ADDICTED-DOCTORS PROGRAM: SENATOR PROMISES PROBE OF PROBLEMS

A co-chairman of the state Senate Health Committee said he plans to hold
hearings this fall to address problems within the state- sanctioned
physician drug-treatment program. His statement followed a claim last week
that a psychiatrist was addicted to drugs when she treated a police officer
who later killed five people and himself.

One flaw in the program is the policy of calling enrolled doctors a day
before a random urine sample is taken, said state Sen. Joseph F. Vitale,
D-Middlesex. Doctors being monitored by the Physicians' Health Program for
signs of drug abuse should at the very least be given unannounced tests, he
said.

"It's a weak excuse to say, 'Well, poor us, we only have volunteers and we
are unable to do (tests),' " Vitale said about the Medical Society of New
Jersey, a nonprofit physicians group that runs the health program.

The program is endorsed by the state to monitor the approximately 600
physicians and health care professionals with substance abuse and
psychological problems.

For doctors in substance-abuse treatment, "probably one of the last things
you (should) do is tell them you are coming," Vitale said.

The PHP collects hundreds of urine samples each week - sometimes on random
days twice a week from the same doctor - but doctors are called a day
before the urine tests are due, according to the Division of Consumer
Affairs, which supervises the Board of Medical Examiners. The board
regulates doctors in the state and works in tandem with the PHP to keep
impaired doctors away from patients.

But Toms River psychiatrist Debbie L. Miller admitted to the board in 1998
that she faked her 1996 tests by hiding someone else's drug-free urine in
her body.

Miller regained her license in 1998 and was ordered to submit to more urine
monitoring - which she also faked, according to her former office manager
and romantic partner, Maria A. Baldasarre.

For four years, Miller abused drugs "24-7" but fooled her drug monitors and
treated patients while she was high, said Baldasarre, now a Florida prison
psychologist.

The psychiatrist went into a drug rehabilitation center in December 2001
and abandoned her Toms River practice. Miller, who could not be reached for
comment, surrendered her license in February for at least six months and
has not reapplied for licensure, according to the board.

Baldasarre said that in the summer of 2001 Miller treated Edward L. Lutes,
a Seaside Heights patrolman and SWAT team member who in April killed five
of his Dover neighbors, wounded his police chief and then killed himself
with police-issued firearms.'The system failed us'

"It adds to the proof of how the system failed us," said 25-year-old
Theresa Williams, whose parents, Tina and Gary, were killed by Lutes on
April 9. In talking about Lutes, "There are just so many signs that were
overlooked, numerous signs that could have -- that my parents could be
alive today."

Baldasarre's claims about Miller's drug use or that she treated Lutes while
on drugs could not be verified by the Asbury Park Press.

Vitale said, "There is a lot at stake here, and we should be doing the best
that we can" to keep impaired doctors away from patients. "There could very
well be a better way."

Vitale said he will hold hearings this fall on the state medical board's
oversight of addicted physicians, and the performance of the PHP.

Aware that Miller had relapsed four times and faked her drug tests, the
medical board said it reinstated Miller's license, with restrictions, in
1998 only after the PHP detailed "Dr. Miller's total compliance with her
program of recovery," according to a prepared statement from Consumer
Affairs. Again with the PHP's recommendation, in 2000 the board lifted all
restrictions and allowed Miller to voluntarily participate in the drug
treatment program.

"Where there is a need for change, and it is in the board's power to make
that change, it will do so," the statement read. "The board is always
concerned that the physicians it licenses are competent to practice. When
it is confronted with physicians who have substance- abuse problems, as
with other cases, the board takes what it feels to be the appropriate
actions based on the facts."

Getting her license back even after admitting to the board about her
relapses and how she cheated the drug tests is "just wrong," Vitale said.

The PHP said it doesn't rely solely on urine testing to watch doctors with
substance-abuse problems; the program uses therapists, 12-step programs and
monitors to carefully watch for relapses.

National drug testing experts say doctors may be able to fool any form of
testing for a while, but urine tests are particularly susceptible to
effective faking.

To avoid being caught, a male doctor could pump clean urine into his
bladder so he passes the test, doctors have said. Bal-dasarre said that
Miller would get clean urine from the cou-ple's dog when she couldn't
ob-tain it from drug-free people. PHP doesn't test if the urine is from a
human.

Peter Lurie, deputy director of Public Citizen's Health Re-search Group,
which tracks doctor conduct nationwide and how state medical boards mete
out discipline said the medical board's handling of Miller is among the
worst he has seen.

"It's just unconscionable," Lurie said. "If they can't take action against
someone like this, who will they take action against? . . . It's pushing
the limits of what medical boards do, in terms of failing to take adequate
action."

Medical board defended

Robert J. Conroy, special coun-sel for the Medical Society of New Jersey,
defended the board, saying its 21 members are tough on substance-abusing
doctors and often errs on the side of keeping doctors out of practice if
they have even a small chance of abusing drugs again.

But doctors who have fooled the PHP tests should not neces-sarily be banned
from practic-ing medicine, Conroy said.

Unannounced visits for urine tests or hair samples on doc-tors would be too
time consum-ing for the program's volun-teers and would cost the state
money that could be better used elsewhere, the Bridge-water lawyer said. He
noted that the PHP is a model for other states' impaired-physi-cian programs.

"I don't think it makes any sense to spend more public money in this area,
because, quite frankly, you still haven't shown me a case where a pa-tient
has been harmed," Conroy said.

Other drug-abuse tests, such as hair samples, which are almost impossible
to fake, would catch too few people to make them worthwhile, he said.

"Why don't we test everybody who drives a motor vehicle in the state?"
Conroy asked. "That would save lives wouldn't it, if we were using the same
theory. Then we can raise everybody's motor vehicle license fees $1,000 to
cover it. That wouldn't make sense, would it?"

Vitale said that if the Medical Society of New Jersey is resis-tant to even
answering ques-tions on the issue, "that is not helpful for anyone. If
there is a problem, then they have a re-sponsibility to examine any number
of solutions. Being in-flexible certainly doesn't get us there."

Carl M. Selavka, director of the Massachusetts State Police Crime
Laboratory System, said urine tests cost about $15 to $20 and only measure
recent drug use. Hair analysis covers 90 days and costs about $50, he said.

Doctors enrolled in the PHP pay for all their own tests and therapy.

Hair samples "could be consid-ered more cost-effective for a chronic
repetitive user," said Selavka, a national drug-testing expert.

At least one other state appears to impose tougher punishment for relapsed
doctors.

Andrew W. Watry, executive director of the North Carolina medical board,
said he recom-mends a doctor stay away from patients for at least two
years, or lose his license permanently after three relapses.

Docs can't be banned

Doctors in New Jersey who fake the drug tests cannot be permanently banned
from med-icine, under state law. There is no statute that allows for
per-manent revocation.

In a January news series on the Board of Medical Examin-ers, the Asbury
Park Press re-ported that over seven years 59 doctors were publicly
disci-plined for abusing drugs and, of those, 27 had relapsed from a prior
abuse.

Many substance-abusing doc-tors avoid public discipline by the board if
they enter and complete the PHP's treatment.

The Press found that, in most cases, doctors who were sus-pended or who
voluntarily sur-rendered their licenses for re-lapsing regained their
licenses in less than six months.

Suspensions or the voluntary surrendering of a license for a relapse were
found by the Press to be less than six months in most cases.

On Sept. 13, the medical board permitted cardiologist Dr. Mark M. O'Connell
to practice medicine again following a four months away from his practice.

O'Connell, of Little Silver, had surrendered his license in May after he
diverted pain killers from intensive-care unit pa-tients at Jersey Shore
Medical Center, Neptune, according to board records.

O'Connell declined comment. He had abused prescription drugs from 1989
through 1995, according to board records.

Mixed opinions

Several patients of Miller's have said the doctor appeared ill, shaky, and
had difficulty writing last fall. Miller told them that she had Lyme
dis-ease, the patients interviewed said.

"The way she acted, she didn't act as if she was right," said Nancy Mills
of Brick, one of Miller's former patients. "She was always trying to
concen-trate too hard while you were there, as if she was preoccu-pied."

But Kathleen Loughran, of Lakewood, another former pa-tient of Miller's,
said Miller looked healthy, and that the doctor was a lucid, articulate and
good psychiatrist.

"If what she (Baldasarre) is say-ing is the truth -- and I doubt it very
much -- she should have reported it," Loughran said.

Moreover, Baldasarre didn't seem like an office manager, Loughran said.

"The last time I was there, she announced the rates had raised," Loughran
said. "Other than that, she was there to chat up the patients."

Robert A. Forrest, who was a patient of Miller's until the doc-tor went
into a drug treatment center in December, said he is concerned other
patients were left without a psychiatrist.

Forrest, a 46-year-old sales rep-resentative, went three months before he
could find another doctor to prescribe him the drugs that Miller had given him.

Forrest finally had to go to an emergency room to get a new prescription
before he found a doctor who would treat him in February.

"I am afraid there are more peo-ple out there that just may not be getting
their medicine. I called two or three doctors," he said. "They couldn't get
me an appointment."

It could not be learned if Miller had a file on Lutes, the killer police
officer. The Ocean Coun-ty Prosecutor's Office declined to comment on the case.

Some of Miller's patients have complained that after 10 months, they still
cannot get access to their medical records or even find out where the
doc-uments are.

"I just think the whole episode is ridiculous, that she had the opportunity
to do this to peo-ple," said Mills of Brick. "It's just mind boggling to
think that you put your trust in peo-ple to help you and they are more
screwed up than you are."