What Constitutes Impairment?
Impairment is defined (determined by the
disciplining authority) as an addiction to, a
dependency on, or the misuse of alcohol, legend
drugs, or controlled substances.
(RCW 18.130.175)
Illness vs. Impairment
Illness and impairment exist on a continuum with illness typically
predating impairment, often by many years.
•Illness is the existence of a
disease
•Impairment is a functional
classification implying the inability
of the person affected by disease to
perform specific activities
Impaired Healthcare Practitioners
Health Professionals have a right and an
obligation to ask for help when they are
struggling with impairment. When they request
assistance, they deserve the same care and
respect that they give their own patients and
client every day.
The Addicted Professional
• Typically, the workplace is the last place addiction
manifests itself.
• Disruptions in family, personal health, and social life
can all occur while the workplace remains unaffected.
• Even small intrusions of addiction into the workplace
should be taken very seriously.
Continued Compulsive Use despite
Negative Consequences
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Losing social stature
Marital problems including divorce
Occupational and career problems
Health issues (hepatitis, diabetes)
Legal problems
Financial ruin
Co-occuring Mental Health Issues
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Depressive disorders
Bi-polar disorders
Anxiety disorders
Panic attacks
Post-Traumatic Stress Disorder
Dementias
The Incidence of Substance Abuse
• Substance abuse impacts 10-15% of the
general population, slightly higher in health care
professions
• The American Nurses Association estimates
that 8-10% of nurses use alcohol or drugs to an
extent sufficient to impair practice
Risk Factors
• Lack of education regarding substance use
disorders.
• Access to pharmaceuticals.
• Self treatment of pain, sleep patterns, emotional
disorders.
• Use of drugs to fulfill a demanding work role.
• Enabling behavior by peers and managers.
The Professional Mindset
• Seeing drugs as an acceptable means of coping.
• A faith in the ability of drugs to promote healing.
• Rationalizing use as needed to continue working.
• The delusion that special knowledge and status
provides immunity.
• Tenacious denial of loss of control.
Common Signs
• ‘Workaholic'--arriving early, staying late, offering to work
extra shifts, offering to cover breaks.
• Only working in areas where drugs are available.
• Volunteers to work with patients who have diminished
awareness.
• Increasingly irritable, and then later in shift, extremely calm.
• Extreme defensiveness regarding practice errors.
Treating the Disease
• Substance use disorders have been considered a
treatable disease for many years.
• Today Healthcare Professionals may enter into
treatment in state approved monitoring programs
without negatively affecting their licenses.
• 42 states offer alternative to discipline monitoring
programs.
Standards of Licensure
When a health care professional misuses alcohol or
drugs that behavior falls under the general category
of Unprofessional Conduct.
Unprofessional Conduct:
Substance Abuse RCW 18.130.180
• Current misuse of:
• Alcohol;
• Controlled substances; or
• Legend drugs
Unprofessional Conduct:
Substance Abuse
• Unauthorized possession or distribution of
controlled substances or legend drugs.
• Diversion of controlled substances or legend
drugs.
• Violation of any drug law.
• Prescribing controlled substances to oneself.
Referral
When there has been no patient harm a
referral or self report to the state approved
monitoring program allows for the fastest entry
into treatment, preserves the ability to work,
and avoids disciplinary action against a
license.
Substance Abuse Monitoring Programs
The Disciplinary Process
Reporting Unprofessional Conduct
An individual or substance abuse monitoring program
may report information to the disciplinary authority
which indicates that the license holder may not be
able to practice his or her profession with reasonable
skill and safety. (RCW 130.080)
Reporting to the Monitoring Program
Health care professionals who enter the
monitoring program voluntarily and have not
been reported to a licensing authority by their
employer will not have their identity disclosed
to the licensing authority.
Reporting to the Disciplining Authority
When evidence substantiates unprofessional conduct
the disciplining authority (e.g., Nursing Commission)
must determine whether a disciplinary or nondisciplinary approach is appropriate.
WAC 246-16-235: Mandatory Reporting
A license holder must report another license
holder if:
(1) The reporting license holder must submit a report when he or she has actual
knowledge of:
(a) Any conviction, determination, or finding that another license holder has
committed an act that constitutes unprofessional conduct; or
(b) That another license holder may not be able to practice his or her profession
with reasonable skill and safety due to a mental or physical condition
A license holder does not have to report when:
(a) A member of a professional review organization as provided in WAC
246-16-255;
(b) Providing health care to the other license holder and the other license
holder does not pose a clear and present danger to patients or clients; or
(c) Part of a federally funded substance abuse program or approved
impaired practitioner or voluntary substance abuse program and the other
license holder is participating in treatment and does not pose a clear and
present danger to patients or clients.
WAC 246-16-220: When and How to Report
(1) Reports are submitted to the department of health. The department will give the report to the appropriate disciplining authority
for review, possible investigation, and further action.
(2) The report must include enough information to enable the disciplining authority to assess the report. If these details are
known, the report should include:
(a) The name, address, and telephone number of the person making the report.
(b) The name, address, and telephone number(s) of the license holder being reported.
(c) Identification of any patient or client who was harmed or placed at risk.
(d) A brief description or summary of the facts that caused the report, including dates.
(e) If court action is involved, the name of the court, the date of filing, and the docket number.
(f) Any other information that helps explain the situation.
(3) Reports must be submitted no later than thirty calendar days after the reporting person has actual knowledge of the
information that must be reported.
Alternative to Discipline Approach
• When not criminally negligent or substantially unsafe
to practice;
• The HCP may be referred to a monitoring program in
lieu of discipline without any action on their license;
• If successful in the program will not be referred back
to the licensing authority.
Disciplinary Approach
• A “Statement of Charges/ Allegations” is filed.
• May go to a formal hearing where a final order and
mandatory referral to a monitoring program is
issued.
• The action will always be reflected against one’s
license.
Substance Abuse Monitoring Programs
RCW 18.130.175
• Costs shall be the responsibility of the license holder.
• Treatment shall be provided by approved treatment
providers.
• Professionals voluntarily entering the program shall
not be reported to the disciplining authority.
What a Monitoring Program Is
• Receives reports of substance abuse and
professional impairment.
• Provides a structured, monitored environment for
recovery using an abstinence model.
• Supports twin goals of protecting the public and
returning the professional safely back to practice.
What a Monitoring Program is Not
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The decision maker of diagnosis or impairment
A provider of treatment
A place of refuge
Simple or easy
Tolerant of unwillingness, dishonesty or denial
Substance Abuse Monitoring Programs
• Washington Recovery & Assistance Program
for Pharmacy (WRAPP)
• Program of the Washington State Pharmacy
Association.
• Services pharmacists and pharmacy technicians
Substance Abuse Monitoring Programs
• Washington Physicians Health Program
(WPHP)
• Independent Non-profit
• Services physicians, dentists, veterinarians,
podiatrists, and physician assistants
• Substance abuse, mental health, and disruptive
behavior tracks
Who We Are…
Washington Health Professional Services
(WHPS)
WHPS
WHPS is operated by the Washington State
Department of Health and has the specific
responsibility to work with and monitor health care
professionals who are impacted by substance
misuse.
Substance Abuse Monitoring Programs
• Washington Health Professional Services
(WHPS)
• Department of Health monitoring service.
• Provides services to 70+ health professions.
• Nursing professionals and chemical dependency
counselors are most common.
How does a HCP enter WHPS?
• Voluntary: Self-referral is encouraged and speeds treatment
and recovery.
• Agreement to Practice: Referred due to criminal his
• Alternative to Discipline: May be referred from a disciplining
authority as an alternative to license discipline.
• License Discipline: Mandatory referral under legal order.
Recovery
• WHPS promotes recovery by:
• Providing an avenue for early intervention;
• Allowing the professional to retain their license while
recovering;
• Developing an individualized, recovery-oriented contract;
and
• Monitoring this contract to ensure the professional is safe to
practice.
Abstinence
• WHPS is an abstinence based program.
• Prescription medications may be used as necessary and with
the knowledge of WHPS.
• In some cases program participants may take medications to
promote recovery and prevent relapse e.g. antabuse,
suboxone.
Confidentiality
• Program participants are protected by all state and federal
confidentiality laws and regulations. Access to records is
limited to Program staff unless a release of information form is
given by the participant.
• If referred by a disciplining authority, information may be
released to that authority if the participant is out of compliance
with contract requirements.
Diagnostic Assessment
• A diagnostic assessment is obtained from a statecertified treatment agency.
• Treatment recommendations can vary depending on
the assessment and level of care outlined by ASAM
criteria
Professional Peer Support Groups
• Program participants are required to attend Professional Peer
support groups.
• The peer support group is comprised of other health care
professionals who discuss issues and concerns of common
interest.
• Topics may include how to inform potential employers about
involvement in the Program, how to deal with the stigma of
chemical dependence, and other return-to-work issues.
Worksite Monitoring
• Employers will be asked to identify a monitor –
usually a direct manager.
• The worksite monitor works with WHPS and the
program participant to implement contract
requirements and restrictions.
• The worksite monitor reports to WHPS regularly on
progress and compliance.
Practice Restrictions
• Practice restrictions may include:
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Limits on overtime and shift rotation.
Will not float from unit to unit.
No access to controlled substances.
Worksite restrictions, e.g., no home health work.
Will not have multiple employers
Drug Screen Testing
• All program participants are enrolled in a random
drug screening program administered through a
contracted third party comprehensive drug monitoring
program.
• Participants must check into the program Monday –
Friday to find out if they have been selected to test
that day.
Other parts of WHPS Contracts
• Completion of treatment recommendations
• Participation in 12-step or Recovery-based
groups
• The need to disclose Chemical Dependency to
all healthcare providers that provide direct
treatment to the client
Each Contract is Different…
Contracts can range in duration anywhere from
one to five years dependent on diagnosis and
where a person is in recovery
Each person is different…contracts are tailored
to each individual person dependent upon a lot
of different factors
Questions? Comments?
Please feel free to contact us!
360-236-2880
whps@doh.wa.gov