Open Letter to WA Medical Board

Melanie de Leon, MPA, JD
Executive Director
Medical Quality Assurance Commission

Ms. de Leon:
Thank you for letter confirming my doubts about the impartiality of the Washington Medical Quality Assurance Commission (MQAC) regarding the case whose adjudication by MQAC I criticized here.

You admitted that MQAC dismissed the blatant bias implicit in the presence of Robert Small, a vice president at Premera Blue Cross, based on the opinion of an assistant attorney general:

"The attorney concluded that Dr. Small was able to perform a neutral review."

Surely MQAC knows that the attorney works for Gov. Inslee, and that Gov. Inslee appointed Dr. Small to MQAC. The people of WA should have no confidence in the off hand opinion of "a staff attorney." I have none. This case only proves that any question about a gubernatorial appointee will get a rubber stamp rejection.

You also state:

"The solicitation or submission of letters of support on behalf of a physician being investigated – in and of itself – does not constitute an ethical violation."

Really? On whose authority? Yours? The solicitation of anything other than a fee by a professional violates the most basic principle of professional ethics, that everything the professional does should be for the client/patient, not vice versa. Never mind that by doing so Dr. Holliday in effect "put the word out" among an indeterminate number of law enforcement officers that I may have threatened their source of alprazolam (Xanax) and likely other addictive drugs.

Chronic use of benzodiazepines for psychiatric illness is controversial at best. Combining two is harder to justify; treating an alcoholic with with these drugs, often known as alcohol in pill form, is contraindicated; and treating an alcoholic law enforcement officer with two benzos AND a z-sleeper poses a clear risk to the public. One WA physician who claims to suffer from PTSD as a result of exposure to trauma in law enforcement wrote in a personal communication to me: "Benzo use indicates difficulty with adrenaline control, and should result in removal from high stress situations."

I suspect more than a little hypocrisy at play here as well. Would MQAC allow a WA physician to practice without sanction after learning that he or she was practicing under the influence of the same combination of drugs? Would an airline pilot be allowed to fly? How can you justify holding the treatment of a law enforcement officer to a lower standard?

MQAC’s handling of this case revealed bias and political influence. MQAC needs to reconsider its choices of experts and its commitment to protecting public safety, not just the safety of patients. Robert Small should resign from MQAC or from his position at Premera immediately.


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