Philip Kees lives downtown in the Armed Services YMCA. and as he shuttles about on Broadway in shorts and a sailor hat pulled down over his bald head, he's indistinguishable from the mass of sidewalk jockeys who seem not to have much to do. But the 54-year-old medical doctor is a busy man. His license to practice medicine was suspended in August 1906 by the California Board of Medical Quality Assurance (BMQA). and he's now acting as his own attorney in fighting the suspension. Two BMQA hearings have concluded that Kees is mentally ill, and the board has decided that he cannot practice medicine again until he passes a psychiatric exam as well as oral and written tests of his medical competency.
Kees has not been a compliant patient. He has appealed the board's actions to the Superior Court in San Diego and while the case stumbles along, he has not met the terms of his probation. He's trying to argue in court that BMQA willfully confused his symptoms of chemical abuse with mental illness. Kees claims that he's simply a recovering alcoholic like thousands of other physicians. But unlike many of them, who are ushered into a board-sanctioned "Diversion" program by the state when their drinking affects their work, he believes he was railroaded out of practice by vindictive officials.
Kees says this vindictiveness began in 1984, when he worked as a physician/psychiatrist at Patton State Hospital, at that time a prison tor mentally deranged sex offenders. Kees says that when he was assigned the two main wards at Patton. he discovered that the hospital was improperly drugging these inmates with massive doses of tranquilizers, in effect using drugs as "chemical restraints." When these sex offenders were released back to the streets, Kees alleges they were not only mentally deranged with a history of violence but also drug addicts, thanks to the State of California.
Kees also disagreed with mixing infected individuals into the inmate population, including those with hepatitis and even AIDS. As chief physician on the two most dangerous men's wards, he says he was not informed as to the identity of the inmates who had these infectious diseases. "They'd pass out 5 razors tor 70 guys,'' Kees remark "and at night, on these open wards there was a lot of flesh-on-flesh contact. Almost all the patients were homosexual." Kees became alarmed that when such men were released from Patton (often with a bus ticket to San Diego); not only were they drug addicts, but they might be carrying AIDS as well.
Some of the psychiatric technicians and other staffers at Patton had complained to the Federal Occupational Safety and Health Administration (OSHA) about the mixing of infected patients into the general inmate population, and Kees says they asked him to testify at the hearings held in the spring of 1984. Kees received a subpoena but claims that Patton administrators told him not to testify. He testified anyway in June and was fired from Patton at about the same time Kees maintains that a vendetta on the part of Patton administrators is what started the BMQA investigation of his activities after he left the hospital.
In court filings, Patton has claimed that Kees was fired for cause — namely, that he had improperly criticized other doctors there, had made racist comments about the patients, and had refused to attend to a suicidal patient.
Two years after he left Patton. Kees's medical practice in Palm Springs was a shambles. Details of how it got that way — and whether it resulted from simple alcoholism or a more serious mental illness — are related in the transcript below. In July of that year, state officials had recommended that Kees undergo detoxification and treatment at Rancho LAbri, an alcohol and drug rehabilitation center that caters to physicians, located near Tecate But shortly after he entered the program, the board went to court In Indio and claimed it had no knowledge of Kees's whereabouts, alleged that he might be dangerous, and successfully argued for a temporary restraining order preventing him from practicing medicine A hearing was also held while Kees was incommunicado at Rancho LAbri, and this hearing resulted in BMQA's declaration that Kees was mentally ill. His license was suspended, pending psychiatric and clinical testing.
When Kees left Rancho LAbri and entered a halfway house in Chula Vista, he was shocked to learn that he'd been tried and found sick and his license was suspended in absentia. He thought he was in a physicians' Diversion program and was therefore safe from prosecution. He also thought, and his counselors have attested, that his problem was substance abuse not mental illness. He demanded another hearing, wherein he would represent himself (he had no money to hire an attorney), and this was granted.
Most of the six-day hearing, in June of 1987, took place in San Diego “They brought out all their heavy artillery and aimed it at one little drunk." Kees says now. The state attorney general's office whose attorneys represented BMQA in this matter, fought for most of 1988 against Kees's contention that BMQA should pay for a complete transcription of the hearing, but Kees finally won that one Below are excerpts from the six volumes of transcripts.
— Neal Matthews
ADM. LAW JUDGE JOHN A. WILLD:
At the outset, may I have the appearances of the deputy attorney general. pleaseP
MS. FITZGERALD: Susan Fitzgerald, Deputy Attorney General
THE COURT: The record may reflect that Dr. Kees is present and is representing himself in this matter....
MS FITZGERALD: At this time we would like to call our first witness. Dr. John Sponsler.
Q: Can you tell us what that document is?
A: This is a report, dated July 10, 1985, to Mr. Ron Cooke, senior special investigator of the BMQA. concerning my examination of Dr. Kees....
Q: Would you tell us. please to the best of your recollection, what was said during your examination, during your interview?
A: It was a difficult interview. I — it was difficult to get information from Dr. Kees. For example, he wouldn't tell me where he was practicing on the day of examination.
Q: Did that seem odd to you?
A: Yes. it did. The whole interview was a very unusual interview, in my experience. It was characterized by secretiveness on the part of Dr. Kees and an unwillingness, apparently, to divulge information about himself.
Another surprising statement that Dr. Kees made at the outset of the interview was that he did not know why he was there being examined by me.
I was flabbergasted by that statement.
DR. KEES: I object. I mean, is he just going to be allowed to give a narrative in whatever he wants to?
THE COURT: We're asking him about the events of the interview. Doctor; and. yes. I think I will allow a narrative.
Q: What was the information that he told you about his background?
A: The history of his training that I was able to get that day was that he graduated from the University of Alabama Medical School in June 1973.
He started internship at Birmingham - Baptist Hospital afterward but told me before completion of his internship, which would have been May 1974, he was caught drinking. He said he was dismissed from his internship, but he got nine months' credit for the time he served in the internship.
He resumed internship in October 74, at Mercy Hospital. Buffalo New York, but began to drink excessively there also and had a blackout and was terminated in March or April of 1974, in Buffalo.
He drank a few more times and told me that he stopped using all alcohol by May 1974.
Q: Did he make any reference to any training or jobs that he had had thereafter?
A: Yes. he did.
Q: What was that?
A: He told me that he spent the next eight years working as medical director of North Carolina Medical Legal Research Services. Inc, which is a firm that specializes in the investigation of medically related personal-injury litigation and medical malpractice.
He told me that his difficulty in obtaining licensure may have been due to the nature of his work for the legal service.
Q: Did he at any time during your interview make any statements that he had abused drugs at any time?
A: Several times he mentioned that he had abused alcohol.
Q: Did he ever mention that he had abused something like Serax or Quaaiude or anything like that?
A: I believe he did. Let me refresh my memory.
Yes. He told me that he abused Serax and Quaaiude, both. He denied having any further use of those two drugs since he stopped drinking.
Q: Without getting to your medical opinion, what was your impression of Dr. Kees during the interview?
A: He was very anxious throughout the interview. He was overly talkative but gave very little information, although he said a lot. He concealed important facts.
I believe such as where he was practicing at that time and was deliberately vague about most of what he told me, wandering off the subject many times into irrelevant details.
He also seemed to be somewhat jovial and euphoric during what should have been a serious and somewhat unpleasant interview for him.
Q: Did you form an opinion at that time as to his veracity? You said that you thought that he was evasive.
A: Well, he wouldn't answer questions about several things.
Q: Did you have an opinion about what he was answering as to the truthfulness?
A: I felt that he was using his stated alcoholism as an explanation for practically all the problems that he had had. That, plus one other medical problem he has — namely, diabetes.
Q: And what was the result of the psychological testing, just generally?
A: The testing was essentially normal.
Q: Did that trigger any reaction in you?
A: I was very surprised. I felt that at the end of my interview, which took place about a month before I saw the test results, that Dr. Kees might have been suffering from a manic-depressive illness or some kind of paranoid disorder. Usually those illnesses would show up on the psychological testing.
Q: That's fine We'll get to that a little bit later
Q: Based on all of the work that you have done in this case have you formed an opinion as to whether Dr. Kees' ability to practice his profession safely is impaired because of mental illness?
A: I have.
Q: What is that opinion?
A: The declaration was made on 6-24-86. And on that date I had the opinion that Dr. Kees was — appeared to be in grave danger to himself and was clearly unable at that time to practice medicine without endangering the public Q: Will you explain how you reached that opinion.
A: Dr. Kees showed evidence of a psychiatric disorder during my interview with him, the exact nature of which I was not able to exactly ascertain by directly interviewing him. He was irritable; he had push of speech, in my opinion; he was somewhat flamboyant and grandiose, rather inappropriate kinds of attitudes and feelings to have in the situation he was in.... He was suspicious and defensive throughout the interview. He insisted that his attorney come in with him. which is an unusual kind of situation. And the attorney didn't say anything throughout the interview, except introduced himself.
Q: And did you come up with a diagnosis and an alternative diagnosis?
A: Yes.,.. I felt that the patient might be suffering from a remitting psychotic disorder, such as bipolar disorder, manic type, and that he might really be alcoholic but showed no signs of intoxication on the day of interview.
Q: Then, subsequent to that July 10th report, after you had seen various other documents, did that opinion change? Did that diagnosis change?
A: Yes. After I had a chance to examine the documents from Fbtton State Hospital... I narrowed it down to two diagnoses: One. and the more likely at that time I felt was paranoid personality disorder And the other less likely was paranoia.
Q: Is there anything — again, to the best of your recollection — in the reports from last June that indicated to you delusional behavior on Dr. Kees' part?
A: Yes ... One of the most glaring observations in the reports was that of Dr Kees rummaging through a garbage can. For what purpose I'm not entirely clear. It was either he was looking for food, or looking for something.
Well, there was one ether report I wanted to comment on, and that was the report of the patient. The patient reported Dr. Kees’ behavior to be distracted, in that she stated that his behavior was unusual, he was — at one point he took an electrocardiogram of her and then later on prepared to do a second electrocardiogram, apparently not remembering that he just finished one; that he seemed to be unable to respond like a doctor would, and that the office was in disarray....
It made me feel that Dr. Kees was probably having episodes of psychosis due to uncertain causes. But among the list of possible diagnoses would again be manic-depressive illness. A second possibility would be some kind of drug intoxication, especially an amphetamine-like drug. The third possibility would be some kind of toxic metabolic syndrome ...."
TESTIMONY OF DR. KEES
The first person that the attorney general's office provided was [Dr. Sponsler] to examine Philip Kees, and that psychiatrist had observed Philip Kees one time for approximately an hour, and part of that hour was consumed, as is normal in any physician's office with making up the required financial papers, getting to know each other, making out whatever papers were necessary for billing, and for him to communicate with me later on and to meet [my attorney].
He then did examine me. as he stated, for approximately an hour.... Sometime later, or at this time apparently, he made — he had some opinions, all of which were negative and he ordered some psychological testing from an excellent psychologist named Dr. Ryan.
Dr. Ryan performed some tests and performed quite an elegant variety of tests — approximately two months later sent back a detailed report and said. "This man is very, very normal." and Dr. Sponsler was completely nonplussed ....
Several months after this. [Dr. Sponsler] was approached again by [the BMQA investigator] who had the famous Patton State Hospital investigatory report, and this report was quite thick, approximately an inch thick. When you looked at it. about a quarter of the report was patient files of mine... Another quarter was supposedly of medical errors that I had committed. When examined there are a lot of names on there, but they aren't Dr. Kees' at all. except for three or four times when it said Dr Kees' orders were not followed.
Virtually the whole rest of the report was filled with a few statements from some janitors and what we call psych techs, which are the people who clean the bathrooms and things like that, that they felt Philip, coming from Alabama, was racially prejudiced. Curiously enough, in the whole report, outside of a few more records that were removed from the desk by the [Patton] investigator that showed that I had friendship with certain investigatory reporters on the Sun and that I worked with certain attorneys in some malpractice cases, the rest of the report was entirely concerned with a few statements of the alleged racial problems that I had. ..
Apparently Sponsler then after this changed his mind, and when given some material that a Sergeant Messenheimer of Bishop had given to [the BMQA investigator] and some statements that Messenheimer had taken at an AA meeting that he attended with me — this caused Sponsler to assume that there was a possibility of a major problem....
My friends are almost — they are all in AA or Adventism. The only female friend that I have had over the last seven years has been the lady in Loma Linda — so I guess I'm ready to open an office in Palm Springs in October 1985. .
Essentially, we were opening as a diagnostic referral center, and what we were doing was rather than have to send somebody to a huge medical center like Southern California or UCLA or Loma Linda, that we could provide, on a local basis, most of the instrumentation that a local internist or GP or family practice or pediatrician would want, and what we did essentially is provide them with the records and let them read them themselves. We received a lot of our equipment on consignment....
There was a physician named Joseph Levine who advanced quite a bit of money towards opening up the office and paying for most of the advertising and the work-ups and layouts for most of the advertising that we used and paid for a lot of the TV spots. He advanced about $10,000 just for the opening.
A lot of the other equipment, the basic equipment, came as a result of a settlement that the Smushkovitch brothers gave me where they allowed me access to a number of clinics and hospitals that they had bought in bankruptcy sales and allowed me to remove whatever equipment I thought that I could use That's how we got started.
There was another doctor that was from Florida ... [and] a fourth physician, Cardio something or other, a Spanish guy who kind of worked around the clinic for a couple weeks and decided it wasn't for him, and he went to work for Fblm Springs Medical Center.
So at about this time levine died. I ended up running the whole show during November, December. January by myself. Somewhere around this time, the Palm Springs Medical Center started going full bore and started giving away essentially most of the things that we did; they gave away free most of the things that we did.
ADM. LAW JUDGE:
Doesn't sound like a medical professional I know. Doctor They were providing free medical services, and you were required to charge for those same services?
DR. KEES: They would offer packages, and to get business they would undercut the competition....
The first thing that happened was that my relationship with Marian chilled I got proud and feisty because I liked all the equipment and all the — cathode tubes, all the electronic equipment that was in there and I felt like a big shot, and Marian had come over and I tried to show off and she would get angry. She said that our relationship was deteriorating, that I was acting like I had told her I used to act in Alabama, that I was turning too many rpm's, that I wasn't paying any attention to her or the relationship and that in her opinion it was insanity to work 7 days a week. 12 hours a day, and if I didn't pay attention to her she would find somebody who would.
This was right before Christmas. I kept on doing what I was doing. In Palm Springs I was going to church and I was going to all of the [AA] meetings. I was holding my own. In fact, according to my billing we even started to come out of the hole and I was able to hire another person and get involved with electronic billing, and we had to hire an outside corporation for that because the building that I was in — I had made another error.
It was so old that it was not wired to handle the phone work that was necessary to run that kind of an operation. We were having all kinds of bugs, and most of the computers and most of the electronic equipment that was in there were having lots of problems which took a lot more time for me to build in filters and resistances and things like that. About now — this is now February, March. I'm deciding that there is no way we're going to make this place work and about now the air conditioning started to fail also
About sometime around here I started to get depressed again. I don't know whether it was the impending loss of this new relationship which was really only the second significant relationship in my life or what, but I just started to get a case of the slows. I started to feel the old feelings of doom and the old anxieties and just feel depressed, and my blood pressure started getting screwed up so I put myself on Lasix, L-a-s-i-x. That brought my blood pressure down. It was pretty high and it brought it down to normal, and because of the pressures I started running quite a bit too I was running around 70 or 80 miles a week.
Essentially what I did around here is that my fears got to be so much that I essentially moved into the office I became unable to drive or be in a motor vehicle of any type essentially just slept on the couch in the office and walked or ran to the meetings, to the medical center, to the various places around Fblm Springs ....
I had joined International Doctors and Alcoholics Anonymous, and at a convention in Cleveland. I met a doctor named Max Weissman, and I met many, many other physicians and consequently badgered everybody on. “You've got to help me" The problem was. I was functioning, but I was miserable The problem is, I did my job but I didn't like anything that was going on around me...
But during this time, this same doctor. Max Weissman. called me up one day and said. "Philip, there is a new antidepressant called Sinequan," S-i-n-e-q-u-a-n, "and it’s for alcoholics who have depression, and I think you ought to take it."
I read about it and I called up the detail man. did everything, learned everything and became a world's expert on Sinequan, didn't think it could hurt and I started taking it.
I had never had a DUI. never had any problem in my life and immediately after I started taking it, I started having problems. I didn't know what was going on ... I got a DUI and surrendered my driver's license My life was coming apart around me. and I had no idea what was happening. The more miserable I became the more — Sinequan has a self-built-in limit, you can't take it like Valium or Librium, it has an — you can take 225 milligrams, and above that you start drying out. You become like a brittle old leaf You don't get any other effect other than the sedating effect, which they now know is the reason you should never give that to an alcoholic It's too sedating. An alcoholic goes after that like a trout goes after a fly, but I didn't know and didn't realize I had become re-addicted. I felt good on Sinequan. If I didn't have it. I felt terrible.
Again, I started to fail. I was supposed to have a partner The partner who was supposed to run the clinic with me died. I was stuck with a commitment to be open 7 days a week. 12 hours a day, and I already explained to you my weakness that led me to say, "Hey. I can do that," and I could. Of course the competition from the HMO was just the thing for my weakness. I just worked harder. The more I lost, the harder I worked, the less hours I played, and I got myself into something that was just a vicious circle. I was totally convinced that if I failed I would be worthless and the whole world would know. I got wound up tighter and tighter and tighter, as I have already described.
I started taking Sinequan to the max. 225 milligrams a day. That pretty much covers it.
THE WITNESS: Officer Phillip Palmer. Palm Springs Police Department... June 15th, 1986.
Q: What time of day was this that you received the report?
A: In the morning.
Q: What did you observe when you arrived on the scene?
A: When I first arrived on the scene I observed a male subject leaning into a Dipsy Dumpster that was just outside in the parking lot area. I observed the subject leaning into the Dipsy Dumpster, removing the contents of the trash, food, and other items, and it appeared as though he was eating them.
Like I say, we watched him for several minutes. He consumed several things, and with some debris in his hand, he walked over near the building and sat down. We exited our police car, and we contacted him.
Q: Can you relate to the best of your recollection what was said during that conversation or the contact that you had with him?
A: I contacted him. I asked him his name He was totally unresponsive I asked him if he had been injured. As I got closer to him and began talking to him, I observed his knees, hands, and elbows were covered with abrasions and scratches, extremely dirty. His clothing was — I don't think he had on shoes, but he had on a loosely fitting pair of shorts and a torn shirt, both covered with dirt and other debris, some of which was from the trash.
I got down close to him. I noticed an odor, a body odor. I asked him if he had been hurt. Again, no comment. At no time during the contact that I had with him did he ever respond to any of my questions.
Q: By "respond." do you mean that he was entirely silent the whole time?
A: Basically, yes. He would make a sound every now and then, but it was totally — you couldn't understand what he was saying at all....
And I told him that I was going to take him into custody, and I was going to transport him to the Desert Hospital emergency room for further examination by the staff there Again, there was no response.
TESTIMONY OF DR. KEES
My memories at this time were that I didn't have much to do and that I had a couple of patients who were young guys who used to come by and shoot the breeze with me and that we started doing some social things together, running and going to parties, and I was just trying to put in time until I was placed by Diversion.
The way my friend Marian tells it, she got a phone call — I was missing meetings. I was going through everything that's shown in this relapse dynamics thing, but I didn't realize at the time — Marian says I called her up late one night about 2:00 o'clock in the morning I told her. “Marian, you're not going to believe this, but I sat down with the authorities out here and the people in AA who know me. and we have decided that I could be a normal drinker." She says that I then kept her on the phone for an hour and — this was in the beginning of June — and that I told her that I was just going to be a controlled drinker, that I was going to have a couple cans of beer Did I say first week in June, this was right around, somewhere around the 12th or 13th of June ...
I remember going around with these two patient friends of mine. I remember going to parties. They were both well-to-do Palm Springs people They were in with the gay theater crowd, so they took me around to some of their meetings, and I met a lot of very bright, witty people and had a lot of free food
I don't remember doing any work at all. I don't remember even seeing any patients. I don't remember doing anything except sending out some charts.... Definitely somewhere in that second week in June I started to drink.
Again in May. possibly around the time of the Sponsler appointment, my blood pressure had gone wacko and I had started taking large amounts of Lasix, and Lasix is probably one of the most powerful diuretics that you can give a person, and I started getting all screwed up in general, and my diabetes got totally out of control. My blood pressure kept going up, so I decided I was going to counteract that by long runs, and my recollection of that June 15th day goes like this.
That I started running in the early morning — which in the desert wasn't early, it was probably 7:00 o'clock. It was probably already hot, and it was the middle of June — that I ran out to Palm Desert to the freeway and then ran over to an Adventist camp called Camp Cedar or something like that and then came back, and on the way back I started having an insulin reaction, and I really started to lose it. and for me an insulin reaction means that I start to get to feeling like I'm dipped in Novocain and I start really having trouble thinking. I just slow way down, and it's pretty typical for anybody who's having one.
I get emotionally — and very slow thinking and I decided that I was going to head for the emergency room because there wasn't — my memory of this day is that it was on a weekend, and I had not checked — I still haven't checked to see what day it was and — and I remember coming down, coming into town, and I remember sitting on a bench across from my Eisenhower Medical Center, and I remember some kids coming by and — this is a bus stop bench, concrete bench that's on India and right next to it is a large trash barrel, not a dumpster, just like a 30-gallon drum.
I remember sitting there, and this kid came by. and I asked him if he would help me across the street They looked at me like I was kind of crazy, and I told them I was afraid to cross the street, that I was afraid I was going to pass out and get run over. The next thing that I remember is the police coming up and asking me what I was doing At the time I was trying to put a shoe back on. and I couldn't get the shoe on.
The police say we didn't talk, but that's not my memory of it at all. I remember us talking, not very well or very coherently, but I do remember us talking, and I remember them being very disgusted and accusing me of being drunk when I was unable to get my shoe back on right. I had taken a very, very large dose of Lasix that morning, and as my memory has it. that was secondary to having drunk three, four, maybe five cans of beer the night before, and that in my confused thinking I was thinking that I was getting rid of the water that I had put on board, but in reality all I was doing was just totally throwing himself into a very serious situation.
THE WITNESS: Doris laverne Schofield. My address is Desert Hot Springs. California.
Q: Mrs. Schofield, were you living at that same address a year ago?
Q: How did Dr. Kees first come to your attention?
A: I was at church, and there was an ad in our church bulletin that the doctor was ready to receive practice And the way it was written up it was like it was a new practice opening.
Q: Did you make an appointment with him?
Q: For what date?
A: For June 9th at 10:00 o'clock.
Q: And when you entered the office, did you notice the reception — what did you notice about the reception room, if anything?
A: When we went in. I noticed there was papers all over the floor. You couldn't walk anywhere without walking on papers. And there were manila folders, and it looked as if they were patients' — I didn't read any of them, but it was paperwork, like doctors have out of their files. And it was scattered, much disarray, all over the whole reception area, and papers on the chairs.
And the doctor was in the little adjoining area, where the nurses, the office nurse sits. And the billing department was right next to the reception area. And that is where he was; in the dark. There were no lights on.
Q: What did you observe about Dr. Kees' appearance?
A: It was dark where he was in that area, and I couldn't see very well. But I noticed that his hair was bushed out at the sides. I thought. "Well, he needs his hair combed." or unruly hair, but I didn't pay too much attention to that part.
But he had cuts on his forehead, and it looked like coagulated blood there, like they hadn't been treated or anything.
And I did notice that immediately. I thought, "Well, this is a very casual doctor," because of the casual atmosphere of everything being littered and everything.
And he didn't have a doctor's coat on. He just had on a shirt. And as he came out into the reception area, I could see that it was soiled. It looked like he had slept in It.
Q: Did the doctor give you any papers to fill out at this time?
A: Yes. He gave both me and the other patient medical history papers to fill out, which we did. And then after we filled them out. he came over and sat down between us in the reception area and proceeded to talk to us about our symptoms. And he was reading the paperwork that we had done But he kept getting us mixed up and he had — then, he took the papers, and he wrote our names on them, and he had my symptoms — my name on her symptoms, and he had them mixed up like that.
So then she said. "This isn't mine" She said, “I don't have heart trouble" And I handed mine to her, "This has something that I don't have I think we have the wrong papers."
So Dr. Kees says. “Just put your name, scratch that out, and put your name on the top and we ll just use it that way."
Q: What did you observe about that examining room?
A: When we went into the room to do the EKG, the table was covered with paperwork, and there was all kinds of papers. It was like a repeat of the reception area There were papers scattered all over, and on the table, and on the floor, and there were bottles of some type of pills that were laying around, and some of fhem had no lids on.
And he just walked over to the table and gave one big sweep and knocked everything off and told me to get undressed and lie down, and he would put the EKG on.
Q: Was there anything that struck you odd as to how he performed the EKG test?
A: Yes. In the first place he used about three times as much lubrication for the electro things There was an excessive amount of that. But he also — he did have them in the right places, but when he went to run the EKG machine — I thought this doctor was very casual in his practice But when he picked up the manual to read how to run the machine, I began to get a little nervous and decided. "I am going to try to get out of this gracefully. This isn't the place l wanted to be." Because he was reading directions of how to operate the machine and talking to himself. "Now, then, you push this button, and you put that, enter this and enter there" to get this machine to work.
And he finally did get it working Then he talked to me obout the symptoms of the heart skip beats, and we were talking, and he was talking okay, medically, about this.
And all of a sudden, in the middle of a sentence he broke off and said. "I don't understand why they do that. They're really crazy to think that they are getting away with it."
I thought, “What in the world is he talking about." So I didn't say anything.
And he said. “You know, they really are gambling with their doing this."
And I said. "What was that?"
And he says. “Well, you know, they think they can get away with buying lottery tickets, but they are really gambling with their buying lottery tickets."
I thought. “What in the world has that got to do with what we are talking about? All of a sudden he is talking about the lottery."
I knew by then I was definitely going to try to get out of there I didn't want to make him angry, because I didn't know what type of person I was dealing wifh.
So I put up with a lot from there on. until I could get out of that office gracefully.
Q: This instrument room, where you had your blood pressure taken, what did it look like?
A: It was littered and cluttered up and had d lot of medication, like around, and open containers pills bottles And there was pills on the floor. I don't know what kind they were There were all sorts and there was two bed pillows on the floor next to the cabinet. And they had soiled floral pillow cases like someone had been sleeping there
Q: After he finished taking your blood pressure, did you have any further conversation with him?
A: Yes. He put that machine away and turned around and looked at me like he had saw me for the first time and said. "Oh, what can I do for you? Now. what was your complaint?"
I said, "Well, you know, I have this heart problem, this heart skips beats."
He says, "Oh, okay. Then I see maybe we better do an EKG on you."
I thought. "Well, he just did that."
But he said. "We better do an EKG." So I went with him. and we went back in the other room. And he proceeded to do the EKG again, only this time even with the handbook, he wasn't able to get the machine to work.
Q: Did you have any further conversation with the doctor?
A: Yes. I did.
I went into the reception area, and he was standing sort of partly in the door, and he moved over a little. And I was standing in the doorway, and he was walking to the other patient and talking about doing lab work. And he turned around and sdid. "I guess you should go over there too and get some lab work done."
I said. "Well. I have already had lab work." He was writing on a pad while he was saying that.
He said. "Okay. Then we don't need this." He crumpled the paper and threw it over his shoulder
Then the other patient's husband walked over, and he sdid, "Well, Doctor, we are just going to cancel our appointment."
They left... and the doctor looked over at me and he says. "That's what they all do They come in here sit down, look at me and laugh, and get up dnd walk out." And so he says. "Ha, ha, to them too."
Q: Mrs. Schofield, at any time did you notice the smell of alcohol on his breath or about his person?
TESTIMONY OF DR. KEES
At about this time the Shiloh Hotel — I wasn't just living in my office. The Shiloh Hotel, which was a big. brand new hotel right around the corner from where my office was. made a deal with me They would let me stay at their place if I took care of their staff. We worked out a barter arrangement where I lived with them or lived in one of their rooms, whichever one wasn't being used, and used their facilities in return for taking care of their Workmen's Comp cases and taking care of their staff.
At this point in time I had two employees plus myself on a full-time basis, one was the billing receptionist and the other was a lady who worked ds a medicdl receptionist, plus I hired people off ond on from the Alano Club plus I did a lot of bartering and — there was an enormous amount of bartering that took place In Palm Springs.
My next big memory is the Easter vacation. For about ten weeks — and it seems to me it was the middle of April — for about ten days we effectively were completely shut down. The intersection that my office was at in Palm Springs was the center of the riot, and I mean there were literally thousands of people outside the office As I said. I was full of fear now. Nobody could come to the office because most of my clients were older people, and for ten days nobody came to the office
ADM LAW JUDGE: Is fhis Easter vacation, 1986, sir?
DR. KEES: Yes. For ten days nobody cdme into the office at all; we had no business. Those ten days seemed like 100 years to me Somewhere in there day after day of nobody coming in, I just got so depressed that I felt that there was nothing to try to continue on for, that the building was unworkable the situation was unworkable that there wasn't anything that could be resurrected, and mentally I began to profoundly experience most of the serious problems of the relapse dynamic that I was later shown at Rancho LAbri. I began to continue to feel like something terrible was about to happen.
I began to be very forgetful. I began to not be able to stay on top of my medical interviews or interrogations. I began to just not be a good physician. I decided that I was not capable of treating patients, so I did several things that were almost simultaneous, and they took place in the end of April or the beginning of May.
I laid everybody off. I went to the Betty Ford Center at the physician's meeting and told them that I had regained the compulsions to drink and that's all that I was thinking about all the time that I was totally distracted, that feelings of fear were back in me, that I was completely incapable of getting behind the wheel of a car or even getting into a car, that I was incapable of being in crowds ....
ADM. LAW JUDGE: We're now in '86, Doctor?
DR. KEES: Yes.
ADM. LAW JUDGE: May, June, July, you're going to give us your best memory; is that right?
DR. KEES: I'll give it everything I've got.
ADM. LAW JUDGE: In the first place. Doctor, can you tell me why your memory is very vague during the months of May, June and July of 1986? What's troubling your memory at that period of time?
DR. KEES: I closed the office. I'm in the process of putting ads in the paper and putting — telling them to pick up their charts if they want to I think I'm a total damn failure. Marian won't talk to me She won't answer my letters; she won't respond to my calls. I have laid everybody off.
At the conclusion of Easter week, there was one outside event that took place and that is — I got up one morning at the Shiloh and I walked next door to my office and as I came to my office I noticed that the vehicle the office vehicle was gone, and as I got near the office that the rear door had been jimmied off of its hinges, and this was a huge rear door. I couldn't lift it so — it's over 200 pounds, and It had been ripped off the hinges — and so I called in to report a burglary.
The police came out and the police came back, and the next thing I knew Cooke's name and BMQA's name was involved in it.... Here I had the place all torn up and there were things missing, and there were drugs missing and I didn't want to catch it in the neck right now. Somebody ought to make a report so that I was covered, and Pingil told me, “Philip, one thing you don't do until we get in is — the police have to make a report, they have to make a report. Just leave everything the way it is. If the police won't make a report. I will make a federal charge."
... When I got inside there was some drugs missing, not a heck of a lot because we didn't have that much.... I can't add much. There was a small amount of money lost, there was an incredible amount of records. What I will tell you now making me look like a fool, but the first thing I did was I called up Pingil and I said, "Pingil," because Pingil has been representing me for almost a year now with Cooke [the BMQA investigator], and I said, "Pingil. I think that goddamn Cooke broke in my office and took my records again." This is exactly what I told him and — I was getting pretty screwed up in my thinking and I totally spent an hour telling Pingil that I thought BMQA had taken my medical records because why would anybody take that stuff and why wasn't all the drugs missing if it was that.
THE WITNESS: Marjorie Askey. A-s-k-e-y. 7677 11th Avenue. San Diego
ADM. LAW JUDGE: Doctor, what do you want this witness to tell us?
DIRECT EXAMINATION BY DR. KEES:
Q: When did we meet?
A: We met in August, I believe, at Rancho LAbri.
Q: You were present when I transferred to Rancho LAbri in July and August of last year?
Q: Can you tell the Court — in your own words, more or less describe the person that you met.
A: You were sitting in the kitchen just like this in the dark and I walked by. I thought. "I have actually seen a living zombie" You were spooky, gave me the creeps — I don't want to hurt your feelings.
Q: About how long were we together at Rancho LAbri?
A: Not too long after I did and I left September 21st and you were still there, so we were probably together a month and a half on a real intense basis.
Q: Did you notice any changes in me during that time?
A: When you first got in you were real — I said spooky, you sort of slithered around. After — we got real tight out there, a lot of people did. but you were sort of standoffish. When we would go out and play volleyball, we couldn't get you to participate. We used to have to go in town to have meetings all the time, twice a week, and for some reason you always got to stay, which I don't know why.
Q: I refused to leave the ranch or get into an automobile?
A: I don't know if you refused, but I know you didn't go.
Q: Have you seen a change in me over the period of a year?
A: I noticed it a little bit right before I left that you were sharing more and you weren't quite so slithery — I don't know if that's an appropriate word.
Q: Would the terms "fearful" or "depressed" possibly be used?
A: Yeah, depressed. Yeah, probably either one of them. At least we didn't at the end — right before I left you would come out once in a while to play volleyball. You didn't stay, but we got you out.
Q: Would you consider using me as a physician if you had that opportunity if I was allowed to practice in the state of California?
A: Yes. I would, and I would also take my baby to you — where you're at today, not where you were when you came into treatment.
A: Honest, no way I would go to you at all. but I would now.
Q: You have seen a change that you appreciated
Q: Just in a question, because I think it would interest people here of the group of us that was at the ranch, have there been many people who have been able to successfully remain sober over this last year?
A: No the success rate is very small.
Q: Four or five out of 20 or 30?
MS. FITZGERALD: Objection, calls for speculation.
ADM LAW JUDGE: I'm not too concerned about the success rate at a particular location, but I suppose it's no further afield than we have gone.
Do you know what the success rate is?
THE WITNESS: Of all the people that I was in — that were in with me there are four, five that we have stayed straight and sober of the ones that I know of which we pretfy much kept in contact.
Q: Were there any other behavioral peculiarities that you noticed early on that have changed?
A: You dressed weird.
Q: Did I?
A: The only way I can term it is you were real strange He would talk and he didn't know what he was talking about. You would act real paranoid sometimes when you were talking — all around the issues, but never dealing directly with the issues, but, like I said, you were sort of antisocial too, most of the time that I was out there You were just starting to come out when I left. You were getting a little more friendly and open
Q: You mean withdrawn and introverted?
A: Yeah, that you didn't like people I don't know if you didn't like them or you didn't trust them.
TESTIMONY OF DR. KEES
So to start with year one I was born in Los Angeles. California, in 1935. My father was a physician and a surgeon ... my mother was a librarian. My father came from a family that was very, very normal, very German, very American, had no problems to speak of. My mother came from an Irish Catholic family that was also very professional. My mother's family was essentially based on the law. and my father's family was traditionally based on the practice of medicine, which is where my middle name Artz came from, which is a German name for potion.
My mother's family was much, much different than my father's family, because my mother's family was not normal. There was probably no one and maybe never has been anyone normal in my mother's family at all. ever.
ADM. LAW JUDGE: Not normal how. Doctor?
DR. KEES: Sir. I will get into that.
The people in my mothe'r's family were highly skewed The family was essentially divided in such a way that every other person in the family was an alcoholic...
The alcoholism in this family was lethal. It was totally hidden. The family was crazy as hell. Nobody in the family talks to anybody else in the family, but they damn well don't tell anybody about their alcoholism either. They don't talk about it. and I didn't find out about it until I became an adult and wondered what was happening to me and researched and did a pedigree on the whole family, and it was at this time that I discovered that my mother's father, who was a very brilliant attorney in St. Paul. Minnesota, who. when she was a teenager, had gotten drunk and fallen asleep in a snow bank and frozen to death and. again, somewhere when I was at the age of around 301 found that two of my mother's siblings had died — actually three had died horrible deaths of alcoholism, and one of her sisters, who was married to a very famous cardiovascular surgeon in Chico, California, filled the bathtub up with hot water about ten years ago and didn't add any cold water and got drunk out of her skull and got into it and scalded herself to death.
Another of my mother's sisters died about 15 years ago in a restaurant trying to chew a steak and. like a lot of alcoholics, swallowing it before it was thoroughly chewed and strangled to death. Both of them had been drunk for approximately 15 or 20 years before they died, and this was pretty typical of the Donovan family.
I grew up as the oldest male in the Kees family, and my father was a very, very wonderful, warm man. but he was a surgeon and physician and he was never home. He had made the unfortunate choice in his career of while he was going to medical school — and he went to medical school in the middle '30s — of joining the CCC in order to be able to finance his way through medical school.
When World War II started, he was one of the first people drafted, even though he had at that time three children: myself and two sisters ...
My mother, who was a person that I have already talked about from the Donovan family, a very passionate, moody, mercurial, sensitive lady with a lot of need, but very, very emotionally — very, very emotionally unavailable to any of us children and who had been raised in a family where her father was an alcoholic was totally unable to deal with us. The only way she could deal with us was in what would now presently be called child abuse. She was stuck on this farm. We were stuck in an Army base in Houlton, Maine, and she was stuck up there and it was lonely. It was during the war and Houlton, Maine is no place to be in the best of times. but this lovely young socialite from St. Paul. Minnesota, was stuck there, and after about two years she just went bonkers and she abandoned us. I was about seven years old at the time We had been abused physically for about a year. When my mother had been without my father for about a year and a half, she became very promiscuous in this Army base, and some of the men she brought home were quite violent with my sisters and myself, but in any case, my mother split one day. and I was the typical kid from a typical alcoholic family. I was the oldest, and I assumed the role that is now laughingly called the responsible one. My next older sister, named Virginia, assumed the role — and it's really funny because we were like out of one of the alcoholic books, she assumed the role of the rebel or the mischievous one and my little sister Marcy. who was my little sister at the time assumed the role of the invisible one and the hard reality was and the condition where my mother was in at the time the best thing to do was either to be like myself, be defiant, or be like my sister Virginia, be mischievous, because my sister Marcy. who was the invisible one caught hell. She was beaten daily.
My mother brought some idiots home, and those guys hurt us and hurt my sister and did some kinky stuff to them, and then one day we came home and Mother wasn't there, and I was seven years old. And for about three months — this is during school. I took care of everybody for three months. I cooked the food, kept the house, took care of the kids until the neighbors saw there was no adult there and called the police In 1943 we were made wards of the state and transferred not to an orphan asylum, but we were transferred to farms that were scattered around the northeast section of Maine and I was about eight years old at the time or nine years old and my sister Virginia was two years younger than I and Marcy was three years younger than that, and for the next two years we were kind of jumbled around.
My father returned on leave in 1944 and found out what happened, and at the time he was in the 11th Airborne, and he went bonkers and decided he was going to kill my mother and he was dissuaded from that, but some relatives of my father came out and got us together in one little nest and started taking care of us. And my father had about six months off between wars, and he bought a house and brought us all together, and those were the happiest days of my life for those six months. Then he went back to the war around the time of the liberation of Manila, and after the termination of the war, liberation with Manila, he was killed.
When he was killed, my mother took control of us again, and she came into quite a nest egg. because there was quite a bit of insurance money and money left over from the veterans' insurance and things like that, so we lived high off the hog for quite some time because we were talking about a quarter of a million dollars, roughly, in 1946 and 1947. and that was a lot of money.
But now I am getting to be too much to handle. I am the defiant one So my mother asked the state to step in again, and I was placed back into a foster home and went to Catholic schools and was raised in Catholic schools. Entirely from the time I was 9, 10, 11, and 12, I was in the company of Jesuits and Irish Christian Brothers and things like that.
Then sometime when I was around 12, my mother remarried again and she remarried an attorney. Quite a famous attorney at that time — there was money and they made a house again, they made a house in New York, and they brought everybody back together again. I was totally resentful of her new husband. I resented his position. I resented his taking over the position my father had. I resented all kinds of different things, and I just didn't like him.
One of the things that I have left out in my story is that my mother, in her haste to get rid of us, started all us kids early. I had started school when I was only four years old. and so I started high school when I was only 12, which was not a good thing to do because I was always small. I was always small. I was constantly moving during this time. I was always the new kid. and I was usually about two years younger than anybody else in the school, and the only way I could survive was to be faster and meaner.
I consequently felt like I didn't belong because I was — I just felt strange. Twelve-year-old boy in the company of 14-year-old boys. I just never fit in. I didn't like this guy at all that I was living with, but it was kind of a truce drawn up for two years. During this two years of time. I went to a school called St. John's prep school that was in Danvers, Massachusetts.
One of the reasons I went to St. John's prep was anytime I ever took a test in my life I would get fantastic scores on it. The IQ test and things that I took at that time were always in the range of 160 plus, so I had scholarships everywhere, yet my grades in school weren't that good, because I never went to school if I could help it. I would prefer to be sitting out on the lawns dreaming, fishing, trout fishing, doing any damn thing except sitting in a school room. and. yet. that was not true of my first four or five years in school.
So I went to St. John's prep for two years, and during those two years I went from a kid that they called zombie who was the smallest kid in the school, six foot tall. 88 pounds as a freshman to a 14-year-old, 140-pound kid who looked three or four years older than he was and who competed with his peers by overcompeting.
I became very mature I got all the secondary sexual characteristics of a male at around 14. and I totally changed. I still felt that I didn't belong. I still felt different. I still felt very strange I was totally isolated from my family because the attorney that we lived with and I couldn't get along. It was just a classical stepfather/stepson relationship... I was isolated from the rest of my family except for my sisters. By now I had seven sisters. Again, most of the time I was in charge I ran the family. I kept everybody together. By now I am even supervising their dating, but I lived in the cellar, because I lived alone. With all those women around, it wasn't that bad. I lived in my own little room in the cellar, and I didn't even eat with anybody else I ate on my own, which wasn't a bad idea at that time because besides basketball and football. I was a cross-country runner and long-distance runner, and when I ate the icebox got empty.
It was an incredible time of my life, but while living down in the cellar, my father, who was the attorney, had received from some customers a case of small bottles of very expensive Jewish sacramental wine, and one day for some reason ... one day I opened this Jewish cherry sacramental wine and drank it.
It was the most wonderful sensation that I had ever been through in my life up until then. It was relaxing, it was warming, and for the first time in my life I felt normal. I felt like I belonged. I felt like my fears were gone I think that would be the way I would explain it right now. For the first time in my life fear did not run me.
... That drink, and the thing that made me convinced that this was the drink that made me fall into the classification of alcoholism is that when those bottles were gone — and they were a case as I said, of 12 small, as I recall, four-ounce bottles of this wine — when they were gone. I tore the place apart looking for more I can remember — just like I did years later when I would wake up the next morning and there would not be anything in the house — looking around the house that night in the cellar looking for more to drink and I didn't find any more ....
THE WITNESS: Donald Earl Dougherty. D-o-u-g-h-e-r-t-y. My professional address is 1196 Third Avenue Suite 210, Chula Vista, California, 92011.
DIRECT EXAMINATION BY DR. KEES:
Q: What is your occupation?
A: I am a medical doctor and a psychiatrist.
Q: Where did you go to school?
A: The University of Minnesota, initially.
Q: Medical school?
A: Medical school.
Q: You did your psychiatric residency here In —
A: San Diego County Mental Health.
Q: Board eligible or board certified?
A: Board eligible
Q: How long have you been pracficing as a psychiatrist?
A: Since 1974, that would be about 13 years.
Q How long have you been a resident of San Diego County?
A: Since 1971.
Q: How long have you been practicing medicine here in San Diego County?
A: Same amount of time as I have been a psychiatrist, 13 years.
Q: To the best of your recall, do you remember when you first met me?
A: Yes. I first saw you at an NA meeting at the Betty Ford Center, and I think it was February of 1986.
Q: February of 1986?
A: That's right.
Q: This was at a conventionf?
A: This was at the annual Betty Ford Recovery Center Convention seminar, right.
Q: Did you observe any unusual or disquieting things that bothered you about my presentation that morning?
Q: When is the next time that you and I met?
A: I think it was at a Diversion meeting in the spring of — probably about three months later, I think.
Q: Approximately in July of 1986 at Dwayne Rogers', the man who just left. Diversion meeting?
A: It wasn't that late I know we were at the International Doctors Alcoholic Association meeting, IDAA meeting in San Diego latter July or early August, and I thought I had seen you at a Diversion meeting a month or two before Q: Correct. At the convention that you are talking about, did you and I spend a great deal of time together?
Q: This was in August, early August?
A: Of '86, right.
Q: You and I spent approximately how much time together?
A: I don't know, several hours. We sat together at some of the meetings, we talked together. We had a suite You came to our room and we chatted for a couple hours. You were a pretty nervous guy.
Q: Describe to the Court what you observed at that time.
A: You were taking notes in the meeting, sweating, red faced, very tense I remember my main object at that point was to try to get you to relax and just let go and not be so hard on yourself, not be so uptight. I think that you sort of did make some progress during those three days.
Q: I was sober?
Q: I was?
A: To the best of my knowledge I wasn't your psychiatrist, I was your friend.
Q: Were you aware that I was having trouble with my licenser?
A: I heard rumors to that effect, but I have no in-depth knowledge of that at all.
Q: My being upset and nervous could be correlated to the upset condition of being in trouble —
A: I would be that way if I were in trouble
Q: You saw me as tense, nervous, possibly depressed and very anxious
about something. Would you have considered me to be psychotid?
Q: Can you amplify on that?
A: I didn't see you talking to people who weren't there I didn't see you reoching out into spoce You were able — your ottention spon, reaction time would hdve been a little delayed dt times becduse you were preoccupied, but I didn't see you requiring ony immediote dttention. psychidtricdlly or psychologicolly....
Q: Dr. Dougherty, do you have anything that I haven't asked you about or -anything that I might be able to offer this court?
ADM. LAW JUDGE: A bit broad. Doctor. Anything else you wont to tell us. Doctor?
THE WITNESS: No I would like to see Dr. Kees continue in the practice of medicine.
CROSS-EXAMINATION BY MS. FITZGERALD:
Q: Is it correct to assume from what you have said that you have also been in the Diversion program as a participant?
A: That's right.
Q: At any time have you been under discipline by the board before you were in Diversion?
A: Yes. there were two, a driving drunk is 502. I think it's an 802 that hospitals send to BMQA when they suspend you and that is how I got into Diversion, because they said. "You better do something, you are in big trouble" Does that answer your question? Is it 802? I graduated from Diversion in March of '86.
Q: You are no longer in any program, any Diversion program or under any discipline by BMQA at this timef?
A: Thot's right. Internationol program of AA.
Q: Just so that I am perfectly clear on this point. at the times that you have had contact with Dr. Kees you have at no time been observing him as a psychiatrist in the analytical mode of looking at him as a patient and diagnosing what is going on? You have stated that you were reacting to him as a friend; isn't that right?
A: That's right, but it's pretty hard to separate that. The closest term I could use and I did. he was very tightly wound lost summer. I was concerned he might explode during that conference, but I have not seen that since that time, and in the probably eight or ten times I have seen him in the last year, it's almost like a miracle happened to him. Almost in that week kind of like something was relieved
TESTIMONY OF DR. KEES
I found out that Alabama [Medical School], which looked so romantic to me from Los Angeles, was not what I thought it would be at all, and when I got to Alabama I was 30 years old. I was from California, and I was the only guy who didn't go to Auburn, Alabama, In the school. I went there thinking I was quite hot stuff, that I was really swift from UCLA.
I was going to show those folks something. That didn't turn out that way. Those guys really knew what they were doing. It was tough. It was hard. They were good students, and they were good competition....
I kept on trying, and by now I am not eating much. I am drinking, but I am not eating much. I am isolated. I am going to school and I hove a lot of lady friends, but I don't hove much communication with anybody else, because, as I said. I was from California; I was considered a flower child. I was older. I wasn't a Baptist and I was from out of state and I was on alcoholic
The isolation and everything meant boredom, and the only way I could deal with the boredom was to keep on drinking. I had all the problems agin of the Donovan family and all the problems of on alcoholic: I was proud; I was arrogant; I was haughty. I was thin-skinned; I was abrasive I was a lot of good things, too but what I am trying to soy is I was hard to get along with.
They probably would have thrown me out of school because they throw out ten percent every year, lots of competition and a high failure rate, just one problem, and that is I got good grades. I never went to school. The way I passed was to find somebody who went to school and get their grade, and the tests were all on Monday, and Friday night I would go get their stuff, Xerox it, and sit in and start studying and go take the test on Monday, pass it, go on out, and party. That is the way I got through medical school. My grades I ran. My grades were in the high 80s or low 90s. and though they had lots of problems with me. they kept passing me.
In my sophomore year in medical school, because I wasn't eating. I started to fail physically. I went to a member of the staff who was in cardiovascular surgery and confessed my problem. He. who is a member of AA. did not suggest AA to me but he brought me to a friend of his who is a psychiatrist and put me under his care.
This is in 1970, and psychiatry at that time was not blessed with the knowledge that it has right now, and the way this good gentleman, who was a brilliant psychiatrist, took care of me was to give me Librium and Valium in the hope that this would wean me away from the alcohol, and since we got all those drugs free at that time from the drug detail men. it was easy to get by the thousands. The directions said to take one every four hours, and I was a good alcoholic and I figured if one every four hours was good, two will make me feel twice as good and four will make me even better, and that is the way I went through medical school....
When I got to do my internship, problems started to happen because ethically I started not liking myself. The problems surfaced when, after seven or eight months of my internship. I went to work one day and I walked into the hospital and I couldn't remember what I was doing. I was beginning to experience at this time also phobias, feelings of doom, feelings of dread, anxiety I was so anxious that I couldn't sit in class. I had to put all my notes on cards and walk the streets in order to study for an examination. I got a terrible fear of crowds. This was after prolonged drinking, and I couldn't get out of the house and get on the streets.
I had this one terrible obsession that made it impossible for me to drive, in that I had this obsession that if I went through a light when I had the green light, that somebody was going to break the rule and run the red light and kill me, so it was impossible for me to drive.
But the thing that was the killer was that I just one day went to the hospital and I walked in and I couldn't remember. I was in a blackout, but I didn't know what a blackout was in those days. I couldn't remember who my patients were. When I looked at the charts, I couldn't even recognize the orders. .. I couldn't remember anything, so I turned myself in to the administrator, and he suggested I take six months off, and I did. They suggested that I get help and I did.
Didn't do any good. I tried everything that was available I went to all the books, all the computers, everything that was known to man about alcoholism and depression, and nothing worked. So I tried another internship, as I already told you. and stumbled through enough to complete the internship and the same thing happened.
That is when I decided and I went through this very profound religious period of my life and during '74 and '75 worked in various medical clinics in inner cities and worked in Central America and Belize and worked in the missions that I talked about. At the end of that time somewhere in there. I read the article on Alcoholics Anonymous, and in '74 I entered AA in Raleigh, North Carolina, and it is whdt I needed.
THE WITNESS: John E. Milner. M-i-l-n-e-r. and my office downtown is 3712 Kenyon Street. San Diego.
DIRECT EXAMINATION BY DR. KEES:
Q What's your profession?
A: I'm a psychiatrist with a subspecialty of child analysis in psychiatry and certified by the California Society as a physician that's specially knowledgeable in the field of drug and alcohol abuse.
Q: How long have you been practicing in California?
A: As a psychiatrist since 1985. As a family practice practitioner before that, since 1961.
Q: How would you describe your present activities or your present practice?
A: Presently I'm the clinical director of the alcohol and drug treatment program at Sharp Cabrillo Hospital, both inpatient program and the clinical director of the nonhospital-based residential program Rancho LAbri. ,
Q: To your memory, the first time you met me was when I got to the ranch in August ?
Q: Would you like to read this letter that you had prepared?
A: It's a very positive letter in which I describe the resolution of the early identified, hopefully transient neurological deficits that are produced by abuse of various recreational drugs and medications. I described their resolution. I have described his involvement In his ongoing personal recovery plan. I have described the transfer of Dr. Kees into a local recovery home as a continuing outpatient. I have described the work that he has been doing in his own recovery program, also making specific note that the ongoing question of a possible affective disorder doesn't seem to be present at that particular point in time and essentially Philip is cognizant of a clearing and that he's doing well and he's not drinking or using.
Q: Can you describe — you say you met me when I first came at the ranch. Can you describe your impression at that timeT?
A: A very sick man who looked not unlike a number of other patients that I see on a daily basis, having just recently been transferred out of an acute care unit prematurely and subject to acute alcohol and drug withdrawal, but he knew why he was there and was willing to stay.
Q: Did you perform any type of a psychiatric work-up at this timer?
A: It's impossible to do a psychiatric work-up on a person in detox. It's like doing psychiatric evaluations on someone in the recovery room.
Q: Are you saying the validity of taking an examination or doing a diagnosis on someone who's under the influence of mind-altering drugs should be questioned?
A: Should be questioned. I think it's quite proven in the literature that it's questionable
ADM. LAW JUDGE: You want the doctor to describe his evaluation when you were admitted?
DR. KEES: (No audible response)
ADM. LAW JUDGE: let's do that. I don't care whether he agrees.
THE WITNESS: Philip came in very sick. He left the ranch a lot better. The recommendation was that he go to a recovery home and stay a very long time, that he not try to work and that he stay out of this that we're in right now and that we give his neurology and his neurophysiology a long time to heal and develop a solid recovery program, and he did that for a number of months.
Q: You felt that the minute that I started taking Sinequan I started a series of dominoes falling?
A: Because it was my impression that you self-medicated yourself, although I have reason to believe that it was a result of a curbstone consult in which a psychiatrist had said if you still remained at the present perhaps you should consider an antidepressant, and being a typical physician, you prescribed for yourself and you dispensed it yourself, and in my mind that began the relapse It was only a matter of time before you added other drugs and then went back to your drug of choice.
Q: Can you explain why an antidepressant can have such a catastrophic effect on a recovering alcoholic?
A: There are some alcoholics, longterm recovery or short-term recovery, who have major affective disorders of a depressed type; they do frequently require an antidepressive medication. I personally do not use that particular drug in my patient population because I have seen other similar disastrous results, as you experienced, from the drug in recovering patient population personally, and if my team has to use an antidepressant, we use a different family of drugs.
Q: From your personal experience it's disastrous for an alcoholic —
A: Particularly to self-prescribe — if a physician addict alcoholic selfprescribes anything more than an aspirin, he's in trouble....
Q: To conclude, your diagnosis of me is as a recovering alcoholid?
A: I would agree at this point in time that the diagnosis can be described as chemical dependency, constant pattern in remission, that you're involved in a treatment program that has a high percentage chance of producing and maintaining a stable remission in all forms of the disease. The question of additional diagnosis remains open as it remains open on anyone within the first 24 months of a recovery.
Q: ... Did your work or your initial work or your follow-up work ever lead to a serious suggestion of a psychosis?
A: Outside of the delirium upon entry, we have had no evidence of a psychosis in the sense that would respond to any type of medical management.
DR. KEES: Thank you. Doctor.
ADM. LAW JUDGE: Miss Fitzgerald, do you have questions?
MS. FITZGERALD: Yes, I do.
CROSS-EXAMINATION BY MS. FITZGERALD:
Q: Are you concerned as to the effect this hearing and Dr Kees' self-representation will have on his mental stateT?
A: I have been vociferous about that.
Q. Could you elaborate?
A: The stress must be incredible the fact that he's handling is — is remaining abstinent and is here indicates to me that he has a fairly on-line effective stress-management program and is highly motivated and is violently interested in this proceeding, but I make no bones about my concern about it.
Q: Doctor. I want you to assume there has been testimony from Dr. Sponsler that his final diagnosis, not his initial one, but his final diagnosis, was of paranoid personality disorder and assume the validity of that diagnosis How would that impact Dr. Kees' recovery from alcohol relapse and drug abuse?
DR. KEES: I object.
ADM. LAW JUDGE: I think that the witness, if he can’t answer he can tell us so but by making that assumption — If he can, I will allow him to respond. If he tells me he cannot —
THE WITNESS: Some people who itch have lice and fleas. If you want to stop from itching, you've got to treat the lice and you have to treat the fleas. Some people have alcoholism and schizophrenia, and some people have alcoholism and bipolar disease, but if you treat both diseases, you have a likelihood of a good, stable remission.
Q: I understand that you say they can be treated together, but I guess — would the paranoid personality disorder that had been worked through and been treated prolong a recovery period before which a physician could be —
DR. KEES: There are about five conditions piled upon each other. It's impossible to follow the logic that she's —
ADM. LAW JUDGE: I think the question is: If we assume there is a paranoid disability, would that have any effect with regard to an alcohol treatment program?
MS. FITZGERALD: That wasn’t quite what I was getting at.
ADM. LAW JUDGE: Try it again. I will stop meddling
BY MS. FITZGERALD:
Q. Add the paranoid personality disorder to the alcohol and drug problem. Will the paranoid personality disorder extend the length of time before an impaired physician can be back practicing, in your opiniorf?
DR. KEES: Is this a hypothetical question?
MS. FITZGERALD: Yes. it is.
ADM. LAW JUDGE: I will let him give a response.
THE WITNESS: Since most people entering recovery are actively using and resemble paranoid personalities. the first task is you have to define if indeed it was just a result of the toxicity. Any time you impair a human brain, even from going through the windshield on Highway 5 and getting a little — you get very suspicious and you don't trust a lot and you have a rather paranoid view of the world, so you have got to differentiate whether it's chemical or whether this is indeed a pre-existing paranoid state Your question was, would it prolong the treatment of the recovery period of chemical dependency —
BY MS. FITZGERALD:
Q: Before an impaired physician, you would think, would be ready to resume practice A: May or may not.
DR. KEES: I object to this.
ADM. LAW JUDGE: I will let his answer stay. He said he may or may not. That's a safe one
DR. KEES: We re using a word that's not defined here. We re using the word “paranoid," — has negative possibilities of success in an occupation.
ADM. LAW JUDGE: I will allow the question and allow the answer to remain.