Physician Health Programs Encourage Treatment Center Enrollment for Drug Addicted and Alcoholic Doctors
One out of every ten adult Americans will experience some sort of drug abuse or alcoholism in their lifetime. For professionals the odds of becoming a drug addict or alcoholic are higher, due in part to the enormous stress and pressure that they face every day. For doctors suffering from substance abuse, the consequences to their patients, their careers, and the general public can be catastrophic.
On September 11, 2009 twenty-year-old Elena Shapiro, a Carolina Ballet ballerina from Winston-Salem, North Carolina, lost her life to a doctor who was allegedly driving under the influence of alcohol (DUI). Dr. Raymond Cook hit Ms. Shapiro as she was getting on the highway. Cook was arrested on suspicion of DUI and was initially charged with death by motor vehicle, DUI, failure to reduce speed, and careless and reckless driving. The doctor is an otolaryngologist and plastic surgeon and an assistant professor at the University of North Carolina School of Medicine. Cook, who is estimated to have been driving at 85 mph, has surrendered his license to practice medicine. The charges have since been amended to include second degree murder.
While, admittedly, a driver does not have to be a doctor wreak such havoc while driving drunk, what if Dr. Cook had been in the operating room instead? Dr. Castro-Moure, the chief of neurosurgery at a California hospital, had to be wrestled to the operating room floor one night before being arrested by police. Staff reported that the surgeon had thrown a fit when he was barred from operating by a nurse who suspected that he was drunk.
Castro-Moure initially became combative while attempting to begin surgery on the spine of a man who had fallen two stories. Although two other doctors had declared the injuries to be not life-threatening, and thus not requiring immediate surgical intervention, Castro-Moure disagreed and began yelling and swearing when told that the necessary equipment would need to be transferred from a different hospital. Once the equipment got to the operating room, however, a nurse refused to proceed with the surgery until the instruments were sterile. The surgeon then physically resisted efforts to subdue him; the 45-year-old Highland Hospital doctor was arrested on suspicion of being under the influence of alcohol and interfering with the duty of police officers. The consequences of a drunken surgeon operating on the spine of an injured man are almost too horrific to even contemplate.
However, medical boards all across the country must address these and other disasters waiting to happen on a daily basis. Studies have found that illicit drug use among doctors is lower than in the general public. According to a recent story in the Harvard Review of Psychiatry, however, doctors are five times more likely to misuse prescription medication. Specialties that place doctors in contact with addictive drugs, combined with ease of access to drugs and stress, result in a nightmare scenario for those susceptible to addictive behavior.
Substance abuse, alcoholism, and mental illness among doctors are not a new phenomenon. In 1958, the Federation of State Medical Boards (FSMB) declared that drug addiction and alcoholism among physicians was a disciplinary problem that needed to be addressed administratively. The FSMB requested that a program be developed for the monitoring and rehabilitation of substance abusing doctors that would serve as a model for state medical boards. The request was ignored.
Years later, the AMA Council on Mental Health produced a paper entitled “The Sick Physician: Impairment by Psychiatric Disorders Including Alcoholism and Drug Dependence” which called attention to this growing public health crisis. In 1974, a model was developed that offered a treatment-based alternative to discipline in recognition of that fact that drug and alcohol addiction is an illness. Today, the Federation of State Physician Health Programs (FSPHP) also focuses on the rehabilitation and monitoring of addicted doctors.
Once upon a time, any doctor who behaved like Castro-Moure would likely have lost his license to practice medicine permanently. Not only would such forfeiture have clearly destroyed his career, but it also would not have encouraged the surgeon to seek treatment for his alcoholism. By 1980, most states had implemented a physician health program to address the substance abuse crisis among the medical community, with a focus on managing and monitoring practicing doctors who are addicted to drugs or alcohol. The programs seek to save the lives and careers of doctors suffering from drug or alcohol addiction and protect the public by ensuring that only clean and sober doctors are licensed to practice medicine. A study of these programs has shown that doctors who are drug addicts or alcoholics actually can be treated and allowed to resume the practice of medicine.
The physician health programs (PHP) are based on a model of intervention, followed by a combination of referral for enrollment in a treatment center and random monitoring. Doctors who fail to comply, however, require quick redress in order to eventually beat their addictions. A recent study by the University of Florida found that over seventy-five percent of enrolled doctors stayed off drugs or alcohol, regardless of the particular type, during a five year monitoring period. Enrollment in the programs is almost equally divided between those who are required by medical boards, employers, or malpractice agencies to participate and those who self-refer or are referred by friends and family.
Once enrolled and under contract with a PHP, the doctor must attend group and individual therapy sessions for both the addiction and any accompanying mental health issues, residential and outpatient treatment center programs, be subjected to random visits from monitors at work, and participate in 12-step programs. Doctors are responsible for paying for the cost of the treatment center and treatment programs, drug testing, monitoring, and follow-up care.
The UF study evaluated roughly 900 doctor participants in 16 state PHPs over a six year period, which is an unprecedented scope. Successful participation in the program required abstention from drugs or alcohol for five or more years, along with random drug testing. Failures were reported to medical boards quickly; approximately 20% experienced at least one incident of failure during the study. Researchers found that, at least within the physician community, best results were achieved by a combination reward-and-punishment system. For instance, a clean drug test resulted in permission to return to work while a positive test called for immediate suspension and put one in danger of losing their license. In the five to seven years after starting treatment, three quarters were actively practicing medicine without drug abuse or malpractice. In the end, researchers determined that longevity of treatment had the most lasting effect on the level of success.
Sources:
http://spotlight.vitals.com/2009/09/dr-raymond-cook-causes-fatal-accident-and-charged-with-dwi/
http://www.huffingtonpost.com/2009/09/16/raymond-cook-doctor-kills_n_288337.html
http://findarticles.com/p/articles/mi_qn4176/is_20060309/ai_n16160545/
Millie Anne Cavanaugh, Esq. is a Los Angeles attorney specializing in immigration and naturalization law; she is a former insurance defense attorney. She is licensed to practice law in California and Massachusetts. The information contained herein is provided for informational purposes only, and should not be construed as a solicitation for your business or as legal advice on any subject matter. You should not act or refrain from acting on the basis of this information without seeking independent legal advice.
