Re: Texas Medical Board

September 12, 2006

"I may not be able to prevent an injustice, but I sure as hell refuse to be quiet about it."

, That statement speaks volumes! You are on the same page as many other very good people here and I thank you for the respect, dignity and eloquence that you posted your story. I was just preparing a statement to read at the SAMHSA meeting next week and was tackling the issue of cutoffs vs. interpretation (as far as where the problem lies). I must say, your level is the lowest positive I've heard of yet. Clearly, the cutoffs are the problem. With no clear guidelines on what any of the numbers really mean, interpretation is sort of a moot point now, isn't it?

There are a few other Texas doctors who have shared their stories here. One's had some similarities to yours--tested positive after using Purell and waterless foam surgical scrub while on a mission trip to Mexico. Alcohol was not his DOC. Following an appearance before the board, they dismissed the complaint. He said that they acknowledged ongoing problems with EtG testing and are looking at each case individually.

Please let us know what happens with your case. I hope you continue to add to the discussion here.

Lorie

Texas Medical Board

Hi everyone. I decided to post under my real name because monitoringof medical professionals in recovery has become too Taliban like toremain quiet. I entered recovery in 1987 for taking prescriptionamphetamines from my mother. I was not intervened upon. Faced withforging prescriptions or getting help I sought medical attention, thenself-reported to the board of medicine. I have NEVER been a drinker,not even socially. I have received continuous random urine drugscreens since 1988. In 1999 I was diagnosed with narcolepsy after acataplectic episode resulted in a fracture. Confirmed twice by TexasMedical Board assigned sleep medicine specialists who now prescriberitalin, provigil and Xyrem with good results. In 2003 I missed asingle urine drug screen while founding a clinic in the remote regionsof Big Bend. The Texas Medical Board suspended my license, then tooktwo years to conclude no problem existed. Every aspect of my life, mymedical care and my prescription writing was thourougly investigatedwithout any negative comment occurring. During my two year period ofunemployment, I maintained urine drug screening in the same monitoringprogram. When my license was restored, I accepted a position as anAssistant Professor of Medicine in the Section of Hospital Medicine atUT Southwestern Medical Center in Dallas. Three days ago I wasnotified that my concentrated urine from August 29th was positive for103ng of EtG. The only ethanol exposure I have is foam for handcleansing. I have attached a copy of the body of my response to themedical board. I do not know what their response will be, but willupdate this site when it occurs. My intention in writing is not somuch as to receive support as to provide it. I've wrestled withtrying to keep this to myself, but have decided to go public. I amcertain there are others out there who are in a similar position, buttoo afraid to post for whatever the reason. I understand, I was thereonce; but no more. I may not be able to prevent an injustice, but Isure as hell refuse to be quiet about it. Likewise, I'm certain thereare those with positive EtG's who have been drinking and hope to slideunder the radar by garnishing some halo effect from other's with anincidental low level positive EtG. We all know their fate. I hope mypost is not considered too lengthy, especially with me adding the bodyof my letter to the Texas Medical Board. If it is, please accept myapologies. I'll not repeat it. Most Respectfully, J. DiBona, M.D.September 11, 2006 TomeoTexas Medical BoardCompliance OfficerP.O. Box 3272McKinney, TX 75070-3272972-529-5837Fax 972-529-5681Mr. Tomeo;This is my formal response to the information you provided me over thetelephone September 8, 2006 around 1100. I wish to convey no degreeof inattentiveness or casual approach to my board order. I take mycommitment very seriously.Information provided to me:My urine drug screen from August 29, 2006 was positive for ritalinicacid and EtG at a level of 103 (I don't know the units.)My response is:I am in full compliance with my board order and have not made anymistakes.My thoughts about my EtG positive urine are:• Daily, significant cutaneous exposure to high concentration ethanoloccurs when I use the standard, hospital provided foam hand cleanser. • Due to scheduling changes I was physically in the hospital August27th at 0700 until August 28th 2100. I rounded with my team August29th 0600 to just before giving my urine drug screen at approximately1100 by memory. • August 25th and August 26th were "routine" clinical days at thehospital, followed by AA from 1800 to 1900. In the evenings Iperformed intensive swimming pool cleanup and recovery from an algaebloom. I believe this activity may have altered my skin absorption ofethanol by removing superficial skin cells and protective oils. • On the same dates I also deep cleaned my carpets. These are theonly additions to my daily routine. Both nights ended near 0100. • I was recently started on Xyrem. Ethanol is not listed as acomponent of this medication. • My albuterol inhaler has an alcohol based propellant/carrier. Ihave not used my inhaler for several months. • I have avoided ethanol containing gasoline. • There is no "accidental" ingestion of alcohol in the form ofvanilla, mouthwashes, foods, communion wine etc. I take my orderseriously, and avoid these things absolutely. The foam hand cleanser is the only source of environmental ethanolexposure I knowingly experience. Avoiding its use is difficult, asalcohol foam is superior to soap and water in reducing nosocomialhospital infections. I request formal Texas Medical Board guidance inwriting advising me on continued alcohol foam hand cleanser use.I am in absolute compliance with my order. I have receipts andbottles of the cleaning materials I used. I continue to be an exampleof expert physician medical care, professionalism, recovery andresponsibility. I am an outstanding example of compliance with theTexas Medical Board.Respectfully, J. DiBona, M.D.Assistant Professor of MedicineUT Southwestern Medical Center5909 Harry Hines Blvd. • Dallas, TX 75390-8889danieldibonamac

September 12, 2006

Thank you, Laurie. I met with the compliance officer today. He's a

straight-up gentleman. Regardless, the current policy is that any

level of EtG triggers an automatic " Statement of Allegations " to be

presented to the Texas Medical Board. Therefore, a formal hearing is

required. I will be notified of the date of the hearing. I do not

know when they will notify me, or when the hearing will be

scheduled. In the meantime, I continue with unavoidable hand

cleanser exposure. When I wrote my response to the TMB, I assumed

cutaneous exposure. After learning a bit more, inhalation may well

be the route of exposure. If that's the case, then even if I

personally do not use the alcohol foam I will still be exposed to

levels of alcohol possibly sufficient to create a positive EtG

result. I round with a resident, two interns, four medical students

and a sub-intern. When these eight people all appropriately wash

their hands during rounds significant amounts of hand cleanser are

dispensed. When the halls are filled with rounding students,

residents, interns, attendings, nurses and patient care assistants I

suspect the volume of aerosolized alcohol would easily be high. I

don't know what will happen. So far I've kept my wits about me. I

can live under a sword of Damocles when it's visible. When it's in

invisible sword that no longer takes shape, then avoiding it remains

impossible. I'm glad this group is here. Take care.

>

> " I may not be able to prevent an injustice, but I sure as hell

refuse to be quiet about it. "

>

> , That statement speaks volumes! You are on the same page as

many other very good people here and I thank you for the respect,

dignity and eloquence that you posted your story. I was just

preparing a statement to read at the SAMHSA meeting next week and was

tackling the issue of cutoffs vs. interpretation (as far as where the

problem lies). I must say, your level is the lowest positive I've

heard of yet. Clearly, the cutoffs are the problem. With no clear

guidelines on what any of the numbers really mean, interpretation is

sort of a moot point now, isn't it?

>

> There are a few other Texas doctors who have shared their stories

here. One's had some similarities to yours--tested positive after

using Purell and waterless foam surgical scrub while on a mission

trip to Mexico. Alcohol was not his DOC. Following an appearance

before the board, they dismissed the complaint. He said that they

acknowledged ongoing problems with EtG testing and are looking at

each case individually.

>

> Please let us know what happens with your case. I hope you continue

to add to the discussion here.

> Lorie

>

> Texas Medical Board

>

> Hi everyone. I decided to post under my real name because

monitoring

> of medical professionals in recovery has become too Taliban like

to

> remain quiet. I entered recovery in 1987 for taking prescription

> amphetamines from my mother. I was not intervened upon. Faced with

> forging prescriptions or getting help I sought medical attention,

then

> self-reported to the board of medicine. I have NEVER been a

drinker,

> not even socially. I have received continuous random urine drug

> screens since 1988. In 1999 I was diagnosed with narcolepsy after

a

> cataplectic episode resulted in a fracture. Confirmed twice by

Texas

> Medical Board assigned sleep medicine specialists who now

prescribe

> ritalin, provigil and Xyrem with good results. In 2003 I missed a

> single urine drug screen while founding a clinic in the remote

regions

> of Big Bend. The Texas Medical Board suspended my license, then

took

> two years to conclude no problem existed. Every aspect of my

life, my

> medical care and my prescription writing were thoroughly

investigated

> without any negative comment occurring. During my two year period

of

> unemployment, I maintained urine drug screening in the same

monitoring

> program. When my license was restored, I accepted a position as an

> Assistant Professor of Medicine in the Section of Hospital

Medicine at

> UT Southwestern Medical Center in Dallas. Three days ago I was

> notified that my concentrated urine from August 29th was positive

for

> 103ng of EtG. The only ethanol exposure I have is foam for hand

> cleansing. I have attached a copy of the body of my response to

the

> medical board. I do not know what their response will be, but will

> update this site when it occurs. My intention in writing is not so

> much as to receive support as to provide it. I've wrestled with

> trying to keep this to myself, but have decided to go public. I am

> certain there are others out there who are in a similar position,

but

> too afraid to post for whatever the reason. I understand, I was

there

> once; but no more. I may not be able to prevent an injustice, but

I

> sure as hell refuse to be quiet about it. Likewise, I'm certain

there

> are those with positive EtG's who have been drinking and hope to

slide

> under the radar by garnishing some halo effect from other's with

an

> incidental low level positive EtG. We all know their fate. I hope

my

> post is not considered too lengthy, especially with me adding the

body

> of my letter to the Texas Medical Board. If it is, please accept

my

> apologies. I'll not repeat it. Most Respectfully, J.

DiBona, M.D.

>

> September 11, 2006

>

> Tomeo

> Texas Medical Board

> Compliance Officer

> P.O. Box 3272

> McKinney, TX 75070-3272

> 972-529-5837

> Fax 972-529-5681

>

> Mr. Tomeo;

>

> This is my formal response to the information you provided me

over the

> telephone September 8, 2006 around 1100. I wish to convey no

degree

> of inattentiveness or casual approach to my board order. I take my

> commitment very seriously.

> Information provided to me:

> My urine drug screen from August 29, 2006 was positive for

ritalinic

> acid and EtG at a level of 103 (I don't know the units.)

> My response is:

> I am in full compliance with my board order and have not made any

> mistakes.

> My thoughts about my EtG positive urine are:

> . Daily, significant cutaneous exposure to high concentration

ethanol

> occurs when I use the standard, hospital provided foam hand

cleanser.

> . Due to scheduling changes I was physically in the hospital

August

> 27th at 0700 until August 28th 2100. I rounded with my team August

> 29th 0600 to just before giving my urine drug screen at

approximately

> 1100 by memory.

> . August 25th and August 26th were " routine " clinical days at the

> hospital, followed by AA from 1800 to 1900. In the evenings I

> performed intensive swimming pool cleanup and recovery from an

algae

> bloom. I believe this activity may have altered my skin

absorption of

> ethanol by removing superficial skin cells and protective oils.

> . On the same dates I also deep cleaned my carpets. These are the

> only additions to my daily routine. Both nights ended near 0100.

> . I was recently started on Xyrem. Ethanol is not listed as a

> component of this medication.

> . My albuterol inhaler has an alcohol based propellant/carrier. I

> have not used my inhaler for several months.

> . I have avoided ethanol containing gasoline.

> . There is no " accidental " ingestion of alcohol in the form of

> vanilla, mouthwashes, foods, communion wine etc. I take my order

> seriously, and avoid these things absolutely.

> The foam hand cleanser is the only source of environmental ethanol

> exposure I knowingly experience. Avoiding its use is difficult, as

> alcohol foam is superior to soap and water in reducing nosocomial

> hospital infections. I request formal Texas Medical Board

guidance in

> writing advising me on continued alcohol foam hand cleanser use.

>

> I am in absolute compliance with my order. I have receipts and

> bottles of the cleaning materials I used. I continue to be an

example

> of expert physician medical care, professionalism, recovery and

> responsibility. I am an outstanding example of compliance with the

> Texas Medical Board.

>

> Respectfully,

>

> J. DiBona, M.D.

> Assistant Professor of Medicine

> UT Southwestern Medical Center

> 5909 Harry Hines Blvd. . Dallas, TX 75390-8889

> danieldibona@...

>

September 12, 2006

, i don't know whether you had that urine retested to confirm

that level, but another argument with that level of 103 is the normal

variation either way (and I don't remember what that percentage

was). Meaning, as easily as it could have been 110....it had the

same chance of being 94. I am sure you are aware of all these things,

but I know sometimes in my frustration over this I forget them! I

understand what you mean, NO ONE has a complete list of items

(edible or inedible) that contain alcohol or may cause

positives....so how can we be expected to know everything when

the 'experts' don't even know everything! Another thing to take to

the board is, if it was a concentrated specimen, the creatinine level

and the possiblity of that causing the higher levels. There is many

publications on Etg that talk about normalizing the Etg level to

creatinine. As Lorie said, I think that was the lowest level I have

heard of that has cost someone the need for a hearing. Glad you are

here also! nancy

> >

> > " I may not be able to prevent an injustice, but I sure as hell

> refuse to be quiet about it. "

> >

> > , That statement speaks volumes! You are on the same page

as

> many other very good people here and I thank you for the respect,

> dignity and eloquence that you posted your story. I was just

> preparing a statement to read at the SAMHSA meeting next week and

was

> tackling the issue of cutoffs vs. interpretation (as far as where

the

> problem lies). I must say, your level is the lowest positive I've

> heard of yet. Clearly, the cutoffs are the problem. With no clear

> guidelines on what any of the numbers really mean, interpretation

is

> sort of a moot point now, isn't it?

> >

> > There are a few other Texas doctors who have shared their stories

> here. One's had some similarities to yours--tested positive after

> using Purell and waterless foam surgical scrub while on a mission

> trip to Mexico. Alcohol was not his DOC. Following an appearance

> before the board, they dismissed the complaint. He said that they

> acknowledged ongoing problems with EtG testing and are looking at

> each case individually.

> >

> > Please let us know what happens with your case. I hope you

continue

> to add to the discussion here.

> > Lorie

> >

> > Texas Medical Board

> >

> > Hi everyone. I decided to post under my real name because

> monitoring

> > of medical professionals in recovery has become too Taliban

like

> to

> > remain quiet. I entered recovery in 1987 for taking prescription

> > amphetamines from my mother. I was not intervened upon. Faced

with

> > forging prescriptions or getting help I sought medical

attention,

> then

> > self-reported to the board of medicine. I have NEVER been a

> drinker,

> > not even socially. I have received continuous random urine drug

> > screens since 1988. In 1999 I was diagnosed with narcolepsy

after

> a

> > cataplectic episode resulted in a fracture. Confirmed twice by

> Texas

> > Medical Board assigned sleep medicine specialists who now

> prescribe

> > ritalin, provigil and Xyrem with good results. In 2003 I missed

a

> > single urine drug screen while founding a clinic in the remote

> regions

> > of Big Bend. The Texas Medical Board suspended my license, then

> took

> > two years to conclude no problem existed. Every aspect of my

> life, my

> > medical care and my prescription writing were thoroughly

> investigated

> > without any negative comment occurring. During my two year

period

> of

> > unemployment, I maintained urine drug screening in the same

> monitoring

> > program. When my license was restored, I accepted a position as

an

> > Assistant Professor of Medicine in the Section of Hospital

> Medicine at

> > UT Southwestern Medical Center in Dallas. Three days ago I was

> > notified that my concentrated urine from August 29th was

positive

> for

> > 103ng of EtG. The only ethanol exposure I have is foam for hand

> > cleansing. I have attached a copy of the body of my response to

> the

> > medical board. I do not know what their response will be, but

will

> > update this site when it occurs. My intention in writing is not

so

> > much as to receive support as to provide it. I've wrestled with

> > trying to keep this to myself, but have decided to go public. I

am

> > certain there are others out there who are in a similar

position,

> but

> > too afraid to post for whatever the reason. I understand, I was

> there

> > once; but no more. I may not be able to prevent an injustice,

but

> I

> > sure as hell refuse to be quiet about it. Likewise, I'm certain

> there

> > are those with positive EtG's who have been drinking and hope

to

> slide

> > under the radar by garnishing some halo effect from other's

with

> an

> > incidental low level positive EtG. We all know their fate. I

hope

> my

> > post is not considered too lengthy, especially with me adding

the

> body

> > of my letter to the Texas Medical Board. If it is, please

accept

> my

> > apologies. I'll not repeat it. Most Respectfully, J.

> DiBona, M.D.

> >

> > September 11, 2006

> >

> > Tomeo

> > Texas Medical Board

> > Compliance Officer

> > P.O. Box 3272

> > McKinney, TX 75070-3272

> > 972-529-5837

> > Fax 972-529-5681

> >

> > Mr. Tomeo;

> >

> > This is my formal response to the information you provided me

> over the

> > telephone September 8, 2006 around 1100. I wish to convey no

> degree

> > of inattentiveness or casual approach to my board order. I take

my

> > commitment very seriously.

> > Information provided to me:

> > My urine drug screen from August 29, 2006 was positive for

> ritalinic

> > acid and EtG at a level of 103 (I don't know the units.)

> > My response is:

> > I am in full compliance with my board order and have not made

any

> > mistakes.

> > My thoughts about my EtG positive urine are:

> > . Daily, significant cutaneous exposure to high concentration

> ethanol

> > occurs when I use the standard, hospital provided foam hand

> cleanser.

> > . Due to scheduling changes I was physically in the hospital

> August

> > 27th at 0700 until August 28th 2100. I rounded with my team

August

> > 29th 0600 to just before giving my urine drug screen at

> approximately

> > 1100 by memory.

> > . August 25th and August 26th were " routine " clinical days at

the

> > hospital, followed by AA from 1800 to 1900. In the evenings I

> > performed intensive swimming pool cleanup and recovery from an

> algae

> > bloom. I believe this activity may have altered my skin

> absorption of

> > ethanol by removing superficial skin cells and protective oils.

> > . On the same dates I also deep cleaned my carpets. These are

the

> > only additions to my daily routine. Both nights ended near

0100.

> > . I was recently started on Xyrem. Ethanol is not listed as a

> > component of this medication.

> > . My albuterol inhaler has an alcohol based propellant/carrier.

I

> > have not used my inhaler for several months.

> > . I have avoided ethanol containing gasoline.

> > . There is no " accidental " ingestion of alcohol in the form of

> > vanilla, mouthwashes, foods, communion wine etc. I take my order

> > seriously, and avoid these things absolutely.

> > The foam hand cleanser is the only source of environmental

ethanol

> > exposure I knowingly experience. Avoiding its use is difficult,

as

> > alcohol foam is superior to soap and water in reducing

nosocomial

> > hospital infections. I request formal Texas Medical Board

> guidance in

> > writing advising me on continued alcohol foam hand cleanser use.

> >

> > I am in absolute compliance with my order. I have receipts and

> > bottles of the cleaning materials I used. I continue to be an

> example

> > of expert physician medical care, professionalism, recovery and

> > responsibility. I am an outstanding example of compliance with

the

> > Texas Medical Board.

> >

> > Respectfully,

> >

> > J. DiBona, M.D.

> > Assistant Professor of Medicine

> > UT Southwestern Medical Center

> > 5909 Harry Hines Blvd. . Dallas, TX 75390-8889

> > danieldibona@

> >

>

September 12, 2006

Hi ,

I do not know the inter-test variability. As Texas apparently uses

no cutoff level, it wouldn't matter in my case. My Etg level was

103nanograms/milliliter. My urine creatine was 213mg/dl, the

specific gravity was not listed on the report, but I am certain was

high. It was the first time in twenty years I've ever apologized to

a tech for handing them " stinky pee " . I appreciate you writing me

back. I hope me going public helps some people. I haven't heard

anything about it from the University yet, but am willing to accept

the consequences. No meaningful guidelines for test interpretation

can move forward if a conspiracy of silence persists. I don't

believe I will experience any negative work consequences for my

posting. It would surprise and sadden me if I did.

Dan

> > >

> > > " I may not be able to prevent an injustice, but I sure as hell

> > refuse to be quiet about it. "

> > >

> > > , That statement speaks volumes! You are on the same page

> as

> > many other very good people here and I thank you for the respect,

> > dignity and eloquence that you posted your story. I was just

> > preparing a statement to read at the SAMHSA meeting next week and

> was

> > tackling the issue of cutoffs vs. interpretation (as far as where

> the

> > problem lies). I must say, your level is the lowest positive I've

> > heard of yet. Clearly, the cutoffs are the problem. With no clear

> > guidelines on what any of the numbers really mean, interpretation

> is

> > sort of a moot point now, isn't it?

> > >

> > > There are a few other Texas doctors who have shared their

stories

> > here. One's had some similarities to yours--tested positive after

> > using Purell and waterless foam surgical scrub while on a mission

> > trip to Mexico. Alcohol was not his DOC. Following an appearance

> > before the board, they dismissed the complaint. He said that they

> > acknowledged ongoing problems with EtG testing and are looking at

> > each case individually.

> > >

> > > Please let us know what happens with your case. I hope you

> continue

> > to add to the discussion here.

> > > Lorie

> > >

> > > Texas Medical Board

> > >

> > > Hi everyone. I decided to post under my real name because

> > monitoring

> > > of medical professionals in recovery has become too Taliban

> like

> > to

> > > remain quiet. I entered recovery in 1987 for taking

prescription

> > > amphetamines from my mother. I was not intervened upon. Faced

> with

> > > forging prescriptions or getting help I sought medical

> attention,

> > then

> > > self-reported to the board of medicine. I have NEVER been a

> > drinker,

> > > not even socially. I have received continuous random urine

drug

> > > screens since 1988. In 1999 I was diagnosed with narcolepsy

> after

> > a

> > > cataplectic episode resulted in a fracture. Confirmed twice

by

> > Texas

> > > Medical Board assigned sleep medicine specialists who now

> > prescribe

> > > ritalin, provigil and Xyrem with good results. In 2003 I

missed

> a

> > > single urine drug screen while founding a clinic in the

remote

> > regions

> > > of Big Bend. The Texas Medical Board suspended my license,

then

> > took

> > > two years to conclude no problem existed. Every aspect of my

> > life, my

> > > medical care and my prescription writing were thoroughly

> > investigated

> > > without any negative comment occurring. During my two year

> period

> > of

> > > unemployment, I maintained urine drug screening in the same

> > monitoring

> > > program. When my license was restored, I accepted a position

as

> an

> > > Assistant Professor of Medicine in the Section of Hospital

> > Medicine at

> > > UT Southwestern Medical Center in Dallas. Three days ago I was

> > > notified that my concentrated urine from August 29th was

> positive

> > for

> > > 103ng of EtG. The only ethanol exposure I have is foam for

hand

> > > cleansing. I have attached a copy of the body of my response

to

> > the

> > > medical board. I do not know what their response will be, but

> will

> > > update this site when it occurs. My intention in writing is

not

> so

> > > much as to receive support as to provide it. I've wrestled

with

> > > trying to keep this to myself, but have decided to go public.

I

> am

> > > certain there are others out there who are in a similar

> position,

> > but

> > > too afraid to post for whatever the reason. I understand, I

was

> > there

> > > once; but no more. I may not be able to prevent an injustice,

> but

> > I

> > > sure as hell refuse to be quiet about it. Likewise, I'm

certain

> > there

> > > are those with positive EtG's who have been drinking and hope

> to

> > slide

> > > under the radar by garnishing some halo effect from other's

> with

> > an

> > > incidental low level positive EtG. We all know their fate. I

> hope

> > my

> > > post is not considered too lengthy, especially with me adding

> the

> > body

> > > of my letter to the Texas Medical Board. If it is, please

> accept

> > my

> > > apologies. I'll not repeat it. Most Respectfully, J.

> > DiBona, M.D.

> > >

> > > September 11, 2006

> > >

> > > Tomeo

> > > Texas Medical Board

> > > Compliance Officer

> > > P.O. Box 3272

> > > McKinney, TX 75070-3272

> > > 972-529-5837

> > > Fax 972-529-5681

> > >

> > > Mr. Tomeo;

> > >

> > > This is my formal response to the information you provided me

> > over the

> > > telephone September 8, 2006 around 1100. I wish to convey no

> > degree

> > > of inattentiveness or casual approach to my board order. I

take

> my

> > > commitment very seriously.

> > > Information provided to me:

> > > My urine drug screen from August 29, 2006 was positive for

> > ritalinic

> > > acid and EtG at a level of 103 (I don't know the units.)

> > > My response is:

> > > I am in full compliance with my board order and have not made

> any

> > > mistakes.

> > > My thoughts about my EtG positive urine are:

> > > . Daily, significant cutaneous exposure to high concentration

> > ethanol

> > > occurs when I use the standard, hospital provided foam hand

> > cleanser.

> > > . Due to scheduling changes I was physically in the hospital

> > August

> > > 27th at 0700 until August 28th 2100. I rounded with my team

> August

> > > 29th 0600 to just before giving my urine drug screen at

> > approximately

> > > 1100 by memory.

> > > . August 25th and August 26th were " routine " clinical days at

> the

> > > hospital, followed by AA from 1800 to 1900. In the evenings I

> > > performed intensive swimming pool cleanup and recovery from

an

> > algae

> > > bloom. I believe this activity may have altered my skin

> > absorption of

> > > ethanol by removing superficial skin cells and protective

oils.

> > > . On the same dates I also deep cleaned my carpets. These are

> the

> > > only additions to my daily routine. Both nights ended near

> 0100.

> > > . I was recently started on Xyrem. Ethanol is not listed as a

> > > component of this medication.

> > > . My albuterol inhaler has an alcohol based

propellant/carrier.

> I

> > > have not used my inhaler for several months.

> > > . I have avoided ethanol containing gasoline.

> > > . There is no " accidental " ingestion of alcohol in the form of

> > > vanilla, mouthwashes, foods, communion wine etc. I take my

order

> > > seriously, and avoid these things absolutely.

> > > The foam hand cleanser is the only source of environmental

> ethanol

> > > exposure I knowingly experience. Avoiding its use is

difficult,

> as

> > > alcohol foam is superior to soap and water in reducing

> nosocomial

> > > hospital infections. I request formal Texas Medical Board

> > guidance in

> > > writing advising me on continued alcohol foam hand cleanser

use.

> > >

> > > I am in absolute compliance with my order. I have receipts and

> > > bottles of the cleaning materials I used. I continue to be an

> > example

> > > of expert physician medical care, professionalism, recovery

and

> > > responsibility. I am an outstanding example of compliance

with

> the

> > > Texas Medical Board.

> > >

> > > Respectfully,

> > >

> > > J. DiBona, M.D.

> > > Assistant Professor of Medicine

> > > UT Southwestern Medical Center

> > > 5909 Harry Hines Blvd. . Dallas, TX 75390-8889

> > > danieldibona@

> > >

> >

>

September 12, 2006

--- Dear Dr.

Am I understanding this right....As a Dr. you have to visit the piss

gulag for 20YEARS???????????????????????? (See Madison

hyperventilating, hair standing on end, dancing in circles)

Will you have to do it FOREVER??????????? (See Madison dropping

over dead from a heart attack. NO WAIT scratch that, ya'll would

enjoy that too much)

Please say it isn't so. Do the rest of ya'll here have to dodge the

sobriety enforcers for life, or is there a time cut off of say 30

years or so?

Someone please answer me.

Thanks.

In Ethylglucuronide , " Dainiel DiBona "

<danieldibona@...> wrote:

>

> Hi ,

> I do not know the inter-test variability. As Texas apparently

uses

> no cutoff level, it wouldn't matter in my case. My Etg level was

> 103nanograms/milliliter. My urine creatine was 213mg/dl, the

> specific gravity was not listed on the report, but I am certain

was

> high. It was the first time in twenty years I've ever apologized

to

> a tech for handing them " stinky pee " . I appreciate you writing me

> back. I hope me going public helps some people. I haven't heard

> anything about it from the University yet, but am willing to

accept

> the consequences. No meaningful guidelines for test

interpretation

> can move forward if a conspiracy of silence persists. I don't

> believe I will experience any negative work consequences for my

> posting. It would surprise and sadden me if I did.

> Dan

>

> > > >

> > > > " I may not be able to prevent an injustice, but I sure as

hell

> > > refuse to be quiet about it. "

> > > >

> > > > , That statement speaks volumes! You are on the same

page

> > as

> > > many other very good people here and I thank you for the

respect,

> > > dignity and eloquence that you posted your story. I was just

> > > preparing a statement to read at the SAMHSA meeting next week

and

> > was

> > > tackling the issue of cutoffs vs. interpretation (as far as

where

> > the

> > > problem lies). I must say, your level is the lowest positive

I've

> > > heard of yet. Clearly, the cutoffs are the problem. With no

clear

> > > guidelines on what any of the numbers really mean,

interpretation

> > is

> > > sort of a moot point now, isn't it?

> > > >

> > > > There are a few other Texas doctors who have shared their

> stories

> > > here. One's had some similarities to yours--tested positive

after

> > > using Purell and waterless foam surgical scrub while on a

mission

> > > trip to Mexico. Alcohol was not his DOC. Following an

appearance

> > > before the board, they dismissed the complaint. He said that

they

> > > acknowledged ongoing problems with EtG testing and are looking

at

> > > each case individually.

> > > >

> > > > Please let us know what happens with your case. I hope you

> > continue

> > > to add to the discussion here.

> > > > Lorie

> > > >

> > > > Texas Medical Board

> > > >

> > > > Hi everyone. I decided to post under my real name because

> > > monitoring

> > > > of medical professionals in recovery has become too

Taliban

> > like

> > > to

> > > > remain quiet. I entered recovery in 1987 for taking

> prescription

> > > > amphetamines from my mother. I was not intervened upon.

Faced

> > with

> > > > forging prescriptions or getting help I sought medical

> > attention,

> > > then

> > > > self-reported to the board of medicine. I have NEVER been

a

> > > drinker,

> > > > not even socially. I have received continuous random urine

> drug

> > > > screens since 1988. In 1999 I was diagnosed with

narcolepsy

> > after

> > > a

> > > > cataplectic episode resulted in a fracture. Confirmed

twice

> by

> > > Texas

> > > > Medical Board assigned sleep medicine specialists who now

> > > prescribe

> > > > ritalin, provigil and Xyrem with good results. In 2003 I

> missed

> > a

> > > > single urine drug screen while founding a clinic in the

> remote

> > > regions

> > > > of Big Bend. The Texas Medical Board suspended my license,

> then

> > > took

> > > > two years to conclude no problem existed. Every aspect of

my

> > > life, my

> > > > medical care and my prescription writing were thoroughly

> > > investigated

> > > > without any negative comment occurring. During my two year

> > period

> > > of

> > > > unemployment, I maintained urine drug screening in the

same

> > > monitoring

> > > > program. When my license was restored, I accepted a

position

> as

> > an

> > > > Assistant Professor of Medicine in the Section of Hospital

> > > Medicine at

> > > > UT Southwestern Medical Center in Dallas. Three days ago I

was

> > > > notified that my concentrated urine from August 29th was

> > positive

> > > for

> > > > 103ng of EtG. The only ethanol exposure I have is foam for

> hand

> > > > cleansing. I have attached a copy of the body of my

response

> to

> > > the

> > > > medical board. I do not know what their response will be,

but

> > will

> > > > update this site when it occurs. My intention in writing

is

> not

> > so

> > > > much as to receive support as to provide it. I've wrestled

> with

> > > > trying to keep this to myself, but have decided to go

public.

> I

> > am

> > > > certain there are others out there who are in a similar

> > position,

> > > but

> > > > too afraid to post for whatever the reason. I understand,

I

> was

> > > there

> > > > once; but no more. I may not be able to prevent an

injustice,

> > but

> > > I

> > > > sure as hell refuse to be quiet about it. Likewise, I'm

> certain

> > > there

> > > > are those with positive EtG's who have been drinking and

hope

> > to

> > > slide

> > > > under the radar by garnishing some halo effect from

other's

> > with

> > > an

> > > > incidental low level positive EtG. We all know their fate.

I

> > hope

> > > my

> > > > post is not considered too lengthy, especially with me

adding

> > the

> > > body

> > > > of my letter to the Texas Medical Board. If it is, please

> > accept

> > > my

> > > > apologies. I'll not repeat it. Most Respectfully,

J.

> > > DiBona, M.D.

> > > >

> > > > September 11, 2006

> > > >

> > > > Tomeo

> > > > Texas Medical Board

> > > > Compliance Officer

> > > > P.O. Box 3272

> > > > McKinney, TX 75070-3272

> > > > 972-529-5837

> > > > Fax 972-529-5681

> > > >

> > > > Mr. Tomeo;

> > > >

> > > > This is my formal response to the information you provided

me

> > > over the

> > > > telephone September 8, 2006 around 1100. I wish to convey

no

> > > degree

> > > > of inattentiveness or casual approach to my board order. I

> take

> > my

> > > > commitment very seriously.

> > > > Information provided to me:

> > > > My urine drug screen from August 29, 2006 was positive for

> > > ritalinic

> > > > acid and EtG at a level of 103 (I don't know the units.)

> > > > My response is:

> > > > I am in full compliance with my board order and have not

made

> > any

> > > > mistakes.

> > > > My thoughts about my EtG positive urine are:

> > > > . Daily, significant cutaneous exposure to high

concentration

> > > ethanol

> > > > occurs when I use the standard, hospital provided foam

hand

> > > cleanser.

> > > > . Due to scheduling changes I was physically in the

hospital

> > > August

> > > > 27th at 0700 until August 28th 2100. I rounded with my

team

> > August

> > > > 29th 0600 to just before giving my urine drug screen at

> > > approximately

> > > > 1100 by memory.

> > > > . August 25th and August 26th were " routine " clinical days

at

> > the

> > > > hospital, followed by AA from 1800 to 1900. In the

evenings I

> > > > performed intensive swimming pool cleanup and recovery

from

> an

> > > algae

> > > > bloom. I believe this activity may have altered my skin

> > > absorption of

> > > > ethanol by removing superficial skin cells and protective

> oils.

> > > > . On the same dates I also deep cleaned my carpets. These

are

> > the

> > > > only additions to my daily routine. Both nights ended near

> > 0100.

> > > > . I was recently started on Xyrem. Ethanol is not listed

as a

> > > > component of this medication.

> > > > . My albuterol inhaler has an alcohol based

> propellant/carrier.

> > I

> > > > have not used my inhaler for several months.

> > > > . I have avoided ethanol containing gasoline.

> > > > . There is no " accidental " ingestion of alcohol in the

form of

> > > > vanilla, mouthwashes, foods, communion wine etc. I take my

> order

> > > > seriously, and avoid these things absolutely.

> > > > The foam hand cleanser is the only source of environmental

> > ethanol

> > > > exposure I knowingly experience. Avoiding its use is

> difficult,

> > as

> > > > alcohol foam is superior to soap and water in reducing

> > nosocomial

> > > > hospital infections. I request formal Texas Medical Board

> > > guidance in

> > > > writing advising me on continued alcohol foam hand

cleanser

> use.

> > > >

> > > > I am in absolute compliance with my order. I have receipts

and

> > > > bottles of the cleaning materials I used. I continue to be

an

> > > example

> > > > of expert physician medical care, professionalism,

recovery

> and

> > > > responsibility. I am an outstanding example of compliance

> with

> > the

> > > > Texas Medical Board.

> > > >

> > > > Respectfully,

> > > >

> > > > J. DiBona, M.D.

> > > > Assistant Professor of Medicine

> > > > UT Southwestern Medical Center

> > > > 5909 Harry Hines Blvd. . Dallas, TX 75390-8889

> > > > danieldibona@

> > > >

> > >

> >

>

September 12, 2006

Hello & Welcome Aboard! Thank you for your openness, your eloquence, & your willingness to join forces with us. You are a most welcome addition to our site. As they say in certain places, keep comin' back. Marsha Dienelt, RN Northern CA Dainiel DiBona <danieldibona@...> wrote: Hi everyone. I decided to post under my real name because monitoringof medical professionals in

recovery has become too Taliban like toremain quiet. I entered recovery in 1987 for taking prescriptionamphetamines from my mother. I was not intervened upon. Faced withforging prescriptions or getting help I sought medical attention, thenself-reported to the board of medicine. I have NEVER been a drinker,not even socially. I have received continuous random urine drugscreens since 1988. In 1999 I was diagnosed with narcolepsy after acataplectic episode resulted in a fracture. Confirmed twice by TexasMedical Board assigned sleep medicine specialists who now prescriberitalin, provigil and Xyrem with good results. In 2003 I missed asingle urine drug screen while founding a clinic in the remote regionsof Big Bend. The Texas Medical Board suspended my license, then tooktwo years to conclude no problem existed. Every aspect of my life, mymedical care and my prescription writing was thourougly investigatedwithout any

negative comment occurring. During my two year period ofunemployment, I maintained urine drug screening in the same monitoringprogram. When my license was restored, I accepted a position as anAssistant Professor of Medicine in the Section of Hospital Medicine atUT Southwestern Medical Center in Dallas. Three days ago I wasnotified that my concentrated urine from August 29th was positive for103ng of EtG. The only ethanol exposure I have is foam for handcleansing. I have attached a copy of the body of my response to themedical board. I do not know what their response will be, but willupdate this site when it occurs. My intention in writing is not somuch as to receive support as to provide it. I've wrestled withtrying to keep this to myself, but have decided to go public. I amcertain there are others out there who are in a similar position, buttoo afraid to post for whatever the reason. I understand, I was thereonce; but

no more. I may not be able to prevent an injustice, but Isure as hell refuse to be quiet about it. Likewise, I'm certain thereare those with positive EtG's who have been drinking and hope to slideunder the radar by garnishing some halo effect from other's with anincidental low level positive EtG. We all know their fate. I hope mypost is not considered too lengthy, especially with me adding the bodyof my letter to the Texas Medical Board. If it is, please accept myapologies. I'll not repeat it. Most Respectfully, J. DiBona, M.D.September 11, 2006 TomeoTexas Medical BoardCompliance OfficerP.O. Box 3272McKinney, TX 75070-3272972-529-5837Fax 972-529-5681Mr. Tomeo;This is my formal response to the information you provided me over thetelephone September 8, 2006 around 1100. I wish to convey no degreeof inattentiveness or casual approach to my board order. I take

mycommitment very seriously.Information provided to me:My urine drug screen from August 29, 2006 was positive for ritalinicacid and EtG at a level of 103 (I don't know the units.)My response is:I am in full compliance with my board order and have not made anymistakes.My thoughts about my EtG positive urine are:• Daily, significant cutaneous exposure to high concentration ethanoloccurs when I use the standard, hospital provided foam hand cleanser. • Due to scheduling changes I was physically in the hospital August27th at 0700 until August 28th 2100. I rounded with my team August29th 0600 to just before giving my urine drug screen at approximately1100 by memory. • August 25th and August 26th were "routine" clinical days at thehospital, followed by AA from 1800 to 1900. In the evenings Iperformed intensive swimming pool cleanup and recovery from an algaebloom. I believe this activity may have altered my

skin absorption ofethanol by removing superficial skin cells and protective oils. • On the same dates I also deep cleaned my carpets. These are theonly additions to my daily routine. Both nights ended near 0100. • I was recently started on Xyrem. Ethanol is not listed as acomponent of this medication. • My albuterol inhaler has an alcohol based propellant/carrier. Ihave not used my inhaler for several months. • I have avoided ethanol containing gasoline. • There is no "accidental" ingestion of alcohol in the form ofvanilla, mouthwashes, foods, communion wine etc. I take my orderseriously, and avoid these things absolutely. The foam hand cleanser is the only source of environmental ethanolexposure I knowingly experience. Avoiding its use is difficult, asalcohol foam is superior to soap and water in reducing nosocomialhospital infections. I request formal Texas Medical Board guidance inwriting advising me on

continued alcohol foam hand cleanser use.I am in absolute compliance with my order. I have receipts andbottles of the cleaning materials I used. I continue to be an exampleof expert physician medical care, professionalism, recovery andresponsibility. I am an outstanding example of compliance with theTexas Medical Board.Respectfully, J. DiBona, M.D.Assistant Professor of MedicineUT Southwestern Medical Center5909 Harry Hines Blvd. • Dallas, TX 75390-8889danieldibonamac

Get your email and more, right on the new .com

September 12, 2006

When I first started urine drug screening the medical boards did not

administer the testing. It was done through the State medical

society. As I was a member of my county physician health committe, I

continued voluntary screening. With narcolepsy, the board insisted

on screening. When I missed a urine drug screen, my order became

public, and the time was reset for another ten years. In years past

people were monitored for two to three years. Then it became five.

The trend is now for a minimum of ten years. There is a growing

momentum among regulatory bodies to pursue lifelong monitoring. I

don't believe anyone in medicine or nursing should expect anything

less than life long scruitiny.

The problem with the low EtG cutoffs are multiple. First is the

variable expression of enzymes metabolising ethanol. Most of these

are inducible enzyme systems. Second is that monitoring bodies have

not uniformly adopted normalizing the EtG level to the urine

creatinine. While this would " hurt " those with low level dilute

specimens, it would " benefit " concentrated urine samples. In

reality, it neither harms nor helps, but simply standardizes an

otherwise diluteable substance against a substance with a fixed

excretion per 24 hours regardless of that persons volume status. In

my case, it would help, as my EtG level of 103ng/ml would reset to

one of 48ng/ml.

The largest problem with EtG is the abscence of any prospective,

controlled examinations deliniating the predictive values of the

positives and negatives. The sensitivity and specifity of the

testing is phenomenal, but in a clinical setting what matters most is

the predictive value of the test result. This is unknown, as it is

with many tests. That is the foundation for " clinical judgement. "

Therefore, if a person encounters authorities willing to exercise or

enlist clinical judgemtent, I usually would say none of us have

anything to worry about. With respect to EtG, that is not my

position. I think we should all worry.

The reason I believe this relates to the absolute inability to avoid

incidental ethanol exposure, especially for a health care

professional. If the mechanism of ethanol getting into our bodies

was limited to oral, or even transdermal, exposure these variables

could be addressed, albeit for some at great inconvience. No

conclusive Class I data exists regarding ethanol exposure and EtG by

any other route than oral. The assumption being made then, is that

any EtG was consumed. What is needed is Class I published data

examining transdermal and inhalation routes of ethanol penetration

into a persons system.

In our society, it is impossible to control what you breath. And, it

is poorly examined, except with respect to cigarettes, asbestos and

certain medications. What is available with respect to ethanol

absorbtion via incidental inhalation is not encouraging. It appears

to be an uncontrollable variable in a person's life.

As for me, it is absolutely unavoidable. Therefore, for me to answer

meaningfully to a test result about, " what my role in it is " becomes

impossible. And that is where I believe the insanity sets in.

I've lived my life with the assumption that as a recovering person I

should be judged not by what I say, but what I do. I do good, and

document it. EtG testing introduces a third element. It used to be

safe to abdicate our words and thoughts and hold how we live our

lives out as proof of our recovery. In fact, many judge an

addict/alcoholic's quality of recovery by the degree of humility in

not speaking up, that is by how much we instead describe the choices

we make day to day and the behaviors we exhibit. With respect to

EtG, this no longer " works. " This " new " magical, uncharacterized

test has stormed the market giving potent ammunition to the opposing

persons assertion, " We hear what you say, but the evidence is against

you. "

As such, I am speaking out. I believe EtG testing must be reigned in

and required to undergo rigorous prospective study to quantify

predictive values prior to establishing cut-offs. Anything other

than that remains arbitrary.

I don't know what the future holds, but I do know this: God not only

gave me the gift of recovery, he gave me a brain and the ability to

process, analyze and interpret data. I don't squander my gifts, and

haven't since I entered into recovery. Regardless of what happens

with my case (I honestly can't believe it would go anywhere, but now

it's going to go to a " hearing " .), I will remain an advocate of

pulling these fanatics into line.

There's an odd thing about fanatics. Underneath it all is the fact

they honestly don't believe what they are fanatical about. Given

that, it is an uphill road for those of us in recovery to be taken

seriously. Dishonesty is an aspect of addiction. Speaking up for

onself is interpreted as defensive. But through all of that, I

believe there is a path to balance, and that it will have to come

from those of us in recovery. I believe it's essential we become

articulate and dispassionate, ruthless in sweeping our own side of

the street, and indefatigueable in pursuing sanity, not just for

ourselves, but also for the system and world we live.

Besides all that, it's going to take an ally with teeth to get

anywhere.

Ya'll take care.

Dan

> > > > >

> > > > > " I may not be able to prevent an injustice, but I sure as

> hell

> > > > refuse to be quiet about it. "

> > > > >

> > > > > , That statement speaks volumes! You are on the same

> page

> > > as

> > > > many other very good people here and I thank you for the

> respect,

> > > > dignity and eloquence that you posted your story. I was just

> > > > preparing a statement to read at the SAMHSA meeting next week

> and

> > > was

> > > > tackling the issue of cutoffs vs. interpretation (as far as

> where

> > > the

> > > > problem lies). I must say, your level is the lowest positive

> I've

> > > > heard of yet. Clearly, the cutoffs are the problem. With no

> clear

> > > > guidelines on what any of the numbers really mean,

> interpretation

> > > is

> > > > sort of a moot point now, isn't it?

> > > > >

> > > > > There are a few other Texas doctors who have shared their

> > stories

> > > > here. One's had some similarities to yours--tested positive

> after

> > > > using Purell and waterless foam surgical scrub while on a

> mission

> > > > trip to Mexico. Alcohol was not his DOC. Following an

> appearance

> > > > before the board, they dismissed the complaint. He said that

> they

> > > > acknowledged ongoing problems with EtG testing and are

looking

> at

> > > > each case individually.

> > > > >

> > > > > Please let us know what happens with your case. I hope you

> > > continue

> > > > to add to the discussion here.

> > > > > Lorie

> > > > >

> > > > > Texas Medical Board

> > > > >

> > > > > Hi everyone. I decided to post under my real name because

> > > > monitoring

> > > > > of medical professionals in recovery has become too

> Taliban

> > > like

> > > > to

> > > > > remain quiet. I entered recovery in 1987 for taking

> > prescription

> > > > > amphetamines from my mother. I was not intervened upon.

> Faced

> > > with

> > > > > forging prescriptions or getting help I sought medical

> > > attention,

> > > > then

> > > > > self-reported to the board of medicine. I have NEVER been

> a

> > > > drinker,

> > > > > not even socially. I have received continuous random

urine

> > drug

> > > > > screens since 1988. In 1999 I was diagnosed with

> narcolepsy

> > > after

> > > > a

> > > > > cataplectic episode resulted in a fracture. Confirmed

> twice

> > by

> > > > Texas

> > > > > Medical Board assigned sleep medicine specialists who now

> > > > prescribe

> > > > > ritalin, provigil and Xyrem with good results. In 2003 I

> > missed

> > > a

> > > > > single urine drug screen while founding a clinic in the

> > remote

> > > > regions

> > > > > of Big Bend. The Texas Medical Board suspended my

license,

> > then

> > > > took

> > > > > two years to conclude no problem existed. Every aspect of

> my

> > > > life, my

> > > > > medical care and my prescription writing were thoroughly

> > > > investigated

> > > > > without any negative comment occurring. During my two

year

> > > period

> > > > of

> > > > > unemployment, I maintained urine drug screening in the

> same

> > > > monitoring

> > > > > program. When my license was restored, I accepted a

> position

> > as

> > > an

> > > > > Assistant Professor of Medicine in the Section of

Hospital

> > > > Medicine at

> > > > > UT Southwestern Medical Center in Dallas. Three days ago

I

> was

> > > > > notified that my concentrated urine from August 29th was

> > > positive

> > > > for

> > > > > 103ng of EtG. The only ethanol exposure I have is foam

for

> > hand

> > > > > cleansing. I have attached a copy of the body of my

> response

> > to

> > > > the

> > > > > medical board. I do not know what their response will be,

> but

> > > will

> > > > > update this site when it occurs. My intention in writing

> is

> > not

> > > so

> > > > > much as to receive support as to provide it. I've

wrestled

> > with

> > > > > trying to keep this to myself, but have decided to go

> public.

> > I

> > > am

> > > > > certain there are others out there who are in a similar

> > > position,

> > > > but

> > > > > too afraid to post for whatever the reason. I understand,

> I

> > was

> > > > there

> > > > > once; but no more. I may not be able to prevent an

> injustice,

> > > but

> > > > I

> > > > > sure as hell refuse to be quiet about it. Likewise, I'm

> > certain

> > > > there

> > > > > are those with positive EtG's who have been drinking and

> hope

> > > to

> > > > slide

> > > > > under the radar by garnishing some halo effect from

> other's

> > > with

> > > > an

> > > > > incidental low level positive EtG. We all know their

fate.

> I

> > > hope

> > > > my

> > > > > post is not considered too lengthy, especially with me

> adding

> > > the

> > > > body

> > > > > of my letter to the Texas Medical Board. If it is, please

> > > accept

> > > > my

> > > > > apologies. I'll not repeat it. Most Respectfully,

> J.

> > > > DiBona, M.D.

> > > > >

> > > > > September 11, 2006

> > > > >

> > > > > Tomeo

> > > > > Texas Medical Board

> > > > > Compliance Officer

> > > > > P.O. Box 3272

> > > > > McKinney, TX 75070-3272

> > > > > 972-529-5837

> > > > > Fax 972-529-5681

> > > > >

> > > > > Mr. Tomeo;

> > > > >

> > > > > This is my formal response to the information you

provided

> me

> > > > over the

> > > > > telephone September 8, 2006 around 1100. I wish to convey

> no

> > > > degree

> > > > > of inattentiveness or casual approach to my board order.

I

> > take

> > > my

> > > > > commitment very seriously.

> > > > > Information provided to me:

> > > > > My urine drug screen from August 29, 2006 was positive

for

> > > > ritalinic

> > > > > acid and EtG at a level of 103 (I don't know the units.)

> > > > > My response is:

> > > > > I am in full compliance with my board order and have not

> made

> > > any

> > > > > mistakes.

> > > > > My thoughts about my EtG positive urine are:

> > > > > . Daily, significant cutaneous exposure to high

> concentration

> > > > ethanol

> > > > > occurs when I use the standard, hospital provided foam

> hand

> > > > cleanser.

> > > > > . Due to scheduling changes I was physically in the

> hospital

> > > > August

> > > > > 27th at 0700 until August 28th 2100. I rounded with my

> team

> > > August

> > > > > 29th 0600 to just before giving my urine drug screen at

> > > > approximately

> > > > > 1100 by memory.

> > > > > . August 25th and August 26th were " routine " clinical

days

> at

> > > the

> > > > > hospital, followed by AA from 1800 to 1900. In the

> evenings I

> > > > > performed intensive swimming pool cleanup and recovery

> from

> > an

> > > > algae

> > > > > bloom. I believe this activity may have altered my skin

> > > > absorption of

> > > > > ethanol by removing superficial skin cells and protective

> > oils.

> > > > > . On the same dates I also deep cleaned my carpets. These

> are

> > > the

> > > > > only additions to my daily routine. Both nights ended

near

> > > 0100.

> > > > > . I was recently started on Xyrem. Ethanol is not listed

> as a

> > > > > component of this medication.

> > > > > . My albuterol inhaler has an alcohol based

> > propellant/carrier.

> > > I

> > > > > have not used my inhaler for several months.

> > > > > . I have avoided ethanol containing gasoline.

> > > > > . There is no " accidental " ingestion of alcohol in the

> form of

> > > > > vanilla, mouthwashes, foods, communion wine etc. I take

my

> > order

> > > > > seriously, and avoid these things absolutely.

> > > > > The foam hand cleanser is the only source of

environmental

> > > ethanol

> > > > > exposure I knowingly experience. Avoiding its use is

> > difficult,

> > > as

> > > > > alcohol foam is superior to soap and water in reducing

> > > nosocomial

> > > > > hospital infections. I request formal Texas Medical Board

> > > > guidance in

> > > > > writing advising me on continued alcohol foam hand

> cleanser

> > use.

> > > > >

> > > > > I am in absolute compliance with my order. I have

receipts

> and

> > > > > bottles of the cleaning materials I used. I continue to

be

> an

> > > > example

> > > > > of expert physician medical care, professionalism,

> recovery

> > and

> > > > > responsibility. I am an outstanding example of compliance

> > with

> > > the

> > > > > Texas Medical Board.

> > > > >

> > > > > Respectfully,

> > > > >

> > > > > J. DiBona, M.D.

> > > > > Assistant Professor of Medicine

> > > > > UT Southwestern Medical Center

> > > > > 5909 Harry Hines Blvd. . Dallas, TX 75390-8889

> > > > > danieldibona@

> > > > >

> > > >

> > >

> >

>

September 12, 2006

---Well Dr. Dan,

I wish you well with your hearing, but don't hold your breath. And

good for you for speaking out. You know, the sobriety enforcers

bank on the fact that you are full of humility, guilt and fear. They

know you will be neurotically searching for your part in all of

this. This keeps you from confronting them and causing them

problems. As long as you go like a sheep to slaughter you will be

praised for " working a good program " (as they strip away your

ability to work in your profession) This is why treatment centers

pound it into your head that any questioning of their unethical,

ineffective medicine is a symptome of the " disease " .

You say that it is an uphill road for those of you " in recovery " to

be taken seriously. But in the same breath you say " dishonesty is

an aspect of addiction " . THIS is the WHOLE problem. Until people

who have overcame addiction can stop calling themselves names and

putting forth the myth that they can't be trusted, it will never

change. Unfortunately, as you have found, it matters not how well

you are doing or what a good Dr. you are. Because when you get a

false positive on a unreliable test, you most certainly are a liar

in their eyes. But who can blame them? The people who are supposed

to be advocating for those with addiction, and the people " in

recovery " themselves, are the ones who propagate this myth.

I believe that you didn't drink. Keep speaking out because UNTIL

people " in recovery " demand true medical treatment, demand that they

not be discriminated against, demand respect, stop calling

themselves derogatory names, and stop the myths that you are always

on the edge of relapse, you will always have trouble being taken

seriously. As far as I'm concerned your " advocates " have screwed

the pooch on this one. So those of you " in recovery " need to stop

being so damn humble and tell people to get the hell over it.

Good luck to you.

In Ethylglucuronide , " Dainiel DiBona "

<danieldibona@...> wrote:

>

> When I first started urine drug screening the medical boards did

not

> administer the testing. It was done through the State medical

> society. As I was a member of my county physician health

committe, I

> continued voluntary screening. With narcolepsy, the board

insisted

> on screening. When I missed a urine drug screen, my order became

> public, and the time was reset for another ten years. In years

past

> people were monitored for two to three years. Then it became

five.

> The trend is now for a minimum of ten years. There is a growing

> momentum among regulatory bodies to pursue lifelong monitoring. I

> don't believe anyone in medicine or nursing should expect anything

> less than life long scruitiny.

>

> The problem with the low EtG cutoffs are multiple. First is the

> variable expression of enzymes metabolising ethanol. Most of

these

> are inducible enzyme systems. Second is that monitoring bodies

have

> not uniformly adopted normalizing the EtG level to the urine

> creatinine. While this would " hurt " those with low level dilute

> specimens, it would " benefit " concentrated urine samples. In

> reality, it neither harms nor helps, but simply standardizes an

> otherwise diluteable substance against a substance with a fixed

> excretion per 24 hours regardless of that persons volume status.

In

> my case, it would help, as my EtG level of 103ng/ml would reset to

> one of 48ng/ml.

>

> The largest problem with EtG is the abscence of any prospective,

> controlled examinations deliniating the predictive values of the

> positives and negatives. The sensitivity and specifity of the

> testing is phenomenal, but in a clinical setting what matters most

is

> the predictive value of the test result. This is unknown, as it

is

> with many tests. That is the foundation for " clinical judgement. "

>

> Therefore, if a person encounters authorities willing to exercise

or

> enlist clinical judgemtent, I usually would say none of us have

> anything to worry about. With respect to EtG, that is not my

> position. I think we should all worry.

>

> The reason I believe this relates to the absolute inability to

avoid

> incidental ethanol exposure, especially for a health care

> professional. If the mechanism of ethanol getting into our bodies

> was limited to oral, or even transdermal, exposure these variables

> could be addressed, albeit for some at great inconvience. No

> conclusive Class I data exists regarding ethanol exposure and EtG

by

> any other route than oral. The assumption being made then, is

that

> any EtG was consumed. What is needed is Class I published data

> examining transdermal and inhalation routes of ethanol penetration

> into a persons system.

>

> In our society, it is impossible to control what you breath. And,

it

> is poorly examined, except with respect to cigarettes, asbestos

and

> certain medications. What is available with respect to ethanol

> absorbtion via incidental inhalation is not encouraging. It

appears

> to be an uncontrollable variable in a person's life.

>

> As for me, it is absolutely unavoidable. Therefore, for me to

answer

> meaningfully to a test result about, " what my role in it is "

becomes

> impossible. And that is where I believe the insanity sets in.

>

> I've lived my life with the assumption that as a recovering person

I

> should be judged not by what I say, but what I do. I do good, and

> document it. EtG testing introduces a third element. It used to

be

> safe to abdicate our words and thoughts and hold how we live our

> lives out as proof of our recovery. In fact, many judge an

> addict/alcoholic's quality of recovery by the degree of humility

in

> not speaking up, that is by how much we instead describe the

choices

> we make day to day and the behaviors we exhibit. With respect to

> EtG, this no longer " works. " This " new " magical, uncharacterized

> test has stormed the market giving potent ammunition to the

opposing

> persons assertion, " We hear what you say, but the evidence is

against

> you. "

>

> As such, I am speaking out. I believe EtG testing must be reigned

in

> and required to undergo rigorous prospective study to quantify

> predictive values prior to establishing cut-offs. Anything other

> than that remains arbitrary.

>

> I don't know what the future holds, but I do know this: God not

only

> gave me the gift of recovery, he gave me a brain and the ability

to

> process, analyze and interpret data. I don't squander my gifts,

and

> haven't since I entered into recovery. Regardless of what happens

> with my case (I honestly can't believe it would go anywhere, but

now

> it's going to go to a " hearing " .), I will remain an advocate of

> pulling these fanatics into line.

>

> There's an odd thing about fanatics. Underneath it all is the

fact

> they honestly don't believe what they are fanatical about. Given

> that, it is an uphill road for those of us in recovery to be taken

> seriously. Dishonesty is an aspect of addiction. Speaking up for

> onself is interpreted as defensive. But through all of that, I

> believe there is a path to balance, and that it will have to come

> from those of us in recovery. I believe it's essential we become

> articulate and dispassionate, ruthless in sweeping our own side of

> the street, and indefatigueable in pursuing sanity, not just for

> ourselves, but also for the system and world we live.

>

> Besides all that, it's going to take an ally with teeth to get

> anywhere.

>

> Ya'll take care.

>

> Dan

>

> > > > > >

> > > > > > " I may not be able to prevent an injustice, but I sure

as

> > hell

> > > > > refuse to be quiet about it. "

> > > > > >

> > > > > > , That statement speaks volumes! You are on the

same

> > page

> > > > as

> > > > > many other very good people here and I thank you for the

> > respect,

> > > > > dignity and eloquence that you posted your story. I was

just

> > > > > preparing a statement to read at the SAMHSA meeting next

week

> > and

> > > > was

> > > > > tackling the issue of cutoffs vs. interpretation (as far

as

> > where

> > > > the

> > > > > problem lies). I must say, your level is the lowest

positive

> > I've

> > > > > heard of yet. Clearly, the cutoffs are the problem. With

no

> > clear

> > > > > guidelines on what any of the numbers really mean,

> > interpretation

> > > > is

> > > > > sort of a moot point now, isn't it?

> > > > > >

> > > > > > There are a few other Texas doctors who have shared

their

> > > stories

> > > > > here. One's had some similarities to yours--tested

positive

> > after

> > > > > using Purell and waterless foam surgical scrub while on a

> > mission

> > > > > trip to Mexico. Alcohol was not his DOC. Following an

> > appearance

> > > > > before the board, they dismissed the complaint. He said

that

> > they

> > > > > acknowledged ongoing problems with EtG testing and are

> looking

> > at

> > > > > each case individually.

> > > > > >

> > > > > > Please let us know what happens with your case. I hope

you

> > > > continue

> > > > > to add to the discussion here.

> > > > > > Lorie

> > > > > >

> > > > > > Texas Medical Board

> > > > > >

> > > > > > Hi everyone. I decided to post under my real name

because

> > > > > monitoring

> > > > > > of medical professionals in recovery has become too

> > Taliban

> > > > like

> > > > > to

> > > > > > remain quiet. I entered recovery in 1987 for taking

> > > prescription

> > > > > > amphetamines from my mother. I was not intervened

upon.

> > Faced

> > > > with

> > > > > > forging prescriptions or getting help I sought medical

> > > > attention,

> > > > > then

> > > > > > self-reported to the board of medicine. I have NEVER

been

> > a

> > > > > drinker,

> > > > > > not even socially. I have received continuous random

> urine

> > > drug

> > > > > > screens since 1988. In 1999 I was diagnosed with

> > narcolepsy

> > > > after

> > > > > a

> > > > > > cataplectic episode resulted in a fracture. Confirmed

> > twice

> > > by

> > > > > Texas

> > > > > > Medical Board assigned sleep medicine specialists who

now

> > > > > prescribe

> > > > > > ritalin, provigil and Xyrem with good results. In 2003

I

> > > missed

> > > > a

> > > > > > single urine drug screen while founding a clinic in

the

> > > remote

> > > > > regions

> > > > > > of Big Bend. The Texas Medical Board suspended my

> license,

> > > then

> > > > > took

> > > > > > two years to conclude no problem existed. Every aspect

of

> > my

> > > > > life, my

> > > > > > medical care and my prescription writing were

thoroughly

> > > > > investigated

> > > > > > without any negative comment occurring. During my two

> year

> > > > period

> > > > > of

> > > > > > unemployment, I maintained urine drug screening in the

> > same

> > > > > monitoring

> > > > > > program. When my license was restored, I accepted a

> > position

> > > as

> > > > an

> > > > > > Assistant Professor of Medicine in the Section of

> Hospital

> > > > > Medicine at

> > > > > > UT Southwestern Medical Center in Dallas. Three days

ago

> I

> > was

> > > > > > notified that my concentrated urine from August 29th

was

> > > > positive

> > > > > for

> > > > > > 103ng of EtG. The only ethanol exposure I have is foam

> for

> > > hand

> > > > > > cleansing. I have attached a copy of the body of my

> > response

> > > to

> > > > > the

> > > > > > medical board. I do not know what their response will

be,

> > but

> > > > will

> > > > > > update this site when it occurs. My intention in

writing

> > is

> > > not

> > > > so

> > > > > > much as to receive support as to provide it. I've

> wrestled

> > > with

> > > > > > trying to keep this to myself, but have decided to go

> > public.

> > > I

> > > > am

> > > > > > certain there are others out there who are in a

similar

> > > > position,

> > > > > but

> > > > > > too afraid to post for whatever the reason. I

understand,

> > I

> > > was

> > > > > there

> > > > > > once; but no more. I may not be able to prevent an

> > injustice,

> > > > but

> > > > > I

> > > > > > sure as hell refuse to be quiet about it. Likewise,

I'm

> > > certain

> > > > > there

> > > > > > are those with positive EtG's who have been drinking

and

> > hope

> > > > to

> > > > > slide

> > > > > > under the radar by garnishing some halo effect from

> > other's

> > > > with

> > > > > an

> > > > > > incidental low level positive EtG. We all know their

> fate.

> > I

> > > > hope

> > > > > my

> > > > > > post is not considered too lengthy, especially with me

> > adding

> > > > the

> > > > > body

> > > > > > of my letter to the Texas Medical Board. If it is,

please

> > > > accept

> > > > > my

> > > > > > apologies. I'll not repeat it. Most Respectfully,

> > J.

> > > > > DiBona, M.D.

> > > > > >

> > > > > > September 11, 2006

> > > > > >

> > > > > > Tomeo

> > > > > > Texas Medical Board

> > > > > > Compliance Officer

> > > > > > P.O. Box 3272

> > > > > > McKinney, TX 75070-3272

> > > > > > 972-529-5837

> > > > > > Fax 972-529-5681

> > > > > >

> > > > > > Mr. Tomeo;

> > > > > >

> > > > > > This is my formal response to the information you

> provided

> > me

> > > > > over the

> > > > > > telephone September 8, 2006 around 1100. I wish to

convey

> > no

> > > > > degree

> > > > > > of inattentiveness or casual approach to my board

order.

> I

> > > take

> > > > my

> > > > > > commitment very seriously.

> > > > > > Information provided to me:

> > > > > > My urine drug screen from August 29, 2006 was positive

> for

> > > > > ritalinic

> > > > > > acid and EtG at a level of 103 (I don't know the

units.)

> > > > > > My response is:

> > > > > > I am in full compliance with my board order and have

not

> > made

> > > > any

> > > > > > mistakes.

> > > > > > My thoughts about my EtG positive urine are:

> > > > > > . Daily, significant cutaneous exposure to high

> > concentration

> > > > > ethanol

> > > > > > occurs when I use the standard, hospital provided foam

> > hand

> > > > > cleanser.

> > > > > > . Due to scheduling changes I was physically in the

> > hospital

> > > > > August

> > > > > > 27th at 0700 until August 28th 2100. I rounded with my

> > team

> > > > August

> > > > > > 29th 0600 to just before giving my urine drug screen

at

> > > > > approximately

> > > > > > 1100 by memory.

> > > > > > . August 25th and August 26th were " routine " clinical

> days

> > at

> > > > the

> > > > > > hospital, followed by AA from 1800 to 1900. In the

> > evenings I

> > > > > > performed intensive swimming pool cleanup and recovery

> > from

> > > an

> > > > > algae

> > > > > > bloom. I believe this activity may have altered my

skin

> > > > > absorption of

> > > > > > ethanol by removing superficial skin cells and

protective

> > > oils.

> > > > > > . On the same dates I also deep cleaned my carpets.

These

> > are

> > > > the

> > > > > > only additions to my daily routine. Both nights ended

> near

> > > > 0100.

> > > > > > . I was recently started on Xyrem. Ethanol is not

listed

> > as a

> > > > > > component of this medication.

> > > > > > . My albuterol inhaler has an alcohol based

> > > propellant/carrier.

> > > > I

> > > > > > have not used my inhaler for several months.

> > > > > > . I have avoided ethanol containing gasoline.

> > > > > > . There is no " accidental " ingestion of alcohol in the

> > form of

> > > > > > vanilla, mouthwashes, foods, communion wine etc. I

take

> my

> > > order

> > > > > > seriously, and avoid these things absolutely.

> > > > > > The foam hand cleanser is the only source of

> environmental

> > > > ethanol

> > > > > > exposure I knowingly experience. Avoiding its use is

> > > difficult,

> > > > as

> > > > > > alcohol foam is superior to soap and water in reducing

> > > > nosocomial

> > > > > > hospital infections. I request formal Texas Medical

Board

> > > > > guidance in

> > > > > > writing advising me on continued alcohol foam hand

> > cleanser

> > > use.

> > > > > >

> > > > > > I am in absolute compliance with my order. I have

> receipts

> > and

> > > > > > bottles of the cleaning materials I used. I continue

to

> be

> > an

> > > > > example

> > > > > > of expert physician medical care, professionalism,

> > recovery

> > > and

> > > > > > responsibility. I am an outstanding example of

compliance

> > > with

> > > > the

> > > > > > Texas Medical Board.

> > > > > >

> > > > > > Respectfully,

> > > > > >

> > > > > > J. DiBona, M.D.

> > > > > > Assistant Professor of Medicine

> > > > > > UT Southwestern Medical Center

> > > > > > 5909 Harry Hines Blvd. . Dallas, TX 75390-8889

> > > > > > danieldibona@

> > > > > >

> > > > >

> > > >

> > >

> >

>

September 13, 2006

A few thoughts for you, :

You say, "The sensitivity and specifity of the testing is phenomenal." I question this test's specificity (and apologize for re-hashing this again...but I'd like to hear 's opinion.) With regards to EtG specificity, Wurst's 2004 study states:

"Furthermore, in a receiver operating characteristic curve analysis to distinguish between nondrinkers and individuals sober > 4 days versus individuals drinking in the recent 4 days, area under the curve was 0.834. At a cutoff of 0.145 mg/liter, sensitivity was 83.5% and specificity 68.3%."

If specificity is defined as "a test's ability to indicate the absence of a biomarker in a sample that is truly negative for that biomarker", and this study indicates a 68% specificityat a 145mg/dl cutoff, it seems to me there is a 32% incidence of false positives for distinguishing between those abstinent for 4+ days and those not. I'm using the equation:

Specificity = __ true negatives _ __

(false positives) + (true negatives)

You say, "Besides all that, it's going to take an ally with teeth to get anywhere." Sadly, I thought we had found that ally when Dr. joined Dr. Skipper's old discussion group and became an active contributor with some really good, thoughtful posts. He sure seemed our staunch advocate when we met with him at ASAM. I don't know what has curbed that enthusiasm. It will be interesting to see what happens at the CSAT meeting next week!

Lorie

> > > > > >> > > > > > "I may not be able to prevent an injustice, but I sure as > > hell > > > > > refuse to be quiet about it."> > > > > > > > > > > > , That statement speaks volumes! You are on the same > > page > > > > as > > > > > many other very good people here and I thank you for the > > respect, > > > > > dignity and eloquence that you posted your story. I was just > > > > > preparing a statement to read at the SAMHSA meeting next week > > and > > > > was > > > > > tackling the issue of cutoffs vs. interpretation (as far as > > where > > > > the > > > > > problem lies). I must say, your level is the lowest positive > > I've > > > > > heard of yet. Clearly, the cutoffs are the problem. With no > > clear > > > > > guidelines on what any of the numbers really mean, > > interpretation > > > > is > > > > > sort of a moot point now, isn't it? > > > > > > > > > > > > There are a few other Texas doctors who have shared their > > > stories > > > > > here. One's had some similarities to yours--tested positive > > after > > > > > using Purell and waterless foam surgical scrub while on a > > mission > > > > > trip to Mexico. Alcohol was not his DOC. Following an > > appearance > > > > > before the board, they dismissed the complaint. He said that > > they > > > > > acknowledged ongoing problems with EtG testing and are > looking > > at > > > > > each case individually.> > > > > > > > > > > > Please let us know what happens with your case. I hope you > > > > continue > > > > > to add to the discussion here.> > > > > > Lorie> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Texas Medical Board> > > > > > > > > > > > > > > > > > Hi everyone. I decided to post under my real name because > > > > > monitoring> > > > > > of medical professionals in recovery has become too > > Taliban > > > > like > > > > > to> > > > > > remain quiet. I entered recovery in 1987 for taking > > > prescription> > > > > > amphetamines from my mother. I was not intervened upon. > > Faced > > > > with> > > > > > forging prescriptions or getting help I sought medical > > > > attention, > > > > > then> > > > > > self-reported to the board of medicine. I have NEVER been > > a > > > > > drinker,> > > > > > not even socially. I have received continuous random > urine > > > drug> > > > > > screens since 1988. In 1999 I was diagnosed with > > narcolepsy > > > > after > > > > > a> > > > > > cataplectic episode resulted in a fracture. Confirmed > > twice > > > by > > > > > Texas> > > > > > Medical Board assigned sleep medicine specialists who now > > > > > prescribe> > > > > > ritalin, provigil and Xyrem with good results. In 2003 I > > > missed > > > > a> > > > > > single urine drug screen while founding a clinic in the > > > remote > > > > > regions> > > > > > of Big Bend. The Texas Medical Board suspended my > license, > > > then > > > > > took> > > > > > two years to conclude no problem existed. Every aspect of > > my > > > > > life, my> > > > > > medical care and my prescription writing were thoroughly > > > > > investigated> > > > > > without any negative comment occurring. During my two > year > > > > period > > > > > of> > > > > > unemployment, I maintained urine drug screening in the > > same > > > > > monitoring> > > > > > program. When my license was restored, I accepted a > > position > > > as > > > > an> > > > > > Assistant Professor of Medicine in the Section of > Hospital > > > > > Medicine at> > > > > > UT Southwestern Medical Center in Dallas. Three days ago > I > > was> > > > > > notified that my concentrated urine from August 29th was > > > > positive > > > > > for> > > > > > 103ng of EtG. The only ethanol exposure I have is foam > for > > > hand> > > > > > cleansing. I have attached a copy of the body of my > > response > > > to > > > > > the> > > > > > medical board. I do not know what their response will be, > > but > > > > will> > > > > > update this site when it occurs. My intention in writing > > is > > > not > > > > so> > > > > > much as to receive support as to provide it. I've > wrestled > > > with> > > > > > trying to keep this to myself, but have decided to go > > public. > > > I > > > > am> > > > > > certain there are others out there who are in a similar > > > > position, > > > > > but> > > > > > too afraid to post for whatever the reason. I understand, > > I > > > was > > > > > there> > > > > > once; but no more. I may not be able to prevent an > > injustice, > > > > but > > > > > I> > > > > > sure as hell refuse to be quiet about it. Likewise, I'm > > > certain > > > > > there> > > > > > are those with positive EtG's who have been drinking and > > hope > > > > to > > > > > slide> > > > > > under the radar by garnishing some halo effect from > > other's > > > > with > > > > > an> > > > > > incidental low level positive EtG. We all know their > fate. > > I > > > > hope > > > > > my> > > > > > post is not considered too lengthy, especially with me > > adding > > > > the > > > > > body> > > > > > of my letter to the Texas Medical Board. If it is, please > > > > accept > > > > > my> > > > > > apologies. I'll not repeat it. Most Respectfully, > > J. > > > > > DiBona, M.D.> > > > > > > > > > > > September 11, 2006> > > > > > > > > > > > Tomeo> > > > > > Texas Medical Board> > > > > > Compliance Officer> > > > > > P.O. Box 3272> > > > > > McKinney, TX 75070-3272> > > > > > 972-529-5837> > > > > > Fax 972-529-5681> > > > > > > > > > > > Mr. Tomeo;> > > > > > > > > > > > This is my formal response to the information you > provided > > me > > > > > over the> > > > > > telephone September 8, 2006 around 1100. I wish to convey > > no > > > > > degree> > > > > > of inattentiveness or casual approach to my board order. > I > > > take > > > > my> > > > > > commitment very seriously.> > > > > > Information provided to me:> > > > > > My urine drug screen from August 29, 2006 was positive > for > > > > > ritalinic> > > > > > acid and EtG at a level of 103 (I don't know the units.)> > > > > > My response is:> > > > > > I am in full compliance with my board order and have not > > made > > > > any> > > > > > mistakes.> > > > > > My thoughts about my EtG positive urine are:> > > > > > . Daily, significant cutaneous exposure to high > > concentration > > > > > ethanol> > > > > > occurs when I use the standard, hospital provided foam > > hand > > > > > cleanser. > > > > > > . Due to scheduling changes I was physically in the > > hospital > > > > > August> > > > > > 27th at 0700 until August 28th 2100. I rounded with my > > team > > > > August> > > > > > 29th 0600 to just before giving my urine drug screen at > > > > > approximately> > > > > > 1100 by memory. > > > > > > . August 25th and August 26th were "routine" clinical > days > > at > > > > the> > > > > > hospital, followed by AA from 1800 to 1900. In the > > evenings I> > > > > > performed intensive swimming pool cleanup and recovery > > from > > > an > > > > > algae> > > > > > bloom. I believe this activity may have altered my skin > > > > > absorption of> > > > > > ethanol by removing superficial skin cells and protective > > > oils. > > > > > > . On the same dates I also deep cleaned my carpets. These > > are > > > > the> > > > > > only additions to my daily routine. Both nights ended > near > > > > 0100. > > > > > > . I was recently started on Xyrem. Ethanol is not listed > > as a> > > > > > component of this medication. > > > > > > . My albuterol inhaler has an alcohol based > > > propellant/carrier. > > > > I> > > > > > have not used my inhaler for several months. > > > > > > . I have avoided ethanol containing gasoline. > > > > > > . There is no "accidental" ingestion of alcohol in the > > form of> > > > > > vanilla, mouthwashes, foods, communion wine etc. I take > my > > > order> > > > > > seriously, and avoid these things absolutely. > > > > > > The foam hand cleanser is the only source of > environmental > > > > ethanol> > > > > > exposure I knowingly experience. Avoiding its use is > > > difficult, > > > > as> > > > > > alcohol foam is superior to soap and water in reducing > > > > nosocomial> > > > > > hospital infections. I request formal Texas Medical Board > > > > > guidance in> > > > > > writing advising me on continued alcohol foam hand > > cleanser > > > use.> > > > > > > > > > > > I am in absolute compliance with my order. I have > receipts > > and> > > > > > bottles of the cleaning materials I used. I continue to > be > > an > > > > > example> > > > > > of expert physician medical care, professionalism, > > recovery > > > and> > > > > > responsibility. I am an outstanding example of compliance > > > with > > > > the> > > > > > Texas Medical Board.> > > > > > > > > > > > Respectfully,> > > > > > > > > > > > J. DiBona, M.D.> > > > > > Assistant Professor of Medicine> > > > > > UT Southwestern Medical Center> > > > > > 5909 Harry Hines Blvd. . Dallas, TX 75390-8889> > > > > > danieldibona@> > > > > >> > > > >> > > >> > >> >>

September 13, 2006

These are the considerations for any diagnostic test being used.

Intentional Alcohol Exposure

Present Absent Totals

EtG Positive a b a + b

Test Result Negative c d c + d

Totals a + c b + d a+b+c+d

Sensitivity = a / (a + c)

Specificity = d / (b +d)

Likelihood ratio for a positive test result = sensitivity / (1-

specificity)

Likelihood ratio for a negative test result = (1 – sensitivity) /

specificity

Positive predictive value = a / (a+

Negative predictive value = d /(c + d)

Pretest probability (prevalence) = (a + c)/ ((a + b + c + d)

Pre-test odds = prevalence / (1 – prevalence)

Post-test odds = pre-test odds x likelihood ratio

Post-test probability = post-test odds / (post-test odds + 1)

This kind of information is obtainable through a prospective

controlled study without having to determine a number needed to treat

(NNT); however, that would be useful to do, as with it, one can then

determine the number needed to harm (NNH) after determining relative

and absolute risk reduction of allowing an impaired professional to

continue practicing unidentified.

Hope this helps.

Gotta go.

September 13, 2006

dan,your insightful posting is awesome and dead spot on,again welcome...you are wise beyond your years young paduan...the force must be strong within you...regards,rDainiel DiBona <danieldibona@...> wrote: When I first started urine drug screening the medical boards did not administer the testing. It was done through the State medical society. As I was a member of my county physician health committe, I continued voluntary screening. With narcolepsy, the board insisted on screening. When I missed a

urine drug screen, my order became public, and the time was reset for another ten years. In years past people were monitored for two to three years. Then it became five. The trend is now for a minimum of ten years. There is a growing momentum among regulatory bodies to pursue lifelong monitoring. I don't believe anyone in medicine or nursing should expect anything less than life long scruitiny.The problem with the low EtG cutoffs are multiple. First is the variable expression of enzymes metabolising ethanol. Most of these are inducible enzyme systems. Second is that monitoring bodies have not uniformly adopted normalizing the EtG level to the urine creatinine. While this would "hurt" those with low level dilute specimens, it would "benefit" concentrated urine samples. In reality, it neither harms nor helps, but simply standardizes an otherwise diluteable substance against a substance with a fixed excretion per

24 hours regardless of that persons volume status. In my case, it would help, as my EtG level of 103ng/ml would reset to one of 48ng/ml.The largest problem with EtG is the abscence of any prospective, controlled examinations deliniating the predictive values of the positives and negatives. The sensitivity and specifity of the testing is phenomenal, but in a clinical setting what matters most is the predictive value of the test result. This is unknown, as it is with many tests. That is the foundation for "clinical judgement."Therefore, if a person encounters authorities willing to exercise or enlist clinical judgemtent, I usually would say none of us have anything to worry about. With respect to EtG, that is not my position. I think we should all worry.The reason I believe this relates to the absolute inability to avoid incidental ethanol exposure, especially for a health care professional. If the

mechanism of ethanol getting into our bodies was limited to oral, or even transdermal, exposure these variables could be addressed, albeit for some at great inconvience. No conclusive Class I data exists regarding ethanol exposure and EtG by any other route than oral. The assumption being made then, is that any EtG was consumed. What is needed is Class I published data examining transdermal and inhalation routes of ethanol penetration into a persons system.In our society, it is impossible to control what you breath. And, it is poorly examined, except with respect to cigarettes, asbestos and certain medications. What is available with respect to ethanol absorbtion via incidental inhalation is not encouraging. It appears to be an uncontrollable variable in a person's life.As for me, it is absolutely unavoidable. Therefore, for me to answer meaningfully to a test result about, "what my role in it is" becomes

impossible. And that is where I believe the insanity sets in.I've lived my life with the assumption that as a recovering person I should be judged not by what I say, but what I do. I do good, and document it. EtG testing introduces a third element. It used to be safe to abdicate our words and thoughts and hold how we live our lives out as proof of our recovery. In fact, many judge an addict/alcoholic's quality of recovery by the degree of humility in not speaking up, that is by how much we instead describe the choices we make day to day and the behaviors we exhibit. With respect to EtG, this no longer "works." This "new" magical, uncharacterized test has stormed the market giving potent ammunition to the opposing persons assertion, "We hear what you say, but the evidence is against you."As such, I am speaking out. I believe EtG testing must be reigned in and required to undergo rigorous prospective

study to quantify predictive values prior to establishing cut-offs. Anything other than that remains arbitrary.I don't know what the future holds, but I do know this: God not only gave me the gift of recovery, he gave me a brain and the ability to process, analyze and interpret data. I don't squander my gifts, and haven't since I entered into recovery. Regardless of what happens with my case (I honestly can't believe it would go anywhere, but now it's going to go to a "hearing".), I will remain an advocate of pulling these fanatics into line.There's an odd thing about fanatics. Underneath it all is the fact they honestly don't believe what they are fanatical about. Given that, it is an uphill road for those of us in recovery to be taken seriously. Dishonesty is an aspect of addiction. Speaking up for onself is interpreted as defensive. But through all of that, I believe there is a path to balance, and that

it will have to come from those of us in recovery. I believe it's essential we become articulate and dispassionate, ruthless in sweeping our own side of the street, and indefatigueable in pursuing sanity, not just for ourselves, but also for the system and world we live.Besides all that, it's going to take an ally with teeth to get anywhere.Ya'll take care.Dan> > > >

>> > > > > "I may not be able to prevent an injustice, but I sure as > hell > > > > refuse to be quiet about it."> > > > > > > > > > , That statement speaks volumes! You are on the same > page > > > as > > > > many other very good people here and I thank you for the > respect, > > > > dignity and eloquence that you posted your story. I was just > > > > preparing a statement to read at the SAMHSA meeting next week > and > > > was > > > > tackling the issue of cutoffs vs. interpretation (as far as > where > > > the > > > > problem lies). I must say, your level is the lowest positive > I've > > > > heard of yet. Clearly, the cutoffs are the problem. With no > clear > > > > guidelines on what any of

the numbers really mean, > interpretation > > > is > > > > sort of a moot point now, isn't it? > > > > > > > > > > There are a few other Texas doctors who have shared their > > stories > > > > here. One's had some similarities to yours--tested positive > after > > > > using Purell and waterless foam surgical scrub while on a > mission > > > > trip to Mexico. Alcohol was not his DOC. Following an > appearance > > > > before the board, they dismissed the complaint. He said that > they > > > > acknowledged ongoing problems with EtG testing and are looking > at > > > > each case individually.> > > > > > > > > > Please let us know what happens with your case. I hope you > > > continue > > > > to

add to the discussion here.> > > > > Lorie> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Texas Medical Board> > > > > > > > > > > > > > > Hi everyone. I decided to post under my real name because > > > > monitoring> > > > > of medical professionals in recovery has become too > Taliban > > > like > > > > to>

> > > > remain quiet. I entered recovery in 1987 for taking > > prescription> > > > > amphetamines from my mother. I was not intervened upon. > Faced > > > with> > > > > forging prescriptions or getting help I sought medical > > > attention, > > > > then> > > > > self-reported to the board of medicine. I have NEVER been > a > > > > drinker,> > > > > not even socially. I have received continuous random urine > > drug> > > > > screens since 1988. In 1999 I was diagnosed with > narcolepsy > > > after > > > > a> > > > > cataplectic episode resulted in a fracture. Confirmed > twice > > by > > > > Texas> > > > > Medical Board assigned sleep medicine specialists who now

> > > > prescribe> > > > > ritalin, provigil and Xyrem with good results. In 2003 I > > missed > > > a> > > > > single urine drug screen while founding a clinic in the > > remote > > > > regions> > > > > of Big Bend. The Texas Medical Board suspended my license, > > then > > > > took> > > > > two years to conclude no problem existed. Every aspect of > my > > > > life, my> > > > > medical care and my prescription writing were thoroughly > > > > investigated> > > > > without any negative comment occurring. During my two year > > > period > > > > of> > > > > unemployment, I maintained urine drug screening in the > same > > > > monitoring> > >

> > program. When my license was restored, I accepted a > position > > as > > > an> > > > > Assistant Professor of Medicine in the Section of Hospital > > > > Medicine at> > > > > UT Southwestern Medical Center in Dallas. Three days ago I > was> > > > > notified that my concentrated urine from August 29th was > > > positive > > > > for> > > > > 103ng of EtG. The only ethanol exposure I have is foam for > > hand> > > > > cleansing. I have attached a copy of the body of my > response > > to > > > > the> > > > > medical board. I do not know what their response will be, > but > > > will> > > > > update this site when it occurs. My intention in writing > is > > not

> > > so> > > > > much as to receive support as to provide it. I've wrestled > > with> > > > > trying to keep this to myself, but have decided to go > public. > > I > > > am> > > > > certain there are others out there who are in a similar > > > position, > > > > but> > > > > too afraid to post for whatever the reason. I understand, > I > > was > > > > there> > > > > once; but no more. I may not be able to prevent an > injustice, > > > but > > > > I> > > > > sure as hell refuse to be quiet about it. Likewise, I'm > > certain > > > > there> > > > > are those with positive EtG's who have been drinking and > hope > > > to > > > >

slide> > > > > under the radar by garnishing some halo effect from > other's > > > with > > > > an> > > > > incidental low level positive EtG. We all know their fate. > I > > > hope > > > > my> > > > > post is not considered too lengthy, especially with me > adding > > > the > > > > body> > > > > of my letter to the Texas Medical Board. If it is, please > > > accept > > > > my> > > > > apologies. I'll not repeat it. Most Respectfully, > J. > > > > DiBona, M.D.> > > > > > > > > > September 11, 2006> > > > > > > > > > Tomeo> > > > > Texas Medical Board> > > > > Compliance Officer> >

> > > P.O. Box 3272> > > > > McKinney, TX 75070-3272> > > > > 972-529-5837> > > > > Fax 972-529-5681> > > > > > > > > > Mr. Tomeo;> > > > > > > > > > This is my formal response to the information you provided > me > > > > over the> > > > > telephone September 8, 2006 around 1100. I wish to convey > no > > > > degree> > > > > of inattentiveness or casual approach to my board order. I > > take > > > my> > > > > commitment very seriously.> > > > > Information provided to me:> > > > > My urine drug screen from August 29, 2006 was positive for > > > > ritalinic> > > > > acid and EtG at a level of 103 (I don't know the

units.)> > > > > My response is:> > > > > I am in full compliance with my board order and have not > made > > > any> > > > > mistakes.> > > > > My thoughts about my EtG positive urine are:> > > > > . Daily, significant cutaneous exposure to high > concentration > > > > ethanol> > > > > occurs when I use the standard, hospital provided foam > hand > > > > cleanser. > > > > > . Due to scheduling changes I was physically in the > hospital > > > > August> > > > > 27th at 0700 until August 28th 2100. I rounded with my > team > > > August> > > > > 29th 0600 to just before giving my urine drug screen at > > > > approximately> > > > > 1100 by memory. > > >

> > . August 25th and August 26th were "routine" clinical days > at > > > the> > > > > hospital, followed by AA from 1800 to 1900. In the > evenings I> > > > > performed intensive swimming pool cleanup and recovery > from > > an > > > > algae> > > > > bloom. I believe this activity may have altered my skin > > > > absorption of> > > > > ethanol by removing superficial skin cells and protective > > oils. > > > > > . On the same dates I also deep cleaned my carpets. These > are > > > the> > > > > only additions to my daily routine. Both nights ended near > > > 0100. > > > > > . I was recently started on Xyrem. Ethanol is not listed > as a> > > > > component of this medication. >

> > > > . My albuterol inhaler has an alcohol based > > propellant/carrier. > > > I> > > > > have not used my inhaler for several months. > > > > > . I have avoided ethanol containing gasoline. > > > > > . There is no "accidental" ingestion of alcohol in the > form of> > > > > vanilla, mouthwashes, foods, communion wine etc. I take my > > order> > > > > seriously, and avoid these things absolutely. > > > > > The foam hand cleanser is the only source of environmental > > > ethanol> > > > > exposure I knowingly experience. Avoiding its use is > > difficult, > > > as> > > > > alcohol foam is superior to soap and water in reducing > > > nosocomial> > > > > hospital infections. I request formal Texas

Medical Board > > > > guidance in> > > > > writing advising me on continued alcohol foam hand > cleanser > > use.> > > > > > > > > > I am in absolute compliance with my order. I have receipts > and> > > > > bottles of the cleaning materials I used. I continue to be > an > > > > example> > > > > of expert physician medical care, professionalism, > recovery > > and> > > > > responsibility. I am an outstanding example of compliance > > with > > > the> > > > > Texas Medical Board.> > > > > > > > > > Respectfully,> > > > > > > > > > J. DiBona, M.D.> > > > > Assistant Professor of Medicine> > > > > UT Southwestern

Medical Center> > > > > 5909 Harry Hines Blvd. . Dallas, TX 75390-8889> > > > > danieldibona@> > > > >> > > >> > >> >>

September 13, 2006

Madison, For once I must say I agree with what you have said...thank

you...and of course, also thanks for the comment on the picture, I

don't think many people saw the actual paper!!!

One mis-conception you have is that ALL people in AA think we need

to 'just accept this'. My group has supported me in pursueing this

to whatever extent I can. They shook my hand over the WSJ article and

KNOW I am standing up for the rights of those in recovery!! I was

told that acceptance does NOT mean you allow yourself to be walked

all over!!! I too agree with Madison that we have to stay stong as a

group, not dwell on the stereotype of addiction....we are no longer

there....and this has now become an issue to help change the

perception of that! I am glad everyone is here and are willing to

stand for thier truth....what is right!! Together we have MIGHTY

power....this is a 'WE' problem and together we can change it!!!

> > > > > > >

> > > > > > > " I may not be able to prevent an injustice, but I sure

> as

> > > hell

> > > > > > refuse to be quiet about it. "

> > > > > > >

> > > > > > > , That statement speaks volumes! You are on the

> same

> > > page

> > > > > as

> > > > > > many other very good people here and I thank you for the

> > > respect,

> > > > > > dignity and eloquence that you posted your story. I was

> just

> > > > > > preparing a statement to read at the SAMHSA meeting next

> week

> > > and

> > > > > was

> > > > > > tackling the issue of cutoffs vs. interpretation (as far

> as

> > > where

> > > > > the

> > > > > > problem lies). I must say, your level is the lowest

> positive

> > > I've

> > > > > > heard of yet. Clearly, the cutoffs are the problem. With

> no

> > > clear

> > > > > > guidelines on what any of the numbers really mean,

> > > interpretation

> > > > > is

> > > > > > sort of a moot point now, isn't it?

> > > > > > >

> > > > > > > There are a few other Texas doctors who have shared

> their

> > > > stories

> > > > > > here. One's had some similarities to yours--tested

> positive

> > > after

> > > > > > using Purell and waterless foam surgical scrub while on a

> > > mission

> > > > > > trip to Mexico. Alcohol was not his DOC. Following an

> > > appearance

> > > > > > before the board, they dismissed the complaint. He said

> that

> > > they

> > > > > > acknowledged ongoing problems with EtG testing and are

> > looking

> > > at

> > > > > > each case individually.

> > > > > > >

> > > > > > > Please let us know what happens with your case. I hope

> you

> > > > > continue

> > > > > > to add to the discussion here.

> > > > > > > Lorie

> > > > > > >

> > > > > > > Texas Medical Board

> > > > > > >

> > > > > > > Hi everyone. I decided to post under my real name

> because

> > > > > > monitoring

> > > > > > > of medical professionals in recovery has become too

> > > Taliban

> > > > > like

> > > > > > to

> > > > > > > remain quiet. I entered recovery in 1987 for taking

> > > > prescription

> > > > > > > amphetamines from my mother. I was not intervened

> upon.

> > > Faced

> > > > > with

> > > > > > > forging prescriptions or getting help I sought

medical

> > > > > attention,

> > > > > > then

> > > > > > > self-reported to the board of medicine. I have NEVER

> been

> > > a

> > > > > > drinker,

> > > > > > > not even socially. I have received continuous random

> > urine

> > > > drug

> > > > > > > screens since 1988. In 1999 I was diagnosed with

> > > narcolepsy

> > > > > after

> > > > > > a

> > > > > > > cataplectic episode resulted in a fracture. Confirmed

> > > twice

> > > > by

> > > > > > Texas

> > > > > > > Medical Board assigned sleep medicine specialists who

> now

> > > > > > prescribe

> > > > > > > ritalin, provigil and Xyrem with good results. In

2003

> I

> > > > missed

> > > > > a

> > > > > > > single urine drug screen while founding a clinic in

> the

> > > > remote

> > > > > > regions

> > > > > > > of Big Bend. The Texas Medical Board suspended my

> > license,

> > > > then

> > > > > > took

> > > > > > > two years to conclude no problem existed. Every

aspect

> of

> > > my

> > > > > > life, my

> > > > > > > medical care and my prescription writing were

> thoroughly

> > > > > > investigated

> > > > > > > without any negative comment occurring. During my two

> > year

> > > > > period

> > > > > > of

> > > > > > > unemployment, I maintained urine drug screening in

the

> > > same

> > > > > > monitoring

> > > > > > > program. When my license was restored, I accepted a

> > > position

> > > > as

> > > > > an

> > > > > > > Assistant Professor of Medicine in the Section of

> > Hospital

> > > > > > Medicine at

> > > > > > > UT Southwestern Medical Center in Dallas. Three days

> ago

> > I

> > > was

> > > > > > > notified that my concentrated urine from August 29th

> was

> > > > > positive

> > > > > > for

> > > > > > > 103ng of EtG. The only ethanol exposure I have is

foam

> > for

> > > > hand

> > > > > > > cleansing. I have attached a copy of the body of my

> > > response

> > > > to

> > > > > > the

> > > > > > > medical board. I do not know what their response will

> be,

> > > but

> > > > > will

> > > > > > > update this site when it occurs. My intention in

> writing

> > > is

> > > > not

> > > > > so

> > > > > > > much as to receive support as to provide it. I've

> > wrestled

> > > > with

> > > > > > > trying to keep this to myself, but have decided to go

> > > public.

> > > > I

> > > > > am

> > > > > > > certain there are others out there who are in a

> similar

> > > > > position,

> > > > > > but

> > > > > > > too afraid to post for whatever the reason. I

> understand,

> > > I

> > > > was

> > > > > > there

> > > > > > > once; but no more. I may not be able to prevent an

> > > injustice,

> > > > > but

> > > > > > I

> > > > > > > sure as hell refuse to be quiet about it. Likewise,

> I'm

> > > > certain

> > > > > > there

> > > > > > > are those with positive EtG's who have been drinking

> and

> > > hope

> > > > > to

> > > > > > slide

> > > > > > > under the radar by garnishing some halo effect from

> > > other's

> > > > > with

> > > > > > an

> > > > > > > incidental low level positive EtG. We all know their

> > fate.

> > > I

> > > > > hope

> > > > > > my

> > > > > > > post is not considered too lengthy, especially with

me

> > > adding

> > > > > the

> > > > > > body

> > > > > > > of my letter to the Texas Medical Board. If it is,

> please

> > > > > accept

> > > > > > my

> > > > > > > apologies. I'll not repeat it. Most Respectfully,

>

> > > J.

> > > > > > DiBona, M.D.

> > > > > > >

> > > > > > > September 11, 2006

> > > > > > >

> > > > > > > Tomeo

> > > > > > > Texas Medical Board

> > > > > > > Compliance Officer

> > > > > > > P.O. Box 3272

> > > > > > > McKinney, TX 75070-3272

> > > > > > > 972-529-5837

> > > > > > > Fax 972-529-5681

> > > > > > >

> > > > > > > Mr. Tomeo;

> > > > > > >

> > > > > > > This is my formal response to the information you

> > provided

> > > me

> > > > > > over the

> > > > > > > telephone September 8, 2006 around 1100. I wish to

> convey

> > > no

> > > > > > degree

> > > > > > > of inattentiveness or casual approach to my board

> order.

> > I

> > > > take

> > > > > my

> > > > > > > commitment very seriously.

> > > > > > > Information provided to me:

> > > > > > > My urine drug screen from August 29, 2006 was

positive

> > for

> > > > > > ritalinic

> > > > > > > acid and EtG at a level of 103 (I don't know the

> units.)

> > > > > > > My response is:

> > > > > > > I am in full compliance with my board order and have

> not

> > > made

> > > > > any

> > > > > > > mistakes.

> > > > > > > My thoughts about my EtG positive urine are:

> > > > > > > . Daily, significant cutaneous exposure to high

> > > concentration

> > > > > > ethanol

> > > > > > > occurs when I use the standard, hospital provided

foam

> > > hand

> > > > > > cleanser.

> > > > > > > . Due to scheduling changes I was physically in the

> > > hospital

> > > > > > August

> > > > > > > 27th at 0700 until August 28th 2100. I rounded with

my

> > > team

> > > > > August

> > > > > > > 29th 0600 to just before giving my urine drug screen

> at

> > > > > > approximately

> > > > > > > 1100 by memory.

> > > > > > > . August 25th and August 26th were " routine " clinical

> > days

> > > at

> > > > > the

> > > > > > > hospital, followed by AA from 1800 to 1900. In the

> > > evenings I

> > > > > > > performed intensive swimming pool cleanup and

recovery

> > > from

> > > > an

> > > > > > algae

> > > > > > > bloom. I believe this activity may have altered my

> skin

> > > > > > absorption of

> > > > > > > ethanol by removing superficial skin cells and

> protective

> > > > oils.

> > > > > > > . On the same dates I also deep cleaned my carpets.

> These

> > > are

> > > > > the

> > > > > > > only additions to my daily routine. Both nights ended

> > near

> > > > > 0100.

> > > > > > > . I was recently started on Xyrem. Ethanol is not

> listed

> > > as a

> > > > > > > component of this medication.

> > > > > > > . My albuterol inhaler has an alcohol based

> > > > propellant/carrier.

> > > > > I

> > > > > > > have not used my inhaler for several months.

> > > > > > > . I have avoided ethanol containing gasoline.

> > > > > > > . There is no " accidental " ingestion of alcohol in

the

> > > form of

> > > > > > > vanilla, mouthwashes, foods, communion wine etc. I

> take

> > my

> > > > order

> > > > > > > seriously, and avoid these things absolutely.

> > > > > > > The foam hand cleanser is the only source of

> > environmental

> > > > > ethanol

> > > > > > > exposure I knowingly experience. Avoiding its use is

> > > > difficult,

> > > > > as

> > > > > > > alcohol foam is superior to soap and water in

reducing

> > > > > nosocomial

> > > > > > > hospital infections. I request formal Texas Medical

> Board

> > > > > > guidance in

> > > > > > > writing advising me on continued alcohol foam hand

> > > cleanser

> > > > use.

> > > > > > >

> > > > > > > I am in absolute compliance with my order. I have

> > receipts

> > > and

> > > > > > > bottles of the cleaning materials I used. I continue

> to

> > be

> > > an

> > > > > > example

> > > > > > > of expert physician medical care, professionalism,

> > > recovery

> > > > and

> > > > > > > responsibility. I am an outstanding example of

> compliance

> > > > with

> > > > > the

> > > > > > > Texas Medical Board.

> > > > > > >

> > > > > > > Respectfully,

> > > > > > >

> > > > > > > J. DiBona, M.D.

> > > > > > > Assistant Professor of Medicine

> > > > > > > UT Southwestern Medical Center

> > > > > > > 5909 Harry Hines Blvd. . Dallas, TX 75390-8889

> > > > > > > danieldibona@

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

September 13, 2006

The table didn't post. When I get a spare minute I'll figure outhow

to post a table where it reads easily. If you can adjust the tab to

line up the columns and rows it will make more sense.

>

> These are the considerations for any diagnostic test being used.

>

> Intentional Alcohol Exposure

> Present Absent Totals

> EtG Positive a b a + b

> Test Result Negative c d c + d

> Totals a + c b + d a+b+c+d

>

> Sensitivity = a / (a + c)

> Specificity = d / (b +d)

> Likelihood ratio for a positive test result = sensitivity / (1-

> specificity)

> Likelihood ratio for a negative test result = (1 – sensitivity) /

> specificity

> Positive predictive value = a / (a+

> Negative predictive value = d /(c + d)

> Pretest probability (prevalence) = (a + c)/ ((a + b + c + d)

> Pre-test odds = prevalence / (1 – prevalence)

> Post-test odds = pre-test odds x likelihood ratio

> Post-test probability = post-test odds / (post-test odds + 1)

>

> This kind of information is obtainable through a prospective

> controlled study without having to determine a number needed to treat

> (NNT); however, that would be useful to do, as with it, one can then

> determine the number needed to harm (NNH) after determining relative

> and absolute risk reduction of allowing an impaired professional to

> continue practicing unidentified.

>

> Hope this helps.

>

> Gotta go.

>

September 13, 2006

I agree with you, Madison. I hope my word choices did not convey

otherwise.

> > > > > > >

> > > > > > > " I may not be able to prevent an injustice, but I sure

> as

> > > hell

> > > > > > refuse to be quiet about it. "

> > > > > > >

> > > > > > > , That statement speaks volumes! You are on the

> same

> > > page

> > > > > as

> > > > > > many other very good people here and I thank you for the

> > > respect,

> > > > > > dignity and eloquence that you posted your story. I was

> just

> > > > > > preparing a statement to read at the SAMHSA meeting next

> week

> > > and

> > > > > was

> > > > > > tackling the issue of cutoffs vs. interpretation (as far

> as

> > > where

> > > > > the

> > > > > > problem lies). I must say, your level is the lowest

> positive

> > > I've

> > > > > > heard of yet. Clearly, the cutoffs are the problem. With

> no

> > > clear

> > > > > > guidelines on what any of the numbers really mean,

> > > interpretation

> > > > > is

> > > > > > sort of a moot point now, isn't it?

> > > > > > >

> > > > > > > There are a few other Texas doctors who have shared

> their

> > > > stories

> > > > > > here. One's had some similarities to yours--tested

> positive

> > > after

> > > > > > using Purell and waterless foam surgical scrub while on a

> > > mission

> > > > > > trip to Mexico. Alcohol was not his DOC. Following an

> > > appearance

> > > > > > before the board, they dismissed the complaint. He said

> that

> > > they

> > > > > > acknowledged ongoing problems with EtG testing and are

> > looking

> > > at

> > > > > > each case individually.

> > > > > > >

> > > > > > > Please let us know what happens with your case. I hope

> you

> > > > > continue

> > > > > > to add to the discussion here.

> > > > > > > Lorie

> > > > > > >

> > > > > > > Texas Medical Board

> > > > > > >

> > > > > > > Hi everyone. I decided to post under my real name

> because

> > > > > > monitoring

> > > > > > > of medical professionals in recovery has become too

> > > Taliban

> > > > > like

> > > > > > to

> > > > > > > remain quiet. I entered recovery in 1987 for taking

> > > > prescription

> > > > > > > amphetamines from my mother. I was not intervened

> upon.

> > > Faced

> > > > > with

> > > > > > > forging prescriptions or getting help I sought medical

> > > > > attention,

> > > > > > then

> > > > > > > self-reported to the board of medicine. I have NEVER

> been

> > > a

> > > > > > drinker,

> > > > > > > not even socially. I have received continuous random

> > urine

> > > > drug

> > > > > > > screens since 1988. In 1999 I was diagnosed with

> > > narcolepsy

> > > > > after

> > > > > > a

> > > > > > > cataplectic episode resulted in a fracture. Confirmed

> > > twice

> > > > by

> > > > > > Texas

> > > > > > > Medical Board assigned sleep medicine specialists who

> now

> > > > > > prescribe

> > > > > > > ritalin, provigil and Xyrem with good results. In 2003

> I

> > > > missed

> > > > > a

> > > > > > > single urine drug screen while founding a clinic in

> the

> > > > remote

> > > > > > regions

> > > > > > > of Big Bend. The Texas Medical Board suspended my

> > license,

> > > > then

> > > > > > took

> > > > > > > two years to conclude no problem existed. Every aspect

> of

> > > my

> > > > > > life, my

> > > > > > > medical care and my prescription writing were

> thoroughly

> > > > > > investigated

> > > > > > > without any negative comment occurring. During my two

> > year

> > > > > period

> > > > > > of

> > > > > > > unemployment, I maintained urine drug screening in the

> > > same

> > > > > > monitoring

> > > > > > > program. When my license was restored, I accepted a

> > > position

> > > > as

> > > > > an

> > > > > > > Assistant Professor of Medicine in the Section of

> > Hospital

> > > > > > Medicine at

> > > > > > > UT Southwestern Medical Center in Dallas. Three days

> ago

> > I

> > > was

> > > > > > > notified that my concentrated urine from August 29th

> was

> > > > > positive

> > > > > > for

> > > > > > > 103ng of EtG. The only ethanol exposure I have is foam

> > for

> > > > hand

> > > > > > > cleansing. I have attached a copy of the body of my

> > > response

> > > > to

> > > > > > the

> > > > > > > medical board. I do not know what their response will

> be,

> > > but

> > > > > will

> > > > > > > update this site when it occurs. My intention in

> writing

> > > is

> > > > not

> > > > > so

> > > > > > > much as to receive support as to provide it. I've

> > wrestled

> > > > with

> > > > > > > trying to keep this to myself, but have decided to go

> > > public.

> > > > I

> > > > > am

> > > > > > > certain there are others out there who are in a

> similar

> > > > > position,

> > > > > > but

> > > > > > > too afraid to post for whatever the reason. I

> understand,

> > > I

> > > > was

> > > > > > there

> > > > > > > once; but no more. I may not be able to prevent an

> > > injustice,

> > > > > but

> > > > > > I

> > > > > > > sure as hell refuse to be quiet about it. Likewise,

> I'm

> > > > certain

> > > > > > there

> > > > > > > are those with positive EtG's who have been drinking

> and

> > > hope

> > > > > to

> > > > > > slide

> > > > > > > under the radar by garnishing some halo effect from

> > > other's

> > > > > with

> > > > > > an

> > > > > > > incidental low level positive EtG. We all know their

> > fate.

> > > I

> > > > > hope

> > > > > > my

> > > > > > > post is not considered too lengthy, especially with me

> > > adding

> > > > > the

> > > > > > body

> > > > > > > of my letter to the Texas Medical Board. If it is,

> please

> > > > > accept

> > > > > > my

> > > > > > > apologies. I'll not repeat it. Most Respectfully,

>

> > > J.

> > > > > > DiBona, M.D.

> > > > > > >

> > > > > > > September 11, 2006

> > > > > > >

> > > > > > > Tomeo

> > > > > > > Texas Medical Board

> > > > > > > Compliance Officer

> > > > > > > P.O. Box 3272

> > > > > > > McKinney, TX 75070-3272

> > > > > > > 972-529-5837

> > > > > > > Fax 972-529-5681

> > > > > > >

> > > > > > > Mr. Tomeo;

> > > > > > >

> > > > > > > This is my formal response to the information you

> > provided

> > > me

> > > > > > over the

> > > > > > > telephone September 8, 2006 around 1100. I wish to

> convey

> > > no

> > > > > > degree

> > > > > > > of inattentiveness or casual approach to my board

> order.

> > I

> > > > take

> > > > > my

> > > > > > > commitment very seriously.

> > > > > > > Information provided to me:

> > > > > > > My urine drug screen from August 29, 2006 was positive

> > for

> > > > > > ritalinic

> > > > > > > acid and EtG at a level of 103 (I don't know the

> units.)

> > > > > > > My response is:

> > > > > > > I am in full compliance with my board order and have

> not

> > > made

> > > > > any

> > > > > > > mistakes.

> > > > > > > My thoughts about my EtG positive urine are:

> > > > > > > . Daily, significant cutaneous exposure to high

> > > concentration

> > > > > > ethanol

> > > > > > > occurs when I use the standard, hospital provided foam

> > > hand

> > > > > > cleanser.

> > > > > > > . Due to scheduling changes I was physically in the

> > > hospital

> > > > > > August

> > > > > > > 27th at 0700 until August 28th 2100. I rounded with my

> > > team

> > > > > August

> > > > > > > 29th 0600 to just before giving my urine drug screen

> at

> > > > > > approximately

> > > > > > > 1100 by memory.

> > > > > > > . August 25th and August 26th were " routine " clinical

> > days

> > > at

> > > > > the

> > > > > > > hospital, followed by AA from 1800 to 1900. In the

> > > evenings I

> > > > > > > performed intensive swimming pool cleanup and recovery

> > > from

> > > > an

> > > > > > algae

> > > > > > > bloom. I believe this activity may have altered my

> skin

> > > > > > absorption of

> > > > > > > ethanol by removing superficial skin cells and

> protective

> > > > oils.

> > > > > > > . On the same dates I also deep cleaned my carpets.

> These

> > > are

> > > > > the

> > > > > > > only additions to my daily routine. Both nights ended

> > near

> > > > > 0100.

> > > > > > > . I was recently started on Xyrem. Ethanol is not

> listed

> > > as a

> > > > > > > component of this medication.

> > > > > > > . My albuterol inhaler has an alcohol based

> > > > propellant/carrier.

> > > > > I

> > > > > > > have not used my inhaler for several months.

> > > > > > > . I have avoided ethanol containing gasoline.

> > > > > > > . There is no " accidental " ingestion of alcohol in the

> > > form of

> > > > > > > vanilla, mouthwashes, foods, communion wine etc. I

> take

> > my

> > > > order

> > > > > > > seriously, and avoid these things absolutely.

> > > > > > > The foam hand cleanser is the only source of

> > environmental

> > > > > ethanol

> > > > > > > exposure I knowingly experience. Avoiding its use is

> > > > difficult,

> > > > > as

> > > > > > > alcohol foam is superior to soap and water in reducing

> > > > > nosocomial

> > > > > > > hospital infections. I request formal Texas Medical

> Board

> > > > > > guidance in

> > > > > > > writing advising me on continued alcohol foam hand

> > > cleanser

> > > > use.

> > > > > > >

> > > > > > > I am in absolute compliance with my order. I have

> > receipts

> > > and

> > > > > > > bottles of the cleaning materials I used. I continue

> to

> > be

> > > an

> > > > > > example

> > > > > > > of expert physician medical care, professionalism,

> > > recovery

> > > > and

> > > > > > > responsibility. I am an outstanding example of

> compliance

> > > > with

> > > > > the

> > > > > > > Texas Medical Board.

> > > > > > >

> > > > > > > Respectfully,

> > > > > > >

> > > > > > > J. DiBona, M.D.

> > > > > > > Assistant Professor of Medicine

> > > > > > > UT Southwestern Medical Center

> > > > > > > 5909 Harry Hines Blvd. . Dallas, TX 75390-8889

> > > > > > > danieldibona@

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

September 13, 2006

I applaud all of you..........I know that I will not be walked upon......"We were powerless......." NOT we are powerless............Joynautiques5 <nautiques5@...> wrote: Madison, For once I must say I agree with what you have said...thank you...and of course, also thanks for the comment on the picture, I don't think many people saw the actual paper!!! One mis-conception you have is that ALL

people in AA think we need to 'just accept this'. My group has supported me in pursueing this to whatever extent I can. They shook my hand over the WSJ article and KNOW I am standing up for the rights of those in recovery!! I was told that acceptance does NOT mean you allow yourself to be walked all over!!! I too agree with Madison that we have to stay stong as a group, not dwell on the stereotype of addiction....we are no longer there....and this has now become an issue to help change the perception of that! I am glad everyone is here and are willing to stand for thier truth....what is right!! Together we have MIGHTY power....this is a 'WE' problem and together we can change it!!! > > > > > > > > > > > > > > "I may not be able to prevent an injustice, but I sure > as > > > hell > > > > > > refuse to be quiet about it." > > > > > > > > > > > > > > , That statement speaks volumes! You are on the > same > > > page > > > > > as > > > > > > many other very good people here and I thank you for the > > > respect, > > > > > > dignity and eloquence that you posted your story. I was > just > > >

> > > preparing a statement to read at the SAMHSA meeting next > week > > > and > > > > > was > > > > > > tackling the issue of cutoffs vs. interpretation (as far > as > > > where > > > > > the > > > > > > problem lies). I must say, your level is the lowest > positive > > > I've > > > > > > heard of yet. Clearly, the cutoffs are the problem. With > no > > > clear > > > > > > guidelines on what any of the numbers really mean, > > > interpretation > > > > > is > > > > > > sort of a moot point now, isn't it? > > > > > > > > > > > > > > There are a few other Texas doctors who have shared > their > > > > stories >

> > > > > here. One's had some similarities to yours--tested > positive > > > after > > > > > > using Purell and waterless foam surgical scrub while on a > > > mission > > > > > > trip to Mexico. Alcohol was not his DOC. Following an > > > appearance > > > > > > before the board, they dismissed the complaint. He said > that > > > they > > > > > > acknowledged ongoing problems with EtG testing and are > > looking > > > at > > > > > > each case individually. > > > > > > > > > > > > > > Please let us know what happens with your case. I hope > you > > > > > continue > > > > > > to add to the discussion here. > > > > > > >

Lorie > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Texas Medical Board > > > > > > > > > > > > > > > > > > > > > Hi everyone. I decided to post under my real name > because > > > > > > monitoring > >

> > > > > of medical professionals in recovery has become too > > > Taliban > > > > > like > > > > > > to > > > > > > > remain quiet. I entered recovery in 1987 for taking > > > > prescription > > > > > > > amphetamines from my mother. I was not intervened > upon. > > > Faced > > > > > with > > > > > > > forging prescriptions or getting help I sought medical > > > > > attention, > > > > > > then > > > > > > > self-reported to the board of medicine. I have NEVER > been > > > a > > > > > > drinker, > > > > > > > not even socially. I have received continuous random > > urine > > > > drug

> > > > > > > screens since 1988. In 1999 I was diagnosed with > > > narcolepsy > > > > > after > > > > > > a > > > > > > > cataplectic episode resulted in a fracture. Confirmed > > > twice > > > > by > > > > > > Texas > > > > > > > Medical Board assigned sleep medicine specialists who > now > > > > > > prescribe > > > > > > > ritalin, provigil and Xyrem with good results. In 2003 > I > > > > missed > > > > > a > > > > > > > single urine drug screen while founding a clinic in > the > > > > remote > > > > > > regions > > > > > > > of Big Bend. The Texas Medical Board suspended my

> > license, > > > > then > > > > > > took > > > > > > > two years to conclude no problem existed. Every aspect > of > > > my > > > > > > life, my > > > > > > > medical care and my prescription writing were > thoroughly > > > > > > investigated > > > > > > > without any negative comment occurring. During my two > > year > > > > > period > > > > > > of > > > > > > > unemployment, I maintained urine drug screening in the > > > same > > > > > > monitoring > > > > > > > program. When my license was restored, I accepted a > > > position > > > > as > > > > > an >

> > > > > > Assistant Professor of Medicine in the Section of > > Hospital > > > > > > Medicine at > > > > > > > UT Southwestern Medical Center in Dallas. Three days > ago > > I > > > was > > > > > > > notified that my concentrated urine from August 29th > was > > > > > positive > > > > > > for > > > > > > > 103ng of EtG. The only ethanol exposure I have is foam > > for > > > > hand > > > > > > > cleansing. I have attached a copy of the body of my > > > response > > > > to > > > > > > the > > > > > > > medical board. I do not know what their response will > be, > > > but > > > >

> will > > > > > > > update this site when it occurs. My intention in > writing > > > is > > > > not > > > > > so > > > > > > > much as to receive support as to provide it. I've > > wrestled > > > > with > > > > > > > trying to keep this to myself, but have decided to go > > > public. > > > > I > > > > > am > > > > > > > certain there are others out there who are in a > similar > > > > > position, > > > > > > but > > > > > > > too afraid to post for whatever the reason. I > understand, > > > I > > > > was > > > > > > there > > > > > > > once; but no more. I may not

be able to prevent an > > > injustice, > > > > > but > > > > > > I > > > > > > > sure as hell refuse to be quiet about it. Likewise, > I'm > > > > certain > > > > > > there > > > > > > > are those with positive EtG's who have been drinking > and > > > hope > > > > > to > > > > > > slide > > > > > > > under the radar by garnishing some halo effect from > > > other's > > > > > with > > > > > > an > > > > > > > incidental low level positive EtG. We all know their > > fate. > > > I > > > > > hope > > > > > > my > > > > > > > post is not considered too

lengthy, especially with me > > > adding > > > > > the > > > > > > body > > > > > > > of my letter to the Texas Medical Board. If it is, > please > > > > > accept > > > > > > my > > > > > > > apologies. I'll not repeat it. Most Respectfully, > > > > J. > > > > > > DiBona, M.D. > > > > > > > > > > > > > > September 11, 2006 > > > > > > > > > > > > > > Tomeo > > > > > > > Texas Medical Board > > > > > > > Compliance Officer > > > > > > > P.O. Box 3272 > > > > > > > McKinney, TX 75070-3272 > > > > > > > 972-529-5837 > > > > > > > Fax 972-529-5681 > > > > > > > > > > > > > > Mr. Tomeo; > > > > > > > > > > > > > > This is my formal response to the information you > > provided > > > me > > > > > > over the > > > > > > > telephone September 8, 2006 around 1100. I wish to > convey > > > no > > > > > > degree > > > > > > > of inattentiveness or casual approach to my board > order. > > I > > > > take > > > > > my > > > > > > > commitment very seriously. > > > > > > > Information provided to me: > > > > > > > My urine drug screen from August 29, 2006 was positive

> > for > > > > > > ritalinic > > > > > > > acid and EtG at a level of 103 (I don't know the > units.) > > > > > > > My response is: > > > > > > > I am in full compliance with my board order and have > not > > > made > > > > > any > > > > > > > mistakes. > > > > > > > My thoughts about my EtG positive urine are: > > > > > > > . Daily, significant cutaneous exposure to high > > > concentration > > > > > > ethanol > > > > > > > occurs when I use the standard, hospital provided foam > > > hand > > > > > > cleanser. > > > > > > > . Due to scheduling changes I was physically in the > > >

hospital > > > > > > August > > > > > > > 27th at 0700 until August 28th 2100. I rounded with my > > > team > > > > > August > > > > > > > 29th 0600 to just before giving my urine drug screen > at > > > > > > approximately > > > > > > > 1100 by memory. > > > > > > > . August 25th and August 26th were "routine" clinical > > days > > > at > > > > > the > > > > > > > hospital, followed by AA from 1800 to 1900. In the > > > evenings I > > > > > > > performed intensive swimming pool cleanup and recovery > > > from > > > > an > > > > > > algae > > > > > > > bloom. I believe this

activity may have altered my > skin > > > > > > absorption of > > > > > > > ethanol by removing superficial skin cells and > protective > > > > oils. > > > > > > > . On the same dates I also deep cleaned my carpets. > These > > > are > > > > > the > > > > > > > only additions to my daily routine. Both nights ended > > near > > > > > 0100. > > > > > > > . I was recently started on Xyrem. Ethanol is not > listed > > > as a > > > > > > > component of this medication. > > > > > > > . My albuterol inhaler has an alcohol based > > > > propellant/carrier. > > > > > I > > > > > > > have not used my inhaler

for several months. > > > > > > > . I have avoided ethanol containing gasoline. > > > > > > > . There is no "accidental" ingestion of alcohol in the > > > form of > > > > > > > vanilla, mouthwashes, foods, communion wine etc. I > take > > my > > > > order > > > > > > > seriously, and avoid these things absolutely. > > > > > > > The foam hand cleanser is the only source of > > environmental > > > > > ethanol > > > > > > > exposure I knowingly experience. Avoiding its use is > > > > difficult, > > > > > as > > > > > > > alcohol foam is superior to soap and water in reducing > > > > > nosocomial > > > > > > > hospital infections. I request formal Texas Medical > Board > > > > > > guidance in > > > > > > > writing advising me on continued alcohol foam hand > > > cleanser > > > > use. > > > > > > > > > > > > > > I am in absolute compliance with my order. I have > > receipts > > > and > > > > > > > bottles of the cleaning materials I used. I continue > to > > be > > > an > > > > > > example > > > > > > > of expert physician medical care, professionalism, > > > recovery > > > > and > > > > > > > responsibility. I am an outstanding example of > compliance > > > > with > > > > > the > > > > >

> > Texas Medical Board. > > > > > > > > > > > > > > Respectfully, > > > > > > > > > > > > > > J. DiBona, M.D. > > > > > > > Assistant Professor of Medicine > > > > > > > UT Southwestern Medical Center > > > > > > > 5909 Harry Hines Blvd. . Dallas, TX 75390-8889 > > > > > > > danieldibona@ > > > > > > > > > > > > > > > > > > > > > > > > > > > >

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September 13, 2006

I hope this table formats well. It's important to master.These are the considerations for any diagnostic test or being used. It is important to recognize how the statistical terms are being misrepresented. It's easy to confuse, but inexcusable. EtG use tests for exposure to ethanol accurately. It does not discriminate intention, but is being marketed as so. The statements used by the associations marketing EtG are substituting sensitivity for the predictive value of a positive. They are definitely not the same thing. Intentional Alcohol Exposure (This is the question asked.) EtG Present Absent Totals Test Positive : a b a + b Result Negative: c d c + d Totals a + c b + d a+b+c+d> Sensitivity = a / (a + c) What has been measured for ethanol exposure.> Specificity = d / (b +d) Not the same thing as accuracy.> Likelihood ratio for a positive test result = sensitivity / (1-specificity)> Likelihood ratio for a negative test result = (1 – sensitivity) /specificity> Positive predictive value = a / (a+ How the EtG test is being used and quoted> Negative predictive value = d /(c + d)How many people are missed who drank.> Pretest probability (prevalence) = (a + c)/ ((a + b + c + d)> Pre-test odds = prevalence / (1 – prevalence)> Post-test odds = pre-test odds x likelihood ratio> Post-test probability = post-test odds / (post-test odds + 1)>> This kind of stistical information is considered Class I data, and is ONLY obtainable through a prospective, controlled study.>This study could be done without having to determine a number needed to treat (NNT) as we are not doing an intervention; however, that would be useful information (the intervention being a consequence experienced as a, well, intervention; as with it, one can then determine the number needed to harm (NNH) ("innocent bystanders" or "friendly fire") after determining relative and absolute risk reduction of allowing an impaired professional to continue practicing unidentified.The boards monitoring health professionals are charged with protecting the public to the best of their ability, not protecting the physicians, nurses, pharmacists and others they regulate. The boards position are a combination of societies influence upon them, and also the influence of entities marketing tools to these agencies to help them do their job. With respect to EtG testing, the liability lies in both places: the boards and the entities marketing the tools. The boards do not have malice, though the atmosphere is clearly one of purging, not retaining professionals. They are discharging their duties to the public.The marketers of EtG testing, however are not charged with anything except advancing profit. When it can be proven that basic statistical terminology was perverted into predatory marketing then malice can be implied. At that point, liability occurs and the balance tips towards legal action seeking damages. For that to happen, there must be a period where information is presented to the distributors of EtG testing describing their errors. After this is recieved, a period of time sufficient for "remedy" must occur. In the abscence of remedy in the presence of information sufficient to cause a change in practice malice has been proved. At that point documentation of damages incurred must happen. Once this is achieved, then a firm legal foundation has been created to launch either a law suit seeking compensation or presentation to a halth care regulatory body seeking relief or both.Hitting the distributors and marketers of inappropriate EtG testing in the pocket book is the ONLY approach that will reign them in.If the foundation for malice is established as above, I predict that the boards will begin to reign themselves in; for if not, they have invited litigation at a level admissable to federal courts; ie, the State government will pull their strings so as not to risk protracted State defense in federal court.My hope is that this group is monitored closely by the EtG industry and regulatory agencies around the country. As they read posts such as this, founded in solid intellect with a command of the issues at stake, we may well begin to invisibly influence corrective behaviors. I still believe most people do not wish to fight. I definitely have ceased personally fighting any and all things. I do not consider the articulation of information to be fighting. I do not believe passive acceptance of injustice is honorable or humble. Furthermore, not agreeing with the opposing party in no way is defensive or arrogant. I left my place of fear and insecurity many years ago and will never return there. Recovery allows me to live my values, not my fears. My strength comes not from power, but from spirit. My value is, and will remain to be of the greatest service I can possibly be to God and other people.Absolute clarity and understanding of what's being measured, quoted and used is essential for the members of this group to master if we are to ever yield effective influence.> > > > > > >> > > > > > > "I may not be able to prevent an injustice, but I sure as> > > hell> > > > > > refuse to be quiet about it."> > > > > > >> > > > > > > , That statement speaks volumes! You are on the same> > > page> > > > > as> > > > > > many other very good people here and I thank you for the> > > respect,> > > > > > dignity and eloquence that you posted your story. I was just> > > > > > preparing a statement to read at the SAMHSA meeting next week> > > and> > > > > was> > > > > > tackling the issue of cutoffs vs. interpretation (as far as> > > where> > > > > the> > > > > > problem lies). I must say, your level is the lowest positive> > > I've> > > > > > heard of yet. Clearly, the cutoffs are the problem. With no> > > clear> > > > > > guidelines on what any of the numbers really mean,> > > interpretation> > > > > is> > > > > > sort of a moot point now, isn't it?> > > > > > >> > > > > > > There are a few other Texas doctors who have shared their> > > > stories> > > > > > here. One's had some similarities to yours--tested positive> > > after> > > > > > using Purell and waterless foam surgical scrub while on a> > > mission> > > > > > trip to Mexico. Alcohol was not his DOC. Following an> > > appearance> > > > > > before the board, they dismissed the complaint. He said that> > > they> > > > > > acknowledged ongoing problems with EtG testing and are> > looking> > > at> > > > > > each case individually.> > > > > > >> > > > > > > Please let us know what happens with your case. I hope you> > > > > continue> > > > > > to add to the discussion here.> > > > > > > Lorie> > > > > > >> > > > > > >> > > > > > >> > > > > > >> > > > > > >> > > > > > >> > > > > > >> > > > > > > Texas Medical Board> > > > > > >> > > > > > >> > > > > > > Hi everyone. I decided to post under my real name because> > > > > > monitoring> > > > > > > of medical professionals in recovery has become too> > > Taliban> > > > > like> > > > > > to> > > > > > > remain quiet. I entered recovery in 1987 for taking> > > > prescription> > > > > > > amphetamines from my mother. I was not intervened upon.> > > Faced> > > > > with> > > > > > > forging prescriptions or getting help I sought medical> > > > > attention,> > > > > > then> > > > > > > self-reported to the board of medicine. I have NEVER been> > > a> > > > > > drinker,> > > > > > > not even socially. I have received continuous random> > urine> > > > drug> > > > > > > screens since 1988. In 1999 I was diagnosed with> > > narcolepsy> > > > > after> > > > > > a> > > > > > > cataplectic episode resulted in a fracture. Confirmed> > > twice> > > > by> > > > > > Texas> > > > > > > Medical Board assigned sleep medicine specialists who now> > > > > > prescribe> > > > > > > ritalin, provigil and Xyrem with good results. In 2003 I> > > > missed> > > > > a> > > > > > > single urine drug screen while founding a clinic in the> > > > remote> > > > > > regions> > > > > > > of Big Bend. The Texas Medical Board suspended my> > license,> > > > then> > > > > > took> > > > > > > two years to conclude no problem existed. Every aspect of> > > my> > > > > > life, my> > > > > > > medical care and my prescription writing were thoroughly> > > > > > investigated> > > > > > > without any negative comment occurring. During my two> > year> > > > > period> > > > > > of> > > > > > > unemployment, I maintained urine drug screening in the> > > same> > > > > > monitoring> > > > > > > program. When my license was restored, I accepted a> > > position> > > > as> > > > > an> > > > > > > Assistant Professor of Medicine in the Section of> > Hospital> > > > > > Medicine at> > > > > > > UT Southwestern Medical Center in Dallas. Three days ago> > I> > > was> > > > > > > notified that my concentrated urine from August 29th was> > > > > positive> > > > > > for> > > > > > > 103ng of EtG. The only ethanol exposure I have is foam> > for> > > > hand> > > > > > > cleansing. I have attached a copy of the body of my> > > response> > > > to> > > > > > the> > > > > > > medical board. I do not know what their response will be,> > > but> > > > > will> > > > > > > update this site when it occurs. My intention in writing> > > is> > > > not> > > > > so> > > > > > > much as to receive support as to provide it. I've> > wrestled> > > > with> > > > > > > trying to keep this to myself, but have decided to go> > > public.> > > > I> > > > > am> > > > > > > certain there are others out there who are in a similar> > > > > position,> > > > > > but> > > > > > > too afraid to post for whatever the reason. I understand,> > > I> > > > was> > > > > > there> > > > > > > once; but no more. I may not be able to prevent an> > > injustice,> > > > > but> > > > > > I> > > > > > > sure as hell refuse to be quiet about it. Likewise, I'm> > > > certain> > > > > > there> > > > > > > are those with positive EtG's who have been drinking and> > > hope> > > > > to> > > > > > slide> > > > > > > under the radar by garnishing some halo effect from> > > other's> > > > > with> > > > > > an> > > > > > > incidental low level positive EtG. We all know their> > fate.> > > I> > > > > hope> > > > > > my> > > > > > > post is not considered too lengthy, especially with me> > > adding> > > > > the> > > > > > body> > > > > > > of my letter to the Texas Medical Board. If it is, please> > > > > accept> > > > > > my> > > > > > > apologies. I'll not repeat it. Most Respectfully, > > > J.> > > > > > DiBona, M.D.> > > > > > >> > > > > > > September 11, 2006> > > > > > >> > > > > > > Tomeo> > > > > > > Texas Medical Board> > > > > > > Compliance Officer> > > > > > > P.O. Box 3272> > > > > > > McKinney, TX 75070-3272> > > > > > > 972-529-5837> > > > > > > Fax 972-529-5681> > > > > > >> > > > > > > Mr. Tomeo;> > > > > > >> > > > > > > This is my formal response to the information you> > provided> > > me> > > > > > over the> > > > > > > telephone September 8, 2006 around 1100. I wish to convey> > > no> > > > > > degree> > > > > > > of inattentiveness or casual approach to my board order.> > I> > > > take> > > > > my> > > > > > > commitment very seriously.> > > > > > > Information provided to me:> > > > > > > My urine drug screen from August 29, 2006 was positive> > for> > > > > > ritalinic> > > > > > > acid and EtG at a level of 103 (I don't know the units.)> > > > > > > My response is:> > > > > > > I am in full compliance with my board order and have not> > > made> > > > > any> > > > > > > mistakes.> > > > > > > My thoughts about my EtG positive urine are:> > > > > > > . Daily, significant cutaneous exposure to high> > > concentration> > > > > > ethanol> > > > > > > occurs when I use the standard, hospital provided foam> > > hand> > > > > > cleanser.> > > > > > > . Due to scheduling changes I was physically in the> > > hospital> > > > > > August> > > > > > > 27th at 0700 until August 28th 2100. I rounded with my> > > team> > > > > August> > > > > > > 29th 0600 to just before giving my urine drug screen at> > > > > > approximately> > > > > > > 1100 by memory.> > > > > > > . August 25th and August 26th were "routine" clinical> > days> > > at> > > > > the> > > > > > > hospital, followed by AA from 1800 to 1900. In the> > > evenings I> > > > > > > performed intensive swimming pool cleanup and recovery> > > from> > > > an> > > > > > algae> > > > > > > bloom. I believe this activity may have altered my skin> > > > > > absorption of> > > > > > > ethanol by removing superficial skin cells and protective> > > > oils.> > > > > > > . On the same dates I also deep cleaned my carpets. These> > > are> > > > > the> > > > > > > only additions to my daily routine. Both nights ended> > near> > > > > 0100.> > > > > > > . I was recently started on Xyrem. Ethanol is not listed> > > as a> > > > > > > component of this medication.> > > > > > > . My albuterol inhaler has an alcohol based> > > > propellant/carrier.> > > > > I> > > > > > > have not used my inhaler for several months.> > > > > > > . I have avoided ethanol containing gasoline.> > > > > > > . There is no "accidental" ingestion of alcohol in the> > > form of> > > > > > > vanilla, mouthwashes, foods, communion wine etc. I take> > my> > > > order> > > > > > > seriously, and avoid these things absolutely.> > > > > > > The foam hand cleanser is the only source of> > environmental> > > > > ethanol> > > > > > > exposure I knowingly experience. Avoiding its use is> > > > difficult,> > > > > as> > > > > > > alcohol foam is superior to soap and water in reducing> > > > > nosocomial> > > > > > > hospital infections. I request formal Texas Medical Board> > > > > > guidance in> > > > > > > writing advising me on continued alcohol foam hand> > > cleanser> > > > use.> > > > > > >> > > > > > > I am in absolute compliance with my order. I have> > receipts> > > and> > > > > > > bottles of the cleaning materials I used. I continue to> > be> > > an> > > > > > example> > > > > > > of expert physician medical care, professionalism,> > > recovery> > > > and> > > > > > > responsibility. I am an outstanding example of compliance> > > > with> > > > > the> > > > > > > Texas Medical Board.> > > > > > >> > > > > > > Respectfully,> > > > > > >> > > > > > > J. DiBona, M.D.> > > > > > > Assistant Professor of Medicine> > > > > > > UT Southwestern Medical Center> > > > > > > 5909 Harry Hines Blvd. . Dallas, TX 75390-8889> > > > > > > danieldibona@> > > > > > >> > > > > >> > > > >> > > >> > >> >>

September 13, 2006

don't cut yurself short darlin you 2 make a great team...and they do say that men a a litle more analytical than women...hush don't tell Harvard that i said that

September 13, 2006

LOL...You are SO, way smarter than me, it's hilarious. And to think I

sorta thought I had a handle on this stuff...

>

> These are the considerations for any diagnostic test being used.

>

> Intentional Alcohol Exposure

> Present Absent Totals

> EtG Positive a b a + b

> Test Result Negative c d c + d

> Totals a + c b + d a+b+c+d

>

> Sensitivity = a / (a + c)

> Specificity = d / (b +d)

> Likelihood ratio for a positive test result = sensitivity / (1-

> specificity)

> Likelihood ratio for a negative test result = (1 – sensitivity) /

> specificity

> Positive predictive value = a / (a+

> Negative predictive value = d /(c + d)

> Pretest probability (prevalence) = (a + c)/ ((a + b + c + d)

> Pre-test odds = prevalence / (1 – prevalence)

> Post-test odds = pre-test odds x likelihood ratio

> Post-test probability = post-test odds / (post-test odds + 1)

>

> This kind of information is obtainable through a prospective

> controlled study without having to determine a number needed to treat

> (NNT); however, that would be useful to do, as with it, one can then

> determine the number needed to harm (NNH) after determining relative

> and absolute risk reduction of allowing an impaired professional to

> continue practicing unidentified.

>

> Hope this helps.

>

> Gotta go.

>

September 13, 2006

Oh, thank God, cause that last thing was looking so foreign to me, I

felt like an idiot.

> >

> > These are the considerations for any diagnostic test being used.

> >

> > Intentional Alcohol Exposure

> > Present Absent Totals

> > EtG Positive a b a + b

> > Test Result Negative c d c + d

> > Totals a + c b + d a+b+c+d

> >

> > Sensitivity = a / (a + c)

> > Specificity = d / (b +d)

> > Likelihood ratio for a positive test result = sensitivity / (1-

> > specificity)

> > Likelihood ratio for a negative test result = (1 – sensitivity)

/

> > specificity

> > Positive predictive value = a / (a+

> > Negative predictive value = d /(c + d)

> > Pretest probability (prevalence) = (a + c)/ ((a + b + c + d)

> > Pre-test odds = prevalence / (1 – prevalence)

> > Post-test odds = pre-test odds x likelihood ratio

> > Post-test probability = post-test odds / (post-test odds + 1)

> >

> > This kind of information is obtainable through a prospective

> > controlled study without having to determine a number needed to

treat

> > (NNT); however, that would be useful to do, as with it, one can then

> > determine the number needed to harm (NNH) after determining relative

> > and absolute risk reduction of allowing an impaired professional to

> > continue practicing unidentified.

> >

> > Hope this helps.

> >

> > Gotta go.

> >

>

September 13, 2006

,

How does one go about presenting this to the laboratories, once the

information is gathered, compiled, and prepared? I've written them

several times (certainly not with your knowledge and eloquence), and

I've gotten no more than a response 9 months ago that they are looking

into my claims/questions scientifically, which takes time. Is an

attorney needed to be taken seriously? I did speak to an atty about

seeking a court-imposed injunctive release and I believe that would be

the legal consequence, should the labs not heed your suggestions

regarding evidence presented against their test.

Lorie

> > > > > > > >

> > > > > > > > " I may not be able to prevent an injustice, but I sure

as

> > > > hell

> > > > > > > refuse to be quiet about it. "

> > > > > > > >

> > > > > > > > , That statement speaks volumes! You are on the

same

> > > > page

> > > > > > as

> > > > > > > many other very good people here and I thank you for the

> > > > respect,

> > > > > > > dignity and eloquence that you posted your story. I was

just

> > > > > > > preparing a statement to read at the SAMHSA meeting next

> week

> > > > and

> > > > > > was

> > > > > > > tackling the issue of cutoffs vs. interpretation (as far

as

> > > > where

> > > > > > the

> > > > > > > problem lies). I must say, your level is the lowest

positive

> > > > I've

> > > > > > > heard of yet. Clearly, the cutoffs are the problem. With

no

> > > > clear

> > > > > > > guidelines on what any of the numbers really mean,

> > > > interpretation

> > > > > > is

> > > > > > > sort of a moot point now, isn't it?

> > > > > > > >

> > > > > > > > There are a few other Texas doctors who have shared

their

> > > > > stories

> > > > > > > here. One's had some similarities to yours--tested

positive

> > > > after

> > > > > > > using Purell and waterless foam surgical scrub while on a

> > > > mission

> > > > > > > trip to Mexico. Alcohol was not his DOC. Following an

> > > > appearance

> > > > > > > before the board, they dismissed the complaint. He said

that

> > > > they

> > > > > > > acknowledged ongoing problems with EtG testing and are

> > > looking

> > > > at

> > > > > > > each case individually.

> > > > > > > >

> > > > > > > > Please let us know what happens with your case. I hope

you

> > > > > > continue

> > > > > > > to add to the discussion here.

> > > > > > > > Lorie

> > > > > > > >

> > > > > > > > Texas Medical Board

> > > > > > > >

> > > > > > > > Hi everyone. I decided to post under my real name

because

> > > > > > > monitoring

> > > > > > > > of medical professionals in recovery has become too

> > > > Taliban

> > > > > > like

> > > > > > > to

> > > > > > > > remain quiet. I entered recovery in 1987 for taking

> > > > > prescription

> > > > > > > > amphetamines from my mother. I was not intervened upon.

> > > > Faced

> > > > > > with

> > > > > > > > forging prescriptions or getting help I sought medical

> > > > > > attention,

> > > > > > > then

> > > > > > > > self-reported to the board of medicine. I have NEVER

been

> > > > a

> > > > > > > drinker,

> > > > > > > > not even socially. I have received continuous random

> > > urine

> > > > > drug

> > > > > > > > screens since 1988. In 1999 I was diagnosed with

> > > > narcolepsy

> > > > > > after

> > > > > > > a

> > > > > > > > cataplectic episode resulted in a fracture. Confirmed

> > > > twice

> > > > > by

> > > > > > > Texas

> > > > > > > > Medical Board assigned sleep medicine specialists who

now

> > > > > > > prescribe

> > > > > > > > ritalin, provigil and Xyrem with good results. In 2003 I

> > > > > missed

> > > > > > a

> > > > > > > > single urine drug screen while founding a clinic in the

> > > > > remote

> > > > > > > regions

> > > > > > > > of Big Bend. The Texas Medical Board suspended my

> > > license,

> > > > > then

> > > > > > > took

> > > > > > > > two years to conclude no problem existed. Every aspect

of

> > > > my

> > > > > > > life, my

> > > > > > > > medical care and my prescription writing were thoroughly

> > > > > > > investigated

> > > > > > > > without any negative comment occurring. During my two

> > > year

> > > > > > period

> > > > > > > of

> > > > > > > > unemployment, I maintained urine drug screening in the

> > > > same

> > > > > > > monitoring

> > > > > > > > program. When my license was restored, I accepted a

> > > > position

> > > > > as

> > > > > > an

> > > > > > > > Assistant Professor of Medicine in the Section of

> > > Hospital

> > > > > > > Medicine at

> > > > > > > > UT Southwestern Medical Center in Dallas. Three days ago

> > > I

> > > > was

> > > > > > > > notified that my concentrated urine from August 29th was

> > > > > > positive

> > > > > > > for

> > > > > > > > 103ng of EtG. The only ethanol exposure I have is foam

> > > for

> > > > > hand

> > > > > > > > cleansing. I have attached a copy of the body of my

> > > > response

> > > > > to

> > > > > > > the

> > > > > > > > medical board. I do not know what their response will

be,

> > > > but

> > > > > > will

> > > > > > > > update this site when it occurs. My intention in writing

> > > > is

> > > > > not

> > > > > > so

> > > > > > > > much as to receive support as to provide it. I've

> > > wrestled

> > > > > with

> > > > > > > > trying to keep this to myself, but have decided to go

> > > > public.

> > > > > I

> > > > > > am

> > > > > > > > certain there are others out there who are in a similar

> > > > > > position,

> > > > > > > but

> > > > > > > > too afraid to post for whatever the reason. I

understand,

> > > > I

> > > > > was

> > > > > > > there

> > > > > > > > once; but no more. I may not be able to prevent an

> > > > injustice,

> > > > > > but

> > > > > > > I

> > > > > > > > sure as hell refuse to be quiet about it. Likewise, I'm

> > > > > certain

> > > > > > > there

> > > > > > > > are those with positive EtG's who have been drinking and

> > > > hope

> > > > > > to

> > > > > > > slide

> > > > > > > > under the radar by garnishing some halo effect from

> > > > other's

> > > > > > with

> > > > > > > an

> > > > > > > > incidental low level positive EtG. We all know their

> > > fate.

> > > > I

> > > > > > hope

> > > > > > > my

> > > > > > > > post is not considered too lengthy, especially with me

> > > > adding

> > > > > > the

> > > > > > > body

> > > > > > > > of my letter to the Texas Medical Board. If it is,

please

> > > > > > accept

> > > > > > > my

> > > > > > > > apologies. I'll not repeat it. Most Respectfully,

> > > > J.

> > > > > > > DiBona, M.D.

> > > > > > > >

> > > > > > > > September 11, 2006

> > > > > > > >

> > > > > > > > Tomeo

> > > > > > > > Texas Medical Board

> > > > > > > > Compliance Officer

> > > > > > > > P.O. Box 3272

> > > > > > > > McKinney, TX 75070-3272

> > > > > > > > 972-529-5837

> > > > > > > > Fax 972-529-5681

> > > > > > > >

> > > > > > > > Mr. Tomeo;

> > > > > > > >

> > > > > > > > This is my formal response to the information you

> > > provided

> > > > me

> > > > > > > over the

> > > > > > > > telephone September 8, 2006 around 1100. I wish to

convey

> > > > no

> > > > > > > degree

> > > > > > > > of inattentiveness or casual approach to my board order.

> > > I

> > > > > take

> > > > > > my

> > > > > > > > commitment very seriously.

> > > > > > > > Information provided to me:

> > > > > > > > My urine drug screen from August 29, 2006 was positive

> > > for

> > > > > > > ritalinic

> > > > > > > > acid and EtG at a level of 103 (I don't know the units.)

> > > > > > > > My response is:

> > > > > > > > I am in full compliance with my board order and have not

> > > > made

> > > > > > any

> > > > > > > > mistakes.

> > > > > > > > My thoughts about my EtG positive urine are:

> > > > > > > > . Daily, significant cutaneous exposure to high

> > > > concentration

> > > > > > > ethanol

> > > > > > > > occurs when I use the standard, hospital provided foam

> > > > hand

> > > > > > > cleanser.

> > > > > > > > . Due to scheduling changes I was physically in the

> > > > hospital

> > > > > > > August

> > > > > > > > 27th at 0700 until August 28th 2100. I rounded with my

> > > > team

> > > > > > August

> > > > > > > > 29th 0600 to just before giving my urine drug screen at

> > > > > > > approximately

> > > > > > > > 1100 by memory.

> > > > > > > > . August 25th and August 26th were " routine " clinical

> > > days

> > > > at

> > > > > > the

> > > > > > > > hospital, followed by AA from 1800 to 1900. In the

> > > > evenings I

> > > > > > > > performed intensive swimming pool cleanup and recovery

> > > > from

> > > > > an

> > > > > > > algae

> > > > > > > > bloom. I believe this activity may have altered my skin

> > > > > > > absorption of

> > > > > > > > ethanol by removing superficial skin cells and

protective

> > > > > oils.

> > > > > > > > . On the same dates I also deep cleaned my carpets.

These

> > > > are

> > > > > > the

> > > > > > > > only additions to my daily routine. Both nights ended

> > > near

> > > > > > 0100.

> > > > > > > > . I was recently started on Xyrem. Ethanol is not listed

> > > > as a

> > > > > > > > component of this medication.

> > > > > > > > . My albuterol inhaler has an alcohol based

> > > > > propellant/carrier.

> > > > > > I

> > > > > > > > have not used my inhaler for several months.

> > > > > > > > . I have avoided ethanol containing gasoline.

> > > > > > > > . There is no " accidental " ingestion of alcohol in the

> > > > form of

> > > > > > > > vanilla, mouthwashes, foods, communion wine etc. I take

> > > my

> > > > > order

> > > > > > > > seriously, and avoid these things absolutely.

> > > > > > > > The foam hand cleanser is the only source of

> > > environmental

> > > > > > ethanol

> > > > > > > > exposure I knowingly experience. Avoiding its use is

> > > > > difficult,

> > > > > > as

> > > > > > > > alcohol foam is superior to soap and water in reducing

> > > > > > nosocomial

> > > > > > > > hospital infections. I request formal Texas Medical

Board

> > > > > > > guidance in

> > > > > > > > writing advising me on continued alcohol foam hand

> > > > cleanser

> > > > > use.

> > > > > > > >

> > > > > > > > I am in absolute compliance with my order. I have

> > > receipts

> > > > and

> > > > > > > > bottles of the cleaning materials I used. I continue to

> > > be

> > > > an

> > > > > > > example

> > > > > > > > of expert physician medical care, professionalism,

> > > > recovery

> > > > > and

> > > > > > > > responsibility. I am an outstanding example of

compliance

> > > > > with

> > > > > > the

> > > > > > > > Texas Medical Board.

> > > > > > > >

> > > > > > > > Respectfully,

> > > > > > > >

> > > > > > > > J. DiBona, M.D.

> > > > > > > > Assistant Professor of Medicine

> > > > > > > > UT Southwestern Medical Center

> > > > > > > > 5909 Harry Hines Blvd. . Dallas, TX 75390-8889

> > > > > > > > danieldibona@

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

September 13, 2006

To answer your question directly then of, " how do you present this

information? " requires a two part response.

Part one: We should expect and count on some degree of information

seeking being done by the testing industry. In the abscence of this,

they are simply being sloppy. This is not their history. Therefore,

we refine, edit and present the information succintly and clearly to

ourselves first; making it easily availble to the public, and track

the IP addresses of who reads it.

Part two: To hell with notifying them directly. You did that already.

The next step would be to notify State monitoring boards, State

legislators, Governors, State Representatives, Congressmen, Senators,

Media outlets and Federal regulatory bodies simultaneously with a well

written electronic communication alleging the EtG industry is

deliberately misrepresenting sensitivity as predictive value as a part

of predatory and misleading marketing to monitoring agencies. We send

a courtesy copy to every identifiable marketer of EtG urine drug

screen testing.

The above takes time, mastery of knowledge with confidence and some

computer skills, but no money. As a group, we have all of this.

I cannot tell whether or not the table I presented earlier is easily

seen and read by others purusing this website. If not, because it is

the first building block of evidence based commentary and conversation

about EtG, then I should recreate it and pass it to someone who knows

how to format it for this group, or post it as a PDF file in the Files

section of this group.

My belief is that this group is closely and silently monitored by the

EtG testing industry. As such, simply racheting up the level of

conversation will garnish enhanced attention. In other words, as we

educate ourselves, we educate them; and in doing so, I believe we

could expect some spontaneous movement away from tyranny and towards

balance. That's easy enough to monitor with a group site " hit "

counter that tracks the ratio of visits to posts. We want that ratio

to skyrocket. If something like a simple hit counter can't be

installed on this group site, then a new website needs to be created.

I own some web site domain space I'm happy to donate.

My second belief is that a smaller population of board related people

also monitor this group. These people are unlikely to be key decision

makers at the boards, but educating them is like preparing new soil

for a garden. It makes downstream labor easier.

These two beliefs of mine contribute to my final thought. This groups

postings should be generally available. One should not have to become

a member to read the postings. I could be wrong, but I think you have

to be a member to read the messages here. The reality is, it is to

our collective advantage to encourage anonymous reading of the

presented material.

Having our own website would make IP address monitoring possible. I

doubt it easy to accomplish this with a group. With logged IP

address (and even pushed cookies) the ability to send alerts

electronically about " breaking " news becomes possible. Also,

databases exist that can cross reference IP addresses to other sites

visited to build broad profiling of who stops and reads. We can even

filter it to capture only IP addresses who spend more than x number of

minutes " anonymously " reading our information.

Yadda, yadda, yadda.

> > > > > > > > >

> > > > > > > > > " I may not be able to prevent an injustice, but I sure

> as

> > > > > hell

> > > > > > > > refuse to be quiet about it. "

> > > > > > > > >

> > > > > > > > > , That statement speaks volumes! You are on the

> same

> > > > > page

> > > > > > > as

> > > > > > > > many other very good people here and I thank you for the

> > > > > respect,

> > > > > > > > dignity and eloquence that you posted your story. I was

> just

> > > > > > > > preparing a statement to read at the SAMHSA meeting next

> > week

> > > > > and

> > > > > > > was

> > > > > > > > tackling the issue of cutoffs vs. interpretation (as far

> as

> > > > > where

> > > > > > > the

> > > > > > > > problem lies). I must say, your level is the lowest

> positive

> > > > > I've

> > > > > > > > heard of yet. Clearly, the cutoffs are the problem. With

> no

> > > > > clear

> > > > > > > > guidelines on what any of the numbers really mean,

> > > > > interpretation

> > > > > > > is

> > > > > > > > sort of a moot point now, isn't it?

> > > > > > > > >

> > > > > > > > > There are a few other Texas doctors who have shared

> their

> > > > > > stories

> > > > > > > > here. One's had some similarities to yours--tested

> positive

> > > > > after

> > > > > > > > using Purell and waterless foam surgical scrub while on a

> > > > > mission

> > > > > > > > trip to Mexico. Alcohol was not his DOC. Following an

> > > > > appearance

> > > > > > > > before the board, they dismissed the complaint. He said

> that

> > > > > they

> > > > > > > > acknowledged ongoing problems with EtG testing and are

> > > > looking

> > > > > at

> > > > > > > > each case individually.

> > > > > > > > >

> > > > > > > > > Please let us know what happens with your case. I hope

> you

> > > > > > > continue

> > > > > > > > to add to the discussion here.

> > > > > > > > > Lorie

> > > > > > > > >

> > > > > > > > > Texas Medical Board

> > > > > > > > >

> > > > > > > > > Hi everyone. I decided to post under my real name

> because

> > > > > > > > monitoring

> > > > > > > > > of medical professionals in recovery has become too

> > > > > Taliban

> > > > > > > like

> > > > > > > > to

> > > > > > > > > remain quiet. I entered recovery in 1987 for taking

> > > > > > prescription

> > > > > > > > > amphetamines from my mother. I was not intervened upon.

> > > > > Faced

> > > > > > > with

> > > > > > > > > forging prescriptions or getting help I sought medical

> > > > > > > attention,

> > > > > > > > then

> > > > > > > > > self-reported to the board of medicine. I have NEVER

> been

> > > > > a

> > > > > > > > drinker,

> > > > > > > > > not even socially. I have received continuous random

> > > > urine

> > > > > > drug

> > > > > > > > > screens since 1988. In 1999 I was diagnosed with

> > > > > narcolepsy

> > > > > > > after

> > > > > > > > a

> > > > > > > > > cataplectic episode resulted in a fracture. Confirmed

> > > > > twice

> > > > > > by

> > > > > > > > Texas

> > > > > > > > > Medical Board assigned sleep medicine specialists who

> now

> > > > > > > > prescribe

> > > > > > > > > ritalin, provigil and Xyrem with good results. In 2003 I

> > > > > > missed

> > > > > > > a

> > > > > > > > > single urine drug screen while founding a clinic in the

> > > > > > remote

> > > > > > > > regions

> > > > > > > > > of Big Bend. The Texas Medical Board suspended my

> > > > license,

> > > > > > then

> > > > > > > > took

> > > > > > > > > two years to conclude no problem existed. Every aspect

> of

> > > > > my

> > > > > > > > life, my

> > > > > > > > > medical care and my prescription writing were thoroughly

> > > > > > > > investigated

> > > > > > > > > without any negative comment occurring. During my two

> > > > year

> > > > > > > period

> > > > > > > > of

> > > > > > > > > unemployment, I maintained urine drug screening in the

> > > > > same

> > > > > > > > monitoring

> > > > > > > > > program. When my license was restored, I accepted a

> > > > > position

> > > > > > as

> > > > > > > an

> > > > > > > > > Assistant Professor of Medicine in the Section of

> > > > Hospital

> > > > > > > > Medicine at

> > > > > > > > > UT Southwestern Medical Center in Dallas. Three days ago

> > > > I

> > > > > was

> > > > > > > > > notified that my concentrated urine from August 29th was

> > > > > > > positive

> > > > > > > > for

> > > > > > > > > 103ng of EtG. The only ethanol exposure I have is foam

> > > > for

> > > > > > hand

> > > > > > > > > cleansing. I have attached a copy of the body of my

> > > > > response

> > > > > > to

> > > > > > > > the

> > > > > > > > > medical board. I do not know what their response will

> be,

> > > > > but

> > > > > > > will

> > > > > > > > > update this site when it occurs. My intention in writing

> > > > > is

> > > > > > not

> > > > > > > so

> > > > > > > > > much as to receive support as to provide it. I've

> > > > wrestled

> > > > > > with

> > > > > > > > > trying to keep this to myself, but have decided to go

> > > > > public.

> > > > > > I

> > > > > > > am

> > > > > > > > > certain there are others out there who are in a similar

> > > > > > > position,

> > > > > > > > but

> > > > > > > > > too afraid to post for whatever the reason. I

> understand,

> > > > > I

> > > > > > was

> > > > > > > > there

> > > > > > > > > once; but no more. I may not be able to prevent an

> > > > > injustice,

> > > > > > > but

> > > > > > > > I

> > > > > > > > > sure as hell refuse to be quiet about it. Likewise, I'm

> > > > > > certain

> > > > > > > > there

> > > > > > > > > are those with positive EtG's who have been drinking and

> > > > > hope

> > > > > > > to

> > > > > > > > slide

> > > > > > > > > under the radar by garnishing some halo effect from

> > > > > other's

> > > > > > > with

> > > > > > > > an

> > > > > > > > > incidental low level positive EtG. We all know their

> > > > fate.

> > > > > I

> > > > > > > hope

> > > > > > > > my

> > > > > > > > > post is not considered too lengthy, especially with me

> > > > > adding

> > > > > > > the

> > > > > > > > body

> > > > > > > > > of my letter to the Texas Medical Board. If it is,

> please

> > > > > > > accept

> > > > > > > > my

> > > > > > > > > apologies. I'll not repeat it. Most Respectfully,

> > > > > J.

> > > > > > > > DiBona, M.D.

> > > > > > > > >

> > > > > > > > > September 11, 2006

> > > > > > > > >

> > > > > > > > > Tomeo

> > > > > > > > > Texas Medical Board

> > > > > > > > > Compliance Officer

> > > > > > > > > P.O. Box 3272

> > > > > > > > > McKinney, TX 75070-3272

> > > > > > > > > 972-529-5837

> > > > > > > > > Fax 972-529-5681

> > > > > > > > >

> > > > > > > > > Mr. Tomeo;

> > > > > > > > >

> > > > > > > > > This is my formal response to the information you

> > > > provided

> > > > > me

> > > > > > > > over the

> > > > > > > > > telephone September 8, 2006 around 1100. I wish to

> convey

> > > > > no

> > > > > > > > degree

> > > > > > > > > of inattentiveness or casual approach to my board order.

> > > > I

> > > > > > take

> > > > > > > my

> > > > > > > > > commitment very seriously.

> > > > > > > > > Information provided to me:

> > > > > > > > > My urine drug screen from August 29, 2006 was positive

> > > > for

> > > > > > > > ritalinic

> > > > > > > > > acid and EtG at a level of 103 (I don't know the units.)

> > > > > > > > > My response is:

> > > > > > > > > I am in full compliance with my board order and have not

> > > > > made

> > > > > > > any

> > > > > > > > > mistakes.

> > > > > > > > > My thoughts about my EtG positive urine are:

> > > > > > > > > . Daily, significant cutaneous exposure to high

> > > > > concentration

> > > > > > > > ethanol

> > > > > > > > > occurs when I use the standard, hospital provided foam

> > > > > hand

> > > > > > > > cleanser.

> > > > > > > > > . Due to scheduling changes I was physically in the

> > > > > hospital

> > > > > > > > August

> > > > > > > > > 27th at 0700 until August 28th 2100. I rounded with my

> > > > > team

> > > > > > > August

> > > > > > > > > 29th 0600 to just before giving my urine drug screen at

> > > > > > > > approximately

> > > > > > > > > 1100 by memory.

> > > > > > > > > . August 25th and August 26th were " routine " clinical

> > > > days

> > > > > at

> > > > > > > the

> > > > > > > > > hospital, followed by AA from 1800 to 1900. In the

> > > > > evenings I

> > > > > > > > > performed intensive swimming pool cleanup and recovery

> > > > > from

> > > > > > an

> > > > > > > > algae

> > > > > > > > > bloom. I believe this activity may have altered my skin

> > > > > > > > absorption of

> > > > > > > > > ethanol by removing superficial skin cells and

> protective

> > > > > > oils.

> > > > > > > > > . On the same dates I also deep cleaned my carpets.

> These

> > > > > are

> > > > > > > the

> > > > > > > > > only additions to my daily routine. Both nights ended

> > > > near

> > > > > > > 0100.

> > > > > > > > > . I was recently started on Xyrem. Ethanol is not listed

> > > > > as a

> > > > > > > > > component of this medication.

> > > > > > > > > . My albuterol inhaler has an alcohol based

> > > > > > propellant/carrier.

> > > > > > > I

> > > > > > > > > have not used my inhaler for several months.

> > > > > > > > > . I have avoided ethanol containing gasoline.

> > > > > > > > > . There is no " accidental " ingestion of alcohol in the

> > > > > form of

> > > > > > > > > vanilla, mouthwashes, foods, communion wine etc. I take

> > > > my

> > > > > > order

> > > > > > > > > seriously, and avoid these things absolutely.

> > > > > > > > > The foam hand cleanser is the only source of

> > > > environmental

> > > > > > > ethanol

> > > > > > > > > exposure I knowingly experience. Avoiding its use is

> > > > > > difficult,

> > > > > > > as

> > > > > > > > > alcohol foam is superior to soap and water in reducing

> > > > > > > nosocomial

> > > > > > > > > hospital infections. I request formal Texas Medical

> Board

> > > > > > > > guidance in

> > > > > > > > > writing advising me on continued alcohol foam hand

> > > > > cleanser

> > > > > > use.

> > > > > > > > >

> > > > > > > > > I am in absolute compliance with my order. I have

> > > > receipts

> > > > > and

> > > > > > > > > bottles of the cleaning materials I used. I continue to

> > > > be

> > > > > an

> > > > > > > > example

> > > > > > > > > of expert physician medical care, professionalism,

> > > > > recovery

> > > > > > and

> > > > > > > > > responsibility. I am an outstanding example of

> compliance

> > > > > > with

> > > > > > > the

> > > > > > > > > Texas Medical Board.

> > > > > > > > >

> > > > > > > > > Respectfully,

> > > > > > > > >

> > > > > > > > > J. DiBona, M.D.

> > > > > > > > > Assistant Professor of Medicine

> > > > > > > > > UT Southwestern Medical Center

> > > > > > > > > 5909 Harry Hines Blvd. . Dallas, TX 75390-8889

> > > > > > > > > danieldibona@

> > > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

September 14, 2006

,

Your going to present all of this,... just as bold as you've presented it here... to The Board when you meet with them right? Are you going in by yourself, or with a lawyer?

I'm also a Texas physician, in the Program ,finishing out my time, and I feel this Board in particular is poorly informed with regard to alcohol and drug use. What they are concerned about is the DALLAS MORNING NEWS so that is where the pendulum needs a counter weight. The articles from a few years ago looking in to lax punishment for BAD doctors is what changed a caring supportive recovery program, treating substance abuse as a medical problem just like diabetes, to a punitive and criminal public show, meant to show the DALLAS MORNING NEWS how they are protecting the people of Texas. Meanwhile, perhaps disregarding good common sense in the care, medically, of a person who perhaps didn't understand they were in an addictive cycle. Furthermore, a person with the Medical problem of addiction is listed alongside those with obvious criminal activity such as medicare and billing fraud or patient molestation.

And another thing, when you leave your hearing in Austin, What about the discrimination you face in your community. In Plano, specifically, you can't belong to the PPG billing group because "Thay don't take too kindley to your type", and Blue Cross/ Blue Shield of North Texas has taken it upon themselves to never let a physician with a prior substance abuse issue be on their panel. I believe that is poorly informed and discriminatory.

If you have a Board order, ...you have it displayed on a website,... it says you have to go to AA meetings,...at your AA meetings you have to sign your logs,...your 11th tradition says the program is based on attraction not promotion and that we should never be displayed in public lists as we keep anonimity at the level of press, radio, and films,..therefore you can't fully comply with your AA program,... which the Board sent you to,... in their order. again poorly informed and disrespectful to a program that I actually like.... for me

But your hearing is about keeping your license, so you can continue to be a good doctor for the patient's you care about and that care about you. take your ass pounding and live to fight another day,... perhaps in the media, perhaps at THE DALLAS MORNING NEWS where the discrimination was started.

Now,since your new, this is what will happen, Lorie and , will somehow take this posting as a direct attack on them, ... and fire back some comment which indicates that they really didn't read the posting. ( Let's see what happens.)

BOB

September 14, 2006

Dr.

Bob,

I don’t do anything with the Texas

Medical Board alone since 2003 when an isolated missed urine drug screen cost

me my license for two years and zero of how I lived my life, documented my

sobriety, provided indigent care to underserved areas and most of all, my

length of documented sobriety had zero impact upon them. I am aware of

the The Dallas Morning News.

As it is against one of our board rules to

speak disparagingly about the The Texas Medical Board, and is punishable by

revocation of our medical license we should talk privately. I’m in Dallas. You are in Plano. I’m glad to

meet you at a meeting sometime.

Dan

Re:

Re: Texas Medical Board

,

Your

going to present all of this,... just as bold as you've presented it here... to

The Board when you meet with them right? Are you going in by

yourself, or with a lawyer?

I'm

also a Texas physician, in the Program ,finishing out my time, and I feel this

Board in particular is poorly informed with regard to alcohol and drug use.

What they are concerned about is the DALLAS MORNING NEWS so that is

where the pendulum needs a counter weight. The articles from a few years

ago looking in to lax punishment for BAD doctors is what changed a caring

supportive recovery program, treating substance abuse as a medical problem just

like diabetes, to a punitive and criminal public show, meant to show the

DALLAS MORNING NEWS how they are protecting the people of Texas.

Meanwhile, perhaps disregarding good common sense in the care, medically, of a

person who perhaps didn't understand they were in an addictive cycle.

Furthermore, a person with the Medical problem of addiction is listed alongside

those with obvious criminal activity such as medicare and billing fraud or

patient molestation.

And

another thing, when you leave your hearing in Austin, What about the

discrimination you face in your community. In Plano, specifically, you can't

belong to the PPG billing group because " Thay don't take too kindley to

your type " , and Blue Cross/ Blue Shield of North Texas has taken it

upon themselves to never let a physician with a prior substance abuse issue be

on their panel. I believe that is poorly informed and discriminatory.

If you

have a Board order, ...you have it displayed on a website,... it says you have

to go to AA meetings,...at your AA meetings you have to sign your

logs,...your 11th tradition says the program is based on attraction not

promotion and that we should never be displayed in public lists as we keep

anonimity at the level of press, radio, and films,..therefore you can't fully

comply with your AA program,... which the Board sent you to,... in their order.

again poorly informed and disrespectful to a program that I actually like....

for me

But

your hearing is about keeping your license, so you can continue to be a good

doctor for the patient's you care about and that care about you. take your ass

pounding and live to fight another day,... perhaps in the media, perhaps

at THE DALLAS MORNING NEWS where the discrimination was started.

Now,since

your new, this is what will happen, Lorie and , will somehow take

this posting as a direct attack on them, ... and fire back some comment

which indicates that they really didn't read the posting. ( Let's see what

happens.)

BOB

September 14, 2006

No thank you Dr. Bob, I don't attend every argument I am invited

to...but thanks for the invite just the same....truly thoughtful of

you...I am very grateful!

>

> ,

> Your going to present all of this,... just as bold as you've

presented it

> here... to The Board when you meet with them right? Are you going

in by

> yourself, or with a lawyer?

>

> I'm also a Texas physician, in the Program ,finishing out my

time, and I

> feel this Board in particular is poorly informed with regard to

alcohol and

> drug use. What they are concerned about is the DALLAS MORNING NEWS

so that is

> where the pendulum needs a counter weight. The articles from a

few years ago

> looking in to lax punishment for BAD doctors is what changed a

caring

> supportive recovery program, treating substance abuse as a medical

problem just like

> diabetes, to a punitive and criminal public show, meant to show

the DALLAS

> MORNING NEWS how they are protecting the people of Texas.

Meanwhile, perhaps

> disregarding good common sense in the care, medically, of a person

who perhaps

> didn't understand they were in an addictive cycle. Furthermore, a

person

> with the Medical problem of addiction is listed alongside those

with obvious

> criminal activity such as medicare and billing fraud or patient

molestation.

> And another thing, when you leave your hearing in Austin, What

about the

> discrimination you face in your community. In Plano, specifically,

you can't

> belong to the PPG billing group because " Thay don't take too

kindley to your

> type " , and Blue Cross/ Blue Shield of North Texas has taken it

upon themselves

> to never let a physician with a prior substance abuse issue be on

their

> panel. I believe that is poorly informed and discriminatory.

>

> If you have a Board order, ...you have it displayed on a

website,... it says

> you have to go to AA meetings,...at your AA meetings you have to

sign your

> logs,...your 11th tradition says the program is based on attraction

not

> promotion and that we should never be displayed in public lists as

we keep

> anonimity at the level of press, radio, and films,..therefore you

can't fully comply

> with your AA program,... which the Board sent you to,... in their

order.

> again poorly informed and disrespectful to a program that I

actually like....

> for me

>

> But your hearing is about keeping your license, so you can continue

to be a

> good doctor for the patient's you care about and that care about

you. take

> your ass pounding and live to fight another day,... perhaps in the

media,

> perhaps at THE DALLAS MORNING NEWS where the discrimination was

started.

>

> Now,since your new, this is what will happen, Lorie and ,

will somehow

> take this posting as a direct attack on them, ... and fire back

some comment

> which indicates that they really didn't read the posting. ( Let's

see what

> happens.)

>

> BOB

>

September 14, 2006

---I attend every argument I am invited to, and even those I'm not.

My fragile feelings are hurt that drbobperry didn't invite me though.

If I understood his post he was recommending that Dr. Dan just bend

over and take it. While it is true that one should pick their

battles and live to fight another day, I believe this is a battle

that needs " a pickin " .

He did say something thought that upset me. The fact that Drs with

addiction were placed on lists beside criminals really pisses me

off. But......this is what happens when a bunch of retards are

running the addiction trickment industry. These " drug counselors "

and " addiction drs " are the REASON people feel the way they do about

people with addiction.

Even thought they call addiction a " disease " , (this is so they can

bill for it), they treat it using a moral model. When people hear

that people with addiction are selfish, self centered, liars,

cheaters, theives who are always on the precipice of relapse, they

believe it. They believe it because it comes from " professionals " .

However, NOBODY knows the truth. That the people who run the

trickment are typically BAT SHIT CRAZY!

In Ethylglucuronide , " nautiques5 " <nautiques5@...>

wrote:

>

> No thank you Dr. Bob, I don't attend every argument I am invited

> to...but thanks for the invite just the same....truly thoughtful

of

> you...I am very grateful!

>

> >

> > ,

> > Your going to present all of this,... just as bold as you've

> presented it

> > here... to The Board when you meet with them right? Are you

going

> in by

> > yourself, or with a lawyer?

> >

> > I'm also a Texas physician, in the Program ,finishing out my

> time, and I

> > feel this Board in particular is poorly informed with regard to

> alcohol and

> > drug use. What they are concerned about is the DALLAS MORNING

NEWS

> so that is

> > where the pendulum needs a counter weight. The articles from a

> few years ago

> > looking in to lax punishment for BAD doctors is what changed a

> caring

> > supportive recovery program, treating substance abuse as a

medical

> problem just like

> > diabetes, to a punitive and criminal public show, meant to show

> the DALLAS

> > MORNING NEWS how they are protecting the people of Texas.

> Meanwhile, perhaps

> > disregarding good common sense in the care, medically, of a

person

> who perhaps

> > didn't understand they were in an addictive cycle. Furthermore,

a

> person

> > with the Medical problem of addiction is listed alongside those

> with obvious

> > criminal activity such as medicare and billing fraud or patient

> molestation.

> > And another thing, when you leave your hearing in Austin, What

> about the

> > discrimination you face in your community. In Plano,

specifically,

> you can't

> > belong to the PPG billing group because " Thay don't take too

> kindley to your

> > type " , and Blue Cross/ Blue Shield of North Texas has taken it

> upon themselves

> > to never let a physician with a prior substance abuse issue be

on

> their

> > panel. I believe that is poorly informed and discriminatory.

> >

> > If you have a Board order, ...you have it displayed on a

> website,... it says

> > you have to go to AA meetings,...at your AA meetings you have to

> sign your

> > logs,...your 11th tradition says the program is based on

attraction

> not

> > promotion and that we should never be displayed in public lists

as

> we keep

> > anonimity at the level of press, radio, and films,..therefore

you

> can't fully comply

> > with your AA program,... which the Board sent you to,... in

their

> order.

> > again poorly informed and disrespectful to a program that I

> actually like....

> > for me

> >

> > But your hearing is about keeping your license, so you can

continue

> to be a

> > good doctor for the patient's you care about and that care about

> you. take

> > your ass pounding and live to fight another day,... perhaps in

the

> media,

> > perhaps at THE DALLAS MORNING NEWS where the discrimination was

> started.

> >

> > Now,since your new, this is what will happen, Lorie and ,

> will somehow

> > take this posting as a direct attack on them, ... and fire back

> some comment

> > which indicates that they really didn't read the posting. (

Let's

> see what

> > happens.)

> >

> > BOB

> >

>

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