Pubdate: Sat, 18 May 2002
Source: Times, The (LA)
Copyright: 2002 The Times
Contact:  http://www.shreveporttimes.com/
Details: http://www.mapinc.org/media/1019
Author: Alisa Stingley, The Times

RX OVERLOAD: ADDICTED DOCTORS

In Louisiana, doctors with substance abuse problems who are investigated by 
the state licensing board rarely lose their licenses.

The majority of actions taken by the Louisiana State Board of Medical 
Examiners against doctors charged with substance abuse problems are either 
suspension or probation, according to figures from recent years. Yet there 
is an unknown number of doctors with drug problems who may never come to 
the attention of the licensing board - or to their patients.

Doctors are often skillful at covering up their problem, said Dan Talley, 
executive director of the Council on Alcoholism and Drug Abuse of Northwest 
Louisiana.

"They are more difficult to treat because they are so knowledgeable about 
the problem and so adept at hiding it," Talley said. "They know the 
pharmacology and effects of drugs and for a long time can maybe avoid an 
overdose. Plus, they are pretty well insulated from criticism. They don't 
have to account for their whereabouts; it's not like they have to answer to 
anybody."

The issue of doctors and substance abuse has been spotlighted locally by 
the case of Dr. Christopher Greer of Bossier City, an ear, nose and throat 
specialist practicing in Shreveport who was arrested April 20. He was 
indicted Wednesday by a federal grand jury on charges of conspiring to 
distribute Schedule II narcotics, three counts of prescription fraud and 
two firearms counts.

Greer is scheduled to be arraigned Wednesday. He is out on bail and in a 
private substance abuse rehabilitation program in Rayville, family members 
said.

According to disciplinary actions published in the Louisiana medical 
examiners board newsletters, 26 doctors were charged with habitual or 
recurring abuse of drugs from March 1999 to December 2001. Six were from 
Northwest Louisiana.

The drug actions made up about 30 percent of the total number of 
disciplinary actions taken by the board during that time.

Only one license was revoked for a drug charge, according to the 
newsletters. During that time period, 12 received suspensions and 13 
received probation. Doctors on probation can continue to practice medicine 
but not while in substance abuse treatment.

Actions by the board are made public through news releases to the media. 
But those are only the doctors who have been investigated by the board and 
where action was taken. Some doctors may never seek treatment and never be 
reported to the board; others may voluntarily seek help through state 
physicians health programs and avoid having the licensing board ever know 
about their drug problem.

Dr. Sidney Wolfe, director of the Health Research Group for the Washington, 
D.C.-based watchdog group Public Citizen, said only a "small fraction" of 
doctors who have drug problems are ever disciplined.

"We find this is a dangerous practice," Wolfe said. "There are doctors who 
are practicing medicine who have drug or alcohol problems and patients 
don't know because the medical board doesn't know about it."

Such impairments may make medical mistakes more likely, he said. "You 
shouldn't have to wait until a patient is harmed or killed for the public 
to know it."

Public Citizen's study of national data found that nearly 68 percent of 
doctors who had received disciplinary actions for substance abuse were 
allowed to continue practicing.

The study said the doctors' behavior was "probably unknown to most if not 
all of their patients."

Each year, about 50 physicians contact the Physicians' Health Foundation of 
Louisiana for help, said Michael R. DeCaire, administrative director of the 
program, based in Baton Rouge. About 80 percent of those have substance 
abuse/chemical dependency problems, he said.

The program, established in 1984 by the Louisiana State Medical Society, 
helps doctors identify four kinds of impairments: substance abuse/chemical 
dependency, psychiatric illness, disruptive behavior and physical limitation.

"First-timers," as DeCaire called them, are not reported to the licensing 
board unless it is a case of patient boundaries (such as sexual misconduct) 
or certain violations, such as diverting a substance for sale or trade, 
DeCaire said.

Doctors can go through treatment after being referred by the program (the 
doctor is not allowed to practice while in treatment), then sign a 
five-year contract for extensive monitoring, and their drug problems likely 
would never be made public.

DeCaire said the program should allay doctors' fears that seeking treatment 
could end their careers.

"We want to help physicians before problems escalate and before possibly 
causing someone harm, whether it's the physician or patients or families," 
he said.

He said that in 2000 and 2001, 96 percent of participants had successfully 
completed the program and had not returned to substance abuse.

"We don't want to seem like a physician policing type organization ... but 
we do hold our participants highly accountable," DeCaire said. "It seems 
very strict, very regimented, and it is."

Monitoring includes attending certain numbers of recovery group meetings, 
continuing medical education and frequent random drug screens. All of the 
requirements must be reported monthly. If there is a pattern of breaching 
the contract, the program notifies the state licensing board, which then 
could take action against the doctor.

For doctors who successfully complete the program, the foundation advocates 
on their behalf to reinstate hospital privileges, sign on to health plans, 
get malpractice insurance and so forth, DeCaire said.

Are more doctors using drugs? Or are more doctors seeking help, knowing 
they can avoid bad publicity or sanctions? It's hard to tell, experts say, 
since few comprehensive studies have been done on the subject.

But one Louisiana rehabilitation facility is seeing a rise in patients 
since it opened eight years ago. Palmetto Addiction Recovery Center in 
Rayville has a special program for doctors, nurses, dentists, 
chiropractors, veterinarians, pharmacists and attorneys. Each year about 
150 to 200 professionals enter the 90-day program, which costs $18,990, 
said marketing director Allen Rainwater.

He said the facility is being expanded to meet a demand he attributed 
partly to nationwide marketing of Palmetto and to more professionals 
seeking treatment.

By successfully completing a treatment program such as the one at Palmetto, 
doctors who have had their licenses suspended or who have been placed on 
probation by the licensing board may avoid losing their licenses.
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MAP posted-by: Terry Liittschwager