Private Practice: Confidential drug and alcohol programs for physicians keep patients in the dark
Whistleblower documents pull back the curtain on secretive programs designed to encourage treatment
(InvestigateTV) – When it comes to the doctors you trust, you tell them everything to help make decisions to best protect your health. But when physicians are facing personal struggles with something as serious as alcohol and substance abuse that could impact their practice, the issue of transparency is a one-way conversation.
Confidential programs meant to help addicted doctors exist across the United States, run by organizations state by state. Their private nature is designed to encourage physicians to seek treatment without fear.
But patient advocates argue they’re at odds with the public’s right to know, with information about doctors enrolled in drug and alcohol treatment and long-term monitoring kept largely behind a cloak of secrecy.
The debate looms over Physician Health Programs, or PHPs, which are operated in nearly every state in the U.S. and the District of Columbia.
These programs are not physical rehabilitation clinics or detox facilities. Rather, they’re a system of specialized treatment, monitoring, and oversight plans often run by state agencies, non-profits, medical systems, and even lobbying groups. Their goal is to get physicians the help they need to hopefully return to practice, while maintaining public safety.
PHPs serve a critical role, given recent research on physician addiction
PHPs, including the ones operated in Utah and Virginia, estimate one in 10 physicians will struggle with drug or alcohol abuse at some point in their career. Others, including the Maryland Physician Health Program, put the number even higher, saying, “More recent data estimates that 12 to 16% of physicians suffer from alcoholism, drug abuse or emotional or mental disorders, a rate similar to the general population.”
Experts including Dr. Sidney Wolfe, the founder of the Health Research Group at the consumer advocacy organization Public Citizen, reacted to the survey, saying, “It does not take a lot of thought or brains to figure out that an impaired doctor practicing medicine poses a risk to their patients.”
Dr. Wolfe said that the risk of falling into alcohol or drug addiction is not unique for physicians. But their access to prescription drugs on the job, their ability to write prescriptions and the extreme stress of the profession can be contributing factors, he explained.
Dr. Chris Bundy, the executive medical director of the Washington Physicians Health Program, said, “Despite the fact that we might like to think of them as superheroes, they get sick like everybody else, and when they do, the option for therapy and treatment should be available to them, just like any other patient.”
That treatment is available in almost every state and Washington, D.C. through those Physician Health Programs, which are known by different names depending on the state.
But InvestigateTV’s months-long national investigation showed those PHPs are largely secretive. By design, a doctor’s enrollment in the program is not shared publicly, no matter how severe the problem that sent them into treatment.
While supporters of the system say it gives doctors a confidential alternative to discipline while still guarding patient safety, critics argue it puts the protection of doctor reputations ahead of a patient’s right to know important details about the physicians making critical decisions about their health.
“I feel like they do have the right to know because they have the power to change your health outcomes.”
Julie Pace has seen behind the curtain of the PHP system and came to InvestigateTV with concerns about the secrecy of the program and how it impacts the patients of those involved.
In 2005, she married a doctor already in recovery for substance abuse. His name is Dr. James Michael Pace, a Mississippi family physician who declined or ignored opportunities to respond to requests for comment made both in person and in four emails sent over the course of two months.
Pace’s publicly available physician profile on the Mississippi State Board of Medical Licensure shows what his former wife calls a “clean slate”.
But documents provided by Julie Pace show much more than what’s available in the public record, although Dr. Pace is not the one responsible for hiding anything. These programs are confidential, with the records Julie Pace supplied providing one of the only ways to see what patients experience in the PHP system.
Those documents indicate Dr. Pace was first enrolled in his state’s PHP in 2003. Since then, he’s signed several contracts or agreements with the program, affirming he would “abstain completely from alcohol and mood-altering substances.”
In one of those contracts from 2018, it’s clearly stated that a relapse “shall be immediately reported by the MPHP to the Executive Director of the MSBML (state licensing board)“, with any action taken potentially deemed disciplinary in nature.
But court records InvestigateTV uncovered confirm Dr. Pace relapsed and had two lengthy stays in rehab in 2018 and 2020 in Tennessee and Georgia, although we’ve found no indication he was ever impaired at work or had patient complaints.
It also appears from various records that Dr. Pace didn’t practice medicine for a period of time and even testified that he had to reapply for his license at one point.
But despite documented relapses and a potential leave of practice, there is no reporting, no disciplinary action, and no change in license status found on the state physician licensing web profile for Dr. Pace. Those profiles are designed to be searched by patients seeking information about their physician’s licensure, history of discipline, or hospital affiliations.
The Mississippi state licensing board said it would not comment on a specific licensee.
Dr. Scott Hambleton, who previously served as the medical director of the MPHP until last year, wouldn’t respond to questions about Dr. Pace, saying he can’t comment on specific licensees nor confirm or deny their participation in the program.
Dr. Hambleton said the process physicians experience in programs is effective and vigorous, with doctors often pulled from practice for weeks or months as part of their treatment. He stated that compliance is documented with random drug testing throughout the monitoring that follows treatment. If MPHP participants experienced a return to substance use, he said the medical board would be notified and they would be immediately pulled from practice.
“I believe everybody deserves second chances, don’t get me wrong. And no one’s perfect. But a pattern of behavior is a definite cause for concern,” Julie Pace said. “They (patients) should know about that. I would want to know. There should be some transparency, there should be accountability.”
While there’s no discipline or licensure status change listed for Dr. Pace, InvestigateTV did turn up other records of note.
InvestigateTV uncovered Form 990 tax filings from the MPHP, which show Dr. Pace served as a representative on the organization’s board and even served as the associate medical director the year before his 2018 relapse.
Little transparency in PHP system, even when it comes to basic statistics
Pace’s case is just one example of what can happen behind closed doors, with little showing up in the public record that patients can access as they make decisions about a provider.
Details aren’t the only thing that are hard to come by in this system where confidentiality is a core value. InvestigateTV discovered only some PHPs in states including Iowa, Tennessee, and Virginia regularly release annual reports that detail how many physicians are currently enrolled in their programs and under some kind of monitoring.
In collaboration with the Arnolt Center for Investigative Journalism at Indiana University, InvestigateTV contacted medical boards across the country seeking information about PHP referrals. Only 22 states provided information.
At least 1,000 physicians from those states have been referred to PHPs by their medical boards since the start of 2020. Those referred included doctors whose discipline records show have been charged with DUI on the way to work, some who tested positive for drugs, one found slurring and stumbling on the job, and another who admitted to drinking daily while working with patients.
“It is a major problem,” said Dr. Wolfe, the Public Citizen watchdog who has researched trends in physician misconduct for decades and has been a long-time critic of what he considers a lax and deferential system for handling the discipline of doctors.
He said the issue of physician illness and impairment needs to be addressed with patient concerns put first. He firmly believes the public has a right to know when physicians are dealing with drug and alcohol abuse issues, with patients given the power to decide whether they’re comfortable seeing a physician in recovery.
“There’s a certain important element of trust between the doctor and the patient,” Dr. Wolfe said. “Since you’re putting your health and life in their hands, they should know as much as possible. It’s not an intrusion on the doctor to let the patient know that this is what they did.”
But the identities of physicians are “zealously” protected in these confidential programs across the country, InvestigateTV found. Websites for programs in several states indicate written permission would be needed from the doctors being treated to release any information, even if the organization was subpoenaed.
Those restrictions on the release of information remain even when doctors are being routinely drug screened and monitored, and actively practicing with a list of conditions following treatment.
As many of the program websites show, the PHPs often have no obligation to report doctors and won’t always notify the medical board when doctors don’t follow the rules. The only firm and universal exception InvestigateTV found is when a physician poses an immediate threat to safety or specific patient harm.
“Why wait until someone has been harmed? The imminent danger almost always means someone’s been harmed, damaged, or killed in some cases because you didn’t catch them earlier on,” Dr. Wolfe said. “Why are the rehab organizations not automatically notifying the medical board? That’s because the state medical associations don’t like the idea.”
State medical associations or state medical societies, as Dr. Wolfe points out, are physician-funded lobbying organizations that play a powerful role in shaping the policies that determine how physicians are licensed, monitored, and policed.
InvestigateTV discovered those groups run or have strong ties to at least 17 of the PHPs across the nation, something Dr. Wolfe finds problematic.
“The rehab programs are not going to be likely to do something that will offend the doctors, namely report the progress or existence of a doctor licensed in that state in a rehab program. They’re not going to like that,” he said. “It’s confidentiality that can benefit the doctor because the doctor will not be found out by the medical board in some cases, in most cases by the patient, to have had a problem.”
Confidentiality key to PHP success, officials say
Dr. Chris Bundy disagrees with Dr. Wolfe’s stance. “I think on balance, that will discourage individuals from seeking care and treatment and will put the public at greater risk.”
Bundy is the man running the Washington PHP, and the immediate past president of the Federation of State Physician Health Programs, an umbrella organization for individual programs.
He said without a confidential option to seek treatment, sick doctors may stay underground and keep practicing until their illness progresses to actual impairment on the job.
“You have to understand that one of the primary motivations for individuals to engage in these programs and remain compliant with the program is that they know that if they’re not, confidentiality will be lost. So that confidentiality is actually a powerful motivator for the compliance that we see in the program,” Dr. Bundy said.
According to Dr. Bundy, the programs yield “gold standard results” when doctors dealing with substance abuse participate and are monitored by PHPs. Studies show abstinence rates approaching 90% at the end of five years for physicians. Other research also shows lower malpractice risks for addicted doctors after they’ve gone through monitoring.
But even when there is a failure, Dr. Bundy says that doesn’t automatically mean a doctor has put patients at risk.
“It just means that they haven’t complied with the terms of the agreement. But again, illness does not equal impairment,” Dr. Bundy. “I think overall, the system has supported the idea that these confidential programs ultimately benefit patients. And patient safety.”
Julie Pace is still skeptical. She’s among those who feel doctors still reap the greatest benefit from the lack of transparency in the system, with patients left in the dark.
“They’re putting their health in your hands basically, to make decisions for them. They should have the right to know if you’ve struggled with anything, I feel like,” she said. “Then they can make their own decisions if they want to continue to see you or not.”
Research into state medical boards and PHPs was conducted by students from the Arnolt Center for Investigative Journalism at Indiana University. They are: Kayan Taraporevala, Lizzie Wright, Ryan Fields, Caroline Geib, Lily Staatz, Lizzie DeSantis, Lauren Ulrich, Sophie Kaelble, and Olivia Blanco.
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