1. Impaired Physicians Harm Patients - Lose Licenses. Overview Definition Causes Warning Signs Treatment SHC Well-Being Committee Medical Board of California Fitness for Duty Examination

2. Overview More awareness of / less tolerance for –Physician error, misconduct, negligence, incompetence –Public wants to be protected from bad doctors More MDs medically impaired than legally impaired –Only 15% of impaired physicians ever identified –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.

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

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

6. Treatment Negative Physician denial Shame and fear Hopelessness Peer denial “Conspiracy of silence” Positive Identification Intervention Motivation (Terror) Coercion Phased Treatment Long-term follow-up 70% success rate

7. SHC Well-Being Committee Federal Law. Darling vs. Community Hospital Self-referral or confidential referral by another Review information & meet the individual Determine if / what problem exists Develop plan & convert it to contract Monitor progress Refuses plan / no compliance, refer to Chief of Staff

8. Medical Board of California Protect public by enforcing Medical Practice Act Division of Licensing –Evaluate credentials, education, skill –CME Diversion Program –45 per year, 300 in 5-year monitoring, 70% success rate Division of Medical Quality –Conducts investigations / takes enforcement action (Cal AG) –Receives 805 reports, malpractice settlements (0.1% involved psychiatrist), criminal charges / convictions, citizen complaints –Sends reports to requesting agencies, NPDB

9. MBC Annual Report 2007 7000 complaints 1000 investigations 400 referred to AG Office for special attention –200 resulted in enforcement action 90 revocations / license surrenders 90 letters of reprimand 20 suspensions 80 probations 20 cases referred to Diversion –50 determined “impaired”

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 not ”impairment” Read investigative file Take thorough history Mental status examination Identify practice-interfering mental status deficits Make diagnosis / prognosis Answer the questions Suggest treatment, practice limitations for safe practice Report fact heavy, logical Other considerations: Examiner liability Sensitive information