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 )

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 Losing social stature Marital problems including divorce Occupational and career problems Health issues (hepatitis, diabetes) Legal problems Financial ruin

Co-occuring Mental Health Issues 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 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 )

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 non- disciplinary approach is appropriate.

WAC : 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 ; (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 : 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 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 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 state- certified 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: 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!