GETTING TREATMENT: PROGRAM HELPS NEVADA DOCTORS BEAT ADDICTION

Alcohol Called No. 1 Drug Abused By Medical Professionals

Victor Rueckl lived a rather charmed life until the day in January
1986 when federal drug agents surrounded him in a Reno parking lot and
arrested him on drug charges.

The son of a prominent Winnemucca doctor, Rueckl was establishing a
solid reputation in his own right: bachelor's degree from the
University of Southern California, medical school at Tufts, residency
at Brown University, a growing medical practice, marriage into a well-
heeled Reno family.

He was also an alcoholic with a cocaine habit that was consuming his
life.

"I come from a long line of drunks," Rueckl explained. "I went through
med school drinking and using (drugs). I drank and smoked pot on a
regular basis, all the way through med school, internships and
residencies." Cocaine entered the picture "around 1982 or '83," he
said, and soon became a daily habit.

He has been clean for nearly 16 years and again is licensed to
practice medicine in Nevada.

For most of those years, a great deal of his time has been spent
helping addicted doctors like himself get back on their feet.

Today Rueckl complements his dermatology practice with his work as the
medical director of the Nevada Health Professionals Assistance
Foundation, a 6-year-old nonprofit that operates with the help of
$125,000 a year in grants from the Nevada Board of Medical Examiners
and the Nevada Hospital Association. The foundation's purpose is
simple: intercede when a Nevada doctor has a drug or alcohol problem
before it ruins their life or career, and endangers the health of any
patients.

Every state has some type of program to steer addicted doctors into
treatment. Rueckl pegs the success rate at 90 percent.

"We're a very young program in Las Vegas," Rueckl said. "We've been
much more successful in the north (part of the state) than in the
south in terms of getting doctors into recovery." But Rueckl added
that the old patterns are changing, and that soon the number of Las
Vegas-area doctors in recovery should surpass the total from Northern
Nevada.

A five-year contract

The program works as follows: If a doctor is suspected of using drugs
or alcohol, for example, if a patient complains that a doctor smells
of booze, the Board of Medical Examiners is notified and the case is
referred to Rueckl.

Rueckl or one of his assistants will evaluate the doctor, which
usually includes a urinalysis. A doctor then will be ordered to attend
a treatment center, at his or her own cost, for an evaluation that
lasts three to four days. Most of the time, doctors end up at the
Talbott Recovery Campus in Atlanta, which specializes in treating
doctors and nurses.

"We basically have the right to walk into any physician's office and
say, 'Pee in the cup for us,' " Rueckl said, though such incidents
take place only when there is reason to suspect a doctor has a problem.

If an evaluation shows impairment, the doctor is required to stay at
the hospital for a full course of treatment, which can take several
months and includes intensive counseling plus a traditional 12-step
program.

Once a doctor is released from the hospital, again with the doctor
footing the bill, they are forced to sign a five-year "contract" with
the diversion program. The contract requires them to submit to random
drug tests and agree to attend regular counseling sessions.

Only when a doctor fails to live up to this contract are they referred
to the Medical Board for discipline and possible loss of license.

Right now there are 60 doctors enrolled in the foundation's five-year
treatment program, and about 40 doctors who have completed the
program. But studies estimate that at least 10 percent of all licensed
doctors have a drug or alcohol problem. With about 3,000 licensed
doctors in the state, that equates to 300 or more.

In recent years, the diversion program has grown to include treatment
for doctors with behavioral problems. Until recently, behavioral
problems largely had been ignored in the health care industry, but
today they are a source of many of the complaints that come before the
medical board.

They're called "disruptive doctors," and the disruptions can come in
many forms: temper tantrums, sexual harassment or any behavior that
disrupts the hospital environment.

"A lot of people like to simply gripe about their doctor, and they may
think they have a good cause. But a lot of those cases get closed,"
says Larry Lessly, executive director of the medical board.

Rueckl said, "In the 1950s, it was OK for a doctor to be a (jerk). It
was OK for someone to go in and scream at people. It's not acceptable
anymore. If you're throwing things around the operating room today,
we'll hear about it tonight."

An overdose of confidentiality

Getting a medical license is extremely tough, which helps explain why
taking it away is rare. Possession of narcotics such as cocaine is a
felony in Nevada, yet doctors who become addicted to drugs or alcohol
are given chances that wouldn't be afforded members of other
professions.

"There are all kinds of things we (doctors) get away with as a special
group," Rueckl said. "Our spouses put up with us a lot longer than
most would because we have good paychecks. We die a lot from overdoses
of confidentiality."

Rueckl calls his own case an exception to the rule. Rarely does he
come across doctors who are addicted to "street drugs" like cocaine or
heroin. Alcohol is the most common culprit, along with prescription
sedatives like Fentanyl or Hydrocodone, a narcotic that one criminal
investigator termed the "Las Vegas cocktail."

"John," a rural Nevada doctor who does not want his name or hometown
identified, traveled a more typical route to addiction. Raised on the
East Coast and schooled at prominent institutions, he lived the
privileged life of achievement common to many doctors. He was a
college athlete who barely drank and never smoked. After medical
school, he settled in rural Nevada and began practicing as an
anesthesiologist.

His idyllic life took a bad turn after surgery forced him to take
sedatives such as Vicodin to control pain. "It was appropriate for a
period of time," John said. "But I later started using it for the
effect it had on me."

The pill-popping became more frequent, and soon he was mixing the
sedatives with alcohol, a combination that enhances the effects of
both substances.

Anesthesiologists are particularly susceptible to addiction, because
more than any medical specialty they come in contact daily with
powerful narcotics. Such was the case with John, who began writing
phony prescriptions in the name of his wife and children as a means of
hiding his dependence.

The addiction continued for four years before his family and close
associates staged a "mini-intervention."

"I was in a lot of denial," John said. "As is always the case when
people are involved in this disease."

But his medical education told him what was wrong. "I was aware that
if I didn't have this (drug), I would go into withdrawal, knew that it
was clearly an inappropriate use and addictive use of that medication.
But I couldn't stop it; didn't know how to stop it. I wanted to
control it desperately, but I just couldn't."

A 28-day stay in a treatment facility came next, followed by "about
five years" of total sobriety. But that was in the mid-1980s, before
the diversion program and its follow-up care had been developed.

John's relapse began slowly, with an occasional drink. Before long, he
was mixing booze with painkillers and prescribing drugs to himself.
When a colleague noticed his pattern of overprescribing, John started
diverting drugs from his practice. It was easy at first: If a patient
required 10 milligrams of a certain drug, John might sign out 100
milligrams from the hospital pharmacy and keep the difference for himself.

Eventually he ended up at Talbott, where he stayed for nearly five
months. Ever since, he's faced twice-a-month drug tests and counseling
sessions. His medical practice is thriving.

Safeguarding patients

Catching a doctor who's getting high is still a matter left largely to
chance.

The State Board of Pharmacy has a database set up that monitors every
time a controlled substance is prescribed in Nevada, a tool useful in
detecting doctors and patients who are abusing prescription drugs. But
the database is useless in catching doctors like John, who feed their
habits by diverting drugs from their hospital pharmacies.

Other professions leave less to chance. Commercial airlines, for
example, are required by the Federal Aviation Administration to test
randomly at least 10 percent of their pilots each year for alcohol and
25 percent for drugs. Any pilot who fails a test is suspended
automatically and forced to enter rehabilitation. Only after a year
can a pilot reapply for a license.

This carrot-stick approach has been remarkably successful. In 1997,
only 15 pilots out of about 34,500 who were tested checked positive
for drugs, and only three of about 20,000 exceeded the blood-alcohol
limit of 0.04 percent.

While pilots are forbidden by law from drinking alcohol less than
eight hours before a flight, there is no similar rule in medicine. A
doctor is never allowed to be impaired while treating patients, but
there is no law against your family doctor unwinding after work with a
cocktail or three.

And it is alcohol, Rueckl said, that is the most common culprit in
diversion cases.

"By far and away, alcohol is still our Number 1 drug," said Rueckl,
who can recall only one doctor in the program who was not a drinker.
"It may not have been their primary drug of choice, but it's a factor,
followed by prescription drugs."