Help for the Impaired Physician
- History and Background
- Inquiry, Intervention and Treatment
- The PRN and the Idaho State Board of Medicine
- How To Contact the PRN
- Mission Statement
- Identification of Workplace Impairment
History and Background of the PRN Program
The Physician Recovery Network was formed in 1986 with the support of the IMA House of Delegates. The PRN consists of an IMA Committee of 18 volunteer members (16 physicians one physician assistant and one lay person) located throughout the State. John Sonntag, MD, of Boise serves as the Chairman of the PRN; Richard Gerber, MD, of Nampa serves as Medical Consultant; and Mark Broadhead, MD, and T. Barry Eschen, MD serve as Associate Medical Consultants. Ben Seymour, CADC, a chemical dependency expert, is a part-time contractor and the Program Coordinator.
The PRN was created to help any Idaho physician or physician assistant who is impaired as a result of chemical dependence, mental illness, senility or behavioral problems. The program's primary mission is to protect the public from unsafe practice by impaired professionals.
The PRN provides a network of trained physicians and other healthcare professionals to aid in confidential investigations of alleged physician impairment and, when appropriate, conduct interventions and coordinate placement in a treatment program. The PRN develops and coordinates an individualized long-term monitored recovery program for each physician. The PRN seeks to educate Idaho physicians and other involved parties about the nature of the PRN program and about the problems of impaired physicians and establish a liaison with other professional organizations concerned with these issues
Nationally, professional health programs have high success rates ranging from 85 to 90 percent. The PRN's recent experience is similar to those results. Success is generally defined as achieving a chemical free, professionally productive lifestyle.
PRN Confidential Inquiry, Intervention and Treatment
The PRN has become an important source of confidential help to healthcare professionals who can get the help they need without necessarily jeopardizing their licenses. Most individuals join the program through some form of "benevolent coercion." They seek assistance because of some external pressure which comes primarily from professional colleagues, but spouses, hospital administrators, lawyers, and others have also called the program about possible impairment or other abnormal behavior.
When a call is made - and it may be made anonymously - the program staff initiates a discreet inquiry. If substantial evidence of impairment is discovered after a complete but confidential investigation, an intervention takes place. The Program Coordinator sets up an appointment with the individual and facilitates a caring confrontation.
If the physician is willing to enter the PRN program, the physician signs a contract agreeing to abide by the PRN requirements for a period of up to five years. Typically, a physician is required to complete an inpatient program at a PRN approved facility. These programs include a complete medical and psychiatric work-up as well as counseling. After successful completion of primary treatment, contract compliance includes total abstinence from addictive chemicals, continuing treatment, participation in physician groups, behavioral monitoring, random toxicology testing, work site monitoring, and attendance at Alcoholics or Narcotics Anonymous. Initially, therapy is weekly and urine testing is frequent.
The PRN and the Idaho State Board of Medicine
The PRN maintains an arm's length relationship with the State Board of Medicine while at the same time interacting with the Board in a manner that develops trust and satisfies legal requirements. As long as physicians are in compliance with the PRN program requirements, they will not be reported to licensing or disciplinary agencies. The PRN will contact the Board if a physician refuses to comply with PRN recommendations.
When physicians follow their recovery program, the PRN can be a powerful advocate. In the past, the PRN has successfully advocated on behalf of physicians before the Board of Medicine, federal agencies, prosecuting attorneys and in court.
The PRN receives financial and staff support from the IMA and the Board of Medicine. The PRN gratefully acknowledges the IMA's and the Board's support; however, the funds supplied by the Board are restricted in how they can be used and don't cover the entire costs of the PRN. Therefore, the PRN regularly solicits donations from medical malpractice carriers, hospitals, local medical societies, and from individual physicians. These entities and individuals provide critically needed funding for the PRN.
How to Contact the PRN
Anyone who suspects that there MAY be impairment should call the Physicians Recovery Network. Calls may be made anonymously. Reporting medical professionals to the program does NOT put their license in jeopardy UNLESS the professional is felt to be acutely impaired and adamantly refuses assistance. All information is strictly confidential. Please call any one of the following:
PRN Program 208-323-9555
Toll Free 800-386-1695
Ben Seymour 208-949-0363 or 866-460-9014
Steven Reames, IMA 208-336-2930
A leading expert in physician impairment has stated that there is considerable reluctance by medical professionals to report their impaired colleagues. Many think they are overreacting and that the situation will get better with time or when circumstances change. He labels this reluctance or delay as potentially "deadly silence." The PRN Committee encourages you to call to discuss "the situation." You don't have to disclose your identity or the identity of the involved professional.
Mission Statement of the Idaho Physician Recovery Network
The mission of the Idaho Physician Recovery Network is to facilitate prevention, identification, intervention, monitoring and rehabilitation for Idaho physicians who have, or are at risk for developing, disorders which are associated with functional impairment. This will be done in a confidential manner consistent with the laws of the State of Idaho so as to protect the public. The mission will be accomplished by the following actions:
- Facilitate the early identification of and intervention with impaired and potentially-impaired physicians, especially those with alcoholism or drug dependency.
- Facilitate referral of physicians to qualified practitioners for evaluation of the illnesses or conditions of impairment.
- Provide assistance in identifying, obtaining, and pursuing effective treatment for these illnesses or conditions.
- Assist physicians recovering from various illnesses which cause impairment to manage their recovery from those illnesses in a manner which permits the safe practice of their profession; provide ongoing recovery management services for those physicians enrolled with the PRN.
- Monitor the progress of enrolled physicians and report regularly on the progress in recovery of physicians referred to the PRN by licensing boards, hospitals, or others.
- Provide ongoing support to physicians and their families, and advocacy to those physicians who are taking appropriate and adequate measures to ensure that their illnesses are managed in a manner which permits the safe practice of their profession.
- Provide advice and assistance to the licensing and disciplinary boards, hospitals, other medical organizations and responsible individuals regarding physicians' health, illnesses that may cause impairment, and the management of individuals suspected of having illnesses which cause impairment.
- Provide education, prevention, and research programs which increase our understanding of the effects of such illnesses and conditions upon the profession and practitioners, and reduce the impact and incidence of such illnesses upon physicians, the profession, and society.
Identification of Workplace Impairment
Impairment in the workplace is not identified by a single sign. No one event is diagnostic. Even a few may not make the case, but a cluster of events, or repetition of the same events, are indicative of a possible problem. A pattern of aberrant behavior usually establishes the condition of impairment; that is, the inability to practice medicine with reasonable skill and safety. The six "I's" help to identify impairment:
This is manifested by mood swings, exhibiting a negative attitude and being argumentative. The display of inappropriate anger and overreaction to criticism are common forms of irritability. Verbal altercations with patients, staff and peers follow and are often associated with other disruptive behavior. This all defines a distinct personality change; that is, the physician assumes and exhibits new traits variously described as being uncharacteristic or simply not the same person!
This starts with shifting the workload to partners, other colleagues, a physician assistant or a nurse practitioner. Blaming the other healthcare professionals for failing to deliver follows, and they begin to complain about the situation. The impaired physician starts manipulating the emergency room (ER), operating room (OR) and on-call schedules to reduce the work load (work is the curse of the chemically impaired). A surgeon, for example, will attempt to be the "good guy" and offer to start a case in the afternoon rather than use the highly coveted early morning slot. This allows the surgeon to drink longer into the "wee small hour," to sleep later in order to minimize hangover symptoms and to buy more time to dilute withdrawal. The surgeon will make attempts to correct performance deficiencies by playing "hurry up - catch up," conducting hasty rounds and taking many short cuts which often result in substandard care to the patient.
Inaccessibility is manifested by frequent tardiness and absences. If confronted, the doctor is provoked to offer an elaborate, lengthy, and circuitous explanation. The doctor is often MIA - "missing in action" - making frequent trips to the bathroom, parking lot, or other secluded spots to snort, smoke, swallow, shoot, or sneak some substance. Prolonged smoke or lunch breaks are taken, and the doctor becomes unavailable. There is frequent beeper "failure," "forgetting to turn it on," or having "dead" batteries. Frequent "illness" is noted, especially on Monday morning or post-holidays. There is early departure as well, especially Friday afternoon or pre-holiday. Nodding off during meetings is not uncommon.
Nurses and other colleagues begin to notice inappropriate orders and inadequate charting in terms of quality, quantity or timeliness. Hospital charts pile up with procrastination and result in repeat appearances on the record room hit list. Medical acumen and technical skills begin to deteriorate. All's well in familiar situations, but injecting a surprise or unexpected element, such as an aberrant artery or bizarre arrhythmia, results in uncertainty, hesitancy, and downright difficulty with these unusual cases, leading to deviation from standard procedures and QA outliers.
Deviation from drug procedures consists mainly of unwitnessed wasting and excessive usage. There is often excessive spillage/breakage, and patients complain about insufficient analgesia indicative of drug diversion. Decreased performance becomes more apparent, resulting in frequent incident reports or malpractice actions. Impairment often is noted when procedures are repeated, as impaired physicians forget they have already performed a procedure due to amnesiac episodes (blackouts).
Impaired physicians choose odd hours for rounds and volunteer for the graveyard shift. Typical avoidance behavior is absence from the doctor's lounge, solitary eating, and non-attendance at departmental meetings, educational sessions, and medical social events.
This includes other unusual observations including: condition of the pupils, discoloration such as jaundice, raspy voice, slurred speech, runny nose, alcohol on the breath, increased use of breath mints, mouthwash, and excessive use of cologne. Staff/peer complaints or hospital gossip can also be early indicators of problems.