Landrith disagrees. He says drug-testing physicians for more than five years would be cumbersome and unfair.

"We don't have any information to the fact that there's something wrong with the status quo. Lifelong monitoring would probably be unfair. We'd say, show us the data. Show us the studies that say it's appropriate. If you can show us the studies, then we'll talk," Landrith adds.

Dr. Greg Skipper, a national expert on physician addiction, heads Alabama's equivalent to the MAP program. He has studied thousands of addicted physicians and thinks lifelong monitoring would better protect not only the public, but also physicians.

photo illustration by Giulio Sciorio


First in a series. Read the rest of "Prescription for Disaster" here.

"I think lifelong [monitoring] is a good idea," Skipper says. He adds that more state boards, such as Alabama's, are requiring some physicians to agree to lifelong monitoring. Arizona's is not among them. In fact, the Arizona Medical Board could not name a single physician who has opted into lifelong drug testing.

"The medical board can say you have to do this indefinitely," Skipper says. "Sometimes malpractice companies will require it. Actually, that's becoming more and more of a trend, where some third-party requires lifelong monitoring."

In California, that third party is the Legislature. After California's physician rehab failed its fourth audit, state lawmakers there forced the board to scrap its MAP program and present something more effective by June 2008.

Audits of the California program revealed many of the same holes found in Arizona's: physicians practicing unmonitored and killing or injuring patients, and MAP graduates relapsing into career-ending addiction.

A full-fledged audit could dig much deeper than New Times did, simply because more information is available to auditors. A committee of state lawmakers can order the Arizona Auditor General to perform such an audit. Fellmeth says that's the only way to evaluate the program's success or failure.

"An external audit is invaluable. Unfortunately, you cannot believe the medical board because most members of the medical board have no idea how that program works or how it's supposed to work. You can't trust the staff of the program to be straight with you. They never want to self-report, 'Oh, we're doing a bad job,'" Fellmeth says.

"We've had 27 years of spin about this program, of essentially lying with this false success rate, and every state program does it. I've seen it. Our program doesn't monitor any participant after they've left the program. They have no idea if this program is effective in the long term. To make any conclusions, you have to continue tracking them."

Downey, the medical board spokesman, says the board isn't cutting breaks for addicted physicians. "The Arizona Medical Board always keeps its mission in mind: Protect public health and safety. It investigates these cases completely, thoroughly, and fairly in a standard way with a formal process."

Downey admits that it's a tricky business to balance the doctor's right to practice with the patient's right to safety.

"We're trying to preserve the physicians we have. If we can rehab a physician and get him to take care of his problem, we don't lose a physician," Downey says. "The problem is, when you revoke a physician's license, you impact the lives of about 2,000 patients who are looking for a physician. That's not so easy these days. That doesn't mean we cut the doctor any deal. It's just, we're trying to balance public safety with the doctor's career here."

Laura Migliano's story ended with her death after Dr. Thomas Grade over-prescribed methadone. But Grade's story continued.

After Migliano's death, Grade's partners voted him out of the practice and the office building he'd constructed. But Grade still held his license to practice, with a restriction only on the drugs he could prescribe.

Two years later, on March 4, 2006, Kathryn Curtis Campbell nearly died during a routine cervical epidural performed by Grade. According to a lawsuit and a medical board complaint, Campbell's heart stopped; she was legally dead. She was revived and rushed to a hospital. The lawsuit has since settled out of court for an undisclosed amount.

Grade continued to practice. Another complaint was filed, but because the board dismissed it in April 2007, the details remain secret.

Two weeks after that complaint was dismissed, Grade's wife, Emily, a radiation oncologist, arranged an addiction intervention.

On a Wednesday afternoon, Grade drove his black Mercedes SUV into the upscale Circle G Ranches neighborhood in Gilbert and parked next to his restored 1969 Camaro in his three-car garage.

At his home, Grade's family and friends, along with a professional interventionist, tried to convince Grade that he needed help for his addiction. The intervention didn't work.

According to a Gilbert police report, "Thomas became very angry and ordered everyone out of the house. When they all refused to leave, Thomas started screaming and yelling obscenities."

Grade shoved his wife, shouted at the interventionist, and retreated to the basement, yelling. Gilbert police arrived at the home to find Grade inebriated and barricaded in the closet of a basement bedroom.

Officers beat down the bedroom door and tried to arrest Grade. When he resisted, they used a Taser on him.

Grade was booked at the county jail. His wife soon dropped all charges.

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