Background
On July 30, 2019, my first article titled "How I Became a Suicidologist" appeared on 番茄社区app. I will self-borrow from this work to make a larger argument. I introduced this essay with the following paragraph:
"Although my work as a suicidologist, it must be confessed, does not appeal to the modern mind, for self-murder is dark, merciless, marvelously cruel, and beats individuals and families 'into the sword that yields not,' it is essential work. But even now, the U.S., caught in the grip of surging, historically high suicide deaths, continues to drag in a pageant of mental health bureaucratic slough to protect inherent financial, administrative, and personal interests."
My readers know something about me. I am one of very few exclusively and specifically trained fellows in adolescent emergency department (ED) psychiatry. Although I have been retired from direct clinical practice for some years, I continue to "consult" with you, my colleagues, with a consistent column. My peer-reviewed programs of study represent a 4-decade arc of investigation and clinical care summarized in articles, essays, tiered investigative assessments, and presentations. Specifically, I have tried to administratively transform work in suicide/violence prevention, including ED physician burnout and patient assaults, AI reliable ED tools intake, and evidence-based curricula to advance hospital-based teamwork.
And then, there is this: "...Detected in my publicly available and conspicuous license background remained a practice misfortune contrasted with attempts to improve myself and the field. A medical board's extrajudicial and extra-punitive pronouncement in 1998 epitomized a perverse blend of the mythical and the hysterical. I had prescribed, wrongly, an opioid to my live-in girlfriend."
The Facts
It is so. 25 years ago, a quarter of a century ago, I prescribed controlled substances to my live-in girlfriend. I did not maintain adequate medical records of her diagnosis and treatment. I subsequently refused to prescribe refills and suggested that she seek medical consultation. She issued a complaint with the state medical board against me for abandonment.
Then, and importantly now, I have never been accused or convicted of, or entered a plea of nolo contendere to any felony, misdemeanor or other crime or relating to alcohol, any controlled substance, public health, welfare, Medicare, or Medicaid issue in any jurisdiction. I am not a U.S. HHS excluded person. My Drug Enforcement Agency registration was never revoked, suspended, limited, or conditioned in any way. I have never been a subject or target of a sexual harassment complaint or investigation. I have never been sued or a party to a malpractice action.
The Verdict
Without the means of full legal representation, the board entered a finding of substandard care, unprofessional conduct, and imposed a 60-day suspension, National Practitioner Data Bank entry, probation, stipulated chaperon requirement, ethics boundaries course, and completion, with a passing evaluation of a board underwritten practice competency assessment. Resultant extreme financial hardship, single parenthood to three children, and a soon thereafter compounding metastatic melanoma diagnosis tolled the expedient completion of some of the more cost prohibitive board conditions. Yet, they have all been completed.
Even so, and years later, no ex post facto benefit was extended to me even as the board revised pointedly applicable policies and procedures for practitioners prescribing to those within significant emotional relationships. My subsequently composed pro se writ of certiorari to the state's Supreme Court was dismissed without prejudice and referred back to the lower "court," i.e., the board.
The board's decision with public record proclamation had run amok. It ravaged then, and continues still to painfully separate me from less fortunate and acutely suffering patients yet to be observed, understood, and salvaged. "The letter of the law [remains] the height of injustice." Translated from Cicero.
Moreover, this severe experience of direct, salient interpersonal and professional humiliation, for which I alone was responsible, was sufficient to trigger foreign, shocking, yet fleeting and impermanent thoughts of death. Providentially, the balance of my life's resilience to death's proximity was in my favor. However, there are limits to even the most heroic endurance. But these limits have not yet been met.
The Hope
Again and again, year after dreadful year, with conditional licensure and consequent disqualification from board certification, I have attempted to research, publish, present, and convey sufficiently, the unremitting suicide toll and suffering experienced by our fellow citizens. The 番茄社区app readership has been respectful to me and of my writing.
I have tried to contribute to dimensional rather than categorical suicidal understanding, contest diagnostic inflation, and minimize the glibly held view that suicidal ideation is the standard of care or adequate surrogate in evaluation. I have strongly advocated for the subspecialty of emergency psychiatry, not yet a certified area in the American Board of Psychiatry and Neurology broad lexicon.
What, then, are reasonable and relevant questions to be asked?
"Who now is left to train the trainers?" "Is the field of mental health so reconciled to the insolvability of suicide, predatory violence, and opioid poisoning that it is left to the ineffective, untried, and inexpert others?" "How do we present a brighter mental health future for the provision of hope and care for its afflicted?" I have grown weary in this isolative work as a non-clinical educational and research suicidologist.
But here is my request. I have a deep personal and professional requirement to return to balanced work, to evolve as an ED clinician-researcher. Of course, in that I have focused on research and training of colleagues, my own intensive, long-term clinical supervision, and board practice tests, within a positive working environment are essential. Without doubt, these represent reasonable requirements of any new licensing medical board and potential sponsoring employer. In spite of my "Scarlet Letter," I welcome this opportunity. It will provide space for safe patient care, regular communication, problem solving, new research questions, and increased team working.
Although contemporaries scoffed at his achievements, Herodotus, an ancient Greek historian wrote, "The worst pain a man can suffer: to have insight into much and power over nothing." At a time of sustained national mental health crises, when all "hands on deck" are required, where I have tried to "recover" and improve my knowledge, reputation, and character, will no one hire me?
Russell Copelan, MD (Ret.), lives in Pensacola, Florida. He graduated from Stanford University and UCLA Medical School. He trained in neurosurgery and completed residency and fellowship in emergency department psychiatry. He is a reviewer for Academic Psychiatry and founder of eMed Logic, a non-profit originator and distributor of violence assessments.