Dominos

 From Doximity

They Fell like Dominos: My License, My Certification, My Profession

By Anne Louise Phelan-Adams, MD

March 7, 2018 Original article

Editor's Note: The following is an opinion piece and does not necessarily reflect the views/position of Doximity.

They fell like dominos, one after another: first, my medical privileges, then my Ohio Medical License, then my state license, then my board certification, finally my DEA license. While, like most physicians, I had concerns about malpractice suit, a medical board investigation never crossed my mind.

I suppose that’s why the certified letter from an investigator with my state medical board took me by surprise. I was alleged to be “an unregistered terminal distributor of dangerous drugs.” I told the investigator everything. I hadn’t distributed anything. Seven months previously, my husband of 37 years announced that he was getting a divorce. I had no home, no marriage, no job, no doctor, not even a car. I couldn’t stop crying. I couldn’t eat. Worst of all, I couldn’t sleep. I tried alcohol; it didn’t help. In desperation, I had ordered a bottle of Xanax from a wholesaler.

That was it. I signed a release of medical records to confirm my statements and document the help I was getting and the progress I was making. I hadn’t seen any patients during that time, violated any laws, or driven under the influence. Since I wasn’t in any legal jeopardy, I didn’t need a lawyer.

Then the second certified letter arrived. The Board had reason to believe that I was “unable to practice according to acceptable and prevailing standards of care by reason of mental illness or physical illness…” I was ordered to submit to a forensic psychiatric exam. Failure to do so would constitute “an admission of the allegations…and a default and final order may thereupon be entered without the taking of testimony or presentation of evidence.” If I didn’t submit to their demands, I could lose my license.

The interview went smoothly. I had no personal or family history of alcoholism or addiction. I could spell W-O-R-L-D backwards. I did my serial 7s down to 57 and my presidents down to Kennedy, at which point the psychiatrist had said, “Enough!” I was still in therapy and taking an antidepressant, but I was back to work and feeling good. I thought that was it.

But again, I was wrong. Four months later, I got a third certified letter. This time the Board ordered me to submit to a 72-hour inpatient addiction evaluation. Knowing what was at stake, I submitted.

When I arrived at the rehab hospital, my phone, wallet and keys were confiscated, and my car, suitcase and body were searched. During my stay, I was assailed with questions I couldn’t answer, questions like “What’s your drug of choice?” and “Does your family know about your addiction?” I submitted to observed urine drug tests, sleep deprivation and hours of interrogation, group therapy and lectures on alcoholism. The cognitive dissonance was unbearable. 

On the morning of the third day in rehab, I was told that, since I was still in denial about my addiction, I would have to stay in rehab at least 28 more days. I had packed for three.

I refused. I was reminded of the consequences to my career. I still refused. I had given the rehab hospital permission to contact my husband, my daughter, my brother and a longtime colleague. They would confirm that, except for that brief period, I was the epitome of sobriety. The nightmare would be over.

It wasn’t. Six weeks later, the fourth certified letter arrived. It stated: “We have reason to believe that you pose an imminent threat to your patients and we thereby are suspending your medical license.” I had to stop practicing immediately. I could have a hearing. It would be adversarial, but it was my last chance to salvage my career.

I prepared assiduously in the 15 days leading up to the hearing. I was an articulate, consistent and contrite defendant, but a terrible lawyer. After eight hours of testimony, the Board’s lawyer concluded that my children were enablers, my spouse was lying, my colleagues were clueless and I was a hopeless drunk full of excuses. Nonetheless, I was hopeful.

Shortly thereafter, the fifth certified letter arrived. I was offered a chance to face my accusers, the eight members of the state medical board, for five minutes at a public hearing. I took the offer. Three and a half minutes into my statement, the Board’s spokesman interrupted me and read a perfunctory statement echoing their lawyer’s sentiments. I was numb.

Two weeks later, the sixth certified letter arrived. It said, “There is clear and convincing evidence that you are impaired in your ability to practice medicine and your Ohio license had been permanently revoked.” The seventh certified letter said my state license was suspended, the eighth, that my Board certification was revoked, and the ninth, that my DEA license was invalidated.

It’s taken me months to be able to write about this. Months to get past the shame of a personal crisis made public, to recover from the pain of the ordeal, and to accept that never again could I practice the profession to which I had dedicated my entire adult life.

I have learned over these months that countless other unwary practitioners have been victims of the same disciplinary fervor. I know now that, to keep their licenses, most of these physicians will submit to what’s demanded of them and they will stay silent to protect their reputations. I, however, was physically, emotionally and financially unable to submit to my Board’s final demand. As a result, I lost everything professionally. I have nothing to lose by speaking out.

My colleagues need to know that if a Board investigator contacts you, you must immediately contact your lawyer. Unlike in a civil case, Boards can presume you’re guilty and ignore exculpatory evidence. Unlike in a criminal case, Boards don’t have to advise of your civil rights because you don’t have any. They can coerce you into medically unnecessary treatment, rob you of your personal freedom, publicly defame you and deprive you of your livelihood, all with complete impunity. 

State legislatures cannot abridge the civil rights of its citizens. However, they allow state medical boards to do so based on the rationale that medical professionals must adhere to higher standards than average citizens. I accept that. However, boards should not be allowed to violate our civil rights when evaluating whether or not we are adhering to those standards. Perhaps in the long run, we can repeal the laws that allow this travesty. For now, any of you who can speak up, please do. Talk to your colleagues, your medical society, your state representative. For those who can’t speak up, please know this: you aren’t a pariah, you aren’t worthless, and you definitely aren’t alone.