Washington Health Professional Services (WHPS)

Chemical Dependency A primary, chronic neurological disease, with genetic, psychological, and environmental factors influencing its development and manifestations. Neuro-chemical changes Craving Impaired control over use Continued use despite consequences

Illness v. Impairment Illness and impairment exist on a continuum with illness predating impairment, often by years. Illness is the existence of a disease. Impairment is a functional classification implying the inability of the person affected by the disease to perform specific activities.

Health Professionals Rates of substance misuse mimic the general population (10 – 15%). Higher rate of prescription drug misuse. The ANA estimates that 6-8% of nurses misuse substances sufficient to impair practice.

Risk Factors Family, environmental Job stress Achievement oriented Familiarity with medications Sense of immunity Access to medications Lack of education

High Risk Practices ICU ER PACU Anesthesiology Oncology Psych

Disease Continuum Typically the workplace is the last place that substance use manifests itself. Disruptions in family, personal health, and social life occur while the workplace remains unaffected. Even small intrusions into the workplace should be taken very seriously.

Uniform Disciplinary Act RCW

Unprofessional Conduct Dishonesty Misrepresentation Negligence Credential restricted in another state Practicing beyond scope Gross misdemeanor or felony conviction Illegitimate use of controlled drugs Use of illegal drugs Abuse of patient/sexual contact with patient

Reporting WAC When a patient has been harmed a report to the department is required. When there is no patient harm, reports of inability to practice with reasonable skill and safety due to a mental or physical condition may be submitted to one of the approved impaired practitioner or voluntary substance abuse programs.

Reporting (2) The license holder does not have to report when he or she is: (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

ADA Protections An individual who has successfully completed treatment (incl. EAP) and is no longer using drugs illegally An individual in treatment and is no longer using drugs illegally An alcohol dependent individual who can perform essential job functions and practice safely. * Drug tests may be required to confirm sobriety

Programs Washington Physicians Health Program –Physicians, PAs, dentists, podiatrists, veterinarians Washington Recovery Assistance Program for Pharmacists –Pharmacists, pharmacy technicians Washington Health Professional Services –Everybody else

Mission Safely return the practitioner back to practice Safety to practice Recovery Contract compliance Evaluate Monitor Enforce

Role Statutory Authority RCW Voluntary Alternative to Discipline All Licensed Providers Confidential Participation Cost

Referral Process Voluntary- Employer or self referral Agreement to Practice Under Conditions - Criminal background concerns In Lieu of Discipline – Referred as an alternative to license discipline Discipline – Referral under legal order

W ashington H ealth P rofessional S ervices Non-punitive approach to recovery from chemical dependency Abstinence based Rigorous Monitoring Quicker identification of relapse behaviors resulting in intervention

WHPS Established in 1988 Stand-alone program in DOH Is not a treatment program Serves 70+ health professions 525 – 550 clients in active monitoring

Monitoring Program Receives reports of substance misuse and professional impairment. Provides a structured, environment for recovery using an abstinence model. Supports twin goals of protecting the public and returning the professional safely back to practice.

Program Components Intake – Chemical dependency evaluation Treatment – Generally Intensive Outpatient Treatment Recovery - Continuing care, self-help (AA, NA), peer support groups Monitoring year contract, random drug screening, workplace restrictions and monitoring, prescription medication monitoring, reporting of non-compliance

Drug Screening Random, observed urine screens x/yr. ETG/ETS testing Hair, nail, blood testing For cause testing Client absorbs cost

Worksite Monitoring Prior job approval Employer notification Employment contract Work restrictions Worksite Monitor Scheduled reports

CRNA Inpatient treatment preferred Connect with WANA peer advisor No access to controlled or abusable substances for at least 12 months. –May consider personal alcohol, marijuana use Fitness for duty evaluation Use of medication assisted treatment considered

“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 clients every day.” P. Bradley Hall MD

John Furman, PhD, MSN, CIC, COHN-S Executive Director Washington Health Professional Services