Alcohol, Drugs and Impaired Provider Programs
When you hear the term “impaired provider,” you may think of the doctor who practices under the influence or who has hit rock bottom to the point he or she can no longer function to hold the practice together.
Posted in Risk Management on Tuesday, November 15, 2016
You may be surprised by what the impaired provider label encompasses.
Case Example: A 25-year-old college student drove after drinking beer while tailgating at a football game. Student was arrested for driving under the influence. The charges were resolved without a conviction. Student successfully completes chiropractic degree without issue and applies for a state license to begin practicing. Five years have elapsed since the charges. Student’s fitness to practice is questioned based on the incident, necessitating a fitness to practice evaluation.
If information in an initial application calls into question the applicant’s fitness to practice, boards may request that the applicant obtain an evaluation. New graduates are often shocked to learn that mistakes they overcame long ago can haunt them once again. Many applicants will choose to submit to a voluntary evaluation in the hopes of expediting action on their applications so they can begin earning a living and avoid lengthy and costly litigation that could result in the denial of their license.
Case Example: A complaint from a competitor doctor is filed, alleging that Dr. X has been observed at a social function having a drink, when Dr. X is known to be a recovering alcoholic. Dr. X’s fitness to practice is called into question based on allegations alone, despite the existence of a factual dispute.
Boards Can Act Swiftly
Allegations regarding substance use alone will likely trigger an immediate whirlwind of events for the doctor. Depending upon the severity of the allegations and the amount of evidence, boards may issue an emergency order, immediately suspending the doctor’s license in order to protect the public while the facts are sorted out. Often, boards will request that the physician submit to a voluntary evaluation of his or her fitness to practice. If the doctor does not submit voluntarily, then the board may exercise its authority to order the doctor to submit to an evaluation. Generally, reasonable cause or probable cause is all that is needed to issue such an order.
Typically the doctor is then referred to the impaired provider program for further referral and coordination in obtaining an independent forensic evaluation. Impaired provider programs are usually managed by a professional association or a private company.
An independent forensic evaluation is separate from a treating provider role, with no physician-patient confidentiality. The doctor will be required to sign releases so that information can be shared between the evaluator, the impaired provider program and the board. The evaluator is really an expert witness, so doctors should exercise due diligence in selecting the evaluator when provided options. The evaluations can cost the doctor thousands of dollars and days lost from practice.
Criteria Is Broad and Encompassing
The DSM-5 now integrates alcohol abuse and dependence into a single disorder called “alcohol use disorder” with mild, moderate and severe subclassifications. Even a diagnosis of alcohol use disorder (mild) may result in a referral to the impaired provider program for abstinence and compliance monitoring. Many doctors are surprised to learn what they believed was responsible social drinking actually meets the criteria for alcohol use disorder (mild).
If the doctor receives a diagnosis necessitating abstinence and monitoring, then the doctor will be required to enroll in the impaired provider program and sign a contract agreeing to follow the terms for participation. The board may also issue an order against the licensee to give teeth to their participation in the program. Generally, boards will characterize their orders, addressing impairment as nondisciplinary in nature, but such orders can still have detrimental collateral effects. Public nondisciplinary orders may result in reputational risk, and some health insurance companies are beginning to take a harder look at these providers for credentialing purposes.
What exactly are the terms of participation in an impaired provider program? The terms may include treatment and abstinence from all intoxicating substances, unless taken as prescribed by a treating physician. The provider’s abstinence will be verified through random urine screens, blood draws or hair testing. The provider is typically also required to participate in Caduceus (recovery groups specifically for healthcare professionals) and other support groups. It is fairly standard for monitoring contracts to range from three to five years.
Providers who are enrolled in a monitoring program must take the program seriously. Too often, doctors approach the program with resistance or with the idea they can beat the system. Those are professionally fatal errors. While most boards are willing to give providers at least one chance in the program, second chances are not guaranteed.
It is important to understand the perspective of the boards, which is that regulated professionals are held to a higher bar than the rest of the public because of the privilege they hold to practice the profession. Sometimes circumstances mandate going the extra mile to maintain that privilege.