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719: Trust Me I’m a Doctor

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Prologue: Prologue

Ira Glass

OK, so before the president got coronavirus, which is sending everything now into some new and unforeseen reality, there were certain things about the election that had settled into predictable rhythms, right? The president will talk about rioters in the streets and law and order. Joe Biden will talk about Donald Trump's character and the way he's done his job.

And when it came to the actual process of voting and the mail-in ballots that are going to be used by record numbers of people this year, the talking points lined up like this. The president said that mail-in ballots were going to be a disaster. Joe Biden said they were a perfectly good way to vote. The experts said the evidence backed up Biden.

Then the president would again insist that they are a disaster. Biden would again say no. The experts would again back him up. The president again would call them a disaster, around and around and around in a circle that never ended, a very tedious circle.

But, you know, we can remove ourselves from that circle, right? For a little perspective.

[DIAL TONE]

Wendy Smith

Good evening, town of Nokomis.

Ira Glass

For a few weeks now, one of our producers, Ben Calhoun, has been calling around to the people who actually handle these ballots that everybody has been yelling about. These people touch them with their hands, and they stack them in stacks. Ben?

Ben Calhoun

Yeah, so the person you're hearing, this is Wendy Smith. She's the person who's responsible for running the election and dealing with mail-in ballots and all that in a small town in my home state, which is Wisconsin. She's in Nokomis, which is way up north.

And I called Wendy because I was wondering how this bizarre year was going for clerks like her. I had seen Wendy in a newspaper story. She had tattoos on both arms and this T-shirt that said, "Why should only one hour be happy?" And it said that she rode motorcycles.

And I just kind of thought I wanted to talk to her. When I originally reached out to her, she was busy sending out absentee ballots to people who'd requested them.

Wendy Smith

You don't mind if I work and talk at the same time, do you?

Ben Calhoun

No, no, I actually imagine that you have a lot to do right now.

Wendy Smith

Yeah, I came in to 29 absentee ballots, and I've got a stack more that have to go.

Ben Calhoun

Oh, wait, so how many total are you looking at compared to a normal year?

Wendy Smith

Oh my gosh. My last presidential, I had 100 absentee voters--

Ben Calhoun

Total.

Wendy Smith

--four years ago-- total. I've already almost tripled for this election what I did four years ago.

Ben Calhoun

Tripled. So that's like 300 voters out of maybe 1,000 that she's responsible for.

Ira Glass

Wow.

Ben Calhoun

And she's getting more requests every week. I've talked to Wendy a couple times now, actually. And both times, she has worked the entire time that we've been talking. You can hear her keyboard and her printer going in the background the whole time.

Wendy Smith

As I've been talking to you, I'm printing off all my absentee ballot requests because I have to have them open and done and in the mail today.

Ben Calhoun

Wendy told me in all her years as clerk, this is definitely the most work she's ever had to do for elections. And one of the reasons for that is that the legislature and the governor keep fighting over how everything should run.

There are also lawsuits in Wisconsin, like there are all over the country, about what the rules for the election should be. And all the little changes that come out of that stuff can be a ton of extra work for Wendy.

Like, in Wisconsin, at one point, they changed the rule about how many days somebody has to be a resident in order to vote. So Wendy started scrambling to fix all that. She's redoing all these envelopes. And then they just changed the rule back, meaning that all of that scrambling and work was for nothing.

Wendy Smith

So then you went back to trusting your envelopes. Ugh. So all the envelopes that I pre-- you're laughing, but try being a one-man-show doing this.

Ben Calhoun

[LAUGHS] No, I'm just so sorry. I imagine you-- I just had an image of you buying Pepto Bismol at Costco by the case or something.

Wendy Smith

Yeah.

Ben Calhoun

And compared to a normal year, how many more times work do you feel like you're doing this year on elections?

Wendy Smith

It's a full-time job.

Ben Calhoun

Is this your only job?

Wendy Smith

No, this is my part-time job.

Ben Calhoun

[LAUGHS] What do you do when you're not doing this?

Wendy Smith

I work for an insurance company. I'm still working plus putting over time in there plus working here.

Ben Calhoun

Oh my gosh.

Wendy Smith

Which is fine.

Ben Calhoun

When do you sleep?

Wendy Smith

Um--

Ben Calhoun

[LAUGHS]

Ira Glass

OK, so she's got the rule changes. She's got tons of extra ballots she's got to keep track of.

Ben Calhoun

Mm-hmm, and the other big thing that's taking up a bunch more time is helping voters. Because people will just fill things out wrong, or they don't know where their ballot is. I talked to her the other day, and she was telling me about this couple.

Wendy Smith

I got to try to locate their number. They're snowbirds. Their ballot went down to Florida. They're not there yet. The ballot came back, and now I got to try to find a way to reach them.

Ben Calhoun

Oh, wow.

Wendy Smith

Right, so I get to dig through about 300 applications to try to find their-- see if they have a phone number.

Ben Calhoun

So Wendy was trying to find them, which it seems like something she kind of does a lot. She digs up numbers for people. She finds people on Facebook.

Wendy Smith

So now, I mean, I know where they live. I can probably drive over there when I'm done with work and say, hey, what do you want to do?

Ben Calhoun

The clerks that I've been talking to, they all kind of talk like this. They have this down-to-earth, sort of civic-mindedness.

Ira Glass

Yeah.

Ben Calhoun

There's this other clerk, Marilynn Pedretti. She's in this town called Holland, which is slightly bigger than Nokomis. It's like 4,300 people. And Marilynn Pedretti spent five years in DC, where she worked for a congressman and then she worked in the Senate. But she got sick of Washington, and so she spent the last 20 years as the town clerk for Holland.

Marilynn Pedretti

I want votes to count. I will not disenfranchise somebody and be lazy. I will do everything I can. I try to find their phone number first. If I can't find that, I try to email. If I don't have that, I'll send them a letter. So yeah, we're doing everything we can to make sure those votes count.

The one thing I find very frustrating is the conspiracy theories that are out there. And people believe them. I'm like, hello, I'm your town clerk. I am not going to throw your ballot away. And you can track it. There's no way I can throw your ballot away.

So when you hear these stories about somebody picked some ballots out of a garbage and they open them up, it's like number one, whoever opened them up should be put in jail because you cannot open up the ballot. If it's sealed, you have to leave it sealed until election day.

And we have 1,800 municipalities in the state of Wisconsin. It's not centralized. It would take 1,800 clerks to do the wrong thing. Are there clerks out there that make mistakes? You bet. But when people come in with these conspiracies that the whole system is rigged, I'm like, no. No, it's not.

Ben Calhoun

All the clerks that I talked to-- and this is in Republican areas and Democratic areas. They all seemed like this was sort of driving them a little nuts, people getting the idea that what they do is very loosely goosey and that people are just going to cheat the system. To them, that's just outlandish because they say that there's too much security built into everything.

Ira Glass

Security like what?

Ben Calhoun

Well, they keep track of every request for a ballot. Unless you can't leave the house, you have to submit your ID to get an absentee ballot. Clerks put tracking info on the ballot. And then they keep track of them when they're sent out and then coming back. And then when it comes back in, it has to have a voter signature and a witness signature for verification.

At the end of the whole election, they also have to have report back to the state what ballots ended up where, like which ones went out and came back and which ones went out and never came back.

Say somebody moves and they ask for a ballot in a new location, that's also something the state tracks. And I just want to say, Wisconsin is pretty typical for how all this stuff works.

Ira Glass

I feel like all these details exist in this universe that doesn't overlap in any way with the discussion that I see in the national media and the arguments that I heard during the presidential debate. It just seems kind of sad that that universe, the national politics universe, is lobbing grenades into these women's universe.

Ben Calhoun

Yeah, I know. I mean, I've been at this for a couple weeks, and I haven't found one clerk that is worried about fraud. All of them are worried about the rule changes and the number of extra mail-in ballots. I mean, they think they can deal with that. It's just a lot more work.

Ira Glass

But they're running into these conspiracy theories a lot-- locally.

Ben Calhoun

Yeah, I know. Yeah, yeah, no, that's what I'm hearing. Marilynn, she's like Wendy. She's a clerk part-time. And she also gardens two acres, and she sells vegetables on the side of the highway.

Marilynn Pedretti

I mean, I have a roadside stand, and I'm out there. And people know who I am. And they'll talk to me about election stuff, which is fun. But this woman who's out there buying my vegetables and knows that I'm the town clerk is telling me that all these dead people are voting.

And it's like, um, no. It's pretty much impossible in the state of Wisconsin for a dead person to vote. If they had died the day before election, maybe I'll not catch that, and maybe that ballot will go through. But that's one vote. It's not like the whole cemetery is voting.

And I just looked at her, said, ahem, you know I'm the clerk, right? Yeah, yeah. Do you think I would let dead people vote? Well, no, not you, but somewhere else. I said, can't happen in the state of Wisconsin. Well, um, it happens in other states. No, it doesn't. Stop listening to that stuff.

And I do it cheerfully. I don't yell or anything. Just like, this is-- it's just wrong, and you've got to stop listening to that stuff.

Ira Glass

Well, Ben Calhoun, thanks very much.

Ben Calhoun

Oh, sure.

Ira Glass

Are you going to stay in touch with these clerks as everything heats up in the next couple weeks?

Ben Calhoun

I mean, as long as they'll answer my calls.

Ira Glass

There are so many jobs like this around the country. Some of them are part-time, like with these two women. Some of them are full-time. Some are paid jobs, lots of volunteer or people get some tiny stipend.

These are people who are throwing themselves into the details of some tasks that just needs to get done for our country to function and doing it in the normal, decent, civic-minded way that you would imagine and that you would hope for.

And it's corny to say it, but we are a country blessed with armies of people who are trying to contribute to their communities in all kinds of ways. And today's program is about a group of people like that, people who are, as best we can tell, trying to do a good job for all of us. They're trying to protect the public. But in this case, too often, they're failing.

From WBEZ Chicago, it's This American Life. I'm Ira Glass. Stay with us.

Act One: Clinical Trial

Ira Glass

Act One, Clinical Trial. So the people that most of today's program is about are doctors, doctors who've agreed to sit on panels to judge other doctors, to discipline them or revoke their licenses when they behave badly. Every state has these medical boards. They grant medical licenses, and they're the ones responsible for taking them away.

We heard about all this from a law professor at Vanderbilt, Rebecca Allensworth. In 2018, she started going to medical board hearings in Tennessee, where she lives. It was research for a book that she plans to write about licensing boards. And what she saw when she got there horrified her. Dana Chivvis is going to take it from here.

Dana Chivvis

When it comes to the Tennessee Board of Medical Examiners, Rebecca is like the one die-hard fan in the stands at a town softball game. She knows all the board members by name. She's interviewed most of them, attended all their meetings in person, or watched the livestream. She even went to their offsite retreat last year.

Dana Chivvis

Before you went to any medical board meetings, how did you imagine they would be?

Rebecca Allensworth

I thought they'd be pretty boring. But I think I also thought it was going to be in some sort of grand state government building. I think I had our state capital in mind or something. But it's just like an office park.

Dana Chivvis

So yeah, so describe what it actually looked like.

Rebecca Allensworth

It's like a three or four-story square office building probably built in the '70s or '80s. This is Nashville, so there's copious parking and--

Dana Chivvis

It sounds like Dunder Mifflin to me.

Rebecca Allensworth

Oh my god, it looked just like Dunder Mifflin. It looked just like Dunder Mifflin.

Dana Chivvis

The first meeting she went to, an OB-GYN appeared before the board to request a new medical license. The board had taken his old license away six months before when they learned that he'd had sex with 11 of his patients. He'd done drugs with at least one of them, too. He'd also prescribe them and other people who were not his patients controlled substances, like codeine and Xanax.

So this doctor was there to ask the medical board for a new license. All that stuff, the sex, the drugs, had happened years before. He'd been to rehab, was sober now, saw the error in his old ways. And the board gave him a new license with some conditions attached, but he could practice medicine again. Rebecca couldn't believe it.

Rebecca Allensworth

There just has to be some sins that are unforgivable in the eyes of the board. The board is a regulatory body. They're not your priest. They're not deciding whether or not you're really sorry. They're deciding whether or not you're a safe provider.

Dana Chivvis

Officially, the board's mission is to protect the health, safety, and welfare of people in the state of Tennessee. Board members and staff repeat that mission all the time, like a mantra.

But since Rebecca has been following the board, she's seen a bunch of cases like that OB-GYN, where doctors have done something really bad, seemingly irredeemable, and somehow, they've managed to keep their medical licenses. They're out there, working as doctors in Tennessee right now.

So this became the question of her research. What was going wrong in the system? Why were these doctors allowed to keep working? One case in particular became the focus of her attention because it seemed like a perfect storm of regulatory failure.

And that's what I want to tell you about today. It's about a doctor named Michael LaPaglia. I'll start the story back in 2013. LaPaglia was working as an ER doctor at the time. And late one night, police got a call about a domestic disturbance at his house.

When the police arrived, they smelled weed and searched the house. They found-- actually, let me just read from the police officer's affidavit.

Quote, "A search of the residence pursuant to the search warrant revealed 45 quart-sized Mason jars which contained marijuana, 127 glass pipes used to smoke marijuana, Glock 19 9 millimeter, grow light with ballast, timer, digital scale, and ledger detailing names/amounts. Also discovered were approximately 52 diazepam, 22 amphetamine, and 24 oxycodone pills."

In addition, the police found on a shelf in LaPaglia's office vials of fentanyl, morphine, and propofol, which is used for general anesthesia. LaPaglia's girlfriend told police that he had threatened to use that stuff to kill her.

In the petition she filed for a restraining order the next day, she said, quote, "Michael told me that if I ever contacted the police for help or reported his drug use, Michael would use his powers as a physician to have me committed to psychiatric facility. Michael stated he would make sure my body wouldn't be found. Michael stated that he would take my life away. I'm in fear for my life and my son's life."

LaPaglia told police his girlfriend was delusional. He was arrested and charged with two drug felonies, intent to distribute a controlled substance, and intent to distribute marijuana. He pled no contest and went to inpatient rehab. He was addicted to Valium at the time.

He lost his job at the hospital. The medical board put him on probation. And he surrendered his DEA registration number, which is the thing you have to have to prescribe controlled substances. That's a big deal. It's very hard to get a job once you've lost your DEA number.

Rebecca Allensworth

No one wants to touch him. No employer is going to take him-- very few employers anyway-- with a record like that. Private insurance, forget it. Hospital, forget it. A few years later, he files for bankruptcy because there's no way to earn money back at the same clip as you are as an ER physician.

Dana Chivvis

But he got a job at an addiction clinic a friend of his owned. It was called EHC, Express Health Care. LaPaglia would see patients like a regular doctor, work up a treatment plan and everything, and then another doctor would write their prescriptions.

Dr. LaPaglia helped a friend of his, Dr. Charles Brooks, get a job at Express Health Care, too. Dr. Brooks was also on probation with the medical board. He'd had sex with a patient-- he says they were having an affair-- and at least once given her a controlled substance-- he says to calm her nerves because they were having an affair.

But unlike Dr. LaPaglia, he did not lose his DEA number. He could still prescribe. Dr. LaPaglia left EHC. And in early 2018, he and Dr. Brooks started up a little side business.

Rebecca Allensworth

So he and Dr. Brooks kind of hatched this plan. LaPaglia and Brooks realized, OK, well, here's what we're going to do. We're going to start a clinic called L&B Healthcare, LaPaglia and Brooks. But LaPaglia doesn't have a DEA number, so we'll use Brooks's.

LaPaglia is going to do the work. He was going to write the prescriptions. It's his phone number on the prescription pad that they make out. But it's Brooks's DEA number, and it's Brooks's signature. Sometimes they were presigned. Sometimes LaPaglia forged the signature. Oh, and they sell them for $300 cash out of LaPaglia's home, at least once in a McDonald's parking lot.

Dana Chivvis

L&B Healthcare didn't have an actual brick and mortar office. LaPaglia would see people wherever it was convenient, write prescriptions for controlled substances, like Klonopin, Valium, and Suboxone. When the facts came out about their operation, it looked like they were selling prescriptions for cash, like drug dealers with stethoscopes.

LaPaglia and Brooks say that's not the case at all, that they were legitimately treating people with addiction problems by prescribing them controlled substances. It's something called medication-assisted treatment, like the way methadone is used to treat heroin addictions. So that's what they said they were doing.

Regardless, it was still illegal. A few months into the venture, the Feds busted them, charged them with drug trafficking, for writing prescriptions for controlled substances without the authority to do so, and fraud for using Brooks's DEA number in the scam. Brooks pled not guilty, but Dr. LaPaglia signed a plea deal with federal prosecutors. He's still waiting to be sentenced, but he could be facing prison time.

So that's the federal criminal court. LaPaglia still had to face the Tennessee Medical Board. And when they found out about L&B Healthcare, they summarily suspended the doctors' medical licenses until they could hold disciplinary hearings for them. The case unfolded over three hearings from March to July 2019.

The first one in March was the disciplinary hearing for LaPaglia's partner, Dr. Brooks. Rebecca was there. She'd been going to medical board meetings for a year at that point.

Rebecca Allensworth

And I see this guy who is doing something that actually even I think the physicians on the board find really offensive, which is giving up control of your pad. And to hand it over to somebody else is really seen as pretty unethical. Most doctors don't view their pad as a moneymaker.

Dana Chivvis

These medical board disciplinary hearings are technically administrative courts. They run kind of like the criminal and civil court systems. But the question they're addressing is more pointed. It's whether a doctor should be allowed to continue to practice medicine. Dr. LaPaglia agreed to testify against Dr. Brooks in front of the medical board.

Andrew Coffman

The signature on that prescription says Charles Brooks, correct?

Michael Lapaglia

Correct.

Andrew Coffman

Is that your signature there?

Michael Lapaglia

That's my writing, yes.

Dana Chivvis

Just to set the stage, the guy asking the questions is Andrew Coffman. He's the prosecuting attorney. He works for the Tennessee Department of Health. Dr. LaPaglia is the one answering his questions.

Andrew Coffman

While you are partners with Dr. Brooks, to your knowledge, was he aware that you were signing his name to blank prescriptions?

Michael Lapaglia

Yes.

Andrew Coffman

What makes you think that he was aware?

Michael Lapaglia

Because sometimes I would run out of presigned prescriptions and had to do what I had to do to take care of the patient. And we've discussed it.

Andrew Coffman

When you went to work for-- with Dr. Brooks, did you believe that what you were doing was against the law?

Michael Lapaglia

No.

Rebecca Allensworth

Dr. LaPaglia was like, yeah, I think we probably cut some corners. I think, you know, mistakes were made.

Michael Lapaglia

No, we discussed it, and we knew that what we were doing wasn't ideal because we had very little resources to get started. But we never imagined that we were breaking the law.

Rebecca Allensworth

His general attitude was like, error in judgment, not a big deal.

Andrew Coffman

But has your opinion changed about whether you were breaking the law?

Michael Lapaglia

Yes.

Andrew Coffman

Why?

Michael Lapaglia

Because federal prosecutors have convinced me otherwise.

Dana Chivvis

I spoke with Dr. LaPaglia. He didn't want me to record our conversation. And we didn't talk for long before he got off the phone. But he reiterated to me that he and Dr. Brooks didn't think they were doing anything wrong. When they worked in addiction clinics, the doctors there would hand prescriptions to receptionists. And the receptionist would call them into a pharmacy. It happened all the time.

He told me, quote, "We did not see any difference between him giving me verbal authorization to call them in and verbal authorization to write a prescription. I still don't see a difference. And if someone had a problem with that, the federal government had a problem with that, they could have just told us to stop. They didn't have to indict us and charge us with two felonies."

I reached out to Dr. LaPaglia several times after that initial call, but he declined my request to talk further. There were three board members hearing Dr. Brooks's case that day. And they were not swayed by this defense that they didn't know they were doing anything wrong, that they were just trying to help their drug-sick patients.

In fact, the board members suspected that L&B Healthcare was not a legitimate business at all. Here's Dr. Charles Handorf, one of the board members, questioning Dr. LaPaglia.

Charles Handorf

Did the clinic ever apply for or receive a business license?

Michael Lapaglia

No.

Charles Handorf

Did the clinic ever apply for or register articles of incorporation with the Secretary of State--

Michael Lapaglia

No.

Charles Handorf

--of Tennessee? Has the clinic ever filed tax returns?

Michael Lapaglia

Um, not to date, no.

Charles Handorf

OK, so sitting here, it sounds like this isn't a business at all.

Dana Chivvis

So that was Dr. LaPaglia testifying at Dr. Brooks's disciplinary hearing in front of the medical board. Once Brooks's case was adjudicated, it was LaPaglia's turn for discipline. He and his attorney had worked out a deal with Andrew Coffman, the Department of Health attorney.

It's called the consent order. It's basically the board's version of a plea deal. So at the next board meeting in May, Coffman presented this deal to the board members. The board had to decide whether to accept it.

Andrew Coffman

Good morning, Andrew Coffman with the Office of General Counsel.

Dana Chivvis

And here's what the deal was. Basically, LaPaglia could go back to practicing medicine in another month. But he'd be on probation for five years, and he'd have to be monitored by a physicians' addiction group. And he'd be banned from prescribing controlled substances for two years.

It's similar to what Dr. Brooks got in March, but slightly less because LaPaglia had admitted guilt and had testified against Brooks. It's what they call a downward departure in the criminal system. Cooperating witnesses often get lighter sentences. It's supposed to give people an incentive to tell the truth.

But the board was not having it with this deal. They looked at LaPaglia and saw a guy whose medical license was already on probation when he used another doctor's prescription pad to write controlled substance prescriptions. Here's Dr. John Hale, one of the board members.

John Hale

This seems rather light. I mean, we just had a physician whose prescriptions were stolen, and his fines were significantly more than that. I can't, in good conscience, approve of this. I'm sorry.

Dana Chivvis

The board has 12 members appointed by the governor. And three of them are not doctors. They're called consumer members-- in this case, a real estate agent, an academic advisor, and a political fundraiser. They were even more pissed than the doctors on the board.

Consumer Member

This man doesn't need to be on the streets or in his office, writing prescriptions in the state of Tennessee, as far as I'm concerned. And we're charged with the responsibility of protecting the citizens of Tennessee, so that's my concern. So how do we get to that point?

Andrew Coffman

Well, the only thing you can do today is reject this order.

Consumer Member

Thank you, counselor. That's all the--

Man

Ms. Cole, I would really appreciate your insight, too, as a consumer member.

Ms. Cole

I share their feelings completely. I live in Knoxville. I know this McDonald's. To think that he could be back there ever is scary to me as a consumer member. And as I have young daughters, and this man is not safe to be out in the public, I don't think.

Consumer Member

Just a tour guide's representation here, this McDonald's is two blocks away from one of the major high schools in Knoxville. So again, I agree with her. This man does not need to be on the streets with this type of ability.

Man

All in favor of denying the motion for this order on LaPaglia, say aye.

All

Aye.

Dana Chivvis

The board rejected the plea deal. It was unanimous. So now Dr. LaPaglia's case will go to trial, or the medical board version of a trial, a contested case hearing, where he has the possibility of getting a much heavier discipline. They could suspend his license for even longer, for instance, or even revoke it altogether.

Rebecca Allensworth

I had been following this case. And so, yeah, I wanted a full hearing. I wanted the opportunity to see Dr. LaPaglia testify and maybe try to talk to him. And I figured everything was lining up for them to finally throw the book at somebody.

Dana Chivvis

Rebecca had been to several of these disciplinary hearings by then. She'd seen so many doctors get away with what she considered to be light punishments. But it seemed like the board was finally going to put its foot down with LaPaglia.

Ira Glass

Dana Chivvis. Coming up, what goes wrong when the board gets a chance to finally put its foot down. That's in a minute from Chicago Public Radio when our program continues.

Act Two: Act Two

Ira Glass

It's This American Life. I'm Ira Glass. Today's program, "Trust Me, I'm a Doctor." We have stories about people trying to do civic-minded things for their own communities and, in the case of medical boards, sometimes failing to accomplish that job the way that lots of us would want them to.

Right now, we are in the middle of Dana Chivvis's story, and we pick up where we left off. The Medical Board in Tennessee has rejected Dr. LaPaglia's plea deal. And two months after that, at their next meeting, the board holds a hearing for his case. Here's Dana.

Dana Chivvis

How these hearings work, they're basically mini trials. Each case gets assigned to a panel of three board members. LaPaglia's panel was made up of two doctors and a consumer member. They sit at the front of the room, facing everyone else.

And they're going to decide if the prosecutor has proven his case, and if so, how to discipline Dr. LaPaglia. There's also an administrative law judge, who acts as a referee, more than anything else.

Man

Today, the board will be considering the case of the Tennessee Department of Health versus Michael LaPaglia.

Dana Chivvis

They hold Dr. LaPaglia's hearing in the Iris Room, a name which defies the interior decorator's vision-- beige carpet, beige walls, fluorescent lights. Dr. LaPaglia is sitting at a table with his attorney, facing the panel. The prosecutor, Andrew Coffman, he's sitting at a table to the right. And Rebecca's there, too, in the front row.

Rebecca Allensworth

It was really weird. It was weird from the first moment when they did opening statements.

Andrew Coffman

Good morning. I'm Andrew Coffman. You heard me introduce myself earlier.

Rebecca Allensworth

The prosecutor went first, Mr. Coffman, and he said--

Andrew Coffman

We're going to hear a lot of facts today, good, bad, and ugly.

Rebecca Allensworth

--this is a rare case where we basically agree with defense counsel on everything.

Andrew Coffman

And in an unusual twist, there's not much dispute between the parties about what those facts are, whether they're good, bad, or ugly.

Rebecca Allensworth

And it was just kind of a half-hearted prosecution. I mean, OK, it's an administrative hearing. It's a little more casual than a criminal trial or something. But it's meant to be adversarial.

Andrew Coffman

Now I think that the evidence is going to show that Dr. LaPaglia believed that he was providing good treatment to people that actually had a need for that treatment.

Dana Chivvis

Coffman is there to prosecute LaPaglia, but it seems like he's going pretty easy on him, like that 2013 drug bust, the one where the cops found Valium, Oxycodone, amphetamines, marijuana, a gun, a scale, a ledger, paralytic agents, and other sedatives. Coffman doesn't say the charge was possession with intent to deliver. He just says LaPaglia pled to some charges--

Andrew Coffman

That related to his own personal use of controlled substances, outside the bounds of the law. And the very next month--

Rebecca Allensworth

If I were prosecuting, I would probably use some stronger language.

Dana Chivvis

LaPaglia is coming across as a guy who once struggled with a substance use disorder, but got help, sobered up, and then, in the course of trying to help other people who suffer from drug addictions, unwittingly bumbled his way into this next bit of trouble with Dr. Brooks. Here's how LaPaglia's defense attorney also described him in his opening statement.

Attorney

He may be dumb, but he's a good doctor. He's responsible. He's done a lot to help the community.

Dana Chivvis

It's like everyone in this trial was on Dr. LaPaglia's side.

I asked Andrew Coffman why he handled the case the way he did. He said, basically, this case wasn't contentious by its very nature. His job was to prove that Dr. LaPaglia Paglia had written prescriptions for controlled substances using another doctor's prescription pad. His star witness? Dr. LaPaglia, who had admitted repeatedly that yes, he had used Dr. Brooks's pad to write prescriptions for controlled substances.

But also, there's another reason why the prosecution was maybe a bit anemic in this case. The Department of Health attorneys, Coffman and his colleagues, were feeling frustrated. When this whole thing started back in March at Dr. Brooks's hearing-- Dr. Brooks, LaPaglia's coconspirator-- Coffman had asked the board to revoke Dr. Brooks's license. But the board rejected that and said it was too harsh.

So the prosecutors went easier on LaPaglia in his plea deal. And then the board rejected that, said it went too easy on him. There was no consistency to their logic. Coffman's boss said later at a board retreat where they discussed this case that they felt a little bit knocked down by the whole thing.

So at LaPaglia's hearing, Coffman just presented the straight facts of the case and told the panel what their options were for disciplining him, didn't suggest a punishment. They didn't know what the hell the board wanted, so they didn't try to guess. And this brings us to the single biggest problem Rebecca sees in the system-- the doctors who sit on these medical boards.

It's a distinguished position to be on the Tennessee Board of Medical Examiners. They have to be appointed by the governor. There is a full-time staff that supports the board-- attorneys, administrators, medical consultants. And they sit in judgment of doctors. But as far as judges go, they're amateurs. Most of them are doctors. They have lots of training in medicine and very little training in administrative law.

The deciders in Dr. LaPaglia's case, the three board members on this panel, were Julianne Cole-- she's a consumer member-- Dr. Phyllis Miller, an OB-GYN, and Dr. Stephen Loyd. Dr. Loyd was the newest member of the board. He'd never done any of this before. In fact, this was his second day on the job.

Stephen Loyd

I hadn't even had orientation. I mean, I walked in there-- and never been to a board meeting. I read all the rulings--

Dana Chivvis

When they were like, we're going to split off into panels for the contested case hearings now, did you have any sense of what that meant or what it would look like?

Stephen Loyd

None. Nope, none.

Dana Chivvis

So what did you do? Did somebody tell you, you go into this room with these people?

Stephen Loyd

[LAUGHS] What did I do?

Dana Chivvis

Yeah.

Stephen Loyd

I shit a sideways brick is what I did. I mean, I had no idea. It's just a very confusing scene the first time you're in because I just didn't understand the decorum. I didn't understand how this proceeded.

I mean, I'm sitting in there. And when the guy who came in who looked like a judge and talked like a judge, but what does this look like? Is this real court? Am I the jury? And if I am the jury, do I behave the same way a jury behaves?

Dana Chivvis

Dr. Loyd told me he did have a brief orientation that morning, but no special training, no real prep for this. Basically, he was just thrown into it. So at Dr. LaPaglia's hearing, he kind of winged it, went with his gut. And he identified with Dr. LaPaglia.

Dr. Loyd is an addiction doctor. He spent two years as Tennessee's opioid czar. And also, like LaPaglia, he's in recovery from a pill addiction.

Stephen Loyd

And so as they're presenting this, here's this figure that I don't know the background on that looks pretty sympathetic. He's done the things you need to do. I'm a second chance guy.

Dana Chivvis

He related to Dr. LaPaglia. He had also made bad decisions while in the throes of a drug addiction. Although to be clear, LaPaglia testified he was sober at the time he was writing the fraudulent prescriptions and had been for years.

Stephen Loyd

I think I equated, hey, this guy did these things. While I didn't write scripts, I stole medication from people, which is bad. And I got better. And I think he can get better.

Dana Chivvis

For Loyd, LaPaglia said all the right things. He said he was drawn to treating people with addictions to benzos because that's what he was addicted to. He said he took issue with the way addiction clinics were treating patients with benzo addictions, that they weren't giving them enough pills to taper effectively.

Michael Lapaglia

They were given possibly two weeks' worth of benzodiazepine and then taken off.

Man

OK, and what would happen after they were taken off? Were they just clean of benzos?

Michael Lapaglia

It's never going to happen.

Man

So what would happen?

Michael Lapaglia

They're going to relapse 100% of the time.

Rebecca Allensworth

I could see Dr. Loyd nodding along. When Dr. LaPaglia was talking about the problem of dual addiction between opiates and benzos and the problem of relapse on benzos, I was like, I could see Dr. Loyd nodding along.

Stephen Loyd

What I heard from him is, I've got these patients who are addicted to benzos. These doctors don't know what they're doing, trying to get them off. And you actually can't get them off that quick. They'll just relapse. He's exactly right. That's exactly right.

Dana Chivvis

After the attorneys were done questioning Dr. LaPaglia, the board members got a turn.

Stephen Loyd

But first of all, thanks, Dr. LaPaglia, for coming today and being honest.

Dana Chivvis

Here's Dr. Loyd.

Stephen Loyd

So your training in addiction is on the job from the folks at Express and then the eight-hour X-waiver class?

Michael Lapaglia

Correct.

Stephen Loyd

OK.

Dana Chivvis

But most of his questions, he's testing LaPaglia, trying to see if he really understands addiction medicine.

Stephen Loyd

Can you tell me how you establish a diagnosis of substance use disorder, severe?

Michael Lapaglia

Through discussing, taking a drug history, going over medical history with the patient.

Stephen Loyd

And so did you ever follow the criteria of the DSM-V for substance use disorder and classifications of mild, moderate, and severe?

Michael Lapaglia

No, we didn't put that in the chart.

Stephen Loyd

OK, and when you're training-- by way, I 100% agree with you about the prevalence of benzos. That's spot on. But when you're treating benzodiazepine dependence, what is your goal?

Michael Lapaglia

Complete abstinence is the goal.

Stephen Loyd

OK, and so how do you get there?

Michael Lapaglia

Extremely slowly.

Dana Chivvis

This goes on for several minutes. Dr. Loyd only asks two questions about the L&B scheme itself. When they finally get to deliberations, Dr. Loyd speaks first.

Stephen Loyd

I'm the newest member of this committee or this board. And I was told that my charge was to protect the health, safety, and welfare of the citizens of the state of Tennessee. And do I believe that taking Dr. LaPaglia's license does that? I actually don't. I don't believe that it does that.

From what I saw today, and hopefully, I'm a decent judge of somebody's heart, I saw somebody that cares about taking good care of a population that struggles to find help. That's what I saw.

Dana Chivvis

One aspect of these medical board hearings that's very different from a criminal trial-- because of transparency laws in Tennessee, the panel members have to deliberate in the open in front of Dr. LaPaglia.

Rebecca says this is another reason the discipline can be so light. It's really awkward for them, raises some potential issues. Like at one point, while the panel members are considering requiring Dr. LaPaglia to get board certified in addiction medicine, LaPaglia interrupts them, steers them away from it.

Woman

Do we want to require him to do that, and if he doesn't complete--

Michael Lapaglia

I respectfully ask no because I may change my mind, or something else may happen. And if I don't fulfill that requirement, I'm never going to get off probation.

Dana Chivvis

The administrative judge has to break in and tell them to quit talking to each other. In the end, here's what the panel decides. They're going to restore Dr. LaPaglia's medical license, which had been summarily suspended in January, when the board first found out about the L&B scheme.

As punishment, they give him five years probation, make him report to the Tennessee Medical Foundation. It's a physician's substance abuse group. And they tell him to take a few professional courses. They don't prohibit him from prescribing controlled substances. He still doesn't have a DEA number, so technically, he can't anyway. But he could petition the DEA to get it back. They don't restrict that either.

It's actually a lighter discipline than what he would have gotten from the plea agreement, the one the board threw out for being too easy on him.

Rebecca Allensworth

So yeah, it was a slap on the wrist. Dr. LaPaglia was all smiles afterwards. So I had chatted with him at the breaks. And he was sort of saying, I'm just hoping to get my license back. And I got this federal thing I got to deal with.

And so, for some reason, they decided to insert this language at the end that says, to give him a path back to full licensure. And when they read that out loud, Dr. LaPaglia winked at me.

Dana Chivvis

Whoa.

Rebecca Allensworth

Which really surprised me. It just really surprised me. I was like, did that just happen?

Dana Chivvis

How did you interpret his wink?

Rebecca Allensworth

I think that he was sort of saying, see, I'm getting what I wanted-- I guess. I think it went even better than he expected. And I think that might be why he winked at me.

So I went up to him afterwards to talk to him. And by this time, I had chatted with him a couple times. And he said something like, I'm just glad to have my license off of suspension so I can make some money. It was a real kind of 180 from the patient care testimony that he had just provided.

Dana Chivvis

I reached out to Dr. LaPaglia about this, but he didn't get back to me.

So here you've got a doctor who lost his DEA number when he was caught with illegal prescription drugs and marijuana at his house in what looked very much like a drug trafficking operation, whose medical license was put on probation, who then went out and broke the law again by using another doctor's DEA number to prescribe controlled substances.

And now here he is, back on probation with the medical board, still with a medical license, which means he can still work as a doctor. In the years that she's been going to medical board meetings, Rebecca has watched a bunch of doctors with egregious histories keep practicing medicine, doctors who have committed health care fraud, doctors who prescribed controlled substances for people who aren't their patients, doctors who have sex with patients.

One doctor prescribed large doses of opioids and other drugs, even though the patients had no medical reason for taking them. Prosecutors asked the board to permanently revoke his license, but he was only put on probation.

As far as I can tell, Tennessee is fairly typical. A statistical study ranked medical boards on a scale of how harsh to light their discipline was. Tennessee was smack in the middle. Of course, I'm talking about the worst cases the medical board sees.

And the board does revoke some doctor's licenses. Since 2017, they've taken 13 licenses away, and 11 doctors have voluntarily surrendered them. That's a significant punishment. As one board member explained to me, a medical license is technically a property right. And it's a big deal to take someone's property from them.

But something does seem to be happening, where medical boards, which are set up to protect the public, to protect the majority of us who never think to ask whether our doctors are safe and operating in our best interests, sometimes the medical boards are letting dangerous doctors continue to practice medicine.

Rebecca Allensworth

On the one hand, I feel like on some level, I understand this problem because I've spent so long studying it. I've seen all the angles. I've seen how the personalities play out and the incentives and the emotions and everything. But there's also a way in which I just don't get it. I don't understand why they won't just take the guy's license.

Dana Chivvis

What's the part of you that understands it?

Rebecca Allensworth

[SIGHS] I think that there's a identification that's not as specific as, oh, that could be me. That's still in play of just being a doctor. This is our calling. We went to similar sets of trainings. We started out walking down the same path.

So I think there is some identification at a kind of very high professional level, like a circling the wagons. Like, we're doctors. And then I think there's also-- and this is probably especially bad for doctors, but they're just kind of softies. They just believe that everybody can be healed and can be made better and are sick and deserving of compassion.

I mean, that's what's really ironic and sad to me, is that it's, in some ways, this whole problem is created by that better part of human nature, the part that's full of mercy.

Dana Chivvis

Rebecca's solution to this whole thing?

Rebecca Allensworth

Well, I think we need to abolish licensing boards, to be perfectly honest.

Dana Chivvis

Instead of having doctors sit in judgment of other doctors and instead of having them do this as a favor to society every few months, Rebecca says have full-time employees whose job it is to regulate the industry, who are trained to notice when they're being affected by the emotional sway of a defendant, and to put their feelings aside as much as possible, like a judge would. Dr. Loyd agrees with Rebecca, in part. He admits he did relate to LaPaglia, and it influenced how he thought about discipline.

Stephen Loyd

If I saw the facts of the case written down on a piece of paper, right? Just boom, right down-- start at the top, go to the bottom. And I get to read that piece of paper without anybody from either side, right? And I just read that, I'd revoke his license.

Dana Chivvis

Just based on the, he used another doctor's DEA license number to prescribe patients.

Stephen Loyd

Just based on flat facts-- drug charges, used another doctor's DEA license, drug dealing, right? Just the plain facts, no defense attorney, no prosecutor. I just saw that written down on a piece of paper, no LaPaglia in the room-- I'd revoke his license.

Dana Chivvis

Hm, that's so interesting.

Stephen Loyd

And this is something-- well, it's something I've gained an appreciation for. And I'm really trying to work on this as a board member. It is very difficult to sit there with another human being in front of you and-- what I want to say-- drop the hammer.

It's a human being, right? It's much easier on a sheet of paper, right? Because when I'm sitting there, I see a guy that's presenting this way. He doesn't look emaciated. He looks healthy. He's dressed professionally. He's got a child that he has emotion around, like me as a dad. Do I want to give him a chance to get that back? Yeah, I do.

Dana Chivvis

But it's not fair to say that's the whole reason the case went askew, that doctors looked too kindly on a fellow doctor sitting before them. Because when considering what to do with LaPaglia's medical license and whether he should be a practicing doctor, the board members never got a full airing of his past misdeeds. As soon as the hearing was over, Dr. LaPaglia did something that made Dr. Loyd suspicious.

Stephen Loyd

I stood up and was headed out, and he approached me. And I can't remember his exact words, but it was very placating, almost like, hey, I appreciate what you've done in your own life. I would like to have that, right? That kind of thing. And I knew it was bullshit.

Dana Chivvis

He felt like he was being manipulated. Something about LaPaglia's affect felt fake.

Stephen Loyd

I knew I had made a mistake. My little man inside of me that I use as my barometer of people was like, oh, man, Steve, this guy is a shyster. He kissed my ass, and I couldn't fucking stand-- I'm sorry to cuss, Dana. I'm--

Dana Chivvis

No, it's fine.

Stephen Loyd

I couldn't stand it. I couldn't stand it. It wore me. So I went outside and googled him. I said goodbye to everybody. I walked out to my car. I grabbed my phone-- or my truck. I sat there, and I googled his name. And the first article that popped up in the way I searched it was the article about his domestic violence.

Dana Chivvis

Andrew Coffman didn't talk about the restraining order against LaPaglia at the trial. It's not a criminal charge. And besides, he said, while it clearly demonstrates bad conduct, it isn't bad conduct related to the practice of medicine.

But that's not all he left out. In 2010, while working as an ER doctor, LaPaglia did something that a federal appeals court said, quote, "shocks the conscience." The police brought a young man named Felix Booker to the ER. They suspected Booker was hiding drugs on his body-- up his butt, to be blunt.

Dr. LaPaglia asked Booker to consent to a rectal exam. Booker was naked, except for a blanket, and in handcuffs and leg shackles. He said no. LaPaglia says Booker consented to the exam, but nobody else who was in the room heard this. And there's no medical record of it.

LaPaglia tried to examine him. Booker clenched his muscles, so LaPaglia had him sedated. Booker was still able to clench his muscles down, so LaPaglia had him medically paralyzed, intubated him, and did the rectal exam. He found a rock of crack. LaPaglia testified at Booker's trial that he'd done rectal exams on two other people the police had brought in to him.

A year after that, there was a fourth guy, Wesley Gulley. Gulley alleged he got the same treatment. LaPaglia asked him to consent to a rectal exam. He said no. LaPaglia threatened to sedate him and paralyze him, so he relented. LaPaglia did the rectal exam and found nothing. The police charged Gulley with resisting arrest. The hospital charged him for the rectal exam.

But apparently, nothing ever happened to Dr. LaPaglia. He wasn't criminally charged for the warrantless, no-consent rectal searches. He didn't even lose his job at the hospital. The searches were reported to the Department of Health, but Dr. LaPaglia was not disciplined for them.

And in a cruel regulatory irony, because he was not disciplined, there's no public record of why the board did not discipline him. Dr. Loyd actually found out about the rectal searches from Rebecca. They had coffee a few weeks after Dr. LaPaglia's hearing.

Stephen Loyd

I mean, that's bringing up emotions right now I can't even-- that's somebody who's taken advantage of their position of power. That's not forgivable. Maybe God could forgive him, but I can't.

I can tell you this. If he paralyzed my son in the ER, I would have fucking killed him. I mean, I would've. I would've went after him. I don't care. They just said, you know, well, you're going to-- you know, you want to pay consequences for this, Steve? Fine. He paralyzed him. He paralyzed his muscles against his consent. The guy did not give consent for that.

Dana Chivvis

Yeah, he had to be intubated. I mean, he couldn't even breathe on his own.

Stephen Loyd

No, no, you can't. I mean, you paralyze all muscles, and your diaphragm is a muscle. So you're not going to able to breathe. Yeah, and that's somebody who will do anything. That's just incomprehensible to me.

Dana Chivvis

Dr. Loyd and the other board members on LaPaglia's panel, all they knew was that LaPaglia had been on probation with the board once before for charges related to his personal drug use, that he'd been treated for a pill addiction and had stayed sober all these years, and that he and Dr. Brooks got caught selling prescriptions using Dr. Brooks's DEA number, which is a way tidier story than the one I just told you.

But Coffman didn't talk about the rectal searches at Dr. LaPaglia's hearing because of the rules of evidence, he told me. It wouldn't have been admissible. Same for the details about the 2014 drug charges, which, by the way, after LaPaglia pled no contest, he was put into something called judicial diversion. It's a kind of probation. And eventually, the case was dismissed.

But more importantly, Coffman said this wasn't a hearing about everything LaPaglia had ever done-- just this one crime, the fraudulent prescriptions. Dr. Loyd didn't learn about the rest of it until it was too late.

Stephen Loyd

When I'm looking at him up there, I mean, it looked like he was doing what he was supposed to be doing. He's trying his best. Sure, that's what I felt. And I think I am a good judge of that, given all the facts. But I didn't have all the facts.

How many strikes do I believe that somebody gets, Dana? As many as they need. In the real world, there's no such thing as the third strike to me. But this is not the real world. You have a professional medical license, and you can harm others. There is a strike limit there.

Dana Chivvis

Dr. Loyd says he asks a lot more questions now during these cases. So how to keep this from happening? How to make sure the board gets a full picture of a doctor's career and past misdeeds before they decide how to discipline them?

Rebecca points to a simple and practical solution-- separate the disciplinary hearing into two parts. Have one hearing where the board hears evidence and decides if a doctor is guilty of the charges, and another hearing where the doctor is disciplined. And at that point, they can learn other information about a defendant's past, both good and bad.

That's how criminal courts work. Once the jury has determined a person's guilt, the judge is the one who does the sentencing and gets to hear more about the defendant. This solution, Rebecca points out, has the benefit of being readily available to the board. It's already legal under Tennessee law.

Last September, the medical board members and staff had an offsite retreat. Rebecca was there. She recorded it for her notes for her book on licensing boards. And one of the things they discussed was Dr. LaPaglia's case, what had gone wrong. Dr. Loyd was still upset about it.

Dr. LaPaglia is a practicing doctor in Tennessee right now. He does house calls for $50 cash. And Loyd explained what he sees as the real problem with that kind of outcome, with this halfway discipline they gave LaPaglia. They've made it so he can't get a job at a hospital or a medical clinic, but he can still see patients.

Dr. Loyd said, quote, "He can only work in a cash-based practice, and so the most vulnerable Tennesseans are the ones at risk. And that's not awesome because the very population that I work personally with on a daily basis. I just put somebody back out there, and I'm struggling with that."

Ira Glass

Dana Chivvis is one of the producers of our program. Rebecca Allensworth wrote about medical boards and Dr. LaPaglia's case for the New York Review of Books.

[MUSIC - "YOU DON'T NEED A LICENSE FOR THAT" BY GEORGE FORMBY]

Credits

Ira Glass

Our program was produced today by Sean Cole. The people who put our program together today includes Bim Adewunmi, Elna Baker, Susan Burton, Ben Calhoun, Dana Chivvis, Aviva DeKornfeld, Hilary Elkins, Noor Gill, Damien Grave, Miki Meek, Stowe Nelson, Katherine Rae Mondo, Nadia Reiman, Robyn Semien, Lilly Sullivan, Christopher Swetala, Matt Tierney, Julie Whitaker, and Diane Wu.

Our managing editor is Sara Abdurrahman, senior editor, David Kestenbaum, our executive editor, Emanuele Berry. Special thanks to David Wendy Helgeson, Reid Magney, Scott McDonnell, and Jakob Elberg. Our website, thisamericanlife.org, where you can stream our archive of over 700 episodes for absolutely free. Plus, there's videos. There's lists of favorite programs. There's tons of other stuff on there, too. Again, that website, thisamericanlife.org.

This American Life is delivered to public radio stations by PRX, the Public Radio Exchange. Thanks, as always, to our program's co-founder, Mr. Torey Malatia. He and his wife are finally taking their first vacation since quarantine. I think they're going to have a good time. He read me their packing list.

Dana Chivvis

45 quart-sized Mason jars which contained marijuana, 127 glass pipes used to smoke marijuana, Glock 19 9 millimeter.

Ira Glass

I'm Ira Glass. Back next week with more stories of This American Life.

[MUSIC - "YOU DON'T NEED A LICENSE FOR THAT" BY GEORGE FORMBY]