1. Monitoring Medical Staff Members
CPPPH Workshop San Diego, California
September 20, 2014
Robin Seaberg MD
Chair, University of California, San Diego
Physician Well-Being Committee

2. Monitoring In special circumstances in lieu of formal evaluation
Most often part of aftercare program
Commonly used with Substance Use Disorders
Mental Health Disorders, Boundaries Violations
Other behavioral contracts
Can be individualized

3. Goals of rehabilitation
Optimize physical and mental health
Motivation to achieve and maintain abstinence
Participation in counseling to build a substance-free life
Adoption of relapse prevention techniques.

4. Aftercare 12 step meetings (AA, NA) Diversion meetings Counseling
Drug screening
Recovery is a life-long process.

5. Planning for return Must occur while still in treatment
PWBC must have coordination and communication with PHP and treatment center
Get an outline of projected discharge recommendations
Department defines role on return
Determine practice parameters

6. Planning for return
Coordination between PWBC and practice representative
Determine who will be making schedule or overseeing hours
Identify potential work site monitor
Prepare re-entry agreement
Determine who will be doing tox testing and formal monitoring.

7. Re-entry process Gradual, staged Continue meeting attendance
Restrict access to drug of choice
No night call in early phases
Worksite monitor

8. Contracts and monitoring
Responsibilities
Consequences
Monitoring
Worksite
Drug screening

9. Participation agreement
Specific requirements to maintain active medical staff privileges based on initial problem and treatment recommendations

10. Participation Agreement
5 year monitoring period
Abstain from all mood-altering substances
Attendance at 12 step and diversion meetings
Worksite monitoring
Random, monitored urine drug screens
Primary care MD prescribes all medications
+/- Naltrexone, Disulfiram administration
Clear consequences

11. Elements of agreement may also include
Therapy, counseling etc
Prescribing restrictions
Names of treating professionals + ROI
Travel restrictions

12. Worksite monitor Has regular contact with the participant
Is aware of the situation
Should be a neutral peer/supervisor
Motivated by a desire to be a support, not a disciplinarian
Be willing to be on the lookout for, and be willing to report signs of relapse
Makes quarterly reports to PWBC/PHP

13. Return to work is not immediate
Participant must establish support system and structure of recovery program at home
Establishing home group, recovery meetings, setting up random tox testing, Sign contract with Monitoring entity
Sign monitoring agreement with PWBC also
Establishing care with mental health professionals as appropriate

14. HPP and PWBC work together to
Monitor continued compliance
Report non-compliance to supervisor and MEC
Provide ongoing support of physician and source for physician questions and concerns
Keep documents attesting to ongoing compliance (tox testing WSM reports, therapy compliance reports)

15. Monitoring is not recovery
Monitoring documents compliance with various components of recovery program.