719: Trust Me I’m a Doctor - This American Life
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00:00 00:00 Transcript Share This American Life Life Partners How to Listen Episodes Recommended About Overview Staff Announcements Fellowships Jobs Music Make Radio On The Road FAQ Submissions Merch Contact Us Our Other Shows Merch Follow Us Life Partners Subscribe to our newsletter Full episode Toggle Audio and Transcript Sync Transcript | Episode #719 | October 2, 2020 719: Trust Me I’m a Doctor Note: This American Life is produced for the ear and designed to be heard.
00:00 00:00 文字记录 分享此 美国生活 生活伙伴 如何收听 剧集 推荐 关于 概述 员工公告 奖学金 工作 音乐 在路上制作电台 常见问题解答 提交 商品 联系我们 我们的其他节目 商品 关注我们 生活伙伴 订阅我们的时事通讯 整集 切换音频和文字记录同步 文字记录 | 内容第 719 集 | 2020 年 10 月 2 日 719：相信我，我是一名医生 注：《This American Life》是为耳朵而制作的，旨在让人们听到。
If you are able, we strongly encourage you to listen to the audio, which includes emotion and emphasis that's not on the page.
如果可以的话，我们强烈建议您收听音频，其中包括页面上没有的情感和重点。
Transcripts are generated using a combination of speech recognition software and human transcribers, and may contain errors.
文字记录是使用语音识别软件和人工转录员结合生成的，可能包含错误。
Please check the corresponding audio before quoting in print.
请在印刷版引用前检查相应的音频。
Prologue: Prologue Ira Glass OK, so before the president got coronavirus, which is sending everything now into some new and unforeseen reality, there were certain things about the election that had settled into predictable rhythms, right?
序言：序言 Ira Glass 好吧，在总统感染冠状病毒之前，现在的一切都进入了一些新的、不可预见的现实，选举中的某些事情已经进入了可预测的节奏，对吗？
The president will talk about rioters in the streets and law and order.
总统将谈论街头骚乱以及法律和秩序。
Joe Biden will talk about Donald Trump's character and the way he's done his job.
乔·拜登将谈论唐纳德·特朗普的性格以及他的工作方式。
And when it came to the actual process of voting and the mail-in ballots that are going to be used by record numbers of people this year, the talking points lined up like this.
当谈到实际投票过程和今年将有创纪录人数使用的邮寄选票时，谈话要点是这样排列的。
The president said that mail-in ballots were going to be a disaster.
总统说邮寄选票将是一场灾难。
Joe Biden said they were a perfectly good way to vote.
乔·拜登表示，这是一种非常好的投票方式。
The experts said the evidence backed up Biden.
专家表示，证据支持拜登。
Then the president would again insist that they are a disaster.
然后总统会再次坚称它们是一场灾难。
Biden would again say no. The experts would again back him up.
拜登再次说不。专家们再次支持他。
The president again would call them a disaster, around and around and around in a circle that never ended, a very tedious circle.
总统再次称它们为一场灾难，一圈又一圈，永无止境，一个非常乏味的循环。
But, you know, we can remove ourselves from that circle, right?
但是，你知道，我们可以将自己从那个圈子中移出，对吧？
For a little perspective.
为了一点观点。
[DIAL TONE] Wendy Smith Good evening, town of Nokomis.
[拨号音]温迪·史密斯 晚上好，诺科米斯镇。
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.
几个星期以来，我们的制片人之一本·卡尔霍恩一直在打电话给真正处理这些大家都在大喊大叫的选票的人。
These people touch them with their hands, and they stack them in stacks.
这些人用手触摸它们，然后将它们堆成一摞。
Ben?
本？
Yeah, so the person you're hearing, this is Wendy Smith.
是的，你现在听到的这个人就是温迪·史密斯。
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.
她是我家乡威斯康星州一个小镇上负责选举和处理邮寄选票以及所有事务的人。
She's in Nokomis, which is way up north.
她在北边的诺科米斯。
And I called Wendy because I was wondering how this bizarre year was going for clerks like her.
我打电话给温迪，因为我想知道像她这样的职员今年会过得怎么样。
I had seen Wendy in a newspaper story.
我在报纸报道中见过温迪。
She had tattoos on both arms and this T-shirt that said, "Why should only one hour be happy?" And it said that she rode motorcycles.
她的双臂上都有纹身，这件T恤上写着“为什么只有一小时快乐？”还说她骑摩托车。
And I just kind of thought I wanted to talk to her.
我只是想和她谈谈。
When I originally reached out to her, she was busy sending out absentee ballots to people who'd requested them.
当我最初联系她时，她正忙着向提出缺席选票的人寄出缺席选票。
You don't mind if I work and talk at the same time, do you?
你不介意我一边工作一边说话，是吗？
No, no, I actually imagine that you have a lot to do right now.
不，不，我实际上认为你现在有很多事情要做。
Yeah, I came in to 29 absentee ballots, and I've got a stack more that have to go.
是的，我收到了 29 张缺席选票，还有一堆必须投票。
Oh, wait, so how many total are you looking at compared to a normal year?
哦，等等，那么与正常年份相比，您看到的总数是多少？
Oh my gosh.
天哪。
My last presidential, I had 100 absentee voters--
我的上一任总统，我有 100 名缺席选民——
Total.
总计。
Wendy Smith --four years ago-- total.
温迪·史密斯——四年前——总计。
I've already almost tripled for this election what I did four years ago.
这次选举我的努力几乎是四年前的三倍。
Tripled.
增加了三倍。
So that's like 300 voters out of maybe 1,000 that she's responsible for.
所以这相当于她负责的大约 1,000 名选民中的 300 名。
Wow.
哇。
Ben Calhoun And she's getting more requests every week.
本·卡尔霍恩 她每周都会收到更多请求。
I've talked to Wendy a couple times now, actually.
事实上，我已经和温迪谈过几次了。
And both times, she has worked the entire time that we've been talking.
两次我们谈话期间她一直在工作。
You can hear her keyboard and her printer going in the background the whole time.
你可以一直听到她的键盘和打印机在后台运行。
As I've been talking to you, I'm printing off all my absentee ballot requests because I have to have them open and done and in the mail today.
正如我一直在与您交谈的那样，我正在打印所有缺席选票请求，因为我必须在今天将它们打开并完成并邮寄。
Wendy told me in all her years as clerk, this is definitely the most work she's ever had to do for elections.
温迪告诉我，在她担任书记员的这些年里，这绝对是她为选举所做的最多的工作。
And one of the reasons for that is that the legislature and the governor keep fighting over how everything should run.
原因之一是立法机关和州长一直在争论一切应该如何运作。
There are also lawsuits in Wisconsin, like there are all over the country, about what the rules for the election should be.
就像全国各地一样，威斯康星州也有关于选举规则的诉讼。
And all the little changes that come out of that stuff can be a ton of extra work for Wendy.
对于温迪来说，这些东西带来的所有微小变化都可能是大量的额外工作。
Like, in Wisconsin, at one point, they changed the rule about how many days somebody has to be a resident in order to vote.
就像在威斯康星州一样，他们一度改变了关于某人必须成为居民多少天才能投票的规则。
So Wendy started scrambling to fix all that.
于是温迪开始努力解决这一切。
She's redoing all these envelopes.
她正在重做所有这些信封。
And then they just changed the rule back, meaning that all of that scrambling and work was for nothing.
然后他们又把规则改回来了，这意味着所有的争先恐后和工作都是徒劳的。
So then you went back to trusting your envelopes.
然后你又开始相信你的信封了。
Ugh.
啊。
So all the envelopes that I pre-- you're laughing, but try being a one-man-show doing this.
所以我预先准备的所有信封——你在笑，但尝试做一个独角戏。
[LAUGHS] No, I'm just so sorry.
[笑]不，我只是很抱歉。
I imagine you-- I just had an image of you buying Pepto Bismol at Costco by the case or something.
我想象你——我刚刚想到你在 Costco 成箱购买 Pepto Bismol 的画面。
Yeah.
是的。
Ben Calhoun And compared to a normal year, how many more times work do you feel like you're doing this year on elections?
本·卡尔霍恩（Ben Calhoun）：与往年相比，您感觉今年在选举方面多做了多少次工作？
It's a full-time job.
这是一份全职工作。
Ben Calhoun Is this your only job?
本·卡尔霍恩 这是你唯一的工作吗？
[LAUGHS] What do you do when you're not doing this?
[笑]当你不这样做的时候你会做什么？
I work for an insurance company.
我在一家保险公司工作。
I'm still working plus putting over time in there plus working here.
我仍在工作，并在那里加班加点地在这里工作。
[LAUGHS] Ira Glass OK, so she's got the rule changes.
[笑] Ira Glass 好的，所以她改变了规则。
She's got tons of extra ballots she's got to keep track of.
她有大量额外的选票需要记录。
Mm-hmm, and the other big thing that's taking up a bunch more time is helping voters.
嗯嗯，另一件花费更多时间的大事是帮助选民。
Because people will just fill things out wrong, or they don't know where their ballot is.
因为人们会填写错误，或者他们不知道自己的选票在哪里。
I talked to her the other day, and she was telling me about this couple.
前几天我和她谈话，她告诉我关于这对夫妇的事情。
I got to try to locate their number.
我必须尝试找到他们的电话号码。
They're snowbirds.
他们是雪鸟。
Their ballot went down to Florida.
他们的选票投向了佛罗里达州。
They're not there yet.
他们还没到那儿。
The ballot came back, and now I got to try to find a way to reach them.
选票回来了，现在我必须设法找到联系他们的方法。
Oh, wow.
哦，哇。
Wendy Smith Right, so I get to dig through about 300 applications to try to find their-- see if they have a phone number.
温迪·史密斯（Wendy Smith） 是的，所以我开始挖掘大约 300 个申请，试图找到他们的——看看他们是否有电话号码。
So Wendy was trying to find them, which it seems like something she kind of does a lot.
所以温迪试图找到他们，这似乎是她经常做的事情。
She digs up numbers for people.
她为人们挖掘数字。
She finds people on Facebook.
她在 Facebook 上找人。
So now, I mean, I know where they live.
所以现在，我的意思是，我知道他们住在哪里。
I can probably drive over there when I'm done with work and say, hey, what do you want to do?
当我完成工作后，我可能会开车去那里说，嘿，你想做什么？
The clerks that I've been talking to, they all kind of talk like this.
和我交谈过的职员们，他们都是这样说话的。
They have this down-to-earth, sort of civic-mindedness.
他们有这种脚踏实地的公民意识。
Yeah.
是的。
Ben Calhoun There's this other clerk, Marilynn Pedretti.
本·卡尔霍恩 还有另一位职员，玛丽莲·佩德雷蒂。
She's in this town called Holland, which is slightly bigger than Nokomis.
她在这个叫荷兰的小镇，这个小镇比诺科米斯稍大一些。
It's like 4,300 people.
大约有 4,300 人。
And Marilynn Pedretti spent five years in DC, where she worked for a congressman and then she worked in the Senate.
玛丽莲·佩德雷蒂 (Marilynn Pedretti) 在华盛顿特区工作了五年，为国会议员工作，然后在参议院工作。
But she got sick of Washington, and so she spent the last 20 years as the town clerk for Holland.
但她厌倦了华盛顿，因此在过去的 20 年里她一直担任荷兰的镇书记员。
I want votes to count.
我想要计票。
I will not disenfranchise somebody and be lazy.
我不会剥夺某人的权利并变得懒惰。
I will do everything I can.
我会尽我所能。
I try to find their phone number first.
我首先尝试找到他们的电话号码。
If I can't find that, I try to email.
如果找不到，我会尝试发送电子邮件。
If I don't have that, I'll send them a letter.
如果没有，我会写信给他们。
So yeah, we're doing everything we can to make sure those votes count.
所以，是的，我们正在尽一切努力确保这些选票发挥作用。
The one thing I find very frustrating is the conspiracy theories that are out there.
我发现非常令人沮丧的一件事是那里的阴谋论。
And people believe them.
人们相信他们。
I'm like, hello, I'm your town clerk.
我说，你好，我是你们的镇书记员。
I am not going to throw your ballot away.
我不会扔掉你的选票。
And you can track it.
并且您可以跟踪它。
There's no way I can throw your ballot away.
我不可能扔掉你的选票。
So when you hear these stories about somebody picked some ballots out of a garbage and they open them up, it's like number one, whoever opened them up should be put in jail because you cannot open up the ballot.
因此，当你听到这些关于有人从垃圾中捡起一些选票并打开它们的故事时，就像第一，无论谁打开它们都应该被关进监狱，因为你无法打开选票。
If it's sealed, you have to leave it sealed until election day.
如果它是密封的，您必须将其密封到选举日。
And we have 1,800 municipalities in the state of Wisconsin.
威斯康星州有 1,800 个市镇。
It's not centralized.
它不是中心化的。
It would take 1,800 clerks to do the wrong thing.
1800名职员才会做错事。
Are there clerks out there that make mistakes?
那里的职员会犯错误吗？
You bet.
你打赌。
But when people come in with these conspiracies that the whole system is rigged, I'm like, no. No, it's not.
但当人们带着这些阴谋说整个系统被操纵时，我想，不。不，不是。
All the clerks that I talked to-- and this is in Republican areas and Democratic areas.
我采访过的所有职员——这是在共和党地区和民主党地区。
They all seemed like this was sort of driving them a little nuts, people getting the idea that what they do is very loosely goosey and that people are just going to cheat the system.
他们似乎都觉得这有点让他们抓狂，人们认为他们所做的事情非常松散，人们只是在欺骗系统。
To them, that's just outlandish because they say that there's too much security built into everything.
对他们来说，这很奇怪，因为他们说一切都内置了太多的安全性。
Security like what?
安全性怎么样？
Ben Calhoun Well, they keep track of every request for a ballot.
本·卡尔霍恩 嗯，他们会跟踪每一个投票请求。
Unless you can't leave the house, you have to submit your ID to get an absentee ballot.
除非您不能离开家，否则您必须提交身份证件才能获得缺席选票。
Clerks put tracking info on the ballot.
职员将跟踪信息记录在选票上。
And then they keep track of them when they're sent out and then coming back.
然后，当他们被发送出去并返回时，他们会对其进行跟踪。
And then when it comes back in, it has to have a voter signature and a witness signature for verification.
然后当它回来时，它必须有选民签名和证人签名以进行验证。
At the end of the whole election, they also have to have report back to the state what ballots ended up where, like which ones went out and came back and which ones went out and never came back.
在整个选举结束时，他们还必须向州报告哪些选票最终去了哪里，比如哪些选票出去又回来了，哪些选票出去后再也没有回来。
Say somebody moves and they ask for a ballot in a new location, that's also something the state tracks.
假设有人搬家并要求在新地点进行选票，这也是国家跟踪的内容。
And I just want to say, Wisconsin is pretty typical for how all this stuff works.
我只想说，威斯康星州在所有这些东西的运作方式方面非常典型。
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.
我觉得所有这些细节都存在于这个宇宙中，与我在国家媒体上看到的讨论以及我在总统辩论中听到的论点没有任何重叠。
It just seems kind of sad that that universe, the national politics universe, is lobbing grenades into these women's universe.
那个宇宙，国家政治宇宙，正在向这些女性的宇宙投掷手榴弹，这似乎有点悲伤。
Yeah, I know.
是的，我知道。
I mean, I've been at this for a couple weeks, and I haven't found one clerk that is worried about fraud.
我的意思是，我已经这样做了几个星期了，但我还没有找到一位担心欺诈的店员。
All of them are worried about the rule changes and the number of extra mail-in ballots.
他们所有人都担心规则的变化和额外邮寄选票的数量。
I mean, they think they can deal with that.
我的意思是，他们认为他们可以处理这个问题。
It's just a lot more work.
只是还有很多工作要做。
But they're running into these conspiracy theories a lot-- locally.
但他们在当地经常遇到这些阴谋论。
Yeah, I know.
是的，我知道。
Yeah, yeah, no, that's what I'm hearing.
是啊，是啊，不，这就是我听到的。
Marilynn, she's like Wendy.
玛丽莲，她就像温迪。
She's a clerk part-time.
她是一名兼职文员。
And she also gardens two acres, and she sells vegetables on the side of the highway.
她还种了两英亩的花园，并在高速公路边卖蔬菜。
I mean, I have a roadside stand, and I'm out there.
我的意思是，我有一个路边摊，我就在那里。
And people know who I am.
人们知道我是谁。
And they'll talk to me about election stuff, which is fun.
他们会和我谈论选举的事情，这很有趣。
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.
但是这个在外面给我买蔬菜的女人知道我是镇书记员，她告诉我所有这些死人都在投票。
And it's like, um, no. It's pretty much impossible in the state of Wisconsin for a dead person to vote.
就像，嗯，不。在威斯康星州，死人几乎不可能投票。
If they had died the day before election, maybe I'll not catch that, and maybe that ballot will go through.
如果他们在选举前一天去世，也许我不会注意到这一点，也许投票会通过。
But that's one vote.
但这只是一票。
It's not like the whole cemetery is voting.
又不是整个墓地都在投票。
And I just looked at her, said, ahem, you know I'm the clerk, right?
我只是看着她，说，咳咳，你知道我是店员，对吧？
Yeah, yeah.
是啊是啊。
Do you think I would let dead people vote?
你认为我会让死人投票吗？
Well, no, not you, but somewhere else.
好吧，不，不是你，而是其他地方。
I said, can't happen in the state of Wisconsin.
我说，这不可能发生在威斯康星州。
Well, um, it happens in other states.
嗯，嗯，其他州也有这种情况。
No, it doesn't.
不，事实并非如此。
Stop listening to that stuff.
别再听那些东西了。
And I do it cheerfully.
我很高兴地这样做。
I don't yell or anything.
我不会大喊大叫什么的。
Just like, this is-- it's just wrong, and you've got to stop listening to that stuff.
就像，这是——这是错误的，你必须停止听那些东西。
Oh, sure.
哦，当然。
Ira Glass Are you going to stay in touch with these clerks as everything heats up in the next couple weeks?
Ira Glass：随着接下来几周一切的升温，你会与这些职员保持联系吗？
I mean, as long as they'll answer my calls.
我的意思是，只要他们愿意接听我的电话。
There are so many jobs like this around the country.
全国各地这样的工作还有很多。
Some of them are part-time, like with these two women.
他们中的一些人是兼职的，就像这两个女人一样。
Some of them are full-time.
其中一些是全职的。
Some are paid jobs, lots of volunteer or people get some tiny stipend.
有些是带薪工作，有很多志愿者，或者人们得到一些微薄的津贴。
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.
这些人全身心投入到一些任务的细节中，这些任务只是为了我们的国家运转而需要完成的，并以你所想象和希望的正常、体面、有公民意识的方式来做。
And it's corny to say it, but we are a country blessed with armies of people who are trying to contribute to their communities in all kinds of ways.
虽然说起来有些老生常谈，但我们是一个拥有众多努力以各种方式为社区做出贡献的人们的国家。
And today's program is about a group of people like that, people who are, as best we can tell, trying to do a good job for all of us.
今天的节目是关于一群这样的人，据我们所知，他们正在努力为我们所有人做好工作。
They're trying to protect the public.
他们正在努力保护公众。
But in this case, too often, they're failing.
但在这种情况下，他们往往会失败。
From WBEZ Chicago, it's This American Life.
来自芝加哥 WBEZ 的《This American Life》。
I'm Ira Glass.
我是艾拉·格拉斯。
Stay with us.
留在我们身边。
Act One: Clinical Trial Ira Glass Act One, Clinical Trial.
第一幕：临床试验 Ira Glass 第一幕，临床试验。
So the people that most of today's program is about are doctors, doctors who've agreed to sit on panels to judge other doctors, to discipline them or revoke their licenses when they behave badly.
因此，今天节目的大部分内容都是关于医生，这些医生同意参加小组来评判其他医生，当他们表现不佳时对他们进行纪律处分或吊销他们的执照。
Every state has these medical boards.
每个州都有这些医疗委员会。
They grant medical licenses, and they're the ones responsible for taking them away.
他们颁发医疗执照，也有责任收回医疗执照。
We heard about all this from a law professor at Vanderbilt, Rebecca Allensworth.
我们从范德比尔特大学法学教授丽贝卡·艾伦斯沃思那里听说了这一切。
In 2018, she started going to medical board hearings in Tennessee, where she lives.
2018 年，她开始参加她所居住的田纳西州的医疗委员会听证会。
It was research for a book that she plans to write about licensing boards.
这是她计划写的一本关于许可委员会的书的研究。
And what she saw when she got there horrified her.
当她到达那里时，所看到的一切让她感到震惊。
Dana Chivvis is going to take it from here.
达纳·奇维斯 (Dana Chivvis) 将从这里接手它。
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.
说到田纳西州体检委员会，丽贝卡就像镇上垒球比赛看台上的一位铁杆球迷。
She knows all the board members by name.
她知道所有董事会成员的名字。
She's interviewed most of them, attended all their meetings in person, or watched the livestream.
她采访了其中的大多数人，亲自参加了他们的所有会议，或者观看了直播。
She even went to their offsite retreat last year.
去年她甚至还去了他们的异地静修所。
Before you went to any medical board meetings, how did you imagine they would be?
在您参加任何医疗委员会会议之前，您想象会议会是什么样子？
I thought they'd be pretty boring.
我以为他们会很无聊。
But I think I also thought it was going to be in some sort of grand state government building.
但我想我也认为它会在某种宏伟的州政府大楼内。
I think I had our state capital in mind or something.
我想我想到了我们的州首府之类的。
But it's just like an office park.
但它就像一个办公园区。
So yeah, so describe what it actually looked like.
是的，所以描述一下它实际上是什么样子的。
It's like a three or four-story square office building probably built in the '70s or '80s.
它就像一栋三四层的方形办公楼，可能建于七十年代或八十年代。
This is Nashville, so there's copious parking and--
这是纳什维尔，所以有充足的停车位，而且——
Oh my god, it looked just like Dunder Mifflin.
天哪，它看起来就像 Dunder Mifflin 一样。
It looked just like Dunder Mifflin.
它看起来就像邓德·米夫林。
The first meeting she went to, an OB-GYN appeared before the board to request a new medical license.
她参加的第一次会议上，一名妇产科医生出现在董事会面前，要求获得新的医疗执照。
The board had taken his old license away six months before when they learned that he'd had sex with 11 of his patients.
六个月前，当委员会得知他与 11 名患者发生性关系时，吊销了他的旧执照。
He'd done drugs with at least one of them, too.
他还和其中至少一个人一起吸毒。
He'd also prescribe them and other people who were not his patients controlled substances, like codeine and Xanax.
他还会给病人和其他非他的病人开一些受控药物，比如可待因和阿普唑仑。
So this doctor was there to ask the medical board for a new license.
所以这位医生在那里向医疗委员会申请新的执照。
All that stuff, the sex, the drugs, had happened years before.
所有这些事情，性，毒品，都发生在几年前。
He'd been to rehab, was sober now, saw the error in his old ways.
他去过戒毒所，现在已经清醒了，看到了他以前的方式中的错误。
And the board gave him a new license with some conditions attached, but he could practice medicine again.
委员会给了他一个新的执照，附加了一些条件，但他可以再次行医。
Rebecca couldn't believe it.
丽贝卡简直不敢相信。
There just has to be some sins that are unforgivable in the eyes of the board.
一定有一些在董事会眼中是不可饶恕的罪过。
The board is a regulatory body.
董事会是一个监管机构。
They're not your priest.
他们不是你的牧师。
They're not deciding whether or not you're really sorry.
他们不会决定你是否真的感到抱歉。
They're deciding whether or not you're a safe provider.
他们正在决定您是否是安全的提供者。
Officially, the board's mission is to protect the health, safety, and welfare of people in the state of Tennessee.
按照官方说法，该委员会的使命是保护田纳西州人民的健康、安全和福利。
Board members and staff repeat that mission all the time, like a mantra.
董事会成员和工作人员始终重复这一使命，就像咒语一样。
But since Rebecca has been following the board, she's seen a bunch of cases like that OB-GYN, where doctors have done something really bad, seemingly irredeemable, and somehow, they've managed to keep their medical licenses.
但自从丽贝卡一直关注董事会以来，她见过很多像妇产科那样的案例，医生做了一些非常糟糕的事情，看似无法挽回，但不知何故，他们却设法保住了他们的行医执照。
They're out there, working as doctors in Tennessee right now.
他们现在在田纳西州当医生。
So this became the question of her research.
于是这就成了她研究的问题。
What was going wrong in the system?
系统出了什么问题？
Why were these doctors allowed to keep working?
为什么这些医生被允许继续工作？
One case in particular became the focus of her attention because it seemed like a perfect storm of regulatory failure.
其中一个案例尤其成为她关注的焦点，因为这似乎是一场监管失败的完美风暴。
And that's what I want to tell you about today.
这就是我今天想告诉你们的。
It's about a doctor named Michael LaPaglia.
这是关于一位名叫迈克尔·拉帕格利亚的医生的。
I'll start the story back in 2013.
故事要从2013年开始说起。
LaPaglia was working as an ER doctor at the time.
拉帕格利亚当时是一名急诊室医生。
And late one night, police got a call about a domestic disturbance at his house.
一天深夜，警方接到电话称他家发生家庭骚乱。
When the police arrived, they smelled weed and searched the house.
当警察到达时，他们闻到了杂草的味道，并搜查了房子。
They found-- actually, let me just read from the police officer's affidavit.
他们发现——实际上，让我读一下警察的宣誓书。
Quote, "A search of the residence pursuant to the search warrant revealed 45 quart-sized Mason jars which contained marijuana, 127 glass pipes used to smoke marijuana, Glock 19 9 millimeter, grow light with ballast, timer, digital scale, and ledger detailing names/amounts.
引用：“根据搜查令对住宅进行搜查，发现了 45 个夸脱大小的梅森罐，其中装有大麻、127 个用于吸食大麻的玻璃管、Glock 19 9 毫米手枪、带镇流器的生长灯、定时器、数字秤和详细记录姓名/金额的分类帐。
Also discovered were approximately 52 diazepam, 22 amphetamine, and 24 oxycodone pills."
还发现了大约 52 粒地西泮、22 粒安非他明和 24 粒羟考酮药丸。”
In addition, the police found on a shelf in LaPaglia's office vials of fentanyl, morphine, and propofol, which is used for general anesthesia.
此外，警方还在拉帕格利亚办公室的架子上发现了用于全身麻醉的芬太尼、吗啡和异丙酚小瓶。
LaPaglia's girlfriend told police that he had threatened to use that stuff to kill her.
拉帕格利亚的女朋友告诉警方，他曾威胁要用那种东西杀死她。
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 psychiatric facility.
她在第二天提交的限制令请愿书中说，“迈克尔告诉我，如果我联系警方寻求帮助或举报他吸毒，迈克尔会利用他作为医生的权力将我送进精神病院。
Michael stated he would make sure my body wouldn't be found.
迈克尔说他会确保我的尸体不会被发现。
Michael stated that he would take my life away.
迈克尔说他会夺走我的生命。
I'm in fear for my life and my son's life."
我为自己和儿子的生命担心。”
LaPaglia told police his girlfriend was delusional.
拉帕格利亚告诉警方，他的女朋友有妄想症。
He was arrested and charged with two drug felonies, intent to distribute a controlled substance, and intent to distribute marijuana.
他被捕并被指控犯有两项毒品重罪，即意图分发受控物质和意图分发大麻。
He pled no contest and went to inpatient rehab.
他没有提出抗辩，并前往住院康复中心。
He was addicted to Valium at the time.
当时他对安定上瘾了。
He lost his job at the hospital.
他失去了医院的工作。
The medical board put him on probation.
医疗委员会让他缓刑。
And he surrendered his DEA registration number, which is the thing you have to have to prescribe controlled substances.
他还交出了他的 DEA 注册号，这是开受控药物处方所必须的。
That's a big deal.
这是一件大事。
It's very hard to get a job once you've lost your DEA number.
一旦你失去了 DEA 号码，就很难找到工作了。
No one wants to touch him.
没有人愿意碰他。
No employer is going to take him-- very few employers anyway-- with a record like that.
没有哪个雇主会以这样的记录雇用他——无论如何，很少有雇主。
Private insurance, forget it.
私人保险，忘了它吧。
Hospital, forget it.
医院，别想了。
A few years later, he files for bankruptcy because there's no way to earn money back at the same clip as you are as an ER physician.
几年后，他申请破产，因为无法像急诊室医生一样快速赚钱。
But he got a job at an addiction clinic a friend of his owned.
但他在朋友开的戒毒诊所找到了一份工作。
It was called EHC, Express Health Care.
它被称为 EHC，即快速医疗保健。
LaPaglia would see patients like a regular doctor, work up a treatment plan and everything, and then another doctor would write their prescriptions.
拉帕格利亚会像普通医生一样看诊病人，制定治疗计划等一切，然后另一位医生会给他们开处方。
Dr. LaPaglia helped a friend of his, Dr. Charles Brooks, get a job at Express Health Care, too.
拉帕格利亚医生也帮助他的朋友查尔斯·布鲁克斯医生在 Express Health Care 找到了一份工作。
Dr. Brooks was also on probation with the medical board.
布鲁克斯医生也在医学委员会试用期。
He'd had sex with a patient-- he says they were having an affair-- and at least once given her a controlled substance-- he says to calm her nerves because they were having an affair.
他与一位病人发生了性关系——他说他们有外遇——并且至少有一次给了她一种受控物质——他说是为了安抚她的神经，因为他们有外遇。
But unlike Dr. LaPaglia, he did not lose his DEA number.
但与拉帕格利亚博士不同的是，他并没有丢失 DEA 号码。
He could still prescribe.
他仍然可以开药。
Dr. LaPaglia left EHC.
LaPaglia 博士离开 EHC。
And in early 2018, he and Dr. Brooks started up a little side business.
2018 年初，他和布鲁克斯博士开始了一项小副业。
So he and Dr. Brooks kind of hatched this plan.
所以他和布鲁克斯博士想出了这个计划。
LaPaglia and Brooks realized, OK, well, here's what we're going to do.
拉帕格利亚和布鲁克斯意识到，好吧，这就是我们要做的。
We're going to start a clinic called L&B Healthcare, LaPaglia and Brooks.
我们将开设一家名为 L&B Healthcare、LaPaglia 和 Brooks 的诊所。
But LaPaglia doesn't have a DEA number, so we'll use Brooks's.
但拉帕格利亚没有 DEA 号码，所以我们将使用布鲁克斯的号码。
LaPaglia is going to do the work.
拉帕格利亚将负责这项工作。
He was going to write the prescriptions.
他要去开处方。
It's his phone number on the prescription pad that they make out.
他们在处方簿上找到了他的电话号码。
But it's Brooks's DEA number, and it's Brooks's signature.
但这是布鲁克斯的 DEA 号码，也是布鲁克斯的签名。
Sometimes they were presigned.
有时他们是预先指定的。
Sometimes LaPaglia forged the signature.
有时拉帕格利亚会伪造签名。
Oh, and they sell them for $300 cash out of LaPaglia's home, at least once in a McDonald's parking lot.
哦，他们在拉帕格利亚的家中以 300 美元现金的价格出售它们，至少在麦当劳停车场出售过一次。
L&B Healthcare didn't have an actual brick and mortar office.
兰德隆与布朗医疗保健公司没有实际的实体办公室。
LaPaglia would see people wherever it was convenient, write prescriptions for controlled substances, like Klonopin, Valium, and Suboxone.
拉帕格利亚会在任何方便的地方见人，开出受控药物的处方，比如氯诺平、安定和舒博松。
When the facts came out about their operation, it looked like they were selling prescriptions for cash, like drug dealers with stethoscopes.
当他们的行动真相大白时，看起来他们是在出售处方以换取现金，就像毒贩拿着听诊器一样。
LaPaglia and Brooks say that's not the case at all, that they were legitimately treating people with addiction problems by prescribing them controlled substances.
拉帕格利亚和布鲁克斯表示，事实并非如此，他们通过给有成瘾问题的人开处方管制药物来合法地治疗他们。
It's something called medication-assisted treatment, like the way methadone is used to treat heroin addictions.
这就是所谓的药物辅助治疗，就像使用美沙酮治疗海洛因成瘾的方法一样。
So that's what they said they were doing.
这就是他们所说的他们正在做的事情。
Regardless, it was still illegal.
无论如何，这仍然是非法的。
A few months into the venture, the Feds busted them, charged 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.
合资企业几个月后，联邦调查局逮捕了他们，指控他们贩运毒品、未经授权为受管制药物开具处方，以及在骗局中使用布鲁克斯的 DEA 号码进行欺诈。
Brooks pled not guilty, but Dr. LaPaglia signed a plea deal with federal prosecutors.
布鲁克斯不认罪，但拉帕格利亚博士与联邦检察官签署了认罪协议。
He's still waiting to be sentenced, but he could be facing prison time.
他仍在等待被判刑，但他可能会面临牢狱之灾。
So that's the federal criminal court.
这就是联邦刑事法院。
LaPaglia still had to face the Tennessee Medical Board.
拉帕格利亚仍然必须面对田纳西州医疗委员会。
And when they found out about L&B Healthcare, they summarily suspended the doctors' medical licenses until they could hold disciplinary hearings for them.
当他们发现兰德隆与布朗医疗保健公司的情况后，他们立即吊销了这些医生的行医执照，直到为他们举行纪律听证会。
The case unfolded over three hearings from March to July 2019.
该案于 2019 年 3 月至 7 月期间举行了三场听证会。
The first one in March was the disciplinary hearing for LaPaglia's partner, Dr. Brooks.
三月份的第一场是拉帕格利亚的合伙人布鲁克斯博士的纪律听证会。
Rebecca was there.
丽贝卡在那里。
She'd been going to medical board meetings for a year at that point.
那时她已经参加医学委员会会议一年了。
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 pad.
我看到这个人正在做一些事情，实际上连我认为董事会的医生都觉得非常冒犯，这就是放弃对你的垫子的控制。
And to hand it over to somebody else is really seen as pretty unethical.
而且把它交给别人确实被认为是非常不道德的。
Most doctors don't view their pad as a moneymaker.
大多数医生并不认为他们的垫子能赚钱。
These medical board disciplinary hearings are technically administrative courts.
从技术上讲，这些医疗委员会纪律听证会是行政法庭。
They run kind of like the criminal and civil court systems.
它们的运行方式有点像刑事和民事法院系统。
But the question they're addressing is more pointed.
但他们要解决的问题更为尖锐。
It's whether a doctor should be allowed to continue to practice medicine.
这是是否应该允许医生继续行医的问题。
Dr. LaPaglia agreed to testify against Dr. Brooks in front of the medical board.
拉帕格利亚医生同意在医学委员会面前作证指控布鲁克斯医生。
The signature on that prescription says Charles Brooks, correct?
处方上的签名是查尔斯·布鲁克斯，对吗？
Correct.
正确的。
Andrew Coffman Is that your signature there?
安德鲁·科夫曼 那是你的签名吗？
That's my writing, yes.
那是我写的，是的。
Dana Chivvis Just to set the stage, the guy asking the questions is Andrew Coffman.
达纳·奇夫维斯 (Dana Chivvis) 做个铺垫，提问者是安德鲁·科夫曼 (Andrew Coffman)。
He's the prosecuting attorney.
他是检察官。
He works for the Tennessee Department of Health.
他在田纳西州卫生部工作。
Dr. LaPaglia is the one answering his questions.
拉帕格利亚博士回答了他的问题。
While you are partners with Dr. Brooks, to your knowledge, was he aware that you were signing his name to blank prescriptions?
当您是布鲁克斯医生的合伙人时，据您所知，他是否知道您在空白处方上签下了他的名字？
Yes.
是的。
Andrew Coffman What makes you think that he was aware?
安德鲁·科夫曼 (Andrew Coffman) 是什么让你认为他意识到了这一点？
Because sometimes I would run out of presigned prescriptions and had to do what I had to do to take care of the patient.
因为有时我会用完预先开的处方，不得不做我必须做的事情来照顾病人。
And we've discussed it.
我们已经讨论过了。
When you went to work for-- with Dr. Brooks, did you believe that what you were doing was against the law?
当您为布鲁克斯博士工作时，您是否认为自己所做的事情是违法的？
No. Rebecca Allensworth Dr. LaPaglia was like, yeah, I think we probably cut some corners.
不。Rebecca Allensworth LaPaglia 博士说，是的，我想我们可能会走捷径。
I think, you know, mistakes were made.
我想，你知道，我们犯了错误。
No, we discussed it, and we knew that what we were doing wasn't ideal because we had very little resources to get started.
不，我们讨论过，我们知道我们正在做的事情并不理想，因为我们开始的资源很少。
But we never imagined that we were breaking the law.
但我们万万没有想到我们触犯了法律。
His general attitude was like, error in judgment, not a big deal.
他的总体态度是，判断错误，没什么大不了的。
But has your opinion changed about whether you were breaking the law?
但您对于自己是否违法的看法有改变吗？
Because federal prosecutors have convinced me otherwise.
因为联邦检察官已经说服了我。
I spoke with Dr. LaPaglia.
我与拉帕格利亚博士进行了交谈。
He didn't want me to record our conversation.
他不想让我录下我们的谈话。
And we didn't talk for long before he got off the phone.
我们没聊多久他就挂断了电话。
But he reiterated to me that he and Dr. Brooks didn't think they were doing anything wrong.
但他向我重申，他和布鲁克斯博士并不认为他们做错了什么。
When they worked in addiction clinics, the doctors there would hand prescriptions to receptionists.
当他们在戒毒诊所工作时，那里的医生会将处方交给接待员。
And the receptionist would call them into a pharmacy.
接待员会把他们叫到药房。
It happened all the time.
这种事一直都在发生。
He told me, quote, "We did not see any difference between him giving me verbal authorization to call them in and verbal authorization to write a prescription.
他告诉我，引用的话，“我们没有发现他口头授权我叫他们进来和口头授权我开处方之间没有任何区别。
I still don't see a difference.
我还是没看出有什么区别。
And if someone had a problem with that, the federal government had a problem with that, they could have just told us to stop.
如果有人对此有疑问，联邦政府也有疑问，他们可以告诉我们停止。
They didn't have to indict us and charge us with two felonies."
他们不必起诉我们并指控我们犯有两项重罪。”
I reached out to Dr. LaPaglia several times after that initial call, but he declined my request to talk further.
在初次通话后，我多次联系拉帕格利亚博士，但他拒绝了我进一步交谈的请求。
There were three board members hearing Dr. Brooks's case that day.
当天，三名董事会成员听取了布鲁克斯博士的案件。
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.
他们并没有被这种辩护所动摇，他们不知道自己做错了什么，他们只是想帮助那些吸毒的病人。
In fact, the board members suspected that L&B Healthcare was not a legitimate business at all.
事实上，董事会成员怀疑兰德隆与布朗医疗保健根本不是一家合法企业。
Here's Dr. Charles Handorf, one of the board members, questioning Dr. LaPaglia.
董事会成员之一查尔斯·汉多夫博士正在向拉帕格利亚博士提问。
Did the clinic ever apply for or receive a business license?
该诊所是否曾申请或获得营业执照？
No. Charles Handorf Did the clinic ever apply for or register articles of incorporation with the Secretary of State--
否。查尔斯·汉多夫 该诊所是否曾向国务卿申请或注册公司章程——
No. Charles Handorf --of Tennessee?
不，查尔斯·汉多夫——田纳西州的？
Has the clinic ever filed tax returns?
诊所曾经提交过纳税申报表吗？
Um, not to date, no. Charles Handorf OK, so sitting here, it sounds like this isn't a business at all.
嗯，到目前为止还没有，没有。 Charles Handorf 好吧，坐在这里，听起来这根本不是生意。
So that was Dr. LaPaglia testifying at Dr. Brooks's disciplinary hearing in front of the medical board.
这就是拉帕格利亚医生在布鲁克斯医生的纪律听证会上在医学委员会面前作证。
Once Brooks's case was adjudicated, it was LaPaglia's turn for discipline.
布鲁克斯的案件宣判后，就轮到拉帕格利亚接受纪律处分了。
He and his attorney had worked out a deal with Andrew Coffman, the Department of Health attorney.
他和他的律师与卫生部律师安德鲁·科夫曼达成了一项协议。
It's called the consent order.
这称为同意令。
It's basically the board's version of a plea deal.
这基本上是董事会版本的认罪协议。
So at the next board meeting in May, Coffman presented this deal to the board members.
因此，在五月份的下一次董事会会议上，科夫曼向董事会成员介绍了这项交易。
The board had to decide whether to accept it.
董事会必须决定是否接受它。
Good morning, Andrew Coffman with the Office of General Counsel.
早上好，总法律顾问办公室的安德鲁·科夫曼。
And here's what the deal was.
这就是交易的内容。
Basically, LaPaglia could go back to practicing medicine in another month.
基本上，拉帕格利亚再过一个月就可以回去行医了。
But he'd be on probation for five years, and he'd have to be monitored by a physicians' addiction group.
但他将被缓刑五年，并且必须接受医生戒毒小组的监控。
And he'd be banned from prescribing controlled substances for two years.
他将被禁止在两年内开出受管制药物的处方。
It's similar to what Dr. Brooks got in March, but slightly less because LaPaglia had admitted guilt and had testified against Brooks.
这与布鲁克斯博士三月份得到的结果相似，但略少一些，因为拉帕格利亚已经承认有罪并作了对布鲁克斯不利的证词。
It's what they call a downward departure in the criminal system.
这就是他们所说的犯罪系统的向下偏离。
Cooperating witnesses often get lighter sentences.
配合证人的刑罚往往较轻。
It's supposed to give people an incentive to tell the truth.
它应该激励人们说实话。
But the board was not having it with this deal.
但董事会并不同意这笔交易。
They looked at LaPaglia and saw a guy whose medical license was already on probation when he used another doctor's prescription pad to write controlled substance prescriptions.
他们查看了拉帕格利亚，发现一个人的行医执照已经处于试用期，当时他使用另一位医生的处方本开出管制药物处方。
Here's Dr. John Hale, one of the board members.
这是董事会成员之一约翰·黑尔博士。
This seems rather light.
这看起来相当轻。
I mean, we just had a physician whose prescriptions were stolen, and his fines were significantly more than that.
我的意思是，我们刚刚有一位医生的处方被盗，而他的罚款远不止于此。
I can't, in good conscience, approve of this.
凭良心来说，我不能同意这一点。
I'm sorry.
对不起。
The board has 12 members appointed by the governor.
董事会有 12 名成员，由州长任命。
And three of them are not doctors.
其中三人不是医生。
They're called consumer members-- in this case, a real estate agent, an academic advisor, and a political fundraiser.
他们被称为消费者会员——在本例中，他们是房地产经纪人、学术顾问和政治筹款人。
They were even more pissed than the doctors on the board.
他们比董事会里的医生还要生气。
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.
就我而言，这个人不需要在田纳西州的街道上或办公室里开处方。
And we're charged with the responsibility of protecting the citizens of Tennessee, so that's my concern.
我们肩负着保护田纳西州公民的责任，所以这是我所关心的。
So how do we get to that point?
那么我们如何才能达到这一点呢？
Well, the only thing you can do today is reject this order.
好吧，你今天唯一能做的就是拒绝这个订单。
Ms. Cole, I would really appreciate your insight, too, as a consumer member.
科尔女士，作为一名消费者会员，我也非常感谢您的见解。
I share their feelings completely.
我完全同意他们的感受。
I live in Knoxville.
我住在诺克斯维尔。
I know this McDonald's.
我知道这家麦当劳。
To think that he could be back there ever is scary to me as a consumer member.
作为一名消费者会员，一想到他可能会回到那里，我就感到害怕。
And as I have young daughters, and this man is not safe to be out in the public, I don't think.
由于我有年幼的女儿，而这个男人在公共场合出现并不安全，我认为不安全。
Just a tour guide's representation here, this McDonald's is two blocks away from one of the major high schools in Knoxville.
这家麦当劳只是导游的代表，距离诺克斯维尔的一所主要高中只有两个街区。
So again, I agree with her.
所以我再次同意她的观点。
This man does not need to be on the streets with this type of ability.
这个人有这种本事，根本不需要流落街头。
All in favor of denying the motion for this order on LaPaglia, say aye.
所有人都赞成否决关于拉帕格利亚的这项命令的动议，说是的。
Aye.
是啊。
Dana Chivvis The board rejected the plea deal.
Dana Chivvis 董事会拒绝了认罪协议。
It was unanimous.
大家一致同意。
So now Dr. LaPaglia's case will go to trial, or the medical board version of a trial, a contested case hearing, where he has the possibility of getting a much heavier discipline.
因此，现在拉帕格利亚医生的案件将进入审判阶段，或者医学委员会版本的审判，即有争议的案件听证会，他有可能受到更严厉的纪律处分。
They could suspend his license for even longer, for instance, or even revoke it altogether.
例如，他们可以暂停他的执照更长时间，甚至完全吊销他的执照。
I had been following this case.
我一直在关注这个案件。
And so, yeah, I wanted a full hearing.
所以，是的，我想要一次完整的听证会。
I wanted the opportunity to see Dr. LaPaglia testify and maybe try to talk to him.
我希望有机会看到拉帕格利亚博士作证，也许还可以尝试与他交谈。
And I figured everything was lining up for them to finally throw the book at somebody.
我认为一切都在等待他们最终把书扔给某人。
Rebecca had been to several of these disciplinary hearings by then.
丽贝卡当时已经参加过几次这样的纪律听证会。
She'd seen so many doctors get away with what she considered to be light punishments.
她见过很多医生在她看来处罚较轻的情况下却逍遥法外。
But it seemed like the board was finally going to put its foot down with LaPaglia.
但董事会似乎终于要坚定支持拉帕格利亚了。
Dana Chivvis.
达纳·奇夫维斯.
Coming up, what goes wrong when the board gets a chance to finally put its foot down.
接下来，当董事会有机会最终坚定立场时，会出现什么问题。
That's in a minute from Chicago Public Radio when our program continues.
芝加哥公共广播电台一分钟后我们的节目仍在继续。
Act Two: Act Two Ira Glass It's This American Life.
第二幕： 第二幕 艾拉·格拉斯 这就是美国生活。
I'm Ira Glass.
我是艾拉·格拉斯。
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.
今天的节目“相信我，我是一名医生”。我们有这样的故事，人们试图为自己的社区做一些有公民意识的事情，但就医疗委员会而言，有时却未能按照我们许多人希望的方式完成这项工作。
Right now, we are in the middle of Dana Chivvis's story, and we pick up where we left off.
现在，我们正在讲述 Dana Chivvis 的故事，我们将从上次中断的地方继续。
The Medical Board in Tennessee has rejected Dr. LaPaglia's plea deal.
田纳西州医学委员会拒绝了拉帕格利亚医生的认罪协议。
And two months after that, at their next meeting, the board holds a hearing for his case.
两个月后，在下次会议上，董事会就他的案件举行了听证会。
Here's Dana.
这是达纳。
How these hearings work, they're basically mini trials.
这些听证会的运作方式基本上是小型审判。
Each case gets assigned to a panel of three board members.
每个案例都会分配给由三名董事会成员组成的小组。
LaPaglia's panel was made up of two doctors and a consumer member.
拉帕格利亚的小组由两名医生和一名消费者成员组成。
They sit at the front of the room, facing everyone else.
他们坐在房间的前面，面向其他人。
And they're going to decide if the prosecutor has proven his case, and if so, how to discipline Dr. LaPaglia.
他们将决定检察官是否证明了他的案子，如果是的话，如何惩罚拉帕格利亚博士。
There's also an administrative law judge, who acts as a referee, more than anything else.
还有一名行政法法官，他的作用最重要的是充当裁判。
Today, the board will be considering the case of the Tennessee Department of Health versus Michael LaPaglia.
今天，董事会将考虑田纳西州卫生部诉迈克尔·拉帕利亚一案。
They hold Dr. LaPaglia's hearing in the Iris Room, a name which defies the interior decorator's vision-- beige carpet, beige walls, fluorescent lights.
他们在“虹膜室”举行拉帕格利亚博士的听证会，这个名字违背了室内装饰师的愿景——米色地毯、米色墙壁、荧光灯。
Dr. LaPaglia is sitting at a table with his attorney, facing the panel.
拉帕格利亚博士与他的律师坐在一张桌子旁，面向陪审团。
The prosecutor, Andrew Coffman, he's sitting at a table to the right.
检察官安德鲁·科夫曼（Andrew Coffman）坐在右边的一张桌子旁。
And Rebecca's there, too, in the front row.
丽贝卡也在前排。
It was really weird.
真的很奇怪。
It was weird from the first moment when they did opening statements.
从他们做开场陈词的第一刻起就很奇怪。
Good morning.
早上好。
I'm Andrew Coffman.
我是安德鲁·科夫曼。
You heard me introduce myself earlier.
你刚才听到我自我介绍了。
The prosecutor went first, Mr. Coffman, and he said--
检察官首先发言，科夫曼先生，他说——
We're going to hear a lot of facts today, good, bad, and ugly.
今天我们会听到很多事实，好的、坏的、丑陋的。
--this is a rare case where we basically agree with defense counsel on everything.
——这是一个罕见的案例，我们在所有事情上基本上都同意辩护律师的观点。
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.
不同寻常的是，各方对于这些事实是什么，无论它们是好、坏还是丑陋，并没有太多争议。
And it was just kind of a half-hearted prosecution.
这只是一种半心半意的起诉。
I mean, OK, it's an administrative hearing.
我的意思是，好吧，这是一次行政听证会。
It's a little more casual than a criminal trial or something.
这比刑事审判什么的随意一点。
But it's meant to be adversarial.
但这本来就是对抗性的。
Now I think that the evidence is going to show that Dr. LaPaglia believed that he was providing good treatment to people that actually had a need for that treatment.
现在我认为证据将表明拉帕格利亚医生相信他正在为真正需要治疗的人提供良好的治疗。
Coffman is there to prosecute LaPaglia, 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.
科夫曼是来起诉拉帕格利亚的，但他对拉帕格利亚的处理似乎相当轻松，就像2013年的缉毒行动一样，警察在这次缉毒行动中发现了安定、羟考酮、安非他明、大麻、一把枪、一个秤、一本账本、麻痹剂和其他镇静剂。
Coffman doesn't say the charge was possession with intent to deliver.
科夫曼并没有说这项指控是为了交付而占有。
He just says LaPaglia pled to some charges--
他只是说拉帕格利亚承认了一些指控——
That related to his own personal use of controlled substances, outside the bounds of the law.
这与他个人在法律范围之外使用受管制药物有关。
And the very next month--
就在下个月——
If I were prosecuting, I would probably use some stronger language.
如果我起诉，我可能会使用一些更强硬的语言。
LaPaglia is coming across as a guy who once struggled with a substance use disorder, but got help, sobered up, and then, in the course of trying to help other people who suffer from drug addictions, unwittingly bumbled his way into this next bit of trouble with Dr. Brooks.
拉帕格利亚给人的印象是一个曾经与药物滥用障碍作斗争的人，但得到了帮助，清醒了，然后，在试图帮助其他吸毒成瘾的人的过程中，无意中又陷入了布鲁克斯医生的下一个麻烦。
Here's how LaPaglia's defense attorney also described him in his opening statement.
以下是拉帕格利亚的辩护律师在开庭陈词中对他的描述。
He may be dumb, but he's a good doctor.
他可能很笨，但他是个好医生。
He's responsible.
他有责任。
He's done a lot to help the community.
他为帮助社区做了很多事情。
It's like everyone in this trial was on Dr. LaPaglia's side.
就好像这次试验中的每个人都站在拉帕格利亚博士一边。
I asked Andrew Coffman why he handled the case the way he did.
我问安德鲁·科夫曼为什么要这样处理这个案子。
He said, basically, this case wasn't contentious by its very nature.
他说，基本上，这个案子本质上不存在争议。
His job was to prove that Dr. LaPaglia Paglia had written prescriptions for controlled substances using another doctor's prescription pad.
他的工作是证明拉帕格利亚·帕格利亚医生曾使用另一位医生的处方簿开出受管制药物的处方。
His star witness?
他的明星证人？
Dr. LaPaglia, who had admitted repeatedly that yes, he had used Dr. Brooks's pad to write prescriptions for controlled substances.
拉帕格利亚医生多次承认，是的，他曾使用布鲁克斯医生的便签本为受管制药物开处方。
But also, there's another reason why the prosecution was maybe a bit anemic in this case.
而且，检方在本案中显得有些无力还有另一个原因。
The Department of Health attorneys, Coffman and his colleagues, were feeling frustrated.
卫生部的律师科夫曼和他的同事感到沮丧。
When this whole thing started back in March at Dr. Brooks's hearing-- Dr. Brooks, LaPaglia's coconspirator-- Coffman had asked the board to revoke Dr. Brooks's license.
当整个事情在三月份布鲁克斯博士的听证会上开始时——布鲁克斯博士是拉帕格利亚的同谋——考夫曼要求董事会吊销布鲁克斯博士的执照。
But the board rejected that and said it was too harsh.
但董事会拒绝了这一说法，并表示这太严厉了。
So the prosecutors went easier on LaPaglia in his plea deal.
因此，检察官在拉帕格利亚的认罪协议中对他放宽了要求。
And then the board rejected that, said it went too easy on him.
然后董事会拒绝了这一提议，称这对他来说太容易了。
There was no consistency to their logic.
他们的逻辑不一致。
Coffman'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.
科夫曼的老板后来在一次董事会静修会上表示，他们在讨论此案时感到整个事情有点让他们感到沮丧。
So at LaPaglia's hearing, Coffman just presented the straight facts of the case and told the panel what their options were for disciplining him, didn't suggest a punishment.
因此，在拉帕格利亚的听证会上，科夫曼只是陈述了案件的直接事实，并告诉陪审团他们对他进行纪律处分的选择，并没有提出惩罚的建议。
They didn't know what the hell the board wanted, so they didn't try to guess.
他们不知道董事会到底想要什么，所以他们没有尝试猜测。
And this brings us to the single biggest problem Rebecca sees in the system-- the doctors who sit on these medical boards.
这给我们带来了丽贝卡在系统中看到的最大的问题——这些医疗委员会的医生。
It's a distinguished position to be on the Tennessee Board of Medical Examiners.
成为田纳西州体检医师委员会的一员是一个杰出的职位。
They have to be appointed by the governor.
他们必须由州长任命。
There is a full-time staff that supports the board-- attorneys, administrators, medical consultants.
有全职工作人员为董事会提供支持——律师、管理人员、医疗顾问。
And they sit in judgment of doctors.
他们对医生做出判断。
But as far as judges go, they're amateurs.
但就法官而言，他们都是业余爱好者。
Most of them are doctors.
他们大多数是医生。
They have lots of training in medicine and very little training in administrative law.
他们接受过很多医学方面的培训，但行政法方面的培训却很少。
The deciders in Dr. LaPaglia's case, the three board members on this panel, were Julianne Cole-- she's a consumer member-- Dr. Phyllis Miller, an OB-GYN, and Dr. Stephen Loyd.
拉帕格利亚博士案件的决策者，即该小组的三名董事会成员，是消费者成员朱丽安·科尔 (Julianne Cole)、妇产科医生菲利斯·米勒 (Phyllis Miller) 博士和斯蒂芬·洛伊德 (Stephen Loyd) 博士。
Dr. Loyd was the newest member of the board.
劳埃德博士是董事会的最新成员。
He'd never done any of this before.
他以前从未做过这些。
In fact, this was his second day on the job.
事实上，这是他上班的第二天。
I hadn't even had orientation.
我什至没有方向感。
I mean, I walked in there-- and never been to a board meeting.
我的意思是，我走进那里——但从未参加过董事会会议。
I read all the rulings--
我读了所有的裁决——
When they were like, we're going to split off into panels for the contested case hearings now, did you have any sense of what that meant or what it would look like?
当他们说，我们现在要分成小组进行有争议的案件听证会时，您是否知道这意味着什么或会是什么样子？
None.
没有任何。
Nope, none.
不，没有。
Dana Chivvis So what did you do?
达纳·奇夫维斯 那么你做了什么？
Did somebody tell you, you go into this room with these people?
有人告诉过你，你和这些人一起进入这个房间吗？
[LAUGHS] What did I do?
[笑]我做了什么？
Dana Chivvis Yeah.
达纳·奇维斯 是的。
I shit a sideways brick is what I did.
我就是这么做的。
I mean, I had no idea.
我的意思是，我不知道。
It's just a very confusing scene the first time you're in because I just didn't understand the decorum.
当你第一次进入时，这只是一个非常令人困惑的场景，因为我只是不明白礼节。
I didn't understand how this proceeded.
我不明白这是如何进行的。
I mean, I'm sitting in there.
我是说，我坐在那儿。
And when the guy who came in who looked like a judge and talked like a judge, but what does this look like?
当那个看起来像法官、说话也像法官的人进来时，但这看起来像什么呢？
Is this real court?
这是真正的法庭吗？
Am I the jury?
我是陪审团吗？
And if I am the jury, do I behave the same way a jury behaves?
如果我是陪审团，我的行为是否与陪审团的行为相同？
Dr. Loyd told me he did have a brief orientation that morning, but no special training, no real prep for this.
洛伊德博士告诉我，那天早上他确实进行了简短的培训，但没有接受特殊培训，也没有为此做好真正的准备。
Basically, he was just thrown into it.
基本上，他只是被扔进去了。
So at Dr. LaPaglia's hearing, he kind of winged it, went with his gut.
因此，在拉帕格利亚博士的听证会上，他有点即兴发挥，凭直觉行事。
And he identified with Dr. LaPaglia.
他认同拉帕格利亚博士。
Dr. Loyd is an addiction doctor.
劳埃德医生是一名戒瘾医生。
He spent two years as Tennessee's opioid czar.
他担任田纳西州阿片类药物沙皇两年。
And also, like LaPaglia, he's in recovery from a pill addiction.
而且，和拉帕格利亚一样，他也正在从药瘾中恢复过来。
And so as they're presenting this, here's this figure that I don't know the background on that looks pretty sympathetic.
因此，当他们展示这个时，这是一个我不知道其背景的数字，看起来非常令人同情。
He's done the things you need to do.
他已经做了你需要做的事情。
I'm a second chance guy.
我是一个有第二次机会的人。
He related to Dr. LaPaglia.
他与拉帕格利亚博士有亲戚关系。
He had also made bad decisions while in the throes of a drug addiction.
他在毒瘾的痛苦中也做出了错误的决定。
Although to be clear, LaPaglia testified he was sober at the time he was writing the fraudulent prescriptions and had been for years.
需要澄清的是，拉帕格利亚作证说，他在写欺诈性处方时是清醒的，而且已经清醒多年了。
I think I equated, hey, this guy did these things.
我想我等同于，嘿，这家伙做了这些事情。
While I didn't write scripts, I stole medication from people, which is bad.
虽然我没有写剧本，但我从人们那里偷了药物，这很糟糕。
And I got better.
我变得更好了。
And I think he can get better.
我认为他可以变得更好。
For Loyd, LaPaglia said all the right things.
对于洛伊德来说，拉帕格利亚说的都是对的。
He said he was drawn to treating people with addictions to benzos because that's what he was addicted to.
他说他热衷于治疗对苯并类药物上瘾的人，因为他就是对这种药物上瘾的。
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.
他说，他对成瘾诊所治疗苯并成瘾患者的方式提出质疑，认为他们没有给他们足够的药物来有效地减少剂量。
They were given possibly two weeks' worth of benzodiazepine and then taken off.
他们服用了可能两周的苯二氮卓类药物，然后就离开了。
OK, and what would happen after they were taken off?
好吧，它们被起飞后会发生什么？
Were they just clean of benzos?
他们只是清除了苯并吗？
It's never going to happen.
这永远不会发生。
Man So what would happen?
那么会发生什么呢？
They're going to relapse 100% of the time.
他们100%的情况都会复发。
I could see Dr. Loyd nodding along.
我看到洛伊德博士也在点头。
When Dr. LaPaglia was talking about the problem of dual addiction between opiates and benzos and the problem of relapse on benzos, I was like, I could see Dr. Loyd nodding along.
当拉帕格利亚博士谈论阿片类药物和苯并类药物的双重成瘾问题以及苯类药物复发的问题时，我想，我可以看到洛伊德博士也在点头。
What I heard from him is, I've got these patients who are addicted to benzos.
我从他那里听到的是，我有这些对苯并类药物上瘾的病人。
These doctors don't know what they're doing, trying to get them off.
这些医生不知道他们在做什么，试图让他们摆脱困境。
And you actually can't get them off that quick.
事实上你不能那么快把它们去掉。
They'll just relapse.
他们只会复发。
He's exactly right.
他是完全正确的。
That's exactly right.
完全正确。
After the attorneys were done questioning Dr. LaPaglia, the board members got a turn.
律师们询问完拉帕格利亚博士后，轮到董事会成员了。
But first of all, thanks, Dr. LaPaglia, for coming today and being honest.
但首先，感谢 LaPaglia 博士今天来到这里并坦诚相待。
Here's Dr. Loyd.
这是劳埃德博士。
Stephen Loyd So your training in addiction is on the job from the folks at Express and then the eight-hour X-waiver class?
史蒂芬·洛伊德 那么你的成瘾训练是在 Express 的工作人员那里进行的，然后是八小时的 X 豁免课程？
But most of his questions, he's testing LaPaglia, trying to see if he really understands addiction medicine.
但他的大部分问题都是在测试拉帕格利亚，试图看看他是否真的了解成瘾医学。
Can you tell me how you establish a diagnosis of substance use disorder, severe?
您能告诉我如何诊断严重的物质使用障碍吗？
Through discussing, taking a drug history, going over medical history with the patient.
通过与患者讨论、记录用药史、回顾病史。
And so did you ever follow the criteria of the DSM-V for substance use disorder and classifications of mild, moderate, and severe?
那么您是否遵循过 DSM-V 物质使用障碍的标准以及轻度、中度和重度分类？
OK, and when you're training-- by way, I 100% agree with you about the prevalence of benzos.
好吧，当你训练时——顺便说一下，我 100% 同意你关于苯并类药物流行的看法。
That's spot on.
那是对的。
But when you're treating benzodiazepine dependence, what is your goal?
但是，当您治疗苯二氮卓类药物依赖时，您的目标是什么？
Extremely slowly.
极其缓慢。
Dana Chivvis This goes on for several minutes.
Dana Chivvis 这持续了几分钟。
Dr. Loyd only asks two questions about the L&B scheme itself.
Loyd 博士只问了两个有关兰德隆与布朗计划本身的问题。
When they finally get to deliberations, Dr. Loyd speaks first.
当他们最终进行商议时，劳埃德博士首先发言。
I'm the newest member of this committee or this board.
我是这个委员会或董事会的最新成员。
And I was told that my charge was to protect the health, safety, and welfare of the citizens of the state of Tennessee.
我被告知，我的职责是保护田纳西州公民的健康、安全和福利。
And do I believe that taking Dr. LaPaglia's license does that?
我相信取得拉帕格利亚博士的执照就能做到这一点吗？
I actually don't.
我其实不知道。
I don't believe that it does that.
我不相信它会那样做。
From what I saw today, and hopefully, I'm a decent judge of somebody's heart, I saw somebody that cares about taking good care of a population that struggles to find help.
从我今天所看到的情况来看，希望我能准确判断某人的内心，我看到有人关心照顾好那些难以寻求帮助的人们。
That's what I saw.
这就是我所看到的。
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. LaPaglia.
这些医学委员会听证会的一个方面与刑事审判有很大不同——由于田纳西州的透明度法律，小组成员必须在拉帕格利亚医生面前公开审议。
Rebecca says this is another reason the discipline can be so light.
丽贝卡说，这是纪律如此宽松的另一个原因。
It's really awkward for them, raises some potential issues.
这对他们来说确实很尴尬，引发了一些潜在的问题。
Like at one point, while the panel members are considering requiring Dr. LaPaglia to get board certified in addiction medicine, LaPaglia interrupts them, steers them away from it.
就像有一次，当小组成员正在考虑要求拉帕格利亚博士获得成瘾医学委员会认证时，拉帕格利亚打断了他们，引导他们远离它。
Do we want to require him to do that, and if he doesn't complete--
我们是否想要要求他这样做，如果他没有完成——
I respectfully ask no because I may change my mind, or something else may happen.
我恭敬地拒绝，因为我可能会改变主意，或者可能会发生其他事情。
And if I don't fulfill that requirement, I'm never going to get off probation.
如果我不满足这个要求，我就永远不会摆脱缓刑。
The administrative judge has to break in and tell them to quit talking to each other.
行政法官必须介入并告诉他们停止互相交谈。
In the end, here's what the panel decides.
最后，这是小组的决定。
They're going to restore Dr. LaPaglia's medical license, which had been summarily suspended in January, when the board first found out about the L&B scheme.
他们将恢复 LaPaglia 医生的行医执照，该执照于 1 月份董事会首次发现兰德隆与布朗计划时被立即暂停。
As punishment, they give him five years probation, make him report to the Tennessee Medical Foundation.
作为惩罚，他们给予他五年缓刑，并让他向田纳西州医学基金会报告。
It's a physician's substance abuse group.
这是一个医生的药物滥用小组。
And they tell him to take a few professional courses.
他们告诉他要选修一些专业课程。
They don't prohibit him from prescribing controlled substances.
他们并不禁止他开受管制药物。
He still doesn't have a DEA number, so technically, he can't anyway.
他仍然没有 DEA 号码，所以从技术上讲，他无论如何也不能。
But he could petition the DEA to get it back.
但他可以向美国缉毒局请求收回这笔钱。
They don't restrict that either.
他们也不限制这一点。
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.
这实际上比他从认罪协议中得到的惩罚要轻，董事会因为对他太宽容而放弃了认罪协议。
So yeah, it was a slap on the wrist.
所以，是的，这是一个手腕上的一记耳光。
Dr. LaPaglia was all smiles afterwards.
拉帕格利亚博士随后满脸笑容。
So I had chatted with him at the breaks.
所以我在课间休息的时候就和他聊天了。
And he was sort of saying, I'm just hoping to get my license back.
他的意思是，我只是希望拿回我的驾照。
And I got this federal thing I got to deal with.
我必须处理联邦事务。
And so, for some reason, they decided to insert this language at the end that says, to give him a path back to full licensure.
因此，出于某种原因，他们决定在末尾插入这样的语言，即为他提供一条重新获得完全许可的途径。
And when they read that out loud, Dr. LaPaglia winked at me.
当他们大声读出来时，拉帕格利亚博士对我眨了眨眼。
Whoa.
哇哦。
Rebecca Allensworth Which really surprised me.
丽贝卡·艾伦斯沃斯 这真的让我很惊讶。
It just really surprised me.
这真的让我很惊讶。
I was like, did that just happen?
我当时想，这件事刚刚发生了吗？
I think that he was sort of saying, see, I'm getting what I wanted-- I guess.
我想他是在说，看，我得到了我想要的——我猜。
I think it went even better than he expected.
我认为事情比他预期的还要好。
And I think that might be why he winked at me.
我想这可能就是他对我眨眼的原因。
So I went up to him afterwards to talk to him.
所以后来我走到他跟前和他说话。
And by this time, I had chatted with him a couple times.
到这个时候，我已经和他聊过几次了。
And he said something like, I'm just glad to have my license off of suspension so I can make some money.
他说了这样的话，我很高兴我的驾照被吊销了，这样我就可以赚点钱了。
It was a real kind of 180 from the patient care testimony that he had just provided.
与他刚刚提供的患者护理证词相比，这真是一个一百八十度大转变。
I reached out to Dr. LaPaglia about this, but he didn't get back to me.
我就此事联系了拉帕格利亚医生，但他没有回复我。
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.
一名医生因在家中携带非法处方药和大麻而被发现携带非法处方药和大麻，这看起来非常像贩毒活动，因此失去了他的 DEA 号码，他的行医执照被缓刑，然后他又出去使用另一位医生的 DEA 号码开出受管制药物，从而再次违法。
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.
现在他又回到了医疗委员会的试用期，仍然持有医疗执照，这意味着他仍然可以作为一名医生工作。
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 prescribed controlled substances for people who aren't their patients, doctors who have sex with patients.
在参加医学委员会会议的这些年里，丽贝卡目睹了一群有着恶劣历史的医生继续行医，犯下医疗保健欺诈的医生，为非患者开出受管制药物的医生，以及与患者发生性关系的医生。
One doctor prescribed large doses of opioids and other drugs, even though the patients had no medical reason for taking them.
一名医生开了大剂量的阿片类药物和其他药物，尽管患者没有任何医学理由服用这些药物。
Prosecutors asked the board to permanently revoke his license, but he was only put on probation.
检察官要求委员会永久吊销他的执照，但他只被缓刑。
As far as I can tell, Tennessee is fairly typical.
据我所知，田纳西州是相当典型的。
A statistical study ranked medical boards on a scale of how harsh to light their discipline was.
一项统计研究根据医疗委员会的纪律严酷程度对医疗委员会进行了排名。
Tennessee was smack in the middle.
田纳西州正好处于中间位置。
Of course, I'm talking about the worst cases the medical board sees.
当然，我说的是医疗委员会看到的最糟糕的情况。
And the board does revoke some doctor's licenses.
该委员会确实吊销了一些医生的执照。
Since 2017, they've taken 13 licenses away, and 11 doctors have voluntarily surrendered them.
自2017年以来，他们已经吊销了13张执照，并有11名医生自愿交出执照。
That's a significant punishment.
这是一个重大的惩罚。
As one board member explained to me, a medical license is technically a property right.
正如一位董事会成员向我解释的那样，医疗执照从技术上讲是一种财产权。
And it's a big deal to take someone's property from them.
夺走某人的财产是一件大事。
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.
但似乎确实发生了一些事情，医疗委员会的成立是为了保护公众，为了保护我们大多数人，他们从来没有想过询问我们的医生是否安全并以我们的最佳利益为出发点，有时医疗委员会会让危险的医生继续行医。
On the one hand, I feel like on some level, I understand this problem because I've spent so long studying it.
一方面，我觉得在某种程度上，我理解这个问题，因为我花了很长时间研究它。
I've seen all the angles.
所有的角度我都看过了。
I've seen how the personalities play out and the incentives and the emotions and everything.
我已经看到了个性如何发挥、激励、情绪等等。
But there's also a way in which I just don't get it.
但还有一种方式我就是不明白。
I don't understand why they won't just take the guy's license.
我不明白为什么他们不直接拿走这个人的驾照。
What's the part of you that understands it?
你的哪一部分理解它？
[SIGHS] I think that there's a identification that's not as specific as, oh, that could be me.
[叹气]我认为有一个身份并不那么具体，哦，那可能是我。
That's still in play of just being a doctor.
这仍然是作为一名医生的作用。
This is our calling.
这是我们的使命。
We went to similar sets of trainings.
我们参加了类似的培训。
We started out walking down the same path.
我们开始沿着同一条路走。
So I think there is some identification at a kind of very high professional level, like a circling the wagons.
所以我认为有一些非常高专业水平的识别，就像绕着马车转一样。
Like, we're doctors.
就像，我们是医生。
And then I think there's also-- and this is probably especially bad for doctors, but they're just kind of softies.
然后我认为还有——这对医生来说可能特别糟糕，但他们只是软弱的人。
They just believe that everybody can be healed and can be made better and are sick and deserving of compassion.
他们只是相信每个人都可以被治愈，都可以变得更好，每个人都生病了，都值得同情。
I mean, that's what's really ironic and sad to me, is that it's, in some ways, this whole problem is created by that better part of human nature, the part that's full of mercy.
我的意思是，这对我来说真正具有讽刺意味和悲伤的是，在某些方面，整个问题是由人性中更好的部分造成的，即充满怜悯的部分。
Well, I think we need to abolish licensing boards, to be perfectly honest.
嗯，说实话，我认为我们需要废除许可委员会。
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 have 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 would.
丽贝卡说，与其让医生对其他医生进行评判，也不是让他们每隔几个月就这样做一次对社会的帮助，而是让全职员工的工作是监管这个行业，他们接受过培训，能够注意到自己何时受到被告情绪波动的影响，并像法官一样，尽可能地把自己的感情放在一边。
Dr. Loyd agrees with Rebecca, in part.
劳埃德博士部分同意丽贝卡的观点。
He admits he did relate to LaPaglia, and it influenced how he thought about discipline.
他承认他确实与拉帕格利亚有关，这影响了他对纪律的看法。
If I saw the facts of the case written down on a piece of paper, right?
如果我看到案情写在一张纸上，对吗？
Just boom, right down-- start at the top, go to the bottom.
只是轰隆隆，从上到下——从顶部开始，到底部。
And I get to read that piece of paper without anybody from either side, right?
我可以在没有任何一方的情况下阅读那篇论文，对吗？
And I just read that, I'd revoke his license.
我刚刚读到，我会吊销他的执照。
Just based on the, he used another doctor's DEA license number to prescribe patients.
正是基于此，他使用了另一位医生的DEA执照号码给患者开药。
Just based on flat facts-- drug charges, used another doctor's DEA license, drug dealing, right?
仅仅基于简单的事实——毒品指控、使用另一位医生的 DEA 执照、毒品交易，对吗？
Just the plain facts, no defense attorney, no prosecutor.
只是简单的事实，没有辩护律师，没有检察官。
I just saw that written down on a piece of paper, no LaPaglia in the room-- I'd revoke his license.
我刚刚看到这句话写在一张纸上，房间里没有拉帕格利亚——我会吊销他的执照。
Hm, that's so interesting.
嗯，这太有趣了。
Stephen Loyd And this is something-- well, it's something I've gained an appreciation for.
史蒂芬·劳埃德：这就是——嗯，这是我所欣赏的。
And I'm really trying to work on this as a board member.
作为董事会成员，我确实在努力解决这个问题。
It is very difficult to sit there with another human being in front of you and-- what I want to say-- drop the hammer.
与另一个人坐在你面前，然后——我想说的是——放下锤子是非常困难的。
It's a human being, right?
这是一个人，对吧？
It's much easier on a sheet of paper, right?
在一张纸上更容易，对吧？
Because when I'm sitting there, I see a guy that's presenting this way.
因为当我坐在那里时，我看到一个人以这种方式进行演讲。
He doesn't look emaciated.
他看起来并不消瘦。
He looks healthy.
他看起来很健康。
He's dressed professionally.
他穿着很职业。
He's got a child that he has emotion around, like me as a dad.
他有一个充满感情的孩子，就像我这个父亲一样。
Do I want to give him a chance to get that back?
我想给他机会挽回吗？
Yeah, I do.
是的，我愿意。
But it's not fair to say that's the whole reason the case went askew, that doctors looked too kindly on a fellow doctor sitting before them.
但如果说医生对坐在他们面前的医生同事过于友善，这就是案件发生偏差的全部原因，这是不公平的。
Because when considering what to do with LaPaglia's medical license and whether he should be a practicing doctor, the board members never got a full airing of his past misdeeds.
因为在考虑如何处理拉帕格利亚的行医执照以及他是否应该成为一名执业医生时，董事会成员从未全面揭露他过去的不当行为。
As soon as the hearing was over, Dr. LaPaglia did something that made Dr. Loyd suspicious.
听证会一结束，拉帕格利亚医生就做了一些让洛伊德医生怀疑的事情。
I stood up and was headed out, and he approached me.
我站起来正要出去，他向我走来。
And I can't remember his exact words, but it was very placating, almost like, hey, I appreciate what you've done in your own life.
我不记得他具体说了什么，但这非常令人安慰，几乎就像是，嘿，我很欣赏你在自己的生活中所做的一切。
I would like to have that, right?
我想要那个，对吗？
That kind of thing.
那种事。
And I knew it was bullshit.
我知道这是胡说八道。
He felt like he was being manipulated.
他感觉自己被操纵了。
Something about LaPaglia's affect felt fake.
拉帕格利亚的情感有些虚假。
I knew I had made a mistake.
我知道我犯了一个错误。
My little man inside of me that I use as my barometer of people was like, oh, man, Steve, this guy is a shyster.
我内心的那个小男人，我用它作为我的人的晴雨表，就像，哦，伙计，史蒂夫，这家伙是个害羞的人。
He kissed my ass, and I couldn't fucking stand-- I'm sorry to cuss, Dana.
他吻了我的屁股，我他妈的受不了了——我很抱歉骂人，达纳。
I'm--
我是——
No, it's fine.
不，没关系。
Stephen Loyd I couldn't stand it.
斯蒂芬·劳埃德 我无法忍受。
I couldn't stand it.
我受不了了。
It wore me.
它磨损了我。
So I went outside and googled him.
所以我出去用谷歌搜索了他。
I said goodbye to everybody.
我向大家告别了。
I walked out to my car.
我走到我的车旁。
I grabbed my phone-- or my truck.
我抓起我的手机——或者我的卡车。
I sat there, and I googled his name.
我坐在那里，用谷歌搜索了他的名字。
And the first article that popped up in the way I searched it was the article about his domestic violence.
我搜索的第一篇文章是关于他的家庭暴力的文章。
Andrew Coffman didn't talk about the restraining order against LaPaglia at the trial.
安德鲁·科夫曼在审判中没有谈论针对拉帕格利亚的限制令。
It's not a criminal charge.
这不是刑事指控。
And besides, he said, while it clearly demonstrates bad conduct, it isn't bad conduct related to the practice of medicine.
此外，他说，虽然这清楚地表明了不良行为，但这并不是与行医相关的不良行为。
But that's not all he left out.
但这并不是他遗漏的全部。
In 2010, while working as an ER doctor, LaPaglia did something that a federal appeals court said, quote, "shocks the conscience." The police brought a young man named Felix Booker to the ER.
2010年，在担任急诊室医生期间，拉帕格利亚做了一件联邦上诉法院称“良心震惊”的事情。警察将一名名叫菲利克斯·布克的年轻人带到了急诊室。
They suspected Booker was hiding drugs on his body-- up his butt, to be blunt.
他们怀疑布克在他的身上隐藏了毒品——坦率地说，是在他的屁股上。
Dr. LaPaglia asked Booker to consent to a rectal exam.
拉帕格利亚医生请求布克同意进行直肠检查。
Booker was naked, except for a blanket, and in handcuffs and leg shackles.
布克全身赤裸，只盖了一条毯子，戴着手铐和脚镣。
He said no. LaPaglia says Booker consented to the exam, but nobody else who was in the room heard this.
他说不。拉帕格利亚说，布克同意接受检查，但房间里的其他人没有听到这一点。
And there's no medical record of it.
而且没有任何医疗记录。
LaPaglia tried to examine him.
拉帕格利亚试图给他做检查。
Booker clenched his muscles, so LaPaglia had him sedated.
布克绷紧了肌肉，所以拉帕格利亚给他注射了镇静剂。
Booker was still able to clench his muscles down, so LaPaglia had him medically paralyzed, intubated him, and did the rectal exam.
布克仍然能够收紧肌肉，因此拉帕格利亚让他在医学上瘫痪，给他插管，并做了直肠检查。
He found a rock of crack.
他发现了一块裂缝的岩石。
LaPaglia testified at Booker's trial that he'd done rectal exams on two other people the police had brought in to him.
拉帕格利亚在布克的审判中作证说，他对警方带到他这里的另外两个人进行了直肠检查。
A year after that, there was a fourth guy, Wesley Gulley.
一年后，第四个人出现了，韦斯利·古利 (Wesley Gulley)。
Gulley alleged he got the same treatment.
格利声称他也受到了同样的待遇。
LaPaglia asked him to consent to a rectal exam.
拉帕格利亚要求他同意进行直肠检查。
He said no. LaPaglia threatened to sedate him and paralyze him, so he relented.
他说不。拉帕格利亚威胁要给他注射镇静剂并使他瘫痪，所以他态度软化了。
LaPaglia did the rectal exam and found nothing.
拉帕格利亚做了直肠检查，但什么也没发现。
The police charged Gulley with resisting arrest.
警方指控格利拒捕。
The hospital charged him for the rectal exam.
医院向他收取直肠检查费用。
But apparently, nothing ever happened to Dr. LaPaglia.
但显然，拉帕格利亚博士什么也没发生。
He wasn't criminally charged for the warrantless, no-consent rectal searches.
他没有因未经授权、未经同意的直肠搜查而受到刑事指控。
He didn't even lose his job at the hospital.
他甚至没有失去医院的工作。
The searches were reported to the Department of Health, but Dr. LaPaglia was not disciplined for them.
这些搜查行动已报告给卫生部，但拉帕格利亚医生并未因此受到纪律处分。
And in a cruel regulatory irony, because he was not disciplined, there's no public record of why the board did not discipline him.
具有残酷监管讽刺的是，由于他没有受到纪律处分，所以没有公开记录说明董事会为何没有对他进行纪律处分。
Dr. Loyd actually found out about the rectal searches from Rebecca.
劳埃德医生实际上是从丽贝卡那里发现了直肠检查的。
They had coffee a few weeks after Dr. LaPaglia's hearing.
拉帕格利亚博士听证会几周后，他们喝了咖啡。
I mean, that's bringing up emotions right now I can't even-- that's somebody who's taken advantage of their position of power.
我的意思是，现在我什至不能激起情绪——那是一个利用自己权力地位的人。
That's not forgivable.
这是不可原谅的。
Maybe God could forgive him, but I can't.
也许上帝可以原谅他，但我不能。
I can tell you this.
我可以告诉你这一点。
If he paralyzed my son in the ER, I would have fucking killed him.
如果他在急诊室让我儿子瘫痪，我他妈的就杀了他。
I mean, I would've.
我是说，我会的。
I would've went after him.
我本来会去追他的。
I don't care.
我不在乎。
They just said, you know, well, you're going to-- you know, you want to pay consequences for this, Steve?
他们只是说，你知道，好吧，你要——你知道，你想为此付出代价，史蒂夫？
Fine.
美好的。
He paralyzed him.
他使他瘫痪了。
He paralyzed his muscles against his consent.
他不顾他的同意，瘫痪了自己的肌肉。
The guy did not give consent for that.
那家伙没有同意。
Yeah, he had to be intubated.
是的，他必须插管。
I mean, he couldn't even breathe on his own.
我的意思是，他甚至无法自己呼吸。
No, no, you can't.
不，不，你不能。
I mean, you paralyze all muscles, and your diaphragm is a muscle.
我的意思是，你麻痹了所有的肌肉，而你的横膈膜就是一块肌肉。
So you're not going to able to breathe.
所以你将无法呼吸。
Yeah, and that's somebody who will do anything.
是的，那是一个愿意做任何事情的人。
That's just incomprehensible to me.
这对我来说简直是无法理解。
Dr. Loyd and the other board members on LaPaglia's panel, all they knew was that LaPaglia 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.
洛伊德博士和拉帕格利亚小组的其他董事会成员，他们只知道拉帕格利亚之前曾因与个人吸毒有关的指控而在董事会缓刑过一次，他因药瘾而接受过治疗，这些年来一直保持清醒，而且他和布鲁克斯医生被发现使用布鲁克斯医生的 DEA 号码销售处方药，这比我刚才告诉你的故事要简洁得多。
But Coffman didn't talk about the rectal searches at Dr. LaPaglia's hearing because of the rules of evidence, he told me.
但科夫曼告诉我，由于证据规则，他没有在拉帕格利亚医生的听证会上谈论直肠搜查。
It wouldn't have been admissible.
这是不可接受的。
Same for the details about the 2014 drug charges, which, by the way, after LaPaglia pled no contest, he was put into something called judicial diversion.
2014 年毒品指控的细节也是如此，顺便说一句，在拉帕格利亚没有提出抗辩后，他被置于所谓的司法转移中。
It's a kind of probation.
这是一种缓刑。
And eventually, the case was dismissed.
最终，该案被驳回。
But more importantly, Coffman said this wasn't a hearing about everything LaPaglia had ever done-- just this one crime, the fraudulent prescriptions.
但更重要的是，科夫曼表示，这并不是一场关于拉帕格利亚所做过的一切的听证会——只是这一项罪行，即欺诈性处方。
Dr. Loyd didn't learn about the rest of it until it was too late.
劳埃德博士直到为时已晚才知道其余的事情。
When I'm looking at him up there, I mean, it looked like he was doing what he was supposed to be doing.
当我看着他在那里时，我的意思是，看起来他正在做他应该做的事情。
He's trying his best.
他正在尽力。
Sure, that's what I felt.
当然，这就是我的感受。
And I think I am a good judge of that, given all the facts.
考虑到所有事实，我认为我对此有很好的判断。
But I didn't have all the facts.
但我没有掌握所有事实。
How many strikes do I believe that somebody gets, Dana?
我相信有人会被击中多少次，达纳？
As many as they need.
他们需要多少就多少。
In the real world, there's no such thing as the third strike to me.
在现实世界中，对我来说，没有第三次打击这样的事情。
But this is not the real world.
但这不是真实的世界。
You have a professional medical license, and you can harm others.
你有专业的医疗执照，你可以伤害别人。
There is a strike limit there.
那里有罢工限制。
Dr. Loyd says he asks a lot more questions now during these cases.
洛伊德博士说，在这些病例中，他现在提出了更多问题。
So how to keep this from happening?
那么如何避免这种情况发生呢？
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?
如何确保董事会在决定如何惩戒医生之前全面了解医生的职业生涯和过去的不当行为？
Rebecca points to a simple and practical solution-- separate the disciplinary hearing into two parts.
丽贝卡提出了一个简单实用的解决方案——将纪律听证会分为两部分。
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.
举行一次听证会，委员会听取证据并决定医生是否有罪，并举行另一场听证会，对医生进行纪律处分。
And at that point, they can learn other information about a defendant's past, both good and bad.
那时，他们可以了解有关被告过去的其他信息，无论是好的还是坏的。
That's how criminal courts work.
这就是刑事法庭的运作方式。
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.
一旦陪审团确定一个人有罪，法官就负责量刑并了解更多关于被告的情况。
This solution, Rebecca points out, has the benefit of being readily available to the board.
Rebecca 指出，该解决方案的优点是董事会可以随时使用。
It's already legal under Tennessee law.
根据田纳西州法律，这已经是合法的。
Last September, the medical board members and staff had an offsite retreat.
去年九月，医疗委员会成员和工作人员进行了异地静修。
Rebecca was there.
丽贝卡在那里。
She recorded it for her notes for her book on licensing boards.
她将其记录下来作为她关于许可委员会的书的笔记。
And one of the things they discussed was Dr. LaPaglia's case, what had gone wrong.
他们讨论的事情之一就是拉帕格利亚博士的案子，以及出了什么问题。
Dr. Loyd was still upset about it.
洛伊德博士仍然对此感到不安。
Dr. LaPaglia is a practicing doctor in Tennessee right now.
拉帕格利亚医生目前是田纳西州的一名执业医生。
He does house calls for $50 cash.
他上门服务需要 50 美元现金。
And Loyd explained what he sees as the real problem with that kind of outcome, with this halfway discipline they gave LaPaglia.
洛伊德解释了他认为这种结果的真正问题是什么，他们给了拉帕格利亚这种半途而废的纪律。
They've made it so he can't get a job at a hospital or a medical clinic, but he can still see patients.
他们已经让他无法在医院或诊所找到工作，但他仍然可以看病人。
Dr. Loyd said, quote, "He can only work in a cash-based practice, and so the most vulnerable Tennesseans are the ones at risk.
洛伊德博士说，“他只能以现金为基础的做法工作，因此最脆弱的田纳西州人是面临风险的人。
And that's not awesome because the very population that I work personally with on a daily basis.
这并不是什么了不起的事情，因为我每天都在与这些人打交道。
I just put somebody back out there, and I'm struggling with that."
我只是把某人放回了那里，我正在为此挣扎。”
Dana Chivvis is one of the producers of our program.
达纳·奇夫维斯 (Dana Chivvis) 是我们节目的制作人之一。
Rebecca Allensworth wrote about medical boards and Dr. LaPaglia's case for the New York Review of Books.
丽贝卡·艾伦斯沃思 (Rebecca Allensworth) 为《纽约书评》撰写了有关医疗委员会和拉帕格利亚医生案例的文章。
[MUSIC - "YOU DON'T NEED A LICENSE FOR THAT" BY GEORGE FORMBY]
[音乐 - 乔治·福姆比的“你不需要许可证”]
Credits Ira Glass Our program was produced today by Sean Cole.
图片来源 Ira Glass 今天我们的节目由 Sean Cole 制作。
The people who put our program together today includes Bim Adewunmi, Elna Baker, Susan Burton, Ben Calhoun, Dana Chivvis, Aviva DeKornfeld, Hilary Elkins, Noor Gill, Damien Grave, Miki Meek, Stowe Nelson, Katherine Rae Mondo, Nadia Reiman, Robyn Semien, Lilly Sullivan, Christopher Swetala, Matt Tierney, Julie Whitaker, and Diane Wu.
今天制作我们节目的人员包括 Bim Adewunmi、Elna Baker、Susan Burton、Ben Calhoun、Dana Chivvis、Aviva DeKornfeld、Hilary Elkins、Noor Gill、Damien Grave、Miki Meek、Stowe Nelson、Katherine Rae Mondo、Nadia Reiman、Robyn Semien、Lilly Sullivan、Christopher Swetala、Matt Tierney、Julie Whitaker 和 Diane吴。
Our managing editor is Sara Abdurrahman, senior editor, David Kestenbaum, our executive editor, Emanuele Berry.
我们的总编辑是 Sara Abdurrahman，高级编辑是 David Kestenbaum，我们的执行编辑是 Emanuele Berry。
Special thanks to David Wendy Helgeson, Reid Magney, Scott McDonnell, and Jakob Elberg.
特别感谢 David Wendy Helgeson、Reid Magney、Scott McDonnell 和 Jakob Elberg。
Our website, thisamericanlife.org, where you can stream our archive of over 700 episodes for absolutely free.
我们的网站 thisamericanlife.org，您可以在其中完全免费地观看我们的 700 多集档案。
Plus, there's videos.
另外，还有视频。
There's lists of favorite programs.
有最喜欢的节目列表。
There's tons of other stuff on there, too.
那里还有很多其他东西。
Again, that website, thisamericanlife.org.
再说一遍那个网站，thisamericanlife.org。
This American Life is delivered to public radio stations by PRX, the Public Radio Exchange.
《美国生活》由公共广播电台 PRX 向公共广播电台播出。
Thanks, as always, to our program's co-founder, Mr. Torey Malatia.
一如既往地感谢我们项目的联合创始人 Torey Malatia 先生。
He and his wife are finally taking their first vacation since quarantine.
他和他的妻子终于迎来了隔离后的第一个假期。
I think they're going to have a good time.
我想他们会玩得很开心的。
He read me their packing list.
他给我读了他们的装箱单。
45 quart-sized Mason jars which contained marijuana, 127 glass pipes used to smoke marijuana, Glock 19 9 millimeter.
45 个装有大麻的夸脱大小的梅森罐子，127 个用于吸食大麻的玻璃管，Glock 19 9 毫米。
I'm Ira Glass.
我是艾拉·格拉斯。
Back next week with more stories of This American Life.
下周我们将带来更多《美国生活》的故事。
[MUSIC - "YOU DON'T NEED A LICENSE FOR THAT" BY GEORGE FORMBY]
[音乐 - 乔治·福姆比的“你不需要许可证”]
This American Life is produced in collaboration with WBEZ Chicago and delivered to stations by PRX The Public Radio Exchange.
《This American Life》与 WBEZ Chicago 合作制作，并由 PRX 公共广播电台传送到各电台。