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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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Politics

Norman Tebbit: Former Tory minister who served in Margaret Thatcher’s government dies aged 94

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Norman Tebbit: Former Tory minister who served in Margaret Thatcher's government dies aged 94

Norman Tebbit, the former Tory minister who served in Margaret Thatcher’s government, has died at the age of 94.

Lord Tebbit died “peacefully at home” late on Monday night, his son William confirmed.

One of Mrs Thatcher’s most loyal cabinet ministers, he was a leading political voice throughout the turbulent 1980s.

He held the posts of employment secretary, trade secretary, Chancellor of the Duchy of Lancaster and Conservative party chairman before resigning as an MP in 1992 after his wife was left disabled by the Provisional IRA’s bombing of the Grand Hotel in Brighton.

He considered standing for the Conservative leadership after Mrs Thatcher’s resignation in 1990, but was committed to taking care of his wife.

Prime Minister Margaret Thatcher and party chairman Norman Tebbit.
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Margaret Thatcher and Norman Tebbit in 1987 after her election victory. Pic: PA

Tory leader Kemi Badenoch called him an “icon” in British politics and was “one of the leading exponents of the philosophy we now know as Thatcherism”.

“But to many of us it was the stoicism and courage he showed in the face of terrorism, which inspired us as he rebuilt his political career after suffering terrible injuries in the Brighton bomb, and cared selflessly for his wife Margaret, who was gravely disabled in the bombing,” she wrote on X.

“He never buckled under pressure and he never compromised. Our nation has lost one of its very best today and I speak for all the Conservative family and beyond in recognising Lord Tebbit’s enormous intellect and profound sense of duty to his country.

“May he rest in peace.”

Lord Tebbit and his wife Margaret stand outside the Grand Hotel in Brighton.
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Lord Tebbit and his wife Margaret stand outside the Grand Hotel in Brighton. Pic: PA

Tory grandee David Davis told Sky News Lord Tebbit was a “great working class Tory, always ready to challenge establishment conventional wisdom for the bogus nonsense it often was”.

“He was one of Thatcher’s bravest and strongest lieutenants, and a great friend,” Sir David said.

“He had to deal with the agony that the IRA visited on him and his wife, and he did so with characteristic unflinching courage. He was a great man.”

Reform leader Nigel Farage said Lord Tebbit “gave me a lot of help in my early days as an MEP”.

He was “a great man. RIP,” he added.

Prime Minister Margaret Thatcher with Employment Secretary Norman Tebbit.
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Lord Tebbit as employment secretary in 1983 with Mrs Thatcher. Pic: PA

Born to working-class parents in north London, he was made a life peer in 1992, where he sat until he retired in 2022.

Lord Tebbit was trade secretary when he was injured in the Provisional IRA’s bombing in Brighton during the Conservative Party conference in 1984.

Five people died in the attack and Lord Tebbit’s wife, Margaret, was left paralysed from the neck down. She died in 2020 at the age of 86.

Before entering politics, his first job, aged 16, was at the Financial Times where he had his first experience of trade unions and vowed to “break the power of the closed shop”.

He then trained as a pilot with the RAF – at one point narrowly escaping from the burning cockpit of a Meteor 8 jet – before becoming the MP for Epping in 1970 then for Chingford in 1974.

Norman Tebbit during the debate on the second reading of the European Communities (Amendment) Bill, in the House of Lords.
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Lord Tebbit during an EU debate in the House of Lords in 1997. Pic: PA

As a cabinet minister, he was responsible for legislation that weakened the powers of the trade unions and the closed shop, making him the political embodiment of the Thatcherite ideology that was in full swing.

His tough approach was put to the test when riots erupted in Brixton, south London, against the backdrop of high rates of unemployment and mistrust between the black community and the police.

He was frequently misquoted as having told the unemployed to “get on your bike”, and was often referred to as “Onyerbike” for some time afterwards.

What he actually said was he grew up in the ’30s with an unemployed father who did not riot, “he got on his bike and looked for work, and he kept looking till he found it”.

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‘Oui’ or ‘non’ for Starmer’s migration deal?

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'Oui' or 'non' for Starmer's migration deal?

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The first European state visit since Brexit starts today as President Emmanuel Macron arrives at Windsor Castle.

On this episode, Sky News’ Sam Coates and Politico’s Anne McElvoy look at what’s on the agenda beyond the pomp and ceremony. Will the government get its “one in, one out” migration deal over the line?

Plus, which one of our presenters needs to make a confession about the 2008 French state visit?

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US

Benjamin Netanyahu nominates Donald Trump for Nobel Peace Prize – as Gaza ceasefire talks continue

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Benjamin Netanyahu nominates Donald Trump for Nobel Peace Prize - as Gaza ceasefire talks continue

Israel’s prime minister has nominated Donald Trump for the Nobel Peace Prize.

Benjamin Netanyahu made the announcement at a White House dinner, handing over the letter for the US president to read.

“Coming from you in particular, this is very meaningful,” Mr Trump said.

The Israeli leader said Mr Trump was “forging peace as we speak, and one country and one region after the other”.

Organisers award the prize to the person who does the most for “fraternity between nations, for the abolition or reduction of standing armies and for the holding and promotion of peace congresses”.

Benjamin Netanyahu showed President Trump the Nobel nomination letter. Pic: AP
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Benjamin Netanyahu handed Donald Trump the Nobel nomination letter. Pic: AP

Mr Trump took credit for stopping Iran and Israel‘s “12-day war” last month, announcing it with fanfare on Truth Social, and the ceasefire has so far held.

The president has claimed US strikes obliterated Iran’s purported nuclear weapons programme – and that the country now wants to restart negotiations.

“We have scheduled Iran talks, and they want to,” Mr Trump told reporters on Monday. “They want to talk.”

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Iran hasn’t confirmed the move, but its president told US broadcaster Tucker Carlson he believes his country can resolve differences with the US through dialogue.

Masoud Pezeshkian also said Iran would be willing to resume cooperation with the UN nuclear watchdog.

However, he said full access to nuclear sites wasn’t yet possible as US strikes had damaged them so badly.

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Netanyahu arrives in US for ceasefire talks

Away from Iran, fighting continues in Gaza and Ukraine.

Mr Trump famously boasted before his second stint in the White House that he could end the Ukraine war in 24 hours.

The reality has been very different – with Ukraine saying last week that Russia unleashed the heaviest aerial attack of the war so far.

Critics have also claimed Vladimir Putin is “playing” his US counterpart and that he has no intention of agreeing a ceasefire.

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Russia bombards Ukraine with drones and missiles

However, Mr Trump could try to take credit for progress in Gaza if – as he’s suggested – an agreement on a 60-day ceasefire is done this week.

Indirect negotiations with Hamas are taking place that could lead to the release of some of the remaining 50 Israeli hostages and a surge in aid to Gaza.

The White House said Middle East envoy Steve Witkoff is travelling to Qatar this week to try to seal the agreement.

Read more:
Israeli soldier describes arbitrary killing of civilians in Gaza

IDF troops ‘psychologically broken’ after Gaza – UN expert

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‘Some Israeli commanders can decide to do war crimes’

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Whether a temporary pause could open a path to a lasting peace remains uncertain, with the two sides’ criteria for peace still far apart.

Mr Netanyahu has said Hamas must surrender, disarm and leave Gaza – something it refuses to do.

He also told reporters on Monday that the US and Israel were working with other countries who would give Palestinians “a better future” – and indicated those in Gaza could move elsewhere.

“If people want to stay, they can stay, but if they want to leave, they should be able to leave,” he added.

“We’ve had great cooperation from… surrounding countries, great cooperation from every single one of them. So something good will happen,” Mr Trump said.

The president was widely criticised earlier this year when he suggested resettling Gaza’s population to countries such as Jordan and Egypt and turning it into the “Riviera of the Middle East”.

Human rights groups said the plan amounted to ethnic cleansing and most Gazans said they would never consider leaving.

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