Friday, February 1, 2008

Is there a Right to Practice Medicine?

On October 11, 2002, Dr. Martin H. Stein, a prominent Virginia psychiatrist, surrendered his medical license to the Virginia Board of Medicine. On January 31, 2008 he petitioned to have his license reinstated.

Stein’s lawyer described him as “a changed man…[who is] looking for the board to give him another chance.” Dr. Samuel Potolicchio, professor of medicine at George Washington University said that Stein “has been doing everything he should be doing to get reinstated.”

I have no first hand knowledge of Stein’s situation. But let’s assume that he is indeed a changed man who has been doing everything right since 2002. What then?

The Board of Medicine’s 2002 Consent Order is painful to read. Stein was “sexually intimate” with “Patient C.” He inculcated false memories of childhood abuse with hypnosis, suggestion and massage. He went shopping with her (for $200 per hour), encouraged her to divorce her husband, and personally appraised her valuables for sale. With "patient H" he prescribed medications in excessive doses, resulting in permanent brain damage. The sordid details go on for 22 pages.

To my reading, the facts detailed in the Consent Order require that Stein not ever be allowed to practice medicine. The violations of trust and competence detailed by the Virginia Board are profound. Reinstating his license would give more weight to Stein’s right to a second chance than to protecting future patients. Responsible self regulation is a core requirement for the medical profession. Practicing medicine is a privilege, not a right. Reinstating a physician who had abused trust so extensively for such a long time would make a mockery of the self regulatory concept.

Yesterday the Virginia Board did the right thing – it refused to reinstate Stein’s license.

37 comments:

Anonymous said...

Martin Stein treated me for several years. I found him to be a warm caring doctor.

Jim Sabin said...

Dear Anonymous

Thank you for your comment. You might be interested in the post I wrote on August 16 that touches on the same topic - whether a physician who violates ethical expectations with one patient can provide good quality care to another, a question whose answer, I believe, is "yes."

As I said in my post about Dr. Stein, the Board of Medicine's report detailed VERY serious and VERY extensive unethical conduct. But the Washington Post articles about him at the time report that he had many admirers as well. This is consistent with your experience - Dr. Stein was capable of providing excellent care. But given the pattern of numerous severe ethical violations, had I been on the Board of Medicine I would have voted not to restore his license. In my view, the risks to patients that Dr. Stein might continue his pattern of misconduct outweighs the risk injustice to him if he was truly a "changed man" who would never offend again.

Again, thank you for your comment. I'm glad you had a positive experience with Dr. Stein!

Best

Jim

Anonymous said...

Just because a doctor is warm and caring, it doesn't mean they know what they're doing.

Sadly, malpractice is more common than people think.

Jim Sabin said...

Dear Anonymous -

I'm sorry for the delay in posting your comment and responding - I was in Hawaii for two weeks and am now at a meeting in DC.

I agree with your comment - but in teaching medical students and residents I emphasize the fact that whatever our level of technical skills, we do best by our patients by letting as much as possible of our own capacity for human decency and plain old "niceness" come into our work.

Best

Jim

Stacey Sharp said...

Well said Jim

Stacey Sharp
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Anonymous said...

I was a patient of Martin Stein for many years. I had only a positive experience, and was quite shocked to learn of his actions in other cases. Hearing people describe him as a drug pusher and reading about what happened with other past patients and drugs, really baffles me. The only medication I took under his care was a standard dose of an anti-epileptic, and for a while an unusually LOW dose of an anti-anxiety medication (I asked him to let me try antidepressants on a few occasions, but because I always had bad reactions within just a couple of days, he would not let me try any others). My life had been like living in Freddy Krugar's basement, and every previous doctor gave up on me because their drugs not only did not work, but made me worse. I finally had found a doctor who understood that sometimes the best drug cocktail is logic, reason, and compassion. I overcame unfathomable challenges which I never would have done if I had continued on the path I had been on with other doctors. I did not go to a new psychiatrist, and I no longer need a therapist - Martin Stein did his job perfectly in my case.

It saddens me greatly to know that other patients suffered in the ways that they did. It saddens me even more to know that it was under the care of Martin Stein who I absolutely know for a fact is amazingly brilliant, perceptive, and compassionate. He was an explorer, always looking to solve problems and not afraid to try.

Unfortunately, being bright, curious, and fearless can make an adult person become like a dangerously impulsive and undisciplined child who runs up stairs without putting each foot firmly on every step to make sure he doesn't fall all the way back down.

I don't believe that people at older ages are capable of suddenly developing new self discipline that is at the level needed to provide unquestionable medical care to the general public.

This is very unfortunate for Martin Stein because it clearly demonstrates that the Board made the right decision. But I want people to know that Martin Stein DID save people's lives. I hope that he is able to find the peace in his life that he helped me to gain in mine.

Jim Sabin said...

Dear Anonymous -

Thank you for your very thoughtful comment.

Your experience confirms our understanding of the complexity of human nature. Dr. Stein clearly served you very well. He was not only helpful in his therapeutic recommendations, but you experienced him, for years, as compassionate and caring. That's good evidence to show what his capacities were.

I find it difficult to imagine how someone with Dr. Stein's capacities could have comported himself as badly as he did with other of his patients. It's hard to imagine that he did not know he was violating fundamental ethical standards in a totally unjustifiable manner.

It would be helpful to the medical profession if Dr. Stein and others who have conducted themselves in a similar manner shared a full and honest account of how they thought about their own actions. Did they delude themselves into seeing the actions as justifiable? If so, how? Did they fully recognize the wrongness of what they were doing, but allow themselves to proceed anyway? If so, how?

Congratulations on your own capacity to hold to your own experience of superb care from Dr. Stein and, at the same time, to hold him responsible for his deviations in other circumstances!

Best

Jim

Anonymous said...

I was a patient of Dr Stein and also happen to be a medical professional (granted, I practice on animals, which may explain my trust in the man, since psychotropics weren't much on my radar and he seemed smart).
Dr. Stein's fall, in my eyes, was a result of pure, unadulterated arrogance. Yes, he was brilliant. This is obvious to anyone who has a conversation with him. Yes, he kept me alive, something many others had greater difficulty doing.
However, he also described anyone who disagreed with him as "an idiot" and certainly saw himself as beyond any rules anyone else had to follow. This may have helped many, but also harmed quite a few. Sometimes, a new approach is necessary, outside-the-box thinking is all that can help. But when it is accompanied by reckless arrogance it can be dangerous.
I was on a cocktail of drugs that has killed other people (read Anna Nicole Smith and Heath Ledger) and am lucky to alive and drug-free today. I have found a brilliant nurse practitioner who has been able to lead me into healing and out of a drug-induced haze.
Yes, Marty Stein kept me alive when I was very suicidal, but he never helped me heal. He was indeed caring and compassionate, but also reckless and believed he didn't need to answer to anyone. And psychiatrists need to be aware that once they have a patient on three psychotropic drugs, any judgement is impaired, and it is very easy for us to accede to more.
I once wondered how I would get along without Marty Stein. Now I wonder how I survived him.
Be careful out there!

Jim Sabin said...

Dear Anonymous

First, I'm glad to hear that you have experienced healing and are doing much better than when you first saw Dr. Stein.

The pattern you describe - originality, creativity, and out-of-the-box thinking, combined with what you call "reckless arrogance," paints a very clear image. It's a constellation of traits that can do great good but also great harm. From what you say, this, sadly, is what happened with Dr. Stein.

Thank you for the very thoughtful comment!

Best

Jim

Cali said...

When I came to Dr. Stein I was severely agoraphobic. Only people who suffer from this know the prison that you are in. Dr. Stein gave me my life back. And I am having a horrible time finding another Dr. that can help me get over the current roadblock I am dealing with. I was never prescribed high doses of medication. And if I ever had a problem with the medicine he would tell me to stop taking it. Dr. Stein restored my life to me. Please give this man another chance. Your doctor is, your doctor not your parent. Maybe some of his patients were drug addicts. So the rest of us have to suffer because of people who abuse their prescriptions?

Jim Sabin said...

Dear Cali -

I am sorry to hear about the difficulty you are having finding another clinician to help you. It's clear from what you say that Dr. Stein did very well by you. We know from other comments that other patients of his had the same experience of excellent care. It is a sad situation that someone who could be as helpful to many as Dr. Stein apparently was could also betray his professional responsibilities as seriously as he did with other patients.

Agoraphobia can indeed be a source of tremendous suffering. But it is also a very helpable condition. There are effective psychological and pharmacological treatments. Your primary care physician or the local professional societies should be able to help you connect with someone who will be able to work well with you as Dr. Stein did many years ago.

I want to wish you good luck and good health in the future!

Best

Jim

Anonymous said...

My experience with Martin H. Stein and the medical business can be summed up as follows: I am lucky to be alive. Martin H. Stein prescribed to me 160mg of Prozac per day -- twice the maximum amount as indicated by the manufacturer's documentation, I later learned. He verbally instructed me to take up to 200mg of Prozac per day, which I did. The side effects from this overdose of medication caused a multitude of issues for my nervous and digestive systems, for which Martin H. Stein prescribed additional medications, including Xanax and Klonipin. He also prescribed a medication for RLS. After 3+ years my digestive and nervous systems were so messed up I thought I might have a condition that was not being addressed, so I went to a gastroenterologist and had several tests performed, all of which came back negative. I also saw a general practitioner who regarded me as a nuisance. Martin H. Stein referred me to a psychologist who was better suited for treating people who had issues deciding what clothes to wear -- seriously.

After losing my job because of my deteriorating health, I quit Martin H. Stein and the medications he had prescribed so I could locate and hold a job. After several very difficult and painful years of no medication, a friend informed me of a relatively new anti-depressant he was taking with very good results. He had been informed of this medication by his sister, who was also having positive results with it. I was then prescribed this medication by a general physician working out of his own clinic -- old school with weekend hours. After several years of taking it on and off, at various levels, and at different times of day, I was able to determine what worked for me. The same was true for a medication he prescribed for RLS. I currently take a small dose of each medication, prescribed by a general practitioner, which I adjust from time to time as needed.

A number of doctors, including those at a hospital, had the opportunity during my association with Martin H. Stein to see that I was being seriously overmedicated, but did nothing to address the situation. The same is true of the companies that filled my prescriptions. My health insurance company did nothing, although they were also aware I was being overmedicated. By the time I was able to focus on something other than my job and providing food, clothing and shelter for myself, the pathetic 2 year statute of limitations for medical malpractice in my state was long past.

My health, personal life, finances and career were seriously disrupted or destroyed for a decade as a result of my experience with Martin H. Stein and his conspirators in the medical business. But, as I said at the beginning, I'm lucky to be alive.

Jim Sabin said...

Dear Anonymous -

I'm very sorry to hear about the terrible medical experiences you've had. I hope that you have gotten back to a state of good health. But you suffered many years of disrupted life. I can't account for why none of the physicians you consulted helped you get out of the harmful treatment you were experiencing earlier.

Since we're at the turn of the year, I want to wish you a healthy and happy 2012!

Best

Jim

Anonymous said...

I saw Dr. Stein from the impressionable age of 16 until I was about 20 and then still kept in touch with him, visiting, writing and calling. For me he was my "knight in shining armor" who did save my life literally and figuratively speaking. He came charging in, did not pussy-foot around me like other therapists had, and I think he was charismatic. That can be dangerous with an ego like his. There were very weak boundaries between us. He was so invested in my treatment, and I knew he truly cared about me, AND I think I needed that person who would reach out to me and pull me out of my crisis. However,, I knew from the beginning somehow, that someday he would get into big trouble. What this might be was vague in my mind. However, I vowed to myself that I would never tell people some of the things he said to me or things that went on which we simply out of bounds, not terrible.
I tore up letters he wrote to me,etc.
He never over-medicated me. He had my best interests at heart. However, he didn't help me deal with my attachment to him...he encouraged it. I moved away and was able to block him out, in a sense. To this day, age 44, he is still a powerful force in my mind when he should not be. He was an intense powerful person. The Washington Post article broke my heart. It was as if he had died. He had done such bad things. I was shocked and grief-stricken like nothing ever before. I was hospitalized due to my feeling so out-of-control emotionally. My rock turned out to be not there. He had promised me (this sounds silly) that he wouldALWAYS be there for me if I needed him.
I wish I could help him. I wish there was resolution to this for me. How do I file this away? I don't even know what he does now. Does anyone help him? He must have gone off the edge...his mind must have gone askew.
I feel so horrified and terrible for the people he hurt.

ruth

Jim Sabin said...

Dear Ruth

Thank you for your thoughtful, compassionate, and pain-laden comment.

It sounds as if even as a teenager you (a) received significant benefit from Dr. Stein, but (b) recognized his failings, which (c) allowed you to keep some (but not enough) self-protective distance in your relationship. He was a "saviour" for you, but also exploited you, ultimately by not helping you detach from him in a healthy manner, which is a basic responsibility for every therapist.

What you are struggling with is analogous to what is seen in adults who have had relationships with parents who were both loving and abusive, and where the parent was ultimately seen to have behaved in a disgraceful manner towards others. This is a very painful state, but one that can be dealt with. I hope you have a strong therapeutic relationship available to you now within which you can work on the difficulties you still experience. If you do not, there are therapists who have had extensive experience working with patients who have been mistreated by previous therapists, and a local psychiatric or psychological professional society could help you identify such a person.

Thank you again for sharing your experience and insights! I want to wish you good luck and good health in the future!

Best

Jim

Anonymous said...

It has been nearly a decade since the Virginia Board of Medicine intervened to protect vulnerable patients from Dr. Stein, and yet his former patients are still writing about him.

It is apparent from his board findings, the comments posted here, as well as those mentioned elsewhere, that many of his patients were dangerously over medicated. At least one woman, wife and mother lost her life to his excessive ego-driven treatments.

This is an epic failure on behalf of the Virginia Department of Medicine to intervene and protect the public. Had Dr. Stein been anything other than a licensed physician, he would certainly have been charged with sexual assaults, drugging and tortuous brainwashing of people. What do you call someone that profoundly overdoses people, and then engages in sexual misconduct with them? What do you call someone that flagrantly ignores the warnings about the proper dosages of prescription medication? What do you call those so-called professionals at George Washington University Hospital that were aware of Stein's gregarious therapies and prescribing, yet chose not to intervene on behalf of the patients?

Why did the career of one man weigh as more important than the careers, health and well-being of the many patients he was mistreating? A career is a career, just because someone chooses a career in medicine should not exempt them from accountability for so many years. This freedom in healthcare, the freedom to practice medicine should not ignore the rights of patients to receive quality, safe, effective and ethical treatment.

Victims rights laws should be in place that would require patients be notified when their providers are found guilty of such gregarious acts. Medical professionals, especially mental health professionals who over medicate, manipulate and engage in sexual misconduct with their patients should at a minimum be held accountable to the same sexual assault laws as any other citizen.

The Commonwealth of Virgina's Board of Medicine is seriously failing to protect the population from the people they entrust with their healthcare. Dr. Stein is no exception, he merely got caught. If you look through the Board findings, you will find other such professionals engaging in misconduct and gross negligence with their patients yet continuing to practice.

Providers who have lost their licenses in other states seem free to relocate to Virginia to continue their practice. Virginia is becoming a safe haven for practitioners who endanger the public, all under their guise of health and medical freedom.

Jim Sabin said...

Dear Anonymous -

Thank you for your comment. It sounds as if you have information about Dr. Stein that goes beyond what I wrote about and what the comments have added.

With regard to the question of filing criminal charges - charges of that kind would have to come from patients. The Board of Medicine cannot make criminal charges on behalf of a patient. From a Google search I just did, I don't find reports of any actions of this kind taken against Dr. Stein.

Unfortunately, your comments about failures of self-monitoring and self-policing on the part of the medical profession, have a great deal of truth. The situation is definitely improving, and medical boards are more vigilant in reviewing potential misconduct and taking the actions allowed to them by law. Certainly the Virginia Board was correct in not reinstating Dr. Stein's license.

Your comment implies that Virginia has been more lax than other states with regard to appropriate discipline. I have no knowledge of the history of actions by the Virginia Board. But in relation to Dr. Stein, the Board did the right thing.

Best

Jim

Anonymous said...

The Board did right in suspending Stein's license and refusing to reinstate it despite Stein's requests. The Board should have begun a more thorough investigation years earlier when the first patient complaints were alleged, rather than wait years for a peer medical provider to file a complaint about him.

In general, upon closing their investigations, it should be required that the Board notify each patient of such outrageous providers and provide the patients with a copy of the disciplinary charges or instructions on how to find them on the Board's website. The disciplined physician should pay the expenses for such notification, rather than the taxpayers of the Commonwealth.

The Board of Medicine should be required by law to share their investigation's findings of sexual abuse by medical providers to other law enforcement agencies. Medical providers found guilty of engaging in sexual exploitation of their patients should be held accountable and investigated by the Commonwealth in the same manner as any other sexual predator. It should not be the responsibility of oftentimes impaired patients to file complaints to multiple enforcement agencies about such predators when the Commonwealth's own Medical Board has already discovered and investigated such actions. There needs to be better communication across enforcement agencies.

Given that Stein's treatments consistently depict a pattern of excessive prescribing, it is difficult to imagine how such impaired individuals could act on their own behalf to file any complaints, criminal or otherwise, or even be aware that an investigation (closed or otherwise) had been done.

As documented, some of his patients were on 22 prescriptions a day for example, with many being double the recommended dosage. Such impaired patients could not reasonably be expected to act in their own behalf or effectively seek help elsewhere, especially when other physicians (GWU) were neglecting to intervene due to misguided attempts to protect Stein, or even worse, when those patients were referred to other physicians who practice in the same unethical manner of overdosing and inculcating false memories.

Jim Sabin said...

Dear Anonymous -

First, I apologize for the long delay in responding. I've been away from the blog for several weeks.

It sounds as if you have knowledge of the history of complaints to the Board. (I don't.) If the Board didn't do a careful enough investigation of earlier complaints about Dr. Stein that would be a serious lapse!

Apart from whether there are legal or regulatory restrictions as to whether the Board can share its findings with law enforcement agencies, I lean against that recommendation. It's possible to imagine that a patient might (a) want to make a complaint to the body that regulates the profession but (b) not want to bring legal charges against the practitioner. I believe that decision should be in the hands of the patient, as it is in the hands of the victim in domestic violence situations. It may seem to observers that a patient's decision about legal charges or victim's decision about a restraining order is not the one they would have recommended, but to me it seems ethically correct for the decision about bringing a legal complaint to be in the hands of the patient and victim.

That said, it's crucial for professional societies and regulatory boards to be diligant and vigilant in their responses to complaints. Part of the implicit contract between society and the medical profession is that the profession will regulate itself in accord with public interest. If a profession fails to do that it will and should lose trust.

Best

Jim

Anonymous said...

to me it seems ethically correct for the decision about bringing a legal complaint to be in the hands of the patient and victim.

If I understand your viewpoint correctly, you are stating that a patient sexually assaulted by a medical provider should be the one to initiate any criminal complaint about the alleged sexual assault. I'm stunned - how is this ethical?

By your interpretation, a physician can sexually assault a minor, the medical board can investigate the action, find the provider guilty, yet the provider would not be subject to the same criminal child abuse laws as the rest of society.

There are mandatory reporting requirements that must be followed when teachers and others suspect such abuse. Why should physicians and the Commonwealth of Virginia Board of Medicine be exempt from such mandatory reporting?

You seem to offer little understanding that, as in the case of Martin Stein, some psychiatric patients may be disabled to such a degree as they can not defend their rights. What if an adult with dementia was sexually assaulted by their physician, and during the course of other investigations the medical board learned of those actions, would you still find it acceptable that the Commonwealth have no mandatory reporting requirement of such crimes?

Furthermore, mental health professionals especially, as well as other physicians who have been investigated by the medical board and found guilty of sexually exploiting a patient should be required to register as a sex offender. Physicians should not be above the law when it comes to sexual offenses.

Jim Sabin said...

Dear Anonymous -

Thank you for the questions you raise. They point to some ambiguity in what I've written that allows for misunderstanding.

For patients with dementia who are not competent to represent themselves, typically a family member would have power of attorney or guardianship, and would speak for that person. And with a minor, of course all applicable laws for reporting would apply.

I don't agree with your suggestion that a physician who has been found culpable for sexual misconduct should be registered as a "sex offender" unless the conduct is found in court to meet that state's definition of "sex offender." As an example of why I disagree with your suggestion - consensual intercourse with a current patient would warrant ethical discipline, perhaps including permanent loss of license. But consensual intercourse does not warrant the label of "sex offender."

Best

Jim

Anonymous said...

"For patients with dementia who are not competent to represent themselves, typically a family member would have power of attorney or guardianship, and would speak for that person. And with a minor, of course all applicable laws for reporting would apply."

I am not getting a clear understanding from you as to whether or not you find it acceptable, under any circumstances, for a mental health practitioner to engage in sexual relations with their client(s). In the case of a patient with dementia being "not competent to represent themselves", that is a legal definition as determined by the courts. A patient with dementia may not necessarily have such a designation of incompetency.

Under any diagnosis, a patient seeking mental health services should be viewed as vulnerable and susceptible to persuasion, and by virtue of their seeking such services should be given every opportunity to receive said medical care in an environment that is safe, healthy and fosters their recovery.

Mental health services are for the benefit of the patient. The only apparent benefit for the provider should be the same as that of any business practice with only a resultant financial gain from the exchange of his/her services as a professional.

Under no circumstances should the mental (or physical) health services of any patient be for the sexual pleasure of the practitioner. There should be a zero-tolerance policy to this effect, which will require laws to be amended and new laws to be passed.

Mental health providers found guilty by either a medical board investigation or another law enforcement or legal entity investigation, should have their license revoked and be automatically reported for criminal investigation of perpetrating a sex crime. In the case of psychiatrists, it is even more unethical to have a sole practitioner diagnosing the patient, medicating them with thought-altering drugs, and then engaging in private guided counseling sessions to discuss the most intimate aspects of their lives, while becoming sexually involved with them.

There should be no exceptions to this - Providers should not be allowed to engage in sexual relations with their clients. Zero-tolerance.

Jim Sabin said...

Dear Anonymous -

Thank you for your further comments.

Re your question, as I've said in many of the posts that can be found under the "doctor-patient sex" tab on the blog, I support the American Psychiatric Association ethics principle that sexual relationships with present and former patients are unethical.

But unethical and criminal are not the same. Civil disobedience involves disobeying laws ("criminal" action) in service of ethical principles. And while I agree completely with your view that mental health treatment should involve a safe and reliable environment, I don't agree that the ETHICAL violation that a sexual relationship would involve is automatically also a CRIMINAL act. As I said, the fact that a sexual relationship was consensual is not a defense against ethical judgment. A psychiatric society ethics committee would presumably expel the physician from the society, and a medical board might revoke the physician's license. But a consensual relationship in a situation where the patient was mature and competent, although clearly a violation of professional ethics, and potentially a source of permanent loss of license, is not something that I would see as a crime in the way that rape is a crime.

Best

Jim

Anonymous said...

Thank you for your reply, although I disagree with your views.

As I said, the fact that a sexual relationship was consensual is not a defense against ethical judgment. A psychiatric society ethics committee would presumably expel the physician from the society, and a medical board might revoke the physician's license.

I fail to understand why even those minimal standards of ethics and enforcement are not being followed in certain cases, such as the following where there was no fine, no suspension, no loss of license, no loss of job, no loss of certification/memberships.

http://www.dhp.virginia.gov/Notices/Medicine/0101027718/0101027718Order02141996.pdf

Anonymous said...

Undoubtedly there were many of us affected by Dr. Stein who have extremely mixed feelings about the medical and emotional/mental health care we received from him. The first time I walked into his office, I saw the office sign outside his door, that gave me some comfort: I believe it was Nuero-behavioral health, or something very like that. It gave me some small measure of comfort in his professionalism and his obviously stated beliefs that psychiatric problems did result from brain-based conditions. Therefore, upon entering his office, and as a mental health provider myself, I was set up to believe this was someone that was thankfully "up to date" and, did not feel in any way stigmatized. Yet, I had a knowledge base and awareness that others of his clients did not, and I still did not survive his treatment unscathed. There were several times I had to talk to other professionals about what happened in his office. I hope they were some of the ones who reported him to the board in some way because this is at least something to hang on to years later when I am left with the reality that he hurt many, many people and that I was unable at the time to report him. The fact of the matter, to me at least, is that he betrayed all of us, and himself. By not acting and prescribing appropriately, he is no longer able to practice medicine. Whether impaired by bipolar disorder or characterological issues or not, mental health providers are expected to take sabbaticals or various other actions when they are medically or emotionally impaired. He hid his impairments rather than facing them. He allowed fear to rule him and apparently covered up mistakes by, for example, signing death certificates, and even threatening patients, and acting on those threats by hospitalizing them. I believe all of this is a betrayal whether your perceived treatment was excellent or not. He is no longer out there to communicate with. We are left to deal with this either with, or without professional help. Some of us undoubtedly feel guilty for not reporting him; anytime that many patients have been egregiously affected, there are many more out there. I have been blessed to have the support I need, yet here I am posting. This is very little in the way of resolution and "letting go." I would urge the Virginia Board and all medical boards who have to deal with such situations to grant avenues to affected patients to get help. How do we meet others that were affected? How do we process our feelings in a group who share our pain regarding the same provider?
We may not want or be entitled to monetary compensation, and yet it would certainly be helpful to process with others affected!

Jim Sabin said...

Dear Anonymous -

Thank you for your very thoughtful comment. It is painful to read.

I'm glad you've gotten the support that you as an individual need for dealing with your disturbing experiences with Dr. Stein. I don't know if any m edical boards of registration or psychiatric societies have found ways to convene patients who have been harmed. I think your suggestion is excellent (assuming the process were done well). I know that individual patients have sought help in "processing" their experiences as you apparently did, but I don't know if any concerted efforts have been made to reach out. Thank you for the excellent suggestion!

Best

Jim

Anonymous said...

Dear Anonymous,

Despite the failings of Dr. Stein, what I find inexcusable is the fact that so many other seemingly educated, experienced and respected medical experts failed to intervene on behalf of the patients - year after year after year.

Patients whose health he destroyed were left at that time with no where to turn for help, as all of his actions, even the egregious over-medicating were seemingly willfully ignored by his peers.

I often think of the little boy mentioned in the Washington Post articles on Stein. What if he had no parent that was willing and able to intervene? Even though he did have such a father, the child lost his mother due to Stein's negligence.

I sent the author of this blog a link to a Virginia medical board case where the psychiatrist was found to be engaging in sexual misconduct with his female client, where he was both diagnosing and medicating her. Yet that comment was not posted here. It's his blog, his right. I ask though, why are the careers of the physicians more important than the lives,careers and emotional well-being of the patients?

What happened to the patients of Stein who were so unlucky as to never have anyone intervene or inform them of the real reason he lost his license? Stein referred patients to his friends - other doctors that covered for him. As such, those patients could easily have been referred to another physician who treats in the same negligent and egotistical manner, as was I. What makes people think that patients following their physician's treatment protocol, taking their medication as prescribed, when they are in fact profoundly over-medicated are able or 'competent' to intervene on their own behalf and recognize the inherent dangers of his treatments? How many lives will those other doctors destroy before the appropriate medical board suspends their license? Or, do the boards just wait for patients to start dying before they intervene, which does indeed seem to be the case.

Anonymous said...

Anonymous said: " I would urge the Virginia Board and all medical boards who have to deal with such situations to grant avenues to affected patients to get help."

The Virginia Medical Board does not even notify the patients when their physicians are found guilty of such charges as Martin Stein. Worse yet, once the physician's license has been revoked, the record of the actions is completely removed from the medical board website. Anyone trying to research potential wrong-doings by him or others, would have no idea any such harm had been done. This is a complete and utter failure of the Virginia Board of Medicine to protect and inform the citizens of the Commonwealth - complete, utter willfully ignorant failure.

Jim Sabin said...

Dear Anonymous -

I'm sorry for the delay in responding to your 1/11 comment. I wanted to follow up on your link to the Virginia Board of Medicine, and I didn't get to do that while I was away on holiday (I just got back.)

Thank you for the link (http://www.dhp.virginia.gov/Notices/Medicine/0101027718/0101027718Order02141996.pdf). It's entirely unclear why the Board chose only to reprimand Dr. Fernando for an incident of oral sex with a patient. The case comes from 1995, and I would guess that in 2013 the Virginia Board would have taken a different action. Here are some of my thoughts:

(1) The Board report says nothing whatsoever about its reasoning. That's a failure of regulatory process. If the Board says nothing about the basis for its actions there's no potential for education.

(2) Even if the Board had specific reasons for the VERY light penalty it imposed (many years of exemplary practice, unusual stressors at the time, self-reporting to the Board on the part of the physician...), at the very least it should have imposed an extended period of monitored practice. Not to do so is a failure to protect patients.

(3) As I said above, this Board action is from 18 years ago. I would be very surpised if an identical incident in 2013 were not handled differently, both in the action taken and in the explication of the Board's reasoning.

Thank you for raising these questions!

Best

Jim

Jim Sabin said...

Dear Anonymous -

I'm guessing that both of the two anonymous comments submitted on 1/19 and the 1/11 comment I just responded to are from the same person. But in case I'm wrong I'll apologize again for the delay in posting and responding - I didn't spend much time on my blog when I was on vacation.

I see the most serious issue in the two comments as this: "...the fact that so many other seemingly educated, experienced and respected medical experts failed to intervene on behalf of the patients - year after year after year." While I don't know any details of who knew what when, it's an unfortunate fact about medical culture that physicians are reluctant to bring concerns about colleagues to the attention of appropriate authorities. Sometimes this is due to uncertainty about the truth of a situation. Sometimes it's because the patient who is reporting his or her own experience refuses to lodge a complaint. But there's no doubt that over the decades there has been a culture of protection of colleagues even when "protecting" a colleague fails to protect patients.

I put the word "protecting" in the previous sentence into quotes, because not reporting serious concerns prevents or delays the response to the colleague's aberrant actions. That delay also exposes the physician to harm.

The situation with regard to your comment about informing other patients is complex. Many people don't want the fact of their psychiatric treatment known to others. In my view, if the board sees a physician as unsafe, the proper response is revocation or suspension of license, not simply "disclosure" to his or her other patients.

Best

Jim

S.A. M. said...

Dr. Stein was bright and creative enough to really help people. Most do nothing or zero at best. He prescribed what worked for me, it would probably be difficult to find another doctor to prescribe what he did,.. because the laws are designed to hurt the patients and the doctors. It is almost impossible to be a good doctor the way the laws are set up in this country.
I did see someone else as good as Stein, I told him I was worried about my finances and he had me take half of my savings and take delivery on gold eagles in 2007, he fixed my problem brilliantly, but that would be cause for a lawsuit also, such a shame, it is illegal to be really great and effective!
Sara

S.A. M. said...

Dr. Stein was bright and creative enough to really help people. Most do nothing or zero at best. He prescribed what worked for me, it would probably be difficult to find another doctor to prescribe what he did,.. because the laws are designed to hurt the patients and the doctors. It is almost impossible to be a good doctor the way the laws are set up in this country.
I did see someone else as good as Stein, I told him I was worried about my finances and he had me take half of my savings and take delivery on gold eagles in 2007, he fixed my problem brilliantly, but that would be cause for a lawsuit also, such a shame, it is illegal to be really great and effective!
Sara

S.A. M. said...

The article in the Post about doctor Stein was written with such careless disregard for the mans wife and children. The article was a family destroyer. That kind of sensationalism should be against the law, that writer should be sued for unethical and family demolishing writings. This country has become such a horrible place, all the rules and regulations are strangling intelligence and kindness.

S.A. M. said...

Dr. Stein was bright and creative enough to really help people. Most do nothing or zero at best. He prescribed what worked for me, it would probably be difficult to find another doctor to prescribe what he did,.. because the laws are designed to hurt the patients and the doctors. It is almost impossible to be a good doctor the way the laws are set up in this country.
I did see someone else as good as Stein, I told him I was worried about my finances and he had me take half of my savings and take delivery on gold eagles in 2007, he fixed my problem brilliantly, but that would be cause for a lawsuit also, such a shame, it is illegal to be really great and effective!
Sara

Anonymous said...

So, now a new problem, given this situation. He is nowhere to be found. Who is the custodian of his records? How do we find out if old records are available to be released? What would be relatively simple is complex.

Jim Sabin said...

Dear Anonymous -
Thank you for raising a question I hadn't thought about. I assume that Dr. Stein is keeping his records, since this is the expectation when physicians stop practicing. If you haven't done it yet, I suggest that you contact the Board of Medicine about how to retrieve your medical record and have it passed on to another clinician.
Good luck!
Bset
Jim

Jim Sabin said...

Dear Sara -

I'm sorry for the long delay in posting and responding to your June 13 comments. I've been away from the blog, but now I'm back.

I'm glad that Dr. Stein was so helpful to you, but I'm not surprised. Other of his patients also described him as being creative and very helpful. The comments give a picture of someone who could provide excellent, innovative care, such as you experienced, but who was also capable of violating important boundaries and, as seen by some of his patients, practicing in a reckless manner.

I hope that your medical needs are being met, and want to wish you the best of luck! Thank you for your comments.

Best

Jim