Doctors with addictions left hanging as diversion program dies

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.