Addicted Professionals

[HockeyPsyGuy]

Intern here interested in Addiction Psych. I was curious, if one were an addiction specialist seeing a patient that works in the medical field for an intake, and they tell you the addiction has gotten to the point where they are going to work intoxicated, is one obligated to report the patient to the state board (or substitute other professional ie lawyer, taxicab driver)?

If so, might this preclude such people from seeking help to begin with?

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[HarryMTieboutMD]

There is a whole body of literature on this. In terms of mandatory reporting, it depends on the state- and it's not always to the board. Most states (47) have long standing physician health programs (PHPs) that coordinate treatment, monitoring, etc.

And yes, most people require an intervention rather than voluntary enrollment.

Here is the definitive paper on the subject (the original data were published in BMJ, fyi): https://www.ncbi.nlm.nih.gov/pubmed/19161896

 

[wolfvgang22]

That is tricky. I think you would have to respect your patients confidentiality as long as no patients are at immediate risk of being harmed. Otherwise, you would need to report him or her to the board immediately.

Probably the best course would be to get the clinician to tell the board voluntarily that he/she os seeking treatment and enroll in the state's substance abuse monitoring program (PHP) that most medical boards have in place. In my state, as long as a patient has not been harmed then the clinician is supposed to be able keep his/her license if treatment is completed and monitoring shows sustained remission.

 

[vistaril]

Intern here interested in Addiction Psych. I was curious, if one were an addiction specialist seeing a patient that works in the medical field for an intake, and they tell you the addiction has gotten to the point where they are going to work intoxicated, is one obligated to report the patient to the state board (or substitute other professional ie lawyer, taxicab driver)?

If so, might this preclude such people from seeking help to begin with?

I wouldn't report the person. thats just me.

 

[HockeyPsyGuy]

Here is the definitive paper on the subject (the original data were published in BMJ, fyi): https://www.ncbi.nlm.nih.gov/pubmed/19161896

Thanks for the reference. Didn't realize the remission rates could be that high...I guess it makes sense. Although I'm not quite sure the article addressed my initial question, definitely broadened what realize is out there.... Seems like almost everyone who enters into the PHPs in the study got in trouble vs went for help on their own accord

 

[smalltownpsych]

Thanks for the reference. Didn't realize the remission rates could be that high...I guess it makes sense. Although I'm not quite sure the article addressed my initial question, definitely broadened what realize is out there.... Seems like almost everyone who enters into the PHPs in the study got in trouble vs went for help on their own accord

Very rarely does someone with addiction severe enough to warrant treatment succeed without serious consequences. A common course of events is patient presents for tx because they realize addiction is getting out of hand. They are not fully committed to doing what needs to be done though and eventually something bad happens. DUI, job loss, loss of family, etc. I find that it is best if I allow the patients illness to create the consequences as opposed to being involved in them myself. Besides there is no law or legal precedent that I know of that mandates reporting impaired practitioners or other individuals. If a cab driver tells me that they are driving drunk, they are putting lives at risk but even if I did report them, the police could not do anything. I did report a parent who appeared intoxicated when she was picking up her kid though. Imminent danger to a child being my rationale. Oh and she wasn't my patient either.

 

[wolfvgang22]

In the states I am licensed in as a physician, the medical boards explicitly state that not reporting another physician who I know is impaired will result in disciplinary action up to and including revocation of my medical license.
Very Orwellian, in my opinion, but there it is.

 

[smalltownpsych]

In the states I am licensed in as a physician, the medical boards explicitly state that not reporting another physician who I know is impaired will result in disciplinary action up to and including revocation of my medical license.
Very Orwellian, in my opinion, but there it is.

Doesn't specify treating verses working with? We have different ethical standards applying to a colleague verses a patient and the states that have been licensed the psychology boards don't mandate that we report other psychologists whether they are colleagues or patients, but defers these types of issues to our ethics code.

 

[HarryMTieboutMD]

I don't think there are any states that require reporting to the board directly without some provision for treatment. Most states of which I am familiar that do require reporting require it for the state's PHP, not the board

 

[wolfvgang22]

Doesn't specify treating verses working with? We have different ethical standards applying to a colleague verses a patient and the states that have been licensed the psychology boards don't mandate that we report other psychologists whether they are colleagues or patients, but defers these types of issues to our ethics code.

They don't seem to specify. I would need to call the boards and ask if I were in this situation.

 

[nancysinatra]

I would not take advice from SDN on a topic like this. Consult a lawyer. States vary, and your obligations re colleagues may be different from patients. And you can bet, the legal consequences if you report someone when you shouldn't, vs. you don't report someone when you should, are going to be a lot worse in the former situation. That doctor you report will have the means to sue you, and a good case if you turn out to be wrong; whereas the distantly removed victimized patient of the impaired doctor you fail to report may have some sort of Tarasoff claim on you, but barely, and you won't be their focus anyway.

 

[nancysinatra]

In the states I am licensed in as a physician, the medical boards explicitly state that not reporting another physician who I know is impaired will result in disciplinary action up to and including revocation of my medical license.
Very Orwellian, in my opinion, but there it is.

Yeah but all states and the federal government also have patient privacy laws. Who knows but they may (probably, I'd guess) trump laws about mandatory reporting, because patient privacy is a way bigger issue in society with way more legislation and case law behind it. A patient and a colleague are different things and it's wise to be informed before taking action against a patient.

 

[michaelrack]

In general, mandatory reporting trumps privacy