RX OVERLOAD: ADDICTED DOCTORS

In Louisiana, doctors with substance abuse problems who are investigated by
the state licensing board rarely lose their licenses.

The majority of actions taken by the Louisiana State Board of Medical
Examiners against doctors charged with substance abuse problems are either
suspension or probation, according to figures from recent years. Yet there
is an unknown number of doctors with drug problems who may never come to
the attention of the licensing board - or to their patients.

Doctors are often skillful at covering up their problem, said Dan Talley,
executive director of the Council on Alcoholism and Drug Abuse of Northwest
Louisiana.

"They are more difficult to treat because they are so knowledgeable about
the problem and so adept at hiding it," Talley said. "They know the
pharmacology and effects of drugs and for a long time can maybe avoid an
overdose. Plus, they are pretty well insulated from criticism. They don't
have to account for their whereabouts; it's not like they have to answer to
anybody."

The issue of doctors and substance abuse has been spotlighted locally by
the case of Dr. Christopher Greer of Bossier City, an ear, nose and throat
specialist practicing in Shreveport who was arrested April 20. He was
indicted Wednesday by a federal grand jury on charges of conspiring to
distribute Schedule II narcotics, three counts of prescription fraud and
two firearms counts.

Greer is scheduled to be arraigned Wednesday. He is out on bail and in a
private substance abuse rehabilitation program in Rayville, family members
said.

According to disciplinary actions published in the Louisiana medical
examiners board newsletters, 26 doctors were charged with habitual or
recurring abuse of drugs from March 1999 to December 2001. Six were from
Northwest Louisiana.

The drug actions made up about 30 percent of the total number of
disciplinary actions taken by the board during that time.

Only one license was revoked for a drug charge, according to the
newsletters. During that time period, 12 received suspensions and 13
received probation. Doctors on probation can continue to practice medicine
but not while in substance abuse treatment.

Actions by the board are made public through news releases to the media.
But those are only the doctors who have been investigated by the board and
where action was taken. Some doctors may never seek treatment and never be
reported to the board; others may voluntarily seek help through state
physicians health programs and avoid having the licensing board ever know
about their drug problem.

Dr. Sidney Wolfe, director of the Health Research Group for the Washington,
D.C.-based watchdog group Public Citizen, said only a "small fraction" of
doctors who have drug problems are ever disciplined.

"We find this is a dangerous practice," Wolfe said. "There are doctors who
are practicing medicine who have drug or alcohol problems and patients
don't know because the medical board doesn't know about it."

Such impairments may make medical mistakes more likely, he said. "You
shouldn't have to wait until a patient is harmed or killed for the public
to know it."

Public Citizen's study of national data found that nearly 68 percent of
doctors who had received disciplinary actions for substance abuse were
allowed to continue practicing.

The study said the doctors' behavior was "probably unknown to most if not
all of their patients."

Each year, about 50 physicians contact the Physicians' Health Foundation of
Louisiana for help, said Michael R. DeCaire, administrative director of the
program, based in Baton Rouge. About 80 percent of those have substance
abuse/chemical dependency problems, he said.

The program, established in 1984 by the Louisiana State Medical Society,
helps doctors identify four kinds of impairments: substance abuse/chemical
dependency, psychiatric illness, disruptive behavior and physical limitation.

"First-timers," as DeCaire called them, are not reported to the licensing
board unless it is a case of patient boundaries (such as sexual misconduct)
or certain violations, such as diverting a substance for sale or trade,
DeCaire said.

Doctors can go through treatment after being referred by the program (the
doctor is not allowed to practice while in treatment), then sign a
five-year contract for extensive monitoring, and their drug problems likely
would never be made public.

DeCaire said the program should allay doctors' fears that seeking treatment
could end their careers.

"We want to help physicians before problems escalate and before possibly
causing someone harm, whether it's the physician or patients or families,"
he said.

He said that in 2000 and 2001, 96 percent of participants had successfully
completed the program and had not returned to substance abuse.

"We don't want to seem like a physician policing type organization ... but
we do hold our participants highly accountable," DeCaire said. "It seems
very strict, very regimented, and it is."

Monitoring includes attending certain numbers of recovery group meetings,
continuing medical education and frequent random drug screens. All of the
requirements must be reported monthly. If there is a pattern of breaching
the contract, the program notifies the state licensing board, which then
could take action against the doctor.

For doctors who successfully complete the program, the foundation advocates
on their behalf to reinstate hospital privileges, sign on to health plans,
get malpractice insurance and so forth, DeCaire said.

Are more doctors using drugs? Or are more doctors seeking help, knowing
they can avoid bad publicity or sanctions? It's hard to tell, experts say,
since few comprehensive studies have been done on the subject.

But one Louisiana rehabilitation facility is seeing a rise in patients
since it opened eight years ago. Palmetto Addiction Recovery Center in
Rayville has a special program for doctors, nurses, dentists,
chiropractors, veterinarians, pharmacists and attorneys. Each year about
150 to 200 professionals enter the 90-day program, which costs $18,990,
said marketing director Allen Rainwater.

He said the facility is being expanded to meet a demand he attributed
partly to nationwide marketing of Palmetto and to more professionals
seeking treatment.

By successfully completing a treatment program such as the one at Palmetto,
doctors who have had their licenses suspended or who have been placed on
probation by the licensing board may avoid losing their licenses.