When medical boards are faced with how to handle substance-abusing doctors, they often use rehabilitation as a substitute for discipline.
In the Washington area and across the country, physicians who test positive for drug or alcohol abuse are monitored, and sometimes they must agree to therapy or other steps. But rarely are they banned from practicing.
In some cases, medical boards are unaware of the problem. Employers may place doctors in the hands of a monitoring group -- usually independent of the medical boards -- or physicians enter rehab voluntarily. Even when doctors enter residential treatment programs, they often retain their licenses to practice.
California's medical board, for example, took no action against anesthesiologist Lewis M. Satloff when it learned of his drug use because he was already in a monitoring program, known in that state as "diversion."
"It's sort of an unusual circumstance," said Dave Thornton, executive director of the Medical Board of California. "We don't want to penalize a physician who's already in diversion by placing him on probation."
Because the rehab program operates in confidentiality, Thornton said, "we didn't realize he was in our diversion program."
Satloff, 48, who practiced in Baltimore before moving to Southern California, stole painkillers -- Demerol and fentanyl -- from a California hospital in 1999, according to medical board records in Arizona, where he also has a license. The drugs were for cardiac surgery patients, and any left over were supposed to be returned to the hospital's supply at the end of the day. But Satloff was using them himself, the records show.
Arizona's medical board became involved after Satloff admitted on his 2000 license renewal application there that he had been treated for drug use, according to the board records.
At one point, someone from the California hospital's staff confronted him about missing drugs, board records show, and he turned himself in to the state's diversion program. Under California law, the theft of Demerol or fentanyl carries a penalty of up to four years in prison.
The hospital -- Children's Hospital Los Angeles -- placed Satloff on leave in September 1999, and he agreed to get help, abstain from drug use and stop practicing medicine temporarily, according to Arizona medical board records and Steve Rutledge, a hospital spokesman. Three months after he entered outpatient treatment, Satloff worked one day as an on-call anesthesiologist at Midway Hospital Medical Center in Los Angeles and relapsed using fentanyl, according to board records and sources. A hospital housekeeper reported finding him in a bathroom at 10:30 p.m. with a syringe in his arm, according to two hospital sources familiar with the incident.
In a statement through his attorney, Satloff said he believes his drug problem was caused by "secondhand environmental exposure to opiates in the operation room." He said studies have shown that such exposure can cause "drug sensitization" and produce withdrawal-like symptoms, placing anesthesiologists at risk of drug abuse.
"Fortunately, through treatment and hard work, I have overcome that problem and have been working drug-free for nearly five years," Satloff said.
Neither Children's nor Midway reported the incidents to police. Four months later, Satloff entered an inpatient rehab center, which recommended that he not practice medicine where he had access to "potential drugs of abuse," according to the medical board records. Satloff returned to Children's Hospital in September 2001, Rutledge said.
The Midway Hospital sources said the Medical Board of California was notified about the incident but took no action. "We sent the report to them, and it certainly talks about the drug theft and his drug problem," one of the sources said.
California medical board officials said they learned about the drug incidents only after Satloff applied to renew his Arizona license. Satloff is now on probation -- but can still practice -- in Arizona and New York, records show. He surrendered his Massachusetts license in 2002, an action that halted a board investigation there, according to a release by that board. His Maryland license is inactive, but he can practice in Hawaii. California, where he has privileges at three Los Angeles area hospitals, has not disciplined him.