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BEVERLY HILLS, Calif. Ariella Morrow, an internal medicine doctor, gradually slid from healthy self-esteem and professional success into the depths of depression.

This story also ran on LAist. It can be republished for free.

Beginning in 2015, she suffered a string of personal troubles, including a shattering family trauma, marital strife, and a major professional setback. At first, sheer grit and determination kept her going, but eventually she was unable to keep her troubles at bay and took refuge in heavy drinking. By late 2020, Morrow could barely get out of bed and didnt shower or brush her teeth for weeks on end. She was up to two bottles of wine a day, alternating it with Scotch whisky.

Sitting in her well-appointed home on a recent autumn afternoon, adorned in a bright lavender dress, matching lipstick, and a large pearl necklace, Morrow traced the arc of her surrender to alcohol: Im not going to drink before 5 p.m. Im not going to drink before 2. Im not going to drink while the kids are home. And then, it was 10 oclock, 9 oclock, wake up and drink. Ariella Morrow, a Los Angeles-area internist, fell into a deep depression and started drinking heavily after a succession of family traumas and a major professional setback. She finally sought help for alcohol dependence and depression at a clinic in Texas.(Bernard J. Wolfson/KFF Health News)

As addiction and overdose deaths command headlines across the nation, the Medical Board of California, which licenses MDs, is developing a new program to treat and monitor doctors with alcohol and drug problems. But a fault line has appeared over whether those who join the new program without being ordered to by the board should be subject to public disclosure.

Patient advocates note that the medical boards primary mission is to protect healthcare consumers and prevent harm, which they say trumps physician privacy.

The names of those required by the board to undergo treatment and monitoring under a disciplinary order are already made public. But addiction medicine professionals say that if the state wants troubled doctors to come forward without a board order, confidentiality is crucial.

Public disclosure would be a powerful disincentive for anybody to get help and would impede early intervention, which is key to avoiding impairment on the job that could harm patients, said Scott Hambleton, president of the Federation of State Physician Health Programs, whose core members help arrange care and monitoring of doctors for substance use disorders and mental health conditions as an alternative to discipline.

But consumer advocates argue that patients have a right to know if their doctor has an addiction. Doctors are supposed to talk to their patients about all the risks and benefits of any treatment or procedure, yet the risk of an addicted doctor is expected to remain a secret? Marian Hollingsworth, a volunteer advocate with the Patient Safety Action Network, told the medical board at a Nov. 14 hearing on the new program.

Doctors are as vulnerable to addiction as anyone else. People who work to help rehabilitate physicians say the rate of substance use disorders among them is at least as high as the rate for the general public, which the federal Substance Abuse and Mental Health Services Administration put at 17.3% in a Nov. 13 report.

Alcohol is a very common drug of choice among doctors, but their ready access to pain meds is also a particular risk.

If you have an opioid use disorder and are working in an operating room with medications like fentanyl staring you down, its a challenge and can be a trigger, said Chwen-Yuen Angie Chen, an addiction medicine doctor who chairs the Well-Being of Physicians and Physicians-in-Training Committee at Stanford Health Care. Its like someone with an alcohol use disorder working at a bar. Email Sign-Up

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From Pioneer to Lagger

California was once at the forefront of physician treatment and monitoring. In 1981, the medical board launched a program for the evaluation, treatment, and monitoring of physicians with mental illness or substance use problems. Participants were often required to take random drug tests, attend multiple group meetings a week, submit to work-site surveillance by colleagues, and stay in the program for at least five years. Doctors who voluntarily entered the program generally enjoyed confidentiality, but those ordered into it by the board as part of a disciplinary action were on the public record.

The program was terminated in 2008 after several audits found serious flaws. One such audit, conducted by Julianne DAngelo Fellmeth, a consumer interest lawyer who was chosen as an outside monitor for the board, found that doctors in the program were often able to evade the random drug tests, attendance at mandatory group therapy sessions was not accurately tracked, and participants were not properly monitored at work sites.

Today, MDs who want help with addiction can seek private treatment on their own or in many cases are referred by hospitals and other health care employers to third parties that organize treatment and surveillance. The medical board can order a doctor on probation to get treatment.

In contrast, the California licensing boards of eight other health-related professions, including osteopathic physicians, registered nurses, dentists, and pharmacists, have treatment and monitoring programs administered under one master contract by a publicly traded company called Maximus Inc. California paid Maximus about $1.6 million last fiscal year to administer those programs.

When and if the final medical board regulations are adopted, the next step would be for the board to open bidding to find a program administrator.

Fall From Grace

Morrows troubles started long after the original California program had been shut down.

The daughter of a prominent cosmetic surgeon, Morrow grew up in Palm Springs in circumstances she describes as beyond privileged. Her father, David Morrow, later became her most trusted mentor.

But her charmed life began to fall apart in 2015, when her father and mother, Linda Morrow, were indicted on federal insurance fraud charges in a well-publicized case. In 2017, the couple fled to Israel in an attempt to escape criminal prosecution, but later they were both arrested and returned to the United States to face prison sentences.

The legal woes of Morrows parents, later compounded by marital problems related to the failure of her husbands business, took a heavy toll on Morrow. She was in her early 30s when the trouble with her parents started, and she was working 16-hour days to build a private medical practice, with two small children at home. By the end of 2019, she was severely depressed and turning increasingly to alcohol. Then, the loss of her admitting privileges at a large Los Angeles hospital due to inadequate medical record-keeping shattered what remained of her self-confidence.

Morrow, reflecting on her experience, said the very strengths that propel doctors through medical school and keep them going in their careers can foster a sense of denial. We are so strong that our strength is our greatest threat. Our power is our powerlessness, she said. Morrow ignored all the flashing yellow lights and even the red light beyond which serious trouble lay: I blew through all of it, and I fell off the cliff.

By late 2020, no longer working, bedridden by depression, and drinking to excess, she realized she could no longer will her way through: I finally said to my husband, I need help. He said, I know you do.

Ultimately, she packed herself off to a private residential treatment center in Texas. Now sober for 21 months, Morrow said the privacy of the addiction treatment she chose was invaluable because it shielded her from professional scrutiny.

I didnt have to feel naked and judged, she said.

Morrow said her privacy concerns would make her reluctant to join a state program like the one being considere by the medical board.

Physician Privacy vs. Patient Protection

The proposed regulations would spare doctors in the program who were not under board discipline from public disclosure as long as they stayed sober and complied with all the requirements, generally including random drug tests, attendance at group sessions, and work-site monitoring. If the program put a restriction on a doctors medical license, it would be posted on the medical boards website, but without mentioning the doctors participation in the program.

Yet even that might compromise a doctors career since having a restricted license for unspecified reasons could have many enduring personal and professional implications, none positive, said Tracy Zemansky, a clinical psychologist and president of the Southern California division of Pacific Assistance Group, which provides support and monitoring for physicians.

Zemansky and others say doctors, just like anyone else, are entitled to medical privacy under federal law, as long as they havent caused harm.

Many who work in addiction medicine also criticized the proposed new program for not including mental health problems, which often go hand in hand with addiction and are covered by physician health programs in other states.

To forgo mental health treatment, I think, is a grave mistake, Morrow said. For her, depression and alcoholism were inseparable, and the residential program she attended treated her for both.

Another point of contention is money. Under the current proposal, doctors would bear all the costs of the program.

The initial clinical evaluation, plus the regular random drug tests, group sessions, and monitoring at their work sites could cost participants over $27,000 a year on average, according to estimates posted by the medical board. And if they were required to go for 30-day inpatient treatment, that would add an additional $40,000 plus nearly $36,000 in lost wages.

People who work in the field of addiction medicine believe that is an unfair burden. They note that most programs for physicians in other states have outside funding to reduce the cost to participants.

The cost should not be fully borne by the doctors, because there are many other people that are benefiting from this, including the board, malpractice insurers, hospitals, the medical association, said Greg Skipper, a semi-retired addiction medicine doctor who ran Alabamas state physician health program for 12 years. In Alabama, he said, those institutions contribute to the program, significantly cutting the amount doctors have to pay.

The treatment program that Morrow attended in spring of 2021, at The Menninger Clinic in Houston, cost $80,000 for a six-week stay, which was covered by a concerned family member. It saved my life, she said.

Though Morrow had difficulty maintaining her sobriety in the first year after treatment, she has now been sober since April 2, 2022. These days, Morrow regularly attends therapy and Alcoholics Anonymous and has pivoted to become an addiction medicine doctor.

I am a better doctor today because of my experience no question, Morrow said. I am proud to be a doctor whos an alcoholic in recovery.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Bernard J. Wolfson: bwolfson@kff.org, @bjwolfson Related Topics California Health Industry Mental Health States Doctors Hospitals Substance Misuse Contact Us Submit a Story Tip

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Dodgers considering Ohtani helping as reliever

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Dodgers considering Ohtani helping as reliever

LOS ANGELES — Shohei Ohtani has proved to be a viable starting pitcher as the postseason approaches, but Los Angeles Dodgers manager Dave Roberts acknowledged Wednesday that the organization has considered whether he might be more valuable helping a weary bullpen — perhaps especially in a shorter series like the three-game wild-card round.

It remains far more likely that Ohtani will serve as one of the Dodgers’ starters in the playoffs, but Roberts said the possibility of Ohtani helping out of the bullpen is “something we’re all talking about.”

“I know that we are going to be talking about it,” Roberts said. “I think the one thing you can say, though, is that we use him once every seven days, eight days, nine days — [11] days in between his last start — so to think that now it’s feasible for a guy that’s just coming off what he’s done last year, or didn’t do last year, to then now put him in a role that’s very, very unique — because he’s a very methodical, disciplined, routine-driven person. The pen is the complete opposite, right? You potentially could be taking on risk, and we’ve come this far, certainly with the kid gloves and managing.”

The Dodgers’ caution while managing Ohtani’s return to the mound in the wake of a second repair of his ulnar collateral ligament was evident Tuesday, when Roberts removed him after five no-hit innings despite just 68 pitches. That decision was predetermined, Roberts said, a function of the team’s hesitancy to push him beyond the five-inning threshold this season.

Ohtani said he understood the decision but added that he wants to “pitch as long as possible.” Later, while addressing the Japanese media, Ohtani expressed an openness to playing the outfield in order to remain in the lineup after exiting as a reliever, saying: “I’ve had conversations with various people, and the idea of me pitching in relief has come up. As a player, I want to be prepared to handle whatever role is needed. If I do end up pitching out of the bullpen, I think that could also mean I’d need to play in the outfield afterward, depending on the situation. So I want to be ready for anything, no matter what comes my way.”

Major League Baseball’s two-way rule, adopted in 2019, allows Ohtani to remain in the game as the designated hitter if he starts on the mound and is replaced. But if he were to start a game — even in the playoffs — as the DH, then pitch in relief, the Dodgers would lose the DH once Ohtani stops pitching. Ohtani’s only path to remaining in the game in that situation would be to play the outfield — something he did seven times with the Los Angeles Angels in 2021.

Ohtani, though, has not done any work in the outfield this year. The Dodgers, meanwhile, are naturally hesitant to add more responsibilities to a player who’s also a catalyst atop their lineup, not to mention a legitimate stolen-base threat.

Asked if Ohtani in the outfield is on his radar, Roberts smiled and said, “No.”

“There’s a lot of variables,” Roberts said, “but to know that he can potentially run out there, it’s great. Maybe just in theory. But, again, I love him for even throwing that out there.”

The Dodgers have long been open to the possibility of Ohtani closing out a critical game in October — like he did to seal a championship for his native Japan in the 2023 World Baseball Classic — but the prospect of him helping as a reliever has ramped up as the bullpen has continued to struggle and the rotation has taken form.

The Dodgers have five other effective starters in Yoshinobu Yamamoto, Blake Snell, Tyler Glasnow, Clayton Kershaw and Emmet Sheehan, the latter of whom also has proved to be effective out of the bullpen. Some of their highest-leverage relievers — Blake Treinen, Tanner Scott, Kirby Yates and Michael Kopech among them — have struggled to varying degrees.

If Ohtani were to pitch in relief, it would be in the ninth inning. But juggling warming up in the bullpen if his turn to bat is coming up, or if he’s required to run the bases, could prove difficult. And the Dodgers would be at risk of either losing him as a hitter or forcing him to play the outfield if the game extends to extra innings.

“I don’t know if it’s a pipe dream,” Roberts said of Ohtani playing the outfield, “but it’s very commendable from Shohei.”

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Sadiq Khan calls out Gaza ‘genocide’, as Starmer ‘delays’ recognising Palestinian state until end of Trump’s state visit

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Sadiq Khan calls out Gaza 'genocide', as Starmer 'delays' recognising Palestinian state until end of Trump's state visit

London’s mayor Sir Sadiq Khan has for the first time described the situation in Gaza as a “genocide”, becoming the most senior Labour figure to contradict the government’s official position.

Earlier this week, a UN Commission said a genocide was taking place in Gaza – something repeatedly denied by Israel.

Meanwhile, Sir Keir Starmer has been under pressure to raise Israel’s bombardment of the territory with Donald Trump during his state visit to the UK.

The prime minister is due to have discussions with the president today, but reports suggest he will delay formally recognising a Palestinian state until this weekend, after Mr Trump has left Britain.

It is claimed the government wants to avoid the issue dominating a news conference the two men plan to hold, according to The Times.

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Trump meets Starmer: What can we expect?

The prime minister has found himself at odds with the US administration over the move, which is opposed to official recognition of Palestine.

The mayor of London, who has engaged in a long-running spat with Mr Trump, has added to the political tension by contradicting official Labour policy at a people’s question time event on Wednesday.

“I think it’s inescapable to draw the conclusion in Gaza we are seeing before our very eyes a genocide,” said Sir Sadiq.

Sir Keir has previously pledged to recognise Palestinian statehood ahead of next week’s United Nations General Assembly in New York if Israel does not meet a series of conditions to improve the humanitarian situation in Gaza.

Other nations, including France, Australia and Canada, have said they plan to take the same step at the UN gathering.

Explainer: What does recognising a Palestinian state mean?

The UK has consistently argued that the issue of whether Israel has committed genocide was a matter for the courts. Israel is fighting a case at the International Court of Justice in The Hague in which the country is accused of genocide.

But some opposition leaders, including Zack Polanski for the Green Party, and the Liberal Democrats’ Sir Ed Davey have specifically referred to the situation in Gaza as genocide.

Read more from Sky News:
Watch: Israel’s Gaza City offensive
MPs denied entry into West Bank

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Is Israel committing genocide?

On Tuesday, the UN Independent International Commission of Inquiry on the Occupied Palestinian Territory released a report, claiming: “It is clear that there is an intent to destroy the Palestinians in Gaza”.

It said Israel’s actions meet the criteria set down for defining a genocide.

The UK government has said its official position was it “has not concluded that Israel is acting with that [genocidal] intent“.

Israel is currently undertaking a major ground offensive in Gaza, with thousands forced to flee from Gaza City in recent days.

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Trump-Starmer talks could be landmark moment – and join pantheon of UK-US summits

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Trump-Starmer talks could be landmark moment - and join pantheon of UK-US summits

In years to come, it may become known simply as Chequers ’25.

But today’s summit between Sir Keir Starmer and Donald Trump, at the prime minister’s country retreat, has the potential to be a landmark moment in UK-US history.

There’s plenty of scope for it to go horribly wrong, of course: over Jeffrey Epstein, Sir Keir’s pledge to recognise Palestine, the president’s lukewarm support for Ukraine, the Chagos Islands sell-off, or free speech.

Trump state visit live – read the latest

But on the other hand, it could be a triumph for the so-called “special relationship” – as well as relations between these two unlikely allies – with deals on trade and tariffs and an improbably blossoming bromance.

Either way, this Chequers summit – on the president’s historic second state visit to the UK – could turn out to be one of the most notable one-to-one meetings between PM and president in 20th and 21st century history.

Sir Keir and Mr Trump have already met several times, most recently at The Donald’s golf courses in Scotland in late July and, before that, memorably at the White House in February.

Donald Trump and Keir Starmer wave as they board Air Force One on a previous trip. Pic: AP
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Donald Trump and Keir Starmer wave as they board Air Force One on a previous trip. Pic: AP

It was then that the PM theatrically pulled King Charles’s invitation for this week’s visit out of his inside pocket in a spectacular stunt surely masterminded by the “Prince of Darkness”, spin doctor-turned-ambassador (until last week, anyway) Peter Mandelson.

And over the years, there have been some remarkable and historic meetings and relationships, good and bad, between UK prime ministers and American presidents.

From Churchill and Roosevelt to Eden and Eisenhower, from Macmillan and JFK to Wilson and Johnson, from Thatcher and Reagan, to Blair and Bush, and from Cameron and Obama… to Starmer and Trump, perhaps?

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‘History’ that binds the UK and US

A brief history of relationships between PMs and presidents

Throughout UK-US history, there have been many examples of a good relationship and close bond between a Labour prime minister and a Republican president. And vice versa.

Also, it has not always been rosy between prime ministers and presidents of the two sister parties. There have been big fallings out: over Suez, Vietnam and the Caribbean island of Grenada.

Leading up to this Chequers summit, the omens have not been good.

First, the PM was forced to sack his vital link between Downing Street and the Oval Office, Lord Mandelson, over his friendship with Epstein.

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Trump meets Starmer: What can we expect?

Second, the president arrived in the UK to a barrage of criticism from London Mayor Sir Sadiq Khan, who accused him of doing more than anyone else to encourage the intolerant far right across the globe.

And third, in a video-link to the ‘Unite the Kingdom’ march in London last weekend, one-time Trump ally Elon Musk called for a dissolution of parliament and a change of government and appeared to encourage violent protest.

Churchill and FDR

Churchill and FDR at the White House in 1941. Pic: AP
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Churchill and FDR at the White House in 1941. Pic: AP

Back in the mid-20th century, the godfather of the “special relationship” was wartime leader Sir Winston Churchill, though it was 1946 before he first coined the phrase in a speech in the US, in which he also spoke of the “iron curtain”.

It was in 1941 that Churchill held one of the most significant meetings with a US president, Franklin D Roosevelt, at a Washington conference to plot the defeat of Germany after Japan’s attack on Pearl Harbour.

Churchill arrived in Washington in December after a rough 10-day voyage on a Royal Navy battleship and stayed three weeks, spending Christmas in the White House and on Boxing Day becoming the first UK PM to address Congress.

The close bond between Churchill and Roosevelt was described as a friendship that saved the world. It was even claimed one reason the pair got on famously was that they were both renowned cigar smokers.

Churchill and Truman

Churchill and Truman catch a train from Washington in 1946. Pic: AP
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Churchill and Truman catch a train from Washington in 1946. Pic: AP

After the war ended, Churchill’s “special relationship” speech, describing the alliance between the UK and US, was delivered at Westminster College, in Fulton, Missouri in March 1946.

The speech was introduced by President Harry Truman, a Democrat, with whom Churchill had attended the Potsdam Conference in 1945 to negotiate the terms of ending the war.

These two were also close friends and would write handwritten letters to each other and address one another as Harry and Winston. Mr Truman was also the only US president to visit Churchill at Chartwell, his family home.

Eden and Eisenhower

Eden and Eisenhower shake hands at the conclusion of their three-day conference in 1956. Pic: AP
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Eden and Eisenhower shake hands at the conclusion of their three-day conference in 1956. Pic: AP

But the transatlantic cosiness came to an abrupt end in the 1950s, when Churchill’s Conservative successor Anthony Eden fell out badly with the Republican president Dwight Eisenhower over the Suez Crisis.

Mr Eden did visit Mr Eisenhower in Washington in January 1956, and the official record of the meeting describes the discussion as focussing on “policy differences and Cold War problems”.

Macmillan and JFK

Harold Macmillan and John F Kennedy at Andrews Air Force Base. Pic: AP
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Harold Macmillan and John F Kennedy at Andrews Air Force Base. Pic: AP

But in the early 1960s, a Conservative prime minister and a Democrat president with seemingly nothing in common, the stuffy and diffident Harold Macmillan, and the charismatic John F Kennedy, repaired the damage.

They were credited with rescuing the special relationship after the rupture of the Suez Crisis, at a time of high tensions around the world: the Berlin Wall, the Cuban missile crisis, and the threat of nuclear weapons.

The two leaders exchanged handwritten notes, as well as Christmas and birthday cards. The Macmillans visited the Kennedys twice at the White House, in 1961 and 1962 – the second described in the US as a “momentous” meeting on the Cuban crisis.

The relationship was abruptly cut short in 1963 by “Supermac’s” demise prompted by the Profumo scandal, and JFK’s assassination in Dallas. But after her husband’s death, Jacqueline Kennedy was said to have had a father-daughter relationship with Macmillan, who was said to have been enchanted with her.

Wilson and LBJ

Johnson meeting with Wilson. Pic: Glasshouse Images/Shutterstock
Image:
Johnson meeting with Wilson. Pic: Glasshouse Images/Shutterstock

After JFK, the so-called “special relationship” cooled once again – and under a Labour prime minister and Democrat president – when Harold Wilson rejected pressure from Lyndon B Johnson to send British troops to Vietnam.

Mr Wilson became prime minister in 1964, just two months after LBJ sent US troops. His first overseas trip was to the White House, in December 1964, and the PM returned to tell his cabinet: “Lyndon Johnson is begging me even to send a bagpipe band to Vietnam.”

Thatcher and Reagan

Thatcher at Reagan's 83rd birthday celebrations. Pic: Reuters
Image:
Thatcher at Reagan’s 83rd birthday celebrations. Pic: Reuters

And even though Margaret Thatcher and Ronald Reagan were ideological soulmates, Thatcher was furious when she wasn’t consulted before the Americans invaded Grenada in 1983 to topple a Marxist regime.

Even worse, according to Mrs Thatcher allies, a year earlier, Reagan had stayed neutral during the Falklands war. Reagan said he couldn’t understand why two US allies were arguing over “that little ice-cold bunch of land down there”.

Thatcher and Reagan became firm friends. Pic: Reuters
Image:
Thatcher and Reagan became firm friends. Pic: Reuters

But their relationship didn’t just survive, it flourished, including at one memorable visit to the presidential retreat at Camp David in 1984, where President Reagan famously drove Mrs T around in a golf buggy.

They would also memorably dance together at White House balls.

Blair and Bush

Blair hosts Bush in Durham in 2003. Pic: PA
Image:
Blair hosts Bush in Durham in 2003. Pic: PA

Camp David was also where in 2001 the Republican president George W Bush and Labour’s Sir Tony Blair embarked on the defining mission of his premiership: the Iraq War. It was to prove to be an historic encounter.

The war was the turning point of Sir Tony’s decade in Number 10. He was branded a liar over claims about Saddam Hussein’s “weapons of mass destruction”, he was vilified by the Labour left, and it was the beginning of the end for him.

And to add to the suspicion among Sir Tony’s critics that he was Mr Bush’s poodle, in 2006 at a G8 summit in St Petersburg – that wouldn’t happen now – a rogue microphone picked up the president calling, “Yo, Blair! How are you doing?”

Cameron and Obama

Cameron and Obama serve food at a barbecue in the garden of 10 Downing Street. Pic: Reuters
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Cameron and Obama serve food at a barbecue in the garden of 10 Downing Street. Pic: Reuters

Some years later, the Tory prime minister sometimes called the “heir to Blair”, David Cameron, bonded over burgers with the Democrat president Barack Obama, serving a BBQ lunch to military families in the Downing Street garden. They also played golf at the exclusive Grove resort in 2016.

They seemed unlikely allies: Obama, the first African-American president, and Cameron, the 19th old Etonian prime minister. It was claimed they had a “transatlantic bromance” in office. “Yes, he sometimes calls me bro,” Lord Cameron admitted.

But not everything went well.

The Tory PM persuaded Mr Obama to help the Remain campaign in the 2016 Brexit referendum, when he claimed the UK would be “at the back of the queue” on trade deals with the US, if it left the EU. It backfired, of course.

Now it’s Sir Keir Starmer’s turn to tread a delicate and potentially hazardous political tightrope as he entertains the latest – and most unconventional – US president.

The greatest dangers for Sir Keir will be a news conference in the afternoon, in the gardens, if the weather permits.

Good luck, as they say, with that.

Before then, there’s the potential for what the Americans call a “pool spray”, one of those impromptu, rambling and unpredictable Q&As we’ve seen so many times in the Oval Office.

For Sir Keir, what could possibly go wrong?

Chequers ’25 could be memorable and notable, like so many previous meetings between a PM and a president. But not necessarily for the right reasons for this UK prime minister.

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