In this powerful episode, Dr. Bob shares his personal story with Brian. Dr. Bob has struggled with alcohol and drug addictions since his early youth all the way through medical school and well into his practice.
In this powerful episode, Dr. Bob shares his personal story with Brian. Dr. Bob has struggled with alcohol and drug addictions since his early youth all the way through medical school and well into his practice.
Brian: Thanks for joining us today and on today's podcast, we have a gentleman with us that has gone through the Tennessee Medical Foundation. The physician program here in Tennessee that supports doctors that are dealing with various problems from addiction to mental health to other issues, and we have a physician with us, for the purposes of this conversation today, we're gonna refer to as Doctor Bob. So Doctor Bob, let me be the first to welcome you. Thanks for being here.
Doctor Bob: Well, thank you Brian. Thanks for inviting me and thanks you for SVMIC for all they do for us Tennessee physicians.
Brian: Well thank you for that. Let's start from the very beginning because I want to make sure that everyone here is a complete story of what this looks like and how it starts and how you find yourself where you do. So Doctor Bob let's just go back to the beginning, when did your problem start or at least when did the activity start that later became a problem that you realized?
Doctor Bob: I was born the last of five and my siblings all seemed to drink and drug, but they grew out of it. I would say my first alcohol intake was unexpectedly from my brothers at about age eight and I did get intoxicated. I started drinking on my own at the age of 12 and did that by stealing my parents' liquor, and wouldn't take all of my dad's liquor, so we took everything he had and mixed in one jar and just drank it. I never drank alcohol for the taste and still wouldn't, I always drank for effect. Shortly after that, friends of mine in the neighborhood started smoking marijuana and that really excited me, which is interesting.
Back then when you first smoke, you usually don't get high the first time around and most people would not like that, but people like me tend to wanna come back and do it again. Marijuana from about age 13 until probably medical school was a near daily thing. We had an adage back then that if you studied for a test stoned, you had to take the test stoned. So since I was usually in that shape when I studied, I had to find someway to be able to do that before I took the test, which was difficult in junior high but in high school it was quite easy. Back then this ... [inaudible 00:02:17] ... the younger people, they had a smoking line and you could go between classes and smoke-
Doctor Bob: And I did not smoke cigarettes at the time but I would take the illegal weed out there with me and smoke before class, several times a day actually. By the time I was 18, I had done nearly every illegal drug that was available. I had never stuck a needle in me. I guess that's one proud thing and I hadn't done PCP, but LSD, Quaaludes, Valium, painkillers, any kinda alcohol, any kinda pot, I had done it and like it all unfortunately. Also I hung with a rough crowd, by the time I was 18 I had been in 15 automobile accidents and eight of those were totaled automobiles-
Doctor Bob: Never got hurt, and I find that to be God's always been looking out after me and that will kinda continue. I had a pretty significant accident when I was 13 years old, burnt both my legs, spent six weeks in the hospital. I was already drinking and drugging by then, so there's no way I would blame that accident on any of my addiction problems, but the old lemonade from lemons. The doctor that took care of me, I was just very impressed by his diligence and his fortitude and his honesty, even though his honesty hurt sometimes, and it was shortly after that I decided I wanted to be a physician.
Brian: So that's really when the idea of becoming a physician really started for you. Did it even cross your mind at that time, knowing that as you had said you'd been drinking and drugging ... Did it ever cross your mind at that time, "Maybe I need to give this up?", or I guess maybe in an addict situation that really never plays a part.
Doctor Bob: I think your latter statement's correct. In an addict situation it never really fits a part. I came from a very intelligent family. I can't say I'm anymore intelligent than anybody else, but I was able to do school work and able to do the partying together, which is an unusual combination as I have come to find out. I did not realize that at the time. You know, took a lot of honors classes in high school and I guess myself and the guy that sat with me are about the only two that were druggies. I didn't realize that everybody else wasn't. But yeah, that planted the seed. That planted the seed. So back to high school, I played football. I actually took some mescaline, which is like LSD and playing in a football game-
Doctor Bob: Did okay. It was junior varsity, but still I was out there. I had perfect attendance until 10th grade and then between mid 10th grade and graduation, I missed about 200 days. Most of those were skips but six weeks of it was an expulsion for being drunk at school.
Doctor Bob: So the consequences are great. By the time it came to graduate high school, I was very diligent about that and I'm a plan A person, I don't have a plan B. I'm not saying that's good or bad, I'm just saying that's the way I am.
Doctor Bob: And I went to college with the sole intent of getting into medical school. Got to college, got caught smoking pot in a dorm. First year, I was on probation for that, I had to talk to the Dean, everything was fine after that. I have a knack of getting away with something a 100 times and getting caught the 101st-
Doctor Bob: Which you'll see is a continuation of the story. I do have an interesting little twist in the story that I won't bore the listeners by all the individual escapades that I had growing up, but I think the car wrecks kinda tells you who and where I was at, at the time is by the time I got to college, I was settling down. Most people get rowdy and crazy when they go to college.
Doctor Bob: As you can tell I've already did it all and that whole adage of study stoned, take test stoned wasn't as good in college and I can tell absolutely doesn't work in medical school. So another teen myth is busted here.
Doctor Bob: And so college was fairly uneventful. Partied when I could, studied when I could, walked a pretty straight line.
Brian: But obviously you did well enough to get into medical school. I found it interesting when you were saying, "The ability to be a good student and still be captured by the demons of the habit.", was really a curse to be honest 'cause never hit rock bottom, did you?
Doctor Bob: Absolutely. Although I had transient consequences, I did not have what we call our bottom. It was just another bump in the road and I felt okay, I got caught this time, but those 100 other times I did not get caught. I actually changed colleges midway, I went from a state university to a Christian university. Although I believed in God and had a faith, I had no act on it. The school I went to, most of the people there grew up in the school, from kindergarten to college and I hate to say they were beat over the head with a bible, but they were beat over the head with a bible and they were tired of it and I was forced to take bible classes and I was forced to go to the chapel and I absolutely loved it.
I call that when I ... I tell my story outside of here, one of my first spiritual awakenings that there is a God, I'm not it and the world is not actually about me. Now trust me I forget that regularly, but it becomes a little bit more permanent and this school had a good acceptance rate to medical school. So I had the grades, I did okay on the MCAT test and I did okay on the interview and I knew if I ever got an interview, I'd probably get in because when they said, "Why do you wanna be a doctor?" I would refer back to that accident I had when I was 13 and why would they not let me in for something like that?
Doctor Bob: Medical school was from my alcohol and drugs standpoint very uneventful, drank beer certain weekend times, smoked a little pot to help me rest, but for the most part that four years was an extremely busy time and I didn't really have time to do that kinda stuff. I considered time to be somewhat of a burden if somebody has too much of that and-
Doctor Bob: That will play out here a little bit later also. I had met my wife at the Christian college. We eventually got pregnant and then married, check the order out there.
Doctor Bob: I had my first son when I was a senior in medical school and he is currently a malpractice defense attorney here in Nashville.
Brian: Wow. Okay.
Doctor Bob: I told him to take the other side, it pays better but he said he couldn't do it.
Brian: Well, yeah. Yeah. I can appreciate that.
Doctor Bob: Yeah, I do too. I like that, and so we had kids, bam, bam, bam. So we had three kids right off the bat and off to residency. Same thing, busy, especially the first year, a little beer here and there, a little pot rarely, was just busy.
Brian: So there was no point then in your training, in medical school or residency that your addiction really affected your ability to learn, practice or anything like that. Did it go unnoticed by professors and attending physicians and things like that, or did they have an idea something was happening?
Doctor Bob: No, it absolutely went unnoticed-
Doctor Bob: By most folks, and again that four years of medical school, three years of residency was not at all a sober period but it was a more restricted period.
Brian: Got you.
Doctor Bob: I had a wife, a very young family, I loved spending times with the kids, I loved working. When I had 100 hour weeks, I was absolutely fine with that. I would even moonlight to try to pay bills.
Doctor Bob: So it was just the business of life was allowing the drugs and alcohol to take a backseat. They weren't out of the car but they were still in the backseat. I still carried them around with me.
Brian: Right. When you wrapped up residency, then you have that decision that okay, now it's time to go into practice, whether it be with a group or independent practice. Was there a concern in the back of your head that, "Now I'm about to get out and I'm gonna have more time because I have studied so hard and this demon is really gonna potentially catch up with me.", or did that never cross your mind?
Doctor Bob: You know that never entered my mind. The thoughts about time being a little bit of a curse and this addiction being a curse are things that I found out now with 20/20 hindsight.
Brian: Hindsight. Mm-hmm (affirmative).
Doctor Bob: Surely did not have that in front of me. I'd done a family practice residency and I decided I absolutely hated working in an office. But I had moonlit in ERs and so had many lucrative ER offers and wound up taking that and moving back home, and that worked very well. It allowed me to have a little bit of a say so in my schedule, kids were at the point where they're playing sports and school things and all that and I was still able to ... I coached every one of their teams, made every one of their school functions. My life was scheduled around what the kids were doing, as was my wife's also, and it hadn't yet slipped on me. I was starting to drink a little bit more, I liked to fish and we'd go out and drink beer and smoke some pot, but for the most part kept it between the lines. Now if you asked my wife that question, you might get a different answer. I have to let you know it's from my perspective.
Doctor Bob: I have a very clear cut point as when the opioid addiction started.
Brian: So tell us about that. So you're practicing along and like you said you're consuming alcohol and the occasional marijuana, but obviously at some point it gets taken up a notch. Correct?
Doctor Bob: Correct.
Brian: Walk us through that. What led up to that ... one, that made you change and two, what did that look like at that point?
Doctor Bob: That's a good question. That's actually a really good point for your readers 'cause this is how things like this sneak up.
Doctor Bob: So I took a stint at a walk-in clinic, it was a year of transition. After being at the walk-in clinic for a few months, the nurse who I very much love, is a fellow said, "Hey, we're cleaning out the sample closet. We've got a sample carton of cough syrup. Do you want it?" I said, "Not really." And he said, "Well, we're gonna throw it away." I said, "Okay." He said, "Well are you sure you don't wanna take it home? You might want or need it for later?" I said, "What the hell? I'll take it home." It was M [inaudible 00:11:30] or M-Clear. I'm not sure it had either two and a half or five milligrams of hydrocodone per teaspoon and I ... I took it home. There were nine one and a half ounce bottles and I put them in my closet and totally forgot about them, and they stayed in my closet about three months until low and behold, I had a cough. I took the bottle out and a teaspoon and I ... No, I didn't do that at all. I took the bottle out and took a big slurp from it because I had a cough and in about 20 to 30 minutes a feeling came over me that was so great. It was a true sense of euphoria that all is good.
I'm happy, I have energy, I have focus and nothing can go wrong. I knew it from that moment that that was something I absolutely loved, and that started what I call a 15 year love affair. And that 15 years is marked by five years of sporadic use, another five years of fairly regular use nearly daily. But certain lines I would never cross and then the last five years is I have to have this drug or I will die, and it all started from having cough syrup available to me for six months. Three at the office, three at home and I actually took it as directed and people like me get those effects from those kinda medicines. It's interesting as a doctor, if you talk to a patient and they have a pain and you say, "I'm gonna give you some hydrocodone for your pain." And they say, "I don't like that. It makes me sleepy, it makes me dizzy, it makes me nauseated."
Doctor Bob: That person's probably not gonna be a drug addict. If they tell you that it gives them energy, it makes them focus, they get all kinds of stuff done and they feel great, guaranteed they're gonna be an addict.
Brian: Those are kinda like the key terms that you know, they perceive the narcotic in a different way.
Doctor Bob: Absolutely. I mean I don't think anybody takes a narcotic thinking they're gonna be awake, alert and ready to go.
Brian: Sure and the interesting part of your story at this point to me is the fact that you had this addiction and this addictive personality probably as well, but it laid dormant. It was the social use and things of that nature and then there was a very typical, "Hey, I have a cough. I need to take some medicine for it." And you just happened to grab one of the samples that had opiate... a narcotic in it and it was just that moment that led to that 15 year love affair as you say.
Doctor Bob: It was immediate. It was immediate and it was insidious, I didn't see it coming. It blossomed and it grew, but yeah that was the seed that started it all. That's exactly correct.
Brian: And it can be that simple for really anybody that might have an underlying addiction. It could be that one see that could do that. That's the beginning of this 15 year love affair. So at some point it is becoming a snowball and it's getting ... You're having to have it, having to have it. At what point in here does that become, "Okay, this is something that I'm doing because I enjoy it and now it's starting to affect my life, my career, my everything." What happen ... Where's that transition?
Doctor Bob: That's probably in the second five years. The way it worked is I had a lot of friends around here, I write you a prescription, you go to the pharmacy, you pay cash, you bring me half back.
Brian: Oh, okay.
Doctor Bob: We'll do it again next month, which is a little unusual for an ER doctor to do that. It went from one or two prescriptions every other month, to three prescriptions a month to ... In the second five years, it was probably five to ten prescriptions a month, and in the final five years was anywhere between 20 and 25 prescriptions a month with high dose narcotics and lots of numbers of them.
Brian: And it was that agreement of, "Go get it. You get half, I get half."
Doctor Bob: Right.
Brian: And I mean it's really starting to grow. What happened that got you at a point that your medical license was in trouble? What was that event?
Doctor Bob: Before I actually answer that question, I will answer the strangest thing is in writing these prescriptions from the very get go ... From the early part, I always knew that I would be caught.
Doctor Bob: Always knew. I was just waiting, is it this one, is it the next one, is it the one before?
Brian: So you didn't see yourself necessarily as 10 feet tall and bulletproof?
Doctor Bob: No.
Brian: You expected to be caught?
Doctor Bob: I expected to be caught. I know that pharmacies have to report twice a month every controlled substance that comes into their pharmacy and I was amazed that some pharmacists is not looking at this saying, "What is this guy writing these people all these prescriptions for?" But it never happened and in fact, the event that actually put my license and my career and all at jeopardy was a friend of mine, one of the guys from the very early get go, went to junior high, high school, et cetera, et cetera, couldn't make contact with me. I was out of town, he went and wrote his own prescription. He got busted by it and when the drug task force asked him about it, they pulled out basically a laundry list, you know where all these prescriptions come to you, to your wife, to your son, to your father, to your mother and of course I was writing them in their name. He was getting them filled and the same story and when he told them that I had written them, they didn't believe him. They said that they knew me and there was no way I would do that.
Doctor Bob: They didn't know me and that was the first shot and they started going through these pharmacy records. Starting putting all this together and it went around to 20 or 30 people that I had been writing scripts to and I was the very last one, and they showed up on my door July 1st, 2011. And they wanted medical records, of which I had none, obviously. They had two drug task force detectives and the medical board's investigator and at that point I turned in a resignation letter to my partners to let them. They refused to take it and I told them it doesn't matter whether they refuse it, it's going to happen and then within a week or so, they were showing up to the hospital looking for medical records. And that point, the chief of staff called me and advised that I get in touch with Roland Gray, who was the medical director at Tennessee Medical Foundation at that point and I did. And luckily Roland was in town and Mike Todd who's the assistant director, both great people. I love these people and I love the Tennessee Medical Foundation for what all they do for people like me.
Doctor Bob: They met with me and I think they're so used to having people ... You know, it's somebody else's fault or I didn't do it or I didn't have that big a problem-
Brian: Playing the blame game. Yeah.
Doctor Bob: Playing the blame game. I was done. I had had it.
Brian: You hit your rock bottom I think.
Doctor Bob: I had hit my rock bottom. I was so deep that my prayers to God were, "Lord, strike me suddenly sober or don't let me wake up."
Doctor Bob: And when I woke up, I was mad at God for not doing his job. Would I have killed myself? Absolutely. I had a nice life insurance plan. I'm sure there is a suicide rider on it and there's many a night when I got off work at one or two in the morning that I went up to the Natchez Trace bridge and tried to figure out how I could drive my vehicle off the bridge to make it look like an accident.
Doctor Bob: I'm not afraid of dying. I'm afraid of being maimed and leaving people ... somebody within that shape.
Doctor Bob: But I didn't know about recovery. I didn't know to be honest and just go seek help. I was so worried about everybody worrying and obviously because of that, I got a much worse consequence.
Doctor Bob: And I was just scared. I mean just scared. I couldn't live with the dope and I couldn't live without the dope and I just saw no way out, no way whatsoever.
Brian: You really felt trapped it sounds like.
Doctor Bob: I was trapped. Death was the best option I was coming up with.
Brian: This is coming full circle now. You got an addiction issue and now you're starting to get some depression and some other mental components that are involved here that's taking you down a really, really ugly road. So I'm assuming at this point now you've got all these investigators with the drug task force and also the Tennessee Licensure Board. So I'm assuming you had maybe a consent order or did they suspend your license all together. What was the outcome of that?
Doctor Bob: I talked to Roland, I talked to Mike from the Tennessee Medical Foundation and they advised that I go to treatment immediately, which actually sounded like a great idea to me. And so I made calls that and within 36 hours I was in Atlanta at treatment.
Doctor Bob: I wanna go back to the dope for a bit-
Doctor Bob: And talk about this. So your listeners can't see lines that I'm making, but if this is normal-
Doctor Bob: Addicts like me take drugs to get higher than normal.
Brian: Way above that, right.
Doctor Bob: Or way above that. Yeah. And so at some point in the addiction, I would say the second five years, I was taking drugs to become normal.
Doctor Bob: Yeah. And then in the last five years, I started so below normal I was taking drugs to get myself to normal and never got there in any single day.
Doctor Bob: Couldn't live with it and I couldn't live without it back to that.
Brian: It was your fuel to keep going.
Doctor Bob: Absolutely. Oh, absolutely. I mean you hit the nail on the head right there. I needed it for energy, I needed it for focus. When it was not there, my body felt so bad but the depression, the hopelessness and the total lack of any drive to do anything was there without the drugs.
Brian: Even the practice of medicine didn't excite you anymore without the drugs.
Doctor Bob: Absolutely. In fact, there was a point in my career, that last five years, where I was a much better doctor on dope than I was not on dope.
Doctor Bob: That being said though, after I was gone the hospital was concerned about their liability and they reviewed 10% of my charts from the previous year and found zero medical errors, zero documentation errors.
Doctor Bob: Which actually made me feel good. That's the only thing that's made me feel good about all of this.
Brian: Is that through all of these addiction issues, nobody else was harmed as far as your delivering of medical care?
Doctor Bob: Correct, correct.
Brian: I got you. So now going back, was your license ... Did they give you a consent order? Did they suspend your license or often you get consent orders and there are certain parameters you have to meet and then they come back and put your license either on probation or what ... How did that process go for you?
Doctor Bob: So it took a while. So that was in 2011-
Doctor Bob: In the summer and my board meeting was in September of 2012.
Doctor Bob: I had not practiced in that interim. They suspended my license for 60 days and then put it on a probationary status for five years, which is where it is right now.
Brian: It was probably mandated by the consent order that you become an active part of the TMF. Correct?
Doctor Bob: Absolutely. Absolutely. So the consent order ... I think all of them in Tennessee require you be under a contract with Tennessee Medical Foundation and basically the contract is a combination of your aftercare recommendation from treatment and certain stipulations put on you by the Medical Boards. And generally those are five year contracts-
Doctor Bob: And under that you meet with your representative at the Tennessee Medical Foundation quarterly, you call daily or now you login daily to see if you need a drug screen and you're required to got to a certain amount of alcoholics anonymous or some type of recovery meeting and document and a weekly caduceus meeting, which is healthcare professionals 'cause it's not just doctors. This is doctors, dentists, pharmacists, veterinarians, meet once a week and it's partly a recovery meeting and partly a professionals meeting. It's very reassuring that there's other physicians that are ahead of you in the process and have walked those walks and behind you in that process that you can pull along with you. And so the Tennessee Medical Foundation has been very helpful in keeping that going.
Brian: So it's often like you said mandated but I would guess that once a physician becomes a part of the Tennessee Medical Foundation in their program and what they require you to do, there is amazing amount of benefit that comes from that. How did the Tennessee Medical Foundation's program, all the way from what Dr. Gray and the associates there did for you to current day, how did that affect your life with not only your family, but your professional life? What difference did that make it to you?
Doctor Bob: It's a great difference. They're always there, they always answer the phone. You may not get the person you need at that particular time. If you need to meet with somebody, they're always available. The mandated meetings and the mandated quarterly meetings with your counselor are really very easy. Physicians and other health care professionals that are under a program like this have about a 90% recovery rate.
Doctor Bob: The population at large is 10% or less recovery rate and that's even after multiple treatment, and it's because there's somebody there, somebody you can lean on, somebody that's ... you have to be accountable for.
Doctor Bob: Accountability is a great thing.
Brian: You're always having to check in-
Doctor Bob: Right.
Brian: And somebody's keeping up with you. Keeping track.
Doctor Bob: Is calling for a urine drug screen daily a pain? Not really. Is going to give one a couple times a month a pain? A little bit. But there have been times in my recovery where a drink or a drug might have sounded good. It didn't sound good for long but to be honest, it might've sounded good, and that looming thought of, "What if I have to take a drug screen soon?" I don't know what actual thing is keeping me sober today, but I know I do a lot of things and I'm afraid to drop any of them. I am so scared of that life that I led.
Brian: And from stories that I've heard and including yours today, addiction is something that you're never cured from. It's always a constant fight, isn't it?
Doctor Bob: Exactly.
Brian: And that's what the TMF provides, is that support and that accountability to help you continue that fight. And I hear there are physicians that go through that program that continue on to be fantastic physicians for years to come, and the credit is often given back to the Tennessee Medical Foundation on all that they did.
Doctor Bob: That's absolutely correct. I could not have done it without them. My only disappointment, I think your readers need to know, if you have any similar problems like mine, call them sooner rather than later. Because most times if you go see them voluntarily, which I'm listed as voluntary ... I'm not voluntary at all but that's how they list me. Yeah, your name my get smeared a little bit but the bottom line is, health care personnel if you're out sick for whatever reason, be it alcohol, drugs, whatever, they're just happy to have you back and have you better. There's nothing worse than living a life with alcohol and drugs and seeing no way out.
Brian: Dr. Bob I want to tell you, I really appreciate you taking the time and giving us a little bit of an insight into your struggle, your addiction and how the Tennessee Medical Foundation helped you through that process because it all started by, "I had a cough." And then ended up with cough syrup that had a narcotic in it and that took an underlying addiction and turned it into this. That there may be a lot of people out there that are that simple step away from a real addiction and problem and I really appreciate you being here to share with us today.
Doctor Bob: Absolutely. Thank you Brian. Thank you for having me.
Speaker 1: Thank you for listening to this episode of Your Practice Made Perfect with your host Brian Fortenberry. Listen to more episodes, subscribe to the podcast and find show notes at svmic.com/podcast. The contents of this podcast are intended for informational purposes only and do not constitute legal advice. Policy holders are urged to consult with their personal attorney for legal advice as specific legal requirements may vary from state to state and change over time. All names in the case have been changed to protect privacy.
Brian Fortenberry is Assistant Vice President of Underwriting at SVMIC where he assists in evaluating risk for the company and assisting policyholders with underwriting issues. He has been involved with medical professional liability insurance since 2007. Prior to his work at SVMIC, Brian worked in the clinical side of medicine and in broadcast media.
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