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Ethics and the Medical Community

Cheryl W. Thompson
Washington Post Staff Writer
Monday, April 11, 2005; 2:00 PM

Washington Post staff writer Cheryl W. Thompson will be online Monday, April 11, at 2 p.m. ET to discuss her three-part series, "Special Treatment: Disciplining Doctors," which examines medical boards, doctors and ethics.

The transcript follows.

Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.


Cheryl Thompson: Good afternoon. Thanks for joining the discussion. I'm looking forward to answering your questions.


Silver Spring, Md.: I don't have an issue with sending addicts to rehab, even if they are MDs. But what are the teeth behind that? Regular addicts have slips that get signed and/or periodic testing, which is reported to various authorities; does the same hold true for doctors?

Cheryl Thompson: In many places, including DC, Maryland and Virginia, there are medical societies or programs that are supposed to monitor doctors with substance abuse problems (i.e. drug tests, therapy, etc.) and then report any problems with a doctor's failure to comply to the medical boards.

Cheryl Thompson: It then falls to the medical boards to take action.


Milford, Conn.: I have been a nurse for 29 years and I commend your investigation. In addition to the problems with discipline and oversight of impaired physicians, what is being done about impaired medical students, and residents?

Cheryl Thompson: Impaired residents can be reported to hospitals and the hospitals can discipline them if they want to. One of the doctors in Sunday's story was placed on leave from a Georgetown residency program because of his substance abuse.


Washington, D.C.: Oh my. I can't frankly believe that there are doctors who went on record sounding aggrieved about their multiple chances with the Boards of their respective states for problems arising from their lengthy drug additions. Sure, everyone makes mistakes, but shooting up "up to 10 times a day" is not a "mistake." And the excuses ("no documented instances" where patient care was affected) sound entirely like rationalizations of an addict who has yet to reach bottom.

And mind-altering drugs, by their very definition, alter judgment! I've heard that drug abuse is a serious problem with doctors, but there has to be a better way to deal with it than to wait for a malpractice suit when the affected doctor hurts a patient. The attitudes ("thank you for helping me retire!") expressed in the piece fall so far outside the realm of embarrassed contrition or mature responsibility that I couldn't believe that licensed professionals expressed them.

I think the very existence of this article has to help the problem, so thanks for writing it!

Cheryl Thompson: Thanks for your comments.


Waterford, Va.: Did you know that Dr. Pholeric was named as one of the area's top doctors by Washingtonian magazine in the November 1995 issue?

Cheryl Thompson: Wow.

Cheryl Thompson: Interesting.


Boise, Idaho: Hi Ms. Thompson,
My entry is more of a comment than a question. I am an RN who has worked many years (21) in a variety of health care settings. I have had the unique opportunity to observe physicians and their struggles. I know the profession has somehow gotten the unfortunate reputation of not policing their own and of protecting each other. However, I have found this not to be the case. I HAVE witnessed countless physicians who sacrifice their personal lives to medicine. The public may not completely understand that the profession of medicine is exceedingly demanding, both in prepatory education and subsequent practice. I have personally seen physicians spend 36-72 hours at a time at the hospital, doing surgery and answering pages, etc.
The overwhelming stress and constraints of insurance reimbursement exact a tremendous toll on physicians. It is no mystery to me as to why physicians fall prey to substance abuse. With demanding hours and personal sacrifice, our society may one day see a severe shortage of men and women who are willing to become physicians. Who will the laywers sue then?

Cheryl Thompson: You're right. I'm sure there are wonderful physicians in this country who are dedicated to helping people.


Sterling, Va.: Hi,

I got nasal surgery back in dec. of last year. I have still been having problems with my nose and the major headaches.

Now that I find this out about Dr. Pholeric, I am really concerned.

What is my course of action at this point?

Cheryl Thompson: If you need information about a specific doctor or have a complaint, you can contact the Virginia Board of Medicine at 1-800-533-1560.


Washington, D.C.: Is there a federal law? You wrote a lot about state laws.

Cheryl Thompson: There is a federal data bank that tracks doctors discipline an medical malpractice settlements. It's called the National Practitioner Data Bank and is run by the U.S. Department of Health and Human Services. It's open to state medical boards, hospitals, etc., but not to the public. More on that in tomorrow's story.


Sterling, Va.: Cheryl,

My concern is the fact it was performed by Dr. Pholeric himself!

Cheryl Thompson: Unfortunately, I can't advise you what to do. But all disciplinary action taken against Dr. Pholeric is on the Virginia medical board's Web site.


Washington, D.C.: Your article noted that there were "loopholes" in the National Practitioner Data Bank. Can you give some examples of these "loopholes"?

Cheryl Thompson: The loopholes will be discussed in tomorrow's story.


Arlington, Va.: After reading your article I wondered what the statue of limitations is regarding services received by the doctors listed in your article? I had four separate procedures performed by Dr. Pholeric and had no knowledge of his drug addiction problems.

Cheryl Thompson: I don't know but you can certainly call the Virginia Board of Medicine's complaint unit at 1-800-533-1560 and they should be able to tell you.


Bethesda, Md.: Where can we get a list of the doctors who were reprimanded for drug use in our area? Thank you.

Cheryl Thompson: The Maryland Board of Physicians publishes monthly newsletters that are public and can be found on their Web site at www.mbp.state.md.us
Look on the left side of the site and click on "newletters/board sanctions." The newsletters list the actions taken against physicians. I can't attest to how up to date it is, though you should be able to find actions for 2004 and 2003.


Silver Spring, Md.: Thank you for doing this strong piece of investigative journalism that is largely overdue. It's very interesting to me that MDs are routinely not held accountable for these indiscretions as are the rest of their allied health colleagues (nursing, pharmacy, PT, etc.)

Cheryl Thompson: Thanks for writing in!


San Francisco, Calif.: Cheryl,
Could you please provide commentary regarding the life altering mistakes the medical and dental boards across the nation have made? I know of a doctor who was licensed in Vermont and California. His ex-wife, a licensed psychologist, reported to the medical board in VT that he was dx w/a psych condition, which was untrue, and proven to be untrue. He was prosecuted without due process, and his license revoked. He has spent five years of his life unemployed. The licensing boards have "wide" latitude to prosecute without due process, and the lives of many innocent, highly skilled doctors are destroyed.

Cheryl Thompson: Did he not have a chance to present his side to the state medical board?


Orono, Maine: President Bush has argued that medical malpractice suits are the main reason/factor behind the nation's skyrocketing healthcare premiums. I've always been skeptical of that claim. It seems to me that behaviors such as smoking and overeating are the main reason that people get sick -- and therefore, the main reason that premiums are so high.

Have you seen any data that justifies the concern about the costs that malpractice cases and the need for doctors to buy insurance to protect themselves actually add to the system each year? This is a hunch on my part, but..I'd bet that they amount to less than 10 cents out of every $1.00 spent on health care in this country.

Any thoughts?

Cheryl Thompson: Unfortunately, I didn't tackle medical malpractice in this series. Sorry.


Alexandria, Va.: The statute of limitations medical malpractice in most states is three years, but in D.C. it's one year. That doesn't allow much time to sort out the complexities of a court case. It could take months to get copies of hospital and doctors' records.

Is there any chance that the D.C. statute will be changed to the three year term that other states use?

Cheryl Thompson: You may want to call Del. Eleanor Holmes Norton at 202-225-8050.


Olney, Md.: I really have a problem with the medical community in general. The specific drug issue is wider spread than I think -- even your graphics show. Those are reported cases. My wife's old family doctor got her hooked on Xanax. He told her he was hooked on it too.
It ended up killing him. My wife has been in and out of rehab, it's cost me thousands of dollars, I lost a job and a career because of her addiction, all because her "trusted" family doctor was so wasted himself he forgot to care about his patient. These doctors are no better than child molesters, they should be punished severely and not allowed to practice medicine ever again.
Its time we stopped these people from endangering other people's lives and families.

Cheryl Thompson: I'm sorry about your wife. Thanks for writing.


Clinton, Md.: How can you find out, whether or not a Physician that is practicing in the District of Columbia is licensed and has Malpractice Insurance?

Is this information available to the public, if so, who can I contact?

Cheryl Thompson: An attorney for the D.C. health department said that doctors are not required to report whether they have malpractice insurance when they apply for a medical license in the city. To find out if a doctor who is practicing in the District is licensed, you can call the Board of Medicine at 202-724-4900. If the doctors works for the District, the city indemnifies them, the attorney said.


Cheryl Thompson: You can also find out if a doctor is licensed by going to our series and clicking on the story and resources and choose your state.


Baltimore, Md.: To Orono Maine --

Not sure if anyone has run the numbers, but the fear of malpractice runs up costs by practice of "defensive medicine" daily, mostly by increasing radiology and laboratory workups instead of using good history taking and physical examination skills. Also, insurers will pay for these studies but not for adequate time for patient visits.

Some of this is probably good, but overall, the more you look, the more you find, the more complications you produce chasing what you find, and the more money you spend.

MD in Baltimore

Cheryl Thompson: Thanks for your comments.


Springfield, Va.: Are these individuals reported to any type of Federal Program?

Cheryl Thompson: I'm sorry, which doctors are you referring to?


Silver Spring, Md.: In follow up to my previous comment about under disciplining as compared to the rest of the allied health professions, would you consider a follow up series of articles on this? That is, comparing rates and severity of disciplinary actions among the allied health professions? I think that would be a very interesting report and may actually help move these medical boards in the right direction.

Cheryl Thompson: It's something I could certainly look into.


Baltimore, Md.: As a hospital based physician and department head, I can attest that physician impairment is taken VERY seriously by credientialling boards and medical executive committees, with careful attention paid to the safety of the public and reporting responsibilities to oversight agencies, as well as to the accused provider's right to due process.

Despite the implication otherwise in your headlines, physicians DO get fired and licenses lifted over this stuff. I have seen it happen.

As regards differences between the District and surrounding jurisdictions, it is interesting that it is easier to bring malpractice suits in DC (different certificate of merit requirements), but a more tolerant eye is turned toward drug use. Can this be surprising in a city that keeps electing Marion Barry?

Cheryl Thompson: I appreciate your comments.


Alexandria, Va.: Who can report a doctor to the board? Does it have to be a patient? Do they have to identify themselves? Can a nurse or fellow doctor report them without fear of repercussions?

Cheryl Thompson: Anyone can report a doctor to a medical board. It can be a patient, another doctor, a nurse, etc. It's common for the complainant to identify themselves and complaints generally are done in writing. Again, it's best to call your state's medical board to get the specifics of what should be included in the complaint.


Cheryl Thompson: I'd like to thank everyone for taking time to write in and for reading the stories. It's important to know what readers think. Thanks again!


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