can now see clearly and say plainly, P.R.N. has no interest in verifying impairment: merely use will suffice.

August 9, 1994

The Harbinger