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Vermont Medical Board Goes Overboard
As expected the Vermont Board of Medical Practice, on a sad day for Vermonters, passed judgment on buprenorphine maintenance physician Michael Schorsch, M.D. after a hearing, confirming my suspicions of impropriety in the board's action as anticipated in this earlier post. I commend Dr. Schorsch for responding to the allegations by defending himself without legal counsel, effectively thumbing his nose at the board. Instead of fighting on the Board's terms he chose to allow his Vermont license to expire late last year, leaving the board with an empty victory. I salute you Dr. Schorsch.
The board correctly determined that Dr. Schorsch's handling of "patient A" did not constitute abandonment. The board failed to document evidence of potential harm to any patient. The board in this decision seems to support a rigid cookbook approach to the practice of medicine that denies the importance of physician discretion in inpatient care.
The board erred in using John Brooklyn, M.D. as an expert witness. According to his curriculum vitae Dr. Brooklyn serves on the faculty of the University of Vermont, creating the appearance at least, of conflict of interest.
The board erred in deeming the Vermont buprenorphine guidelines, partially authored by Dr. Brooklyn, to represent standard of care. Clinical guidelines do not represent standard of care and often include a disclaimer to that effect. In particular the use of Dr. Brooklyn's "appropriateness" criteria as analyzed here was inappropriate as was the characterization of these criteria as objective when in fact they are quite subjective.
The board ordered that Dr. Schorsch must complete a professional ethics program -- punishment thinly disguised as education -- and subject his practice to monitoring for a period of three years with special attention to documentation as conditions of reinstatement of his license -- should he want to renew. I found no documentation in the decision of any ethical failure on the part of Dr. Schorsch.
I have attempted to determine whether the Federation of State Medical Boards maintains guidelines for its member boards to ensure both quality and ethical handling of investigations of physicians and resulting disciplinary actions. To date, FSMB representative Drew Carlson has provided no evidence that any such guidelines exist or that the organization engages in any oversight of the conduct of its member boards.
I hope Dr. Schorsch will continue to defy the Vermont medical board. He would be more than justified in refusing to treat Vermont residents from his office in New Hampshire as well. We need more physicians who are willing and able to defy bad decisions arising from witch hunts by arrogant medical boards.
Aside from any adverse impact this ill advised decision might have on Dr. Schorsch's career, such rigid and extreme application of such subjective rules will almost certainly harm the very people the Vermont Board of Medical Practice should protect -- patients -- and in particular those who desperately need help for addictive disorders, by discouraging physicians from treating this vulnerable population.
Vermonters can tell their legislators how they feel. Perhaps you will want to ask the legislature to add language providing for a duty to protect patients to the statute enumerating the Powers and duties of the board: