A family doctor disciplined three times for drug abuse in the last 10 years is accepting new patients in a Dartmouth clinic, bringing to light a widespread problem among Nova Scotia physicians.

Meet Stephen Harley. The ex-drug addict spent years in and out of rehab programs, fighting a destructive addiction to narcotics. He lied, cheated, filled out illegal medical records, all for a few pills of Dilaudid or Hydromorph Contin. He lost his job more than once, stuck in a cycle of quitting, relapsing and avoiding the many drug tests imposed to him. Stephen Harley is not any drug addict. He is also a family doctor, who admittedly abused his powers as a physician to obtain narcotics and feed his addiction.

According to The College of Physicians and Surgeons of Nova Scotia, Harley started using in 2004, writing “fraudulent narcotics prescriptions for his family and friends, which he then used for himself.” For four years, the phony prescription scheme went on. Until a confidential complaint was lodged in May 2008.

His license was immediately suspended and he was sent in treatment. Six months later, the Hearing Committee of the College issued a decision: Harley was reprimanded, but could go back to work with restrictions, including regular urine screenings for drugs. He was also prohibited from prescribing narcotics to his patients until October 2009.

Harley is far from being the only doctor ever caught intoxicated or tampering with prescriptions on the job. Addiction is one of the main reason why doctors are disciplined by the College of Physicians and Surgeons of Nova Scotia, according to an analysis of all final decisions published online between 1995 and 2014.

On a total of 42 physicians whose final disciplinary decision was published online by the College, 13 were accused of “inappropriate prescription”. Then came sexual misconduct, misdiagnosis and malpractice.

 

The tip of the iceberg

Like many doctors fighting addiction, Harley was probably sent to the Centre for doctor wellness, an assessment and counselling service for physicians, veterinarians, dentists and residents in Nova Scotia. The Center is run by doctor Carolyn Thomson and one colleague. Services are partly paid by membership fees of the provincial doctors association, Doctors NS.

“Their biggest worry is their job. All other aspects of their life have degraded before, their family, their marriage, sometimes their health situation. They feel like work is the one place where they can feel good and put everything else out of their mind,” says Carolyn.

The tall blond doctor explains it is really hard to know exactly how many doctors suffer from addiction issues, but points out to one key proportion. “One physician out of 10 will face addiction issues at one point or another in his or her career. Some specializations like intensive care, anaesthetists and family medicine are more likely, too.”

Doctor Michael Teehan, of the Dalhousie Faculty of Medicine, goes even further. “In his lifetime, practically every doctor will either have addiction problems or see a colleague struggling with addiction issues.”

Relapse and redemption

The spiral of addiction went on for doctor Stephen Harley.

On October 14, 2009, a few days after his narcotics prescription restriction was lifted, he slipped again.

This time, he “obtained the narcotics Dilaudid and Hydromorph Contin through non-prescription means for his own use,” failed to provide a random urine sample for drug testing and deliberately avoided tests.

Harley was permanently prohibited from prescribing narcotics, ordered to pay a fee of $8,500, four times higher than for his first offence.

In December 2010, he was allowed to return to practice with stricter restrictions, including more random drug screenings.

And then he relapsed for the third time, failing a urine screening in early 2011.

The College decided to give him one last chance, justifying its decision in a short statement.

“We acknowledge that Dr. Harley’s drug addiction is an illness very difficult to overcome and manage. It is therefore appropriate and just to give Dr. Harley an opportunity to return to practice in light of the success management of his addiction and his demonstrated competence.”

How many is too many?

Harley is not an outlier, according to our analysis. Since 1995, the College revoked the license of 8 doctors, including one doctor accused of inappropriate prescription. All other doctors were reprimanded and had to pay a fee of a few thousand dollars. Some were issued restrictions like random drug testing, supervised classes or were forbidden to prescribe narcotics.

 

Pattie Lacroix, from The College of Physicians and Surgeons of Nova Scotia, stresses that “situations where there is more than one complaint are taken into account when a settlement is made.” She also argues that the number of complaints related to “physician health and fitness” [i.e. addiction issues] have gone down steadily since 2009.

Independent psychological consultant John Streukins has another explanation. “Substance-use disorders are classed as a disability and as such, people need to be accommodated in the workplace under the Employment and Assistance for Persons with Disabilities Act. They need to be given a fair opportunity to correct their addiction problem. It would be no different if an employee has cancer. He can’t be fired. He needs to be given an opportunity to be fit for work again.”

Almost a year after being allowed to practice, Stephen Harley now has his name and title back on a clinic door. In May 2014, he started working at the Burnside Family Practice and Walk-In Clinic in Dartmouth. Staff confirmed Harley is still accepting new patients, adding that “he has gotten tons of inquiries from new patients and his schedule is booked solid every day.”

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