Wes Boyd MD posted a provocative piece on the Psychology Today blog. It explored “so why do PHPs send docs they’ve newly diagnosed under medical board order to a couple of places in Kansas, at least one of which features a polygraph expert on staff, and which charges ~ $7500 cash up front – no insurance accepted – for a “voluntary” four day evaluation?

https://www.psychologytoday.com/us/blog/almost-addicted/201904/why-physicians-who-need-psychiatric-care-go-kansas

My comment, certain not to win me a coveted “recommended program” status:

“Dr. Boyd’s concerns are indeed appropriate. I fear he understates the severity and extent of the fraud. 

Having spoken with and /or studied hundreds of cases of physicians subjected to compulsory so-called “psychological fitness for duty evaluations” or PFFDEs by PHPs around the country, numerous patterns are prominent. The physician may have been wrongfully ordered by the medical board itself for a PFFDE and prevented from objecting. The PHP may not even be qualified to conduct the PFFDEs – in fact, many are licensed not as legitimate licensed mental health practices but as “educational non-profit corporations.” In fact, despite clearly conducting an indepth psychiatric evaluation and making a psychiatric diagnosis and assessment of impairment, some have actually denied to US DHHS that they conduct such diagnostic assessments, rather calling their assessments “peer review.” These assessments meet none of the requisite criteria as clearly articulated by HCQIA.

And then, still deprived of contesting the findings of the assessment and having in hand a legitimate, contemporaneous comprehensive psychiatric evaluation which disproves these PHP findings, the physician is still denied any opportunity to contest what amounts to an involuntary civil commitment and their independent evaluation is ignored. 

Then, based on this criminal diagnostic fraud and wholesale denial of the medical equivalent of due process, that PHP often “recommends” to the board – that recommendation being a virtual order to comply – that the physician be sent to one of their “preferred evaluation centers” for a four day evaluation. First, there is no model for this evaluation in all of mental health. It’s a contrivance of the PHP franchise. But second, that non-neutral, non-insurance accepting facility, fundamentally contaminated by such a “preferred” relationship, often returns a diagnosis in synch with the referring PHP and may “recommend” the physician be sent to yet another “preferred facility” in the Board – PHP network for extended hospitalization for their newly diagnosed condition. And in this newly described Medical Regulatory Treatment Complex, it’s either comply or a) you get your licensed revoked; and b) you get publicly declared mentally ill, substance-abusing or behaviorally disordered, never to recover your reputation again. The costs to extract oneself from the maw of this grotesque machine are bankrupting and nearly invariably, the legal efforts futile.

Is it any surprise physicians might kill themselves trapped in such a Kafkaesque nightmare? Or might want to conceal any efforts at getting legitimate confidential help for a mental health concern?

Dr. Boyd has previously advocated for a national independent annual audit of all state Physician Health Programs. Both FSPHP and the APA (psychiatry) refuse to examine these concerns or support independent audit. One must certainly ask why. APA’s 2017 position statement on PHPs establishes a new benchmark for institutional moral cowardice.

Absent any oversight or medicolegal responsibility, I believe the time has come to strongly recommend that any physician ordered by a medical board or any other entity having control over their license or credentialing to submit to a PHP evaluation immediately engage knowledgeable counsel to seek an injunction against the board mandating compliance with that order until the legitimacy, integrity and legal rights afforded licensees are clearly and irrefutably established. 

In my opinion, no physician should ever risk their hard-earned careers to such a fundamentally dishonest and sadistically predatory operation.

Kernan Manion MD is the Executive Director of CPR – The Center for Physician Rights www.PhysicianRights.net. “