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OK, so before the president got coronavirus, which is sending everything now to some new and unforeseen reality, there were certain things about the U.S. that had settled into predictable rhythms.

Right.

The president would talk about rioters in the streets and law and order. Joe Biden would talk about Donald Trump's character in the way he's done his job.

And when it came to the actual process of voting in the mail, in ballots that are going to be used by record numbers of people this year, the talking points lined up like this, the president said that mail in ballots were going to be a disaster. Joe Biden said they were a perfectly good way to vote. The experts said the evidence backed up Biden. Then the president would again insist that they are disaster. Biden would again say no. The experts would again back him up.

The president again would call them a disaster around and around and around in a circle that never ended. A very tedious circle.

But, you know, we can remove ourselves from that circle, right? For a little perspective. Good evening, Talamona comes for a few weeks now, one of our producers, Ben Calhoun, has been calling around to the people who actually handle these ballots, that everybody has been yelling about. These people touch them with their hands. They stack them in stacks.

Ben Yeah. So the person you're hearing this is Wendy Smith. She's the person who's responsible for running the election and dealing with mail in ballots and all that in a small town in my home state, which is Wisconsin. She's in Tacoma, which is way up north. And I called Wendy because I was wondering how this bizarre year was going for clerks like her. I had seen Wendy in a newspaper story. She had tattoos on both arms and this T-shirt that said, why should only one hour be happy?

And said that you rode motorcycles. And I just kind of thought I wanted to talk to her.

When I originally reached out to her, she was busy sending out absentee ballots to people who had requested them.

You don't mind if I like work and talk at the same time, do you?

No, no. I actually imagine that you have a lot to do right now.

Yeah, I came in to turn in an absentee ballot then, and I've got a stack more that have to go. Oh, so how many total are you looking at compared to like a normal year? Oh my gosh, my last presidential I had one hundred absentee voters four years ago, total. I've already almost tripled for this election. What I did four years ago tripled.

So that's like 300 voters out of maybe a thousand that she's responsible for. Wow. And she's getting more requests every week. I've talked to one of you a couple of times now, actually, and both times she has worked the entire time that we've been talking.

You can hear her keyboard and her printer going in the background like the whole time, as I've been talking to, I printed off all my absentee ballot requests because I have to have them open and done.

And in the mail today, Wendy told me in all her years as clerk, this is definitely the most work she's ever had to do for elections. And one of the reasons for that is that the legislature and the governor keep fighting over how everything should run. There are also lawsuits in Wisconsin like there are all over the country about what the rules for the election should be.

And all the little changes that come out of that stuff can be a ton of extra work for Wendie, like in Wisconsin. At one point they changed the rule about how many days somebody has to be a resident in order to vote. So Wendy started scrambling to fix all that. She's like redoing all these envelopes and then they just changed the rule back, meaning that all of that scrambling and work was for nothing.

So then you went back to trusting your envelopes. So all the envelopes that I see, you're laughing.

But, you know, one man show, one that, you know, I'm just so sorry.

Like, I imagine you like I just had an image of you buying Pepto abysmal at Costco, buy the keys or something.

Yeah. And compared to a normal year, like how many more times work do you feel like you're doing this year?

And it's a full time job. Is this your only job?

No, this is my part time job.

Well, what is your what do you do when you're not doing this? I work for an insurance company. I'm still working, plus putting overtime in there, plus working here. Oh, my gosh. Which is fine.

When do you when do you sleep. Oh.

OK, so she's got rule changes, she's got tons of extra ballots she's got to keep track of. Mm hmm. And the other big thing that's taking up a bunch more time is helping voters because people will just like fill things out wrong or they don't know where their ballot is. Like I talked to her the other day and she was telling me about this couple.

I got to try to locate their number, their snowbirds. Their ballot went down to Florida. They're not there yet. The ballot came back. And now I got to try to find a way to reach them. Oh, wow. Right. So I get to dig through about 300 app applications to try to find their if they if they have a phone number.

So when he was trying to find them, which it seems like something she kind of does a lot like, she digs up numbers for people. She finds people on Facebook.

So now we know where they live. I can probably drive over there when I'm done with work and say, hey, what do you want to do?

The clerks that I've been talking to, they all kind of talk like this, like they have this down to earth sort of civic mindedness. Yeah. Like there's this other clerk, Marilyn Pedretti. She's in this town called Holland, which is slightly bigger than the Nokomis. It's like 4300 people. And Marilyn Pedretti spent five years in D.C. where she worked for a congressman and then she worked in the Senate, but she got sick of Washington. And so she spent the last 20 years as the town clerk for Holland.

I want votes to count. I will not disenfranchise somebody and be lazy. I will do everything I can. I try to find their phone number first. If I can't find that to try to email. If I don't have that, I'll send them a letter. So, yeah, we're doing everything we can to make sure those votes come.

The one thing I find very frustrating is that the conspiracy theories that are out there and people believe I'm like, Hello, I'm your town clerk.

I am not going to throw your ballot away and you can track it.

There's no way I can throw your ballot away, you know, so when you hear these stories about somebody picked some ballots out of a garbage and they open them up, it's like no one, whoever opened them up should be put in jail because you cannot open up the ballot.

You know, it's sealed. You have to leave it sealed until Election Day. So and we have eighteen hundred municipalities listed. Wisconsin, it's not centralized. You would it would take 1800 clerks to do the wrong thing.

Either clerks out there that make mistakes.

You bet.

But when people come in with these conspiracies that that the whole system is rigged, I'm like, no, no, it's not.

All the clerks that I talked to, and this is in like Republican areas and Democratic areas, they all seemed like this was sort of driving them a little nuts. People getting the idea that what they do is very lossy goosey and that people are just going to cheat the system to them. That's just outlandish because they say that there's too much security built into everything. Security like what?

Well, they keep track of every request for a ballot. Unless you can't leave the house, you have to submit your ID to get an absentee ballot clerk's, put tracking info on the ballot and then they keep track of them when they're sent out and then coming back. And then, like when it comes back in, it has to have a voter signature and a witness signature for verification at the end of the whole election. They also have to report back to the state what ballots ended up where, like which ones went out and came back in which ones, you know, went out and never came back.

Say somebody moves and they ask for a ballot in a new location. That's also something the state tracks. And I just want to say it like Wisconsin is pretty typical for like how all this stuff works.

I feel like all these details exist in this universe that doesn't overlap in any way with the discussion that I see in the national media and the arguments that I heard during the presidential debate.

It seems kind of sad that that universe, the national politics universe, is lobbing grenades into these women's universe.

Yeah, no, I mean, I've been at this for a couple of weeks and I haven't found one Clark, that is worried about fraud. All of them are worried about, like the rule changes and the number of extra mail in ballots. I mean, they think they can deal with that. It's just a lot more work.

But they're running into these conspiracy theories a lot. GOGOI Yeah, no. Yeah, yeah. No, that's what I'm hearing. Maryland, she looks like Wendy. She's a clerk part time and she also gardens two acres and she sells vegetables on the side of the highway.

I mean, I have a roadside stand and I'm out there and people know who I am. And they'll talk to me about election stuff, which is fun. But this woman who's out there buying my vegetables and knows that I'm the town clerk is telling me that all these dead people are voting. It's like, no, it's pretty much impossible in the state of Wisconsin for a dead person to vote if they had died the day before election, maybe I'll not catch that and maybe that ballot will go through.

But that's one vote. It's not like the whole cemetery is voting, you know. So and I just looked at her, you know, and the clerk, right? Yeah. Yeah. Do you think I would let people vote? Well, no, not you, but somewhere else I said can't happen in the state of Wisconsin. Well, it it happens in other states.

I know it doesn't stop. Stop listening to that stuff, you know, and I do it cheerfully. I don't, you know. Yeah. I just like it's just it's just wrong. And you got to stop listening to that stuff, you know.

Ben Calhoun, thanks very much. Oh, sure. You're going to stay in touch with these clerks as everything heats up in the next couple of weeks.

I mean, as long as they answer my calls, there are so many jobs like this around the country.

Some of them are part time like with these two women. Some of them are full time, some are paid jobs, lots of volunteer or people get some tiny stipend.

These are people who are throwing themselves into the details of some tasks that just needs to get done for our country to function and doing it in the normal, decent, civic minded way that you would imagine and that you would hope for. And it's going to say it. But we are a country blessed with armies of people who are trying to contribute to the communities and all kinds of ways. And today's program is about a group of people like that, people who are, as best as we can tell, trying to do a good job for all of us.

They're trying to protect the public. But in this case, too often they're failing from Chicago to this American life. I'm IRA Glass.

Stay with us. At one clinical trial, so the people that most of today's program is about are doctors, doctors have agreed to sit on panels to judge other doctors, to discipline them or revoke their licenses when they behave badly.

Every state has these medical boards.

They grant medical licenses and they're the ones responsible for taking them away. We heard about all this from a law professor at Vanderbilt, Rebecca Ounsworth. In twenty, she started going to medical board hearings in Tennessee where she lives. It was research for a book that she plans to write about licensing boards and what she saw when she got there horrified her.

The service is going to take it from here when it comes to the Tennessee Board of Medical Examiners, Rebecca is like the one die hard fan in the stands at a town softball game. She knows all the board members by name. She's interviewed most of them, attended all their meetings in person or watched the live stream. She even went to their offsite retreat last year before you went to any medical board meetings.

How did you imagine they would be? I thought they'd be pretty boring, but, yeah, I think I also thought it was going to be like in some sort of grand state government building, I think I had like the, ah, state capitol in mind or something, but it's just like an office park.

So, yes, I describe what it actually looked like.

It's like a, you know, three or four story square office building, you know, probably built in the 70s or 80s. This is Nashville. So there's copious parking and it sounds like Dunder Mifflin to me. Oh, my God. It looked just like Dunder Mifflin. It looked just like Dunder Mifflin, the first meeting she went to. And Ogwyn appeared before the board to request a new medical license. The board had taken his old license away six months before when they learned that he'd had sex with 11 of his patients.

He'd done drugs with at least one of them, too. He'd also prescribed them and other people who were not his patients controlled substances like codeine and Xanax. So this doctor was there to ask the medical board for a new license. All that stuff, the sex, the drugs had happened years before he'd been to rehab sober now saw the error in his old ways and the board gave him a new license with some conditions attached. But he could practice medicine again.

Rebecca couldn't believe it. There just has to be some sins that are unforgivable in the eyes of the board. The board is a regulatory body.

They're not they're not your priest. You know, they're not deciding whether or not you've really you're really sorry. They're deciding whether or not you're a safe provider.

Officially, the board's mission is to protect the health, safety and welfare of people in the state of Tennessee. Board members and staff repeat that mission all the time like a mantra. But since Rebecca's been following the board, she's seen a bunch of cases like that OBGYN where doctors have done something really bad, seemingly irredeemable, and somehow they've managed to keep their medical licenses. They're out there working as doctors in Tennessee right now. So this became the question of her research, what was going wrong in the system?

Why were these doctors allowed to keep working? One case in particular became the focus of her attention because it seemed like a perfect storm of regulatory failure, and that's what I'm going to tell you about today. It's about a doctor named Michael La Paglia. I'll start the story. Back in 2013, the Paglia was working as an E.R. doctor at the time. And late one night, police got a call about a domestic disturbance at his house. When the police arrived, they smelled weed and searched the house.

They found. Actually, let me just read from the police officer's affidavit, quote, A search of the residence pursuant to the search warrant revealed. Forty five quart sized mason jars which contained marijuana. Seven glass pipes used to smoke marijuana. Glock 19 nine millimeter growe light with ballast timer, digital scale and ledger detailing names. Amounts also discovered where approximately 52 diazepam, 22 amphetamine and twenty four oxycodone pills. In addition, police found on a shelf in the Paglia's office vials of fentanyl, morphine and propofol, which is used for general anesthesia.

The Paglia's girlfriend told police that he had threatened to use that stuff to kill her. In the petition, she filed for a restraining order. The next day, she said, quote, Michael told me that if I ever contacted the police for help or reported his drug use, Michael would use his powers as a physician to have me committed to a psychiatric facility. Michael stated he would make sure my body wouldn't be found. Michael stated that he would take my life away.

I'm in fear for my life, in my son's life. The Paglia told police his girlfriend was delusional. He was arrested and charged with two drug felonies, intent to distribute a controlled substance and intent to distribute marijuana. He pled no contest and went to inpatient rehab. He was addicted to Valium at the time. He lost his job at the hospital. The medical board put him on probation and he surrendered his DEA registration number, which is the thing you have to have to prescribe controlled substances.

That's a big deal. It's very hard to get a job once you've lost your DEA number. No one wants to touch him.

No, no employer's going to take him. Very few employers anyway with a record like that. Private insurance. Forget it. Hospital, forget it. A few years later, he filed for bankruptcy because, you know, there's there's no way to earn money back at the same clip as you are as an E.R. physician, but he got a job at an addiction clinic, a friend of his owned.

It was called C Express Health Care. The Bagli would see patients like a regular doctor work up a treatment plan and everything, and then another doctor would write their prescriptions. Dr. Lee Piglia helped a friend of his, Dr. Charles Brooks, get a job at Express Health Care to Dr. Brooks was also on probation with the medical board. He'd had sex with a patient. He says they were having an affair and at least once, given her controlled substance, he says, to calm her nerves because they were having an affair.

But unlike Dr. Paglia, he did not lose his DEA number. He could still prescribe.

Dr. Lee Paglia left DHC and in early twenty eighteen, he and Dr. Brooks started up a little side business, so he and Dr. Brooks kind of hatched this plan.

Lurpak, Leon Brooks realized, OK, well, here's what we're going to do. We're going to start a clinic called LMB Health Care, LA Paglia and Brooks. But Paglia doesn't have a DEA number, so we'll use Brooks's the Paglia's going to do the work. He's going to write the prescriptions. It's his phone number on the prescription pad that they make out. But it's Brooks's DEA number and it's Brooks's signature. Sometimes they were preassigned. Sometimes the pagla forged the signature.

Oh, they sell them for three hundred dollars cash out of the package in his home at least once in a McDonald's parking lot.

LMB Health Care didn't have an actual brick and mortar office. The pagla would see people wherever it was convenient, write prescriptions for controlled substances like Klonopin, Valium and Suboxone. When the facts came out about their operation, it looked like they were selling prescriptions for cash like drug dealers with stethoscopes.

The Pagliano, Brooke, say that's not the case at all, that they were legitimately treating people with addiction problems by prescribing them controlled substances. It's something called medication assisted treatment, like the way methadone is used to treat heroin addictions. So that's what they said they were doing. Regardless, it was still illegal. A few months into the venture, the feds busted them, charge them with drug trafficking for writing prescriptions for controlled substances without the authority to do so, and fraud for using Brooks's DEA number in the scam.

Brooks pled not guilty, but Dr. La Paglia's signed a plea deal with federal prosecutors. He's still waiting to be sentenced, but he could be facing prison time.

So that's the federal criminal court. Paglia's still had to face the Tennessee Medical Board, and when they found out about LMB health care, they summarily suspended the doctor's medical licenses until they could hold disciplinary hearings for them. The case unfolded over three hearings from March to July 20, 19, the first one in March was the disciplinary hearing for the Paglia's partner, Dr. Brooks. Rebecca was there, she'd been going to medical board meetings for a year at that point, and I see this guy who is doing something that actually even I think the physicians on the board find really offensive, which is giving up control of your your pad.

And to to hand it over to somebody else is really seen as pretty unethical. Most doctors don't view their patas as a moneymaker. These medical board disciplinary hearings are technically administrative courts, they run kind of like the criminal and civil court systems, but the question they're addressing is more pointed. It's whether a doctor should be allowed to continue to practice medicine. Dr. Lee Paglia agreed to testify against Dr. Brooks in front of the medical board, the signature on that prescription drugs that you're seeing for the first time, right?

Yes, just to set the stage, the guy asking the questions is Andrew Kaufman. He's the prosecuting attorney. He works for the Tennessee Department of Health Prescription.

Dr. Lou Pagla is the one answering his questions while you were partners with Dr. Brooks. To your knowledge, was he aware that you were signing his name to my prescriptions? Yes. What makes you think that he was aware? Because sometimes I would run out of free time prescriptions and had to do what I had to do to take care of the patient. And we've discussed it. When you went to work for with. Dr. Brooks, did you believe that what you were doing was against the law?

No, doctor, the heckler was like, yeah, I think we probably cut some corners. I think, you know, mistakes were made.

So we discussed it and we knew that what we were doing wasn't ideal because we had very little resources to get started, but we never imagined that we were breaking the law.

His general attitude was like an error in judgment. You know, not a big deal.

Has your opinion changed about whether you were breaking the law? Yes. Why? Because federal prosecutors have convinced me otherwise.

I spoke with Dr. Lou Paglia. He didn't want me to record our conversation and we didn't talk for long before he got off the phone, but he reiterated to me that he and Dr. Brooks didn't think they were doing anything wrong when they worked in addiction clinics. The doctors there would hand prescriptions to receptionists and the receptionist would call them into a pharmacy. It happened all the time. He told me, quote, We did not see any difference between him giving me verbal authorisation to call them in and verbal authorization to write a prescription.

I still don't see a difference. And if someone had a problem with that, the federal government had a problem with that. They could have just told us to stop. They didn't have to indict us and charge us with two felonies.

I reached out to Dr. Laperriere several times after that initial call, but he declined my request to talk further.

There were three board members hearing Dr. Brooks's case that day, and they were not swayed by this defense, that they didn't know they were doing anything wrong, that they were just trying to help their drug sick patients. In fact, the board members suspected that LMB health care was not a legitimate business at all. Here's Dr. Charles Hahndorf, one of the board members questioning Dr. Lee Paglia. Did the clinic ever apply for or receive a business license? No.

Did the clinic ever apply for a register and articles of incorporation with the secretary of state of Tennessee? Has the clinic ever filed tax returns?

That's a date now.

OK, so sitting here, it sounds like this isn't a business at all. So that was Dr. Lee Paglia testifying at Dr. Brooks's disciplinary hearing in front of the medical board. Once Brooks's case was adjudicated, it was the paglia's turn for discipline. He and his attorney had worked out a deal with Andrew Kaufman, the Department of Health attorney. It's called the consent order. It's basically the board's version of a plea deal. So at the next board meeting in May, Kaufman presented this deal to the board members.

The board had to decide whether to accept it. Good morning, Intercropping with the Office of General Counsel.

And here's what the deal was.

Basically, Paglia could go back to practicing medicine in another month, but he'd be on probation for five years and he'd have to be monitored by Physicians Addiction Group and he'd be banned from prescribing controlled substances for two years.

It's similar to what Dr. Brooks got in March, but slightly less because the Paglia had admitted guilt and had testified against Brooks. It's what they call a downward departure in the criminal system. Cooperating witnesses often get lighter sentences. It's supposed to give people an incentive to tell the truth. But the board was not having it with this deal.

They looked at Paglia and saw a guy whose medical license was already on probation when he used another doctor's prescription pad to write a controlled substance, prescriptions. Here's Dr. John Hill, one of the board members.

This seems rather like I mean, we just had a physician whose prescriptions were stolen and his funds were significantly more than that. I can't in good conscience approve this. I'm sorry.

The board has 12 members appointed by the governor and three of them are not doctors. They're called consumer members, in this case, a real estate agent, an academic advisor and a political fundraiser. They were even more pissed than the doctors on the board.

This man doesn't need to be on the streets or in his office writing prescriptions in the state of Tennessee as far as I'm concerned. And we're charged with the responsibility of protecting the citizens of Tennessee. So that's my concern. So how do we get to that point? Well, you can. The only thing you can do today is reject this order. Thank you, Counsel, for this call. I would really appreciate your insight. And remember, I share their feelings completely.

I live in Knoxville and Donal's, which I you know, to think that he could be back there ever is scary to me as a consumer member. And for as I have young daughters and, you know, this man is not safe to be out in the public, I don't think. Mr Howard's representation here, this McDonald's is two blocks away from one of the major high schools in Knoxville. So, again, I agree with her. This man does not need to be on the streets with this type of ability.

All in favor of denying the motion for this order on Paglia S.I. The board rejected the plea deal. It was unanimous.

So now Dr. Lee Paglia's case will go to trial for the medical board version of a trial, a contested case hearing where he has the possibility of getting a much heavier discipline. They could suspend his license for even longer, for instance, or even revoke it altogether. I had been following this case.

And so, yeah, I wanted a full hearing. I wanted the opportunity to see Dr. LaPadula testify and to maybe talk to him.

And I figured everything was lining up for them to finally throw the book at somebody.

Rebecca had been to several of these disciplinary hearings by then. She'd seen so many doctors get away with what she considered to be light punishments.

But it seemed like the board was finally going to put its foot down with the Paglia Dataquest. Coming up, what goes wrong with the board gets a chance to finally put its foot down.

That's in a minute. And Chicago Public Radio when our program continues. Support for this American life comes from Capital One, welcome to Banking Reimagined Capital One. Checking and savings accounts have no fees or minimums and a top rated banking app that lets you manage your money any time anywhere. Check on the account balance deposit checks, pay bills and transfer money on the go. This is banking reimagined. What's in your wallet? Capital One and a member FDIC. Support for this American life comes from Squarespace, create a Web site to showcase your work, publish new content, or announce your upcoming events or performances and make it stand out with designer crafted templates that are e-commerce ready and all mobile friendly right out of the box.

Start your free trial and receive a special offer on your first purchase at Squarespace dot com American and use promo code American. A dream is just a great idea that doesn't have a website yet. Make it a reality with Squarespace. This American Life, I'm IRA Glass. Today's program. Trust me, I'm a doctor. We have stories about people trying to do civic minded things for their own communities. And in the case of medical boards, sometimes failing to accomplish that job the way that lots of us would want them to.

Right now, we are in the middle of dinner services story and we pick up where we left off. The medical board in Tennessee has rejected Dr. Gail Paglia's plea deal. And two months after that, at their next meeting, the board holds a hearing for his case. Here's Dana.

How these hearings work. They're basically mini trials. Each case gets assigned to a panel of three board members. The Paglia's panel was made up of two doctors and a consumer member. They sit at the front of the room facing everyone else. Yes, sir. And they're going to decide if the prosecutor has proven his case and if so, how to discipline Dr. Lee Paglia. There's also an administrative law judge who acts as a referee more than anything else.

Today, the board will be considering the case of the Tennessee Department of Health vs. Michael the Foglia.

They hold Dr. Lipgloss hearing in the Irish and name, which defies the interior decorators vision to beige carpet, beige walls, fluorescent lights, any.

Dr. Doctor Paglia is sitting at a table with his attorney facing the panel. For the record, the prosecutor, Andrew Kaufman, he's sitting at a table to the right. Rebekah's there to in the front row. Thank you.

It was really weird. It was weird from the first opening statements every moment when they did opening statements. Good morning.

I'm Andrea Kaufman, the firm I introduced myself earlier.

The prosecutor went first, Mr. Kaufman, and he said, we're going to hear a lot of facts today. Good, bad and ugly. You know, this is a rare case where we basically agree with defense counsel on everything.

And in an unusual twist, there's not much dispute between the parties about what those facts are, whether they're good, bad or ugly.

It was just kind of a halfhearted prosecution. I mean, OK, it's an administrative hearing. It's a little more casual than a criminal trial or something, but it's meant to be adversarial.

Now, I think that the evidence is going to show that Dr. Paglia. Believed that he was providing. Good treatment to people that actually have a need for that treatment, Kaufman is there to prosecute the Pagliaro, but it seems like he's going pretty easy on him like that 2013 drug bust, the one where the cops found Valium, oxycodone, amphetamines, marijuana, a gun, a scale, a ledger, paralytic agents and other sedatives.

Hoffman doesn't say the charge was possession with intent to deliver.

He just says LA Paglia pled to some charges that related to his own personal use of controlled substances outside the bounds of the law.

And the very next month, if I were prosecuting, I would probably use some stronger language than the Paglia's coming across as a guy who once struggled with the substance use disorder. But God help sobered up. And then in the course of trying to help other people who suffer from drug addiction is unwittingly bumbled his way into this next bit of trouble with Dr. Brooks. Here's how the Paglia's defense attorney also described him in his opening statement.

He may be dumb, but he's a good doctor. He's for he's responsible. He's done a lot to help the community.

It's like everyone in this trial was on Dr. Paglia's side is. I asked Andrew Kaufman why he handled the case the way he did. He said basically this case wasn't contentious by its very nature. His job was to prove that Dr. Laperriere had written prescriptions for controlled substances using another doctor's prescription pad. His star witness, Dr. Lou Paglia, who had admitted repeatedly that, yes, he had used Dr. Brooks's pad to write prescriptions for controlled substances. But also, there's another reason why the prosecution was maybe a bit anemic in this case, the Department of Health attorneys, Kaufman and his colleagues were feeling frustrated when this whole thing started back in March.

At Dr. Brooks's hearing, Dr. Brooks, the Paglia's coconspirator Kaufman had asked the board to revoke Dr. Brooks's license, but the board rejected that, said it was too harsh. So the prosecutors went easier on the Paglia in his plea deal and then the board rejected that, said it went too easy on him. There was no consistency to their logic, Kaufman's boss said later at a board retreat where they discussed this case, that they felt a little bit knocked down by the whole thing.

So Bagley Paglia's hearing Kaufman just presented the straight facts of the case and told the panel what their options were for disciplining him didn't suggest a punishment. They didn't know what the hell the board wanted, so they didn't try to guess. And this brings us to the single biggest problem Rebecca sees in the system, the doctors who sit on these medical boards.

It's a distinguished position to be on the Tennessee Board of Medical Examiners. They have to be appointed by the governor. There's a full time staff that supports the board attorneys, administrators, medical consultants, and they sit in judgment of doctors. But as far as judges go, they're amateurs. Most of them are doctors. They have lots of training in medicine and very little training in administrative law. The Decider's and Dr. Lee Paglia's case, the three board members on his panel were Julieanne Cole.

She's a consumer member, Dr. Phyllis Miller and OBGYN and Dr. Steven Lloyd. Dr. Lloyd was the newest member of the board. He'd never done any of this before. In fact, this was his second day on the job.

I hadn't even had orientation. I mean, I walked in. I never been to a board meeting.

I read all the rulings when they were like, we're going to split off into panels for the for the contested case hearings. Now, did you have any sense of what that meant or what it would look like?

No, no, no. So what did you do?

Did somebody tell you, like you go into this room with these people? What did they do? Yeah, she had a sideways bridge. I mean, I had no I had no idea.

You know, it's just a very confusing scene the first time you're in, because I just I just didn't understand the decorum. I didn't understand how this proceed. I mean, I had you know, I'm sitting in there and and when the guy who came in who looked like a judge and talked like a judge. But what does this look like? There's this real court. Am I the jury? And if I am the jury, do I behave the same way a jury behaves?

Dr. Lloyd told me he did have a brief orientation that morning, but no special training, no real prep for this. Basically, he was just thrown into it. So it Dr. Paglia's hearing he kind of winged it went with his gut and he identified with Dr. Laperriere. Dr. Lloyd is an addiction doctor. He spent two years as Tennessee's opioid czar. And also, like Laperriere, he's in recovery from a pill addiction.

And and so, you know, as they're presenting this, you know, here's this here's this figure that I don't know the background on that looks pretty sympathetic. He's done the things you need to do. I'm a second chance guy. He related to Dr. Le Paglia, he also made bad decisions while in the throes of a drug addiction, although to be clear, Le Paglia testified he was sober at the time he was writing the fraudulent prescriptions and had been for years.

I think I quoted, you know, hey, this guy did these things, you know? Well, I didn't write scripts. I you know, I stole medication from people, which is, you know, which is bad. And and I got better. And and I think he can get better.

For Lloyd, Paglia's said all the right things, he said he was drawn to treating people with addictions to Benz's because that's what he was addicted to. He said he took issue with the way addiction clinics were treating patients with benzo addictions, that they weren't giving them enough pills to taper effectively.

They were given possibly two weeks worth of benzodiazepine and then taken off. OK, and what would happen after they were taken off where they just clean up? It's never going to happen to what would happen. They're going to relapse 100 percent of the time.

I could see Dr. Lloyd nodding along, like when Dr. LaPadula was talking about, like the problem of dual addiction between opiates and Bonzo's.

And the problem of relapse on Benzyl was like I could see Dr. Lloyd nodding along when I heard from him, is I've got these patients who are addicted to benzoate. These doctors don't know what they're doing, trying to get them off. And you actually can't get them off that quick. They'll just relapse. He's exactly right. That's exactly right.

After the attorneys were done questioning Dr. Paglia, the board members got a turn to. First of all, thank you for coming today and being honest. Here's Dr. Lloyd. So you're training addiction is on the job from the folks at experience and then at our X Y reclass. Correct.

OK, but most of his questions, he's testing Leapai glib, trying to see if he really understands addiction medicine.

Can you tell me how you establish a diagnosis of substance use disorders severe through discussion, taking the drug history, going over medical history with the patient to answer? Did you ever follow the criteria of the DSM five for substance use disorders and classifications of more moderate and severe knowing for sure? OK, and then when you're trained, by the way, 100 percent agree with you about the prevalence of Benz's on the spot, but when you're when you're treating a benzodiazepine dependence, what what is your what is your goal?

Complete abstinence is the goal. OK, and so how do you get there? Extremely slowly. This goes on for several minutes. Dr. Lloyd only asks two questions about the LMB scheme itself. When they finally get to deliberations, Dr. Lloyd speaks first.

I'm the newest member of this committee or this board. And I was told that my charge was to protect the health, safety and welfare of the citizens of the state of Tennessee. And do I believe that that that taking doctors will paglia's license does that? I actually don't. I don't believe that it does that from what I saw today. And, you know, hopefully the discharge of somebody thought I saw somebody that cares about taking good care of a population that struggles to find help.

That's what I saw. One aspect of these medical board hearings that's very different from a criminal trial because of transparency laws in Tennessee, the panel members have to deliberate in the open in front of Dr. Lou Paglia. Rebecca says this is another reason the discipline can be so light. It's really awkward for them, raises some potential issues, like at one point, while the panel members are considering requiring Dr. Laperriere to get board certified in addiction medicine, Paglia interrupts the steers them away from it.

Do we want to require him to do that? Or and if he doesn't complete, I respectfully ask no, because I may change my mind or something else may happen. If I don't fulfill that requirement, I'm never going to get off probation.

The administrative judge has to break in and tell them to quit talking to each other some measure. In the end, here's what the panel decides.

They're going to restore Dr. Paglia's medical license, which had been summarily suspended in January when the board first found out about the LMB scheme as punishment.

They give him five years probation, make him report to the Tennessee Medical Foundation. It's a physician's substance abuse group, and they tell him to take a few professional courses. They don't prohibit him from prescribing controlled substances. He still doesn't have a DEA number. So technically he can't anyway. But he could petition the DEA to get it back. They don't restrict that either. It's actually a lighter discipline than what he would have gotten from the plea agreement, the one the board threw out for being too easy on him.

So, yeah, it was a slap on the wrist. Daughter of the Pagliaro was all smiles afterwards, so I had chatted with him at the breaks and. He was sort of saying, you know, I'm just hoping to get my license back and, you know, and I got this federal thing I got to deal with. And so for some reason, they decided to insert this language at the end that says and, you know, to give him a full a path back to full licensure.

And when they read that out loud, Dr. La Paglia winked at me. Oh. Which really surprised me. It just really surprised me. I was like, that just happen.

When you interpret his wink, I think that he was sort of saying, like, see, I'm getting what I wanted. I guess I think I went even better than he expected. And I think that might be why he winked at me. So I went up to him afterwards to talk to him. And by the time I had chatted with him a couple of times and he said something like, I'm just glad to have my license off of suspension so I can make some money.

It was a real kind of 180 from the like patient care test testimony that he had just provided.

I reached out to Dr. Lee Paglia about this, but he didn't get back to me.

So here you've got a doctor who lost his DEA number when he was caught with illegal prescription drugs and marijuana at his house in what looked very much like a drug trafficking operation whose medical license was put on probation, who then went out and broke the law again by using another doctor's DEA number to prescribe controlled substances. And now here he is back on probation with the medical board, still with a medical license, which means he can still work as a doctor in the years that she's been going to medical board meetings.

Rebecca has watched a bunch of doctors with egregious histories keep practicing medicine, doctors who have committed health care fraud, doctors who prescribe controlled substances for people who aren't their patients, doctors who have sex with patients.

One doctor prescribed large doses of opioids and other drugs, even though the patients had no medical reason for taking them. Prosecutors asked the board to permanently revoke his license, but he was only put on probation, as far as I can tell.

Tennessee is fairly typical. A statistical study ranked medical boards on a scale of how harsh to light their discipline was. Tennessee was smack in the middle. Of course, I'm talking about the worst cases the medical board sees and the board does revoke some doctors licenses since 2017. Seventeen, they've taken 13 licenses away and 11 doctors have voluntarily surrendered them. That's a significant punishment. As one board member explained to me, a medical license is technically a property. Right.

And it's a big deal to take someone's property from them.

But something does seem to be happening where medical boards, which are set up to protect the public, to protect the majority of us who never think, to ask whether our doctors are safe and operating in our best interests. Sometimes the medical boards are letting dangerous doctors continue to practice medicine.

Like on the one hand, I. I feel like on some level I understand this problem because I've spent so long studying it. I've seen all the angles, I've seen how the personalities play out and the incentives and the emotions and everything. But there's also a way in which I just don't get it. Like, I don't understand why they won't just take the guy's license.

What's the part of you that understands it? I think that there's a. ID that's not as specific as, oh, that could be me. That's still in play of just being a doctor like this is our calling, we went to similar through similar sets of trainings.

We started out walking down the same path. So I think there is some like identification at a kind of.

Very high professional level, like a circling the wagons, you know, like we're doctors, and then I think there's also and this is probably especially bad for doctors, but they're just kind of softies.

They just believe that everybody can be healed and can be made better and are sick and deserving of compassion. I mean, that's like what's like this really ironic and like sad to me is that it's in some ways this whole problem is created by that, like better part of human nature, the part that's full of mercy.

A solution to this whole thing? Well, I think we need to abolish licensing boards, to be perfectly honest. Instead of having doctors sit in judgment of other doctors and instead of having them do this as a favor to society every few months.

Rebecca says her full time employees whose job it is to regulate the industry, who are trained to notice when they're being affected by the emotional sway of a defendant and to put their feelings aside as much as possible like a judge. What Dr. Lloyd agrees with Rebecca.

In part, he admits he did relate to LA Paglia and it influenced how he thought about discipline. I saw the facts of the case written down on a piece of paper like this. Right now I'm starting to get to the bottom and I get to read that piece of paper without anybody from either side. Right.

And I just read that I'd revoke his license just based on the way he used another doctors DEA license number to prescribe patients just just just based on flat facts, drug charges used in other doctors, DEA license, you know, drug dealing or just just plain facts. No, no defense attorney. No prosecutor. I just saw that written down on a piece of paper. No, literally in a room. I revoke his license. Hmm. That's so interesting and this is well, it's something I've gained an appreciation for, and I think and I'm really trying to work on this as a board member.

It is very difficult to sit there with another human being in front of you and. You know what I want to say, drop the hammer. Yeah, it's a human being, but it's much easier on a sheet of paper, right? Because when I'm sitting there, I see a guy that's presented this way. He doesn't look emaciated. He looks healthy, he's dressed professionally. He's got a child. He has emotion around like me as a dad.

Do I want to give him a chance to get that back? Yeah, the. But it's not fair to say that's the whole reason the case went askew, the doctors look too kindly on a fellow doctor sitting before them, because when considering what to do with Paglia's medical license and whether he should be a practicing doctor, the board members never got a full airing of his past misdeeds. As soon as the hearing was over, Dr. La Paglia did something that made Dr.

Lloyd suspicious. I stood up and and, you know, was headed out and he approached me. And I can't remember his exact words, but it was very. Placating almost like. I appreciate what you've done in your own life. I would like to have that right, that kind of thing. Mm hmm. And I knew and I knew it was bullshit.

He felt like he was being manipulated. Something about the Paglia's aspect felt fake.

I knew I had made a mistake. My little man inside of me that I used as my barometer, people like, oh, man, Steve, this guy is a shyster. He kissed my ass and I couldn't fucking stand. I'm sorry because I'm just fine. I couldn't stand it. I couldn't stand. It wore me, so I went outside and Googled it. I said goodbye to everybody, I walked out to my car, I grabbed my phone or my truck.

I sat there and I Googled his name. And the first article that popped up in the way I searched it was the article about his his domestic violence. Andrew Kaufman didn't talk about the restraining order against the Paglia at the trial. It's not a criminal charge. And besides, he said, well, it clearly demonstrates bad conduct. It isn't bad conduct related to the practice of medicine, but that's not all. He left out in 2010 while working as an E.R. doctor, the Piglia did something that a federal appeals court said, quote, shocks the conscience.

The police brought a young man named Felix Booker to the E.R. They suspected Booker was hiding drugs on his body of his. But to be blunt, Dr. Paglia asked Booker to consent to a rectal exam. Booker was naked except for a blanket and in handcuffs and leg shackles. He said no. Paglia's says Booker consented to the exam, but nobody else who was in the room heard this, and there's no medical record of it. The Baglio tried to examine him.

Booker clenched his muscles so the Paglia had him sedated. Booker was still able to clench his muscles down, so the Paglia had him medically paralyzed, intubated him and did the rectal exam. He found a rock of crack. La Paglia testified Ebookers trial that he'd done rectal exams and two other people the police had brought in to him a year after that, there was a fourth guy, Wesley Gully. Gulley alleged he got the same treatment. Paglia asked him to consent to a rectal exam.

He said no. Paglia threatened to sedate him and paralyze him. So he relented. The Paglia did the rectal exam and found nothing. The police charged with resisting arrest. The hospital charged him for the rectal exam, but apparently nothing ever happened to Dr. Le Paglia. He wasn't criminally charged for the warrantless no consent rectal searches. He didn't even lose his job at the hospital. The searches were reported to the Department of Health, but Dr. Le Paglia was not disciplined for them.

And in a cruel regulatory irony, because he was not disciplined, there's no public record of why the board did not discipline him. Dr. Lloyd actually found out about the rectal searches from Rebecca. They had coffee a few weeks after Dr. Paglia's hearing. I mean, that's bringing up emotions right now, I can't even that's somebody who's taking advantage of their position of power. That's that's not forgivable. Maybe God could forgive him. I can't I can tell you this, if he paralyzed my son in the E.R. to fucking kill the.

I mean, I would have I would have went after I don't care, they just said, you know, well, you're going to, you know, pay consequences this day. But he paralyzed he he paralyzed his muscles. Against his against his consent, the guy did not give consent for that. Yeah, he had to be intubated. I mean, you couldn't even breathe. No, no, you can't. You paralyze all muscles in your diaphragm, a muscle.

Right. So you're not going to able to breathe. Yeah. And that's that's somebody who will do anything that's just incomprehensible to me. Dr. Lloyd and the other board members on the Paglia's panel, all they knew was that LA Paglia had been on probation with the board once before for charges related to his personal drug use, that he'd been treated for a pill addiction and had stayed sober all these years, and that he and Dr. Brooks got caught selling prescriptions using Dr.

Brooks's DEA number, which is a way tidier story than the one I just told you. But Kaufman didn't talk about the rectal searches that Dr. Paglia's hearing because of the rules of evidence. He told me it wouldn't have been admissible. Same for the details about the 2014 drug charges, which, by the way, after LA Paglia pled no contest, he was put into something called judicial diversion. It's a kind of probation and eventually the case was dismissed.

But more importantly, Kaufman said this wasn't a hearing about everything Laperriere had ever done, just this one crime, the fraudulent prescriptions. Dr. Lloyd didn't learn about the rest of it until it was too late. When I'm looking at him up there, I mean, look like he's doing what he was supposed to be doing. He's trying his best. Sure. That's what I felt. And I think I am a good judge of that, given all the facts.

Yeah, but I didn't have a whole facts. How many strikes do I believe that somebody gets the money they need in the real world? There's no such thing as the third strike to me. But this is not a real world. You have a professional medical license and you can harm others. There is a strike limit there. Dr. Lloyd says he asks a lot more questions now during these cases, so how to keep this from happening, how to make sure the board gets a full picture of a doctor's career and past misdeeds before they decide how to discipline them?

Rebecca points to a simple and practical solution, separate the disciplinary hearing into two parts, have one hearing where the board hears evidence and decides if a doctor is guilty of the charges. And another hearing where the doctor is disciplined. And at that point, they can learn other information about a defendant's past, both good and bad. That's how criminal courts work once the jury has determined a person's guilt. The judge is the one who does the sentencing and gets to hear more about the defendant.

This solution, Rebecca points out, has the benefit of being readily available to the board. It's already legal under Tennessee law. Last September, the medical board members and staff had an offsite retreat, Rebecca was there. She recorded it for her notes, for her book on licensing boards.

And one of the things they discussed was Dr. Le Paglia's case, what had gone wrong?

Dr. Lloyd was still upset about it. Dr. Lee Paglia is a practicing doctor in Tennessee right now. He does house calls for 50 dollars cash.

And Lloyd explained what he sees as the real problem with that kind of outcome. With this halfway discipline they gave the Paglia, they've made it so he can't get a job at a hospital or a medical clinic, but he can still see patients. Dr. Lloyd said, quote, He can only work in a cash based practice, and so the most vulnerable Tennesseans are the ones at risk, and that's not awesome because the very population that I work personally with on a daily basis, I just put somebody back out there and I'm struggling with that.

Danny Chevis is one of the producers of our program, Rebecca Allensworth wrote about medical boards and Dr. Paglia's case for the New York Review of Books.

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