System Changes Needed to Support Physicians Seeking Help

In hindsight, Luther Philaya, M.D., believes his symptoms of anxiety started when he was a child. It wasn’t until his second year of medical school, however, when he had his first panic attack and became aware that something was really wrong.

“I was prescribed Xanax, and it not only aborted the panic attack, but for the first time, I didn’t feel anxious. It was like I was in heaven,” Philaya said. “I tried amitriptyline and nortriptyline, but benzodiazepines worked the best, and I was prescribed them on and off through medical school and residency, and they got me through.”

Philaya, now 60, is board certified in family medicine and has spent 22 years working in a rural setting, first as a family practice doctor and then in the emergency department. While at first he was getting legitimate prescriptions from his doctors, soon he was asking physician friends to write them. When an injury led to a prescription for hydrocodone, he added opiates to the mix.

“It was the 1990s, and the drug companies told us opiates were safe, but I realize now that I treated the anxiety with benzodiazepines and the depression with opioids,” Philaya said. “Both washed down well with top-shelf gin. I ignored the mental health problems I knew I’d had for a long time, I felt calm and energetic, and I was highly functional. Doctors don’t get help for these problems.”

In 2010, things started to spin out of control. Philaya began to divert medications; he would prescribe them to someone who would fill the prescriptions and return part of the supply to him. He was having problems in his personal life as well, and his depression became severe.

In late 2012, he rented a cabin in northern Minnesota with a plan to end his life. He calculated the dosages he would need to die, and with a bottle of whiskey, he began swallowing pills. Philaya fell asleep before he finished taking the opiates, and a friend found him, still alive. The friend made coffee and stayed with him until he was awake and safe.

The next day, Philaya called a rehabilitation center and began the process of admitting himself to the center’s program for health care professionals.

He informed his supervisor at work that he would be going to rehab. “I was hoping for support from the only health care system I’d worked for—I had been there for 22 years. That support never materialized. The environment became hostile, and my colleagues ostracized and avoided me.”

Philaya’s employer reported him to the state’s medical licensing board. In addition, he had self-enrolled in Minnesota’s physician monitoring program, and his honesty regarding medication diversion also triggered a licensing board report. The cascade continued and included the loss of his job, board sanctions, revocation of board certification, and convictions under the Drug Enforcement Act.

Over the last five years, Philaya has been active in the recovery community in St. Paul, and he has remained abstinent from drugs and alcohol. He has fulfilled the requirements of both the medical and legal communities and has been able to reinstate his Minnesota medical license. He has worked in medical informatics, but has not yet returned to the practice of clinical medicine.

“I wanted to give back, and I applied for an addiction medicine fellowship at the University of Wisconsin-Madison. I was accepted and was scheduled to begin in January of 2017.”

With credentialing and licensure in place to start training in Wisconsin, Philaya learned that the Office of the Inspector General had placed him on an exclusion list: a physician convicted of diversion cannot work for any agency that receives federal funding. Despite that setback, his plan now is to start a cash-based family practice with a sensitivity to issues related to addiction, a sensitivity he has not seen in his own physicians.

Cases like Philaya’s illustrate how complex it can become when a physician chooses to seek treatment for mental illness and addiction. Once a physician gets into a difficult place, seeking help may trigger a career-ending cascade of events. Medical boards are charged with protecting the public, and it’s not unreasonable to assume that someone in the throes of addiction with a suicidal depression should not be treating patients.

Philaya came to the attention of his state medical board when he sought help and was reported. Another way physicians come to attention is through self-report on licensing forms, both for initial licensure and for renewal. States vary on whether they ask specifically about mental illness and substance abuse, as opposed to other illnesses that may be disabling, and about the time frame of treatment for these disorders. Along the spectrum, there are states that don’t ask about psychiatric illness, others that ask about mental illness that is currently disabling, and those that ask in a very broad way whether an applicant has ever been treated for any psychiatric disorder. Answering “yes” may delay licensure and subject the physician to intense scrutiny, a demand for psychiatric records or further evaluation, and significant expense.

In a country where physician burnout is rampant and suicide claims approximately 400 physicians a year, one might wonder what purpose it serves to ask these questions on state licensing forms. Does physician self-report make patients safer? Does it dissuade physicians from getting much-needed care for fear of having to report it and open oneself up to intrusion?

Philaya quietly suffered for decades, all the while self-medicating. Did he mention his panic attacks, his anxiety, his depression, or his medication use on his licensing renewal forms during that time? “I was in the throes of addiction,” he said. “Did I answer the questions honestly back then? No. Better to lie than to risk the fallout of answering ‘yes.’ And when I was finally honest about my mental illness and addiction, I learned that my fears were justified.”

Untreated physicians suffer, their families suffer, they leave medicine early, and they die. Moreover, their patients remain at risk. Barriers to care need to end, and physicians should be encouraged to get help before they endanger the public or themselves, without fears that their privacy will be violated or their careers detoured. Observable unsafe behaviors should be one trigger for board reporting—not specific diagnoses or a willingness to seek help—and physicians should be asked only if they suffer from any condition that impairs their ability to function professionally.

Luther Philaya’s story is a difficult and tumultuous one. The last five years of his life have been marked by newfound mental wellness, as well as both personal and professional tragedy that has included the recent death by suicide of one of his children. Still, he remains upbeat and optimistic.

“I’ve paid a huge toll for getting the help I needed. The financial cost has been great, the ostracism from peers has been shaming, my professional and personal lives have gone through turmoil, and a legal blemish that will remain with me for life. ... But I’m a fighter, and each time I’ve been punched, I’ve gotten up with more resolve than ever. Despite the battles I’ve endured, since I sought help, I can honestly say I’m in a much better place than I was five years ago.” ■