Susan Haney, MD, a board-certified emergency physician in Coos Bay, Oregon, was 2 years into her career when she had her first manic episode, likely a side effect of the steroid prednisone, which she had been prescribed for an asthma flare-up. Her boss at Bay Area Hospital told her that if she wanted to return to work, she would need to have written clearance from the medical board.
In retrospect, Haney says, "I don't think they had any idea of what they would set in motion."
Haney says the Oregon Medical Board posted her name and the nondisciplinary action on their website and in their newsletter. Her local newspaper read it and ran a story about her. "They effectively announced my mental illness to the general public despite my objections," she says.
During the next decade, she had two more manic episodes, and more board investigations and actions followed. Despite being cleared for work each time, Haney says the board actions decimated her career in emergency medicine and her income, which is about half of what she would have earned by now. She is frustrated, sad, and angry about what happened but considers herself lucky to be practicing medicine in urgent care.
Being Investigated Is Scary
After her first manic episode in 2006, Haney contacted the board's medical director, a retired general surgeon, who told her the only way the board would authorize her return to work was if she agreed to open a board investigation.
She gave them the green light because she thought she had nothing to fear — she was cooperating fully and wasn't impaired. Now Haney says she was naive. "The board is not your friend," she says.
Haney was also anxious to return to work. She worked in a seven-person emergency department, and two colleagues were on maternity leave or medical leave.
"My colleagues kept calling asking me when I was going to return to work, and I kept saying, 'I don't know because the board won't tell me,' " she says.
She was also feeling a lot of financial pressure. She was 2 years out of residency, owed $100,000 in student loans, and had just bought a house.
"I was really scared ― I didn't know how long this would last or if they would let me return to work. Early on, I even got a fitness for duty evaluation from the state's consulting psychiatrist, who cleared me for work, and the board still wouldn't let me return. They told me I had to go through their bureaucracy and a board meeting, which didn't make sense to me."
Haney consented to give the board's investigative staff access to her medical records because she feared that if she challenged them, they would suspend or revoke her license immediately.
After investigating her for 4 months, the board cleared Haney to return to work at Bay Area Hospital. She agreed to the board's "corrective action" terms: she would continue to receive psychiatric care, maintain a physician-patient relationship with a primary care physician, and enroll in the Health Physicians Program (HPP) for substance abuse monitoring.
Haney suspects that the board investigation damaged her reputation at work. "Before this, my work evaluations were consistently excellent. Afterwards, they were all adequate. I don't think that was a coincidence."
Worst Time of Her Life
Five years later, after taking prednisone for another asthma flare-up, Haney had a more severe manic episode and was hospitalized.
The consulting psychiatrist who evaluated her reported her case to the medical board, stating she had bipolar disorder, was mentally incompetent, and shouldn't be practicing medicine. The board opened a second investigation of her in 2012, which lasted 4 months.
Haney had quit her job at Bay Area Hospital in 2011 because she was pregnant and was planning to take a year off to care for the baby at home.
"That was the worst time of my life. I lost the baby at 4 months, I wasn't working, and now I was under investigation by the board again," she says.
The board issued an "interim stipulated order" that required that she be monitored regularly for mental illness and substance abuse by the Health Professionals Services Program (HPSP) for 2 years. "The board accused me of abusing prednisone, which I wasn't. I was using it as prescribed and medically indicated," she said.
The board order was reported to the National Practitioner Databank and is now permanently in her record. Although the board cleared her to work, she could not find a permanent job in a hospital emergency department.
"The repeated 'nondisciplinary' public board orders have had the same net impact on my career as if I had been disciplined for killing or harming my patients. For all intents and purposes, people treat it as a disciplinary action for the rest of your career," she said.
To keep afloat financially, she found locum tenens work in local emergency departments until 2019.
Mental Health Toll
Haney feels that the stress of repeated board investigations has affected her mental health. "Both times this happened, it made my mental health worse, made the mania worse, and subsequent depression worse."
Particularly distressing to her was the fact that the administrative staff who investigated her were attorneys and persons in law enforcement, rather than medical professionals with mental health training.
"I was required to disclose intimate personal details of my psychological and psychiatric history to anybody at the board who requested them. These investigators were asking me about my childhood history. That was traumatic and none of their business!"
Haney had quietly managed episodes of major depression since she was in her early 20s with the help of a psychiatrist. Her third episode of mania, which occurred in 2014, triggered a more severe depression, which she says deepened when she learned that the HPSP had notified the board about her manic symptoms and that she would not be released from the 2-year monitoring contract. When the board notified her 2 weeks later that they were opening another investigation, Haney says she had an emotional crisis, attempted suicide, and was briefly hospitalized. Several weeks later, she decided to take a mood stabilizer, which she continues to take.
The board’s 2015 corrective action agreement required Haney to only practice medicine in settings that the board’s medical director preapproved and to obtain a preapproved monitoring healthcare practitioner who would send quarterly reports to the medical director. Haney says the “nondisciplinary” action agreement was also reported to the National Practitioner Data Bank.
She also agreed to ongoing monitoring by the HPSP for mental illness and substance abuse, which involved random drug testing. When she didn’t call in one day in 2019 and missed a scheduled test, the board opened another investigation on her that lasted 7 months until July 2020. Haney said this was despite 3 subsequent negative tests.
Haney believes that the "open investigation" doomed a job offer from a hospital emergency department in the Virgin Islands. "I had passed all the required credentialing and explained previous board orders. They pulled the rug from under me 1 week before I was supposed to move there," says Haney.
Her license was inactivated again because she hadn't practiced medicine for a year, which she says was a new board policy. Although Haney says the medical director reactivated her license after talking with her, "By the time I was able to apply emergency medicine jobs, no one was interested in me anymore."
Haney started her medical career when she was 42 as a second career. She says the board investigations and actions have resulted in a significant loss of work and income. "I have only worked 14 of the past 17 years as a doctor. I live cheaply because I never know how much longer my career will last," says Haney.
The ordeal has devastated her finances. She has shelled out at least $200,000 in legal fees — she hired an attorney in 2007 and filed a lawsuit against the board in Oregon district court alleging that members had violated several of her rights. The district judge sided with the state medical board and it was upheld on appeal in 2012, referring to state laws that gave the board absolute immunity from civil lawsuits. "I had no legal recourse to contest their decisions, no matter how injurious or unjust," says Haney.
She has also shelled out at least $100,000 to be evaluated and monitored by the health physician program (now HPSP) for several years. Physicians who agree to be monitored by these health programs have to pay their fees. The board finally agreed last July to end her HPSP participation.
Haney also filed a complaint in 2007 with the federal Department of Health and Human Services Office for Civil Rights (HHS-OCR), alleging that the board violated her civil rights under the Americans with Disabilities Act (ADA). She says that her lawsuit and the OCR investigation of the board enabled her to withdraw from the HPP in good standing in 2008.
What Would She Have Done Differently?
She regrets not hiring an attorney earlier because "most likely the board action would not have been made public. It snowballed after that ― any mistake I made in my career was viewed in the lens of potential impairment."
She also regrets telling her employer about the nature of her illness and reporting it to the board. A psychiatrist she saw later shared advice he gives to other patients who want to remain anonymous: get help but go out of town, use a false name, and pay cash.
"I wish I had that advice when all this started. That was the best way to protect my career," says Haney.
Protecting the Public?
The Oregon Medical Board declined to comment on Haney's experience because investigations are confidential, but the executive director, Nicole Krishnaswami, JD, answered questions in an email about how the current board operates.
She says the board has 11 medical professionals and employs a medical director and expert consultants in specialty-specific fields. MDs with mental health training are involved in investigating/reviewing cases involving doctors with mental illnesses.
"State medical boards have a responsibility to protect and inform the public. State laws further require state agencies to provide access and transparency regarding the board's official actions. If the board receives a complaint that a licensee is impaired and thus unable to safely practice, the board has a responsibility to investigate and ensure the licensee is practicing medicine safely," Krishnaswami said.
The HPSP is the monitoring program established by state law to provide oversight in order to ensure that licensees are not practicing while impaired. HPSP is separate from the board and the board adopted a statement outlining its perspective on the program in support of doctors with substance abuse and mental health disorder.
The board also founded the Oregon Wellness Program, which provides free, confidential counseling to all Oregon-licensed physicians and physician assistants.
Haney feels there is huge stigma associated with mental illness in the medical profession. "If I had cancer twice, I wouldn't have been put in this position and would be at the peak of my career," she says.
Nearly half of the 862 emergency medicine physicians surveyed last October said they were reluctant to seek mental health treatment. The reasons included fear of professional repercussions and stigma in the workplace. Several physicians said they were concerned about potentially having to report the treatment on medical license applications in the future, according to a survey by the American College of Emergency Physicians.
In addition, 26% of the more than 12,000 physicians who responded to a Medscape survey last year said they didn't want to risk disclosure (20%) or that they distrusted mental health professionals (6%).
Another Physician Fights Back
Steven Miles, MD, an award-winning professor emeritus of medicine and bioethics at the Center for Bioethics at the University of Minnesota, in Minneapolis, understands their reluctance. In 1996, he disclosed on his license renewal application that he had recently been diagnosed with a mainly depressive type of bipolar disorder and was in treatment. He had already told his employer, who was supportive.
That set off a 14-month investigation of him by the Minnesota Board of Medical Practice. Miles and his psychiatrist refused to release his confidential records to a panel of physicians, most of whom had no expertise in mental health care. He also filed a federal claim that the board's requests violated the ADA, and he won the case.
"Had the board given me evidence of impaired ability to practice with ordinary skill and safety, I would have cooperated. Instead, they proposed a course of action which would have degraded the privacy of my relationship with my psychiatrist and arguably increased the barrier to getting proper care and the risk of impairment," he said.
The board kept renewing his license, and Miles continued to work full time. "I was empowered and protected by my stature in the field at the time my mental illness was diagnosed. Early-career physicians do not yet have that protection and should be very careful of disclosing, given the still widespread stigma of mental illnesses," he said.
His Advocacy Led to Changes
Miles went public to mobilize support for his ADA claim. He wrote editorials that were published in JAMA and Minnesota Medicine that refer to the American Psychiatric Association's 1984 position paper, which says that the mandatory disclosure of the physician's confidential medical record is without merit. Miles adds that major newspapers ran stories based on his editorials.
The board backed down after Miles won his ADA case, and it met with him. "I said this is not good stewardship of the medical profession; you are injuring doctors by keeping them from psychiatric care, which is out of line with the medical view of the treatability of depression and that needs to change," he says.
Miles says he won a victory because his practice continued. "I also won a victory in the way the board was handling these questions, which was an opening salvo in a process that continues to this day."
The original form asked whether he had ever been diagnosed with or treated for manic depression, schizophrenia, compulsive gambling, or other psychiatric conditions.
The revised form asks, "Do you have a physical or mental condition that would affect your ability, with or without reasonable accommodation, to provide appropriate care to patients and otherwise perform the essential functions of a practitioner in your area of practice without posing a health or safety risk to your patients? If yes, what accommodations would help you provide appropriate care to patients and perform other essential functions?"
Miles says that the final wording wasn't ideal and that it was confusing to physicians. He says this prompted additional changes in wording by the board. Starting in January, applicants will be asked, "Do you currently have any condition that is not being appropriately treated that is likely to impair or adversely affect your ability to practice medicine with reasonable skill and safety in a competent, ethical, and professional manner?," the medical board's executive director, Ruth M. Martinez, said in an email.
When asked whether the board still investigates physicians who reveal mental illnesses on licensing applications, Martinez responded, "All disclosures are evaluated to assure that the practitioner is qualified and safe to practice."
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Cite this: An MD's Nightmare Began With Reporting Her Manic Episode to the Medical Board - Medscape - Nov 03, 2021.