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Ask Dr. Salvo

March 7, 1995

Ask Dr. Salvo

Dear Dr. Salvo,

Wait till you read this item from a fall issue of the Journal of the American Medical Association! As you have pointed out, this is a most reliable organ designed to publicize and protect the business interests of A.M.A. members and their various "Boards" [Scientific, or actual medical issues are adequately covered by The New England Journal of Medicine, a hieratic encyclical of considerable scientific integrity and political ignorance]. Since the Caducers cadre, and MASA, and C.I.P., and P.R.N. are all political and fiduciary in nature, we will assume that "quoting the JAMA means quoting the A.M.A." especially if there is big money involved. Is there? One might say so if $100,000,000 seems like a lot, to the readers. That modest figure takes the 4,000 physicians treated by Dr. G. Douglas Talbott over the past few years and multiplies that number by $25,000. The latter figure is the cost for each 30 day admission to the Talbot-Marsh Recovery Campus in Atlanta, Georgia. I said "modest figure" because it is far commoner for the bibulous unfortunate to be taken in -- that's the phrase alright for several months of salubrious volunteer work in the emergency room. The people who refer them, report on them, "treat" them, and rule on their subsequent tandem-style 5-year "follow up care" -- are all the same people, compassionably overlapping into various powerful committee like so many amorous squid. The vast preponderance of these networkers are not trained in medicine or psychiatry. They have been, or still are, serious alcoholics. The few if any psychiatrists involved are not specially qualified. What all these Big Brothers have in common is their own history of alcoholism and some months or years of attendance at A.A. meetings. Their by now sanctified cliche's for living are stirred in together and mulled over with profound insights from Esalen Institute, the I'm OK Cult, the California Psychobabble, Rolfing and Roughage, and whatever is current -- all these ingredients are organized into a daily schedule of activities at the "treatment center." This course, along with falling off trees into the arms of fellow sufferers, or climbing ropes and falling off logs 12 feet off the ground -- all this can fill up two weeks. If the sufferer's insurance will hold still for two more weeks of "in patient care the whole schedule cranks up and is done over again, but with some new players recently arrived. Some of the patients have been "through the ropes" so long as to become indistinguishable from the alcoholic jocks on the staff. When this occurs the patient is quietly re-classified into staff. He is paid, badly, and given to understand that he is lucky to be allowed to work at all. Indeed, he is, especially if his professional license is in the hands of his captors for long as PRN and the Center see fit.

From Dr. Talbott's Gulag, occasional faint cries of protest emerge, and less frequently, information and requests for help in escaping bondage. Some of these letters-in-a-bottle claim that Dr. G. informs them that he will "hold" their license till he sees fit to restore it, based on their work performance, thinking right thoughts and saying right things, as well as abstention from whatever drug they formerly took for pleasure, solace, or anesthesia.

Under these conditions the laborers in Talbott's vineyard labor mightily and presumably earn quite a bit for Dr. Talbott, since they are pledged to do their penance by working hard and earning little for themselves. This approach, formerly called "peonage" when it was discovered in state hospitals, is as good a way to make money as was slavery ever was, except one must pay the peons a pittance and it jumbles up the book-keeping.

Dr. Salvo, I will close by offering for publication a couple of recent epistles, or bulls, coming straight from Talbott's ashram to us -- his prospective sons and servants.

Please comment on these treasures,
Double Mole

P.S. I meant to mention the P.O.W. syndrome that is endemic among the subjects of Talbott's Gulags. One day I talked to a Montgomery doctor and asked if he'd like to participate in a salutary lawsuit against the Physicians Recovery Network on grounds of civil rights violations. He replied that far from it, he would testify for the PRN. "They saved my life, they turned it around," he said, with conviction.

This man, I know, had been forced to stay at Talbott's place for three or four months and had suffered severe financial stresses. -- D.M.

"In response to such inconsistencies, the federation's immediate past president, Hormoz Rassekh, MD, established an ad hoc committee on physician impairment. Its chair, Barbara Schneidman, MD, MPH, associate vice president of the American Board of Medical Specialties, told the conference that draft recommendations for a model impaired physician treatment program should be ready for the federation's review in the spring of 1995.

After nearly 18 months' work, Schneidman says the committee has developed a list of elements it thinks are essential for effective treatment. The committee will recommend that any impaired physician treatment program working with a state medical board have the following features:

A. Assessment programs that employ providers who are experienced in evaluating chemically dependent health professionals. Assessments should include complete psychological evaluations and medical examinations, including appropriate urine and blood screening. Neuropsychiatric examinations should be considered to assess memory and cognitive understanding levels.

B. If inpatient care is required for the assessment, admission should generally be for a minimum of 3 days. Treatment providers and the physicians in their care must be willing to release assessment results to the state medical board so that board members can make appropriate disciplinary decisions. The state medical board would be notified if any physician left treatment against the provider's medical advice.

C. Treatment administered by experienced providers and the ability to offer inpatient programs lasting at least 30 days. To avoid conflicts of interest, there should be no special connections between treatment program providers and members of state medical boards. Any physician leaving treatment against the provider's medical advice would be subject to notification by the state board.

D. Follow-up care with discharge monitoring to ensure that physicians who return to work practice medicine safely and skillfully. Follow-up should include attendance at Alcoholics Anonymous or a similar program, participation in a support group, involvement of family members in the recovery process, individual psychiatric treatment, and urine screening witnessed by a same-sex observer.

E. Recognition that relapse requires prompt attention to protect public safety. Three levels of relapse should be recognized: behavior that may be indicative of relapse, use of alcohol or an addictive substance in a nonmedical setting, and relapse during active medical practice.

F. The recommendations also will stress the importance of maintaining the confidentiality of physicians in treatment, the need for supervision for 5 years following treatment, and that the parameters of treatment and follow-up care be described in a contract agreed on by providers and the physicians they are treating.

Approaches in the States

In recent years, medical licensing boards throughout the United States have softened stiff disciplinary approaches. Many medical boards already have formed cooperative relationships with treatment groups, some that are sponsored by state medical societies, in which formal, public disciplinary action no longer is pursued so long as physicians comply with terms set out in treatment and follow-up monitoring.

Massachusetts is one of those states. "Our boards is not well versed in chemical addiction and dependency," says Alexander Fleming, JD, executive director of the Massachusetts Board of Registration in Medicine. "There is never a public record when patient safety is not compromised."

In Georgia, however, a group of treatment providers is developing a pocket- size booklet that goes beyond chemical dependency in its description of 10 "problem" categories. The booklet, along with related slides, is intended as an educational tool for physicians and members of the Georgia Board of Medical Examiners. The categories it will list are the following (G):

1 Substance-related disorder

2 Substance-related disorder associated with partial remission or replase

3 Inappropriate prescribing practices

4 Mental disorder

5 Misinformed, possibly after a period away from medical practice

6 Physically disabled

7 Behaviorally disruptive

8 Sexually exploitive

9 Unethical

10 Cognitive or other problems associated with age

The group also emphasizes the need to distinguish between slips in sobriety or behavior problems and true relapse, says G. Douglas Talbott, MD, medical director of the Talbott-Marsh Recovery Campus in Atlanta, Ga. "After treating about 4000 physicians, I think that in the neighborhood of 30% to 40% of physicians, after treatment, use [prohibited substances] once or twice. It can be a step to recovery or a treatment failure.

Talbott says the booklet and slides should be completed by the end of this year. He and others at the conference say that state programs such as Georgia's, along with the federation's efforts, demonstrate that physician impairment is a multifaceted problem requiring solutions at the local and national levels.

-- by Rebecca Voelke

JAMA, October 26, 1994 - Vol 272, No 16, page 1238.

Dear Double Mole,

Thanks for your thoughtful letter and especially for the valuable long fragment from the Dead Head Scrolls of Qumrau, Georgia. It will no longer be possible for unbelievers to claim the scrolls don't exist, or that no human hand could be so subtle, no mind so mendacious as to leave such disgraceful literature behind as a snare for the unwary, a snore for the unworried. Not only does Talbott live! but so do his disciples in Alabama and Mississippi, and so do snake oil and horse feathers.


Non obscurantor

Dear Doubly,

Item A is to laugh, as are the assessments themselves, at least at Jackson Recovery and Bradford Parkside. A conscientious medical student would do better.

Item B. There is effectively no confidentiality in this system, although the term is invoked from time to time. All the players on the PRN side belong to each other's committees. Why 3 days? If the patient really needs to be in hospital at all, he needs to be there for 10 or 12 days to ensure the prevention of DT's, convulsions, and death. Three days won't do it. This one error is in itself evidence of malpractice.

Item C - I have already noted the incestuous-nestuous quality of the Impaired Physicians Committee serves as field operative/bounty hunters. Then they fly back to a treatment center where they serve as consultants, and where they have just forcibly referred a hapless physician. Later they sit solumnly on various committees and boards, deciding the fate of the culprit. "Enmeshed" like the dysfunctional family they are!

Item D. The graduating pupil, as he is leaving the treatment center, is allowed to learn that he must now sign up on a five-year contract, during which the various civil rights violated by PRN will continue to be ignored or denied. Item D is full of fairly obvious directives toward damnation by one's spouse and children, just the way they arranged it all in the Nazi Youth Movement. What if you'd rather be "witnessed" by a female? Which is the more perverse, Dr. Strangelove?

What if recovery for you means returning to the Zen masters of your youth, or acupuncture?! A judge in Miami is getting good results with court restraint, plus counselling, plus acupuncture. Is AA with all of its 1930's evangelism and excessive public prayer, the only way? "It is if you want to practice medicine in Alabama" is the routine reply of MASA members to this question.

Item E - "To protect public safety" vividly recalls "In the interests of national security" of our Nixon years and later. Please note that behavior implies use, use implies relapse whether at work or anywhere "in a non-medical setting." In your bedroom? All of this means "impaired," but it is left undefined.

Item F - Confidentiality is a farce in this system. We have several witnesses prepared to testify that the C.E.O. of the PRN is fond of strutting before the horrified ranks of the Caduceus Club and exulting over the various "Docs" he has brought down and humbled into several months of highly rewarding inpatient "treatment."

Doubly Mole, is it possible that the "10 problem categories" for the Georgia (and tomorrow the world) Board may be describing the outline of a grandiose scheme that has hubris for design and ignorance for its limits? Does it have any limits? I don't believe so. Items G4, 5, 7, 8, and 10 all attest to the looseness of thought and the derailment of reason so often seen in the chronically psychotic and the severely retarded or brain damaged. Since the presses are fairly howling for more material I will submit this now to E.T. Perhaps next month I will comment on the Paragraph G items in detail.

Cheers to you and the Club, Doubly,

-- March 7, 1995

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