Impaired Physicians
Harm Patients - Lose Licenses.
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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
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Drug and Alcohol Abuse
Mental Illness
Medical Illness
Dementia
Warning Signs
Early - Late
• Personal appearance and behavior
• Treatment of patients
• Conflicts with colleagues / staff
• Legal problems
Treatment
Negative
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Physician denial
Shame and fear
Hopelessness
Peer denial
“Conspiracy of silence”
Positive
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Identification
Intervention
Motivation (Terror)
Coercion
Phased Treatment
Long-term follow-up
70% success rate
SHC Well-Being Committee
Federal 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 California
Protect 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
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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”
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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