At its 2018 meeting in September, the ACEP Council voted to adopt a resolution on reducing physician barriers to mental health care. Credit: ACEP

I am a board-certified emergency physician licensed to practice medicine in Oregon since 2001. I am a competent and caring physician. I have never been accused of professional misconduct or incompetence, and I have never been sued for malpractice.

I also have a history of recurrent episodes of major depression. Up until 10 years ago, I managed my depression privately without interference or oversight from any medical licensing board. I had never been hospitalized because of mental illness. I had never missed a day of work due to mental illness.

While on vacation in March 2006, I had a severe asthma exacerbation that required an extended course of high-dose prednisone. Experienced prescribers, and many patients, know that mild dose-dependent mood and cognitive changes are fairly common during corticosteroid therapy and that more severe psychiatric side effects are occasionally seen at higher dosage levels.1 The prednisone caused me to become clinically manic for the first time in my life. I realized that my judgment was becoming impaired, so I reported my illness to my employer in order to arrange for a brief medical leave of absence. I also contacted my primary care physician, who had appropriately prescribed the prednisone, and my personal psychiatrist, and I re-established care with a previous psychotherapist. After discussing this matter with a colleague, I asked my employer whether I should preemptively report my illness to the state medical board in order to keep my professional credentials unblemished by rumors about the cause and severity of my symptoms. In response, my employer decided to require that I obtain written permission from the Oregon Board of Medical Examiners (BME) before permitting me to resume work.

I immediately called the BME’s physician health program, the Health Professionals Program (HPP), hoping to obtain confidential help. The HPP staff informed me that without a “chemical component” (addiction or substance abuse) to my diagnosis, they were not able to assist me. They recommended that I instead discuss this matter directly with the BME’s medical director. The medical director, a retired general surgeon, told me that the only way I could obtain written permission authorizing my return to work was to open a formal board investigation into my fitness to practice medicine. Thinking I had nothing to fear from this process (after all, I was fully cooperative and hadn’t done anything wrong), I naively asked that the investigation begin.

The Investigation and Aftermath

During the investigation, which lasted nearly four months, the BME would not permit me to return to work. It required that I disclose intimate personal details of my psychological and psychiatric history to anybody at the BME who requested them. None of the BME staff who investigated me were psychiatrists or psychologists, and most of them were not even health care professionals. My only direct contact with the BME during that time was through an investigator with a background in law enforcement. This investigator successfully discouraged me from seeking legal assistance because of the potential for prolonging the BME investigation and further delaying my return to work. Despite numerous requests, BME staff would not allow me to appear in person or to testify in my own defense.