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ACEP Now: Vol 37 – No 12 – December 2018At its 2018 meeting in September, the ACEP Council voted to adopt a resolution on reducing physician barriers to mental health care.
ACEP
At the conclusion of the investigation, the BME issued a non-disciplinary public “corrective action order,” effectively announcing my mental illness to the general public. This order required that I continue psychiatric care, that I maintain a physician-patient relationship with a primary care physician, and that I refrain from the abuse of drugs or alcohol, all of which I had already been doing. The order was published in the BME’s quarterly newsletter, was picked up and published by my local newspaper, and was made available on the BME’s public website, despite my objections and despite the fact that I did not act incorrectly and was not in violation of any regulation or statute as a result of my illness. Publication of this order was not based upon any actual threat that my illness posed to the general public but was rather a standard policy acted upon without regard to public safety or privacy considerations. There had been no allegations that I violated any medical practice standards at any time.
Because the BME did not have a program in place for formally monitoring physicians with mental illness, I was eventually referred back to the HPP. The HPP then constructed a psychiatric monitoring program for me so that I could finally be permitted to return to work. Despite the fact that I did not have a substance-use disorder, as a standard condition of HPP enrollment, I was required to participate in its faith-based 12-step addiction treatment program.2,3
I was also forced to sign release forms permitting full disclosure of sensitive, personal mental health information, including ongoing psychotherapy records, between the HPP, my health care providers, my employer, and the medical board. This information was shared and discussed (distorted and misinterpreted) by persons who were not qualified to evaluate it. As a result of this breach of my medical privacy, I fear I’ll never again feel safe within the private sanctity of a psychotherapeutic relationship. I was also denied the right to freely choose my own psychiatrist or psychologist, who required “preapproval” by the medical directors of the BME and HPP.
When I attempted to assert my rights to privacy, autonomy, religious freedom, and appropriate medical and mental health care, the BME threatened me with emergency suspension of my license unless I complied fully with the HPP. In response, in the spring of 2007, I finally hired an attorney and filed a federal lawsuit against the BME. In late 2012, the U.S. Court of Appeals for the Ninth Circuit upheld a district court opinion that “employees of a state medical review board are entitled to absolute immunity from civil suit for their quasi-judicial and quasi-prosecutorial acts” and that I had no legal recourse to contest BME or HPP decisions, no matter how injurious or unjust.
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20 Responses to “Emergency Physician with Depression Chronicles Her 10-Year Fight to Keep Her License”
December 18, 2018
Louise B AndrewThank you, Susan, for sharing your painful story which might help spare other physician readers from what happened to you at the hands of your employer and medical board. It is a sorry state of affairs when a physician with an unblemished record who voluntarily and confidentially requests protected time to get an iatrogenic illness under control is then subjected to 10 years of unjustified harassment followed by discrimination for the rest of her career. All the result of ignorance and stigma by regulators (and employers), and yet done with absolute immunity, and impunity, with the hackneyed excuse that it is protecting patient safety.
Considering the frequency with which a version of this story is being repeated across the nation every day, I cannot in good conscience EVER recommend voluntarily reporting a mental health issue to any regulatory body, even to physician health programs who are poised to label all “burned out” physicians as uniquely in need of their “supportive services”. Numerous reports have revealed that taking this path will result in unjustifiable scrutiny, substance use diagnosis and monitoring (without criteria for either abuse or impairment needing to be met), coupled with the threat of licensure board reporting and subsequent discipline for non-compliance. It is a highly profitable racket (for PHPs), who receive consideration for referrals to high end rehab centers supposedly specially equipped to deal with (deep pocket) physicians, who will go along with almost anything for fear of licensure deprivation. As a consequence, it is a health-wealth-and livelihood, and sometimes life draining experience for physicians.
December 25, 2018
erik j roskesMy opinion?
This is stigma, pure and simple.
I do a lot of disability evaluations. People are “able” or “disabled” not by a diagnosis but by how that diagnosis impairs their functioning. I know many people with mental illness who are disabled, because the illness makes them unable to function episodically or over a sustained period of time.
But I know many others who are completely “able”. This could be because the illness was never disabling (like hypertension), or because they got treatment and the illness remitted or resolved and no longer is present (like an infection, or a cancer in recovery), or because they receive ongoing treatment enabling them to function (like insulin-dependent diabetes).
Can you imagine if doctors (or anyone else) with hypertension (which could after all lead to strokes and brain damage) or an infection (which could after all lead to fever and delirium) or cancer (which could after all lead to brain mets) or insulin-dependent diabetes (which could after all lead to hypo- or hyper-glycemia and disordered thinking) were treated this way?
Our medical boards continue to treat doctors with mental illness differently from doctors with other illnesses. Is it any wonder we do not admit it, or seek treatment, and that we have a higher than baseline suicide rate?
December 26, 2018
Christian Wolff, MAThere is a distinct history to the gross injustices in occupational licensing as described by Dr. Haney. Although one could speculate on contextual pre-histories of the problem, one possibility is that “the problem,” started as a well-intentioned solution to public outcries about poor medical treatment. The governmental response was to increase medical regulations. Additionally, in order to keep disciplined providers from simply setting up a fresh practice in a new state, the Health Care Quality Improvement Act of 1986 (HCQIA), sponsored by Sen. Ron Wyden of Oregon was passed in Congress. The National Provider Data Bank was established and broad immunities were extended further and further to various peer review groups – this rooted in the notion of “sovereign state immunities” asserted by most or all states in the United States. Medical Boards, in acting as tribunals against physicians when there were external or sua sponte complaints began exploiting their positions of unchecked power resulting in many of the injustices we are seeing today. In response, States across the nation started (or put renewed energy into) developing independent judiciaries via legislatively supported, centralized, Administrative Hearings Offices. The Oregon history is that the state Department of Justice (DOJ) fought tooth and nail against the independence of Administrative Law Judges (ALJ) and ultimately won a war against Separation of Power. As Dr. Haney stated, she is not alone, and it is not only the injustices she describes. As I write, more and more healthcare regulatory boards are following suit in every aspect. Where medicine goes, so go the other healthcare professions. Similarly, where America goes, so go other similar nations such as Austrailia and the U.K. The injustices described by Dr. Haney are now international. Fortunately, the inherent wrongness Dr. Haney describes is easy to see by anyone who is informed. I have become a scholar in these matters and can vouch for Dr. Haney’s testimony. We all owe her a debt of gratitude for sharing her story with us because it could as easily be any licensed professional. If not already, then in the future. You, a colleague, a professional who is a family member or friend. In 2015, the Supreme Court of the United States (SCOTUS) decided North Carolina State Board of Dental Examiners (NCDB) v. Federal Trade Commission (FTC) which removes much of the immunity boards and other peer reviews have enjoyed and exploited. This year (2018), SCOTUS dealt some serious blows to “Chevron Deference.” Chevron, a 1984 SCOTUS case basically stated that in interpreting an ambiguous statute, the body which wrote the statute should prevail because “they” know best what they meant. But this causes serious problems with separation of powers, SCOTUS opined. We professionals who are being abused in ways even remotely similar to the way Dr. Haney has been abused are being given tools to fight for the restoration of justice for all, but the campaign still needs real persons who will step forward and wield those tools. I do not have the words to describe the respect I have for Dr. Haney as a person and as a medical professional who has stepped up to this plate.
December 26, 2018
Railroaded Medical professional ,still fightingIF people only knew how medical / nursing/ psychology boards operated, they would never get a license to practice in this field.
Exposing THEM now , in how they operate and making it public , social media ,and guess what the boards do not like it one bit. They do not like being treated how they treated the medical persons before them .
I think the people that make up these boards are manipulative sociopaths and love to show ‘their work” and look at the dangerous ones we caught” . They also love that “wow ” , public shaming and bullying which is unprofessional conduct and unnecessary . Kudos to Dr Haney for really protecting the public and sticking up for what is right . The boards need to be revamped and have cases heard by juries, instead of a bunch of power hungry insensitive predatory thugs, who have narcissistic personality disorders , anti social personality disorders, completely incapable of empathizing with their prey.
December 27, 2018
J. SchaeferWay to go Corrupt Oregon Board of Medicine. The first thought when reading this, is this Board if forcing Drs to lie, do not tell the truth , and wing it on your own. Do not put anything in a medical record they can get, and hold against you. Lie to your Dr, and do not take any medications that can help your condition . It its not in a record they cannot public it and go on their public sham crusade, and lie and call it ‘public safety”.
Everyone on these boards needs a psych eval by a provider of MY Choice and drug , hair urine blood, once a month .
Are these boards in the 16th century ? shame on them!! Surely they have relatives , offspring that have inherited their mental conditions.
December 27, 2018
Mark SmithI am sorry that you had to go through this- simply for being honest and having a desire to help others.
I hope it all works out in the future. Take care.
December 27, 2018
Dr ANN PayneI congratulate you Dr Haney for your courage and literally , conviction . Unbelievable (but unsurprising) discrimination by the licensing authorities and its very clear that the experience had to be a huge stressor.
Depression can make your a stronger person .
I think you’ve shown this’- and your clear writing of the events and help others Tease out , areas we can target for reform.
Thank you so much for your wisdom and experience. Ann Payne
December 28, 2018
David Ladley DODr. Haney, if I were in your shoes, and had a comfortable amount of time and money, I would gather all of the physicians you named in this article and others who have been thus harmed, and form a coaliation with the stated goal of bringing this matter before the Supreme Court of the United States. It can’t be that hard to deem state medical licensing boards’ immunity from legal liability unconstitutional, and is a wonderful case in point of the danger of immunity from legal liability for any person or institution.
December 28, 2018
APThank you for your courage. It’s ridiculous that physicians often are the least supportive and least tolerant of colleagues even during routine hardships let alone physical or God forbid, mental illness. There is a strange punitive nature in how the traditional medical culture address mental illness. However, is that surprising considering how we often treat and talk about our patients who struggle with mental disorders? We rightfully praise cancer survivors and build glossy beautiful centers for oncology care but psychiatric wards are often cheerless and seem to be the last to receive attention. Psychiatric patients languish in the ED, even children. Would we accept such care for those with CHF?
What are we so afraid of as doctors that we stand by and watch colleagues burn out or suffer in silence ostracized from friends, colleagues and patients? Are we afraid to think we may too one day end up with such a stigmatizing illness and transfer our feelings of potential self-loathing onto these colleagues?
If someone is impaired, yes, protect patients and the public and get the board involved. However, for everyone else managing their illness and frankly doing it with more courage and less resources than most, can we please give apply some rational evaluation skills? Can we offer an ear to listen for ten minutes? Can we try to empathize, encourage and respect their patient experience too?
Can we remember there is a good chance many of the same people often praised as being amazing docs have experienced mental illness?
It takes tremendous negative energy to fight doing the right thing than to move ahead and begin to release the biases and stigma that corrode our character and culture. We are trained to heal, support and relieve suffering and we take pride in that for good reason. We are more than equipped to provide these supports to our brothers and sisters who work long arduous shifts by our side.
For everyone who is fighting to make that change possible, thank you. For every hospital and licensing board who reviews these situations with intelligence, concern for patient safety and the physician, wisdom and respect, thank you.
December 29, 2018
Anne Phelan-AdamsDr. Haney
Thank you for this well-written, insightful and honest essay about the abuses you suffered at the hands of your state medical board. I’m certain that many more healthcare professionals have suffered similar abuses but are fearful of going public because of their well-founded fear of more abuse. That an agency created by a state legislature is given complete impunity to violate the rights of its own citizens is beyond my ability to comprehend. The right to face one’s accusers, to a fair and impartial hearing, to procedural due process, to protections under the ADA and even the right to privacy within the context of a therapist-patient relationship, these rights seem to be waived the moment one applies for a medical license. All licensed medical professionals need to be aware that they are just one personal crisis, one mental health disorder and one professional misstep away from the destruction of the career they’ve devoted their life too. Abuse of power thrives in the shadow of silence. We all need to speak out against it.
Anne Phelan-Adams, MD
http://www.physicanrights.net
December 29, 2018
Karen ShackelfordI have known Dr. Haney for several years. She has demonstrated incredible personal strength in her pursuit of justice. It is indescribably difficult as a private citizen rendered vulnerable by innuendo to fight a medical board, which is unencumbered by legal constraints and which possesses all of the resources of the state government. The fact that she systematically presented the relevant issues and conflicts to a broad audience that included the US Congress, ultimately prevailing in her self-defense, is worthy of praise. She certainly has my admiration. An amazingly competent and strong woman. A credit to our profession.
December 30, 2018
donna twomeyDr. Haney I congratulate you on your courage to publish this account of injustice by the BME and shed some much needed light on the plight of physicians dealing with diseases of mental health. Just as an individual physician would recommend and hope any patient of theirs seek help and follow best practices to treat a chronic illness, so to should all state medical boards. The gate keepers throughout the various medical fields need to do a better job supporting and empowering the individuals within their fields to recognize mental health issues exist within their populations in the same, if not higher, percentages than the general population.
December 30, 2018
Julie MilliganThank you Dr. Haney for publishing this information. I congratulate you on managing your mental health while dealing with this travesty. Until doctors can come forward with their health issues without fear of reprisal, we will continue to lose doctors to suicide. I wish you all the best.
December 30, 2018
Dr. LThank you for your bravery. We meed more voices of reason in our state medical boards. We also need better support for all our caregivers in medicine. I think every ER MD could use therapy or coaching regardless of any mental health diagnosis. What happens when the providers for one of our countries mass shootings develops symptoms of PTSD? Should they not seek help for fear of retaliation by the BME? You were brave, honest and naive. I’m sorry that you suffered the consequences but I hope it has begun to make a change in the system.
January 9, 2019
Gail S. Hunter, RNBravo Dr. Haney-it has gone on too long, this bullying of physicians by their medical boards. Physicians, and for that matter all medical professionals, being frightened to ask for help for fear they will lose their livelihoods. In my 35 years of practice I am ashamed to say that this fear has not changed much. By standing tall and refusing to be beaten down and by refusing to be shamed we all benefit and I pray that with your strength come changes long overdue. Oregon Board of Medical Examiners you should be ashamed of yourselves. You did NOT protect the privacy of Dr. Haney. You did not protect HER as a patient when she willingly and voluntarily came to you for assistance. SHAME ON YOU.
January 13, 2019
Gary GaddisThis story by Dr Haney is in-f*%king-furiating, because it shows regulatory stupidity, burden and excess so very well.
There but for the grace of God go any of us, given how some regulators think.
Further, to have a treated mental illness does not equal mental instability, any more than chronic diabetes or hypertension implies impaired decision-making capacity due to a non-mental illness cause, on the part of a doctor or nurse or other licensed health care professional!
And, recognizing a mental health-related, TRANSIENT need to not practice should not be treated any differently than taking a few days away from practice to recover from a “physical” illness, such as pneumonia or an acute MI.
Many physicians have been briefly hospitalized for an acute exacerbation of a physical illness. Their hospitalizations did not subject them to the trials and tribulations suffered by Dr. Haney. What makes transient exacerbations of mental illness any worse than or different than transient exacerbations of physical illness?
I personally think, from MY experience of decades ago, that some time spent with a psychologist in the short run helps one be more mentally healthy in the long run.
Further, given that physician suicides are more frequent than in the general population, and the investment made by society in each physician’s education, it is illogical to do ANYTHING to stand between physicians and their mental health. To treat an episode such as Dr Haney’s as a long-term problem is unjust, illogical and an example of mis-directed societal efforts.
Finally, I can think of other health-related conditions that could impair patient care much more than mental health issues. What about the tightly-controlled Type I diabetic who might become hypoglycemic and make a bad judgment? What about the morbidly obese doctor who sets a very poor example of health maintenance for their patients? What about the 80 year old office-based doctor with mild dementia who does not have to re-credential with a hospital staff?
There are so many examples of potential clinician impariment that could hurt patients that are so much more likely to be problematic than the brief exacerbation of mania, as was exemplified in the case of Dr. Haney, a doctor who recognized a brief inability to practice, did the right thing, and then was punished severely and unjustly for doing precisely the next right thing.
Shame on the State of Oregon and its regulatory mechanisms involved in this gross miscarriage of justice forced upon Dr Haney.
January 22, 2019
Frosso Adamakos, MDThis is INSANE! We are health care providers, and we treat our own worse than the public! Thank you so much for sharing your terrible story.
March 5, 2019
Jerod BarnesProfiles in courage.
Emergency Medicine physicians are superheroes. It takes a special person to stay cool under pressure and perform during uber-stressful, chaotic patient encounters. It’s true leadership at its finest. The buck stops with ‘you’. And ‘you’ will always have my utmost respect because of that superhero quality that is shown on every shift. I’ve worked with more than 50+ ED physicians in my career. Not one of them would be comfortable with attention brought onto themselves. Just doing their job.
I have been lucky enough to be invited to the table, and work side by side ED physicians for the past 12 years of my career. I am a proud member of SEMPA, and very thankful that ACEP gives us constant encouragement and guidance to practice ED medicine at its finest. We owe a big debt of gratitude to ACEP.
I’m not surprised to read the negative experiences that Dr. Haney experienced. But am deeply, deeply saddened. Working in the medical field does not shield us from the human condition. Courage comes in a lot of different forms. And writing this article brought light to a topic that needs constant coverage to make meaningful change. We have a long way to go.
Thank you for your courage Dr. Haney.
Jerod A. Barnes MSPAS, PA-C
May 20, 2019
NLThis is horrible and very true. I am battling these same demons and the immunity of the board is ludicrous. It allows them to follow a nebulous path whereby you are constantly trying to prove your innocence rather through a nebulous process that is never defined. I am going through the same thing. I think we should band together.
January 26, 2023
Susan T. Haney, MD, FACEP, FAAEMMe too. You can contact me through the ACEP Wellness Section. I’m sorry that you have been going through this senseless ordeal, and I hope that you are OK.