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Over the past 20 years, John F. Pholeric Jr. struggled on and off with cocaine addiction, cycled in and out of rehab and was convicted of a felony. During that time, he also practiced medicine.
Pholeric, 55, an ear, nose and throat specialist in Fairfax and Loudoun counties, admitted snorting cocaine "three to four times per week" in his office in 1999. He stole drugs from hospitals where he worked and wrote more than 40 fraudulent prescriptions for his own use, according to Virginia and District medical board records.
Several times, the Virginia Board of Medicine took up Pholeric's case. But it never took away his license to practice.
Pholeric, who retired last month after he was questioned by a Washington Post reporter about his substance abuse, is not alone. Virginia Board of Medicine records show that an Arlington ophthalmologist who performed cataract surgery under the influence, his hands shaking and his speech slurred, still has his license. So does a Loudoun County gastroenterologist who deprived his colonoscopy patients of painkillers and injected himself with the drugs between operations.
Scores of physicians in the area and across the country have been given repeated chances to practice, despite well-documented drug and alcohol problems, a Post investigation has found. They have stayed in business with the permission of state medical boards and hospitals, even when many have relapsed multiple times and posed a danger to patients, records show.
When physicians were disciplined, the process sometimes was so slow that they moved to another state and became licensed before a paper trail surfaced detailing their transgressions.
According to a review of medical board records, 74 doctors in the District, Maryland and Virginia were disciplined for substance abuse from 1999 through 2004. In five other cases, the boards found that doctors violated the law by abusing drugs or alcohol but took no action despite the doctors' repeated substance abuse. In nine other cases, the physicians surrendered their licenses for the time being to avoid investigation and possible punishment, according to board records.
In the 74 cases in which doctors were disciplined, most had their licenses suspended temporarily. Ten doctors were reprimanded and five others were placed on probation, but their licenses were not suspended.
Seven of the disciplined doctors have been convicted of felony drug crimes. One doctor who was convicted in Virginia and served time in prison once again has a license to practice in the state.
Of the 74 physicians, 53 percent have been disciplined more than once for alcohol or drug use during their medical careers. Nine were sanctioned at least three times by the same board.
The District and Maryland boards do not permanently revoke doctors' licenses. In Virginia, where a license can be permanently taken away only with a doctor's agreement, just one was revoked for substance abuse from 1999 to 2004, records show.
Critics say lenient treatment of substance-abusing physicians flows from a seriously flawed national system of disciplining doctors. At its heart is a network of state medical boards made up primarily of physicians who, critics argue, are unwilling to exact strict punishment on their colleagues. A federal data bank designed to track problem doctors has critical loopholes and is closed to the public. Malpractice lawsuits often end in sealed settlements, adding to a cloak of secrecy that keeps patients from learning a doctor's full history.
Patient advocacy groups say bad doctors are also coddled by hospitals and other employers as part of a culture of clemency and second chances.
"Medicine tolerates behavior that in any other industry would be unacceptable," said Lucian Leape, a physician and expert on patient safety who teaches at the Harvard School of Public Health. "There are patients' lives at stake . . . and that's more important than a doctor's career."
Charles B. Inlander, president of the People's Medical Society, an Allentown, Pa.-based nonprofit consumer health advocacy group, said doctors who are drug addicts are often given too much leeway.
"If a pilot gets caught, they're out. If an engineer gets caught, they're out," Inlander said. "Why does a doctor get special treatment?"
Hospitals and other employers can discipline physicians. But when it comes to a doctor's license, the authority rests with state boards of medicine, which usually are appointed by governors. In the District, board members are mayoral appointees.