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Doctors with addictions left hanging as diversion program dies

Doctors with addictions left hanging as diversion program dies

Picture of William Heisel

In 2002, when I was covering medicine for The Orange County Register, we produced a series of stories called "Doctors Without Discipline" that uncovered serious flaws in the way the Medical Board of California handled complaints from the public about physicians.

As part of the fallout of that series, California legislators appointed an independent enforcement monitor to review the board's work and make recommendations. In November 2004, the monitor, Julie D'Angelo-Fellmeth, released a report about the board's failings, followed by a report in November 2005 that focused on the board's diversion program, which allowed doctors to undergo drug and alcohol treatment without any penalty against their license and without any public disclosure. That report prompted a follow-up report by the Bureau of State Audits in June 2007 that noted, among other things, that the diversion program was not doing what it was supposed to do: stop doctors from abusing drugs and alcohol.

Specifically, the diversion program has not always required a physician to immediately stop practicing medicine after testing positive for alcohol or a nonprescribed or prohibited drug, as required by program policy; has determined that positive drug tests were not a relapse without providing any justification for such a determination; and has not followed the advice of its advisory committee to have a trained medical review officer review contested results.

With so much evidence mounting after so many years of passing the buck, the medical board finally shut the diversion program down. Doctors with addictions now would be forced into more or less three options:

• Quit practicing and enter a treatment program.

• Continue to practice while gradually working to modify their addictive behavior.

• Continue to practice while hiding their drinking or drug abuse.

Which do you think they are more likely to do? Consider the sad history of Steve Leo Balt, a psychiatrist with a host of psychological problems, including alcoholism, bulimia and kleptomania.

• October 2004 - While still a psychiatric resident at Stanford University Hospital, Balt is arrested for drunk driving. He pleads guilty to a misdemeanor DUI charge and is put on a three-year probation.

• January 2005 - After being arrested for stealing from an electronics store, he is placed on a one-year probation.

• March 2005 - Balt is arrested for petty theft again. This time he was stealing about $12 worth of sandwiches and sodas.

• May 2005 - A medical board investigator visits Balt about his DUI conviction. A month later, Balt calls the board about entering the diversion program.

• July 2005 - From now until November 2006, Balt attends weekly sessions with a psychotherapist to address his alcohol abuse. He later admits" that he was not honest during his therapy and failed to inform his psychotherapist that his eating disorder and his shoplifting behavior had resurfaced during the time of his therapy."

• August 2005 - Balt undergoes a one-month inpatient treatment for his eating disorder. Upon discharge, his prognosis is listed as "fair due to the fact that he will have continued monitoring by the medical board." He immediately enters a 10-week outpatient alcohol treatment program.

• December 2005 - Balt enters the medical board diversion program and, shortly thereafter, returns to full-time psychiatric residency training at Stanford. He later tells a medical board psychiatrist that "his eating disorder returned and increased in 2006, after he had resumed his psychiatric residency program."

• October 2006 - Still unable to control his kleptomania, Balt is arrested for grand theft for stealing $400 worth of textbooks from the Stanford Bookstore.

• November 2006 - Balt quits his residency training and enters an inpatient treatment program that lasts until May 2007.

• May 2007 - Upon leaving treatment, Balt starts an outpatient treatment program through August 2007.

• December 2007 - A medical board psychiatrist says that Balt can safely practice medicine "as long as he is actively participating in the treatment of his psychiatric conditions and complies with ongoing monitoring."

• June 2008 - That monitoring disappears when the diversion program is shut down.

Clearly, the diversion program was not working. Even in Balt's case, after all that treatment, Balt couldn't stop stealing. None of these facts would have been made public had the diversion program continued, and, in this way, its demise is a boon for patients. It allows them to know the salient facts about a doctor's past and decide for themselves whether they want to seek treatment from that doctor. My guess is that there are patients with addictive behaviors who would want to talk with a psychiatrist who had struggled with the same conditions.

At the same time, it's hard to see how the end of the diversion program helps a doctor like Balt. One more option is gone for him. Maybe this will be the cold shock he needs to wake him up. Maybe it will tip him back over the edge. If you read about Balt's case and don't feel a twinge of sympathy, then you have a heart with a black lining.

Comments

Picture of Audrey  Van Bokkelen

Dear Mr. Heisel,

I've known Dr. Steven Balt for almost 3 years now, and while all the facts you post are accurate, how do they apply to the quality of care he provides to his patients?  Dr. Balt is an unfortunate example of someone who, because of his profession, must make drastic changes and undergo extreme programs to show how they have "changed."  Although Dr. Balt's resume of addictive behaviors sounds daunting, I also think the more important note is how the experiences have changed him.  As I know it (and his peers) he is now a prestigous addiction medicine doctor as well as highly respected psychiatrist in community mental health.  I've searched online to look at patient reviews of Dr. Balt and every patient has given him very high reviews.  It is for this reason that I think you should do a follow up article based on a personal interview to see where he is today.  What do you think about asking him if the increased scrutiny has affected his practice, for better or for worse?  What has he learned from his lesson?  Isn't this what free journalism is all about?  Let's not dramatize the negative, but also glorify the positive!  What do you think Mr. Heisel?

Regards,

Audrey

Picture of William Heisel

Audrey,

Thank you for your thought provoking comment. My point in writing this post was to highlight how the system had failed Dr. Balt. If you are in contact with him and would like to arrange an interview, I think it would be a great way to explore both the upsides and downsides of physician treatment programs and to answer the questions you pose. You can contact me via editor@reportingonhealth.org.

William Heisel

Picture of <span class="username">Guest (not verified)</span>

When the Medical Board closed diversion for physicians, through some type of flaw or loophole it remained open via this same Medical Board to physician assistants. Importantly ALL iof the oversight disappeared as there were no longer the state legislated Diversion Evaluation Committee (DEC) comprised of trained medical professionals and even community members. How is this possible? I was a PA in diversion after becoming addicted to painkillers after multiple surgeries to save my limb from amputation after a terrible accident. After 18 months is diversion, one month inpatient, 3 months outpatient, daily AA meetings, biweekly "group therapy sessions, biweekly random drug and alcohol tests, monthly evaluations by the corporate group tasked with ADMINISTERING the program, Maximus, a huge corporation, comprised of "nurse monitors". They have tacitly taken over the role of the DEC.strictly for financial gain and NOT permitted legally to make any ruling on licensing. 18 months into my program I fractured and dislocated my shoulder and was in the hospital for one week, a controversy ensued, believe it or not as to whether I could receive analgesia while the team of doctors ( an orthopedic shoulder specialist, ED doc, and a pain specialist unanimously ruled that I MUST have pain medication. In fact refusing to forcefully (somewhat violently actually given the bone fragments were moving around). When I called prior to any of this my "nurse monitor", she informed me my license would be revoked should i take anything more then a tylenol for the procedure. Well on the advice of my physician team, the fact that my arm was getting poor blood flow and there was simply NO alternative, I consented to treatment with narcotic analgesia. I was familiar with the law and knew this was my right. I was certainly not going to have my arm amputated because some nurse (with a background in psychiatry by the way) told me so. Well little good this did, my license was revoked based on her recommendations. Despite the disbelief of my medical team.
With physician assistant becoming so widely used and face the same problems doctors do and have with regard to addiction, mental illness. I would strongly recommend, truly, how the public is being kept safe, and PA's are being assisted, without any oversight from out "parent " Medical Board in California. There are multiple violations of Article 6.5 of the legislative code, regarding what is mandated by a diversion program. California's Physician assistant program has just been "flying under the radar" hoping Julie Felmouth won't catch wind of the shenanigans they have going on there. A currently practicing member for example was high on heroin wandering the streets of San juan Capistrano, CA. This gentleman is frighteningly unstable and I believe dangerous. On the flipside, the month my license was revoked I had been featured in the newspaper for saving a young girl and had a received many accolades for saving the life of a young mother with toxic shock syndrome, a reportable CDC case. Also in the top ten percent of the nation on my boards and beloved by my patients who inundated the board with grateful patient lettersm, to no avail. As a journalist and consumer advocate I strongly advise you to examine the actions of California PA's in Diversion program.How it is even operating, since our governing body is the Medical Board, I don't have a clue. I think in their caving to to Felmouth and her Sand Diego operation.....they forgot about PA's who still have a diversion program, WITH NO OVERSIGHT, and runs afoul of the law. The cronies there want to keep their job and there are financial gains to be had by these large poorly run groups such as Maximus. I urge you to investigate this matter, Sincerely, Michelle

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