The Virginia Health Practitioners’
Monitoring Program
700 East Franklin Street, Suite 300 Tower
Richmond, VA 23219
804-828-1551 866-206-4747
Penelope P. Ziegler, M.D.
Medical Director
VA HPMP
 Program established by Virginia General
Assembly in 1997 as Health Practitioners’
Intervention Program (HPIP)
 Chapter 25.1 of Title 54.1, passed in 2009
formally changed name from HPIP to Health
Practitioners’ Monitoring Program (HPMP)
 More accurately reflects primary role of program
 Outreach and education about professional
impairment, previously done by HPIP, now done
by Department of Health Professions (DHP)
HPMP Operation
 Operated by Virginia Commonwealth
University, Department of Psychiatry, under
a Memorandum of Agreement with DHP
 Funding is via professional licensure fees;
amount of funding is determined by DHP
 Oversight and coordination
 Monitoring Program Committee (MPC)
 7 members appointed by the Director of DHP
 Meets 6 times yearly or as needed to review
program operation, policies, specific cases
 DHP liaison/ program manager
What Is Practitioner Impairment?
 Impairment refers to a practitioners’
inability to perform professional duties with
skill and safety as result of an illness or
other health issue
 Substance use disorder
 Psychiatric illness
 Medical condition
 Potential impairment refers to the diagnosis
of a condition that, without treatment,
could be expected to result in impairment
Epidemiology of Addiction (85-90% of
HPMP cases) in Health Care Professionals
 Alcohol abuse and dependence
 No difference in overall incidence or prevalence
 Usually have later onset, less antisocial behavior
 Illicit drug abuse and dependence
 Lower than in general population
 Marijuana is most common drug of choice
 Prescription drug abuse and dependence
 Higher than in general population
 Oral opioids are most common drug of choice in all
health care professions
How Is Impairment Identified?
Changes in behavior
 Extreme mood swings, temper outbursts
 Lateness, cancels cases/ appointments
 Documentation illegible or not completed
 Falls behind in duties
 Rounds late at night
 Misses exams, deadlines for papers
Changes in appearance
 Disheveled
 Major weight loss or gain
 Pale, plethoric or diaphoretic
Other Indicators of Addiction
 Disappears while on duty or during cases
 Requests weekend duty (drugs are at work!)
 At workplace evenings, weekends off
 Unreachable, cell phone/pager “didn’t work”
 Alcohol on breath
 Long sleeves even in hot weather
 Appearing sick or calling off on Mondays
Virginia Reporting Requirements
 Licensed practitioners, health care institutions,
professionals associations and malpractice insurers are
required to report to the appropriate Boards practitioners
who may be mentally or physically unable to practice
safely as the result of an apparent impairing condition
 Any such person or institution making a report in good
faith is immune from civil liability
 Psychiatric facilities are required to report the inpatient
admission of any licensed practitioners to the
appropriate Boards
 Interesting conflicts with State and Federal
confidentiality statues, HIPAA, etc.
Assessment and Treatment Planning
When addiction or other impairment is
suspected, careful evaluation is required
 Is substance dependence a primary diagnosis?
 Are other psychiatric disorders present which also
require immediate treatment?
 Are there medical conditions which will complicate
the treatment and recovery?
Once diagnosis is established, treatment
planning is next step
 What type of treatment is needed?
 What level of care is indicated for initial treatment?
Essential Elements of Treatment
 Effective reduction of denial, resistance
and intellectualization
 Acceptance of chronic nature of disease and
need for ongoing treatment
 Relapse prevention which addresses issues
specific to the professional’s practice
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Re-entry stresses
Access to drugs
Need for monitoring
Dealing with Board issues, legal issues
How Are Health Care Practitioners
Referred to HPMP?
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By Board Order
By DHP staff during process of investigation
By colleague or peer
By physician, therapist
By treatment program
By employer, hospital
By attorney
By family, significant other, friend
By training program, school
Self-referred
Monitoring as an Alternative to Discipline
 Eligibility
 Active Virginia license or application
 Impairing or potentially impairing condition
 Advantages
 Encourages early identification and referral to
appropriate treatment
 Preserves valuable professionals’ ability to return to
practice following treatment with ongoing monitoring
 Improves practitioner’s prognosis for recovery
Components of Monitoring
 Participation Contract (PC)
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Agrees
Agrees
Agrees
Agrees
to enter HPMP program
to abstain from alcohol and other drugs
not to practice until cleared to do so by HPMP
to provide all relevant medical records and releases
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Agrees to continued abstinence if indicated
Treatment plan is specified in detail
Drug screening program is specified
Agrees to be responsible to:
 Recovery Monitoring Contract (RMC)
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Follow rules of HPMP
Provide timely reports
Provide drug screens when selected
Not to return to work until approved to do so by HPMP
Drug Monitoring
 Random urine drug screens at individualized
frequency and content (medical director is
Medical Review Officer)
 Third party administration of screening
program provided by Affinity Online Solutions
 Daily check in by telephone or online
 Collection sites, billing, chain of custody forms provided by
Affinity Online Solutions
 System of alerts for missed calls, no shows, positive results,
nonnegative results
 MRO consultation available if requested
 Lab services provided by LabCorp
 Hair testing utilized on individual case basis