In the fourth and final day of the hearing probing Helena physician Mark Ibsen’s medical practice, the Board of Medical Examiners' attorney, Mike Fanning, pushed Ibsen on allegations that Ibsen may have psychological problems that interfere with his ability to adequately perform his job.

The tension between Ibsen and Fanning was immediately evident when Fanning began his questioning of Ibsen.

Shortly after Fanning started his line of questioning, hearing officer David Scrimm interrupted. “I can see the tension,” he said. “I would ask that you (both) scale it back a little bit now before it gets any further down the road.”

“What kind of guidance would you give me?” Ibsen asked.

“Be cool,” Scrimm said.

Fanning's line of questioning aimed at Ibsen’s behavior focused in large part on posts to Ibsen’s Facebook page.

“Did you say you won’t stand for bullying?” Fanning asked.

“I might have,” Ibsen replied.

“Did you indicate you were going to do something to make this process ugly?” Fanning asked.

“This process is pretty ugly already,” Ibsen replied.

Fanning read from another alleged Facebook post by Ibsen.

“Clearly my lawyerly nemesis at (the Board of Medical Examiners) has upped the ante,” Fanning read. “Now his career is on the line which means it’s going to get real nasty real quick.”

“What did you intend to do to make it nasty?” Fanning asked.

Ibsen’s attorney, John Doubek, tried several times to stop this line of questioning, objecting that it was irrelevant to the issues in the case. Fanning argued that his questioning was relevant to show Ibsen’s character and how previous issues for which Ibsen was accused of may have resurfaced.

Fanning kept pressing Ibsen on his Facebook posts, asking what Ibsen’s intent was.

“Were you trying to threaten me?” Fanning asked.

Fanning asked if Ibsen’s friend, a retired opthomologist, had written a letter at Ibsen’s request.

“He (Ibsen’s friend) called me a vicious dog … and he was going to ensure that I was silenced,” Fanning said. “He (Ibsen) has tried to undermine anybody who’s ever threatened him, and he sees me as a threat.”

Ibsen denied Fanning’s allegation that he was vengeful.

“Everybody that’s testified in this hearing that’s challenged you has suffered some form of counter-attack or retaliation,” Fanning said.

Ibsen replied with one word.

“No,” he said.

When asked whether he thought the Board of Medical Examiners and Fanning had acted outside the bounds of their responsibility, Ibsen said, “Yes.”

Ibsen said his problem is not with the board.

“I don’t think the board has heard about any of this,” Ibsen said to Fanning. “My problem is with you. It seems to me the process was quite secretive. There were several agreements in place but … it became clear to me the process was going somewhere with no interest in any resolution. … It seems the process is going to go on and on, maybe to build your career. I have no idea what you’re up to.”

In 2006, Ibsen entered into an agreement with the Montana Professional Assistance Program, a sort of diversion program, to avoid possible discipline through the more formal process with the state’s Board of Medical Examiners.

Ibsen signed a contract with the assistance program, but he said he was not happy with the terms.

“I thought it was parallel to sending me to the gulag,” he said.

The 2006 issues, Ibsen said, were “driven by malice.”

At the time, Ibsen was working at St. Peter’s Hospital as an emergency room physician and, he said, he sought an evaluation because he was pressured by the other doctors he worked with. Ibsen said they thought he had a substance abuse problem.

“In order to save my job I had to go to the Menninger Clinic,” Ibsen said.

Ibsen said after a five-day evaluation at the Houston clinic, he was diagnosed with narcissistic personality disorder.

Narcissistic personality disorder is a condition in which people have an excessive sense of self-importance, an extreme preoccupation with themselves and lack of empathy for others.

“I said, ‘Great, now let me go back to work with all the other narcissists,’” he said.

The five-day evaluation and diagnosis cost $10,000, Ibsen said, and the clinic’s recommendation was a 10-week in-patient treatment program that would cost $1,000 per day.

“I could hear ka-ching, ka-ching,” he said. “I thought the whole thing was driven by malice.”

Ibsen then got a second evaluation and complied with its treatment recommendations.

“I didn’t like it, but I wanted to keep my job. It turns out the job was gone anyway,” he said.

Fanning asked Ibsen if he would be able to again enter into a treatment agreement with the Montana Professional Assistance Program.

“I live in the now,” Ibsen replied. “I don’t know what I’ll do if it’s offered (in the future).”

Terence Corrigan can be reached at