Should I refuse FFDE?

[TulaneUnderdog]

Hi forums, thank you in advance for any advice and tips you can give me. I implore you to be as brutal as possible and obviously the person whom I am taking the biggest advice from is my Attorney, Program director, and Physician Health group (PHP).

Last month, i received a DUI while off-duty from work on saturday night. They pulled me over for speeding and asked how much i drank due to saying they smell it on me to which I said I had mixed cocktails hours ago and people have spilled beer on me and that I did not drive drunk. He did not buy narrative and offered breathalyzer to which i refused. I believed i passed FTS but he arrested me and warranted for my blood alcohol which was drawn. I self-reported the following week to which my PD filed a referral to Academic Affairs for fit for duty assessment. PHP got involved and agreed. I submitted to UDS and Etg (negative) and also PD was requested to fill any evaluations of issues on-duty to which he showed it to me himself which was “absolutely none” over my 3 years residency. Im on my final year resident and he submitted back that I met graduation status as my past 3 years had no moments of erratic behavior, inebriation, missed obligations, nor poor performance but in fact improvement and readiness to be attending. So referral therfore was for “DUI arrest” to which PHP now demands i do fit for duty eval, a 3-day program to evaluate if im fit for work (FFDE)

Fast forward to this final week. My BAC returned below legal limit (0.06) and my DA decided to drop my case due to lack of evidence that i truly was impaired. My charge is lifted and reduced to Speeding. My criminal attorney notified me that my narrative was true and i was not impaired. So far my license suspension has now been lifted (due to refusing chem test) and that violation is now reversed and I am free to use my drivers license. My attorney said he thought my DA would plea bargain for reckless driving (which would be admission of guilt) but due to bac and no property/human dmg, decided to proceed with dismissal and just traffic infraction.

My PHP is still demanding to do FFDE for the DUI arrest but it is now dismissed. I personally find this wrong. I told them i have dismissal and sent court documents verifying, along with evidence of my minimal BAC and negative drug screenings but they still said “its not about the criminal matter”. They threatened to send me to the Board for non-compliance. I feel backed to a corner. My plan is to continue to refuse FFDE, aware repercussions include termination, revoked license, removal from duties in program, miss graduation, and and financial loss and time as it is a lot of money from both paying more legal fees and fighting what is likely a yearlong battle.

I called my PD who agrees to hold off on FFDE as he personally confirms i had no on-duty report to provoke the refferral, just that off-duty incident. He says he will personally serve collateral as he notes i have 3 years of objective evidence in evals that i wasnt under influence or faltered in my work. He still is working with my criminal attorney and called the PHP himself affirming this but they are not budging. Part of me thinks “just do FFDE” and my PHP argues if I believe I got nothing to hide, i should go FFDE and they will diagnose my with nothing and say I am fit for work. I call bull****. I find it sus they offer 4 facilities that are all in patient with 90d programs attached that they are advertising to the evaluees to also do after they get stamped with whatever ICD code they catch with the dozens of IQ tests, memory exams, attention tests, and depression/personality screens. I will be at mercy of whatever they say I have which will be impossible to contest and remove against assessments by a multidisciplinary group of Psychiatrists, Addictionologists, and Neurocognitive Therapists who will put me through 8h stressful testing while inpatient over 3 days.

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[GoSpursGo]

What does your PD say?

 

[TulaneUnderdog]

He says hold off on FFDE. But he is buddy-buddy with me and also signed non-committal so is unaware of the whole situation. He holds biases that also may not be reflective of my best interests in that he had been short staffed while Im not working due to sick leave and fmla and knows ffde will mean i will be a month off work. He however promises to serve as collateral to dispel for any concerns of this behavior ever showing up on-duty. I have my MSPE and 3 years of evaluations from my faculty that i am going to send to medical board anyway

 

[xffan624]

I think I had posted about this under my own account so I guess I will disclose that I did undergo one of these evaluations based on what I thought was rather a flimsy reason.

TLDR I was doing poorly in the program for multiple reasons but had good ITE. There was a single incident where I was I on call asleep and I didn't hear the cell phone ( I still maintain the phone didn't ring for some reason due to poor signal or something) over a period of 30 minutes. It did ring eventually and I was present immediately and not impaired in any way and saw the patient (which was not urgent). Regardless, the attending thought the 30 minute gap was suspicious and made a suggestion to the program that maybe substance abuse was involved.

Several weeks later, this process was initiated (I knew nothing about this until it was started). I was urine tested and came back clean, did the pysch eval and got cleared after a week out of work. It was definitely a traumatic and stressful experience but understand that it's not a guarantee that you will end up in any future PHP program or other ramifications.

 

[TulaneUnderdog]

I think I had posted about this under my own account so I guess I will disclose that I did undergo one of these evaluations based on what I thought was rather a flimsy reason.

TLDR I was doing poorly in the program for multiple reasons but had good ITE. There was a single incident where I was I on call asleep and I didn't hear the cell phone ( I still maintain the phone didn't ring for some reason due to poor signal or something) over a period of 30 minutes. It did ring eventually and I was present immediately and not impaired in any way and saw the patient (which was not urgent). Regardless, the attending thought the 30 minute gap was suspicious and made a suggestion to the program that maybe substance abuse was involved.

Several weeks later, this process was initiated (I knew nothing about this until it was started). I was urine tested and came back clean, did the pysch eval and got cleared after a week out of work. It was definitely a traumatic and stressful experience but understand that it's not a guarantee that you will end up in any future PHP program or other ramifications.

Yours does not sound like an FFDE though. Sounds like urine screen and reasonable psych eval which is also what I did. They want me to do FFDE, a $4000 ordeal of going 3d inpatient at a facility.

 

[xffan624]

Yours does not sound like an FFDE though. Sounds like urine screen and reasonable psych eval which is also what I did. They want me to do FFDE, a $4000 ordeal of going 3d inpatient at a facility.

Not sure what they called it as it was several years ago. I was removed from work for a week while they did all this. Sorry that sounds awful. Is there any neutral entity that can advise you of your rights?

 

[TulaneUnderdog]

haha, my attorney

 

[mistafab]

My brother in Christ -

I am not a lawyer.’

I would not play the game with the FFDE. Your PD backs you. Your legal status cleared you. These roaches want to consume you. Do not agree to them. Let the board hear about it and look at the facts themselves.

If you get FORCED to do it, that’s another matter. Don’t give in voluntarily here

 

[TulaneUnderdog]

My brother in Christ -

I am not a lawyer.’

I would not play the game with the FFDE. Your PD backs you. Your legal status cleared you. These roaches want to consume you. Do not agree to them. Let the board hear about it and look at the facts themselves.

If you get FORCED to do it, that’s another matter. Don’t give in voluntarily here

I am forced. The PHP is funded by the board. They were born to protect health of physicians and treat burnout, substance use, and depression. Not abiding by them will lead to being sent as “noncompliant” to the Board.

 

[NotAProgDirector]

You're in for a complicated mess no matter what you do.

Let's start with the initial incident. I really can't fault the police for what they did. Presumably you were speeding enough that they pulled you over. You smelled like alcohol. You refused a breath test. So they brought you in, got a warrant, and tested you. And ultimately your level was below the limit. Charges were dropped / decreased to match your actual situation.

Now let's look at it from the board's viewpoint. They get an alert that you were pulled over for suspected DUI. Likely this is a mandated reporting scenario. They see that the charges were dropped. But honestly looking at the situation, it's quite possible your BAC was > 0.08 at the time of the stop -- the delay in getting a warrant / blood sample likely allowed your level to drop. So you don't meet the legal definition of DUI. But that doesn't obsolve them of investigating whether you actually do have a problem. The standard for concern is much lower than the legal standard. The story above demonstrates this well -- someone sleeping through their pager/phone for 30 minutes certainly doesn't violate any law, but is enough for a program to be concerned. So, a fit for duty exam is completely reasonable IMHO.

But, you're in a state where the PHP process has gotten out of control. A FFD exam is completely reasonable -- but this should not require a 3 day stay. And it's completely unacceptable for the group that is evaluating you to then also run a "treatment center" - such that if they diagnose you with something, they then can make lots more money treating it. It's an enormous conflict of interest, and I'm surprised it's legal. In my state, the FFD exam would be done by Occ Med in house, be a single day, and no cost. Substance and other testing would be required. You'd be out of work for 2+ weeks as the tests are not the quick drug screens we do on admissions, but mass spec studies which would survive legal scrutiny. If you were unhappy with an in house eval because of concerns it would be unfair, then you could arrange your own eval, at your own cost, with approval of the GME office (i.e. they would need to approve the evaluator).

So you're in a bind, and unfortunately the PHP/Board has unfettered power here. If you refuse the exam, they will likely automatically remove your license. Unless you can prove that they are being discriminatory (i.e. they are doing this because of a protected class), courts will allow the board to police its own ranks. You will not graduate from your residency program, and you will have great difficulty getting a license in any other state with "license revoked after refusal to participate in PHP program".

You have very limited options. Your PD cannot save you here, they have zero influence over the board. To me, your options would seem to be 1) do the evaluation and hope for the best; 2) refuse the eval and likely have your physician career come to an end; or 3) see if you can request / demand a hearing before the board to describe your situation. Even that I think will fail -- many physicians will realize that it's likely you were over the limit when pulled over and used perfectly legal delaying tactics to postpone the blood draw as long as possible. That will be fine in the legal arena, but not in the licensing arena. Your best option is probably to agree to be tested, and even if they then mandate a 90 day treatment program you should consider this a "cost" to fix this mistake. Sadly your refusal to participate immediately may be considered a concerning feature already and be one strike against you.

Your story should act as a cautionary tale to others. Trying to gauge how much you can safely drink before getting behind the wheel is a mistake. There's nothing magical about 0.08 -- I'm sure your driving was "impaired" at 0.06. Alcohol is never a requirement for a fun time. If you're going to be driving home, then I highly recommend not drinking at all. Or arranging for another driver.

Best of luck

 

[NotAProgDirector]

Thought of one more thing to add: If you want to "fix" the PHP system in your state, that's a good goal. But you can't do that now. Get out of the hole you've dug for yourself and save your career. Then, if you want to become an advocate for changing the system and use your story as a cautionary tale -- I hope you succeed.

 

[TulaneUnderdog]

You're in for a complicated mess no matter what you do.

Let's start with the initial incident. I really can't fault the police for what they did. Presumably you were speeding enough that they pulled you over. You smelled like alcohol. You refused a breath test. So they brought you in, got a warrant, and tested you. And ultimately your level was below the limit. Charges were dropped / decreased to match your actual situation.

Now let's look at it from the board's viewpoint. They get an alert that you were pulled over for suspected DUI. Likely this is a mandated reporting scenario. They see that the charges were dropped. But honestly looking at the situation, it's quite possible your BAC was > 0.08 at the time of the stop -- the delay in getting a warrant / blood sample likely allowed your level to drop. So you don't meet the legal definition of DUI. But that doesn't obsolve them of investigating whether you actually do have a problem. The standard for concern is much lower than the legal standard. The story above demonstrates this well -- someone sleeping through their pager/phone for 30 minutes certainly doesn't violate any law, but is enough for a program to be concerned. So, a fit for duty exam is completely reasonable IMHO.

But, you're in a state where the PHP process has gotten out of control. A FFD exam is completely reasonable -- but this should not require a 3 day stay. And it's completely unacceptable for the group that is evaluating you to then also run a "treatment center" - such that if they diagnose you with something, they then can make lots more money treating it. It's an enormous conflict of interest, and I'm surprised it's legal. In my state, the FFD exam would be done by Occ Med in house, be a single day, and no cost. Substance and other testing would be required. You'd be out of work for 2+ weeks as the tests are not the quick drug screens we do on admissions, but mass spec studies which would survive legal scrutiny. If you were unhappy with an in house eval because of concerns it would be unfair, then you could arrange your own eval, at your own cost, with approval of the GME office (i.e. they would need to approve the evaluator).

So you're in a bind, and unfortunately the PHP/Board has unfettered power here. If you refuse the exam, they will likely automatically remove your license. Unless you can prove that they are being discriminatory (i.e. they are doing this because of a protected class), courts will allow the board to police its own ranks. You will not graduate from your residency program, and you will have great difficulty getting a license in any other state with "license revoked after refusal to participate in PHP program".

You have very limited options. Your PD cannot save you here, they have zero influence over the board. To me, your options would seem to be 1) do the evaluation and hope for the best; 2) refuse the eval and likely have your physician career come to an end; or 3) see if you can request / demand a hearing before the board to describe your situation. Even that I think will fail -- many physicians will realize that it's likely you were over the limit when pulled over and used perfectly legal delaying tactics to postpone the blood draw as long as possible. That will be fine in the legal arena, but not in the licensing arena. Your best option is probably to agree to be tested, and even if they then mandate a 90 day treatment program you should consider this a "cost" to fix this mistake. Sadly your refusal to participate immediately may be considered a concerning feature already and be one strike against you.

Your story should act as a cautionary tale to others. Trying to gauge how much you can safely drink before getting behind the wheel is a mistake. There's nothing magical about 0.08 -- I'm sure your driving was "impaired" at 0.06. Alcohol is never a requirement for a fun time. If you're going to be driving home, then I highly recommend not drinking at all. Or arranging for another driver.

Best of luck

That may have been the most truthful and factual answer so far. I honestly might FFDE after hearing this; I don’t want to pick a fight with the board. Especially with my livelihood being the stakes. It is already soul crushing to be out of work and not graduate with my peers. Ill FFDE; it will be painful, costly, and I wont look forward to what demons in my head they uncover but that is my penance. I don’t believe they do 90-day for mild AUD which Im sure will be their easiest ICD to diagnose me with (with DUI arrest, you can catch many of the DSM criteria just with that). For mild AUD, it will be outpatient treatment, which is something they will offer via virtual meets and also monetize out of. But inpt isnt the end of world, I honestly may have conditions that should be treated. I don’t meet CAGE or AUDIT for AUD but I certainly showed poor judgment already to drink and then drive

 

[TulaneUnderdog]

Thought of one more thing to add: If you want to "fix" the PHP system in your state, that's a good goal. But you can't do that now. Get out of the hole you've dug for yourself and save your career. Then, if you want to become an advocate for changing the system and use your story as a cautionary tale -- I hope you succeed.

However, there is one crucial thing you mentioned that I disagree with, as right as you are overall, and is why I am hesitating to succumb to their recs; and its the fact that I was impaired while driving. I would trust the judgment of the American judicial process, especially in my "wet" state riddled with deaths due to DUI, where they hold ZERO tolerance for driving impaired. I was accused of DUI, forced to provide evidence to prove or disprove I have one, and a prosecutor has body camera, FST results, evidence, and a narrative to all draw from and determine if he should take this to court or not. He did not because he appropriately so found insufficient evidence, objectively subjectively, and therefore ruled me as not guilty. If a case is dropped, It is dropped. My "driving under influence" accusation is dropped by the District Court of the USA, then you must agree that I did not drive under the influence unless you want to appeal the US criminal court. . No one can contest this even we are held to a higher standard due to being doctors; if DA sniffs any sense of DUI on me, he would do so with severe conviction and much gusto; otherwise I did not DUI and now have it on public record to back that I did not DUI. Which makes actually makes it easier to provide as evidence if I do proceed to take this to the Board as I now have an entire judicial process in heavy detail to provide.

Also you are not respecting the prosecution's competence and that they likely did extrapolate my BAC prior to draw nor respecting that they read the Body cam footage and field sobriety test. I did not employ "legal-delaying" tactics with forcing them to warrant and then draw ETOH; I literally saw that they didn't have a breathalyzer on them and they took me to what looked literally like an old Fax machine from '90s with a tube that looked like it still had residue of someone's breath in it. Of course I'd facking turn that down; take the blood ETOH, not because I was delaying, but because I'd trust the specificity and sensitivity of that where my life hinges on it. Low-and-behold, it shows I was below legal limit and it will be hard to contest what was a whole blood eval out of our tax dollars. Also, what you are suggesting is what Prosecution employs all the time in DUI cases, "retrograde extrapolation", but guess what: they drew that blood quite fast because that cop wants to hold a crime against me so you bet your arse he hauled to the infirmary and got that blood <1 hour. So, you're a doctor, I'm 0.06 so you want to extrapolate an hour prior for a naive drinker that is no Irishman or near-cirrhotic/alcoholic so extrapolate 0.01-0.015 an hour per studies right? Okay 0.07-0.075, congrats. Prosecutions employ that tactic all the time. Well guess what, I'm sure they considered it but looked at the body cam film and saw my FTS performance, overall demeanor and speech, and found that would not hold up in court as well as they didn't see my arse waddling or falling down because I truly was not impaired.

With that, I am referred to FFDE for a "DUI". It will be an easy case to say that is BS when the charges are dismissed and luckily since it is a criminal matter, I have many objective evidence and whole description of the truth of what happened which is that I was not impaired. But I agree, doctors should be held to a higher standard and I should regardless have an evaluation of if I have an underlying substance use that can harm patients around me and therefore must be investigated and then treated before I return to work. Now, it would make more sense to hinge the FFDE on something beyond what is now a dismissed charge and instead on what can be easier to obtain such as reports on work especially during my 80-h work weeks where it would be easy on my night ICUs to consume and then later be caught and reported. No such events have happened. There is 3 years of evidence on me and 1000s of hours of work on me to disprove this. I drink off-duty; i still can show up hungover or miss attendance. Is this something I want to fight the board over and waste 1 year of my time and extra $10,000 when I can just do the FFDE, take the AUD, and return back to my livelihood so I can be a doctor; probably not.

 

[GoSpursGo]

However, there is one crucial thing you mentioned that I disagree with, as right as you are overall, and is why I am hesitating to succumb to their recs; and its the fact that I was impaired while driving. I would trust the judgment of the American judicial process, especially in my "wet" state riddled with deaths due to DUI, where they hold ZERO tolerance for driving impaired. I was accused of DUI, forced to provide evidence to prove or disprove I have one, and a prosecutor has body camera, FST results, evidence, and a narrative to all draw from and determine if he should take this to court or not. He did not because he appropriately so found insufficient evidence, objectively subjectively, and therefore ruled me as not guilty. If a case is dropped, It is dropped. My "driving under influence" accusation is dropped by the District Court of the USA, then you must agree that I did not drive under the influence unless you want to appeal the US criminal court. . No one can contest this even we are held to a higher standard due to being doctors; if DA sniffs any sense of DUI on me, he would do so with severe conviction and much gusto; otherwise I did not DUI and now have it on public record to back that I did not DUI. Which makes actually makes it easier to provide as evidence if I do proceed to take this to the Board as I now have an entire judicial process in heavy detail to provide.

As highlighted by @NotAProgDirector , the legal arena is completely different than the licensing arena. Just because a DA legally could not prove "beyond a reasonable doubt" that you DUI, it is certainly reasonable to believe you "likely" DUI for all of the reasons outlined here. And be honest with yourself--you knew that when you were pulled over for speeding and smelled like alcohol that the officer had good justification for asking you to perform a breathalyzer, and at least in part of the reason you refused was as a delaying tactic. It worked out for you and you don't have a DUI on your legal record, but even if your math was right and you were 0.075 are you really going to stake your livelihood on the board believing that because you were JUST under the legal definition of DUI that it was a good decision for you to drive? Come on, you're a doctor--you know that is not a clinically relevant difference but rather an arbitrary legal definition. You need to own up, to yourself more than anyone else, that it was a mistake for you to drive in that situation.

You're going to lose this battle if you try to wage it.

 

[TulaneUnderdog]

As highlighted by @NotAProgDirector , the legal arena is completely different than the licensing arena. Just because a DA legally could not prove "beyond a reasonable doubt" that you DUI, it is certainly reasonable to believe you "likely" DUI for all of the reasons outlined here. And be honest with yourself--you knew that when you were pulled over for speeding and smelled like alcohol that the officer had good justification for asking you to perform a breathalyzer, and at least in part of the reason you refused was as a delaying tactic. It worked out for you and you don't have a DUI on your legal record, but even if your math was right and you were 0.075 are you really going to stake your livelihood on the board believing that because you were JUST under the legal definition of DUI that it was a good decision for you to drive? Come on, you're a doctor--you know that is not a clinically relevant difference but rather an arbitrary legal definition. You need to own up, to yourself more than anyone else, that it was a mistake for you to drive in that situation.

You're going to lose this battle if you try to wage it.

I refused breathalyzer because out here in the sticks it looks uncalibrated with the expertise of its use and maintenance being contingent on the officer. If I was going to delay and be sly, I would refuse FSTs, working with officer, and pretend to have CP/etc/ill. Part of DA's ruling of dismissal is the fact that I cooperated which usually doesn't occur in individuals if they were impaired. He reviewed the camera and didn't see any impairment in speech, performance, and even cooperation with the force as he probably watched all 30min of me walking, shooting the crap with the officers, and not being cuffed and free to roam without impairment. If you truly suggest I was likely impaired; feel free to submit your appeal for reconsideration of dismissal of my charge to the US criminal court system.

As for lab values 0.05,0.06,0.07,0.08; I'm with you on that. I agree all of these are just numbers and don't correlate at all if individuals are impaired or not as some are impaired at lower levels and some not at higher numbers. You bet he based the impairment on beyond numbers and saw the tests, film, and correlated it all together. Trust the justice system, especially over a criminal charge. A DUI isn't shoplifting. I did not miss jury duty here. This is criminal court in a state controlled by Mothers Against DD and those widowed by death of loved ones to DDs. I've got the legal system aggressively wanting to press for guilt and they would if they wanted to. There's no bribery or corruption here on my meager resident salary. As for accepting FFDE, I've already noted I will do it; this **** is way over my head and this is not a fight I want.

 

[GoSpursGo]

False, I refused breathalyzer because out here in the sticks the crap looks uncalibrated with the expertise of its use and maintenance being contingent on the officer. If I was going to delay and be sly, I would refuse FSTs, working with officer, and pretend to have CP/etc/ill. Part of DA's respect of dismissal is the fact that I cooperated which usually doesn't occur in individuals if they were impaired. You bet he reviewed the camera and didn't see any demeanor of impairment in speech, performance, and even cooperation with the force as he probably watched all 30min of me walking, shooting the **** with the officers, and not being cuffed and free to roam without impairment. You are drawing biases in the fact that I was impaired. 0.05,0.06,0.07,0.08; I agree all of these are just numbers correlate at all if individuals are impaired or not as some are impaired at lower levels and some not at higher numbers. Bet your arse, he based the impairment on beyond numbers and saw the tests, film, and correlated it all together. Respect the justice system, especially over a criminal charge. I did not miss jury duty here. This is criminal court in a state controlled by Mothers Against DD and those widowed by death of loved ones to DDs. I've got the legal system aggressively wanting to press for guilt and they would if they wanted to. There's no bribery or corruption here on my meager resident salary. As for accepting FFDE, I've already noted I will do it; this **** is way over my head and this is not a fight I want.

You're missing the point.

I'm glad you're going to just do FFDE. I hope that in the future you don't put yourself in a position where you're relying on some slim margin to determine whether or not you were driving under the influence.

 

[TulaneUnderdog]

You're missing the point.

I'm glad you're going to just do FFDE. I hope that in the future you don't put yourself in a position where you're relying on some slim margin to determine whether or not you were driving under the influence.

Again I do not know why there is little respect to how district court treats criminal cases and how aggressive prosecution is to ensure a charge is placed as this is taxpayer money in full use. They ensure the guilty are punished. No criminal matter is taken lightly in this wet state of countless deaths to drunk drivers; you bet he extrapolated the 0.06 backwards to whatever the value is and sternly studied film, field test, and the narrative. Likely impairment would not get dismissed either my friend. Criminal charges are not just pulled at a glance out of the desk and dropped.

 

[ScubaV]

That may have been the most truthful and factual answer so far. I honestly might FFDE after hearing this; I don’t want to pick a fight with the board. Especially with my livelihood being the stakes. It is already soul crushing to be out of work and not graduate with my peers. Ill FFDE; it will be painful, costly, and I wont look forward to what demons in my head they uncover but that is my penance. I don’t believe they do 90-day for mild AUD which Im sure will be their easiest ICD to diagnose me with (with DUI arrest, you can catch many of the DSM criteria just with that). For mild AUD, it will be outpatient treatment, which is something they will offer via virtual meets and also monetize out of. But inpt isnt the end of world, I honestly may have conditions that should be treated. I don’t meet CAGE or AUDIT for AUD but I certainly showed poor judgment already to drink and then drive

 

[j4pac]

Again I do not know why there is little respect to how district court treats criminal cases and how aggressive prosecution is to ensure a charge is placed as this is taxpayer money in full use. They ensure the guilty are punished. No criminal matter is taken lightly in this wet state of countless deaths to drunk drivers; you bet he extrapolated the 0.06 backwards to whatever the value is and sternly studied film, field test, and the narrative. Likely impairment would not get dismissed either my friend. Criminal charges are not just pulled at a glance out of the desk and dropped.

You need to find a way to separate your case from your goal to advocate for others. You cannot advocate for others and make this a deal until you appropriately address your current issues. NotAPD is unbelievably wise. Dismissing the concerns he raises is foolish. That has been seen time after time after time. If he has a concern, you should have a concern…period.

 

[Apollyon]

"Looks" bad. Your casual evaluation of the BAC measurement machines belies reality. How would you even know that there was residue from a prior test? You know ethanol is volatile, right?

Portable breath analysis machines are not admissible, but give officers on the street a baseline idea.

17 years ago, I rode along with a Sheriff's Department in the South (I'll give you a hint - they are now on On Patrol Live). The deputy with whom I rode said he wasn't worried about keeping up his speed enforcement certs, but, the alcohol enforcement? He says he kept that up, because he couldn't live with letting a guilty drunk driver get away with it due to him.

 

[RangerBob]

After reading everything here, I'm in agreement with the PHP that a FFDE evaluation is needed here. Our medical executive committee would've ordered one for the same reason, and continued pushing it even if charges were dropped--every physician should know not to drive at all if they've been drinking. You were speeding as well, which does suggest some degree of impairment of judgement since most people who had a little alcohol in their system, but not enough to be affected (debatable if that exits unless we're talking about a sip of communion wine) would know to follow all laws to a T to prevent getting pulled over.

Physicians are held to a higher standard. The legal limit is just that--the legal limit. But it's not the ethical standard we physicians are held do, and considering the immense responsibility we have to patients, further investigation here is certainly merited.

I am concerned by the degree of defensiveness you've shown here on the forums that there's something deeper under the surface going on here. I see too many excuses/explanations. When we have a physician referred to FFDE give us the sorts of excuses/defenses you've been giving, and to the degree you're giving them (you're still giving them even after you've agreed you should do the FEDE) alarm bells are going off like crazy. Frankly, that's when we start questioning if further evaluations are needed. Initially I agreed the 3-day inpatient stay was excessive, but now I'm not so sure.

I'd urge you to reflect deeply and be honest with yourself about what, if anything, is going on here.

 

[TulaneUnderdog]

After reading everything here, I'm in agreement with the PHP that a FFDE evaluation is needed here. Our medical executive committee would've ordered one for the same reason, and continued pushing it even if charges were dropped--every physician should know not to drive at all if they've been drinking. You were speeding as well, which does suggest some degree of impairment of judgement since most people who had a little alcohol in their system, but not enough to be affected (debatable if that exits unless we're talking about a sip of communion wine) would know to follow all laws to a T to prevent getting pulled over.

Physicians are held to a higher standard. The legal limit is just that--the legal limit. But it's not the ethical standard we physicians are held do, and considering the immense responsibility we have to patients, further investigation here is certainly merited.

I am concerned by the degree of defensiveness you've shown here on the forums that there's something deeper under the surface going on here. I see too many excuses/explanations. When we have a physician referred to FFDE give us the sorts of excuses/defenses you've been giving, and to the degree you're giving them (you're still giving them even after you've agreed you should do the FEDE) alarm bells are going off like crazy. Frankly, that's when we start questioning if further evaluations are needed. Initially I agreed the 3-day inpatient stay was excessive, but now I'm not so sure.

I'd urge you to reflect deeply and be honest with yourself about what, if anything, is going on here.

It'll be uncovered by FFDE for sure. I'll update the progress as we speak!

 

[dozitgetchahi]

He says hold off on FFDE. But he is buddy-buddy with me and also signed non-committal so is unaware of the whole situation. He holds biases that also may not be reflective of my best interests in that he had been short staffed while Im not working due to sick leave and fmla and knows ffde will mean i will be a month off work. He however promises to serve as collateral to dispel for any concerns of this behavior ever showing up on-duty. I have my MSPE and 3 years of evaluations from my faculty that i am going to send to medical board anyway

What you need in this situation is not your PD, not your criminal attorney, not the SDN peanut gallery, but a GOOD attorney who specifically works in representing doctors before the state medical board and PHP in your state. If you are currently not working with such an individual, then I recommend you log off SDN and start calling attorneys offices ASAP. This sort of attorney is the person who will actually be able to provide good guidance here.

I also *would not* go along with any evaluation until you have spoken with such an attorney, and they are involved in your situation.

 

[TulaneUnderdog]

What you need in this situation is not your PD, not your criminal attorney, not the SDN peanut gallery, but a GOOD attorney who specifically works in representing doctors before the state medical board and PHP in your state. If you are currently not working with such an individual, then I recommend you log off SDN and start calling attorneys offices ASAP. This sort of attorney is the person who will actually be able to provide good guidance here.

I also *would not* go along with any evaluation until you have spoken with such an attorney, and they are involved in your situation.

Exactly but my attorney is saying refuse FFDE. This is why I like hearing the opinions here because the outcome by the Board is what my peers has said and it will be relentless that not even he can prevent. He cannot stop that, only react to it, follow it up, and delay it so even in best case scenario where things go my way: there is heavy collateral damage in the form of time, money, and loss of favor with my program which surprisingly is the only one supporting me. He is "good" with medical cases and dealt with identical cases that actually do involve DUI and subsequent disciplinary action but I doubt he cares that I am out on a job. I know he is looking out for my best interests but does not realize that I simply want to just go to work and graduate on this final stretch. He wants to take this to war but I'm not about freezing my entire career for a year as well as piss off the only support I have which is my program.

 

[Crayola227]

After reading everything here, I'm in agreement with the PHP that a FFDE evaluation is needed here. Our medical executive committee would've ordered one for the same reason, and continued pushing it even if charges were dropped--every physician should know not to drive at all if they've been drinking. You were speeding as well, which does suggest some degree of impairment of judgement since most people who had a little alcohol in their system, but not enough to be affected (debatable if that exits unless we're talking about a sip of communion wine) would know to follow all laws to a T to prevent getting pulled over.

Physicians are held to a higher standard. The legal limit is just that--the legal limit. But it's not the ethical standard we physicians are held do, and considering the immense responsibility we have to patients, further investigation here is certainly merited.

I am concerned by the degree of defensiveness you've shown here on the forums that there's something deeper under the surface going on here. I see too many excuses/explanations. When we have a physician referred to FFDE give us the sorts of excuses/defenses you've been giving, and to the degree you're giving them (you're still giving them even after you've agreed you should do the FEDE) alarm bells are going off like crazy. Frankly, that's when we start questioning if further evaluations are needed. Initially I agreed the 3-day inpatient stay was excessive, but now I'm not so sure.

I'd urge you to reflect deeply and be honest with yourself about what, if anything, is going on here.

Agree 100%

We have seen physicians who died of alcohol abuse, similarly admit to being both aware of an alcohol issue but also in a lot of denial. It goes with the territory.

I'm surprised that the OP isn't having it sink in, this is explained quite easily. The legal system is "beyond a reasonable doubt" and innocent until proven guilty. The  board is "there is doubt" and guilty until a heap of some encouraging data suggests otherwise.

It's hard to prove a negative. The board, partly to protect their own legitimacy, as well as that of the the profession, has to have hoops in such a case. Because if something bad happens they can say "oh look at all this **** he had to do due diligence due diligence etc." If they don't, then it looks really bad. That's taking the jaundiced view beyond immediate patient safety.

The  justice system cares about your rights and justice for you. The medical system gives 2 ****s about that. It's sobering (yikes no pun intended) and upsetting to know they have your balls in a vice, don't give a damn about you, and can make you dance not just for patient safety, but their own appearances. It comes as a surprise but given residency it shouldn't 😬

That's the situation even if we take the most generous view of the OP.

If I thought this was the left hand not talking to the right hand (PHP wants FFDE, but the board has not been advised or you haven't been able to make a case about this) I would say hold off on doing it until you can make some case for yourself. But I think others are correct.

I will say 2 things. Is your attorney experienced with this stuff? If so, your attorney will be aware of what push back if any you have here. If the attorney says you have to do it, you have to do it

You have to play ball with the board. If you don't, they can always just pull your license. This is also why the legal **** you talk about matters not. You have *rights* through the criminal justice system, but a license is considered a privilege, and privileges can just be taken away.

The board has VERY broad powers here and can yank it whenever they want. You can look into it, the times someone has ever legally challenged a board and won is very small. Judges are loathe to wade into the determinations of a legally autonomous professional body's judgment where public safety is concerned. (It's often lost on people that the board is given its own broad powers of investigation and power as a regulatory body under the law. They are effectively judge jury executioner in their own right within their jurisdiction. They ARE a legal government agency. They get to pass down judgements)

So the DA or whatever has zero jurisdiction here, they don't "trump" the board in a legal sense if that's what you're thinking. They're not just another entity such as yourself or a hospital or school that is going to have to hew because they're "under" the courts in this way like other private entities.

Attorneys are useful mainly because they understand your rights, and how the board does or does not have to respect them (remember it's very little), and mainly they understand the idiosyncrasies of what this particular body in your particular state likes to handle things and what wiggle room you may have. If they have experience that is.

But the DA or the attorney is not in charge here.

Also when you apply for a license, there is always some section saying "if you sign here, you acknowledge and agree to allow us all sorts of rights investigating you (they can even subpoena your medical and even psych records, contrary to some opinions I've seen here) and if you ever don't cooperate we can just pull your license."

Anyway this sucks, but OP I hope this kinda helps you understand why you are being treated like this, and how to approach this.

 

[Apollyon]

Exactly but my attorney is saying refuse FFDE. This is why I like hearing the opinions here because the outcome by the Board is what my peers has said and it will be relentless. He cannot stop that, only react to it follow it up and even in best case scenario things go my way there is heavy collateral damage in the form of time, money, and loss of favor with my program which surprisingly is the only one supporting me. He is "good" with medical cases and dealt with identical cases that actually do involve DUI and subsequent disciplinary action but I doubt he cares that I am out on a job. I know he is looking out for my best interests but does not realize that I simply want to just go to work and graduate on this final stretch. He wants to take this to war but I'm not about freezing my entire career for a year as well as piss off the only support I have which is my program.

Do the FFDE, and show how you go through it like you don't even belong there. Or, maybe you do.

As @RangerBob says, med exec would look at you like a "Usual Suspect". Pro tip: you do NOT want that.

 

[dozitgetchahi]

My attorney is saying refuse FFDE. This is why I like hearing the opinions here because it is the outcome I would suspect. He is "good" with medical board cases and I know he is looking out for my best interests but does not realize that I simply want to just go to work and graduate on this final stretch. He wants to take this to war but I'm not about freezing my entire career for a year as well as piss off the only support I have which is my program.

Ok, so that is a good piece of info here.

The thing about these evaluations is that they tend to be highly biased - although the degree of bias may be different based on who is doing them. In at least one state (Ohio), the chance of being referred to a 3 month inpatient treatment program after one of these evals is >80% (some say >95%, depending on whose data you look at). Then there is a lengthy process after the “treatment” where you may not be allowed to work. There are many doctors who go through the three month treatment process and still are not back at work a year (sometimes 2 years) later. It’s not a fast process.

If you are someone who has drank fairly consistently and ultimately had a DUI pullover - even if the charges were dropped - my take is that the chances of being put into a 3 month treatment program are very high. Your attorney may be saying this because the chances of you coming through this 3 day eval and going on your merry way are very low.

This is likely to be a long and messy process for you, regardless of which direction you go here. I think your chances of coming through a 3 day eval smelling like a rose and “going to work and graduating” in the near future are unfortunately low here. State boards and PHPs are *very interested* in DUIs, and anything they perceive as irresponsible drinking etc among doctors.

Next time, dude, don’t drive in any kind of proximity to drinking. And maybe stop drinking altogether.

 

[Crayola227]

Exactly but my attorney is saying refuse FFDE. This is why I like hearing the opinions here because the outcome by the Board is what my peers has said and it will be relentless that not even he can prevent. He cannot stop that, only react to it, follow it up, and delay it so even in best case scenario where things go my way: there is heavy collateral damage in the form of time, money, and loss of favor with my program which surprisingly is the only one supporting me. He is "good" with medical cases and dealt with identical cases that actually do involve DUI and subsequent disciplinary action but I doubt he cares that I am out on a job. I know he is looking out for my best interests but does not realize that I simply want to just go to work and graduate on this final stretch. He wants to take this to war but I'm not about freezing my entire career for a year as well as piss off the only support I have which is my program.

Hold up, is this a MEDICAL BOARD attorney, or just someone who does employment law???? Not created equal. If this attorney was actually good AND specifically was familiar with representing docs to the board, they would understand THE most important thing to a physician especially in training, to go to WORK, and any "war" is JUST to do that.

This sounds more like an employment law attorney, they often are more into the social justice side of things in industries where you just get another job while sticking it to your old employer.

If I'm not misunderstanding, you're saying based on his advice you know that what people are saying here is correct?

I agree with #dozitgetchahi 100% what they said, you should definitely speak to a good attorney before the FFDE if you can. But this attorney sounds like he doesn't get it.

 

[TulaneUnderdog]

Ya the least "sus" FFDE program of the ones I am limited to on my PHP's list is the UF Gainesville one; looks like a solid program with neuropsychiatrists and forensic medicine. Have already sent application. Does not seem to have any conflict of interest but they do have in-patient program. Has resident discount. In-patient side anyway looks almost like a hotel. They would accurately diagnose and treat.

 

[dozitgetchahi]

Ya the least "sus" FFDE program of the ones I am limited to on my PHP's list is the UF Gainesville one; looks like a solid program with neuropsychiatrists and forensic medicine. Have already sent application. Does not seem to have any conflict of interest but they do have in-patient program. Has resident discount. In-patient side anyway looks almost like a hotel. They would accurately diagnose and treat.

Many have argued that *all* of these types of evaluation locations are inherently biased…especially if they have a treatment program at the same location.

Is your attorney actually someone who does state medical board cases? And I don’t mean someone who has done a few here and there, but someone who spends most of their time dealing with the board (and is on a first name basis with them)? These things make a big difference…

If you are working with such a person, I would take their advice seriously if I were you.

 

[Crayola227]

Ok, so that is a good piece of info here.

The thing about these evaluations is that they tend to be highly biased - although the degree of bias may be different based on who is doing them. In at least one state (Ohio), the chance of being referred to a 3 month inpatient treatment program after one of these evals is >80% (some say >95%, depending on whose data you look at). Then there is a lengthy process after the “treatment” where you may not be allowed to work. There are many doctors who go through the three month treatment process and still are not back at work a year (sometimes 2 years) later. It’s not a fast process.

If you are someone who has drank fairly consistently and ultimately had a DUI pullover - even if the charges were dropped - my take is that the chances of being put into a 3 month treatment program are very high. Your attorney may be saying this because the chances of you coming through this 3 day eval and going on your merry way are very low.

This is likely to be a long and messy process for you, regardless of which direction you go here. I think your chances of coming through a 3 day eval smelling like a rose and “going to work and graduating” in the near future are unfortunately low here. State boards and PHPs are *very interested* in DUIs, and anything they perceive as irresponsible drinking etc among doctors.

Next time, dude, don’t drive in any kind of proximity to drinking. And maybe stop drinking altogether.

The Uber $ is 100% worth it. If you cannot afford Uber on top of drinks, you cannot afford drinks. ****, I've taken the bus too one or both ways.

Frankly I was too exhausted in residency to both leave the house AND drink. I ordered food in and drank at home with friends more than anything if I had the energy. A lot of doctors I know mostly just drink at home, just to avoid this kind of bull****.

 

[TulaneUnderdog]

He's board. I know him well because he was the one who had won a landmark case against our PHP for a cards fellow who had claimed he was fired inappropriately for pt death at cath lab with suspicion of substance ingestion at the time. Had a lot of evidence against him by nurses and staff of erratic behavior/appearing intox etc but he was able to dismiss them and rule them all as simply hearsay and proved it all circumstantial without obj evidence. Had won case and restored his license but at cost that he still no longer could be cards fellow at said program. He is purely board. He says no to FFDE as he notes the referral was in place for "DUI" that no longer exists and is an inconsistency that he notes he is able to fight. Was planning to use my PD to assist with substantiating with no on-duty reports of impairment. All of that sounds like sunshine and butterflies, but he can't stop the dominoes that fall after of my PHP reporting non-compliance to the board and now making what would have been an easy return after FFDE to now a yearlong affair.

 

[Crayola227]

Ya the least "sus" FFDE program of the ones I am limited to on my PHP's list is the UF Gainesville one; looks like a solid program with neuropsychiatrists and forensic medicine. Have already sent application. Does not seem to have any conflict of interest but they do have in-patient program. Has resident discount. In-patient side anyway looks almost like a hotel. They would accurately diagnose and treat.

Yeah my understanding is that this state, maybe because of the zeal of DUI prosecution, tends to be somewhat less unreasonable to deal with compared to some others.

 

[Crayola227]

He's board. I know him well because he was the one who had won a landmark case against our PHP for a cards fellow who had claimed he was fired inappropriately for pt death at cath lab with suspicion of substance ingestion at the time. Had a lot of evidence against him by nurses and staff of erratic behavior/appearing intox etc but he was able to dismiss them and rule them all as simply hearsay and proved it all circumstantial without obj evidence. Had won case and restored his license but at cost that he still no longer could be cards fellow at said program. He is purely board. He says no to FFDE as he notes the referral was in place for "DUI" that no longer exists and is an inconsistency that he notes he is able to fight. Was planning to use my PD to assist with substantiating with no on-duty reports of impairment. All of that sounds like sunshine and butterflies, but he can't stop the dominoes that fall after of my PHP reporting non-compliance to the board and now making what would have been an easy return after FFDE to now a yearlong affair.

Lol no offense so what's your question to us exactly?

You have to just do what your attorney and the board says.

Have you made it 100% clear to your attorney your goals in the following order are: retain a license, go back to work?

It's possible that going to war is what he thinks is needed for this.

It's scary to give any push back to a board, but if you're dealing with experienced folks that have had good results (the case you cite is a phenomenal outcome) then just do what they say.

To be fair though, and you hint at a suspicion of this, is that sometimes attorneys can get caught up in a "mission" using the law, and you just want to make sure he isn't trying to use your case as some sort of example in an axe to grind against the board. You don't want an attorney that seems more concerned their buddy buddy working relationship to the adversial party in this, but you also don't want this other kind that lives to be a thorn.

 

[Crayola227]

OK so now it makes sense why the OP is a bit indignant here. It sounds like his attorney's tack (which may fly in this state, from what I've heard in rumors this might make sense) is that if things get dismissed the board can be pressured against these things, and I would guess, hope, that explains things the OP has said and their attitude about all this.

Just another reason to have an attorney. Many entities, especially a board, can ask for the moon even if they have no right to it, and if you go along and give it to them, they get it. They can bully and threaten to no end. The only time entities with powers like a board will ever back down on anything outside the law, is with an attorney.

I agree with others, it sounds like the attorney (and heck, even you) think that the picture even with the FFDE is not going to look good. You're out of work a while either way. I was just telling someone in another thread about finances (people worry too much about paying down debt even as a resident when they need a legal fund and rent/mortgage money saved up more).

This also might be a situation like we had with another poster about a PIP.

Certain things, if you agree, is considered an admission in itself. This attorney might think you're better off making a case against even needing a FFDE or that the FFDE is not warranted to begin with because of the dismissal, and that this might be easier to defend/push against than an unfavorable FFDE. Because whatever those folks say, as professionals you're not really going to be able to argue if they feel in their "professional judgment" you need indefinite PHP 🙄

Sometimes it's about not giving someone enough rope to hang you with.

Tread cautiously of course about pushing back against the board but it sounds like you're in hands better than ours.

 

[TulaneUnderdog]

Lol no offense so what's your question to us exactly?

You have to just do what your attorney and the board says.

Have you made it 100% clear to your attorney your goals in the following order are: retain a license, go back to work?

It's possible that going to war is what he thinks is needed for this.

It's scary to give any push back to a board, but if you're dealing with experienced folks that have had good results (the case you cite is a phenomenal outcome) then just do what they say.

To be fair though, and you hint at a suspicion of this, is that sometimes attorneys can get caught up in a "mission" using the law, and you just want to make sure he isn't trying to use your case as some sort of example in an axe to grind against the board. You don't want an attorney that seems more concerned their buddy buddy working relationship to the adversial party in this, but you also don't want this other kind that lives to be a thorn.

honestly I think i got more than enough for answers lol. Its tough for me. Fugged if I do and fugged if I dont. But its better fugged if I do; I will win sympathy points for substance use, be fit for work, and be on good terms with my program. My PD still calls every day and he is saying he might find a way to still pull me into work like “with supervision” as he is soooo short staffed. As for my attorney, yes he wants the PHP to take this to the board and fight their investigation there. But personally as everyone said, i stupidly didnt call an uber. BAC is not Zero. The UF program seems fair. I am scared of all the tests theyll do including neurocognitive things like for attention IQ and memory but whatever they catch is what i must be treated for to better myself anyway.

 

[dozitgetchahi]

He's board. I know him well because he was the one who had won a landmark case against our PHP for a cards fellow who had claimed he was fired inappropriately for pt death at cath lab with suspicion of substance ingestion at the time. Had a lot of evidence against him by nurses and staff of erratic behavior/appearing intox etc but he was able to dismiss them and rule them all as simply hearsay and proved it all circumstantial without obj evidence. Had won case and restored his license but at cost that he still no longer could be cards fellow at said program. He is purely board. He says no to FFDE as he notes the referral was in place for "DUI" that no longer exists and is an inconsistency that he notes he is able to fight. Was planning to use my PD to assist with substantiating with no on-duty reports of impairment. All of that sounds like sunshine and butterflies, but he can't stop the dominoes that fall after of my PHP reporting non-compliance to the board and now making what would have been an easy return after FFDE to now a yearlong affair.

You seem to be convinced that the FFDE is going to go very smoothly, and that you will go on your merry way after it. My take on the situation is that this is unlikely to happen. Whether your DUI charges got dismissed or not, the fact of the matter is that something about how you were driving that day drew the attention of the cops, and you got arrested. In a situation like this, you will in all likelihood be referred to a 3 month tx program and charged $50k for that. They usually aren’t going to give a “resident discount” for that.

For your prospects in the future, it is better if this eval doesn’t happen (if at all possible). That’s what your attorney is getting at. He can do a better job of protecting you if one of these physician eval institutions doesn’t write up a 30 page hit job on your personal and professional history, that will be sent to the medical board and quite possibly published online by the board. Because I’ve seen what comes out of these institutions when someone in my med school class went through the process, and it’s ugly. Mountains made out of molehills…Russian level disinformation. They will call up all your friends, family and anyone from your educational history to try to dig up whatever tiny speck of dirt they can find, and make it sound like a cataclysmic problem.

 

[Crayola227]

honestly I think i got more than enough for answers lol. Its tough for me. Fugged if I do and fugged if I dont. But its better fugged if I do; I will win sympathy points for substance use, be fit for work, and be on good terms with my program. My PD still calls every day and he is saying he might find a way to still pull me into work like “with supervision” as he is soooo short staffed. As for my attorney, yes he wants the PHP to take this to the board and fight their investigation there. But personally as everyone said, i stupidly didnt call an uber. BAC is not Zero. The UF program seems fair. I am scared of all the tests theyll do including neurocognitive things like for attention IQ and memory but whatever they catch is what i must be treated for to better myself anyway.

You seem to be convinced that the FFDE is going to go very smoothly, and that you will go on your merry way after it. My take on the situation is that this is unlikely to happen. Whether your DUI charges got dismissed or not, the fact of the matter is that something about how you were driving that day drew the attention of the cops, and you got arrested. In a situation like this, you will in all likelihood be referred to a 3 month tx program and charged $50k for that. They usually aren’t going to give a “resident discount” for that.

Yeah I am very surprised at the conclusion drawn here.

It is NOT better "fugged if I do" for reasons explained. I can't break this down right now squaring for OP what other folks said above vs what we and the attorney are saying.

What aPD and others say has a lot of merit, but it's *precisely* why if you and your attorney can just get off the merry go round NOW, you are better off. Worst case is the attorney pushes back and the board says no way, then you are off to FFDE. I doubt they pull your license just for the attorney trying to wiggle you out from it. You either can or you can't. I'm not sure what you lose by trying here. It just takes time for the board admin wheels to move which is why this pathway may not be shorter than the FFDE and 3 month PHP ****show. There is a BIG difference between this gets dismissed vs you have to do the FFDE and PHP tx, especially for future licensing and credentialing. Yes you need to finish training so you have to appease the board now, but these things are all connected.

No one here can tell you not to take an attorney's advice.

 

[Crayola227]

You seem to be convinced that the FFDE is going to go very smoothly, and that you will go on your merry way after it. My take on the situation is that this is unlikely to happen. Whether your DUI charges got dismissed or not, the fact of the matter is that something about how you were driving that day drew the attention of the cops, and you got arrested. In a situation like this, you will in all likelihood be referred to a 3 month tx program and charged $50k for that. They usually aren’t going to give a “resident discount” for that.

Ugh the whole fact they talk about a "resident discount" makes me wonder about their volume of business and the fact they self refer. Shady af.

Gotta wonder what the kick back to the board or its docs is. I read this was an issue a while back and I would be surprised if this was ever really addressed.

 

[wish i was at the lake]

The Doctor’s Crossing podcast had an excellent episode featuring a physician who had to undergo evaluation after he fell asleep on the job. It was unbelievable to me how much scrutiny he went through despite no alcohol or substance use. https://doctorscrossing.com/wp-content/uploads/2022/07/Episode-089-Transcript.pdf

 

[NotAProgDirector]

It's a slightly positive sign that they let you pick your FFDE site. The worst states have a single provider, you get no choice at all, and ultimately everyone ends up being referred for a 90 day stay. It's a huge financial COI.

It sounds like your atty was successful with that other person. But, they lost their cards fellowship. Not great, but their career continues. if you lose your residency spot, it's completely unknown whether you'll be able to get another one / complete training. So the risk in your situation is much higher.

But as others have mentioned, this could easily turn into a 90 day stay. And if that happens, your residency may drop you anyway since that would extend your training into the next academic year.

So get input from your atty and PD, and try to make the best decision you can. Understanding that it could end badly no matter what you choose.

 

[Crayola227]

Ugh, so I'm reading this again.

Sounds like, you got the DUI, got your PD involved, he asked for the eval and got the PHP involved. The PD decided since it was dropped, he doesn't care about the FFDE. The PHP still wants their pound of flesh and is threatening to send this to the board as noncompliant?

Is the board not already part of this yet?

I agree with your attorney. Why should you just cave to this PHP? Sounds like they don't have **** on you and they mostly want to "gotcha" on something or halfway make it up for $50k, and they're trying to bully you into it.

Dude, if this is true and it's with your attorney's advice, just don't and then explain it to the board. Let's use a different example. Mistaken identity. You can get pulled over for ANYTHING and arrested for ANYTHING. Say it's all a mix up. Now someone wants a FFDE for $4k and 3 day inpt. Who in their right mind with nothing wrong with them, would ever consent to such a thing? Of course you wouldn't comply with that demand! You'd want to take it up with the board, right? Explain why you didn't comply, right?

The issue here is a fewfold, and I won't get into all the reasons it seems you feel guilty (you allude to maybe feeling like you need/deserve treatment?). You feel guilty and you feel like the PHP has something on you and you feel like maybe this is all fair based on your not having fully clean hands here. The PHP will eat you alive. This is probably playing into why your attorney is advising you away here.

Ugh so before the board orders a PHP, you have some options typically. Like you've already said, tests have been done. Sometimes people are able to be evaluated by a psychiatrist or other body of their choosing and have the board take that into account, so at least it's not all this other crooked entity's word. Let your attorney push back and protect you from the PHP.

My plan is to get a medical board attorney

So is the one advising you a medical board attorney or NOT? Who is the one you're mentioning giving you advice??

He still is working with my criminal attorney and called the PHP himself affirming this but they are not budging. Part of me thinks “just do FFDE” and my PHP argues if I believe I got nothing to hide, i should go FFDE and they will diagnose my with nothing and say I am fit for work. I call bull****

Oh jesus, remember I said that anyone can say anything to get what they want, and as long as you consent... one more time. Anyone can lie any time unless under deposition. Attorney's job is to know what they can and can't demand by law and how it will go over with the entities with power to make decisions.

This PHP will say anything to get you to consent to shooting yourself in the dick.

I think I had posted about this under my own account so I guess I will disclose that I did undergo one of these evaluations based on what I thought was rather a flimsy reason.

TLDR I was doing poorly in the program for multiple reasons but had good ITE. There was a single incident where I was I on call asleep and I didn't hear the cell phone ( I still maintain the phone didn't ring for some reason due to poor signal or something) over a period of 30 minutes. It did ring eventually and I was present immediately and not impaired in any way and saw the patient (which was not urgent). Regardless, the attending thought the 30 minute gap was suspicious and made a suggestion to the program that maybe substance abuse was involved.

Several weeks later, this process was initiated (I knew nothing about this until it was started). I was urine tested and came back clean, did the pysch eval and got cleared after a week out of work. It was definitely a traumatic and stressful experience but understand that it's not a guarantee that you will end up in any future PHP program or other ramifications.

This isn't bad advice, big difference here is it sounds like the PHP wasn't involved yet. A standard way these happen is you dance to the tune of the hospital and HR, it all gets sent to the board, the board reviews, the board may review an outside psychiatrist's eval (hopefully one you picked, not the hospital), refer you to one of theirs maybe maybe not, and this is the process to determine if it warrants a review to their PHP and what if any recs they have to the PHP for what they want, vs if the PHP has recs to the board.

So in this case, it sounds like your compliance with any parties that were NOT the PHP, was able to keep them out of it. My understanding is that all of this is very state dependent.

Unfortunately, there is more against the OP than the word of a pissy attending. Look at what happened to you based merely on subjective conjecture. The OP already has a greedy PHP on his back and court records. It's not good.

 

[Crayola227]

My brother in Christ -

I am not a lawyer.’

I would not play the game with the FFDE. Your PD backs you. Your legal status cleared you. These roaches want to consume you. Do not agree to them. Let the board hear about it and look at the facts themselves.

If you get FORCED to do it, that’s another matter. Don’t give in voluntarily here

This, 100% this.

 

[Crayola227]

I am forced. The PHP is funded by the board. They were born to protect health of physicians and treat burnout, substance use, and depression. Not abiding by them will lead to being sent as “noncompliant” to the Board.

No, the PHP makes recs and carries out the will of the board. Yes, boards rarely go against the recs of their PHP, especially given they are an arm of it effectively.

If you have to comply with the PHP, you have to. But obviously your attorney is going to argue there aren't (as it stands because of dismissal and data to date), grounds to do so. It's anyone's guess if how the board responds to all the inputs it receives (your atty, PD, court records, your med records, and PHP), but the atty's guess is probably best.

 

[TulaneUnderdog]

Lot of new updates in short period of time: PD called saying he can let me back into working but only if I comply with my PHP. He now has change of heart and is saying "just do it; that will help pull you out of Leave of Absence and help you graduate on time". I'm going to have to bring this to the attorney

Yes I got medical board atty!

Is the board not already part of this yet?

Nope

Sounds like, you got the DUI, got your PD involved, he asked for the eval and got the PHP involved. The PD decided since it was dropped, he doesn't care about the FFDE. The PHP still wants their pound of flesh and is threatening to send this to the board as noncompliant?

Yup he pretty much did it out of protocol.


Overall I'm just gonna succumb to the authorities; I'm t minus months from graduating and this is the fastest out I see unless they truly red mark with no fitness for duty. My PD is letting me back in so I can keep up with the final training and present my final conference and crit analysis. UF Recovery after calling them up as well sound like they have very good structure. A forensic psychologist wasn't in any of the other programs and considering I have a lot of criminal details, I want them to look into it that they will use as collateral. Note they will call attorney and discuss the legal story. Note they will also call my PD for collateral.

 

[Crayola227]

That may have been the most truthful and factual answer so far. I honestly might FFDE after hearing this; I don’t want to pick a fight with the board. Especially with my livelihood being the stakes. It is already soul crushing to be out of work and not graduate with my peers. Ill FFDE; it will be painful, costly, and I wont look forward to what demons in my head they uncover but that is my penance. I don’t believe they do 90-day for mild AUD which Im sure will be their easiest ICD to diagnose me with (with DUI arrest, you can catch many of the DSM criteria just with that). For mild AUD, it will be outpatient treatment, which is something they will offer via virtual meets and also monetize out of. But inpt isnt the end of world, I honestly may have conditions that should be treated. I don’t meet CAGE or AUDIT for AUD but I certainly showed poor judgment already to drink and then drive

Ye gads. A lot could be said.

Listen, this has nothing to do with picking a fight with the board. Sometimes fish that go with the current get washed out to sea. This is about doing whatever it takes to save your career. That could be mean doing lots of uncomfortable things. Pushing against the board. 90 days in "prison." 50K. I dunno.

 

[Crayola227]

Have already sent application. Does not seem to have any conflict of interest but they do have in-patient program. Has resident discount. In-patient side anyway looks almost like a hotel. They would accurately diagnose and treat.

Ye gads. I am seeing a level of naivete that really concerns me. You already sent an app??? Without consulting a board atty????

You don't understand how self referrals are a COA? That was my red flag for naivete here.

 

[Crayola227]

I will win sympathy points for substance use, be fit for work, and be on good terms with my program.

Um, I feel so bad continuing to pick bones here, but no, just no.

There really is no such thing as sympathy points for substance use in medicine. Maybe on a personal basis, like I feel for docs with SUD. But in the official arena? Boards? PHPs? HRs? Hospitals? Hospital legal risk management? Malpractice insurance? No no no no no.

This is telling me you have a fantasy of going in, being 100% honest, absolving yourself of all sins, and everyone is going to treat you fairly and help you for doing the right thing.

That is not how this works. Maybe if you had a MH dx and no SUD there would be subjective sympathy and some protections while getting raked over coals. We like to foster this idea that SUD is a psych dx like all the others and treat them as such, but that isn't the real world.

I'm never goint to tell someone to lie to the board or its agents. But I am going to tell you, never, ever, ever, give information you don't have to. These are not situations where honesty under your own judgment helps you.

No offense, but we act like attys are for criminals to get away with ****. The reality, is that it is the honest folks most likely to pass on attorney advice that need it most. Attorneys were made for folks like you.

 

[Crayola227]

The Doctor’s Crossing podcast had an excellent episode featuring a physician who had to undergo evaluation after he fell asleep on the job. It was unbelievable to me how much scrutiny he went through despite no alcohol or substance use. https://doctorscrossing.com/wp-content/uploads/2022/07/Episode-089-Transcript.pdf

Best case scenario is always you aren't an dingus AND 0% SUD. Then at least some of the people instituting these rules aren't regarding you with contempt.

ETA: reading this and reflecting on grammar, I wonder if we have a visa situation here.

 

[Crayola227]

Please keep us updated. Knowing how these go is very helpful to other people in a bad way in their careers.