Shady ‘Diagnosing for Dollars' Scams Rob Licensees of Livelihoods and More
Irrevocable harm is being done by PHMPs—organizations that were originally designed to help licensed professionals seek confidential help for their mental and physical problems without risking the suspension or revocation of their licenses.
PHMPs have become overly aggressive, controlling organizations with far too much reach into people's lives and complete power over whether they will ever be able to return to their practice. Rife with possible conflicts of interest and lacking both oversight or regulation, they now resemble more of a well-organized racket than a healing and helping mechanism.
Untrained PHMP staff are diagnosing licensed professionals and thrusting them into “treatment” programs of dubious value that licensees are forced to pay for out of their own pockets. Not only have they not helped them address their problems or maintain their licenses, but they have also driven some to permanent unemployment, bankruptcy, and even suicide.
What are PMHPs and PMPs?
A PHMP is a Professional Health Monitoring Program, and a PMP is a Prescription Monitoring Program. The original intent of these programs was to provide a pathway for professionals suffering from a physical or mental impairment to get the help they need and be monitored in their practice without involving their professional practice board and jeopardizing their licenses. PHMP programs are run by nonprofit corporations, state medical societies, or state medical licensing boards.
They exist in almost every state and are represented by an umbrella organization known as the Federation of State Physician Health Programs. Depending on the type of license you hold, and what state you're licensed in, these programs go by different names. Here are a few examples:
- PHMP: The Professional Health Monitoring Program in Pennsylvania for surgeons, medical physicians, graduate medical trainees, and physician assistants, as well as RNs, LPNs, CRNAs, RDNs, and CNSs.
- SARPH: The Secundum Artem Reaching Pharmacists with Help (Pennsylvania) for pharmacists.
- PAP: The Professional Assistance Program (New York) for physicians, physician assistants, and specialist assistants, as well as pharmacists.
- SPAN: The Statewide Peer Assistance for Nurses forNew York for RNs, LPNs, CRNAs, RDNs, and CNSs.
- PAPNJ: The Professional Assistance Program of New Jersey for surgeons, medical physicians, graduate medical trainees, and physician assistants, as well as pharmacists.
- RAMP: The Recovery and Monitoring Program (New Jersey) for RNs, LPNs, CRNAs, RDNs, and CNSs.
What is a PMHP Evaluation?
The PHMP will put you through an evaluation in which they decide whether and how you're impaired.
The problem is these evaluations are not conducted by trained medical or psychiatric practitioners. Misdiagnoses, as well as false diagnoses and over-diagnoses, are rampant.
Anything you say during the evaluation can be twisted around and come back to hurt you. You may mention that you and your partner drink wine with dinner, and the interviewer may decide you have a drinking problem.
Who Can Report?
Although some licensees self-report to the PHMP, most are reported by others.
It's easy to report someone. Anyone can do it.
All it takes is an anonymous phone call. If you're a hospital-based practitioner, you can be reported to the administration, and they will report you to the relevant PHMP. Someone can write a letter directly to the PHMP or submit a complaint form to the Department of State website.
More than half of all complaints about physicians and physician assistants come from the public— patients, friends, and family members.
One of your colleagues or co-workers could have reported you, whether maliciously or because they honestly believed you were impaired and wanted you to get help, or possibly because they were afraid of violating your state's mandatory reporting law. If someone you work with believes you're impaired, and they don't report you, they can be accused of misconduct themselves, as most state have mandatory reporting statutes, including New Jersey and New York, for example.
Professionals can be reported for a wide scope of behavior, some involving obvious signs of impairment and others for nothing more than hunches or subjective opinions, including:
- Colleagues observed you falling on the operating room floor in the middle of surgery.
- A patient said they smelled alcohol on your breath.
- A nurse said you were verbally abusive to him.
- A colleague noticed the patients assigned to you on the nursing unit were complaining their pain was not being addressed.
- A co-worker said you'd gotten behind in your paperwork and other duties.
- A staff member thought your anger had spiraled out of control.
- A colleague thought you were “acting weird.”
Let's take a look at some common problems that licensees may face and how the PHMP would not be the best place to get help.
A very real problem: An estimated 10-15% of health care professionals will misuse drugs or alcohol at some point during their careers, a statistic mirrored in the general population.
How the PHMP can mess things up for you: They may decide you're a drug addict based on one screening test when your real problem is that you can't sleep because of tremendous pressures at work. You smoke marijuana once in a while to help you sleep, but that's the extent of your drug use. You need a therapist more than you need detox, but there's nothing you can do to change what the PHMP has decided.
A very real problem: Depression's symptoms, including mood swings, defensiveness, isolation, irritability, slow thinking, and poor judgment, definitely do impact work performance.
Given the extended hours, lack of sleep or difficulty sleeping, and additional stressors that come with caring for COVID-19 patients—not to mention the strain of having sick loved ones, homeschooling children, social distancing, etc.—it's no wonder health care providers feel burned out.
According to the 2020 Medscape National Physician Burnout & Suicide Report on more than 15,000 physicians in 29 specialties:
- 44% reported experiencing burnout;
- 11% said they were depressed (feeling down, sad, or blue, which is known as “colloquial” depression); and
- 4% said they were clinically depressed (experiencing severe depression lasting more than two weeks and not caused by a normal, grief-associated event).
How the PHMP can mess things up for you: The person evaluating you for the PHMP is not a doctor or a psychiatrist and may not recognize your symptoms as depression-related. Again, you may end up in a treatment program for an issue you don't even have.
A very real problem: The “disruptive physician” is a character type well known in clinical circles and the subject of many courses, policies, training materials, and discussions. The American Medical Association (AMA) defines disruptive behaviors as “Conduct, whether verbal or physical, that negatively affects or that potentially may negatively affect patient care.”
“The disruptive practitioner is by definition contentious, threatening, unreachable, insulting and frequently litigious. He will not, or cannot, play by the rules, nor is he able to relate to or work well with others.”
- Dr. Fishter, a staff psychiatrist at Lewistown Hospital in Mifflin County Pennsylvania, commenting on a 28-day suspension imposed by Lewiston Hospital on Alan Gordon, MD, for his verbal abuse of a nurse. -RiskRx, 2015
“Physicians have a responsibility to address situations in which individual physicians behave disruptively, that is, speak or act in ways that may negatively affect patient care, including conduct that interferes with the individual's ability to work with other members of the health care team, or for others to work with the physician.” - AMA Code of Ethics
How the PHMP can mess things up for you: It will be up to the PHMP evaluator to decide what's at the root of your behavior, and they are not qualified to do so.
Is the PHMP My Only Option?
That's what they want you to believe. Licensees are often made to feel they have no choice but to enter a program and or face disciplinary action. Don't fall for it.
If you receive a Letter of Concern or a phone call from the PHMP saying you need to participate in an evaluation to protect your professional license, the first thing you need to do is call the Lento Law Firm at 888-535-3686. Let one of our experienced attorneys help you navigate the system and protect your license and your practice.
Problems with PHMPs
Some call it Diagnosing for Dollars because it's a closed, self-perpetuating system.
A report will send you to the PHMP, the PHMP will evaluate and diagnose you, the PHMP gets you to sign a VPN, your PHMP caseworker decides you need treatment at one of their “preferred” facilities, and you have to continue dancing to their tune until they release you.
In one AMA Journal of Ethics article, the author observed that “most physicians do not know much about these programs, but given that they wield a lot of power and generally operate outside the scrutiny of the wider medical community, a closer examination is warranted.”
Michael Langan, MD, an internal medicine specialist in Boston who has first-hand experience with a PHMP, told Medscape News in 2015 that he “feared the role of PHPs has expanded well beyond its original scope, becoming monitoring programs that have the power to refer physicians for evaluation and treatment even on the basis of administrative failings, such as being behind on chart notes.”
In a 2012 editorial in the Journal of Addiction Medicine, the physician authors noted that “for most physicians, participation in a PHP evaluation is coercive, and once a PHP recommends monitoring, physicians have little choice but to cooperate with any and all recommendations, if they wish to continue practicing medicine.”
What they don't tell you is that you are under no obligation to go, and we strongly suggest you don't.
Once a report is provided to the state's PHMP, a very rigid intake process ensues, and you will quickly lose control. Call us before you make a mistake you will regret. Detractors of the PHMP system claim “physicians who voluntarily disclose they have mental health or drug problems can be forced into treatment without recourse, face expensive contracts, and are frequently sent out of their home state to receive the prescribed therapy.”
A PHMP comprises two programs, the Voluntary Recovery Program (VRP) and the Disciplinary Monitoring Unit (DMU).
Warning: Don't sign anything! Call the Lento Law Firm right away.
If you're facing a DMU, call the Lento Law Firm immediately. You need an experienced attorney in your corner to help you fight for your rights and your professional license.
Call us at 888-535-3686.
If you're being told you need to enroll in a VRP, call the Lento Law Firm immediately. You are not required by law to work with this program, and it could very well be the worst move you ever make in your career. We can help you defend your license without falling into this trap.
Call us at 888-535-3686.
Voluntary Recovery Program (VRP)
Don't be lulled into complacency by the word “voluntary,” and don't be fooled into thinking that just because you referred yourself to the program, you'll maintain some control over the program. You won't.
Enrolling in a VRP will make you lose all control over your own life. You can't question decisions, seek second opinions, or explore alternative options.
The VRP Contract
What they say: Confidential program. Avoid a professional investigation and potential disciplinary action. No danger of losing your license. No public embarrassment. You'll get the help you need.
What you should know: The PHMP is not there to help you; it's there to protect the public from you. You'll give them access to all your medical records, and your caseworker will interpret them and decide what to use them for and when. Every decision from the beginning to the end of the program will be made by your caseworker. It's the caseworker who decides what your impairment is and what kind of help you need for it. You're in danger of your license being suspended or revoked any time your caseworker feels you're not complying with the VRP.
The Time Frame
What they say: You are agreeing to enter into a consent agreement with the licensing board for a period of no less than three years.
What you should know: It could be a lot longer than three years. They start counting when the licensing board approves you for the VRP, which can take 3-9 months. On top of that, your caseworker can get the time extended in any number of ways at any point during the process.
The Case Worker
What they say: You will be assigned a caseworker, someone who will be “on your side” throughout the process. Don't fall for it!
What you should know: Your caseworker is not your advocate; they are more like a dual agent—a therapist and the enforcer of your signed PHMP agreement at the same time.
Your caseworker is not a medical or psychiatric professional.
Your caseworker might be a recovering drug or alcohol abuser, many of whom can be extremely strict. Do you have a glass of wine with dinner most nights? Your caseworker may think that constitutes an alcohol problem, and you have no way to dispute that decision.
Your caseworker will be the sole judge of whether you are compliant and cooperative with the terms of the program. The consent agreement you signed stipulates that disciplinary action, including suspension or revocation, will be deferred so long as the licensee “adheres to the terms and conditions of the agreement and maintains satisfactory progress in the program.”
A Case of Perceived Noncompliance
To illustrate how much power the caseworker wields and the extent of damage it can cause, take a look at this 2015 Michigan case:
Three nurses sued the state's Department of Licensing and Regulatory Affairs, along with the private contractor that administers the Health Professional Recovery Program or HPRP, and employees of both after a caseworker for the contractor reported the nurses to the state as “non-compliant” with the HPRP, resulting in the suspension of their licenses without a hearing.
The plaintiffs sued on behalf of a class of all HPRP participants from January 2011 to the present for “denying procedural or substantive due process, conspiracy to interfere with civil rights, neglect to prevent said conspiracy, breach of contract, civil conspiracy, and disability discrimination in violation of the Americans with Disabilities Act and the Rehabilitation Act of 1973.”
According to the complaint: “Unfortunately, a once well-meaning program, HPRP, has turned into a highly punitive and involuntary program where health professionals are forced into extensive and unnecessary substance abuse/dependence treatment under the threat of the arbitrary application of pre-hearing deprivation by the Bureau of Healthcare Services.”
In a groundbreaking decision, the judge found that Michigan health professionals were intended beneficiaries of the state contract for HPRP, and as such, they could sue to enforce the terms of the contract as third-party beneficiaries.
The Treatment Program
What they say: You will get the help you need.
What you should know: To get the help you need, you must start with an accurate diagnosis, but who diagnoses you? A PHMP-ordered drug test that comes back positive may get you branded as a drug addict. If someone reported you because they smelled alcohol on your breath, the PHMP might decide you're an alcoholic. If you blew up at work, the PHMP might decide you need anger management when what you really need is treatment for the depression that's making you so irritable.
Treatment centers are businesses that rely on a steady flow of people who need treatment. Many of the “preferred” treatment centers also donate money to the Federation of State Physician Health Programs (FSPHP). The treatment center may demand cash up-front, often asking questions such as, “Isn't your medical license worth $80,000?” Remember that you're not working while you're in treatment.
If you disagree with the treatment plan, you have no recourse.
It's a standard formula, no matter the diagnosis: a 90-day treatment program followed by a program of weekly groups, 12-step meetings, and therapy. It's a one-size-fits-all solution no matter what your issue is.
They'll probably demand you stop taking your psychiatric medications.
You're responsible for paying all costs associated with the treatment plan, even if you're unemployed. Costs can be as low as drug testing ($50) or as high as outpaitent treatment at an out-of-state treatment center ($5,000-10,000 per week). These treatment facilities don't take insurance because the criteria are not met for inpatient treatment. Submitting a claim to your insurance company would be committing insurance fraud.
Many VRPs entail years of post-program monitoring, which of course, you will pay for out of pocket.
What they say: When a licensee successfully fulfills the terms of the consent agreement and completes the VRP, no disclosure, publication or public record is made of the participant's involvement in the VRP or the events precipitating their enrollment.
What you should know: You won't automatically be reinstated after successfully completing your 3-year VRP. There will be hoops to jump through, including a fitness-for-work exam and filing a petition for reinstatement.
You may be hit with out-of-the-blue requirements for mental health evaluations, additional drug tests, etc., at the whim of your caseworker.
Whether you legitimately need help or someone just thinks you do, you need to be able to address the problem or the accusation quickly and without risking either your reputation or your license to practice.
The PHMP will lead you to believe they're the only game in town, but that's not the case.
If you receive a Letter of Concern or a phone call from the PHMP saying you have to participate in an evaluation to protect your professional license, the first thing you need to do is call attorney Joseph D. Lento and the Lento Law Firm at 888-535-3686. Let attorney Lento and his expert team help you navigate the system and protect your license and your practice.