When Doctors Cross the Ethical Boundary

He says it started slowly.

Two or three beers a night in medical school, to help him get to sleep.

But Matthew Hopkins says that by the time he became a psychiatric resident at Dartmouth Hitchcock a combination of genes and stress developed into uncontrollable alcoholism.

Hopkins: As it got worse I was coming to work with hangovers and feeling kinda crummy. I’ve always been in the borderline range for ADHD. I think my drinking and coming to work hungover made that a lot worse.

He saw a psychiatrist, lied to her about his drinking problem, and got a prescription for the stimulant Adderall.

Hopkins: At first I did it as directed and it really kinda helped me out because it’s kind of a cure for hangovers. But I started abusing it and taking more than I should. I kept telling her I needed more. And I knew exactly what to say, I’m a psychiatrist myself, I know exactly what to say to get more.

And then Hopkins started abusing the privileges of his profession.

Over the course of about six months he wrote twenty fake prescriptions for Adderall, before a pharmacy caught on to him.

As damaging and perhaps embarrassing as it may be, Hopkins’s story is not a secret.

It’s available for anyone to read.

State boards of medicine keep public files on all doctors that have crossed the conduct boundary.

Austen: They are there protecting the public day in and day out, most times unnoticed.

Dale Austen is the senior vice president of the Federation of State Medical Boards.

A study by the Federation found only ten percent of people were aware of the medical board, not to mention its public files.

Austen: What they expected of the medical board was that the medical board was assuring the competence of physicians that they were licensing. So there is work to be done certainly and greater awareness of the good work medical boards do.

Part of that work is exposing doctors who misbehave.

State board actions are published in their newsletters.

And the New Hampshire state board’s website contains a database of any physicians they’ve had to discipline.

Dr. Hopkins isn’t listed because he was a resident at the time.

But when he got caught for writing fake Adderall scripts, the board acted quickly.

Hopkins: That day I got caught I thought my life was over.

The Board immediately suspended his license and he lost his job.

But Hopkins’s medical life would get a second chance.

He was referred to New Hampshire’s physician health program run by Dr. Sally Garhart.

Hopkins: She told me, well, I think you need to go to rehab for three months just to you need to do that just to jump through that hoop if you ever want to get your license back. You got a lot of things you got to do. And I said OK, cause I was willing to do anything.

Hopkins signed a five year contract with the physicians health program: three months of rehab, several random drug tests a month, and therapy.

The program is meant to get doctors back on track.

Some are referred by the medical board, others come in voluntarily before they’ve been caught.

Dr Garhart, who runs the program, says it’s an extremely successful system.

Doctors have upwards of eighty percent recovery rates for substance abuse, which is four times that in the rest of the population.

Garhart: It’s because the theory is it’s a combination of education, and once you break through they get into a good treatment track and we do strict monitoring. Which really helps in early recovery.

There are about thirty five doctors in New Hampshire currently under contract with the program.

Not all of them have drug or alcohol problems.

Some are monitored for mental illness, and others are helped with behavioral problems like anger management.

Garhart says treating behavioral issues is essential for good practice, but it’s also the hardest.

Garhart: When people are stressed and overworked they don’t always say the right things. And for physicians if somebody doesn’t like what you’re doing, they can call up and report you to the board of medicine. So people get reported on for their abnormal behavior whereas they wouldn’t necessarily report their auto mechanic who screamed and yelled at them.

Garhart admits not all physicians complete the program, and they are referred back to the Board of Medicine for discipline.

Dori Tothill is the New Hampshire Board’s investigator.

She looks into every complaint that comes to the Board, many from colleagues and patients.

Having an affair with or making a pass at a patient or practicing under the influence are common.

But Tothill says a majority of complaints are based on quality of care.

Tothill: And that’s what the board of medicine looks at. Did somebody receive appropriate care? Did they receive the right medicine? Did they receive a follow up visit that they should have received? Was their surgery done correctly?

Disciplinary action for these offenses can be fines, continuing medical education classes, or removing a doctor’s license.

Tothill says many of the doctors improve after they’ve been disciplined.

And for those who don’t, they usually end up losing their license permanently.

Those are rare cases, and the Board has taken away about a dozen licenses over the last decade.

The saddest ones, she says, are when the Board has to force old doctors into retirement.

Tothill: And these oftentimes are great doctors that have delivered three generations of babies and been great family doctors and never had a complaint in their life their entire career have been wonderful. But it’s just time, for whatever reason. And usually it’s for medical reasons. It could be a surgeon that’s not able to stand on their feet.

Tothill sees her job as protecting the public.

She encourages people to report doctors, even if it’s just a gut feeling that something’s not right.

Dr. Hopkins says none of his patients were harmed by his substance abuse.

And he thinks his experiences will actually help him in his career.

He’s decided to pursue addiction psychiatry.

SOQ

Story Links
New Hampshire State Board of Medicine

Federation of State Medical Boards Doctor Search

New Hampshire Board of Nursing Newsletter with Disciplinary Action

New Hampshire Board of Pharmacy Meeting Minutes with Disciplinary Action