Impaired Healthcare Practitioners

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1 Developed by FirstLab in association with the Florida Medical Association

2 Impaired Healthcare Practitioners Training Program FirstLab, in conjunction with the Florida Medical Association, has developed a training tool that meets the JCAHO MS.2.6 requirements. This comprehensive program provides a recurring educational function for all of your current staff and future hires. This allinclusive program provides information that participants will be able to utilize professionally and personally. This dynamic program includes: A 55 minute video featuring Dr. Raymond Pomm, Medical Director of the Florida Physicians Recovery Network, a nationally recognized expert. A comprehensive manual A summary of JCAHO s MS.2.6 An overview of substances and conditions Federal and state regulations Sample by-laws, policies and procedures An incident summary tool Training instructions Participant Handouts One hour of level 1 CME credit An exhaustive list of related resources

3 A Word About FirstLab From Our President FirstLab is a diversified healthcare services and regulatory information management company. Founded in 1988, as a full service clinical laboratory, FirstLab is now a leading Third Party Administrator (TPA) of drug and alcohol testing programs, background investigations, and commercial driver qualification file programs. In addition, FirstLab is a behavioral healthcare pharmacy provider. Historically, FirstLab has been committed to innovative behavioral healthcare, uncompromising business ethics, and technical advancement. Our mission is to create long-term professional and personal relationships with our clients by meeting their specific business needs. Starting with our core business of workplace testing services, FirstLab has expanded its capabilities over the years and now delivers a wide range of innovative, cost-effective products and services to a rapidly growing and diversified client base. Our clients include Fortune 500 companies, law enforcement agencies, state and municipal governments, airlines, hospital and treatment facilities, sports organizations and Professional Health Monitoring Programs. FirstLab s Professional Health Monitoring program was created in response to a call from a professional association inquiring about a drug-testing program for its recovering members. We immediately recognized that by enhancing our standard workplace testing programs, we could provide a specific blend of services to meet the unique needs of recovering professionals such as doctors, dentists, lawyers, nurses, and pharmacists. These services include expanded drug testing panels to detect a wide variety of substances at low levels, toll-free random notification call-in systems, compliance monitoring, and a state-of-the-art computerized information management system to assist programs in organizing their results. Today, FirstLab is the largest Professional Health Monitoring program in America, providing services to state and professional associations nationwide. These programs are key to ensuring the successful recovery of impaired professionals and overall public safety. Closely monitored professional recovery programs have demonstrated success rates as high as 90%, saving lives and careers while promoting public safety. We feel that helping to implement the JCAHO mandated educational requirement is an important extension of our commitment to promote a healthy and safe environment in which we can all live and work.

4 It is our sincere hope that the lessons contained in this program may encourage impaired practitioners from all disciplines to take the first step to a life of recovery, knowing they will be treated confidentially within a successful medical model that encourages a rebuilding of their lives and careers, rather than being penalized for having a treatable disease. Thanking you for your interest in our program and looking forward to working with you in the near future, I remain, Respectfully yours, David M. Martin, Ph.D. President and Chief Executive Officer FirstLab

5 A Word About the Florida Medical Association Impaired Healthcare Practitioners Mission The Florida Medical Association (FMA) serves as an advocate for physicians and their patients to promote the public health, to ensure high standards in medical education and ethics, and to enhance the quality and availability of health care. The Florida Medical Association, along with its component medical societies, is the largest, most effective organization representing the interests of all Florida physicians and their patients. The FMA provides members with a strong voice and active representation in state legislation, medical, ethical, and legal affairs, medical economics, and practice issues. The Florida Medical Association and county medical societies offer membership benefits that make a significant difference to patients, practices, and the profession. Based in Tallahassee, Florida, the FMA sponsors a variety of services including legislative and regulatory advocacy, legal advocacy, legal advice, educational opportunities, and an extensive Member Benefits program. Benefits Advocacy in the Legislature Intervention with Government Agencies Reimbursement Assistance Legal Advice, Discounted Contract Review Information on Education Resources Professional Benefits and Discounts Leadership and Networking Opportunities Service to the Profession The Florida Medical Foundation The Florida Medical Foundation is closely affiliated with the FMA. Founded in 1956, the mission of the Florida Medical Foundation is to support medical education, scholarship and research; contribute to the personal and professional development of physicians; and to promote the delivery of high quality health care in Florida. The Florida Medical Foundation administers the Florida Physicians Recovery Network (PRN), which is funded through the Florida Department of Health as well as through charitable contributions. The purpose of the PRN is to ensure the public health and safety by assisting impaired practitioners. By supporting impaired practitioners in regaining health, the PRN attempts to maintain the integrity of the healthcare team in its role in serving the public. Based on requests for educational training from professionals across the state, the Florida Medical Foundation partnered with FirstLab to provide this program to identify impaired practitioners and assist in their return to satisfying careers.

6 Joint Commission on Accreditation of Healthcare Organizations Background Impaired Healthcare Practitioners The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) evaluates and accredits more than 17,000 health care organizations and programs in the United States. An independent, not-for-profit organization, JCAHO is the nation s predominant standards-setting and accrediting body in health care. Since 1951, JCAHO has developed state-of-the-art professionally based standards and evaluated the compliance of health care organizations against these benchmarks. 1 Effective in January 2001, JCAHO issued revisions to selected medical staff standards in the Comprehensive Accreditation Manual for Hospitals to cover matters of individual physician health. The revisions, known as MS.2.6, are included in this section of the manual. They acknowledge that an organization has an obligation to protect patients from harm and therefore, must design a process that provides education to staff about matters of physician health. The purpose of the process is to identify and manage matters of practitioner health in a manner separate from the medical staff disciplinary function. The process aims to assist and rehabilitate, rather than discipline a practitioner, who needs to retain, or return to, optimal functioning. It directs each accredited facility to design and implement a process that: Provides education about practitioner health Addresses prevention of physical, psychiatric, or emotional illness Facilitates confidential diagnosis, treatment, and rehabilitation of practitioners who suffer from a potentially impairing condition 1 Source: JCAHO website, Oct. 2002

7 Revisions to Selected Medical Staff Standards Comprehensive Accreditation Manual for Hospitals Effective January 1, 2001 Physician Health MS.2.6 The medical staff implements a process to identify and manage matters of individual physician health that is separate from the medical staff disciplinary function. Intent of MS.2.6 An organization has an obligation to protect patients from harm. In this regard, the medical staff and organization leaders design a process that provides education about physician health, addresses prevention of physical, psychiatric, or emotional illness, and facilitates confidential diagnosis, treatment, and rehabilitation of physicians who suffer from a potentially impairing condition. The purpose of the process is assistance and rehabilitation, rather than discipline, to aid a physician in retaining or regaining optimal professional functioning, consistent with protection of patients. If at any time during the diagnosis, treatment, or rehabilitation phase of the process it is determined that a physician is unable to safely perform the privileges he or she had been granted, the matter is forwarded to medical staff leadership for appropriate corrective action that includes strict adherence to any state or federally mandated reporting requirements. Process design should include mechanisms for the following: Education of the medical staff and other organization staff about illness and impairment recognition issues specific to physicians; Self-referral by a physician and referral by other organization staff; Referral of the affected physician to the appropriate professional internal or external resources for diagnosis and treatment of the condition or concern; Maintenance of the confidentiality of the physician seeking referral or referred for assistance, except as limited by law, ethical obligation, or when the safety of a patient is threatened; Evaluation of the credibility of a complaint, allegation, or concern;

8 Monitoring of the affected physician and the safety of patients until the rehabilitation or any disciplinary process is complete; and Reporting to the medical staff leadership instances in which a physician is providing unsafe treatment. Scoring for MS.2.6 a. Has the medical staff implemented a process to identify and manage matters of individual physician health that is separate from the medical staff disciplinary function? b. Does the process design include the seven items listed in the intent statement? Score Question a Question b 1 Always Always 2 Usually Usually 3 Sometimes Sometimes 4 Rarely Rarely 5 Never Never

9 Definition and Scope of the Problem Impaired Healthcare Practitioners Impairing conditions can affect anyone in the general population; healthcare professionals are not immune. In fact, approximately 15% of practicing physicians have had or currently have a substance related impairment. If psychological and physical impairments are added, the percentage of practitioners with an impairment increases substantially. Chemical dependency is recognized as a disease based upon the medical disease paradigm, being chronic, progressive, and relapsing. There is no cure but there is effective treatment and the condition can be kept in remission through a process of recovery; not unlike that for diabetes, hypertension, or heart disease. Since 1972, in various policy statements, the American Medical Association has defined the impaired physician as: one who is unable to practice medicine with reasonable skill and safety to patients because of physical or mental illness, including deterioration through the aging process or loss of motor skill, or excessive use or abuse of drugs, including alcohol. Impairment generally leads to decreased or altered clinical judgment, or diminished technical skills; therefore it has a deleterious or even dangerous impact on patient safety. A practitioner s impairment can also lead to significant problems with others in the hospital, community, family, and friends. Professionals often feel helpless when such a realization occurs about a colleague and are therefore, silent, becoming part of the problem itself. Organizations that tolerate these conditions increase the risk of unflattering publicity, and litigation from patients who have been harmed. Impaired practitioners are not usually able to recognize their own impairments and therefore, do not voluntarily seek help. This denial is an unconscious process on the part of the individual, but is often also found amongst hospital personnel, other treating professionals, and people in the community. Early intervention with any impairment, whether physical, psychological, or chemically related, is critical in achieving the best outcome for the practitioner and preserving patient safety. Practitioners who are evaluated and who participate in a treatment program have an excellent chance of returning to their careers.

10 Problems Associated With Impairment Types of Impaired Behavior Substance Abuse Personality Disorders - Disruptive Behavior Physical Impairments Psychological Impairment Boundary Violations The most effective strategy for combating impaired behavior in the workplace is to observe and document poor performance. The following are signs of impaired behavior, which has a bearing on the quality of patient care being delivered: General Signs of Practitioner Impairment Personality changes which take place rapidly, or over time, such as increased irritability Changes in personal grooming habits or in mode of dress Memory lapses or generalized forgetfulness Withdrawal from social situations in which the practitioner had previously participated Alterations in clinical judgment or behaviors such as undue delay in returning consultation calls Complaints from hospital personnel In The Workplace Making rounds late, at off times, or displaying abnormal behavior during rounds Reports of unavailability or inappropriate responses to phone calls, particularly from the Emergency Department Decreasing quality of performance in functions such as charting or staff presentations Inappropriate orders or over prescribing of medications Delegation of tasks to unqualified personnel Isolation or withdrawal from staff functions, particularly functions that were usually attended by the practitioner Complaints from patients or patients families re: hostile, withdrawn, or unreasonable behavior Involvement in malpractice suits and legal sanctions against the hospital Frequent disruptions of appointment schedule Hostile, withdrawn, unreasonable behavior Excessive ordering of drugs from pharmacy, mail-order, or internet

11 Physical Signs Deterioration of personal hygiene, clothing, and dressing habits Multiple physical complaints and signs such as tremors, diaphoresis (sweating), irritability, mood swings, marked weight loss or gain, reduced attention span, forgetfulness, hyperactivity Frequent accidents resulting in injuries such as strains, sprains, abrasions, hematomas, fractures Pre-Employment Issues Numerous job changes within the past 5 years Frequent geographic relocations Unexplained intervals between jobs Work at jobs inappropriate for qualifications Reluctance to undergo immediate physical exam Complicated and elaborate medical history Indefinite or inappropriate references Reluctance to allow spouse and/or children to be interviewed Conviction for DWI or DUI It is very important to verify all education, previous sites of practice or employment, and claims of licensure. All lapses of greater than 30 days after medical school in an applicant s paperwork must be fully explained and documented.

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