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By New Times
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Phoenix residents may not recognize the name of Dr. Michael Mahl, but Tucsonans might. In 1997, Mahl, a child psychiatrist, was accused of molesting a number of boys at his Tucson group home for troubled teens.
According to medical board records and news media reports, Mahl's descent into drug and sex addiction started with prescription medication and then eventually included cocaine abuse. Mahl testified before the medical board that using cocaine drove him to sexual compulsion. Despite allegations of abuse from his employees and boys at his group home, Mahl was never criminally charged.
In August 2002, the medical board gave Mahl his license back and placed him on the standard five-year probation for drug use. Mahl moved to Chandler, where he's been working as a psychiatrist for adults. On August 9, 2007, Mahl's five-year probation ended, meaning that if Mahl screws up again, the Arizona Medical Board may be the last to know. Even though he testified that cocaine use launched his cycle of drug and patient abuse, he is free to prescribe drugs and counsel adults behind closed doors, without drug tests or accountability.
Mahl is among dozens of addicted physicians who've graduated from rehab and now practice medicine — including performing surgery and prescribing drugs — unmonitored.
At his office in Chandler, Mahl says he doesn't need drug tests anymore. "Five years is adequate. I couldn't imagine having to do it beyond five years," he says.
Mahl knows a number of physicians who finished the five years and then relapsed while seeing patients, but he's optimistic that he won't join them by relapsing.
Arizona lawmakers are, too. They aren't currently considering changes to physician-relapse laws. But at least one doctor thinks the existing system is broken. Cosmetic surgeon Stephen Locnikar wrote a book about his years in Arizona as an addicted doctor.
"I did the board's addiction program, but I never thought it actually applied to me. I thought, I'm just doing this because they're requiring it," Locnikar says.
He graduated from Arizona's rehab program, only to relapse and practice as an addict for years. He tells stories of snorting cocaine off his private bathroom sink between surgeries.
Locnikar believes addicted physicians should be monitored for the duration of their practice.
"After five years, they take the physicians off probation. It doesn't make sense," he says. "After my probation ended, I started drinking, picked up a few pills on the house. Then within a very short period of time — months — I was deep into addiction again. Whenever that probation period was up, and I had no gun to my head, I would relapse. If the probation had kept going, I don't think I would have relapsed. It's absolutely necessary for addicts."
To be fair, no one's trying to let doctors in Arizona get away with murder. In the past decade, the Arizona Medical Board's rate of physician investigation and discipline has increased, and a number of policies have changed for the better. The board has more investigators and examines complaints twice as quickly as it did. But one practice hasn't changed — the board's Monitored Aftercare Program (MAP) for addicted physicians.
Local addiction experts Dr. David Greenberg and Dr. Michel Sucher run the MAP program. They did not return messages left at their office and declined requests through the board's spokesman, Roger Downey, for interviews. Downey said his agency is too busy to track the relapses of MAP graduates. Greenberg and Sucher report that 80 percent to 90 percent of MAP graduates do not relapse, Downey added.
New Times researched hundreds of medical board and physician records to see whether that success rate was accurate. It's impossible to determine because some doctors enter and exit the program confidentially. But 75 percent of the MAP graduates investigated relapsed after their drug testing ended. And those are just the physicians who were caught.
The investigation included records of 50 physicians who were disciplined for substance abuse between 2002 and 2007. Only 20 of the 50 doctors graduated from MAP. The board revoked the licenses of the 30 who didn't graduate.
But of the 20 addicted physicians who did graduate from MAP, 15 relapsed after the board stopped monitoring them — and while they were practicing medicine.
Many doctors who graduated from MAP in the 1980s and '90s were not caught relapsing until 2002 or later. Because they weren't drug-tested, there's no knowing exactly when they relapsed or how long they practiced under the influence.
Based on a five-year records review, at least 200 addicted physicians have enrolled in Arizona's MAP program. Downey reports that an additional eight to 10 doctors self-report into confidential rehab each year.
Several legislators were contacted about the laws governing MAP. None was aware that legislation passed in the 1980s requires drug testing of addicted physicians for only five years.
Bob Stump, a Republican who chairs the state's House Health Committee, was surprised to learn Arizona's MAP program has never been audited. "I would certainly be curious to know, myself, what the relapse rate is," he says.
Stump says he has long supported malpractice reform and other physicians' rights but adds that public safety remains his highest priority.
"We can't allow physicians who are relapsed to be taking patients," he says. "If an audit of the board's Monitored Aftercare Program would be helpful to that end, then I would certainly be in support of that."