LSBME – Mental Health and Medical Professionals – Investigations
Health Law Talk Presented by Chehardy Sherman Williams
What are the issues involving mental health and healthcare providers when their respective licensing boards investigate? As a provider, what do you disclose to your board investigator? What do you disclose to the mandatory evaluation recommended by the board to their mental health professional? In this episode of health law talk, we sit down with Normand Pizza and Conrad Meyer to discuss best practices for defending providers when dealing with board required mental health evaluations.
+ Full Transcript
Welcome to Health Law Talk, presented by Chehardy Sherman Williams Health Law. Broken down through expert discussion, real client issues and real life experiences, breaking barriers to understanding complex healthcare issues is our job.
Conrad Meyer (00:21):
And good afternoon, everyone. Welcome to the show, Another episode of Health Law Talk here in the studio today Conrad Meyer, Rory Belina who as the title would suggest a very important topic today. mental health issues and providers, and what are some of the issues that providers face when dealing with mental health problems? And with respect to that, we have a special guest on the phone with us today, Norman Pizza, healthcare attorney. Norm, how you doing?
Norman Pizza (00:48):
I’m doing fine. Good to be with y’all.
Conrad Meyer (00:50):
Absolutely. We’re very happy to have you on the show today. And, and just for our listeners, Norm, go ahead and introduce yourself and, and give a little background about what, who you are, what it is that you do.
Norman Pizza (01:00):
All right. I’m Norman Pizza, and it’s, I say it as pizza. and I have been a lawyer since 1974. I have been doing healthcare law since about 1984. So I’m a lawyer almost 50 years, and I’ve been doing healthcare law for the, a very large portion of that time. I have a lot of physician clients also have a lot of hospital clients, and I do represent a great number of physicians before the Board of Medical Examiners and nurses, before the, either the Board of Registered Nurses or the Board of Licensed Practical Nurses. So I’ve done a fair amount of work in connection with representing healthcare providers before their licensing boards. probably more physicians than nurses, but certainly both.
Conrad Meyer (01:51):
Well, certainly, I guess, I mean, we can obviously say you have experience doing this and, and we’re glad to have you on the show. Very important topic. I’m assuming that you’re very familiar with mental health issues and providers vis-a-vis not only just in practice as a practical application, but also how in front of the board and, and other issues related to the board, Is that right?
Norman Pizza (02:13):
That’s right. And, and just as a, a side and, and it’s a probably not completely relevant, but it actually forms a part of my background and you know, this, but I have a lot of children eight in fact, and one wife. but , what I was gonna say is two of my children are healthcare professionals. Two of ’em are physicians. and, and so I wind up and my, my wife actually has a degree in that too. So I, I wind up seeing this not only in connection representing physicians, but just in discussions with my, my children and, and, and, and my wife. So yeah, I, I have a fair amount of dis of experience and knowledge while I am no therapist at all, but certainly have offhand knowledge of much of this.
Rory Bellina (03:04):
And Dr. Pizza, if you
Conrad Meyer (03:05):
Wouldn’t mind, well, not Dr. Lawyer, Pizza,
Rory Bellina (03:07):
I apologize. , Mr. Pizza’s. I, I’m used to saying,
Conrad Meyer (03:10):
Doctor, we have so many doctors in the show. We get, we, we lose concept. There
Rory Bellina (03:13):
We go. I apologize. Thank you for the clarification.
Norman Pizza (03:15):
I, I do have a child who’s a doctor pizza, but I’m not it.
Rory Bellina (03:18):
Okay. Okay. as far as, you know, the concept of the, the Ls, b e and then the, the foundation as we refer to it, can you kind of give our listeners for some of ’em that might not be here, kind of a, a brief gist. I mean, we all know that, you know, every state has their licensing boards, but, and a lot of states have these foundations. But if you kind of explain the dynamic of the foundation here in Louisiana and kind of, you know, what it was set up for and a little bit of background on that.
Norman Pizza (03:46):
Well, you know, the Board of Medic, you’re talking about the board,
Conrad Meyer (03:48):
I think. Yeah, we’re talking about the board and then the Physician’s Health Foundation.
Norman Pizza (03:51):
Right. Okay. So I’m talking about the board first. The board is founded certainly to protect patients, but it also is there to protect physicians. And sometimes that protection, and this is a little off topic, but it have to be mentioned sometimes that protection spills over into problems that might constitute violations of antitrust laws. Mm-hmm. . But I’ll point out that the board protects physicians because physicians think of the board as their board and something that’s there not only to help their patients, but to help them. And frequently, very frequently the board has a adversarial relationship with physicians when they come before it, rather than merely a friendly relationship. And because of that adversarial relationship, physicians are sometimes fooled, and fooled is the right word, into thinking that they can come before the board when there’s a problem against them, and that it’s going to be a friendly relationship when it’s not.
and so it’s, and I guess cuz I’m a lawyer, it’s like I’m feathering my own nest, but really I’m not, This is based on experience. Physicians really need to be represented when there’s a complaint filed against them, even if it’s completely bogus complaint, because someone has to be there to protect them. And this is particularly true when there is something related to their mental health or because of a drug problem or a sex problem. all of those really require that they’d be represented because there’s some big giant pitfalls that, or perhaps deep pitfalls that they can fall into if no one is there to tell them, Hey, watch out for this problem. so have I answered your question?
Conrad Meyer (06:01):
Absolutely. And, and, and let’s talk about some of those, those pitfalls. So we, so you know, before, well, before we get into pitfalls, I wanna talk about the foundation cause we haven’t established that yet. So, so the Physician’s Health Foundation my understanding, that’s a non-profit that was set up as sort of an intermediary to the board for physicians relative to alcohol, drug, or other behavioral issues, even sexual issues. Is that right, Norm? Do I have that
Norman Pizza (06:27):
Correct? Yeah, that, no, that’s, that’s correct. And you know, it, it, it’s a nice idea. it’s a wonderful idea. I’m not the least bit satisfied that it achieves its goals.
Conrad Meyer (06:42):
And why do you say that? What? Gimme gimme the history. Cuz I, I, I, I’m, I’ve had my issues with that and, and, and with, with representing physicians too. but I’m, I’m based on your experience. What, what, when you say that, what do you mean?
Norman Pizza (06:55):
Well, and this comes back to the whole issue of is the board helping the physician as well as the patient? Or is it only helping the patient mm-hmm. . And so when a physician shows up before the foundation or, or goes before one of the treatment facilities that are used for the physician, You
Conrad Meyer (07:20):
Mean the board approved the board approved
Norman Pizza (07:21):
Treatments board? Yeah. The board approved that they said,
Conrad Meyer (07:23):
Cause they won’t send ’em any place else. It’s gonna be board approved.
Norman Pizza (07:25):
No. And, and these, and these places have contracts already in place with the board and physicians think that they go there and it’s a physician patient relationship. Mm-hmm. , it’s not, it’s not at all. Now that doesn’t mean there’s not therapy and treatment given Yes, there is some, but everything that the physician says, everything that the physician says goes back to the board in detail. And so if the physician says something that is not related to why the physician is there to begin with mm-hmm. , and it implicates the physician in potentially other wrongdoing mm-hmm. , the board finds that out. And now the physician is in the situation of having to explain why he did or did not do this un this other event,
Conrad Meyer (08:20):
Norman Pizza (08:21):
Unrelated. And now he’s, he’s now having to deal with a subsequent issue or even a, an issue that might be seven or eight years prior mm-hmm. that was long forgotten. so it behooves the physician to know that it’s not a physician patient relationship or a therapist patient relationship. It’s really a reporting agency back to the board of Medical examiners and therapy goes along with it. Yes. But it’s much more than just therapy. And the physician has to know that that’s happening because it really should affect his willingness to be candid with the therapist when they have their meetings. So
Conrad Meyer (09:08):
Let, let’s take a step back and look at the anatomy of how this would look. So in a, if a, if a physician had a alcohol drug sexual issue, dis behavior issue, and say that physician wanted to self report, Okay. or that physician exhibited some of that behavior and a complaint was filed. So then under either scenario, they’re gonna be sort of tasked, meaning they, the physician are gonna be tasked either by the board or they’re gonna be recommended to go to one of these board approved clinics like Acumen or Pine Grove. is that, is that fair to say? Is that correct?
Norman Pizza (09:49):
Yeah. And in fact, it might form a part of a consent order that the physician is told, Hey, you can avoid a hearing and an expense and a perhaps worse result if you agree to a consent order now. And the consent order will be that you’ll go
Conrad Meyer (10:05):
Get evaluated to
Norman Pizza (10:06):
The, to be evaluated. Right. and when you go to the evaluation, the therapist says, You need to be very candid with me. And when he’s candid, something else comes up that the physician feels like this is not an issue. It’s not even before the, the board, but now it becomes an issue and it is before the board.
Conrad Meyer (10:26):
So it’s a gotcha moment.
Norman Pizza (10:27):
It’s a gotcha moment. Absolutely. Positively. And I have seen it on multiple occasions.
Conrad Meyer (10:32):
And I have two, I mean, I’ve, I’ve, I’ve had clients that have similar, I mean very similar situations not un not unheard of. and, and these clinics, from my understanding, when they, when they do this, these clinics are not cheap. I mean, you’re not talking like a weekend thing. You’re talking sometimes even two weeks a month, sometimes longer, that you have to pay for these evaluations. Is that right?
Norman Pizza (10:55):
That’s correct. And there is another aspect to this, and I’m fortunate that I don’t have any of these addiction pathologies. I’m just fortunate. But if you are a, if you’re an individual that has got some of these problems when you go to the, this therapy unit or place it is not uncommon. In fact, it’s part of the treatment for them to basically accuse you of being an addict. Either a drug addict, an alcoholic a sex addict, whatever it may be. You start off, they accuse you. and you may find this to be, particularly if your particular case is very limited, you may find this to be extraordinarily insulting and demeaning. And you have to know that going in. And no one’s going to tell you you that unless you have really someone who’s got past experience with how this works,
Conrad Meyer (11:58):
So that there, there kicks in about getting representation. So, I mean, if you’re, you know, if you’re going in as blind, you’re not gonna know any of this. And you know, unless you get an experienced healthcare attorney who’s been dealing with this with clients over the years, you’re not gonna know what to do.
Norman Pizza (12:12):
That’s exactly right. And frankly, my advice to, and this is not just to physicians, but it’s to nurses also. Right? when you go before one of these groups or one of these therapists, you need to be ready to not be candid. You could certainly be completely candid about the peculiar event that got you there, and I think you should be. But when they start to ask you questions, Well, have you had any of these kinds of issues in the past? Have you have, have you got desires or have you had ever had problem when these problems begin? which are not unreasonable questions for a therapist to ask,
Conrad Meyer (12:52):
Norman Pizza (12:53):
But in the context of this kind of treatment, they are terrible
Rory Bellina (13:00):
Norman Pizza (13:01):
And they’ll scorch you for revealing this information.
Rory Bellina (13:05):
Right. Norm, I think you’ve, you know, you’ve articulated some really good points and definitely experience that you’ve had with the, with the board. You know, what do you think that, why do you think this, this has been their approach in the recent past? Or where do you think this kind of position comes from? Either from the board or from the foundation? Do you think it comes from good intentions? Do you think it’s self-serving for the foundation to, you know, essentially diagnose a physician with, with something so that they can be, you know, treated per se, and then have some sort of rehab and come out of the rehab and, you know, continue with that? What are your, what are your thoughts with, you know, why it’s like this?
Norman Pizza (13:45):
I think this is born of good intentions, and I think the good intention is to protect the public. And I think that a therapist would probably say that it’s unlikely that some event of misconduct by a medical professional is isolated and is infrequently when it occurs the very first such event. And so it’s appropriate in our normal treatment of patients, it’s appropriate for us to find out how long this has gone on, how deep the problem may be. And that’s all part of a therapist’s duty. What the problem here is that the board has an obligation to the public. And so when they find out that an individual has had past problems or has a predilection for other problems, they think there’s a duty to take action. And, and in, in, in a, in a broader view, perhaps. That’s right. for example, if a physician or just pick any medical professional, not just a physician, let’s say a physician has a problem with pediatric sex abuse, with child sex abuse, there’s very few people on this planet that would think, this isn’t something we need to take care of and deal with and prevent in the future.
you know, me with and I’ll throw this in cuz it’s, I’m using, I have 32 grandchildren and, and I certainly am one person who would say, if the physician is abusing children, I wanna know about it and get that physician out of there. That’s how I feel. But if I’m representing the physician, my mindset is different. I, I’m, I’m a lawyer, we represent people and we try to protect their rights and their interests. So if I’m representing a physician who has such a problem, I’ve got to tell that physician, Be careful. Be careful what you say, because the board’s obligation, and this is, this is important on a lot of respects, the board’s obligation is broader than the physician. It’s to the public. And so in connection with protecting the public, they are going to trample on the norms that a physician is accustomed to, which is a physician patient, right, of confidentiality. The physician has surrendered it, and their therapist has agreed in advance that anything and everything that is said is gonna go right back to the board based on its duty to the public.
Conrad Meyer (16:24):
And do you think when the physician goes to one of these clinics or these, you know, to be evaluated for whatever reason, whether it’s self-reporting or, or because the board has issued a consent order that they’ve agreed to go to, what do you think these physicians know that they don’t have a true therapist patient relationship? Do they understand that going in? Well,
Norman Pizza (16:47):
My, my constant experience, and I say I use that word constant because it’s appropriate, and my constant experience is that they have no clue that this is going to happen. Mm. So let, let, and let’s, let’s expand on this just a little bit. You know, I took, I took the example of the the child sex abuse, right? Because that’s the, that’s the most egregious example mm-hmm. . And, and it’s an easy one when you talk about that. You said, Yo, you’re gonna do something about that. Sure. I get it. But having said that, there are numerous examples of things that don’t even rise even close to that. So let’s talk for example, about perhaps a consensual relation, a consensual sexual relationship between two individuals, man and woman who are both equal in age, basically at a similar place in their careers mm-hmm. . and there’s no
Conrad Meyer (17:44):
And no quid profile.
Norman Pizza (17:46):
No. And and there’s no supervisor relationship,
Conrad Meyer (17:50):
Norman Pizza (17:50):
Okay. They’re, they’re pretty much equals, They might be nurse, they might be physician, they might be two physicians. All of that could be true. Okay. and, and so they engage in some conduct, let’s say it’s sexual con misconduct that is harmful to one or both of them in some way or to the people that they work with, which happens, particularly if they work in close proximity to each other. And somehow that gets before the board. Now, should that be the subject of this same examination by the board for misconduct? Mm-hmm. ? Well, I don’t, I don’t think so. I I don’t think that the public’s interest rises even close to the same level that it does. When I, when I talk about child abuse does the board and does the public have some rights here that need to be dealt with? And the boards should provide some kind of protection? Yeah, possibly they should, but it’s not remotely close to the child sex abuse issue. But the rules and principles that are used in the rural egregious case still apply. And so anything that physician says or does before that therapist goes back to the board and subjects the physician to rigorous examination and potential punishment.
Conrad Meyer (19:12):
Agreed. And, and, and, and I’ve seen that. And let me, and let me just kind of ad lib to the example you gave as another quote, unintended consequence of going to these clinics without knowing that what you say could be used really against you. So, so one example to take your example, if a physician has a boundary issue, for example, with a patient, okay? And they go to the clinic and they are evaluated. And during that conversation and whether that that boundary issue, whether the clinic evaluation was, was required through some consent order or through a just simple referral from the board that you must go to this, this clinic to be evaluated. But during the evaluation and the discussion with a therapist, it comes out that when they were in college, or even in med school, a residency, they smoked weed. They smoked marijuana once. Well, suddenly you saying that, or you’ve had a few drinks when you were in residency, you, you went to the bar after your hour and had drinks with your friends. Well, suddenly that gets reported back. And now you’re being referred to the foundation for these monitoring agreements. That Right. You, you never intended to go in there to begin with. And sometimes, and
Norman Pizza (20:34):
You don’t even, and you don’t even have a
Conrad Meyer (20:36):
Problem. No, you don’t have a problem. You don’t have a problem. But now you’re under a two or a three or a four, sometimes a five year monitoring agreement. When I say monitoring agreement, I mean about the drug and alcohol. Well, they, they, they randomly test you and you have polygraph tests simply for saying that at the at the clinic. I mean, I know you’ve seen that. I’ve seen that. R yeah. I think all of us have seen that. You know, I have
Norman Pizza (20:58):
Rory Bellina (20:58):
Yeah, Dr. Piza, I have a, I apologize Mr. Piza. I’ll get it. I’ll get it right on the third time.
Conrad Meyer (21:04):
See, see, Norm you, you’ve really got Rory over here on a, on a whim. I mean, he thinks you’re a physician. I . That’s
Rory Bellina (21:11):
A good, that’s a good thing. It’s not a bad thing. you know, one thing that, that I wanted to kind of go back to is the intent of the foundation and the intent of the board because mm-hmm. , like you mentioned, you thought that it did start off with, with good intent or with good intentions. What are some of the, the, the beneficial things that you have seen out of the board or the foundation? Or is it in your experience that you, you know, I also want to try to bring a a across the point on this podcast that, you know, they, they do do some good things. they do do a lot of things, a lot of good things. As soon as say some things, they, they do a lot of good things. you know, and, and, and I think that, you know, it’s important to talk about some of the, the hiccups or the pitfalls that physicians may run into when they report, but you know, the intent behind them and some of the good things that they do. Can you elaborate on, on that?
Norman Pizza (22:05):
Sure. You know, it’s certainly physicians just like everybody else, sometimes have addictive behavior that makes them take drugs or alcohol. And that does absolutely positively affect their ability to practice medicine and how they treat their patients. And the dangers to patients because the physician has a substance abuse problem of some kind. And the foundation has been very helpful to physicians and they start to recognize their problem. They go before the foundation, they get treatment, and they can be very successfully treated. and it improves their condition. They go back into practice and become very successful, useful physicians, good for the public, good for themselves. And look, the foundation has done that, and it does it most of the time, and it is extraordinarily beneficial to the public, to the board, to the, to the patients and to the physician. No question about that. it is, it is very beneficial and useful and, and no one can deny it. And, and I’ll be the first person to say, Yes, this is a useful result. It’s a valuable result, and we shouldn’t remove that result. It’s only tempered by the physician has to have a full understanding of the scope of what’s going to happen when they go before the foundation or that treatment that’s provided for by the foundation.
Rory Bellina (23:35):
And that’s exactly where I was gonna go next, because I think that physicians talk a lot and they, they hear about this. They read in, you know, laco or whatever journals that they’re reading from the, the board that the disciplinary actions that some of their peers face. What kind of chilling effect do you think some of this action has on physicians that do need help, that do want to self-report, but that are concerned that their past eight to 10 years of life could be in, in the hands of someone or be, you know, I’ll be thrown away because they report for something and want to get help, but, but their concerned with their license and their career and, you know, for their family, you know, income, everything.
Norman Pizza (24:15):
Well I really wish that the therapist and the board would tell physicians in advance that anything and everything you say to the therapist will go, come back to us. And if you add on to some problem that we didn’t know about, we have the right and indeed the duty to examine that and determine if you need additional discipline.
Rory Bellina (24:42):
Is there a reason that you think they don’t do that?
Norman Pizza (24:45):
Yeah, I, I, I think one thing is they don’t actually think about it in advance, but they know it. But I think also there is sort of hey, we wanna know everything because if there’s other problems, we wanna deal with that too. I, I think there is an aspect of we wanna know it all and we don’t trust you completely to tell it all to us. I, I think that is a part of this process. Well
Conrad Meyer (25:08):
Also think that physicians very smart though.
Norman Pizza (25:11):
Conrad Meyer (25:11):
I said the norm. The physicians are very, they’re very smart people. I mean, they didn’t get to be physicians because they, you know, they would last in a class. Right? So I mean, I mean, if, if, I guess one of the things is if the therapist comes out and says, Hey, by the way, we’re gonna, you know, we don’t have you, you don’t have this true therapist patient relationship. We can tell the board everything. They might not. And
Norman Pizza (25:30):
We have the obligation to tell the board
Conrad Meyer (25:32):
Everything. Right? I mean, does that somehow put the, the, the, the, the physician on notice that, hey, I might not be as candid as I want to be. And, and they don’t want that. They want them to be a free, you know, free flowing, transparent doc, you know? And
Norman Pizza (25:46):
Well, you know, the therapist is accustomed and taught right to ask for and find out everything. That’s what they’re supposed to do. The difference here though is that their duty is not really just to the physician, Mr. Peter. It is back and forth. What do you think? And that’s the part the doctor doesn’t know.
Rory Bellina (26:06):
What do you think the position is for some of your clients? Cause I’ve had this come up with a client who was actually concerned to bring in their attorneys or to, you know, to bring us into a meeting with the board. Because, you know, their thought was that if I bring an attorney, I look, I look guilty per se. What do you think that, you know, what do you say to the physicians that either have been called before the board or the foundation, or that they, you know, they wanna self-report and really do get help want an attorney there, you know, to make sure that they don’t overstep something or disclose something that they don’t need to. But, but had that perception that if I bring an attorney with me, does it look like I’m trying to hide something?
Norman Pizza (26:51):
and I have heard that let me say that the board has taken some steps to help that. And now they’re saying that when a physician is unrepresented, they will provide an attorney that the, that the board has, I, I’ve actually seen them do that now.
Conrad Meyer (27:08):
That’s a first. I’ve never, this is Roy and I are looking at me and say, like, what, We have a a public sort of a public defender for the board.
Norman Pizza (27:15):
Yes, I have actually had that happen. I don’t, Now let me say that this attorney is the board’s choice, and I’m not confident that that doesn’t mean the, the lawyer’s not a good one. I just, I’m not confident that their loyalties are sufficiently for the physician .
Conrad Meyer (27:33):
I would agree with that. I mean, why, why by why bite the hand that feeds them? Right?
Norman Pizza (27:37):
yeah. I, and I’m not knocking the, the individuals that do this, but, I’m just not confident that their loyalties are sufficiently strong to the physician. Now, I’ve heard physicians say, Oh, look, I don’t want to, I don’t wanna bring you there because they’re gonna think I’m, I have heard that statement. Yeah. And so the first problem is because they’re worried about that they’re discouraged from even contacting a lawyer. and certainly the, the cost of it is, is an issue that they worry about too. that being said, when I hear that, my response is, Listen, the board has physicians appear before them constantly represented by counsel. They actually frequently like to have the lawyer on the other side because it protects the rights of the physician and it actually expedites getting things done. and that, but that sounds so self-serving. I know, but it, it is absolutely true. I have, I have had on more than one occasion, the lawyers for the board say, Well, I’m so glad that such and such a physician is represented in this matter. I have had that many, many times be said. And unfortunately, physicians don’t know that, don’t think it. And it’s also back to the mindset of the board is there for me, without understanding, No, the board is there for the public and you also,
Conrad Meyer (29:17):
Right? And, and I think that’s and I think that’s really good. I mean, I think the, the problem, and I guess I have this problem too with, with, with physician clients is, and, and you’ll, you’ll, he, you’ll understand when I say this, is there some sort of relationship between the board, the foundation, and these clinics that somehow require a constant feeding right, of, of evaluations you know, where the board is saying, Well, just, we get evaluated, pick one of our clinics and go get evaluated. You know? And, and, and I’ve heard from clients and providers alike that’s, that, that, that say that it’s incestuous, that this is just some sort of kickback. what’s been your experience?
Norman Pizza (30:09):
Well, I’ve heard that too. And, and let me say, I don’t have hard evidence that that’s true. I certainly have circumstantial evidence that that makes me think that it could be true mm-hmm. . but, but to actually state it for certain, I can’t do that. I will say that I know they do have contracts. I know that they rely on the referrals from the board to stay open. I know that the cost is not insignificant. I can’t tell you how many patients they treat that are not referred to them by the board that keep them open. I don’t know the level of income they make from board referrals. Mm-hmm. . I know it’s not insignificant more than that, I cannot say.
Conrad Meyer (31:01):
Got it. So what happens when, and I had this recently with a pool of residents who to, to, I did a, a talk for there, there it was the the co the question was, we as mental as, as providers especially through c have had a, a severe mental health stress, right? Dealing with covid, the lockdowns, whatever, all of the different parameters surrounding covid have just put a real strain on these providers especially even the residents coming up. And the question was, Well, you know, Conrad, what we want to go see a mental health provider? And, you know, we’re part of a system. They have mental health providers here in our, in our GME program. They’ve got all that. but some of these residents were, were truly, I would say the word I would use. We were, were concerned. Is that the right path to go? What happens if we say the wrong thing? Are they truly looking out for my interests? You know? And, and it was a very difficult question to answer. What would you say to a pool of residents, you know, who, who would pose the same question to you? Normal? How would you, how would you tell, how would you answer that question?
Norman Pizza (32:21):
well, you know, if they were just talking to me as individuals, I would first ask them, Tell me the nature of your problem.
Conrad Meyer (32:30):
Norman Pizza (32:31):
And if it was a relatively minor problem, that is not a drug problem, not a sex problem. Let’s just say I’ve been depressed mm-hmm. , I’m, I’m anxious about exams. I’m accustomed to being the number one in my class. And right now I’m like number 50 in my class, . Right? And, and, and those are not uncommon kinds of problems. Mm-hmm. and if it’s just that kind of problem, I would say use that service. If they said to me though, Look I’m self-medicating with alcohol or with marijuana, or with other drugs, or I might have some kind of sexual addiction or something like that, I would absolutely, positively tell them, don’t go to that group. And the reason is that those individuals have a divided duty. They certainly have a duty to the resident who comes to see them.
Mm-hmm. . But they also have a duty to the medical school. And their duty to the medical school is that the residents that are coming there turn out to be good residents who treat their patients properly, appropriately and continue to be good physicians. Now, the fact that they have this pos this, this problem doesn’t mean they’re not going to be a good physician. Right. But it does mean when they go to talk to the, to these, this voluntary group or this group that’s there for them, that the therapist that they talk to, or the physician they talk to, because it is divided or her divided obligation may counsel them to do things that are not in their own interest, is turn in terms of being a physician in the future. Or even potentially having to report them to the medical school itself. all of which, and, and that that’s because of the duty they have to the medical school.
And because of a concern they may have to the public, to the public under, under the terrace off standard. That goes back to like 1976. so just to put a cherry on top, if, if, if the physician goes to the therapist and said, you know, I’m having suicidal thoughts, Right? and having thoughts of killing people, I, I’ve thought about going to the, going to subway station and, and just killing, you know, the first person that gets off the train. and I’m gonna do that next week, probably on a Monday. Well, that fits the terrace off definition. And they now have an obligation to report them to the police. Mm-hmm. now, I mean, I’m giving a really over the top probably most unlikely kind of situation, right. But nonetheless, it is possible that a physician or a resident would have a suicidal thought and say, I’m gonna take my life next week cuz I’m really depressed and I’m gonna do it using, you know, some medication that I’ve, I have access to, or a gun gun or something like that. And, and you would say, Well that’s wonderful that they’re gonna report them then to a, a psych facility cuz it’s gonna keep them alive. And, and that’s true. However, if they went to their own private therapist, the same thing would happen and then they would get care and it wouldn’t be then part of their medical school file.
And so their future as a physician mm-hmm. would be better off.
Conrad Meyer (36:02):
And I was thinking the same thing. I think, I think if you’re coming to me as a private attorney, as your counsel, I would say go find a therapist, pay cash and, and, and stay off the books if it’s a real serious problem like you were mentioning. So, so that way you, you really, you protect yourself cuz you have a true therapist patient relationship.
Norman Pizza (36:25):
That’s exactly right.
Rory Bellina (36:26):
Norman Pizza (36:27):
The obligation of the therapist is just to you. It’s not to you and to the medical school, Right. Or to the board of medical examiners or some other group that has real true obligations and real beneficial something very beneficial to society and to the public as a whole. But you as the physician are worrying about yourself. And as a lawyer, we represent you, that physician, not the public as a whole.
Rory Bellina (36:58):
Mr. Pizza, I wanted to talk with you briefly about kind of where do we go from here and, and one thing that Conrad and I and you I believe were speaking with before we started was you know, there was, it was in the news for a while, a physician out of New York who unfortunately took her life. She was kind of on the front lines during C and it actually, I was, you know, reviewing it, preparing for the show, and it’s the Lore Healthcare Provider Protection Act. I don’t know if you you’re familiar with that or not, but essentially what the, and the act it, it was signed into law. I, the, it was, you know, it established a grant for training you know, also some best practices policies, and they wanted to I think the focus is on physician and healthcare, professional mental health you know, burnout, that kind of thing. Do you see that that is the, the best way going forward as far as kind of, you know, helping physicians or healthcare providers see the symptoms and, and get help? Or do you think it needs to be kind of a total reform of these processes so that they’re not scared to self report because they’re such in fear of the disciplinary action they could face?
Norman Pizza (38:11):
Well, you know, I think that the New York law, for example, provides insulation from civil and criminal liability if they act in good faith. And I suppose if I were drafting legislation using the term in good faith would have some appeal to me representing the legislature in making a law as a lawyer representing a client. I’m not nearly so confident that the words in good faith really protect anyone. what it means is that a DA or a plaintiff gets to argue in court as to whether your actions or inactions constitute good faith. that litigation may or may not be confidential. I, and so there’s no guarantee that the therapist is actually protected from a lawsuit or a criminal action based on the good faith standard. A lot depends on who interprets what good faith means. and if they don’t interpret good faith the way you think of it, you face potential liability. Am I answering your question?
Rory Bellina (39:34):
Yeah, I think so. I, I think what I was trying to get to the part of is that, you know, if a physician or a provider has an issue or, or, or needs help, we’re not trying to discourage that. I think we’re just trying to explain to them that, you know, that there are some, there are some hiccups that they could face or there’s some, you know, based on what they say and what the issue is, you know, they, they’ll get some help, but they might get more than that. They might get additional monitoring, They might get you know, put into one of these foundation systems. There’s, there’s just things that they need to be aware of. I mean, I think we could all agree that if they need help, that they should get the help, but also be aware of, you know, what, what that might entail as well.
Conrad Meyer (40:14):
Well, I think what we’re trying to say is, is the pitfalls, Roy, the unintended consequences of what happens if you go in uninformed and, and, and you follow in one of these bear traps, right? You go in with the intention, Hey, I’m gonna go to, I’m gonna go to these clinics and I’m gonna get evaluated and I’m, I’m gonna be really open and honest. I’m gonna, I’m gonna, you know, play ball with the therapist. Right? And suddenly things that you did before that have no bearing on why you came in to begin with, now you’re stuck in with these monitoring agreements and you’re paying for polygraphs and drug tests, and you’re like, Wait a minute, I really didn’t do any of this. Right. So, you know, and, and I agree with you. I don’t, I don’t wanna discourage that, you know, I don’t wanna discourage physicians from getting mental health. I want them to get to mental health. I mean, I think all of us need, you know, you know, sometimes you need to sit down and talk to someone. But what I, I think to norm’s point is you need to know, especially when going to these board approved places that when you’re talking to people, you’re not talking just to that therapist, you’re talking to the board as well.
Norman Pizza (41:19):
Sure. And even the medical school, even when the medical school offers help.
Conrad Meyer (41:22):
Norman Pizza (41:24):
this, this is a kind of Trojan horse. what’s that old thing about related to the Trojan Horse Greeks? Beware of Greeks bearing gifts.
Conrad Meyer (41:33):
. That’s right. That’s exactly right.
Norman Pizza (41:35):
So, so when they offer that help, that’s in good faith. I don’t wanna say it’s not in good faith, it is in good faith and frequently very useful. But it depends on the level of your problem, whether you should accept that help or whether you should go get independent care from a unrelated therapist to take care of your problem. And if you have any doubt, if you have any concern, I would say your rule of thumb should be go to an independent therapist
Rory Bellina (42:06):
And Norm. That’s exactly where I wanted to go. As we start to wrap this up in kind of a final thoughts is, you know, if there is someone listening that, that, you know, is that person or that knows someone that, that needs some help, like we all said, we’re not trying to discourage getting the help, but, you know, kind of what do you recommend they do, whether they go to the bore or the foundation or, or go independent, just to kind of summarize, you know, how we can make sure that they get help, but they’re also protecting
Themselves, protect themselves.
Norman Pizza (42:37):
Well, first believe it or not doctors call me and I’m sure they call you, and I give them advice over the phone, and it’s not infrequent that I make no charge whatsoever. Mm-hmm. , and I say that as background for this. If you have a concern that perhaps your mental problem is serious, call the lawyer first and ask, Is it prudent for me to go get this free help, or should I go to the independent therapist? and if the question is just that, it’s unlikely that I’ll charge them anything for that advice. and I may tell them, Go get the free help based on your concern what your problem is. but if if what they say is, is more serious in my mind and could trigger a greater deeper investigation, I’m gonna tell them, Go get an independent therapist.
Conrad Meyer (43:34):
That’s great advice. That’s great advice. And so with that norm, I think we’re gonna wrap it up here for the I think a very informative, you know, episode. I, I think one that needed to be done, one, especially in light of some of the cases that I think Rory has, and, and I know I have, and, and Norm, I know you have because we get these questions asked all the time. And, and it really caught my attention when I went to the, the PGY three s at this, this one residency group. And I was asked that, and it really caught me off. I’m like, Wow, I can’t, you know, I I, and all the attendings are sitting there right in the audience and I’m like, Do I do the party line? Right? Or do I, and do I say, as your, as your attorney, here’s what I really would do. Right? right. So anyway, with that being said, thank you very much Norm for joining us in today’s episode. I think we’re gonna wrap this up. we’re gonna be looking for everyone to comment. If you have any comments, please come to our podcast channel we’re at the Apples, Spotify, Google, all those things. And I think we even have an, an email now. Is that right, Laurie?
Rory Bellina (44:38):
Yes. Yeah, that’s correct. If you have any questions, comments, topics for future podcasts, please.
Conrad Meyer (44:42):
Emails. Emails. I think it’s podcasts@chehardycom. Correct. So Norm, thanks for joining us today. Stick around for a moment while we talk to you after the broadcast. And everyone, check us out at shahar.com podcast, Health Law Talk, Conrad Meyer, Rory Belina, we’re out, and look forward to hearing you soon. All right.
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