Drugs, Doctors: Worrisome Mix After O.C. Crash

It seems all the more tragic and senseless when a doctor who has dedicated his life to caring for a patient’s health is found to be abusing his own with drugs or alcohol.

So when officers arrested Dr. Ronald Joseph Allen of Laguna Beach last Sunday for allegedly driving under the influence when he triggered a fatal traffic accident, it raised troubling questions about whether the incident could have been prevented.

Is there an adequate detection system within the medical community to flag doctors who have developed drug or alcohol problems? And are doctors at greater risk for dependency problems because of the stress in their jobs or their easy access to drugs?

“I think there are a significant number out there who need help,” said Dr. Max Schneider, chairman of the physicians health committee at St. Joseph’s Hospital in Orange County. It is hoped, he said, that the Allen case will “make some people . . . blow the whistle. It is not tattling. It is calling fire when you see smoke.”

Among those most concerned about doctors on drugs are the physicians who have been through treatment themselves. Addicts don’t worry about harming patients, said Dr. Gordon Fraser, a gynecologist and former addict who practices in South-Central Los Angeles.

“Once you become addicted, you have no judgment,” Fraser said.

As the medical community has found, the insidious nature of drug addiction does not spare doctors, even though they are well aware of the dangers. But experts do not believe the substance abuse problem is more common for physicians than other professions.

There has not been a conclusive study to determine the magnitude of the drug problem among medical personnel. Officials said their assessment is based on limited surveys and the experience of those who treat impaired doctors.

“There is absolutely no data about the scope of the problem,” said Gail Jara, executive director of the California Society of Addiction Medicine. “But the most commonly accepted rule of thumb is that 10% of the population will have drug or alcohol addiction problems and physicians by and large are representative of the entire population.”

The issue of doctors on drugs is a major concern, however, because lives are at stake in the performance of a physician’s job.

California’s system for detecting and treating impaired physicians has been credited with saving hundreds of doctors from their addictions or from making disastrous mistakes while intoxicated. California is one of only eight states in the country that has a legislatively mandated program to treat impaired physicians.

But while the system has been credited with many successes, it also has critics.

It can only help those who acknowledge their problem or suffer such a serious addiction it prompted an investigation that threatened their job. In the past 10 years, the Medical Board of California’s program to treat impaired physicians has served just 618 doctors. Some more seek treatment on their own outside of the state’s mandated program.

Critics say that still leaves a lot of cases untreated if 10% of the state’s 77,000 physicians suffer from drug or alcohol dependency problems.

Even supporters of the state’s program say the most difficult problem is in the detection of physicians in trouble.

Dr. Fraser in Los Angeles said he did not seek help for his drug problem until it had grown so serious that his wife threatened to do whatever she could to get his medical license revoked. He said his colleagues at work were unaware of his addiction.

“She said that if I did nothing about it she would personally see to it that my license to practice medicine would be taken away,” he said. “I took barbiturates to sleep, tranquilizers to calm down and speed to get going in the morning.”

Ultimately, Fraser said he skipped sleeping entirely and couldn’t see patients because he was too tired. “My income fell to zero. I kept spinning like a top.”

Fraser said he got into drugs and alcohol at the age of 45 after he lost a malpractice case and had no insurance to pay the award. He has now been drug- and alcohol-free for seven years, although he still attends daily meetings for recovering addicts. He also serves on committees to treat physicians at five hospitals in Los Angeles.

“The only people who can police doctors are doctors themselves, but most are very ignorant about drugs and alcohol,” he said.

Medical officials say doctors can be more adept than most at hiding their problems by using pharmaceutical chemicals instead of street drugs or alcohol. They also can be more likely to deny they have an addiction or to believe that they can handle it themselves.

Some officials are also concerned that hospitals have a legal or financial motivation to overlook the warning signs of drug addiction because of the that fear doctors will sue if their employer accuses them of a job-threatening problem. In that environment, hospital personnel can also believe it will do no good to complain about a doctor’s behavior.

“It’s often very intimidating for people who work with physicians to make this confrontation, particularly in hospital settings,” said Dr. Mary Ann Barr, who treats addicted physicians in the Bay Area. “The fear among professionals is that they will get stonewalled by the hospital community.”

In Allen’s case, the fatal traffic accident last Sunday was the third time in two years the young internist had been arrested on drug- or alcohol-related charges. A Mission Viejo couple were killed in the head-on collision and their 11-year-old daughter was critically injured.

At a hearing Thursday, prosecutors said Allen will face manslaughter charges in the case because he was intoxicated at the time of the accident. They also said he had both fresh and old needle marks on his arms, although they gave no explanation for the marks.

Last year, a $7,500 warrant was issued for Allen’s arrest when he failed to appear in court to answer drunk driving charges stemming from a minor traffic accident in April, 1992. And just last month, Allen, 31, was charged with drunk driving and resisting arrest when he was allegedly involved in a hit-and-run accident that damaged three parked cars.

After the accident last month, Allen’s privileges at South Coast Medical Center were suspended.

His suspension was also reported to the Medical Board of California for further action. But officials said the report sat on a clerk’s desk for a month. If the response had been more timely, board officials said an investigation would have been launched that might have pressured Allen into a special substance abuse program for doctors.

“I think this incident will serve as a catalyst for us to get together . . . and make sure our colleagues know we are available and non-judgmental and confidential and competent to handle the problem,” said Richard M. Sheridan, chairman of the Orange County Medical Assn. committee that counsels addicted physicians and directs them to treatment.

One of the major complaints about California’s program for detecting and treating impaired physicians, however, is that the agency responsible for disciplining doctors is the same arm assigned to treat them. Both functions belong to the Medical Board of California.

Many doctors believe that structure discourages doctors from seeking help out of fear they will lose their license to practice if they confess to a serious illness. Most other states with legislatively mandated programs for impaired physicians designate an outside agency, usually a professional society of physicians, to receive complaints or disclosures about drug abuse.

Also, the Allen case comes at a time when the Medical Board of California is under intense fire for administrative inadequacies and allegations of illegalities.

Several officials with the board were removed from their jobs in January when a California Highway Patrol investigation found that top officials had destroyed records of complaints against doctors to try to erase a backlog that had caused the Legislature to threaten the board’s funding.

The Legislature is now considering a package of corrections for the medical board.

Privately, several doctors who treat physicians for drug problems said the shake-up has led the medical board to be more aggressive in disciplining doctors and, as a result, there has been an even greater chilling effect on doctors who might voluntarily disclose their problems.

“It used to be somebody would voluntarily come into the diversion program,” one doctor said. “Right now, I would think twice about referring somebody to the diversion program.”

The medical board’s diversion program is the unit that targets physicians who are identified as having drug or alcohol problems. The doctors referred to its treatment program undergo intense in-patient therapy and are rigorously monitored with regular drug tests and evaluations for up to five years. In return, they can keep their license if they succeed in resolving their abuse problem.

When Dr. Fraser was put in the diversion program, he said it was so strict that “I gave them a lot of trouble.” He said he resented being sent to a recovery house populated with convicted felons and being constantly monitored at the hospital after finishing detoxification.

Fraser said his initial fear upon entering the diversion program was that he might lose his license. But when he saw some physicians in the program die from their addictions, his priorities changed. “My priority became not saving my license but saving my life,” he said.

Dr. Richard Ikeda, the chief medical consultant to the Medical Board of California, said the public has a lot at stake in helping treat doctors suffering from addiction problems. “The main benefit is taking a highly skilled individual who has been totally devastated and getting him clean and sober and back to work,” he said.

State law also requires that each hospital have a “wellness committee” to hear drug abuse complaints about physicians and, if necessary, urge them to seek treatment or refer them to the medical board for investigation.

The medical board’s diversion program is monitoring 247 doctors and boasts a 78% success rate with success defined as a participant who remained sober for two years or more.

Officials attribute the high success rate to the motivation doctors have to keep their jobs. But they say the same motivation is what keeps many from acknowledging they have a problem.

Psychiatrist Milner said the Allen case “certainly should humble us all. . . . It should make us all recognize that in spite of a highly developed criminal justice system and a highly sophisticated early identification and treatment option available to physicians as a society, we’re not making a lot of progress in dealing with this disease of alcoholism and drug addiction.”