When California medical doctor Scott Greer submitted hair and urine samples to a Medical Board of California’s investigator, lab tests found signs of opiates and oxycodone — but no signs of alcohol.

A year later Greer was placed on probation for 7 years. His license suspended for 30 days and he agreed to restrictions including submitting to regular random alcohol and drug testing.

Two young children  died in 2003 after being killed by a drug-impaired driver who had been given multiple prescriptions for narcotics by multiple doctors helped trigger the pushback against Greer. Greer was one of those doctors providing real prescriptions for bogus needs. Observed claimed Greer needed the money made from writing the scripts to cover other costs related to his own substance abuse.

The issue of testing doctors for drug use was a key part of California’s Proposition 46 which became the focus of campaign spending and lots of it. The measure would lift the cap on pain and suffering in medical malpractice cases from $250K to over $1 million.

Greer was never given the chance to enter a physician health program (PHP). PHPs exist in almost every state but three — California, Nebraska and Wisconsin.

Most have a track record for helping impaired doctors who are struggling with alcoholism, drug addiction or mental health disorders. Yet, they remain an underused resource.

Many physicians are unaware that PHPs exist. If they know of their existence, many doctors don’t understand what they do. Other physicians hate to notify a PHP that a colleague is suspected of being impaired as they don’t want to jeopardize someone’s career.

“Addiction is an illness,” said Paul H. Earley, an addiction medicine physician in Atlanta. “Ten percent of Americans will develop an addiction in their lifetime. Doctors are the same.”

Some PHPs are managed by nonprofit corporations and others by a state’s medical society. Others fall under the control of state medical licensing boards. Some are well funded, others aren’t.

PHPs also differ in the scope of the services they provide. Some stick strictly with substance abuse problems and others address all health issues. The Colorado PHP, for instance, monitors chemical dependency, mental health concerns, sexual misconduct, physical illness as well as stress management.

Regardless of the range of services, PHPs function similarly. Although they don’t provide services themselves, they serve as “overseers” and refer doctors to the appropriate specialist for evaluation and treatment. Often in the case of substance abuse, treatment may mean residential treatment as well as follow-up monitoring which can last for five years.

“We are health-conscious organizations and we manage the gap between the physician and the system in which a doctor works,” said Earley.