1. Impaired Physicians Overview Definitions Causes Warning Signs Treatment SHC Well-Being Committee Medical Board of California Physician Fitness for Duty Examination

2. Overview Public more aware / less tolerant More MDs medically impaired than legally impaired –Medical impairment early –Legal impairment late

3. Legal Definition of Impaired Physician “Physician is unable to practice medicine with reasonable degree of skill and safety because of physical or mental illness substance abuse, or age-relate deterioration.” Diagnosis Impairment Disability

4. Causes of Impairment Drug and Alcohol Abuse Mental Illness Medical Illness Dementia

5. Warning Signs Personal appearance and behavior Treatment of patients Conflicts with colleagues / staff Legal problems

6. Treatment Outcome Factors Negative Physician denial Shame Fear Attitude Peer denial Conspiracy of silence Positive Early identification Effective intervention Adequate motivation Coercion works! Phased treatment Long-term follow-up Physician compliance

7. SHC Well-Being Committee Required by Federal Law Self-referral or confidential referral by another Review information & meet with individual Determine if / what problem exists Develop plan & convert it to “contract” Long-term monitoring If refuses plan or no compliance, refer to Chief of Staff

8. Medical Board of California Protect Public by Enforcing Medical Practice Act Approximately 100,000 licensed physicians in California Division of Licensing Division of Medical Quality –Receives alerts: 805 reports, malpractice settlements, criminal charges / convictions, citizen complaints –Conducts investigations / takes enforcement actions –Sends reports: NPDB, requesting health care facilities

9. MBC Annual Report FY ‘07-08 7000 complaints 1000 investigated 400 referred for enforcement (civil / criminal) 300 formally accused –30 revocations / license surrenders –90 letters of reprimand –15 suspensions –85 probations –50 determined “impaired” –30 dismissed

10. Physician Fitness for Duty Examination Is physician danger to self, others, public? Is physician’s ability to practice safely impaired by mental illness or physical illness that affects competency? Does physician require therapy or other measures to practice safely? *Axis II is not impairment Read investigative file Take thorough history Do mental status examination Identify practice-interfering mental deficits Make diagnosis / prognosis Answer the consult questions Suggest treatment, practice limitations for patient safety Report is be fact heavy, logical Other issues: Examiner liability Sensitivity of information