Impaired PhysiciansHarm Patients - Lose Licenses.

• Overview• Definition• Causes• Warning Signs• Treatment• SHC Well-Being Committee• Medical Board of California• Fitness for Duty Examination

Overview

• More awareness of / less tolerance for– Physician error, misconduct, negligence, incompetence– Public wants to be protected from bad doctors

• More MDs medically impaired than legally impaired– Only 15% of impaired physicians ever identified– Medical impairment early – Legal impairment late

Legal Definition of Impaired Physician

• Physician is unable to practice medicine with reasonable degree of skill and safety because of physical or mental illness substance abuse, or age-relate deterioration.

Causes of Impairment

• Drug and Alcohol Abuse• Mental Illness• Medical Illness• Dementia

Warning SignsEarly - Late

• Personal appearance and behavior

• Treatment of patients

• Conflicts with colleagues / staff

• Legal problems

Treatment

Negative• Physician denial• Shame and fear• Hopelessness• Peer denial• “Conspiracy of silence”

Positive• Identification• Intervention• Motivation (Terror)• Coercion• Phased Treatment• Long-term follow-up• 70% success rate

SHC Well-Being CommitteeFederal Law. Darling vs. Community Hospital

• Self-referral or confidential referral by another

• Review information & meet the individual

• Determine if / what problem exists

• Develop plan & convert it to contract

• Monitor progress

• Refuses plan / no compliance, refer to Chief of Staff

Medical Board of CaliforniaProtect public by enforcing Medical Practice Act

• Division of Licensing– Evaluate credentials, education, skill– CME

• Diversion Program– 45 per year, 300 in 5-year monitoring, 70% success rate

• Division of Medical Quality– Conducts investigations / takes enforcement action (Cal AG)– Receives 805 reports, malpractice settlements (0.1% involved

psychiatrist), criminal charges / convictions, citizen complaints– Sends reports to requesting agencies, NPDB

MBC Annual Report 2007

• 7000 complaints • 1000 investigations• 400 referred to AG Office for special attention

– 200 resulted in enforcement action• 90 revocations / license surrenders• 90 letters of reprimand• 20 suspensions • 80 probations• 20 cases referred to Diversion

– 50 determined “impaired”

Physician Fitness for Duty Examination

• Is physician danger to self, others, public?

• Is physician’s ability to practice safely impaired by mental illness or physical illness that affects competency?

• Does physician require therapy or other measures to practice safely?

• * * * Axis II not ”impairment”

• Read investigative file• Take thorough history • Mental status examination• Identify practice-interfering

mental status deficits• Make diagnosis / prognosis• Answer the questions• Suggest treatment, practice

limitations for safe practice• Report fact heavy, logical • Other considerations:

• Examiner liability• Sensitive information