Pubdate: Sun, 29 Sep 2002
Source: Asbury Park Press (NJ)
Copyright: 2002 Asbury Park Press
Contact:  http://www.app.com/
Details: http://www.mapinc.org/media/26
Author: James W. Prado Roberts
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

ADDICTED-DOCTORS PROGRAM: SENATOR PROMISES PROBE OF PROBLEMS

A co-chairman of the state Senate Health Committee said he plans to hold 
hearings this fall to address problems within the state- sanctioned 
physician drug-treatment program. His statement followed a claim last week 
that a psychiatrist was addicted to drugs when she treated a police officer 
who later killed five people and himself.

One flaw in the program is the policy of calling enrolled doctors a day 
before a random urine sample is taken, said state Sen. Joseph F. Vitale, 
D-Middlesex. Doctors being monitored by the Physicians' Health Program for 
signs of drug abuse should at the very least be given unannounced tests, he 
said.

"It's a weak excuse to say, 'Well, poor us, we only have volunteers and we 
are unable to do (tests),' " Vitale said about the Medical Society of New 
Jersey, a nonprofit physicians group that runs the health program.

The program is endorsed by the state to monitor the approximately 600 
physicians and health care professionals with substance abuse and 
psychological problems.

For doctors in substance-abuse treatment, "probably one of the last things 
you (should) do is tell them you are coming," Vitale said.

The PHP collects hundreds of urine samples each week - sometimes on random 
days twice a week from the same doctor - but doctors are called a day 
before the urine tests are due, according to the Division of Consumer 
Affairs, which supervises the Board of Medical Examiners. The board 
regulates doctors in the state and works in tandem with the PHP to keep 
impaired doctors away from patients.

But Toms River psychiatrist Debbie L. Miller admitted to the board in 1998 
that she faked her 1996 tests by hiding someone else's drug-free urine in 
her body.

Miller regained her license in 1998 and was ordered to submit to more urine 
monitoring - which she also faked, according to her former office manager 
and romantic partner, Maria A. Baldasarre.

For four years, Miller abused drugs "24-7" but fooled her drug monitors and 
treated patients while she was high, said Baldasarre, now a Florida prison 
psychologist.

The psychiatrist went into a drug rehabilitation center in December 2001 
and abandoned her Toms River practice. Miller, who could not be reached for 
comment, surrendered her license in February for at least six months and 
has not reapplied for licensure, according to the board.

Baldasarre said that in the summer of 2001 Miller treated Edward L. Lutes, 
a Seaside Heights patrolman and SWAT team member who in April killed five 
of his Dover neighbors, wounded his police chief and then killed himself 
with police-issued firearms.'The system failed us'

"It adds to the proof of how the system failed us," said 25-year-old 
Theresa Williams, whose parents, Tina and Gary, were killed by Lutes on 
April 9. In talking about Lutes, "There are just so many signs that were 
overlooked, numerous signs that could have -- that my parents could be 
alive today."

Baldasarre's claims about Miller's drug use or that she treated Lutes while 
on drugs could not be verified by the Asbury Park Press.

Vitale said, "There is a lot at stake here, and we should be doing the best 
that we can" to keep impaired doctors away from patients. "There could very 
well be a better way."

Vitale said he will hold hearings this fall on the state medical board's 
oversight of addicted physicians, and the performance of the PHP.

Aware that Miller had relapsed four times and faked her drug tests, the 
medical board said it reinstated Miller's license, with restrictions, in 
1998 only after the PHP detailed "Dr. Miller's total compliance with her 
program of recovery," according to a prepared statement from Consumer 
Affairs. Again with the PHP's recommendation, in 2000 the board lifted all 
restrictions and allowed Miller to voluntarily participate in the drug 
treatment program.

"Where there is a need for change, and it is in the board's power to make 
that change, it will do so," the statement read. "The board is always 
concerned that the physicians it licenses are competent to practice. When 
it is confronted with physicians who have substance- abuse problems, as 
with other cases, the board takes what it feels to be the appropriate 
actions based on the facts."

Getting her license back even after admitting to the board about her 
relapses and how she cheated the drug tests is "just wrong," Vitale said.

The PHP said it doesn't rely solely on urine testing to watch doctors with 
substance-abuse problems; the program uses therapists, 12-step programs and 
monitors to carefully watch for relapses.

National drug testing experts say doctors may be able to fool any form of 
testing for a while, but urine tests are particularly susceptible to 
effective faking.

To avoid being caught, a male doctor could pump clean urine into his 
bladder so he passes the test, doctors have said. Bal-dasarre said that 
Miller would get clean urine from the cou-ple's dog when she couldn't 
ob-tain it from drug-free people. PHP doesn't test if the urine is from a 
human.

Peter Lurie, deputy director of Public Citizen's Health Re-search Group, 
which tracks doctor conduct nationwide and how state medical boards mete 
out discipline said the medical board's handling of Miller is among the 
worst he has seen.

"It's just unconscionable," Lurie said. "If they can't take action against 
someone like this, who will they take action against? . . . It's pushing 
the limits of what medical boards do, in terms of failing to take adequate 
action."

Medical board defended

Robert J. Conroy, special coun-sel for the Medical Society of New Jersey, 
defended the board, saying its 21 members are tough on substance-abusing 
doctors and often errs on the side of keeping doctors out of practice if 
they have even a small chance of abusing drugs again.

But doctors who have fooled the PHP tests should not neces-sarily be banned 
from practic-ing medicine, Conroy said.

Unannounced visits for urine tests or hair samples on doc-tors would be too 
time consum-ing for the program's volun-teers and would cost the state 
money that could be better used elsewhere, the Bridge-water lawyer said. He 
noted that the PHP is a model for other states' impaired-physi-cian programs.

"I don't think it makes any sense to spend more public money in this area, 
because, quite frankly, you still haven't shown me a case where a pa-tient 
has been harmed," Conroy said.

Other drug-abuse tests, such as hair samples, which are almost impossible 
to fake, would catch too few people to make them worthwhile, he said.

"Why don't we test everybody who drives a motor vehicle in the state?" 
Conroy asked. "That would save lives wouldn't it, if we were using the same 
theory. Then we can raise everybody's motor vehicle license fees $1,000 to 
cover it. That wouldn't make sense, would it?"

Vitale said that if the Medical Society of New Jersey is resis-tant to even 
answering ques-tions on the issue, "that is not helpful for anyone. If 
there is a problem, then they have a re-sponsibility to examine any number 
of solutions. Being in-flexible certainly doesn't get us there."

Carl M. Selavka, director of the Massachusetts State Police Crime 
Laboratory System, said urine tests cost about $15 to $20 and only measure 
recent drug use. Hair analysis covers 90 days and costs about $50, he said.

Doctors enrolled in the PHP pay for all their own tests and therapy.

Hair samples "could be consid-ered more cost-effective for a chronic 
repetitive user," said Selavka, a national drug-testing expert.

At least one other state appears to impose tougher punishment for relapsed 
doctors.

Andrew W. Watry, executive director of the North Carolina medical board, 
said he recom-mends a doctor stay away from patients for at least two 
years, or lose his license permanently after three relapses.

Docs can't be banned

Doctors in New Jersey who fake the drug tests cannot be permanently banned 
from med-icine, under state law. There is no statute that allows for 
per-manent revocation.

In a January news series on the Board of Medical Examin-ers, the Asbury 
Park Press re-ported that over seven years 59 doctors were publicly 
disci-plined for abusing drugs and, of those, 27 had relapsed from a prior 
abuse.

Many substance-abusing doc-tors avoid public discipline by the board if 
they enter and complete the PHP's treatment.

The Press found that, in most cases, doctors who were sus-pended or who 
voluntarily sur-rendered their licenses for re-lapsing regained their 
licenses in less than six months.

Suspensions or the voluntary surrendering of a license for a relapse were 
found by the Press to be less than six months in most cases.

On Sept. 13, the medical board permitted cardiologist Dr. Mark M. O'Connell 
to practice medicine again following a four months away from his practice.

O'Connell, of Little Silver, had surrendered his license in May after he 
diverted pain killers from intensive-care unit pa-tients at Jersey Shore 
Medical Center, Neptune, according to board records.

O'Connell declined comment. He had abused prescription drugs from 1989 
through 1995, according to board records.

Mixed opinions

Several patients of Miller's have said the doctor appeared ill, shaky, and 
had difficulty writing last fall. Miller told them that she had Lyme 
dis-ease, the patients interviewed said.

"The way she acted, she didn't act as if she was right," said Nancy Mills 
of Brick, one of Miller's former patients. "She was always trying to 
concen-trate too hard while you were there, as if she was preoccu-pied."

But Kathleen Loughran, of Lakewood, another former pa-tient of Miller's, 
said Miller looked healthy, and that the doctor was a lucid, articulate and 
good psychiatrist.

"If what she (Baldasarre) is say-ing is the truth -- and I doubt it very 
much -- she should have reported it," Loughran said.

Moreover, Baldasarre didn't seem like an office manager, Loughran said.

"The last time I was there, she announced the rates had raised," Loughran 
said. "Other than that, she was there to chat up the patients."

Robert A. Forrest, who was a patient of Miller's until the doc-tor went 
into a drug treatment center in December, said he is concerned other 
patients were left without a psychiatrist.

Forrest, a 46-year-old sales rep-resentative, went three months before he 
could find another doctor to prescribe him the drugs that Miller had given him.

Forrest finally had to go to an emergency room to get a new prescription 
before he found a doctor who would treat him in February.

"I am afraid there are more peo-ple out there that just may not be getting 
their medicine. I called two or three doctors," he said. "They couldn't get 
me an appointment."

It could not be learned if Miller had a file on Lutes, the killer police 
officer. The Ocean Coun-ty Prosecutor's Office declined to comment on the case.

Some of Miller's patients have complained that after 10 months, they still 
cannot get access to their medical records or even find out where the 
doc-uments are.

"I just think the whole episode is ridiculous, that she had the opportunity 
to do this to peo-ple," said Mills of Brick. "It's just mind boggling to 
think that you put your trust in peo-ple to help you and they are more 
screwed up than you are."
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