A PHP Trojan Horse at Your Door

California bill AB 408 is very dangerous legislation. Your urgent attention and vigorous opposition to it is needed.

First, A Leave of Absence Explanatory Note

Dear Physician Interrupted Readers,

It’s been a while since I posted. Why the absence? In short, there’s only so much anguish, fear, and urgency a person can contain at one time. Hearing the stories of so many docs’ plights dealing with the thug enterprise known as the MRTRC – the Medical Regulatory Therapeutic Rehabilitation Complex (aptly pronounced “Mr. Trick) – was already taking a toll and triggering traumatic memories of my own career homicide a decade ago. But I was pleased we were finally making progress in bringing attention to the malignancy that is the Physician Health Program enterprise and arming docs with strategies to help them defend themselves and protect their rights. Three US senators and the Disability Rights Section of the Civil Rights Division of the DOJ were compelling closer scrutiny of the MRTRC’s federal law violations, particularly the ADA (Americans with Disabilities Act).

And then, soon after the January inauguration, the entire Civil Rights Division of the DOJ was basically slated for evisceration, this after a decade of CPR's efforts, repeatedly coaxing them into looking at the Board-PHP-Rehab cabal that is operational nationally and violating the ADA and multiple other federal laws (as we’ll explore in the next piece). And from what I could see, based on two senior DOJ trial attorneys’ in-depth interviews over a span of half a year with numerous other physicians, they were finally making major progress in comprehending the complex, legally interwoven matrix of violations within the MRTRC cabal. How demoralizing!

So, what refreshing thing did I do to replenish myself? I must be addicted to existential jigsaw challenges or a glutton for punishment. Seeing that I’m a specialist in all things mental, I decided I had to prioritize studying my – and my liberal democratic ilk’s – mental concussion and figure out why so many of us are stuck in a state of political overwhelm-paralysis. Why are formerly deeply committed people now wandering around zombified like they’re in a trance and not taking action to confront this horrendoma of democratic governance usurpation? Not that it’s not entirely understandable. Just that the pathological mechanism of overwhelm-paralysis is not understood, and urgently needs to be. Because once we do that, we might be able to come to our senses, learn how to protect ourselves, and take some form of collective action.

A Koan: The Reason Why Overwhelm Overwhelms? Because It’s Overwhelming

One thing became really clear: you know why they call it “overwhelm?” Because it’s overwhelming. Admittedly, a tautology, but also a key to the nature of the current psychopolitics of overwhelm and, it turns out, to the focus of this article, understanding and dismantling the malignant DNA of the predatory PHP movement. It is the combination of both the abundant and complex nature of the material and the intricate methodologies of its conveyance that is specifically designed to be stealthy and frustrate recognition by the target.

Psychopolitical Overwhelm-Paralysis and Mr. Trick’s Entrancing Obfuscation Have the Same MO – Predation and Deceit

And while I was researching the neuropsychiatry of intentional overwhelm and its relationship to the newest and most devious psyops technology – undetectable cognitive warfare, along came a legal brief filed by a med student with an ADA-covered disability who ran into a challenge with her med school, took them on legally, and WON! [Note, dear readers - a med student!] It was a well-thought-out brief jointly composed with disability rights groups strongly opposing an extremely dangerous bill rapidly moving through the CA legislature, and on a fast track to enactment. And when I read her and colleagues’ brief along with the proposed legislation [AB 408] [for easier digestion, see CPR’s Executive Summary of AB 408], and recognizing the urgency of staunchly and publicly opposing it, I felt like I was thrust into confronting another rapidly lethal sociopolitical pandemic about to spread across the land. Given that I have close to 15 years of study of the malevolent Mr. Trick system and have been stunned by how crafty and truly toxic it is, and yet so thoroughly intervention-resistant, I was shocked out of my dogged preoccupation with the Trumpian overwhelm-paralysis syndrome and compelled to scrutinize this emerging deadly strain of PHP infectivity. Here’s what I discovered in my MRTRC pathogen analysis lab.

California’s AB 408 is the Ebola of PHP-empowering legislation. It MUST be contained.

What follows is both an examination of the life-threatening physician rights hazard that this proposed law is, and a call to action for all physicians, miraculously still of sound mind, to take a little time to study and then, ASAP, scream “OPPOSE” and “TABLE” and “GET AN INDEPENDENT COMMISSION TO EXAMINE” AB 408.

Because it's so important, I needed to explain exactly why it's so toxic and why it needs your active immediate attention. It’s a deep dive that spans a few articles, so put on your scuba gear. I’ll start with a familiar scenario.

The "Safe Haven" That Isn't

Dr. Sarah Chen had been struggling. Ten years of emergency medicine, including during COVID, staffing shortages, high-needs patients, critical time-compressed decisions, and a constant anxiety about patient violence not to mention omnipresent legal snipers had left her exhausted. When she confided to her chief about feeling burned out and having trouble sleeping, she never imagined it would threaten everything she'd worked for.

"Have you heard about the Physician Health and Wellness Program?" he innocently suggested. "It's a confidential support program for doctors grappling with work stress. It’s who we recommend. We strongly encourage it. You know … patient safety, make sure you’re okay to practice….”

One month later, Dr. Chen found herself $10,000 in debt, on compulsory non-practicing medical leave, urgently searching for a knowledgeable attorney, mandated to attend 90 days of inpatient "treatment" for a diagnosis she disputed, and facing the choice between immediate compliance or losing her medical license. The "confidential support" had morphed into an investigatory file that could be used against her not only in her job but even in licensing actions. The "wellness program" had become her prosecutor, judge, and jury – with no right to appeal.

This isn't fiction. It's the reality facing physicians who interact with Physician Health Programs (PHPs) and their congeners across the nation. And if the rapidly progressing California Assembly Bill 408 [CPR’s Executive Summary of AB 408] passes, it will codify this deception into law, creating a model even worse than the present FSPHP-touted "gold standard" for every state to follow.

AB 408 promises to establish a "Physician Health and Wellness Program" (PHWP) offering "support, treatment, and monitoring of physicians and surgeons with substance use disorders or mental or physical health conditions." If you don't understand the nuances of the language or the deviousness of the players, it sounds oh so benevolent. It sounds tailor-made, like the kind of program our beleaguered profession desperately needs.

It's none of these things.

All your records are classified as "investigatory or security files compiled for licensing purposes."

Buried in the bill's language is a provision that exposes the true nature of this "wellness" program: It’s not benevolent. It’s not geared toward your well-being. It’s not safe. You are assigned and must submit to a non-impartial evaluator connected to the medical board. All records—including your PHWP screening assessment, confidential medical evaluations, treatment notes, and lab results—are classified as "investigatory or security files compiled for licensing purposes." These aren't medical records you can access, amend, or challenge, as are your protected rights under HIPAA. They're evidence files that can be weaponized against you while remaining sealed from your view.

This is the "safe haven" being sold to California physicians. A haven where seeking help for burnout makes you a target. Where confidential means "confidential from you, but not from us." Where wellness is code for predatory referral and ongoing surveillance. The only people this is a safe haven for are the PHWP, their regulatory sibling with police power, the Medical Board of California, and the jointly approved via secret process "preferred programs" that “evaluate” you and “treat” you.

The CA PHWP Proposed in AB 408 Is Healthcare’s Version of ICE

And here's why every licensed professional in America should be watching California right now. This isn't just about doctors. The PHP movement already has nurses, PA’s, pharmacists, dentists, and veterinarians under their jurisdiction. They’re now moving into the med student arena, and even the legal profession! (Maybe recalcitrant legislators are next!). California's bill is the template—get the model passed here, export it everywhere.

The question isn't whether this could happen in your state. It's whether you'll recognize the Trojan Horse when it arrives at your door, wrapped in the comforting verbiage of “safe haven,” “rehabilitation," "wellness," and “confidential support."

PHPs Decoded: What Your Medical Society Won't Tell You

When your state medical society endorses a Physician Health Program, they'll tell you it's about “protecting patients” and “supporting struggling colleagues.” What they won't tell you is that they're endorsing a system that operates more like a protection racket than a medical service.

Here's what PHPs claim to be: Confidential, voluntary programs that help “impaired physicians” get treatment while protecting public safety.¹ They promise rehabilitation over punishment, support over sanctions, advocacy for protection of your job and career from the Board and hospital meanies who just don’t understand the stresses of medicine.

Here's what they actually are: Quasi-judicial entities with the power to end your career, operating without oversight, due process, or accountability. They're not medical programs—they're investigatory arms of state medical boards dressed in clinical clothing.

The Regulatory Capture Playbook

The PHP movement has perfected a three-step process for capturing medical boards:

1. Create the Appearance of an Impaired Physician Crisis and Install the Moral Panic Button: Emphasize rare cases of notable impaired physicians to sensationalize the situation, portraying its extreme, and justify expansive prophylactic evaluation, detention, and long-term monitoring systems.

2. Control the Solution: Establish exclusive referral networks to costly, hand-picked four-day evaluation and long-term treatment centers, many of which are generous donors to their annual conference and fundraising campaigns.

3. Eliminate Competition: Acquire exclusive contracts with state Medical Licensing Boards (MLBs) and use the Boards’ police power to mandate participation while blocking access to your records, second opinions, or alternative treatment, if truly warranted.

The result? Medical boards don't regulate PHPs—PHPs effectively control medical board decisions about physician fitness. When a PHP declares you "impaired," the medical board rubber-stamps that determination. No questions asked.² Why? Because the MLB's and the PHP's are virtual siblings in the same regulatory family "protecting patient safety."³

Following the Money: The Exclusive Contracting Web

Here's where the "health and wellness" facade crumbles entirely. While they conduct screening assessments (which they persist in denying), PHPs don't provide “comprehensive evaluation” and treatment—they broker it. And they broker it exclusively to facilities that share their self-advantageous AA philosophy and, more importantly, their profit-seeking business model:

• Mandatory PHP "intake screening”: "Free, confidential evaluation" to help “sort things out and make any referrals they feel are needed”.

• Coerced Non-Practice Agreement: a coercively compelled agreement not to practice "until we get to the bottom of this…” which most physicians assume is just a gentleman's agreement for a short period of inquiry.

• Mandatory 4-day evaluations: $5,000-$10,000 (cash only) (must use MLB/PHP-selected evaluators, most out of your home state).

• "Preferred" treatment centers: $30,000-$90,000 for 90-day programs

• Required monitoring and PHP program fees: $500-$800/month for 5 years

• Random drug testing: Some as high as $100-$300 per test, multiple times monthly, often to investigate challenged false positives from non-FDA-approved tests done by a “preferred” lab

• Total direct cost to physician: $50,000-$250,000.⁴ And your detention time may be extended if it's felt by the infallible authorities that you have not sufficiently rehabilitated.

Can't afford it? Too bad. Refuse to pay? Lose your license. Want a second opinion? Not permitted. Think your treatment should be outpatient therapy with your own therapist instead of inpatient rehab? The PHP's contracted facility disagrees (“they don’t understand how devious physicians like you really are”) – and their opinion, and the PHP puppeteer’s invariable affirmation, are the only ones that count.

This isn't healthcare. It's systematized extortion by white-coated medical staff wearing a sheriff's badge. At that, camouflaged behind a benevolent Potemkin village of medically ethical and professional treatment, law-abiding operations, and empathic support.

The "Voluntary" Myth

PHPs love to emphasize their "voluntary" nature. Technically true—in the same way that handing over your wallet to an armed robber is "voluntary." You can choose not to participate. You'll just lose your medical license, your hospital privileges, and your ability to practice medicine anywhere in the United States, and likely the world. Doesn't do much for your reputation either. Nor self-esteem for that matter. But, alas, your well-being was never the focus.

Because here's what your medical society's endorsement letter won't mention: Once you're referred to a PHP—whether by a concerned colleague, a hospital administrator, or your own request for help—declining to participate is reported to the medical board as "non-compliance." In PHP-speak, asking for help with burnout or depression and then disagreeing with their diagnosis and “recommended” $90,000 treatment prescription and five years of "monitoring" automatically equals “denial” and "impairment requiring immediate intervention."

The Nature of Corrupt Mercy – PHPs’ Ensnaring Compassion

Perhaps most insidiously, PHPs have corrupted the very concept of physician wellness. They've weaponized our profession's commitment to patient safety and our ethical obligation to address impairment. They've turned seeking help into a perilous act and voluntarily going to a PHP an act of career suicide.

The message is clear: Struggle in silence (or do as some do and get help out of state under a different name), or risk everything.

This is the system California's AB 408 seeks to enshrine in law. But unlike existing PHPs that already operate in legal grey zones and prey upon and bankrupt physicians, AB 408 explicitly grants these programs civil immunity, investigatory powers, and the state's full authority—while stripping away even the pretense of medical confidentiality or physician rights.

Your medical society will likely endorse it. They probably haven't read past the title and the sweetly worded PR. But there's also the possibility they are in tight with the PHP and the MLB and actually helped author it. After all, PHP's are the spawn of medical societies who wanted to shield themselves from the legal liability of malpractice, and perhaps let enterprising members run a profitable, insider-referral rehab gig, while also finding a way to publicly and oh-so-compassionately donate funds for "physician well-being."

Coming Up … (remember to refill your O2 tanks before then)

In the next article, we’ll look at the plethora of likely federal and Constitutional violations AB 408 manages to pack into one rapid-track bill, what a high-liability house of cards it is for California government, and why simply informing responsible legislators and the executive branch in clear language raises their risk if they choose to ignore your well-grounded, documented statutory violation concerns.

Concerned? What To Do Now:

1. Read AB 408 and/or CPR’s Executive Summary of AB 408.

2. Read Part 2 of this article (in press) and take further action as suggested there.

3. Don’t wait for somebody else to fix this. If you’re any kind of clinician or licensed trainee in any field of healthcare, or a med student, or a lawyer (whose LAPs remarkably resemble the PHP enterprise and, coincidentally, apparently share the same referral networks), this has your name on it. Take this seriously and take an active role in protecting all of our professions. If you don’t, don’t bother telling me your sob story after you’ve been sent to SingSing KS and coughed up ten grand for the privilege of being declared a danger to the public.

1. Unbeknownst to the naïve physician presenting to the PHP on mandated referral, they get their initial diagnosis and impaired physician designation at the PHP, which then gaslights them and claims it didn’t conduct an assessment or make a preliminary diagnosis. Tell me, how else would this faux educational non-profit practicing medicine without a license or malpractice insurance determine what condition a person was grappling with and where best to refer them if they didn’t conduct some sort of assessment? Do you mean to tell me that Joe Schmoe the ragman and his garbage collector crew could form a PHP and do assessments?

2. Most physicians are not aware that MLBs generally have a Medical Officer. It is clear from a review of hundreds of cases that this is little more than a decorative position intended to serve the illusion of medical professionalism and assurance of compliance with healthcare law. Your expectation would be that a medical officer would be the ONLY person who could review medical records, consider medical conditions, make compulsory referrals compliant with ADA parameters and evaluate PHP findings, and determine next steps. You would expect that that person’s role would be to ensure the integrity of the medical evaluation and recommendation process. You would expect that the medical officer would at least have a rudimentary understanding of applicable laws governing physicians’ rights and duties of confidentiality such as the ADA, HIPAA, 42 CFR Part 2, and laws governing the corporate practice of medicine as undertaken by their exclusively contracted PHPs. You would expect that a physician in such a role would have training in legitimate drug testing and interpretation. And, by the same standards that MLBs assign to physician professionalism, you would rightfully expect that hired person would have both integrity and sufficient courage of assertion to convey their reasoned stance to the MLB’s executive director and president. You might even presume that, surely, the MLB’s internal and external legal counsel would support such independence. Surely the MLB must have an internal compliance and audit team. Surely, even if it doesn’t, it’d have some form of active state oversight that would, as a default, ensure that the MLB was compliant with all applicable federal and state law and that physicians’ rights were upheld. You’d be wrong on ALL presumptions. But you won’t know that until you’re thrust into this hellhole. And then, you will also discover, there’s nothing you can do about it.

3. It's important to know that, while the PHPs used to consider physician support their number one objective, of recent, their publicly declared primary mission is to "protect the public.” Why would anyone subject themselves to any evaluation by an organization whose raison d’être is not to focus on what you’re grappling with, but whether they can make a case you could be a risk to "the public?” This inverted mission statement aside, this would necessarily mean that, as this is not a medical evaluation or therapeutic undertaking per se, but rather a public safety business matter, all such evaluations would need to be paid for by the ordering entity – whether a hospital or a medical board – including not only the PHP evaluation but all downstream evaluations deriving from it. Transferring that cost onto the selected evaluee is then not only predatory opportunism in the context of an anti-trust setting resembling a state-sponsored RICO, it may also be a blatant violation of the ADA guidance on medical examinations.

4. This does not include extraordinarily costly legal fees or lost income. Keep in mind, like divorce litigation, the more protracted this is, the more the legal fees. And the more the legal fees and the longer the non-practice agreement, the more financial devastation to the physician and the more likely the exhaustion of legal resources. It’s essentially a well-crafted system of concealed substantive due process deprivation.