PROGRAMS FOR ADDICTED DOCTORS DRAW CRITICISM

SAN FRANCISCO -- Troubling cases in which doctors were accused of
botching operations while undergoing treatment for drugs or alcohol
have led to criticism of rehab programs that allow thousands of U.S.
physicians to keep their addictions hidden from their patients.

Nearly all states have confidential rehab programs that let doctors
continue practicing as long as they stick with the treatment regimen.
Nationwide, as many as 8,000 doctors may be in such programs, by one
estimate.

These arrangements largely escaped public scrutiny until last summer,
when California's medical board outraged physicians across the country
by abolishing its 27-year-old program. A review concluded that the
system failed to protect patients or help addicted doctors get better.

Opponents of such programs say the medical establishment uses
confidential treatment to protect dangerous physicians.

"Patients have no way to protect themselves from these doctors," said
Julie Fellmeth, who heads the University of San Diego's Center for
Public Interest Law and led the opposition to California's so-called
diversion program.

Most addiction specialists favor allowing doctors to continue
practicing while in confidential treatment, as does the American
Medical Association.

Supporters of such programs say that cases in which patients are
harmed by doctors in treatment are extremely rare, and would pale next
to the havoc that could result if physicians had no such option.

"If you don't have confidential participation, you don't get people
into the program," said Sandra Bressler, the California Medical
Association's senior director for medical board affairs.

California's program ends June 30. If no alternative program is
adopted, the rules could revert to the zero-tolerance policy in place
before 1980, when doctors who were found by the medical board to have
drug or alcohol problems were immediately stripped of their licenses.

1% Of Physicians

No other state has followed California's lead. But the president of
California's medical board, Dr. Richard Fantozzi, said that behind the
scenes, regulators nationwide share his ambivalence toward such
programs. "To hide something from consumers, something so blatant ...
it's unconscionable today," Fantozzi said.

Between 10 percent and 15 percent of physicians nationwide will have a
substance abuse problem at some point in their lives, a rate similar
to that of the general population, according to widespread estimates.

An estimated 7,500 to 8,000 practicing doctors are probably in
confidential treatment, or about 1 percent of all physicians
practicing in the U.S., said Dr. Greg Skipper, head of Alabama's
program and a leader of an upcoming study on the issue.

Opponents of such programs are unable to cite any documented cases in
which doctors who were confidentially undergoing treatment botched
operations while drunk or high. But they say the very secrecy of the
programs makes it hard to assess the risks. Nevertheless, some doctors
have been accused of harming patients while they were in treatment.

California Case

Opponents of California's program have focused on the case of Dr.
Brian West, a Long Beach plastic surgeon who has been accused of
negligence by the state medical board and is fighting to keep his license.

In 1999, West performed a double mastectomy and breast reconstruction
surgery on Becky Anderson. The procedure left her with gaping,
infected wounds that wouldn't close and, ultimately, a grotesque lump
the size of a melon caused by organs spilling through an unhealed hole
in her abdomen.

Weeks before performing his final, futile procedure on her, West was
arrested for a drunken-driving accident.

After his conviction, West entered the diversion program for
alcoholism. A year later he performed a tummy tuck on a 37-year-old
woman that also healed poorly.

West ultimately flunked out of the treatment program after
investigators uncovered a pattern of relapses, binge drinking and
doctored urine tests that "demonstrate that he is a physician who has
been long and chronically impaired by alcohol," according to a 2005
medical board complaint.

West's supporters say he has been made a scapegoat, asserting that he
is not to blame for his patients' complications and that the severity
of his drinking problem has been exaggerated by investigators. "I have
no information from any of my investigations that Dr. West has ever
cared for patients while under the influence of alcohol," said his
lawyer, Dominique Pollara.

West admitted no fault in settling Anderson's malpractice lawsuit for
$250,000, Pollara said. The tummy-tuck patient lost her case.

Without the assurance of confidentiality, some say, addicted doctors
will go underground and continue to practice without getting any treatment.