Your Part 2 assessment of the deluded agency members' and the Washington State PHP, is spot on. it was true when I got snared back in the late 1990s. I had, at the age of 40 graduated first in my class, elected to AOA and debt free from Michigan State College of Human Medicine. I was proud of my achievement. Until I learned that the saying "Pride Goith before a fall' is actually far worse. "Pride Goith before destruction" is the accurate phrase. Everything you stated in part 2 was true back then. I did enough research on WPHP and the various treatment centers they used, to conclude that even a non lawyer can recognize antitrust violations with a modicum of legal education. I do not know if that is still true today, but I suspect that it is. Most of the facilities whose fees were paid for or at least subsidized by WPHP and the Washington State Medical Board were in that relationship for the financial incentive. Despite the requirement of competitive bidding in my state, contracts to WPHP and their bedfellows appeared to be funded via non competitive parameters. They were "awarding" grants to the main inpatient treatment facilities where they sent physicians for automatic mandatory 90 day stays. These costs were paid for by the already out of work physicians. it was a terrible experience.
oh my- I'm specialized in addiction and I treat physicians/PA's with SUD's in NY, years ago i worked in an IOP that cared for nurses in the equivalent predicament.
While treating addictions with replacement therapies (in this case OUD) is tricky and avoiding scheduled meds is preferred, a risk/reward discussion that an ability to maintain abstinence on MAT and have clear urine tests- is a clinical decision (I wish i could underline these last two words).
I'm sorry to see medical providers get this treatment in Indiana, because nearly losing a job (including whichever way it was discovered, how it was handled internally and reported) is a challenging process for a provider to experience. The pressure avoiding MAT hopefully allows vivitrol, 'no medication' has risks for relapse, which can be fatal. This punitive approach is not surprising to read, it lacks understanding about the mechanism of addiction and comprehensive treatment needed for success. This bias is common in the general public and medical professionals are not immune. Its not foreign to recovery (tho 12 step has been very supportive for many providers).
I'm glad to see the DOJ step up, the line "perhaps you didn’t fully understand what we said.." had me laughing out loud. Great article, thanks!
Many thanks Sonya. As you saw, there were multiple aspects of this that got DOJ going. One, the case ancestry of MAT (see ACLU document on MAT cases) made the application to boards entirely logical. Another, uniform application of any mandatory tx runs country to the ADA's insistence for case by case analysis and a tailored regimen, something boards and assistance programs, whether out of ignorance or interrupting their automatized referral flow, are loathe to do. Third, perhaps most importantly, it's not just mandatory adoption of exclusively one tx and the exclusion of all other accepted txs (bad enough), it's that it's also HARMFUL. It's dangerously bad medicine. And it intrudes on the only legitimate treatment authority, the doctor/clinician. BON is saying "our top shelf abstinence program and our needs to maintain it is more important that your scummy life."
What I believe DOJ is also saying "sorry, there's no one tx protocol fits all people in this arena. And your insistence that there is only one - yours - is so dangerously flawed in its narcissistic exceptionalism as to be committable." So ... either these "professional assistance" programs and the boards to which they're obediently allegiant, understand this central principle of the clinician's and treater's choice of treatment and the unlawfulness of their "Gold Standard" approach, or they're toast.
And ... that's not to say that MAT doesn't pose some challenges - with monitoring, abuse potential, trustworthiness of the patient's compliance .... But those don't free one from the need to comply with the law as written and if desired develop whatever additional procedures one needs.
Thanks Rana. There's a lot in that DOJ LOF. And every time I read it and reference the prior court decisions on ADA MAT-OUD, I'm struck by how powerful it is. Can't discriminate on selection of disabilities; can't dictate tx plan you'll accept; can't jeopardize your licensees' health ....
Your Part 2 assessment of the deluded agency members' and the Washington State PHP, is spot on. it was true when I got snared back in the late 1990s. I had, at the age of 40 graduated first in my class, elected to AOA and debt free from Michigan State College of Human Medicine. I was proud of my achievement. Until I learned that the saying "Pride Goith before a fall' is actually far worse. "Pride Goith before destruction" is the accurate phrase. Everything you stated in part 2 was true back then. I did enough research on WPHP and the various treatment centers they used, to conclude that even a non lawyer can recognize antitrust violations with a modicum of legal education. I do not know if that is still true today, but I suspect that it is. Most of the facilities whose fees were paid for or at least subsidized by WPHP and the Washington State Medical Board were in that relationship for the financial incentive. Despite the requirement of competitive bidding in my state, contracts to WPHP and their bedfellows appeared to be funded via non competitive parameters. They were "awarding" grants to the main inpatient treatment facilities where they sent physicians for automatic mandatory 90 day stays. These costs were paid for by the already out of work physicians. it was a terrible experience.
oh my- I'm specialized in addiction and I treat physicians/PA's with SUD's in NY, years ago i worked in an IOP that cared for nurses in the equivalent predicament.
While treating addictions with replacement therapies (in this case OUD) is tricky and avoiding scheduled meds is preferred, a risk/reward discussion that an ability to maintain abstinence on MAT and have clear urine tests- is a clinical decision (I wish i could underline these last two words).
I'm sorry to see medical providers get this treatment in Indiana, because nearly losing a job (including whichever way it was discovered, how it was handled internally and reported) is a challenging process for a provider to experience. The pressure avoiding MAT hopefully allows vivitrol, 'no medication' has risks for relapse, which can be fatal. This punitive approach is not surprising to read, it lacks understanding about the mechanism of addiction and comprehensive treatment needed for success. This bias is common in the general public and medical professionals are not immune. Its not foreign to recovery (tho 12 step has been very supportive for many providers).
I'm glad to see the DOJ step up, the line "perhaps you didn’t fully understand what we said.." had me laughing out loud. Great article, thanks!
Many thanks Sonya. As you saw, there were multiple aspects of this that got DOJ going. One, the case ancestry of MAT (see ACLU document on MAT cases) made the application to boards entirely logical. Another, uniform application of any mandatory tx runs country to the ADA's insistence for case by case analysis and a tailored regimen, something boards and assistance programs, whether out of ignorance or interrupting their automatized referral flow, are loathe to do. Third, perhaps most importantly, it's not just mandatory adoption of exclusively one tx and the exclusion of all other accepted txs (bad enough), it's that it's also HARMFUL. It's dangerously bad medicine. And it intrudes on the only legitimate treatment authority, the doctor/clinician. BON is saying "our top shelf abstinence program and our needs to maintain it is more important that your scummy life."
What I believe DOJ is also saying "sorry, there's no one tx protocol fits all people in this arena. And your insistence that there is only one - yours - is so dangerously flawed in its narcissistic exceptionalism as to be committable." So ... either these "professional assistance" programs and the boards to which they're obediently allegiant, understand this central principle of the clinician's and treater's choice of treatment and the unlawfulness of their "Gold Standard" approach, or they're toast.
And ... that's not to say that MAT doesn't pose some challenges - with monitoring, abuse potential, trustworthiness of the patient's compliance .... But those don't free one from the need to comply with the law as written and if desired develop whatever additional procedures one needs.
Thanks Rana. There's a lot in that DOJ LOF. And every time I read it and reference the prior court decisions on ADA MAT-OUD, I'm struck by how powerful it is. Can't discriminate on selection of disabilities; can't dictate tx plan you'll accept; can't jeopardize your licensees' health ....