WA Medical Board OK with Policing Under the Influence

or

Officer’s Little Helper

My discovery of a local PTSD “expert” prescribing 2 benzos and a z-sleeper to an active duty law enforcement officer with a history of alcoholism exposed failures at the state medical board and the DEA.

A forensic psychologist invited me to weigh in on a case referred to her by a local law enforcement agency to provide a fitness for duty opinion in light of the medication regimen which included, over a period of years, z-sleepers: eszopiclone, zolpidem, and zaleplon, and benzodiazepines: alprazolam, clonazepam, and clorazepate, as well as other psychoactive drugs. These drugs can produce impaired judgement, disinhibition, impairment of motor skills, amnesia, dependency and addiction. Abstinence can lead to grand mal seizures. This sounded to me like a recipe for disaster, so I reported the case to the Washington Medical Quality Assurance Commission (MQAC) which found no evidence of professional misconduct and closed the case. I base much of what follows on my review of public disclosure documents obtained from the state.

In the process of filing the report I accessed the practice Website of treating psychiatrist William Holliday, MD, which boasted of his work as a consultant to the United States Drug Enforcement Administration and his treatment of numerous DEA agents (the latter removed as of yesterday). I then reported my discovery to the DEA Office of the Inspector General.

MQAC

The documents provided to me by the state included no explanation whatsoever of the Commission's failure to charge, however, I discovered that none other than Robert Small, MD had acted as Reviewing Commission Member. I confirmed with Premera Blue Cross that Dr. Small works for them as Assistant Medical Director for Behavioral Health, and that Dr. Holliday is a network provider for the company. Failure to charge strongly suggests bias or favoritism arising from this relationship.

State workers should redact all instances of the names of patients and complainants (me) from public disclosure documents prior to release. Although I found my name nowhere, I found at least two unredacted patient names. The name of the officer I examined appeared at least 20 times.

Holliday

The records include a response from Dr. Holliday with six or more letters of support from his patients, at least one of which indicated the psychiatrist had directly asked him to write the letter in his behalf. A DEA agent wrote one of the letters, and three mentioned obtaining “Xanax” obtained from Holliday. Even for a physician to inform a patient of such an investigation suggests the physician wants help from the patient, a potential boundary problem.

Holliday’s treatment records for the officer I examined contained no evidence that he had accessed the state controlled substance prescription database. State law prevented me from accessing it since the officer was not under my care.

Holliday expressed opinions about the case as well as implying that he commonly provides opinions about law enforcement officers under his care. MQAC has disciplined physicians in the past for mixing forensic and clinical roles, but apparently overlooked the role conflict in this case, again suggesting bias.

DEA

OIG referred the matter to the local DEA office, which after as long as six months has not concluded the investigation. I receive regular reports from Congressman Adam Smith whose office has monitored the agency’s investigation.

Conclusions

  • Law enforcement officers should not take drugs that the FAA prohibits pilots from taking while flying. We need neither impaired police officers nor DEA foxes guarding the chicken coup.
  • MQAC failed on several fronts. Robert Small’s key role gives the appearance of bias and favoritism afforded to his company’s network physician, a fact that MQAC apparently failed to consider. MQAC failed to protect the privacy of at least two patients. MQAC failed to consider the ethical implications of a physician who asks his patients to write letters in his behalf after revealing his own problems to them. The essence of a profession is that the professional works for the client (patient), expecting nothing in return, whether support, a letter, or sexual favors, except payment of a fee. I wonder whether those patients taking controlled substances like Xanax felt they must write a good letter to guarantee their continued supply. One wonders whether some patients refused altogether or provided letters that did not provide sufficient praise and how that might affect their relationship with Holliday.
  • In failing to provide a rationale for not charging Holliday, MQAC leaves itself open to suspicion of bias and conflict of interest.

Recommendations

  • Local law enforcement agencies, and in particular DEA, should immediately implement policy to remove agents taking controlled substances from active duty, or at least fieldwork.
  • To avoid the appearance of cover-up MQAC should publish the names of all physicians reported, along with the rationale for not charging. MQAC should consider possible ethics problem such as role conflicts and requests for assistance from a patient by a physician.
  • MQAC should extend the time limit for appealing their decision beyond the current 30 day limit to allow complainants adequate time to obtain public disclosure documents which can take months.
  • Robert Small should be removed from MQAC, and no insurance industry shill should be appointed in the future.
  • The Department of Health should grant forensic examiners access to the controlled substances prescription database.
  • The Department of Health should do a better job of protecting patient privacy by redacting identifying information from public disclosure documents.

At best this case represents sloppy work by both MQAC and DEA, and at worst, corruption. Citizens deserve better from their government.

 

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