| Off the Couch |

Not the Mafia

He could do teshuvah or he could lawyer up and face the Ministry of Health

 

Josh was yet another patient who’d come to my office requesting a dangerous, over-the-top cocktail of addictive medications prescribed to him by Dr. Solbern. It was time to handle this problem the old-fashioned way.

PART II

 

I remember the first time I met one of Dr. Solbern’s patients. Ruchy was a young woman who had booked an appointment with me for ADHD and told me she needed a refill of her Vyvanse. When she told me the dose, I nearly fell off of my chair.

“You take 150 mg a day?! That’s twice the maximum dosage approved by the Ministry of Health,” I responded with honest shock.

Ruchy was either abusing this medication and at risk of serious adverse effects —including bursting her heart — or selling it on the streets.

“That’s what Dr. Solbern prescribes me, so what’s your problem?  Listen, I just need a refill,” she snapped, “and Dr. Solbern is out of the country.”

Our visit didn’t go particularly well, as I wasn’t going to follow this fellow’s alleged treatment plan. There was no way anyone could be prescribing this dose in good faith, and I felt a moral duty to contact this unknown senior colleague to let him know that his patient was doctor-shopping for drugs.

“Yes?” came a disembodied voice from the other end of the phone line when I called the following week. “This is Dr. Solbern. How can I help you?”

I introduced myself as a junior colleague who had seen one of his patients. I let him know that I was worried about her drug-seeking behaviors as well as the high dose of the medication she was taking.

“It could be,” he answered nonchalantly. “But she’s done very well at that dose, so I really don’t see a problem here.”

I wasn’t sure I’d heard correctly. “I’m sorry, Doctor, but did you just say that she was ‘doing well’ at that dose of 150 mg per day? That’s twice the maximum dose — you were prescribing her that?”

“Sure. I trust my patients and they trust me. Listen, Dr. Whoever-you-are, I’ve been doing this for a long time and I know what I’m doing.  Have a great day.”

He hung up, and I made a mental note.

When it happened again, I called Dr. Solbern once more and had a similarly unsatisfying discussion. This time I contacted a colleague to see if I was the only one who’d had a concerning experience with a patient of Dr. Solbern.

“For sure,” Dr. Levin confirmed. “The guy is a liability for our patients. Don’t you know they call him The Candyman?”

Actually, I didn’t. But I knew right then that we had to do something.

My colleague, however, was less enthusiastic about taking a stand against a fellow physician, but we agreed to revisit the idea if nothing changed over time.

And nothing did. When Josh came around asking me to refill dangerous doses of Xanax and Adderall that had been previously prescribed by Dr. Solbern, that was enough to get me thinking about rounding up a posse.

I’d been meeting my friends Avi and Yochi, a pair of well-connected askanim, for lunch on a monthly basis to discuss public health issues in the Anglo community. This time, though, I’d invited two other psychiatrists for the sake of having a solid roundtable discussion about how to deal with the issue at hand.

As we munched on quesadillas and shared a massive plate of nachos, I brought up my concerns with Dr. Solbern and his reckless prescribing habits.

Yochi almost choked on his lemonade. “That guy’s still around? He’s been giving out painkillers since before any of us were bar mitzvah-ed.”

Avi nodded. “We actually tried going to local rabbanim to shut him down after one of our cases involved a bochur who overdosed with the medications Dr. Solbern gave him.”

“Not so easy to shut down a doctor,” my colleague Dr. Levin piped up. “We don’t have any proof he’s doing anything illegal.”

“Well, each of us can contest, from our own experiences, that at worst he’s a drug dealer, and at best a menace to society.”

There were enough nods around the table to go vaiter and offer up my plan.

“You know, back when I’d just finished my training and was working in an inpatient psychiatric unit in Boston, we kept on getting patients from a Dr. Ming. All sorts of bad stories with overdoses, addictions, arrests. We’d detox the patients, they’d go back out, get their fix from Dr. Ming, and before you could say ‘public health crisis,’ they’d be back on the wards. One day Dr. Antonina had enough and told us she was ready to do things ‘the old-fashioned way.’ ”

“What’s that?” asked Dr. Sharfer, a psychologist who specialized in addictions. “Break Dr. Ming’s kneecaps like the mob does?”

“Dr. Antonina might have been Italian and from Boston, but she wasn’t much of a mafioso. That being said, she had a flair for handling things like they did back in the day,” I continued. “She wrote up a letter stating her concerns regarding Dr. Ming’s dangerous and negligent practice of medicine. She listed specific examples and made a recommendation that Dr. Ming’s license be temporarily revoked pending a full investigation by both the State’s Department of Public Health and its medical board. She had about ten of us sign it and then faxed it over to Dr. Ming’s office. Within five minutes she had this crook on the phone begging her not to send it in to the authorities.”

“Nu?  Did she do it?” Avi asked between mouthfuls of quesadillas.

“She gave him an ultimatum that the next time she even heard his name, she’d send it in to the local newspapers as well.”

“If that’s not mafia-style I don’t know what is,” grinned Dr. Levin. “I say, let’s do it. This guy Solbern is a public health crisis. Just because he’s a Yid doesn’t mean he’s allowed to put our patients at risk.”

Yochi nodded. “I’m all for giving him an opportunity to do teshuvah, but if you’ve got the letter, I’ll sign it.”

I pulled the pre-printed letter out of my bag and put copies for everyone on the table.

Even Dr. Sharfer agreed this was the best plan for the current situation. “I don’t like the idea of being a moser against a fellow psychiatrist but you make a good point. Hopefully this will just stay between colleagues and not go further. This isn’t about playing mafia, it’s about our patients. I’m in.”

We had five signatures on the letter and Yochi agreed to drop it off at Dr. Solbern’s office later that day.

Dr. Solbern’s reign as The Candyman was over. He could do teshuvah or he could lawyer up and face the Ministry of Health. I didn’t think he’d have the energy or wherewithal for the latter.

And as for the patients who were seeing him for their fix? They would have it tough. Maybe they’d shop around for another “candyman.” But for our part, there were enough helpful faces around the table to support anyone who was ready to get sober.

 

Identifying details have been changed to protect the privacy of patients, their families, and all other parties.

 

Jacob L. Freedman is a psychiatrist and business consultant based in Israel. When he’s not busy with his patients, Dr. Freedman, whose new book Off the Couch has just been released in collaboration with Menucha Publishers, can be found learning Torah in the Old City or hiking the hills around Jerusalem.

Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com

(Originally featured in Mishpacha, Issue 849)

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