Massachusetts Derails Revolution In Addiction Medicine While Drug Abuse Soars
Massachusetts Derails Revolution In Addiction Medicine While Drug Abuse Soars
January 23, 2014
Part 2 in a series about the pioneering work of Dr. Punyamurtula Kishore
In the previous article, we examined the revolution in addiction medicine set in motion by Dr. Punyamurtula Kishore and how the state of Massachusetts wielded its prosecuting power against him and his clinics, which have consequently been shut down.
Naturally, some readers were tempted to do Internet research on Dr. Kishore and found they weren't prepared to read the countless evils attributed to him by the media campaign to vilify him. Over the course of this second article and those that follow, we will dissect, point by point, all the nonsense currently parading as journalistic fact in the media. The reality distortion field fostered by both state and media defies explanation.
But there are some medical truths about Dr. Kishore's holistic treatment program, known as the Massachusetts Model, that have been as completely erased as his Wikipedia page was the day he was indicted. The kind of "memory war" being waged against Dr. Kishore has been nearly total in extent. As he regards the GPS ankle bracelet that restricts his movements, speaking of the relentless pressures being applied against him by the Attorney General, he ably captures his personal situation with a single word: Kafkaesque.
As noted in the first article, there are competing treatment models for drug addiction. There are what Dr. Kishore calls "the fragmented approaches," such as those that substitute methadone or Suboxone® for the abused substance. Under these scenarios, the addict has replaced one dealer (his pusher) for another (the state) with dependency on narcotics as active as before (albeit in a regulated program using prescribed narcotics). With such "replacement therapies" being a billion-dollar business, it isn't surprising to see media concern over the growth of "methadone mills." The state does one better than the local pusher: it pays for bus and taxi vouchers to get the addicts to the methadone.
Now pay close attention: when we read about the "consensus" of medical experts concerning how addiction treatments should operate, or how frequently drug tests should be administered, the hidden assumption is that the experts are right. Confidence in the consensus of enforced orthodoxy rules the roost.
But recall the point made in the first article in this series: the proper yardstick to measure success in addiction medicine is sobriety. Modern medicine isn't interested in objective measurement because it would expose the disaster that current paradigms inflict on people.
Strong words, yes. So it is now time to back them up with clinical evidence: evidence that blows the orthodox approach out of the water, and puts modern medicine on trial.
The Elephant in the Room
If you assumed that Dr. Kishore's approach was better merely because it was holistic, or non-narcotic, or integrated, but otherwise came pretty close to conventional addiction medicine in terms of measured results, you're in for a shock.
In the previous article, we pointed out that under conventional treatment programs, only 20% of those entering those programs are still sober after the first month. What's the situation after an entire year of conventional treatment? Out of 100 people entering such conventional programs, how many are sober after one year? Between 2% and 5% are sober after one year. And that higher 5% number is a "soft" statistic, because a significant number of those individuals comprising that 5% are self-reporting their sobriety: their sobriety isn't the result of an objective test. So, the conventional medicine of the "experts" cited in the government documents of Massachusetts gets no more than 5 out of every 100 entering addicts through to sobriety after a full year of treatment. This is the world that these "experts" know, the miserable reality that they accept as inevitable.
Compare those dismal statistics to Dr. Kishore's Massachusetts Model. For every 100 addicts entering his program, 37 are sober at the end of one year. That 37% success rate is a "hard" statistic as it is established with actual testing (blood, urine, saliva, sweat, hair), not self-reporting. There is objective proof for that 37% success rate. The best the standard treatments achieve is returning 5 out of every 100 addicts back to society. Dr. Kishore delivers 37 out of 100 back to society: his approach is 7 to 18 times more effective in treating addiction.
So, what do the medical experts say about those 32 people out of every 100 entering their conventional treatment programs that they fail to help over the course of a year, people that Dr. Kishore does deliver from the life-destroying power of substance abuse?
The methadone and Suboxone® clinics, which are 5% effective in treating addiction over the span of a year, are still running strong, yet drug addiction is skyrocketing in New England. In a January 16, 2014 news conference, Massachusetts Senate President Therese Murray said her state didn't just have the worst heroin addiction problem in New England, it had the worst in the entire country. But those clinics that were achieving a staggering 37% effectiveness in treating addiction were dismantled by a mindless government juggernaut, while the Christian doctor who pioneered these unprecedented successes was reduced to poverty and the loss of his reputation in a hail of media lies.
It isn't as if Dr. Kishore's method is comparable to the status quo, or only marginally better than what current medicine characterizes as "best practices." Dr. Kishore's treatment regimen is far more effective than conventional medicine in real world results.
So who, then, is the real expert in addiction medicine?
Perhaps the only way to compete against such an enormous performance edge, with a growing base of clinics radiating into the worst areas of Massachusetts (such as Weymouth and Springfield, where Dr. Kishore had opened two clinics), was simply to take Dr. Kishore out of the picture. And this is exactly what the state of Massachusetts did in September, 2011. The takedown was done very shrewdly, by throwing a tarp over the elephant in the room and then measuring Dr. Kishore's program by conventional canons of treatment.
In other words, the valedictorian was judged by delinquents and dropouts, with the media mindlessly spreading misinformation dutifully supplied by the latter. We'll provide some examples of this toward the end of this article. But first, it behooves us to take a deeper look into Dr. Kishore's hands-on approach to better understand the truth behind the legal attacks.
The Second Month of Treatment
In the earlier article, we spent considerable time discussing the complex array of events that occur during the first four weeks of treatment, the phases that Dr. Kishore has analyzed and separately treated with such success. With conventional treatment programs, only 20% are still sober after one month. That Dr. Kishore has 37% still sober after twelve months is due in large measure to what he achieves in the first month of treatment under the Massachusetts Program. But the path to sobriety entails further complexities in the life of addicts, who need to make it all the way through a full year without any serious relapse.
As noted earlier, sobriety brings problems back to the surface, and so Dr. Kishore's unprecedented success in the first month of treatment can draw out detractors protecting the status quo: "You sobered him up and look, he killed himself. He should have had methadone. Dr. Kishore is a killer!" But such claims ring false because nobody died while under Dr. Kishore's care. For someone practicing addiction medicine, a perfect record in respect to patient mortality while under one's care is extraordinary. (Of course, the closing of his clinics put his former patients at risk, but this was the consequence of state aggression, not of Dr. Kishore's program.)
The second month of treatment involves considerable myth-busting: a deep dive into the drug ecosystem to bust up existing mythologies. Some of this mythology is in the addict's mind. What Dr. Kishore calls "stinking thinking" is exemplified by such notions as "I took drugs because my mom boozed it up."
It's a delicate process to disabuse the addict of his or her myths during the second month of treatment. It is necessary to reset the patient's logic-the patient's thinking systems-regarding boyfriends, girlfriends, peers, employers, family, and life situations.
The second month is not an arms-length, remote treatment program, but requires face-to-face, in-person redirection of the patient. It is all about the resetting of boundaries.
Conventional treatments barely scratch the surface of what's required to get patients through the second month. This is why, for every patient who begins the second month of today's status quo treatment programs, only 50% make it through to the third month. Under Dr. Kishore's approach, fully 90% of those entering the second month make it through.
"I set the bar quite high," Dr. Kishore says, "in contrast to the establishment message to medical professionals, which amounts to this: it's okay to be a bottom-feeder. These lowered expectations drive the copouts and rationalizations foisted on the people of Massachusetts."
The Third Month and Beyond
During the third month, the addict's physiology returns to its pre-narcotic state, introducing new problems. Let's consider two representative examples.
Women on drugs don't menstruate, because opiates suppress the menses. But after a period of sobriety, menstruation resumes, often in the form of polymenorrhea (e.g., weekly menstrual periods). Some women get painful premenstrual migraines as well. Their body is still recovering, responding to renewed sobriety in ways that involve primary care, the main emphasis of a good physician.
Men who had Crohn's Disease (a leaky gut) prior to addiction were delighted to discover that their narcotics habit fixed this problem. No more ruined underwear: those abused drugs were a plus! But sobriety brings back the original problem. This falls under the umbrella of primary care: the physician is actually able to do M.D. work once again. It is the primary care doctor who is best situated to reset these natural physiological baselines for the patient.
Beyond the physiological dimension is the social interaction aspect: the patients need fellowship, they need someone to confide in. The physician might find himself in the position of an English butler as he deals with the patient's needs. But whether physiological or interpersonal, the treating doctor must be vigilant about his patients. "Otherwise," says Dr. Kishore, "you will miss important cues that tell you the recovery is in jeopardy and in danger of being derailed."
In months four through six, the patients will still exhibit the same cues and triggers as before. The addict will "celebrate" his or her sobriety with a drink. They need to keep their eyes on the summit to keep climbing. They can't look down to contemplate how far they've come, because they'll simply let go of their grip on the rock that's holding them up.
Says Dr. Kishore, "Addiction turns a person into a one-trick pony: get drugs, use drugs, sleep, go to job, repeat. We need to break this pattern, and prevent new vicious cycles from taking its place." Too many addicts gravitate to unhealthy substitute activities: extreme sports become the norm for males, sexual promiscuity for females. Extreme sports lead to injury, which leads to pain, which leads back to pain medications and their abuse. Psychological pain resulting from promiscuity traces a similar path back into abuse. In both cases, it isn't sufficiently appreciated that addicts generally feel pain more intensely than non-addicts. The treating physician needs to be on top of this.
Dr. Kishore summarizes the situation very simply. "My peers don't want to invest this much time in an addict's life, but the reality is that an addict is surrounded by things that will pull them down. Nobody recognizes this. You have to be there with them to know this, and to treat them accordingly."
The purpose of getting the addict through an entire year is to insure that all seasonal triggers have been covered. Aside from those that form a natural part of his or her life (holidays, birthdays, and other calendar mileposts and celebrations that can trigger drinking and drugging) are external factors, including seasonal affective disorder. "Sobriety Maintenance is of necessity a one-year process. The addict needs unbroken sobriety for all four seasons," says Dr. Kishore. "Nobody is doing this but us. We do this because we do care."
Behind that web of personal and social elements is the hard science of measuring sobriety. Dr. Kishore's philosophy in this respect is foundational to his success. "Drug testing is the golden rule. An addict's denial systems are robust. Drug tests cut through them." It is on this point that Dr. Kishore and establishment medicine disagree, and this disagreement constitutes a major element in the case against Dr. Kishore. We will see how the testimony of those "experts" with the 5% success rate was leveraged to destroy the doctor with the 37% success rate. In the mean time, heroin addiction is skyrocketing and overdose deaths are worsening in the Commonwealth of Massachusetts. The statist fiddle plays as Rome burns.
Slips, Relapses, and Testing Frequency
One charge that appears repeatedly in media indictments of Dr. Kishore is that he was conducting urine tests too frequently, doing so to make a fast buck at the state's expense. The state auditor published the results of a three-year study that cites the consensus of "medical experts" to argue for reduced testing frequencies. Testing more frequently than the norm is indicative of waste and/or fraud.
Before we address the question of testing frequency, note precisely how the state measures that frequency. The state asks, "How many tests per patient were conducted over time?" The state then conducts statistical analysis based on the answer to this question. And if all therapies had identical track records, perhaps that approach could be justified. If Dr. Kishore's results matched those of the methadone therapists, one could argue that his testing frequency might be excessive.
So, imagine that Dr. Kishore tests twice as often as a conventional addiction program does, just for the sake of argument (we'll see later this isn't the case, but is useful to illustrate the point). If we measure strictly by who's in those programs, Dr. Kishore would then be testing twice as often as the conventional programs do.
But what if we asked the question in a more intelligent way? "What is the ratio of the total number of tests performed to the number of patients still sober after one year?" Measured by actual success rather than raw participation, the conventional programs are testing urine nearly four times more often than Dr. Kishore does. They are the ones squandering state money on testing in support of a 95% failure rate. The conventional yardsticks not only misrepresent reality, they actually endanger the very people they were allegedly designed to help.
Further, isn't the doctor achieving a 37% success rate better able to articulate the proper approach to urine testing than the ones achieving a 5% or lower success rate? How many lives are lost because the tail is allowed to wag the dog, and mediocrity to trump excellence?
The medical profession merely pools its ignorance as it rallies around the standard therapies that yield financial benefits to doctors, while the state further compounds that pooled ignorance by comparing notes with other states. This drives costs down by using the lowest common denominator as the anchor of reference.
The Massachusetts auditors approvingly cited the policies of other Medicaid bureaucracies, such as that of Georgia, which limits members to 25 tests per year. The report cites other money-saving approaches: "New York will only pay for two tests per week, Vermont for eight tests per month, and New Jersey for two tests per month." All such arbitrary limits were proposed by pre-selected experts who (1) have nowhere near Dr. Kishore's years of experience with these populations and modalities and (2) can only dream of achieving treatment success on the scale achieved by Dr. Kishore's low-tech approach to addiction medicine. (A Harvard faculty member saw through the Boston Globe's chosen "authority" on testing frequency: "That MGH clinician is an expert with adolescents, not chronic alcoholics and drug addicts who inhabit the sober homes. His clinical judgment is irrelevant.")
In the Massachusetts Model developed by Dr. Kishore, testing is proportioned to the patient's specific situation and accounts for the distinction between a relapse and a slip. A slip back into substance abuse is not yet a full relapse, and if caught early enough can be treated without having the patient restarting week-one detox all over again (with all progress lost). Urine testing is designed to catch slips before they become relapses, taking into account the cues and triggers distributed throughout the seven days of a given addict's week.
In other words, all such testing is deliberately designed and patient-specific, not indiscriminate. This is most obvious at the two testing extremes. At the Dios Houses (God Houses or Prayer Houses) in Springfield, Dr. Kishore prescribes only weekly testing because such groups provide superior oversight, speaking to the spiritual needs of the patient in a structured way. At the other extreme, a 16-year-old emancipated minor may require as many as five or six tests a week when most vulnerable to resuming substance abuse. If a sober house program is weak, the testing needs to be boosted, intrusive though it is.
But for most of Dr. Kishore's patients, three tests per week secured the best results in terms of relapse prevention. He estimates the mean number of tests per week across all his patients to be around 2.2. How strange, though, that he is the one who has to justify his testing frequency. One would think that the programs that fail to give 32 out of 100 people their lives back, as Dr. Kishore's program does (37% versus their 5%), should be the ones to justify their testing strategies.
When testing isn't frequent enough, the addict's arrival at the treatment center can be an exercise in futility. "You have a wasted visit if we're talking to an addled brain," notes Dr. Kishore. A lapse in testing can amount to a missed opportunity, with the treating doctor receiving the most disheartening of phone calls: "Your patient is here at the hospital with a lesion on his arm" (denoting the infected site where he injected drugs again).
It would be dangerously naïve to think that the government thinks all this through to ask itself, "Why mess with success?" Political expedience does not involve helping the citizens of Massachusetts recover from their state's heroin crisis. The state spends $11 billion a year on Medicaid and $4 billion on public health: 46% of its $32 billion budget, much of it directed to some sort of addiction care. Despite being an unsustainable drain on the people of Massachusetts, the call to throw even more money at the problem without changing tactics is being raised again. Why? Because the state's best hope for addressing its drug addiction crisis was arrested at his home at 10:45 PM on September 20, 2011. The events that led up to Dr. Kishore's jailing that night provide a disturbing glimpse into the pit of Massachusetts governance.
The State's Tangled Web
Attorney Paul Cirel, of law firm Collora LLP, briefly served as Dr. Kishore's lawyer in 2006 during a Blue Cross audit of his clinics. Cirel and Kishore parted company in December 2007. "We didn't see eye to eye," says Dr. Kishore.
On May 2, 2009, Dr. Kishore was in New Orleans at a ceremony conducted by the American Board of Addiction Medicine (ABAM). As he was preparing to go onstage to receive his ABAM certification, he received a phone call from Paul Cirel. "I'm going on stage right now, I'll call you back after the ceremony," Dr. Kishore told Cirel.
After receiving his certification, Dr. Kishore returned Cirel's call. This is what Cirel told him: "I'm going to call the Board and tell them you're resigning as a doctor. You won't need your license anymore." This was the first obvious shot across the bow, which Dr. Kishore rebuffed.
Then, on December 22, 2009, the Attorney General Office's Brian Robinson conducted a sting operation against Dr. Kishore at a sober house called Safe Haven run by a lawyer no longer allowed to practice law. This sober home consisted of four or five buildings rife with sex and drugs, a place where eight to ten people had previously died. Not knowing it was a setup, Dr. Kishore went to the meeting with his Chief of Nursing and other key team members.
The entire conversation was videotaped through one-way mirrors. Neither Dr. Kishore nor his associates said or did anything illegal. The sting failed of its purpose, which was evidently to catch Dr. Kishore bribing Safe Haven with a $10 kickback per drug test.
As a result of this stunt, the government wasted the time of a busy physician and his staff in its efforts to try and entrap him. The request to Dr. Kishore to have him come down to help the Safe Haven sober home was a government lie. It was a sting operation and nothing more. Apparently stung by the failure of its own ruse, the Attorney General's office began to escalate the attacks on Dr. Kishore.
One of the apparent sticking points was a curious one. "My labs are integrated into my practices," Dr. Kishore pointed out. Although he only tested his own patients, this was seen as a threat to commercial testing labs (one of which launched a frivolous civil suit against Dr. Kishore's clinics in March 2011 over alleged monopolistic practices). Legislation to outlaw integrated labs was introduced in 2013 (to protect commercial labs from God-knows-what).
By 2010, Dr. Kishore was at the top of his game. All audits of his clinics turned out well (a 1999 MassPro audit revealed deficiencies corrected without incident, a 2007 MassPro audit found no deficiencies whatsoever, and the clinics passed a five-year prospective audit by a government Medicare auditor in December 2009). Dr. Kishore's pioneering achievement, the Massachusetts Model, was working well and generating excitement about the future of addiction medicine.
That's when the gorilla showed up.
The ensuing grand jury indictments were premised on co-employment and co-location of services with sober houses, arrangements that the state reclassified as bribery and kickback schemes despite the presence of legally valid signed contracts. The irony, as noted by a Harvard faculty member, is that Dr. Kishore's business structure matched the authoritative description of valid co-location and co-employment models published in October 2010 by the National Association of Community Health Centers.
"We paid rent for space, we paid employees, and we followed the Safe Harbor Rules. My company, PMAI, had two lawyers on staff, one specifically to help insure compliance with the law in all we did. Predictably, a state system as complicated as this is bound to break."
With $1.7 million in cash reserves to run his clinics (which had a $9.9 million annual payroll due to the labor-intensive nature of getting a 37% sobriety rate at the one-year mark), Dr. Kishore acquired a new attorney. On October 8, 2010, PMAI's HR lawyer introduced Dr. Kishore to attorney Frank Libby (of Libby & Hoopes, which reportedly had close ties to the state's Attorney General). Libby proposed the following settlement: "I want you to plead guilty pre-indictment. We'll monitor you for five years and then you can resume practice. That's how it works in Massachusetts." The state wouldn't accept a settlement that didn't destroy all 52 of Dr. Kishore's practices, so the good doctor fired Libby.
Massachusetts expected accused doctors and clinics to plea-bargain and settle, but Dr. Kishore refused to be the victim of so blatant a shakedown. It appears that Massachusetts law has never put a case like this all the way through the judicial process: Dr. Kishore might well be the first to run the full length of the gauntlet.
Dr. Kishore then met attorney Don Stern, thinking that he might be the salvation of his medical practices. Stern's focus was corporate and criminal law rather than health care law. Stern met with Attorney General Martha Coakley and returned with an ultimatum: Dr. Kishore needed to give up all his on-site labs to survive. "We don't want you to run labs" was Coakley's position as reported through Stern (a man for whom Dr. Kishore has high regard).
Testing labs can be the "cash cow" of a practice, but Dr. Kishore's clinics rolled their laboratory revenues back into the practice, investing in expansion to help more patients with his superior addiction treatment program. Unlike Dr. Kishore's on-site labs, however, commercial labs keep their money: it's all profit. Perhaps it's no surprise then that powerful interests own the commercial testing labs in Massachusetts.
Come July 2011, Dr. Kishore had to cut down the size of his practice: 32% of his income had been frozen by the state without notice, causing the remaining cash to dwindle quickly given the labor-intensive nature of the Massachusetts Model for addiction treatment. His practice shrank down to about a half dozen centers just to survive. As a result, the treatment benefits to addicts relying on the closed centers were abruptly cut off.
The Arrest of Punyamurtula Kishore, M.D., M.P.H., F.A.S.A.M.
Assistant Attorney General Nancy Maroney set up a meeting with Dr. Kishore and his attorneys for September 27, 2011, but he was arrested without warning a week earlier, at 10:45 PM on September 20. No meeting with the attorneys occurred as scheduled, apparently because Maroney's proposed meeting was a fabrication. Dr. Kishore spent the night at the Medford Police Barracks. He was taken to court on September 21, appearing before an array of cameras and members of the media, 40 strong, which had come from as far away as Brazil, India, and China to gape at the spectacle being heralded by the Attorney General.
The media was told that the prisoner was planning to escape to India with embezzled Medicaid cash (Coakley later asserting that "he stole $20 million.") The alleged "escape to India" was the pretext for the surprise arrest. Dr. Kishore, like many other dedicated physicians, firmly believed in the concept of doctors without borders and never bothered to change his Indian passport. Although he hadn't been to India since 1986-a quarter of a century earlier-the fact of his Indian passport was used as a legal cause against him. The fact that his wife and children are American citizens somehow got lost in the media circus.
The massive amount of media present from so many countries suggests that this was a well-planned hit against Dr. Kishore, one calculated to boost Ms. Coakley's stature as a prosecutor ferreting out fraud. By making the case a high profile one, the state was now committed and refused to admit error or retract its claws: this man Kishore was both a crook and a menace, as established with confident zeal by media fiat. Appearing in court exhausted, haggard, and unshaven, he looked like the perp he supposedly was. Ecce homo. He was transferred to Middlesex Jail prior to the bail hearing the next day (at which the judge refused to permit cameras) and from there he was moved to a downstairs cell at the Middlesex courthouse in Woburn around 2 PM on September 22, 2011.
The Attorney General did not want Dr. Kishore released on bail, but his attorneys negotiated an arrangement requiring that he surrender his passport and wear the GPS ankle bracelet.
Following Dr. Kishore's release, there was a shift in the media war as voices raised in defense of Dr. Kishore (and in opposition to the brutal tactics and specious reasoning of the state) grew into a chorus of disaffection with Ms. Coakley. This apparently motivated her to hold another press conference on September 30 to defend her actions. Despite Dr. Kishore having been released with a GPS ankle bracelet, she had him rearrested on October 6, landing him back in jail once again. The second arrest was arranged by filing new charges, increasing the bail amount, and arguing before a judge that the prior bail arrangement should be vacated and the man incarcerated without warning. The judge initially agreed and issued the warrant.
In court the next day, the prosecution reasserted that Dr. Kishore should never be released from confinement. The defense countered that the previous judge declared the original bail conditions to be adequate. That one glimmer of sanity managed to break through this Orwellian process and Dr. Kishore was released. Why arrest him a second time and insist he not be released? Had he remained in custody, you would have never known the story of Dr. Kishore and his breakthrough in addiction medicine, nor about the resulting breakdown in governmental ethics that crushed his work underfoot. He would have been left in the memory hole in which the state was determined to keep him.
Despite having two arrests on record against Dr. Kishore, the Attorney General still had very little to show for all this sound and fury signifying nothing. She was maintaining a media tempest in a legal teapot. The thin grounds for indictment were looking ever thinner.
The paucity of evidence led to the infamous email heist known as EmailGate, with the state prosecutors looking for dirt they simply didn't have by raiding Dr. Kishore's gmail accounts, including his discussions with his attorneys (or not, if you still have faith in the "anti-taint" procedures designed by the fox guarding the chicken coop). Nonetheless, the media strategy against Dr. Kishore was straightforward and consistent: people believe that if there's smoke, there's fire, so the press releases and media coverage painted a sky full of smoke.
As a result of these crippling actions by the state, Dr. Kishore's remaining clinics survived only two weeks past his September 21 arrest. By his second arrest, they fell apart completely because unpaid yet dedicated employees had no choice but to leave and seek work elsewhere.
He Was Numbered With the Transgressors
For media purposes, Dr. Kishore's case was bundled with other cases, cases marked by significant numbers of collaborators and reports of collusion. Other companies hauled before the state's tribunals had groups of individuals indicted (since conspiracy necessarily involves co-conspirators). However, Dr. Kishore stood alone: he was the only person at PMAI who was indicted. In the state's eyes, Dr. Kishore masterminded the complex "kickback scheme" entirely on his own, without any assistance or co-conspirators from his own firm. To the state, he was a one-man wrecking crew. How remarkable that the man who developed the most successful addiction treatment program to date, a program requiring such an extraordinary amount of hands-on time on his part, had time left over for not only for his wife and children but also to mastermind a multi-million dollar fraud all on his own. In this instance the sheep were scattered, but the shepherd alone had been struck.
But Dr. Kishore's story rarely appears alone: it is always conflated with the stories of other perpetrators, and to this day is resurrected (automatically and mindlessly) when stories "associated" with his case appear in the media, thus keeping his name before the public in continual connection with others.
While averse to playing the race card, Dr. Kishore cannot help but wonder why mention of his case (in sidebar posts on media websites for "related stories," etc.) almost always appear when stories about aliens accused of illegal actions are run. This media practice has the net effect of inciting xenophobia against him, continually pushing these older negative stories about him ever higher in Internet search engine rankings. From Dr. Kishore's perspective, this is no accident: the destruction of his reputation bears all the marks of an orchestrated campaign.
An illegal alien, scheduled to be deported, was caught in a raid and given a GPS ankle bracelet just like Dr. Kishore wears. The Boston Globe successfully applied media pressure to lobby to get her ankle bracelet removed. Dr. Kishore, who is here legally, still has his ankle bracelet on two-and-a-half years later. Is this a double standard, or is it simply too important to maintain around-the-clock vilification of Dr. Kishore to be even-handed?
Look up a local media article about accused Boston Marathon bombing suspect Tsarnaev: there's Dr. Kishore's story on the same web page. Look up an article about Salvatore DiMasi: there's Dr. Kishore's story in the side bar. He's always being associated with shady characters. Just as with the Attorney General's press conference, he continues to be numbered with the transgressors by the local media.
Such content aggregation by the media creates what amounts to manufactured news. The interest in Dr. Kishore's story doesn't originate with the public. It is forced upon the public in an Orwellian fashion. Dr. Kishore doesn't see these as merely neutral insertions: he believes he's being continually sullied by these media processes.
Since May 2013, Berger & Montague's website out of Pennsylvania has had the top-ranking story on Google about Dr. Kishore, replete with authoritative-looking hyperlinks. Whether it is or isn't, the page looks like a staged blog. The hyperlinks provided aren't relevant to Dr. Kishore's case, pointing to a different case altogether. This creates a false association, a false impression built on a foundation of dislocated authority.
Solomon wrote that the way of transgressors is hard (Prov. 13:15). Did the state treat Dr. Kishore in terms of this proverb after his arrest? It certainly seems so, and if so, then coercive pressure was being applied in ways that border on the abuse of power. A very conservative driver (as I know from personal experience with him), he nonetheless received eight traffic tickets in just six months after his release on GPS. Garner too many tickets and you lose your driver's license, further restricting your ability to travel. Dr. Kishore successfully fought all but one of the tickets (what a colossal waste of time for a pioneer working to save the lives of addicts to appear in traffic court every two weeks). Was Dr. Kishore an easy target for ticketing because of his GPS ankle bracelet, with police like moths being drawn to the flame? Nobody truly knows. That this particular smoke might come from an underlying fire is more plausible than the Attorney General's trial-by-media program.
The Commonwealth of Massachusetts is like a fisherman who's caught a dolphin in his net as well as actual fish: "Dolphin, what dolphin? That thing has fins and swims. It's no dolphin. I only catch fish in my nets!" And what better way to prove that the alleged dolphin is really a fish than by pasting scales on it, cutting gills into its cheeks, and twisting its flukes by ninety degrees? This process is what the next (and final) section of this second article will begin to examine.
Did Dr. Kishore Provide "Improper Care" To His Patients?
Dr. Kishore requested a speedy trial, meaning it should have begun six months after arraignment on March 21, 2012. State foot-dragging pushed the trial to June 4, then to September 2012, then to January 2013, then April 2013, then October 2013, and now his trial is scheduled for April-May 2014.
These denials of Dr. Kishore's right to a speedy trial were spearheaded by the state. Why? If the state has hard evidence against the accused, why keep pushing the trial off into the future? What does time buy prosecutors with a solid case on their hands? Nothing. But if you've cobbled together a case that's built on spurious grounds and still need to find a smoking gun, you're likely to keep postponing in the hope that more data-mining might yield something that will stick against the defendant you've been mistreating.
Perhaps one reason for these delays is the possibility that the prosecution wants to be able to demonize Dr. Kishore with a particularly stinging label: a doctor who was reprimanded by the state board of medicine for providing improper care to his patients. If the reprimand could be made to stick, then Dr. Kishore could be made out to be an incompetent doctor, destroying his credibility (and that of his treatment program for addiction). By going after a malpracticing physician, the Attorney General can argue that the prosecution of Dr. Kishore isn't malicious but justifiable. After all, the medical board went after this man! Such a fact could potentially swing a decision in the prosecution's favor during the main trial, as it would bear on Dr. Kishore's character and professional ethics. In other words, he's no dolphin, he's a fish who rightfully belongs in our net: we caught the right guy.
On September 19, 2012, the board of medicine told Dr. Kishore, "We want to revoke your license." His attorney at the hearing pointed out that the board cannot revoke on a "first offense" (if there even was an offense). What was the alleged offense, anyway? Why is he being reprimanded? The board told Dr. Kishore why: "You arranged to send four drunk women to the hospital" (see Appendix A below for details). Dr. Kishore was fined and sanctioned but kept his license-and he appealed the board's action (thus suspending the fine until the appeal could be heard).
The Massachusetts Psychiatric Society (MPS) caught wind of this case. Representing 1,700 psychiatrists, the MPS attempted to intervene in Dr. Kishore's case, arguing in effect that they regularly do the very thing Dr. Kishore did, and if the board was going to sanction such life-saving policies, then the 1,700 psychiatrists wanted a voice in that hearing since a negative outcome for Dr. Kishore could impact their practices and their patients in a disastrous way.
In March 2013, the board granted the intervention request of the psychiatrists, meaning Dr. Kishore effectively had 1,700 other M.D.s standing in legal and clinical solidarity with him on this matter. This was a wonderful ray of light in a very dark time.
That ray was snuffed out on October 7, 2013, when the Attorney General's office successfully convinced Judge Frieger to reverse the original decision. Dr. Kishore stood all alone once again, no longer with the collective weight of 1,700 psychiatrists standing by him: their voices were driven out of the courtroom. The psychiatrists were limited to submitting a friend of the court brief-their thunderous shout was throttled back to a polite whisper.
Dr. Kishore's appeal (now without the MPS standing next to him to argue the same issue against the board) is scheduled for March 2014. In a just world, he would win the appeal. In a moral world, the board wouldn't have silenced the voice of 1,700 psychiatrists (who hold both Ph.D. and M.D. degrees). But Dr. Kishore might lose the appeal and be reprimanded, or worse. The fact that revocation was demanded despite this being Dr. Kishore's first appearance before the board suggests that this is precisely the result the state desires.
Should the board exonerate Dr. Kishore for protecting those four lives in 2006, another strategy to revoke his license has emerged. On December 9, 2013, John Costello of the board's complaint committee wrote Dr. Kishore stating that Costello would recommend revocation of Kishore's license at the committee's February 5, 2014 meeting. Why? Because Dr. Kishore lost two medical records-two records out of a total of a quarter million records.
One of those two records was lost to vandalism at the Brookline clinic after Dr. Kishore's sudden jailing. The other record, locked inside the Framingham clinic by the landlord, will be recovered shortly. Costello's letter, devoid of justice and common sense, exudes the kind of raw bureaucratic power that prompted this article's legal reviewer to tell me, "In their system, there is no defense against such charges." When I mentioned that doctors in New Orleans who lost medical records destroyed by Hurricane Katrina were off the hook thanks to a new state initiative, I was told "Yes, but those doctors weren't the target of an attorney general."
Perhaps the prospect of having a discredited physician entering the courtroom motivated the postponement of the main "kickback" trial until after these board actions took place. Should Dr. Kishore succeed in appealing the reprimand and fending off the complaint over vandalism beyond his control, the prosecution case is no worse off. But if either the reprimand or complaint sticks, the prosecution could leverage their target's resulting loss of credibility: he was a fish all along, never a dolphin. The public sees doctors who lose their licenses as quacks.
Dr. Kishore arrived in the United States in 1977 with only eight dollars in his pocket. If the board of medicine and the Attorney General have their way, he will soon be worse off now than when he arrived.
Appendix A: Autopsy of a Medical Board Reprimand
The reprimand against Dr. Kishore involves the fact that he arranged to have four women transported to the hospital. The power to transport is contained in state law: MGL Part I, Title XVII, Chapter 123, Section 12(a) governs transportation of an incapacitated patient who may also be a danger to himself or others. This gives the M.D. permission to transport the patient (e.g., to a hospital) and to call an ambulance. You need the so-called "pink paper" to do this. If you transport without a pink paper, you are violating the patient's civil rights. Only three groups-doctors, police, and social workers-have the authority to order a pink paper.
On August 4, 2006, four women came in drunk to a sober house, violating the curfew. Dr. Kishore had them transported to the emergency room, but once there they refused to be tested. "The board reprimanded me for transporting the patients without seeing them, but I did see them that very morning, and I based my decision on the dangerous change in them from earlier in the day. I was 30 miles away from the sober house when they contacted me, and I simply couldn't waste precious time driving out to re-examine the women without a chaperone present. The law states that there is no need to examine the patient if there's enough data on the table to justify transportation. If a patient calls up drunk, perhaps threatening to cut their wrists or to sleep and not wake up, you force the issue by calling the police."
The Massachusetts Psychiatric Society, representing 1,700 psychiatrists, noted in their paperwork filed with the board that their members have referred 40,000 patients per year using pink papers without seeing the patient. The MPS holds that psychiatrists need this power, and that they need to exert it from afar before a situation escalates.
The psychiatrists of Massachusetts each send an average of two dozen people a year to hospitals using pink papers without first seeing them. Dr. Kishore did this with only four people in his entire career, and he had actually seen those four the day they were transported. Yet who was threatened with the revocation of his medical license?
Dr. Kishore summed up his position in this way: "Relapse is a danger to the patient's life. The behavior of the four women had dangerously altered since I had seen them in the morning. I was in a damned if I do/damned if I don't situation. When you face something like that as a doctor, you have no choice but to apply the Hippocratic Oath: Do no harm. They were my patients, and I wasn't about to hear that one of them fell asleep in bed with a lit cigarette and died in the resulting fire, or chose to overdose that night and die in her sleep."
Dr. Kishore sued the Commonwealth of Massachusetts to appeal the board's reprimand. The case will be heard before his main trial begins. In the meantime, all you will read in the media is that Dr. Kishore was fined and reprimanded for providing "improper care" to his patients. Should he prevail in his appeal, you will not likely hear of it: the stories of the "improper care" reprimand will not be revised, and the truth of his exoneration will not likely be published. If he fails in his appeal (now that the 1,700 psychiatrists of Massachusetts have been shocked to learn that they have no stake nor voice in the outcome of this obviously pertinent case), that would likely become a heavily-touted story leading into Dr. Kishore's main trial because that news would be politically useful.
Martin G. Selbrede is Chalcedon’s resident scholar and Editor of Faith for All of Life and the Chalcedon Report.