Happy – and Hope-filled – New Year!

2025 Shows Signs of Being a Year of Substantive DOJ Impact on the MRTRC

Greetings dear devoted readers of Physician Interrupted!

First and foremost,

Hoping your Christmas – Hannukah –Winter Holiday was an enjoyable and restful one!

And thank you for bearing with 2024’s fits and starts of the aptly named “Physician Interrupted.”

Hope-Filled 2025?

You might be thinking “Hope-filled? On this tumultuous planet? In this fractured country? What’s there to be hopeful about?”

Notwithstanding significant elements of the social order being in chaos, it’s important to find those areas of life where there might be some sense of order, or at least diminished turmoil. Our focus here at Physician Interrupted is, of course, on physicians’ rights, especially in their interactions with the trio of authorities – state medical boards (MLBs), so-called physician health programs (PHPs), and the facilities that credential and employ physician, i.e. hospital corporations (including residency programs).¹ Together, they constitute the primary circle of the Medical Regulatory ‘Therapeutic Rehabilitation’ Complex or MRTRC.² Any one of these can initiate an administrative cascade around alleged physician impairment or, the nuclear allegation “unsafe practice,” and within a short and intensive period of time, lead to a physician being ensnared in the death-grip of a due process-deprived “suspected impairment” workup by the exclusively contracted PHP. And once this cascade begins, within a half-year, it can easily cost tens of thousands of dollars in evaluations as well as legal defense, yield a very marginal if any positive outcome, and lead to job and career derailment and psychiatric debility.

It’s been a one-sided game since the MRTRC parties teamed up in this regulatorily-capturing cabal, one that has been largely invisible to the vast majority of the medical and legal profession. When I gave a talk at a national association meeting several years ago, while most of the audience was familiar with “sham peer review,” only a handful knew what a PHP was. And even though they indicated familiarity, their actual understanding of its not-so-beneficent operations was severely wanting. They, like most in the medical profession, thought the MLB-affiliated PHP was a specialized program run by and for doctors to help them navigate their way through the assessment of either their board’s or their hospital employer/credentialer’s allegations and guide them through this career-perilous minefield. How wonderful.

In the profession as a whole, if they gave it much thought at all, most presumed the PHP was a specialized mental health group that had a deep understanding of the challenges physicians face and, being physicians themselves or some other sort of licensed mental health professional, would know the best ways to compassionately interact with physicians and discretely direct them to appropriate resources to address their situation, whatever it might be, so that their jobs or carers wouldn’t be in jeopardy from harsh attitudes toward present (or even past) mental health and substance use concerns. Unfortunately, that dangerously naive understanding persists through the present.

PHPs – More Harm Than Good?

After much study and in-depth interviews with over a thousand physicians, I and numerous colleagues have come to a much more jaded view of the enterprise. This PHP “referral, “ whether by the board or one’s hospital, turns out to be not so beneficent. In fact, it can lead to permanent reputational damage, inextractable interruption in one’s practice for a unconscionably prolonged (and often statutorily prohibited) length of time, and cause physicians to come away from their engagement with the PHP system and its self-referral system to its closed network of “preferred programs” embittered, financially ruined, and marginally able to remain in the profession.

It’s difficult for anyone who’s not been caught in this Kafkaesque nightmare – where one is faced with unsupported accusations of impairment or incompetence and is now virtually a lifelong detainee in the PHP enterprise – to really get a sense of how rights-depriving, career-perilous, and psychiatrically debilitating this well-rehearsed enterprise is.

The predominant attitude amongst lawyers representing physicians who are familiar with the MRTRC modus operandi is that this system has no accessible egress, it’s that airtight. And if the lawyer or physician client fought back too hard and bucked the system, the MRTRC enterprise would make it very clear they tolerate no pushback. They would make the challenge to their absolutist authority a very protracted and costly battle. And so, many lawyers have essentially taken the “cop a plea” approach to mollify the charging entity in the hope of getting some time reduced from their sentence.

Medical Profession Naivete

However, the predominant understanding that persists within the medical profession is that the PHPs are beneficent programs, in many cases funded by ‘contributions’ via surcharges to their license renewal fees. And surely they are established as a trustworthy resource for that unfortunate minority of physicians who run into problems with substance abuse or troubling mental health issues. After all, studies show that just about half the profession – that’s right, 50% – are grappling with some degree of burnout. While burnout’s an occupational stress syndrome consisting of exhaustion, often cynical detachment and depersonalization, and reduced accomplishment, whether actual or self-perceived, the PHP nationwide enterprise has capitalized on this epidemic as being evidence of how sick and therefore dangerous to patient care half the medical population is.

And this orchestrated societal panic generated behind the veneer of professional opinion certainly helps keep the “referrals” coming in. By the way, these are not referrals in the traditional sense, but ordered fitness-for-duty psychiatric evaluations that are nearly invariably detached from any connection to actual job performance, a prerequisite of the Americans with Disabilities Act (ADA). Turns out, that misunderstood law is not just relevant to these mandatory fitness for duty examinations (FFDEs), it is the most important if not sole law governing medical exams of those who have a disability or, critically important in the MRTRC domain, are newly alleged to have a disability.

Many physicians referred to their PHPs for a psychiatric FFDE unquestioningly submit, presuming that it’s a confidential psychiatric consultation subject to the prevailing professional ethics and laws governing such privacy-invasive medical examinations. While the ever-responsive PHPs promptly undertake these mandated assessments, they inform the detained evaluee, generally after the naive physician has trustingly signed a stack of intake and HIPAA-appearing disclosure permissions, that, no, that wasn’t really a diagnostic evaluation, just a ‘screening’, and it’s for this reason that they can’t have their mandated evaluation medical record.³

PHPs Are Not Legitimate Mental Health Practices

The idea that PHPs are just a specialized mental health group that’s part of a national brand of physician-oriented mental health centers is a dangerous misunderstanding. It is neither a mental health program nor does it abide by professional medical ethics. And it is not beneficent in its mission, at least to the physicians who are referred for its services. Notably, several years ago, the PHP enterprise changed its orientation from behavioral mental health-oriented assessment and provider, or coordinator, of treatment services to one nearly identical to the MLBs’ heroic banner – that they are there to “protect the public.”

So …, Here’s Where “Hope-filled” Comes In

That ruse, a most deceptive one ensnaring thousands of physicians, residents, and even medical students yearly, has finally been exposed. And this deception along with their conducting unwarranted and costly medical exams, has alarmed three US senators – so much so that they ordered the US DOJ to investigate boards’ and PHPs’ potential illegal behavior under Title 2 of the ADA in their handling of alleged performance impairment.

And given extensive interviews DOJ has been conducting for close to two years, it would appear that DOJ’s gotten at least a preliminary understanding, albeit limited to the narrow legal scope of ADA Title 2 statutory enforcement, of the array of systematized, well-crafted, weaponized FFDEs they, with the full backing of their exclusively paired medical boards, have been conducting. An examination of DOJ’s ADA cases involving impermissible inquiry, adverse job/career actions, and systematized FFDE referrals to a due-process denied closed network of “approved” centers specializing in licensing board-mandated referrals reveals increasing depth of understanding and, reassuringly, increasingly emphatic enforcement of Title 2 of the Americans with Disabilities Act.

And studying these, one also gets the sense that they’re no longer blind to law enforcement areas outside of their immediate ADA jurisdiction that are implicated in their investigations. Routine denials of due process, violations of confidentiality, unfair and deceptive practices, and even the possibility of coordinated control of unlawful actions amongst MRTRC operations in multiple states, eg. impairment rehabilitation rackets, seem to have come into their awareness.

What’s so hopeful about this is not just that three senators caught the drift and saw how physicians are being deprived of multiple protections afforded them by, at a minimum, the ADA, which governs the FFDE referral process by all states’ medical boards and hospitals. And not just that there’s solid evidence that DOJ is actively interviewing harmed physicians, residents, and medical students about the variety of ADA-prohibited wrongs and harms committed upon them.

The Trajectory of DOJ Title 2 ADA Enforcement Cases

A close read of legal actions taken by DOJ (and its Title 1 ADA enforcement sibling EEOC) indicates that they are finally getting a grasp of how extensive and elaborately crafted abuse of physicians’ rights is. And it also suggests that they’re coming to an appreciation of how systematized this orchestration of abuse of multiple federal laws has operated, and how it’s been craftily done so extensively under the radar. Even more encouragingly, they appear to be comprehending that the matrix of combined abuses of the ADA, HIPAA, 42 CFR Part 2, the FTC Act, and others, have been so routinized and normalized that the careers of those harmed are virtually DOA within moments after their initial ensnarement. And what’s probably amazing to them and to the senators is that it’s been so normalized and the operation’s been unquestioningly granted tacit governmental approval with impenetrable immunity, while the vast majority of physicians don’t have a clue about this insidious malignancy.

So, yes, indeed there is hope.

But it needs to be hope coupled with action. And not just by the DOJ or by three concerned senators. That action begins with every physician and medical student becoming aware of how malevolent and dangerous this invisible cabal is and exactly how their rights are jeopardized, and how these compound wrongs result not only in irreparable career damage and psychological harm, but in jeopardizing society’s access to competent and compassionate care.

Here are a few helpful links to learn more:

The Complex Problem of Physician Health Programs

ABC11 Eyewitness News: Exposing PHP Abuses

In 2025, expect to see more elaboration by numerous authors of this exceedingly well-crafted collusion whose matrix of unlawful actions has resulted in untold harm to thousands upon thousands of effortfully trained and dedicated physicians and medical students. And it will continue to exert its harm until physicians and all medical professionals confront this systematized abuse of lawfully protected rights.

Let’s make 2025 the year that we reinforce our hope with determined action to halt this coordinated administrative harm to the profession of medicine and to the population of patients it serves.

1. Unfortunately, we need to add medical schools to this mix, as they have increasingly been pulled into the toxic MRTRC vortex, whether naively (as many hospitals may have been) or knowingly. The latter would be most distresing. And I’ve spoken at length with numerous med students whose educational trajectory has been destroyed by unwarranted referral to state MLB-affiliated PHP programs, for which there is ZERO justification.

2. We’ve come to pronounce this acronym as “Mister Trick.”

3. The reasoning is indeed circumspect. But when you’re in a submissive position, and your job or career is in the balance, you don’t have much leverage to quibble. You just proceed on trust. Alas, the trust is not warranted.