I-Team: Some NC doctors, patients still don't trust medical watchdog

CHAPEL HILL, N.C. (WTVD) -- A group of North Carolina doctors and their patients are claiming the state's leading non-profit medical watchdog is not fulfilling its mission and instead unfairly treating physicians and the people relying on their care.

The complaints are directed at the North Carolina Physicians Health Program, whose website says the organization "assists health care providers with substance use disorders, mental health issues, burnout, communication problems and other issues that may affect their ability to deliver optimal care and services to their patients."

The NCPHP, whose financial supporters include the NC Medical Board, assessed nearly 1,000 patients between 2014 and 2018.

'This can't be real'

Ginny Dudek, a Chapel Hill resident battling Lyme Disease, tells ABC11 the NCPHP right now is assessing her physician and the process has prevented the doctor from seeing patients.

"I'm a retired nurse and I've seen lots and lots of doctors in my life," Dudek says. "She's irreplaceable. This can't be real, this can't be happening. She's a good doctor.

ABC11 has spoken with the physician and is choosing not to name her.

"Never once was there an indication that she wasn't really sharp," Dudek adds. "I'm being denied access to my healthcare, to the healthcare that I need and to the healthcare that has returned me to that state of health."

According to the physician, the NCPHP received an anonymous complaint against her, and assessors are now accusing her of being an alcoholic and that she puts herself in dangerous situations. The physician adds that she was ordered to attend a four day treatment program at a drug rehab center in Virginia - on her own dime - and then a 28 day program followed by monitoring.

The physician, who is rejecting the diagnosis and has not completed the 28 treatment, says she is being "strongly advised" by the NCPHP and NC Medical Board "not to practice" medicine until further notice (ABC11 cannot verify those claims because NCPHP cases are confidential.)

Complaints lead to state audit of NCPHP

Dudek's doctor is one of several physicians reaching out to the I-Team expressing concerns about the NCPHP and detailing prior engagements with them. Two physicians, who spoke on condition of anonymity, tell ABC11 they chose to relocate to another state to practice medicine instead of following the NCPHP's recommendations for treatment.

"They told me that I would lose my license," a physician recalls. "They refused to accept my clean bill of health."

Dr. Jesse Cavenar, a former Duke professor and Chief Medical Review Officer for the U.S. Army, says he's been working with "dozens" of physicians who are trying to navigate the NCPHP process.

"Radiologists, anesthesiologists, internal medicine, surgeons, you name it," Cavenar says in an interview with ABC11. "There are some physicians who deserve to lose their license, and I'm not contesting that for a minute, but if there's a diagnosis being made that doesn't meet muster and the guy loses his license about that, that's something else. I think that's very wrong."

Cavenar's accusations of false diagnoses helped lead to investigation by the North Carolina State Auditor's Office. In a performance audit released in 2014, NC Auditor Beth. A Wood reported no evidence of abuse of financial impropriety, but NCPHP's rules and regulations "did not provide reasonable assurance that an abuse of authority would be prevented or timely detected if it occurred."

In other words, investigators couldn't prove something nefarious was going on, but at the same time there was no definitive way to negate the accusations either.

Among its many findings, the audit would go on to report the NCPHP "did not have objective, impartial due process procedures for physicians who disputed the Program's evaluations and directives," and there was not any "reasonable assurance that physicians received objective and quality evaluations without experiencing any undue burden."

"If a doctor is practicing and loses his license, all of his patient load is without a doctor," Cavenar warns. "I'm just raising questions with them about how do you do what you're doing."

Positive follow-up report

The 2014 report's conclusion also listed five specific recommendations, and in February of this year the auditor's office released a short follow-up report that judged the following:

• The Program should ensure physicians have access to objective, independent due process procedures.

• The Medical Board and Medical Society should develop and implement plans for better oversight of the Program.

• The Program should not allow treatment centers to fund its retreats and should stop directly paying scholarships to the centers.

• The Program should make it clear in writing that the physician may choose separate evaluation and treatment providers. It should also develop procedures for selecting and monitoring treatment centers.

• The Program should continue its effort to identify qualified in-state treatment centers.

In her letter to the NCPHP, the state auditor writes the program "took appropriate corrective action" and complimented the "courtesy and cooperation" of NCPHP staff during the investigation.

Dudek's future treatment in limbo

Despite the positive report, Ginny Dudek and her physician still find themselves at odds with the NCPHP.

"Where's the evidence? Where did they come up with the evidence?"

Left without her physician, Dudek says she's having a tough time finding another primary care physician whom she can feel comfortable with and build a new relationship.

"I went from doctor to doctor to doctor to doctor until I found her," she recalls. "I don't think there's another person like her out there."

As for Dudek's physician being assessed by the NCPHP, she tells ABC11 the impasse will continue without her agreeing to out-of-state treatment.

NCPHP Responds to ABC11

Dr. Joseph Jordan, CEO of the NCPHP, would not agree to an on-camera interview. Instead, we sent him several questions related to Ginny Dudek's concerns, Dr. Cavenar's allegations, and the two state audits among other things:

We've heard from patients of doctors frustrated that they can't see their doctors because of issues related to NCPHP. These patients think their doctor is being unfairly investigated and their health care is being denied. What is your message to them

We understand this may be a confusing and upsetting situation for patients, which is compounded by the confidential nature of the process. We ask patients to understand that NCPHP and the NC Medical Board each have an obligation to ensure that medical professionals are safe to practice. NCPHP's role is to help determine whether a medical professional is safe to practice and, if needed, help that medical professional get better so he or she can safely return to practice.

Can you offer more specifics please on the changes to ensure "independent due process" as mentioned in the state audits?

All medical professionals evaluated by NCPHP have the option to request that any recommendation be reviewed by a panel of outside experts. This review process ensures that NCPHP does not have unchecked authority to refer someone for a more comprehensive assessment or directly to treatment.

NCPHP has a very strong track record of making the right call. The 2014 audit conducted by the NC Office of the State Auditor used outside psychiatric and addiction experts to review a random selection of 10 percent of NCPHP's referrals over a 10-year period. They determined that NCPHP made appropriate recommendations in 100 percent of cases reviewed. Out of 110 cases reviewed, there was not a single instance where the reviewers found NCPHP referred someone for assessment or treatment without cause.

What is the nature of the relationships between the NCPHP and certain treatment centers like Acumen Institute in Kansas and the Farley Center in Williamsburg, VA? Of the treatment or diagnostic centers offered to Doctors, how many are in North Carolina? Why not more?

NCPHP provides a comprehensive list of inpatient assessment and treatment centers for medical professionals to choose from. Most inpatient centers are in neighboring states, although two are located in NC. As part of a multi-state consortium of physician health programs, NCPHP uses an outside expert to evaluate centers and make sure that medical professionals are getting the best assessment and treatment so they can get back to treating patients. As more NC centers demonstrate that they meet quality criteria established by the physician health programs, they will be added to our provider list. We recognize the value of offering a wider range of NC-based options. For the record, NCPHP also refers to numerous outpatient treatment and assessment providers, all of whom are in North Carolina. NCPHP receives no direct or indirect benefit for making referrals.

Even with the state's follow up audit, ABC11 has heard from several physicians accusing the NCPHP of "abusing its power" and pushing "unfounded" and "unsubstantiated" allegations and diagnoses of physicians. What is your response?

Just like most people, it's common for medical professionals referred to NCPHP to believe they don't have a problem and look for alternate explanations if our team finds evidence of something that needs further assessment or treatment. As life-long helping professionals, we understand that response.

The bottom line is that there is just no evidence that NCPHP has ever made a referral without sufficient cause and, in fact, there is compelling evidence that NCPHP's judgment is incredibly sound when making referrals, as documented by the 2014 State Auditor's findings.

The 2014 auditor's report found no evidence of abuse by NCPHP. Between the additional protections implemented since then, and the increased oversight provided by the NC Medical Board and NC Medical Society, NCPHP has made a good program even better. Indeed, a follow-up report by the NC Office of State Auditor released in March 2019 documented no findings, indicating NCPHP has successfully implemented all recommended policies and protections to ensure that medical professionals are treated fairly.