Plastic surgeon Ronald S. Perlman thrives in the limelight. He has served as a celebrity judge at top-flight beauty pageants, helped run a charity that assists abused women - even raffled off his services at a society auction.
His Perlman Plastic Surgery Center, which specializes in breast implants and laser facial surgery, is a fixture in Washington's Spring Valley neighborhood, a few blocks from the Maryland line. He also ran a satellite office in Greenbelt for 15 years and is licensed in Virginia.
But for years, a debilitating side of the high-profile surgeon's life remained a secret from patients: abuse of drugs, including cocaine, prescription pain pills and alcohol, state records show. The Maryland Board of Physicians investigated him three times as he struggled with the problem.
Perlman's battle with substance abuse - and the board's effort to balance a doctor's interests with those of patients - has now come to light.
In January, 17 years after his problems first came to the attention of state officials, Perlman surrendered his Maryland license. He did so rather than contest charges that he practiced while "habitually" abusing drugs and misleading the board about it, records show. He is still permitted to practice in Washington and Virginia.
With his decision to give up his license, the board's record became publicly available. The Sun obtained it, and Perlman consented to a lengthy interview last week. He readily discussed his problem and emphasized his belief that patients were never at risk, the issue the state medical board weighs in dealing with doctors who misuse drugs and alcohol.
Perlman, 54, said he is no longer abusing drugs, has been in recovery for nearly four years and is "committed to keeping myself sober for the rest of my life."
"I've made my mistakes, and I'm ready to admit to them," he said in an interview in his Washington office, which is filled with memorabilia from his contacts with prominent politicians and celebrities including Donald Trump. "Obviously, I made some wrong choices." But he insisted he has not harmed anyone, other than himself.
"I have not had a standard-of-care issue associated with my problem," he said. "I have always practiced excellent medicine and have continued to do so."
Perlman's disciplinary case offers a rare look at how regulators treat - and try to keep tabs on - drug-abusing doctors.
It's an imperfect system. Regulators don't routinely track doctors once they finish a course of rehabilitation treatment, yet experience shows that many people suffer relapses that could pose a threat to patients. Moreover, regulators are sometimes slow to act when drug problems surface and often don't share information with the public.
Over nearly two decades, Perlman came to medical regulators' attention three times in connection with his problems, and he wound up undergoing treatment for them three times.
Every state has some type of doctor rehab system. Like Maryland, about half give the job to the medical licensing board. The rest rely primarily on doctors' groups. Either way, the goal is to balance the obligation to help heal a sick doctor against the state's duty to protect the public from harm.
Estimates vary on the numbers of doctors who abuse drugs or alcohol at some point in their careers. California's medical board, which has supervised the treatment of hundreds of doctors over the past 25 years, puts the figure at about one in five. Three of four doctors recover after completing treatment, according to California officials.
The Maryland Board of Physicians Professional Rehabilitation Program, on the grounds of Spring Grove Hospital Center in Catonsville, has nearly identical success rates. In 2000, the latest year for which figures could be obtained, the program treated 88 people. As of last week, 45 doctors were enrolled. An estimated 17,000 doctors practice in Maryland.
Unlike airline pilots, who are forced off the job if they develop a drug problem, Maryland doctors can, and often do, continue to practice. They sign contracts agreeing to a treatment plan - which typically lasts three years and can consist of group and individual therapy and regular monitoring of urine. If they complete rehab, they are released from further monitoring and the matter is not made public.
Not everybody makes it through without a hitch, said Dr. Burton D'Lugoff, the program's medical director.
"Relapses aren't an indictment of the program," said D'Lugoff, a retired psychiatrist and former Johns Hopkins professor. "We don't have a definitive treatment for addiction."
Doctors who relapse, as Perlman did, are reported by the treatment program to the medical board for possible disciplinary action. But years can go by while the board investigates, and during that time there's no way for patients to know about the doctor's condition. These cases become public only when the medical board votes to file disciplinary charges and impose a penalty, as happened in Perlman's case.