Addicted doctors may seek help, but don't always reveal themselves
Addicted doctors may seek help, but don't always reveal themselves
Some physicians avoid in-house help, stay under the radar
No one doubts that addicted physicians pose a significant liability risk and threat to patient safety, so risk managers are eager to offer help when asked. But what if the doctor doesn't ask you or anyone else in your organization and instead goes outside for help in beating the addiction? Shouldn't you be involved so you can address the risk management concerns?
Ideally, that would be the best scenario, most risk managers agree. But nearly all states have confidential rehabilitation programs that allow doctors to continue practicing while being treated for addiction, an issue that is gaining attention as California moves toward abolishing its confidential program on June 30, 2008. The Medical Board of California announced in 2007 that the program was ineffective and would be closed.
Most impaired physicians come to the risk manager's attention, or at least the attention of someone in the organization who can help, through their own behavior in the workplace or because they self-report, says Paul English Smith, JD, FASHRM, CPHRM, vice president and general counsel at Cabell Huntington Hospital in Huntington, WV, and past president of the American Society for Healthcare Risk Management (ASHRM) in Chicago. Smith has seen several such incidents in his career, and he says the best situation is when the physician is aware he or she has a problem and comes asking for help. "The worst is when they are fooling themselves and trying to fool others into thinking they don't even have a problem," he says. "That is most likely to lead to a situation where you have to eventually sever the relationship to protect patient safety."
Steer toward in-house help
Health care providers usually have a system in place to aid impaired physicians and staff, either internally or through a rehabilitation resource outside the organization. The risk manager may not necessarily be informed or involved in the process because of confidentiality constraints, Smith says, but there is reason to encourage physicians to go that route rather than seeking help on their own and keeping it secret from the provider.
If the rehab goes well, the risk manager may never need to get involved, but if the physician's situation is known within the health organization, the potential risks can be brought to the risk manager's attention when necessary, he says. Even physicians who are ready to seek help can do so without letting anyone at the hospital know, he notes, so the goal for risk managers is to encourage those impaired physicians to seek help inside the system, not outside. "We want you to get help if you have an addiction, so we're not going to discourage getting help anywhere," Smith says. "But we have the resources internally to help, and we'd like to see you take that route. We'd like to be part of the process."
Physicians fear punishment
To encourage physicians to seek help internally, much of the risk management department's work will be at arm's length, helping the physician wellness program or employee assistance program obtain the resources they need, for instance. The risk manager also must help create an atmosphere in which physicians do not fear punishment if they come forward, Smith says.
"The compartmentalization is very important, and physicians have to be assured that if they ask for assistance, that information is not going to be passed all over the organization and the risk manager isn't going to be meeting with them the next day to talk about restricting their privileges and any kind of punishment," Smith says. "They have to be encouraged to seek help, and they won't if they think you're going to come down hard on them right away."
Smith also says you should look for opportunities to offer help early in the person's addiction, rather than waiting until the problem is so severe that it comes to your attention through an adverse event. For instance, if there is ever a concern about a physician's condition and the doctor responds by denying a problem and saying, "Test me right now, if you don't believe me," you should test immediately.
"It sounds like defiance, and too often people back down and don't do the drug or alcohol test," Smith says. "But sometimes that is how the person is asking for help. If they challenge you to test them, test them right away. Otherwise, you might be losing an opportunity to help."
Confidentiality is key
Jeffrey Driver, JD, MBA, chief risk officer with Stanford University Medical Center in Palo Alto, CA, and past president of ASHRM, also has experience with impaired physicians and staff. About 10 years ago he "learned the hard way" about how to deal with impaired physicians and staff when a nurse and a resident physician died from drug addictions without seeking help through the in-house resources that were available. He is now actively engaged in encouraging physicians and staff to come forward when they need help.
Driver says the promise of confidentiality is key to getting impaired physicians to come forward. They are always fearful of the damage to their reputation and their careers, not to mention potential criminal charges or civil liabilities, he says. Though some of those consequences may be legitimate, it is more productive to create an environment in which the physician sees your organization as an ally, he says. That environment helps keep the physician within your system when seeking help, and Driver says that is always preferable.
"But that doesn't mean I personally have to know," he says. "If my committee knows and I have comfort that my committee is addressing the physician's needs, then I don't have to know the particular physician, who it is, and what the details are. The bigger concern is that the person is getting help, and I know that our system will bring me into the picture if and when that is appropriate."
The risk manager will have a role to play when patient safety is threatened, and in that case direct intervention may be required. Driver recalls an incident in which staff reported that a surgeon was in the operating room in an impaired condition, unable to proceed, and so Driver had the surgeon pulled out of the room for an immediate sit down with him and a physician leader. But once the surgeon entered the hospital's diversion program, Driver's direct involvement ceased.
"That surgeon came back completely rehabilitated, a real success story, so the process works if the risk manager understands that it is rehabilitative and not punitive," Driver says. "But still, I was in the loop, and so if something had gone wrong in that physician's rehabilitation program, I would have known and would have been able to act."
Sources
For more information working with addicted physicians, contact:
- Jeffrey Driver, JD, MBA, Chief Risk Officer, Stanford University Medical Center, Palo Alto, CA. Phone: (650) 725-6996. E-mail: [email protected].
- Paul English Smith, JD, FASHRM, CPHRM, Vice President and General Counsel, Cabell Huntington Hospital, 1340 Hal Greer Blvd., Huntington, WV 25701. Phone: (304) 526-2000. E-mail: [email protected].
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