Mr. Trick's PH Peas

A toxic brand. Maybe not good for anybody's health?

Apr 25, 2024

The Medical Regulatory ‘Therapeutic Rehabilitation’ Complex (MR TRC - yes, sounds exactly like the way it reads) was a previously undescribed collective until colleagues Bob Emmons, Louise Andrew, and I collaborated on a paper defining this powerful entity that has life-and-death power over a physician’s career.1

Since then, I’ve written here and elsewhere abundant posts about this invisible cabal. Dr. Andrew has published abundant commentary on LinkedIn, and Dr. Emmons has published two papers, one with ADA expert attorney William Goren, further detailing ethical and legal aspects of the MRTRC’s participation in the conduct of what are known as PFFDEs or Psychiatric Fitness for Duty Evaluations.2 These FFDEs can be initiated by any of the triad of entities – hospitals (HCEs or Health Care Entities in statutory parlance); MLBs (state medical boards); and so-called physician health programs (“PHPs”). These intrusive PFFDEs have become so normalized that you could be sent for one for as minor an incursion as yawning on early morning rounds.

All three are members of powerful national trade groups. All three have tight links with state and national medical societies and they sit on each other's boards like an incestuous dynasty. The power and influence they collectively wield is … well … remember what President Eisenhower warned about the military-industrial complex? That became more apparent over the years, where now, war and the defense industry essentially drive the economy.3 Same for the profit-driven purveyors of ‘therapeutic rehabilitation’ initiated at career gunpoint.

The Suave Mr. Trick

Mr. Trick is quite the persuasive salesman and lobbyist. He manages to convince corporate healthcare executives, state governors, AGs, and legislators of the existence of a massive epidemic of “problem docs” who are on the loose, drinking and drugging, and preying on unsuspecting citizens. This campaign of propagandization serves the purpose of creating a moral panic and fuels the creation of diverse legislative measures allowing them to aggressively intervene, even to the point of overruling well-established rights protections afforded by the Constitution and diverse federal statutes. “Because, by golly, we’re here to protect the citizens from dangerous practitioners. And besides, what’s the risk of vaporizing a few docs’ careers for the cause? They’ll be so debilitated and impoverished, they won’t be able to sue. And hey, it's good PR too! It shows how valiantly vigilant we are in ‘protecting the public.’”

It’s been quite a successful regulatory capture. Only the PHP-afflicted docs know who the real predators are. But, they’ve been made voiceless. When you’ve been wrongfully alleged to be impaired, falsely diagnosed, paraded in public as crazy and a menace to society, you’re thoroughly discredited. But that series of falsehoods is made believable to the public, having been tightly woven as an unchallengeable verdict by multiple professionals of presumed integrity.4

Three Senators, the DOJ, and the ADA

As I wrote earlier, fortunately, word has finally gotten to three receptive US Senators (Wyden, Merkley, and Booker) who, alarmed, have insisted on active engagement of the US DOJ Civil Rights Division. Their immediate focus was on violations of the ADA which prohibits discriminatory practices in licensing, employment, and all other public access services (including PHPs and their and MLB’s sycophantic ‘preferred programs’).

Previously unknown to most, the ADA also governs how hospitals (and government agencies like MLBs, and PHPs) initiate and conduct these PFFDEs. No, you can’t willy-nilly decide to send a doc off to the shrink to get psychiatrically invaded, Rorschached, biopsied, and repeatedly interrogated while wired to a polygraph machine, just because you felt they acted kinda squirrelly or they were a little too testy to handle. (I know this must come as a surprise but relentless stress combined with sleep deprivation seldom brings out the best in people.) Or because, in your corporate playbook, making an allegation of “impairment” and “unsafe to practice” is a surefire and virtually undiscoverable way to get a doc off your staff and ensnared in what will amount to a multi-year bankrupting ordeal that will exact permanent career and psychiatric damage on the selected doc, maybe even leading them to die by suicide. (But, hey, in the MRTRC, the common refrain is an indifferent shrug and “not my problem; I didn’t create this system; s/he can find a lawyer to navigate the board and PHP system; all I know is they’re off our hands.”)

Dr. J. & The PHP Fight Club

Almost a year ago, my colleague Pamela Wible MD with whom I run a weekly private MRTRC trauma/take action group – we’ve since renamed it “The PHP Fight Club” – invited as guests surviving family members of a doc, Dr. Jay Neufeld, a pediatric physiatrist and founder of the Journal of Pediatric Rehabilitation, who died by suicide at the hands of one particularly vicious PHP-affiliated enterprise in Mississippi. We examined his case based on the detailed factual narrative written by Wendy Dean MD in her extraordinary book “If I Betray These Words” exploring the powerful phenomenon of moral injury in healthcare.

With this available history and corroborating family members present, we used Dr. J’s story as a representative “case study in cumulative harms” to help participants incrementally name each of these cascading violations. They could immediately identify with many as having been done to them, though they previously didn’t have a name for each particular ensnaring tactic. I believe these assaults represent a relentless series of “psychological concussions” that produce both overwhelming complex psychological trauma and virtually irreparable moral injury. (Pamela and I agree that the term doesn’t go far enough; it’s really moral assault.)

In that discussion and subsequent conversations, we unpacked the sequence of ethical and legal violations committed against Dr. J’s rights. With each of these violations, it is important to recognize that there are very real and far-reaching harms that result, harms that are cumulative and soon overwhelm all coping capacity.

Having spent months reconstructing Dr. J's life, his journey as a physician, and his embrace of his life mission – helping disabled kids have the fullest quality of life possible – Pamela has written an extraordinarily tender and hard-hitting piece both celebrating his life and exploring the relentless psychological abuse that contributed to his death.

Whistleblower’s Wish: Dr. J’s Last Words by Pamela Wible MD

Pamela was driven to dig deeper, not simply due to incredulity or because one of her areas of expertise is studying and preventing physician suicide. She discovered that, just before he died, Dr. J. filmed an anguished video selfie asking God’s and his family’s forgiveness. In it, he spoke about the unbearable suffering from his lengthy mistreatment – at the hands of his own hospital where he was chair of the department he founded, through the PHP “preferred facility” to which his hospital "referred" him for lengthy treatment for a diagnosis he didn't have, and into “aftercare” and “monitoring.” His experience, as we have learned examining many similar cases, was a forced treatment – coerced under the extortion of losing his license if he didn’t consent – based on a contrived diagnosis, an “impairment,” and which treatment would be administered by unlicensed hacks that systematically psychologically abused him.5

After he was financially drained and psychiatrically brutalized by that so-called behavioral healthcare facility, having been forced to complete a more than three-month stay (under threat of “being reported to the board for non-compliance”), he was discharged. He returned from Mississippi to Idaho, broken and despondent, only to find he had been fired from his directorship while on forced medical leave, his office emptied of all of its loving and gratitude-filled memorabilia, and his belongings carted off to his home. He would now be demoted but kept on staff – as a ‘favor’ to help him ‘save face’ – and would be subjected to ongoing “monitoring” for his non-existent illness.

This was nothing less than sadistic torture. Hyperbole? Here’s the UN definition of torture:

“For the purpose of this Convention, the term “torture” means any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purpose as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed, or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by, or at the instigation of, or with the consent or acquiescence of, a public official or other person acting in an official capacity…. (United Nations, 1995, pp. 294-300).”

Recall that PHPs, almost always exclusively contracted by medical licensing boards to ‘handle’ allegedly impaired physicians, act in the name of the state. And they do so under the false identity of a licensed mental health program. However, this is but one part of their deception. Though they conduct invasive mental health examinations, they are not licensed mental health programs. And their mission is not the beneficent care of the troubled physician (though it originally had been). It is identical to the boards’ – to ‘protect the public.’ Thus, these entities act in an official capacity with the acquiescence and police power of the medical board and the silent complicity of the state.

Is Suicide From Psychological Torture Really “Suicide?”

Dr. J’s death wasn’t suicide in the customary sense; it was yet another Mr. Trick homicide. Perhaps it was initially meant to be just a corporate healthcare power play, a below-the-belt punch, getting him to sign their “now you’re damaged goods” 30% salary-reduced contract, intended to show him who’s boss. Maybe it was only intended to be a “career bruiser,” a despot’s strategy drawn from the corporatized healthcare leader’s retaliation playbook.

But, keep in mind, in Mr. Trick’s healthcare domain run by gangs, there are no fair referees in this ring. It was a back-alley pummeling that left him reeling. Had he lived, it still would have been a career homicide. But we know that such career assassinations ultimately contribute to suicide. And even then, his death by conspiratorial cruelty would have been masqueraded by the suave, pseudo-compassionate Mr. Trick as another unfortunate suicide by an “impaired physician.” “But, oh, we tried to help him … he should’ve come to us sooner.”

Systematized Stripping Of One's Profession Is Not Only Unlawful, But Evil, And Must Be Confronted.

What these utterly indifferent MRTRC folks don’t seem to understand is that for many in health care, their career as a physician is not a job. It is a calling, it is their mission in life. In fact, it is their life. Killing a career in this hideous Zersetzung manner is not simply “wrong;” even labeling it as “manslaughter” is insufficient. It is such inhumane behavior as to rightfully be called evil. It is so reprehensible, it is barely tolerable to even contemplate it. But contemplate it we must. Because it must be confronted. And the only people who can confront it are the people to whom it has been done and those who know it’s being done.

We must, as a profession, examine its occurrence and daringly explore its prevalence. We must detail its dishonest and psychologically abusive practices. And we must vow to put into place measures that will hold such morally bereft assailants – whether individuals or whole systems – accountable, and urgently move to halt such practices.

At your earliest moment, I encourage you to read Pamela’s extraordinary piece in its entirety. Both at the beginning and the end, there is a link to a petition, one that we believe can then be presented to concerned senators and representatives and to the US DOJ to compel them to break through their disbelief and dare to look at this systematized abuse. It is only by doing so that we can begin to collaborate on naming and examining these hideous phenomena that cross multiple enforcement domains and to work together to implement safeguards that protect physicians from these extraordinary harms.

Physicians should not have to live in fear of threats of career harm from mean-spirited hospitals, lawless medical boards, and predatory PHPs. But because of this malevolent system that unsuspectingly tyrannizes and overwhelms them, they need our help, our voice. We must help free them from the ever-present threat of being ensnared in Mr. Trick’s inescapable abusive web so that they can once again thrive in their careers and pursue the healing work they love and consider their calling.

Whistleblower’s Wish: Dr. J’s Last Words

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