Should I refuse FFDE?

[TulaneUnderdog]

Please keep us updated. Knowing how these go is very helpful to other people in a bad way in their careers.

Today was a big day. My PD pulled something left field. He got me back into work (starting next week) after pulling strings with members of Academic Affairs. The catch? You guessed it, sign up for FFDE. He hates it but tells me “look, you no longer will miss training, just play along. Also face it, you did drink and drive… we can get you to graduate on time, now that you are out of leave of absence”.

Before yall draw conclusions; yes this is sus and sounds like a trap. FFDE is really something they want leverage over me for and it makes it even more suspicious than ever before as if I will fall into a trap of negative assessments and ICD codes that can tear my license like tissue paper. But….

Yall dont know the context of how close the relationship is between PD and I going back as far as MS3 when he gave me a free interview and positive eval for other programs. He fished me out the match and was the one who gave me this livelihood in the first place. He will not squanch it. He protected me more than yall know and so please read this with the context that he truly is a father to me with Zero ulterior motive whatsoever other than “my program is short staffed as hell” and “we gotta get you to work”.

So I will do FFDE. My atty I ran it by because he called to tell me that i should file with my criminal atty a “factual innocence” motion so that the Arrest also is removed from record. He shook his head and told me “you’re giving them something to revoke your license for”. But he also said if I am truly adamant, then to set up a 2nd Psychiatric eval privately to counterbalance an FFDE, preferably by Addictionologist.

Antways, My PD also was prolly set up by PHP likely to make me do it too but he knows this is the way. It will suck and i will update. I understand my other options by @Crayola227 that I can just face the board. The problem is I literally can get back to work and get paid right now. Until… of course my evaluation results say otherwise.

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[Crayola227]

Today was a big day. My PD pulled something left field. He got me back into work (starting next week) after pulling strings with members of Academic Affairs. The catch? You guessed it, sign up for FFDE. He hates it but tells me “look, you no longer will miss training, just play along. Also face it, you did drink and drive… we can get you to graduate on time, now that you are out of leave of absence”.

Before yall draw conclusions; yes this is sus and sounds like a trap. FFDE is really something they want leverage over me for and it makes it even more suspicious than ever before as if I will fall into a trap of negative assessments and ICD codes that can tear my license like tissue paper. But….

Yall dont know the context of how close the relationship is between PD and I going back as far as MS3 when he gave me a free interview and positive eval for other programs. He fished me out the match and was the one who gave me this livelihood in the first place. He will not squanch it. He protected me more than yall know and so please read this with the context that he truly is a father to me with Zero ulterior motive whatsoever other than “my program is short staffed as hell” and “we gotta get you to work”.

So I will do FFDE. My atty I ran it by because he called to tell me that i should file with my criminal atty a “factual innocence” motion so that the Arrest also is removed from record. He shook his head and told me “you’re giving them something to revoke your license for”. But he also said if I am truly adamant, then to set up a 2nd Psychiatric eval privately to counterbalance an FFDE, preferably by Addictionologist.

Antways, My PD also was prolly set up by PHP likely to make me do it too but he knows this is the way. It will suck and i will update. I understand my other options by @Crayola227 that I can just face the board. The problem is I literally can get back to work and get paid right now. Until… of course my evaluation results say otherwise.

A little confused. Who is the attorney you ran the FFDE by? For ease of discussion, let's say the first attorney is your criminal attorney, and now you have a board attorney? At what point in this winding tale did he come on board? Was he the one advising you against the FFDE in the beginning or was that the criminal attorney? Can you give us a timeline of involvement of the board attorney, like where you were in all of this when he came on board, and his advice?

A few thoughts. I have zero doubts that your PD is in your corner, and of course anything you can do to make him happy and keep him in your corner is great.

But you do identify one issue, and I identify another. The two as I see it, his #1 concern is the short staffing. It has to be. The other, is that based on what you've said so far, my vibe is that the PD is not super familiar with this scenario and how a resident can dig out of it.

Also, the hospital and what meets their muster for employment is a SEPARATE thing from the board, believe it or not (beyond you just having a license to begin with) So from the beginning, it sounds like your PD just did what any PD was going to do as far as reporting. I'm surprised it was a referral to PHP without notifying the board as well. Your PD may not have given a damn about you being cleared by PHP and FFDE, but it sounds like it wasn't up to him (it actually isn't). So someone in HR or whoever above him said, no, actually they have to do x,y,z, and then we can have him back to work.

So that is one moving piece, the program and the hospital and what they need to employ you. Of course, the other requirement is having a license, but that's not up to them, they have zero to do with that decision beyond are they going to say nice things or not to the board.

Of course, if the FFDE and PHP ****s you, whether they clear you or not I'm guessing the board gets involved either way.

So the reality is that it doesn't sound like your PD knows enough about how all of this works and the law and the PHP and the board (if he did, he wouldn't be now coming down with a different word from someone above him what needs to be done).

He wants you back at work tomorrow, and the HR or whoever knows what it takes from their end (FFDE). They don't need the FFDE for facts or decision making obviously; they need it for legal risk management/CYA.

However, that doesn't mean that's what is best for keeping the board off your back.

Seriously, the board attorney is LITERALLY the only person in this entire sordid tale that can be expected to care about NOTHING else but keeping you out of hot water with the board, having a license, and if you can do it without the FFDE and PHP inpt that would be icing on the cake. And they are likely the only person who is apt to know what this is all means for the board. It might seem like a program has all the power, but they have zero power against the board where you are concerned.

I just worry the PD's advice is short sighted, it might get you to work tomorrow, but maybe the FFDE and PHP hangs you out to dry with the board and the hoops they want. Rereading, it sounds like that is what the board attorney fears.

In my experience, most board attorneys know very little about representing you to a residency program and how to manage that end of it. They tend to know more about other areas of physician employment. They know best about keeping a license with the board.

Also, the FFDE might also grease the wheels for termination etc especially if things go south with the PHP and board. This may not be your PD's goal, but it gets forgotten in these things despite the considerable power of a PD, it's more they have the ability to sink you at their level, tank you with anyone that talks to them, but not necessarily save you from higher powers. There are people above the PD and they care more about CYA than staffing even. They give zero ****s about you and the ones really deciding your fate you will never even talk to.

So your PD might be doing the best he can for you, but he has to follow the advice he's given. And everyone else involved could be blowing as much smoke up his ass as anyone is up yours. Also in these cases sometimes where the PD really does play the role of good cop, there can also be a bad cop in all this that won't hesitate to hang you out to dry. It could be an assistant PD, it could be a chair.

Maybe he has more insight or strings to pull than I know. All the more reason really for your attorney to talk to him. The general rule is don't sign any releases an attorney doesn't tell you to sign, unless it's a release for your attorney to talk to someone, those you should sign.

If he's really in your corner, than he should understand if the explanation is, "Well for HR/Academic Affairs they might be satisfied to bring him back on a FFDE, but if it goes south then he's given ammo he didn't have to with the board to pull his license, so the best way to salvage this guy and get him back to you free and clear is...."

Please, believe me. You can have one of the sweetest, kindest PDs in the world, and the dominoes to cut you and find your replacement could already be falling.

Oh, I forgot to mention, I have seen a resident fight the board with an attorney and psychiatrist/medical providers, and this can actually affect what the board decides is needed for follow up. Like in this case, say because it''s all dismissed, just based on, you had less than zero alcohol in your blood no legal trouble. If there aren't other red flags, the board could instead decide to have you do outpatient treatment while still practicing. Weekly drug tests, that kind of thing. This might be administered by the PHP, but it might be the board deciding what satisfies them.

It's possible the HR wants a FFDE, as aPD said that can look like different things. They can be done for different reasons, not all punitive. I don't even know that they are always something that involves a PHP or the board, they can be internal matters.

So the issue is, the hospital may want a FFDE, but does it have to be with the PHP? Yes, the PHP is then gonna report you to the board if you don't do theirs. I find it hard to believe in something like this it's possible for it to not end up in front of them at some point.

Anyway, how you move forward and to whom you give info, and whether or not you should do this, the board attorney's advice is probably best.

You can dance the tune of the hospital but don't be surprised if it isn’t sufficient.

Truthfully it is all hospital/program/state/board dependent.

Anyway, just my thoughts and things to consider. I hope it is as straightforward as doing the FFDE, getting cleared by the PHP, all while working towards graduation, and the board never gets involved or has any decisions to make regarding the PHP because the PHP rubberstamps you and the board rubberstamps that report. I question if you PD really knows the likelihood it plays out that neatly, that the hospital knows and is giving good advice, that the hospital isn't playing games (people forget there are often hospital legal risk management attorneys involved in all of this, and they DGAF and will play any game), that the PHP isn't playing games.

I doubt anyone knows better than an attorney experienced with the board.

The problem could be, what gets you out of hot water with the board per the board attorney (refuse FFDE) could as aPD says force the hand of your PD who might [not] be able to bring you on next year to graduate. But what's the point of the PHP and $50k 3 months inpt and all this if you can't graduate anyway? Coming through this with an intact license might be better.

Have you asked your board attorney if he has experience with how this works with residents? Perhaps the board is somewhat more lenient given the supervision.

Board certification is important, so important people forget that the license is tantamount and even without board cert, with a full unrestricted license you have a lot more well paying job prospects than if you have nothing but an MD.

 

[LucidSplash]

I’m just gonna say it. I’m not sure why anyone would consider any advice here beyond the very astute @NotAProgDirector. There’s a lot of discussion here that I think involves a lot of speculation and pontification rather than sane advice from someone with direct professional knowledge of these situations. My $0.02. The thread should have ended after the posts from the most knowledgeable person on the subject.

 

[Crayola227]

Dude if you think your eval results are gonna suck and **** you, why would you think it's worth going back to work just to end up pulled anyway, but this time ****ed by a bell you can't unring with the board?

Good luck man. I hope you take your attorney's advice about how to not take his advice. He could be wrong because of the complicating factor of your residency.

This, and the podcast above, are all reasons to literally give up any and all recreational substance use all together while a resident. Maybe have a single drink at home only on a night after work when you don't work the next day and no call. If you can't do that, maybe you really should because it's a problem. Take the Uber both ways so no car. If you're going to **** up it's better to do it as an attending.

 

[GoSpursGo]

I’m just gonna say it. I’m not sure why anyone would consider any advice here beyond the very astute @NotAProgDirector. There’s a lot of discussion here that I think involves a lot of speculation and pontification rather than sane advice from someone with direct professional knowledge of these situations. My $0.02. The thread should have ended after the posts from the most knowledgeable person on the subject.

Agreed. I think there is a real lack of understanding of what a delicate place the OP is in due to the fact that he is in training. I don’t disagree that this whole thing a bit of a railroading, but there also not a lot he can do about it. Even the “positive” story from the attorney resulted in that person losing their fellowship, which would be an unacceptable result here during residency.

 

[TulaneUnderdog]

Agreed. I think there is a real lack of understanding of what a delicate place the OP is in due to the fact that he is in training. I don’t disagree that this whole thing a bit of a railroading, but there also not a lot he can do about it. Even the “positive” story from the attorney resulted in that person losing their fellowship, which would be an unacceptable result here during residency.

ya I want to maintain the good graces with my program who really is the only people supporting me rn. I guess after all the holiday ICU nights I volunteered for, cross coverage in clinic, and 3 years without acting up till now, this is my PD’s way of thanking me. I got FFDE scheduled at UF but its weeks away and I can work in meantime which is unheard of for anyone pending Fitness for Duty

Also i called an anesthesia resi who went off grid after arguing with staff but then reappeared a year later back to work. He never opened up until i first shared my story and he admitted he did the same. He was sent for UDS, and it was positive benzos and thc. He had gone to UF and was dxed Bipolar 1, substance abuse d/o, and depression. He surprisingly was deemed “fit for work” but only after completion of 90d treatment, bipolar rx with psych f/u, and consent to 5-years of unpredictable urine screens.

 

[TulaneUnderdog]

Won’t annoy the atty anymore than I have but yes I paid the guy after my criminal proceedings were concluding but unfortunately after signing to accept PHP recs and unfortunately after signing that refusal of recs = noncompliance+Board awareness.

So where my atty stands at:
- Refuse FFDE and pay my own evaluation by that certified in Addiction Medicine
- Contest DUI dismissal must be interpreted as not an instance of drunk driving, filing for factual innocence of arrest
- Allow escalation to Board and contest non-compliance in that it was “doomed” to happen from fact all facilities charge exorbitant fees unaffordable beyond residency salary, all located out of state (minus 1), and limited to only 5 options
- Beat the PHP to it and file investigation himself to Board

Obviously he’s not happy I will go FFDE but it won’t get in the way of those other plans below: he says Im giving them inarguable fodder to use against me if I go through with it. He truly is honest that there is no guarantee of beating the case but has a lot of zeal to escalate due to that there is “nothing-to-lose” doubting my license is on line and I have a very strong case in that criminal record is clean, i have on-duty support, and collateral of my program and 3-year eval to defend me. Board won’t side with PHP- worst case scenario (as someone said) is I won’t lose my license, will remain out of a job (i will moonlight), and I will FFDE anyway. Best case is I probably will still need an evaluation but way more lax (simple psych referral, drug screening, and with more in-state options).

I did look into Fit for Duty evals by our PHP and got anecdotal evidence as well that they truly are not sus with cleanest one being the Florida one. It costs way more but you pay for what you get which is objective assessments. Its double the price than the rest but UF Recovery is run by Dr. Titelbaum who was a self-professed drug addict turned Psych and now runs as director there. Their mission is that all SUDs are treatable diseases that should not impair someone from
the field after addressed. They favor getting docs fit for duty affirmation and getting them back to work.

 

[LucidSplash]

Agreed. I think there is a real lack of understanding of what a delicate place the OP is in due to the fact that he is in training. I don’t disagree that this whole thing a bit of a railroading, but there also not a lot he can do about it. Even the “positive” story from the attorney resulted in that person losing their fellowship, which would be an unacceptable result here during residency.

Yeah. I’m a little uncomfortable with the aggressive posturing of the attorney as represented here. Without much more knowledge of this guy’s background, it probably wouldn’t hurt to find another attorney with experience in this area, ideally with residents not just doctors who had already finished training, and get a second opinion at least.

 

[Apollyon]

He surprisingly was deemed “fit for work” but only after completion of 90d treatment, bipolar rx with psych f/u, and consent to 5-years of unpredictable urine screens.

Nothing surprising about any of that. That's almost boilerplate for PHPs. 5 years of monitoring is now standard, and random UDS are part and parcel.

And, I mean, of course the urine screens are unpredictable. That's the entire point!

 

[NotAProgDirector]

I will agree with the OP that being allowed to work while a FFD eval is pending is very rare. The whole point of an FFD eval is to determine if you're fit for duty. Hence usually you cannot work until it is complete. OP should be very grateful that their program is allowing this.

 

[Crayola227]

I’m just gonna say it. I’m not sure why anyone would consider any advice here beyond the very astute @NotAProgDirector. There’s a lot of discussion here that I think involves a lot of speculation and pontification rather than sane advice from someone with direct professional knowledge of these situations. My $0.02. The thread should have ended after the posts from the most knowledgeable person on the subject.

Respectfully disagree. The worst thing that can happen in these threads actually, is to just shut them down because some authority has had the final word. I can tell you this 100% from personal experience.

PDs are crucial and have a lot of power. But even their knowledge and control have limits. Does it sound like to anyone here, that the OP's PD, as close as anyone is to this, knew exactly what was required and what the OP should do to save themselves? No, they clearly did not.

aPD already said this would work differently at their hospital in their program. aPD was surprised that the OP would be able to work during this time. There are always surprises.

Futher, if the OP has to do 3 months inpt, are they able to work during that time? Wasn't it aPD who said unless the PD can bring the OP on next year in that case, they still don't finish residency if they can't work for 3 months? And it could be longer?

So in that case, what is gained going against the attorney and accumulating all the negatives dozitgetchahi pointed out, like the atty fears? Does the atty have no insight into what the PHP is going to do to OP given what they know of both?

If the residency is not finished in any case, isn't the license the most important thing? And the ability to be licensed in other states? What will have the most or least negative effect on the license?

These are just questions worth considering imho. If he can work and the FFDE goes well, then it might all work out. Hard for any of us to say where we are.

Do people really not see, that the cards fellow had an amazing outcome? Dude was FIRED FOR KILLING SOMEONE WHILE OBSERVED HIGH AT WORK, and dude WALKS with his license?And this is a less than stellar outcome because he lost the fellowship?? He already lost it. He salvaged the license and his ability to work. Best outcome of course is to graduate, but sometimes that isn't possible.

I am actually surprised anyone would take anyone's advice on the internet over an experienced attorney's when they are in legal hot water with their career.

It's all spec until things unfold. Rarely does anyone have all the answers, there are surprises in this process for most physicians, even experienced IRL advisors directly on the case.

aPD's is good advice, but there are other people with some experience. I'm not a program director. I'm no expert. Sometimes I'm spot on and other times I'm not. Take it for what it is.

The OP was wise to note, that almost every entity he is dealing with has an agenda and almost none of them line up perfectly with his. He has little control, but what he has, he needs to use as best he can for himself.

These situations are hard, and my advice would be to learn as much as possible about your state, your board, your residency's leadership and processes, your hospital's structures and policies, read as much as you can on SDN about residents in trouble, read aPD's advice, listen to former residents, find what you can on the internet from anyone who has had any experience, read the laws in your state, listen to your attorney.

You don't have to take anyone's advice, it's all advice. Take it all in. Figure out what applies and what doesn't, what outcomes you think is reasonable/likely and try to plan for it. Set reasonable goals. Hell, even a good attorney will be able to do more for you if you come in with some knowledge, perspective, ideas, and questions.

Every case is unique. It's why medicine and law are both said to be "practices."

 

[TulaneUnderdog]

Ya i appreciate the insight from everyone. This is a situation where I truly believe the best way to go is through it.

 

[Gonio5]

Several things.

I met an attorney that does nearly exclusively DUI cases at a local business club meeting. He said to never do a field sobriety test because it's the officer's word against yours and that the officer can have lots of leeway to say you're drunk. He said that it could be cold, dark, rainy, and you are on a rocky surface with pebbles such that even someone who didn't drink all year could fail. He said it was ok to do blow or get a blood test.

The abuse organization that the state uses have been known, in some states, to be a huge money making racket that does everything to make money. They'll test you, require psychotherapy, and all kinds of things. You might need to go through with it but you should consult with an attorney that deals with state medical board matters a lot.

 

[NotAProgDirector]

Maybe it's good to have your own breathalyzer? They seem to cost $130 or so. That way, one could blow and, if low, then drive knowing they'd pass any police stop.

Seems much easier to just not drink when you're planning on driving.

 

[LucidSplash]

Respectfully disagree. The worst thing that can happen in these threads actually, is to just shut them down because some authority has had the final word. I can tell you this 100% from personal experience.

PDs are crucial and have a lot of power. But even their knowledge and control have limits. Does it sound like to anyone here, that the OP's PD, as close as anyone is to this, knew exactly what was required and what the OP should do to save themselves? No, they clearly did not.

aPD already said this would work differently at their hospital in their program. aPD was surprised that the OP would be able to work during this time. There are always surprises.

Futher, if the OP has to do 3 months inpt, are they able to work during that time? Wasn't it aPD who said unless the PD can bring the OP on next year in that case, they still don't finish residency if they can't work for 3 months? And it could be longer?

So in that case, what is gained going against the attorney and accumulating all the negatives dozitgetchahi pointed out, like the atty fears? Does the atty have no insight into what the PHP is going to do to OP given what they know of both?

If the residency is not finished in any case, isn't the license the most important thing? And the ability to be licensed in other states? What will have the most or least negative effect on the license?

These are just questions worth considering imho. If he can work and the FFDE goes well, then it might all work out. Hard for any of us to say where we are.

Do people really not see, that the cards fellow had an amazing outcome? Dude was FIRED FOR KILLING SOMEONE WHILE OBSERVED HIGH AT WORK, and dude WALKS with his license?And this is a less than stellar outcome because he lost the fellowship?? He already lost it. He salvaged the license and his ability to work. Best outcome of course is to graduate, but sometimes that isn't possible.

I am actually surprised anyone would take anyone's advice on the internet over an experienced attorney's when they are in legal hot water with their career.

It's all spec until things unfold. Rarely does anyone have all the answers, there are surprises in this process for most physicians, even experienced IRL advisors directly on the case.

aPD's is good advice, but there are other people with some experience. I'm not a program director. I'm no expert. Sometimes I'm spot on and other times I'm not. Take it for what it is.

The OP was wise to note, that almost every entity he is dealing with has an agenda and almost none of them line up perfectly with his. He has little control, but what he has, he needs to use as best he can for himself.

These situations are hard, and my advice would be to learn as much as possible about your state, your board, your residency's leadership and processes, your hospital's structures and policies, read as much as you can on SDN about residents in trouble, read aPD's advice, listen to former residents, find what you can on the internet from anyone who has had any experience, read the laws in your state, listen to your attorney.

You don't have to take anyone's advice, it's all advice. Take it all in. Figure out what applies and what doesn't, what outcomes you think is reasonable/likely and try to plan for it. Set reasonable goals. Hell, even a good attorney will be able to do more for you if you come in with some knowledge, perspective, ideas, and questions.

Every case is unique. It's why medicine and law are both said to be "practices."

Maybe I shouldn’t tell you this and it will make me seem like an AH but I almost never read the entirety of your posts because when I do, I find they tend to be far too long, redundant, a bit grandiose and pompous, and tend towards pontification, speculation, and conjecture rather than actual helpful advise IMHO. When I do read them I find that I almost always have an opinion that is nearly 180 from what you recommend as a course of action. So you can respectfully disagree all you want because I also disagree with most of your posts. 🤷🏼‍♀️

I advise the OP to listen to NotAPD here and not get sidetracked with too much “this situation is unfair and you should fight the power at all costs” rhetoric. The situation sucks and it DOES sound a bit railroady but regardless it is the situation the OP is in. Not to mention the OP has admitted that there are some real personal issues at play that should be addressed anyway. The OP is not blameless. There will be no easy resolution but IMHO APD has given the best advice. Reasonable to get a second opinion from another attorney but tread lightly in all things here.

 

[Crayola227]

Maybe it's good to have your own breathalyzer? They seem to cost $130 or so. That way, one could blow and, if low, then drive knowing they'd pass any police stop.

The issue with these has to do with accuracy and keeping them calibrated. The error on them is enough to **** you.

If there's any doubt, as can be with these machine, it doesn't change management because the safe thing is to just not drive rather than chance it.

Not for reason of drinking, I like to use my cruise control.

What you said about the FST, makes me think not only do you not want to do that, besides not coming to attention speeding, even if you hadn't been drinking, the other detail here where drunks spilled alcohol on OP, if that happened also don't drive.

There's so much here, even if the BAC had been way under, even if you were pulled over not for speeding but for like a taillight, it sounds like any suspicion can lead down this road since the standard is suspicion and not evidence per se.

I've heard other horror tales where for some reason cops smelled booze due to no wrongdoing, and look what can happen.

 

[Crayola227]

So my partner is a pilot, has known guys that fly commercially. The FAA is even worse than med boards.

Story is guy was at a party, had only had one drink, it was a hot day, he had been sweating earlier in the day, and anyway he fainted. Hit his head and blood everywhere. The people at the party freaked and called an ambulance while he was out. He went along with the ride because his wife was freaked and the dude isn't a doctor and he needed stitches. Of course blood and alcohol drawn in the ED. Simple dehydration and fainting. Alcohol nowhere near anything to doubt this dude.

The fact he lost consciousness and there was ANY alcohol in his system, triggered a whole ****show. Didn't matter he wasn't driving, wasn't drunk, wasn't anywhere near working, wasn't breaking the law.

I would say it's enough to make you swear off any substances. But that podcast transcript above - dude is a devout Muslim and takes nothing, and still a ****show.

For the record I don't advise anyone to fight anything to "fight the system." I would tell someone to lay down and let the whole med board run the train on them if that was what it would take and you were willing to do it to keep your career.

Sadly something close is what ends up happening sometimes. It's fine, the only reason I see to fight is because sometimes the train is coming for you and it isn't going to save you.

Anyway certain industries certain careers, it might just be easier not to touch anything even if legal. Definitely not during residency. These horror tales were specifically why I never smoked herb during med school or training-

Here's another tale. Med student smokes weed in their off time, no reason anyone thinks they ever came in impaired. Gets a fingerstick on an HIV positive patient. Immediately occ health has blood drawn. Comes up positive for weed. Down the road, tests positive for HIV, was negative prior. Worker's comp that would cover treatment, as well as disability insurance if that happened as a result, both deny the claims, claiming that it was the student's negligence because they may have been high at work and that led to the stick. Whether or not that was true, that is how it went down. No idea if they fought this and won.

Who told me this tale of woe? My ****ing medical school during orientation about fingersticks and why you should consider never smoking weed during your career, even where it is "legal." Consider it the price of being a physician, they said.

So no weed. As for alcohol, med students do dumb things. The idiosyncrasies of residency placement and the Match, makes time off for board/PHP ****ery a potential kiss of death.

It's all hearsay from me. But I think there are lessons to learn from horror stories.

 

[NotAProgDirector]

Like most complicated issues, everyone is "right" here to some extent.

The medical licensing boards see their role to police the medical field and keep patients safe from impared physicians. Thus they take all reports seriously and want to ensure public safety. Relying upon the legal system alone (i.e. if someone is not convicted then there is no issue) would likely catch the most severe issues, but will have a high false negative rate. But a more expansive process is certain to sweep up people with no issues at all and cause them great difficulty. Medical boards aren't really equipped to evaluate these issues, so they have been outsourced to these "expert centers" which are fraught with issues.

There's no question that submitting to a FFD evaluation can lead to a world of problems, and that if possible to avoid it that would be best. It's also very likely that it's impossible to stop once the process has started, and that legal wrangling may only make matters worse. In the OP's case it's possible that if they start some legal process with the board to not do the FFD, that the board will suspend their license until the matter is settled. Then, their training is paused no matter their PD support. By the time the issue is settled, it's anyone's guess whether their spot remains or not.

It's a horrible situation all around for the OP. On the other hand, there are physicians who need help like this and we do need a way to address that. Finding that balance is difficult, perhaps impossible. Personally I think a reasonable solution would be a two step process -- first a quick evaluation by someone in Occ Med or similar, shouldn't be more than a long office visit. Substance testing is a must, and since this is for legal purposes the full mass spec is needed. If concerns are raised there, then referral to one of these more intensive evaluations is warranted. In all situations, the sites that do the evaluations should be separated from the delivery of programs else the risk of self referral is high -- the reason for Stark laws. But the financial viability of running an evaluation only program is suspect, so we would probably need to settle for a compromise where the testing site can only refer to other sites -- but that could greatly inconvenience physicians in these programs. So, no good answers. But the status quo seems unacceptable.

I have been involved in issues like this, and it is incredibly difficult. Differentiating recreational MJ use (which is probably fine) from chronic use to manage uncontrolled psych issues (which is probably not) is incredibly challenging. And once you're in a program like this, any small issue instantly gets escalated and investigated. It's riskier for residents in training, as it's easier for boards to deny licensure in the first place than to take one away. I had a resident who went through this process (all local, not one of these programs) and found a likely underlying issue for which they got help -- so perhaps a win. But then missed a random drug screen and almost lost everything. It can be like walking on a knife's edge, and can seem punitive.

Cray's comments and concerns are valid. The system absolutely can get out of control. When it does, whether pushing back vs "going with the flow" is the right call is a judgment call. My experience is that pushing back usually ends badly. But going with the flow can end badly also, and then in retrospect would seem that pushing back would have been the better choice.

 

[TulaneUnderdog]

Like most complicated issues, everyone is "right" here to some extent.

The medical licensing boards see their role to police the medical field and keep patients safe from impared physicians. Thus they take all reports seriously and want to ensure public safety. Relying upon the legal system alone (i.e. if someone is not convicted then there is no issue) would likely catch the most severe issues, but will have a high false negative rate. But a more expansive process is certain to sweep up people with no issues at all and cause them great difficulty. Medical boards aren't really equipped to evaluate these issues, so they have been outsourced to these "expert centers" which are fraught with issues.

There's no question that submitting to a FFD evaluation can lead to a world of problems, and that if possible to avoid it that would be best. It's also very likely that it's impossible to stop once the process has started, and that legal wrangling may only make matters worse. In the OP's case it's possible that if they start some legal process with the board to not do the FFD, that the board will suspend their license until the matter is settled. Then, their training is paused no matter their PD support. By the time the issue is settled, it's anyone's guess whether their spot remains or not.

It's a horrible situation all around for the OP. On the other hand, there are physicians who need help like this and we do need a way to address that. Finding that balance is difficult, perhaps impossible. Personally I think a reasonable solution would be a two step process -- first a quick evaluation by someone in Occ Med or similar, shouldn't be more than a long office visit. Substance testing is a must, and since this is for legal purposes the full mass spec is needed. If concerns are raised there, then referral to one of these more intensive evaluations is warranted. In all situations, the sites that do the evaluations should be separated from the delivery of programs else the risk of self referral is high -- the reason for Stark laws. But the financial viability of running an evaluation only program is suspect, so we would probably need to settle for a compromise where the testing site can only refer to other sites -- but that could greatly inconvenience physicians in these programs. So, no good answers. But the status quo seems unacceptable.

I have been involved in issues like this, and it is incredibly difficult. Differentiating recreational MJ use (which is probably fine) from chronic use to manage uncontrolled psych issues (which is probably not) is incredibly challenging. And once you're in a program like this, any small issue instantly gets escalated and investigated. It's riskier for residents in training, as it's easier for boards to deny licensure in the first place than to take one away. I had a resident who went through this process (all local, not one of these programs) and found a likely underlying issue for which they got help -- so perhaps a win. But then missed a random drug screen and almost lost everything. It can be like walking on a knife's edge, and can seem punitive.

Cray's comments and concerns are valid. The system absolutely can get out of control. When it does, whether pushing back vs "going with the flow" is the right call is a judgment call. My experience is that pushing back usually ends badly. But going with the flow can end badly also, and then in retrospect would seem that pushing back would have been the better choice.

honestly you have the best equipoise of the situation out of the rest. i agree

I want to stay on good terms with as many parties as I can: my program, the board, atty, and myself, all with separate agendas with collateral damage to me: “get him back to work”, “he may not be fit to work”, “he is fit and never warranted an eval for a crime he didnt commit”, and “I just wanna graduate on time while hold a license”. And thats FFDE. I have enough anecdotes to say these programs are no longer sus, at least what I got from coresis who returned after being near Psycho.

These eval centers’ reputation check out based on the 1000s of docs going through and rule in your favor and there is more money to make that way. Worst ruling is “unfit” and takes true untreatable Dx such as very low IQ or debilitating untreatable personality traits. But lets be honest, no one should be a Dr with Low IQ or antisocial personality. They do everything they can to say “fit but treat X,Y, and Z” to favor you but also monetize extra treatment as well as make you return when you relapse to make more

 

[HemeOncHopeful19]

After reading everything here, I'm in agreement with the PHP that a FFDE evaluation is needed here. Our medical executive committee would've ordered one for the same reason, and continued pushing it even if charges were dropped--every physician should know not to drive at all if they've been drinking. You were speeding as well, which does suggest some degree of impairment of judgement since most people who had a little alcohol in their system, but not enough to be affected (debatable if that exits unless we're talking about a sip of communion wine) would know to follow all laws to a T to prevent getting pulled over.

Physicians are held to a higher standard. The legal limit is just that--the legal limit. But it's not the ethical standard we physicians are held do, and considering the immense responsibility we have to patients, further investigation here is certainly merited.

Wait are you saying I can’t have a beer with my cheeseburger on Friday night or you’ll push for a FFDE even if charges are dropped? This sounds like the opposite of the type of person I would want on a med exec committee…

For the record I think the primary reason for “every physician should know not to drive at all if they've been drinking” is because they are at risk of being unfairly treated/taken advantage of by PHP boards etc.

I also think OP is rationalizing a lot in this thread

 

[TulaneUnderdog]

Wait are you saying I can’t have a beer with my cheeseburger on Friday night or you’ll push for a FFDE even if charges are dropped? This sounds like the opposite of the type of person I would want on a med exec committee…

For the record I think the primary reason for “every physician should know not to drive at all if they've been drinking” is because they are at risk of being unfairly treated/taken advantage of by PHP boards etc.

I also think OP is rationalizing a lot in this thread

Ya what personality trait will that be diagnosed as by the eval center haha

 

[RangerBob]

Wait are you saying I can’t have a beer with my cheeseburger on Friday night or you’ll push for a FFDE even if charges are dropped? This sounds like the opposite of the type of person I would want on a med exec committee…

For the record I think the primary reason for “every physician should know not to drive at all if they've been drinking” is because they are at risk of being unfairly treated/taken advantage of by PHP boards etc.

I also think OP is rationalizing a lot in this thread

if you plan on driving then no, you shouldn’t drink, unless you wait a sufficient amount of time to drive so you BAL drops back down to almost zero.

Med Exec’s job is to police the medical staff so that the hospital doesn’t. It’s why medicine is a profession—we (physicians) our own metrics/requirements (MOC—ugh…) and regulate/police ourselves. Unless the situation is so serious the legal system need to get involved.

Med Exec has a few goals/worries
1) Protect patients
2) Enforce med staff bylaws

And to a much lesser extent:
3) Protect hospital
4) Protect themselves (patients harmed by a physician not disciplined by Med Exec can sue Med Exec. And physicians harmed (if privileges are revoked) can sue as well)

There are others but these are the most relevant here

Between your classic righteous doc who always puts the patient’s well-being first (think Dr Cox from Scrubs) and the ones paranoid that they can get sued for not disciplining a poorly behaving doc (think of Ted the lawyer—imagine if he was a doc), Med Exec staff will almost always agree to investigate the sorts of things the OP has presented.

Thankfully most of the docs on our Med Exec are in the former group. But when these sorts of things come up the committee is always consulting with hospital legal council (hospital insures Med Exec typically) to understand legal obligations/exposure.

The fact a med exec committee refers someone for FFFE doesn’t mean that person is guilty/will lose their practicing privileges/get reported to the Board—just that Med Execs are typically very conservative and will typically recommend further investigation/outside expert review. This risk averse stance is mostly by design. So they almost always err on the side of “do no harm” to the patient, not the physician.

 

[HemeOncHopeful19]

if you plan on driving then no, you shouldn’t drink, unless you wait a sufficient amount of time to drive so you BAL drops back down to almost zero.

Med Exec’s job is to police the medical staff so that the hospital doesn’t. It’s why medicine is a profession—we (physicians) our own metrics/requirements (MOC—ugh…) and regulate/police ourselves. Unless the situation is so serious the legal system need to get involved.

Med Exec has a few goals/worries
1) Protect patients
2) Enforce med staff bylaws

And to a much lesser extent:
3) Protect hospital
4) Protect themselves (patients harmed by a physician not disciplined by Med Exec can sue Med Exec. And physicians harmed (if privileges are revoked) can sue as well)

There are others but these are the most relevant here

Between your classic righteous doc who always puts the patient’s well-being first (think Dr Cox from Scrubs) and the ones paranoid that they can get sued for not disciplining a poorly behaving doc (think of Ted the lawyer—imagine if he was a doc), Med Exec staff will almost always agree to investigate the sorts of things the OP has presented.

Thankfully most of the docs on our Med Exec are in the former group. But when these sorts of things come up the committee is always consulting with hospital legal council (hospital insures Med Exec typically) to understand legal obligations/exposure.

The fact a med exec committee refers someone for FFFE doesn’t mean that person is guilty/will lose their practicing privileges/get reported to the Board—just that Med Execs are typically very conservative and will typically recommend further investigation/outside expert review. This risk averse stance is mostly by design. So they almost always err on the side of “do no harm” to the patient, not the physician.

So just to clarify, what is “almost zero” in your mind and do you publish this number in your hospital bylaws?

 

[RangerBob]

So just to clarify, what is “almost zero” in your mind and do you publish this number in your hospital bylaws?

No--not published in the bylaws. Interpret it as you'd like. General rule of thumb is you need to wait at least one hour to drive after you've had one drink. Ask a sober friend if you smell of alcohol and if they'd trust you to drive their child home. When they can answer "yes," then you're good to go.

We can't regulate what people do/don't do on their free time. But Med Exec is expected to respond to an issue when it is brought to their attention if it causes a concern for the ability for a physician to safely provide patient care. `The earlier case of a resident not responding to phone call for 30 minutes, in what sounds to have been a very innocent mistake (possible phone malfunction), is a good example of how even things that could be 100% innocent can lead to a major headache for the person. I'm not sure how many attendings/PDs would have escalated that case the way it was, but it shows how even small/more innocuous things (phone not going off) without any patient harm can still lead to a whirlwind of trouble. Because there could have been patient harm had the situation been different.

In the OP's case, the OP was under the legal limit. He/she was legally allowed to drive. I'm sure the hassle from the legal charges alone (which have been dropped) was stressful enough they will never drink again without waiting well more than an hour per drink. If they even ever drink again.

Add in the FFDE fiasco, and it wouldn't surprise me if the stress from that is enough to make them quit altogether (where there is or isn't a SUD disorder involved.)

Others need to take the OPs situation as a learning lesson. Physicians are held to a higher standard. And we should be--just as airline pilots and military generals are. As AProgDirector mentions, there's likely no way to get a perfect balance of only picking up the truly guilty/public health risks from innocent bystanders, as our system is set up to err on the side of patient safety.

Of note, these high standards of which we hold ourselves to is a large part of why we are so respected as a profession.

 

[TulaneUnderdog]

No--not published in the bylaws. Interpret it as you'd like. General rule of thumb is you need to wait at least one hour to drive after you've had one drink. Ask a sober friend if you smell of alcohol and if they'd trust you to drive their child home. When they can answer "yes," then you're good to go.

We can't regulate what people do/don't do on their free time. But Med Exec is expected to respond to an issue when it is brought to their attention if it causes a concern for the ability for a physician to safely provide patient care. `The earlier case of a resident not responding to phone call for 30 minutes, in what sounds to have been a very innocent mistake (possible phone malfunction), is a good example of how even things that could be 100% innocent can lead to a major headache for the person. I'm not sure how many attendings/PDs would have escalated that case the way it was, but it shows how even small/more innocuous things (phone not going off) without any patient harm can still lead to a whirlwind of trouble. Because there could have been patient harm had the situation been different.

In the OP's case, the OP was under the legal limit. He/she was legally allowed to drive. I'm sure the hassle from the legal charges alone (which have been dropped) was stressful enough they will never drink again without waiting well more than an hour per drink. If they even ever drink again.

Add in the FFDE fiasco, and it wouldn't surprise me if the stress from that is enough to make them quit altogether (where there is or isn't a SUD disorder involved.)

Others need to take the OPs situation as a learning lesson. Physicians are held to a higher standard. And we should be--just as airline pilots and military generals are. As AProgDirector mentions, there's likely no way to get a perfect balance of only picking up the truly guilty/public health risks from innocent bystanders, as our system is set up to err on the side of patient safety.

Of note, these high standards of which we hold ourselves to is a large part of why we are so respected as a profession.

Not that I ever enjoyed ETOH like that but I cant even muster to sip a can of beer anymore. It has robbed my job and livelihood. I now hang with the aforementioned coresi who graduated the FFD process and he’s a good sober influence with >300d on him w/o etoh benzos and thc. We shot pool last night and sipped red bull on the rocks now haha.

 

[HemeOncHopeful19]

No--not published in the bylaws. Interpret it as you'd like. General rule of thumb is you need to wait at least one hour to drive after you've had one drink. Ask a sober friend if you smell of alcohol and if they'd trust you to drive their child home. When they can answer "yes," then you're good to go.

We can't regulate what people do/don't do on their free time. But Med Exec is expected to respond to an issue when it is brought to their attention if it causes a concern for the ability for a physician to safely provide patient care. `The earlier case of a resident not responding to phone call for 30 minutes, in what sounds to have been a very innocent mistake (possible phone malfunction), is a good example of how even things that could be 100% innocent can lead to a major headache for the person. I'm not sure how many attendings/PDs would have escalated that case the way it was, but it shows how even small/more innocuous things (phone not going off) without any patient harm can still lead to a whirlwind of trouble. Because there could have been patient harm had the situation been different.

In the OP's case, the OP was under the legal limit. He/she was legally allowed to drive. I'm sure the hassle from the legal charges alone (which have been dropped) was stressful enough they will never drink again without waiting well more than an hour per drink. If they even ever drink again.

Add in the FFDE fiasco, and it wouldn't surprise me if the stress from that is enough to make them quit altogether (where there is or isn't a SUD disorder involved.)

Others need to take the OPs situation as a learning lesson. Physicians are held to a higher standard. And we should be--just as airline pilots and military generals are. As AProgDirector mentions, there's likely no way to get a perfect balance of only picking up the truly guilty/public health risks from innocent bystanders, as our system is set up to err on the side of patient safety.

Of note, these high standards of which we hold ourselves to is a large part of why we are so respected as a profession.

I agree with some of what you're saying but overall I find the premise to be ridiculous. A single alcoholic beverage would take the average American to a BAC of 0.02 (male) or 0.03 (female), and I think it is wild to imply that one should expect to be risking their career by driving at that level.

I also strongly disagree with unpublished "rules" for physicians. If you think 0.02 should risk your license and career then make it an official policy or law, otherwise it will be another one of those things that only gets applied to "troublemaker" docs while the Neurosurgeon who earns the hospital $$ gets more leeway.

 

[Apollyon]

The OP changed the title.

 

[RangerBob]

I agree with some of what you're saying but overall I find the premise to be ridiculous. A single alcoholic beverage would take the average American to a BAC of 0.02 (male) or 0.03 (female), and I think it is wild to imply that one should expect to be risking their career by driving at that level.

I also strongly disagree with unpublished "rules" for physicians. If you think 0.02 should risk your license and career then make it an official policy or law, otherwise it will be another one of those things that only gets applied to "troublemaker" docs while the Neurosurgeon who earns the hospital $$ gets more leeway.

You may think way. I'm sure many others do. But there's a reason that most businesses don't allow their employees to drink anything on the job, bus drivers and pilots can't have any EtOH in their system, etc. How many sawmills let their employees come in after they had a drink?

There's no determined safe level to drive with EtOH in our body. That it what it comes down to. And when our livlihood is at stake, it's just not worth it. As others have said--call an Uber.

I'm not saying that docs can't drink anything. Clearly no Med Exec will pull one's privileges if an attending got into an auto accident and had a BAL of 0.01. But if they were near (but still under) the legal limit and someone was hurt/killed? Very different story. That physician would likely get a FFDE. The whole thing is on a sliding scale though--at what point is the BAL too high and the charge too serious for it to be ignored even if the doc is not legally at fault? When it's in the gray area, it also depends on the personalities on Med Exec, how well the doc is liked/respected, etc.

You are absolutely correct about how these "rules" aren't evenly applied. Those with power/prestige/wealth always have different standards. Programs absolutely allow their surgeons to act like bigger jerks than they allow their hospitalists. Lets not even talk about what politicians and Wall Street bankers get away with... Sadly, that's a part of life and has always been--though we should work to make things more equitable.

 

[LucidSplash]

I agree with some of what you're saying but overall I find the premise to be ridiculous. A single alcoholic beverage would take the average American to a BAC of 0.02 (male) or 0.03 (female), and I think it is wild to imply that one should expect to be risking their career by driving at that level.

I also strongly disagree with unpublished "rules" for physicians. If you think 0.02 should risk your license and career then make it an official policy or law, otherwise it will be another one of those things that only gets applied to "troublemaker" docs while the Neurosurgeon who earns the hospital $$ gets more leeway.

I think that is the most conservative advice out there.

How about this: I’m a surgeon and I take home call up to 1-2 weeks at a time sometimes. My personal choice is to not drink anything at all when on call. I know some surgeons who will have a single beer occasionally when on home call. The reality is that if you’re not in-house even if you get called in, a single beer would likely be out of your system with a BAC at zero by the time you had to operate. Maybe not by the time you had to make the decision whether or not to operate but certainly to operate.

But if the patient has a complication, and someone finds out that you did have a beer 6 hours before an operation, you have no way to prove it was just one beer or that your BAC was zero before surgery or when you decided to do surgery. Or if you’re at a BBQ and someone posts a picture to Facebook and you have a drink in your hand a few hours before surgery, some plaintiff attorney can find that and even if the postop complication is in no way related, you’re probably going to end up settling. For me, I’d rather not take the risk. I don’t need a glass of wine when I’m on call.

You can be against unwritten rules for doctors all you want. But the reality is that this a highly scrutinized profession. Some of that is absolutely ridiculous (see also #MedBikini nonsense from a couple years ago) and rightfully has receive pushback. But you have to pick your battles and if you wouldn’t want your surgeon operating right after a beer, then it’s hard to argue they should be driving right after a beer. Even if YOU would be ok woth your doc having a beer before your surgery, most people wouldn’t. The MEC is probably the least of your worries honestly. You’re rolling the dice with your career and with any attorney out to make a buck. So you can see how people might feel the same about a doc making the decision to drive even minimally under the influence.

 

[anonperson]

The Doctor’s Crossing podcast had an excellent episode featuring a physician who had to undergo evaluation after he fell asleep on the job. It was unbelievable to me how much scrutiny he went through despite no alcohol or substance use. https://doctorscrossing.com/wp-content/uploads/2022/07/Episode-089-Transcript.pdf

Interesting story.

From what I read, dude fell asleep in the OR during a case as a first year anesthesia resident. I think it's a little naive to think there weren't going to be any consequences to that.

The board went too far for sure but that's a bad look for the resident.

 

[Crayola227]

Interesting story.

From what I read, dude fell asleep in the OR during a case as a first year anesthesia resident. I think it's a little naive to think there weren't going to be any consequences to that.

The board went too far for sure but that's a bad look for the resident.

That's a very interesting take if you read the entire transcript.

 

[dozitgetchahi]

Respectfully disagree. The worst thing that can happen in these threads actually, is to just shut them down because some authority has had the final word. I can tell you this 100% from personal experience.

PDs are crucial and have a lot of power. But even their knowledge and control have limits. Does it sound like to anyone here, that the OP's PD, as close as anyone is to this, knew exactly what was required and what the OP should do to save themselves? No, they clearly did not.

aPD already said this would work differently at their hospital in their program. aPD was surprised that the OP would be able to work during this time. There are always surprises.

Futher, if the OP has to do 3 months inpt, are they able to work during that time? Wasn't it aPD who said unless the PD can bring the OP on next year in that case, they still don't finish residency if they can't work for 3 months? And it could be longer?

So in that case, what is gained going against the attorney and accumulating all the negatives dozitgetchahi pointed out, like the atty fears? Does the atty have no insight into what the PHP is going to do to OP given what they know of both?

If the residency is not finished in any case, isn't the license the most important thing? And the ability to be licensed in other states? What will have the most or least negative effect on the license?

These are just questions worth considering imho. If he can work and the FFDE goes well, then it might all work out. Hard for any of us to say where we are.

Do people really not see, that the cards fellow had an amazing outcome? Dude was FIRED FOR KILLING SOMEONE WHILE OBSERVED HIGH AT WORK, and dude WALKS with his license?And this is a less than stellar outcome because he lost the fellowship?? He already lost it. He salvaged the license and his ability to work. Best outcome of course is to graduate, but sometimes that isn't possible.

I am actually surprised anyone would take anyone's advice on the internet over an experienced attorney's when they are in legal hot water with their career.

It's all spec until things unfold. Rarely does anyone have all the answers, there are surprises in this process for most physicians, even experienced IRL advisors directly on the case.

aPD's is good advice, but there are other people with some experience. I'm not a program director. I'm no expert. Sometimes I'm spot on and other times I'm not. Take it for what it is.

The OP was wise to note, that almost every entity he is dealing with has an agenda and almost none of them line up perfectly with his. He has little control, but what he has, he needs to use as best he can for himself.

These situations are hard, and my advice would be to learn as much as possible about your state, your board, your residency's leadership and processes, your hospital's structures and policies, read as much as you can on SDN about residents in trouble, read aPD's advice, listen to former residents, find what you can on the internet from anyone who has had any experience, read the laws in your state, listen to your attorney.

You don't have to take anyone's advice, it's all advice. Take it all in. Figure out what applies and what doesn't, what outcomes you think is reasonable/likely and try to plan for it. Set reasonable goals. Hell, even a good attorney will be able to do more for you if you come in with some knowledge, perspective, ideas, and questions.

Every case is unique. It's why medicine and law are both said to be "practices."

I completely agree here.

OP is likely to get his most valuable advice from his attorney, but it is completely worthwhile for physicians to swap stories and strategies in a situation like this. APD has a viewpoint, but his is hardly the only (or even necessarily most) valuable viewpoint here. Any docs responding who have had personal experience in dealing with PHPs or board related issues may have extremely valuable insights for OP. There are also physicians groups (iirc there is one out there called CPR, run by Dr Kernan Manion) that deal in helping physicians navigate situations like this. OP would do well to Google and get in touch with some of these types of folks, who may be very helpful, and who may supply information that even his attorney isn’t giving him.

 

[Crayola227]

The question of course veers into, what is a physician allowed to do off the job that is common, legal, not particularly immoral? Because that is *driving* under the limit.

Notice I said off the job here. Residents get 1 to 2 week vacations like anyone else. Not talking about coming in with BAC >0

 

[dozitgetchahi]

I think that is the most conservative advice out there.

How about this: I’m a surgeon and I take home call up to 1-2 weeks at a time sometimes. My personal choice is to not drink anything at all when on call. I know some surgeons who will have a single beer occasionally when on home call. The reality is that if you’re not in-house even if you get called in, a single beer would likely be out of your system with a BAC at zero by the time you had to operate. Maybe not by the time you had to make the decision whether or not to operate but certainly to operate.

But if the patient has a complication, and someone finds out that you did have a beer 6 hours before an operation, you have no way to prove it was just one beer or that your BAC was zero before surgery or when you decided to do surgery. Or if you’re at a BBQ and someone posts a picture to Facebook and you have a drink in your hand a few hours before surgery, some plaintiff attorney can find that and even if the postop complication is in no way related, you’re probably going to end up settling. For me, I’d rather not take the risk. I don’t need a glass of wine when I’m on call.

You can be against unwritten rules for doctors all you want. But the reality is that this a highly scrutinized profession. Some of that is absolutely ridiculous (see also #MedBikini nonsense from a couple years ago) and rightfully has receive pushback. But you have to pick your battles and if you wouldn’t want your surgeon operating right after a beer, then it’s hard to argue they should be driving right after a beer. Even if YOU would be ok woth your doc having a beer before your surgery, most people wouldn’t. The MEC is probably the least of your worries honestly. You’re rolling the dice with your career and with any attorney out to make a buck. So you can see how people might feel the same about a doc making the decision to drive even minimally under the influence.

I agree with both you and HemeOncHopeful…we are an extremely scrutinized profession and for that reason I’ve elected to not drink altogether for the last 5 years or so. I have seen several situations already where certain doctors I’ve worked with were put under the magnifying glass in part because they were well known drinkers and partiers from social media and work events…because of that, I simply don’t want to be seen drinking at all at this point. I don’t think it’s worth the risk.

On the other hand, I absolutely agree with HemeOncHopeful that in regards to fairness, rules regarding these things should be as specific (and documented) as possible.

 

[dozitgetchahi]

The question of course veers into, what is a physician allowed to do off the job that is common, legal, not particularly immoral? Because that is *driving* under the limit.

Notice I said off the job here. Residents get 1 to 2 week vacations like anyone else. Not talking about coming in with BAC >0

This question gets into all sorts of interesting topics…for instance, there are some institutions (CCF notoriously, but others too) that include nicotine in their drug testing protocols. Anyone found smoking tobacco either gets denied a job altogether, or if found positive after they’ve started working there, they get put into a nicotine cessation program. Is this an OK thing to do to medical employees? I have little sympathy for smokers in general, but the fact of the matter is that it’s legal to smoke tobacco in the US, and nobody argues that nicotine is an intoxicant that impairs your performance.

Also, now cannabis is recreationally legal in a bunch of states. It’s considered socially/professionally acceptable to drink off duty as long as you don’t show up intoxicated to work. Is there eventually going to be a similar mindset for cannabis use? You can legally drive with some detectable alcohol in your system…the question is still out as to whether cannabis will ever be regarded similarly.

There are other moral/ethical questions regarding medical licensure too. Is it OK for a doctor to also have a side gig as a stripper, porn star etc? These jobs are technically legal, but there are docs in the past who were dragged into confrontations with the medical board in part because of part time jobs like this.

 

[HemeOncHopeful19]

Interesting story.

From what I read, dude fell asleep in the OR during a case as a first year anesthesia resident. I think it's a little naive to think there weren't going to be any consequences to that.

The board went too far for sure but that's a bad look for the resident.

A resident falling asleep?

Drug test, EtOH test that day, if negative... give him a day off.

What's complicated about it?

 

[anonperson]

A resident falling asleep?

Drug test, EtOH test that day, if negative... give him a day off.

What's complicated about it?

Guy fell asleep during a pediatric case. Wasn't a general case but also wasn't just local since he was involved. He also didn't do great on ITEs or vaguely alludes to that. Attending doesn't appear to be in the room either at this point since a nurse woke him up.

This isn't like he fell asleep in the call room and slept through a phone call.

Did he go through the ringer? Sure. But maybe he wasn't cut out for anesthesia as a specialty.

 

[anonperson]

The question of course veers into, what is a physician allowed to do off the job that is common, legal, not particularly immoral? Because that is *driving* under the limit.

Notice I said off the job here. Residents get 1 to 2 week vacations like anyone else. Not talking about coming in with BAC >0

You can still be convicted of driving impaired even if you are below the legal limit of intoxication in some states. If the DA can show your driving was that bad, such as with video evidence, you can still get hit with some type of charge.

.08 or whatever the limit in the state is not some magical line.

 

[anonperson]

This question gets into all sorts of interesting topics…for instance, there are some institutions (CCF notoriously, but others too) that include nicotine in their drug testing protocols. Anyone found smoking tobacco either gets denied a job altogether, or if found positive after they’ve started working there, they get put into a nicotine cessation program. Is this an OK thing to do to medical employees? I have little sympathy for smokers in general, but the fact of the matter is that it’s legal to smoke tobacco in the US, and nobody argues that nicotine is an intoxicant that impairs your performance.

Also, now cannabis is recreationally legal in a bunch of states. It’s considered socially/professionally acceptable to drink off duty as long as you don’t show up intoxicated to work. Is there eventually going to be a similar mindset for cannabis use? You can legally drive with some detectable alcohol in your system…the question is still out as to whether cannabis will ever be regarded similarly.

There are other moral/ethical questions regarding medical licensure too. Is it OK for a doctor to also have a side gig as a stripper, porn star etc? These jobs are technically legal, but there are docs in the past who were dragged into confrontations with the medical board in part because of part time jobs like this.

Being a smoker isn't a protected class. Yeah, it's heavy handed by the Cleveland clinic but it isn't hurting their ability to recruit or retain employees.

Ja Morant was suspended for waiving a gun around on an Instagram video. Owning a gun is a constitutional right but he portrayed a negative image for the NBA so he got suspended and lost money.

In certain jobs, you have to portray a certain image and that means foregoing certain things.

Just because it's legal doesn't mean it won't affect you in other ways. I wouldn't want my kids babysitter to be a stripper in her off time.

 

[Crayola227]

A resident falling asleep?

Drug test, EtOH test that day, if negative... give him a day off.

What's complicated about it?

The big issue as I see it, was partly it's anesthesia, where 1) lots of rec drug abuse 2) can't test for the gases huffed. The doc noted this.

BUT

a 7 year battle to get a license, $40,000 legal fees to speak nothing of the cost of PHP related stuff for YEARS, flying cross country for 3 day polygraph testing, multiple hair and nail testing, their ignoring 16 sleep experts about his having a previously undiagnosed sleep disorder stabilized with meds and sleep, PHP vague dx of "personality d/o untreatable cannot practice medicine," of a devout Muslim with an otherwise perfect and high achieving life resume.... I get the special concern for anesthesia, but this is what happens when the standard is proving a negative.

Yeah, totally unreasonable. It's tempting to suggest it's exaggerated and BS... but dude is now practicing and he's not the only one with these stories. I find them plausible, and I don't imagine that many docs in practice after all of it, are lying.

 

[NotAProgDirector]

A resident falling asleep?

Drug test, EtOH test that day, if negative... give him a day off.

What's complicated about it?

I don't think this is the right answer either. In this case the resident had a sleep disorder -- getting that diagnosed is key. What's warranted is an honest evaluation of the situation, looking for causes.

If your family member had a bad outcome due to the anesthesiologist falling asleep during the case, and you discovered that it had happened before and all that had been done was giving someone a day off, I doubt you'd think that was OK.

 

[dozitgetchahi]

That's a very interesting take if you read the entire transcript.

Being a smoker isn't a protected class. Yeah, it's heavy handed by the Cleveland clinic but it isn't hurting their ability to recruit or retain employees.

Ja Morant was suspended for waiving a gun around on an Instagram video. Owning a gun is a constitutional right but he portrayed a negative image for the NBA so he got suspended and lost money.

In certain jobs, you have to portray a certain image and that means foregoing certain things.

Just because it's legal doesn't mean it won't affect you in other ways. I wouldn't want my kids babysitter to be a stripper in her off time.

Agreed. But what is the LEGAL implication of these things?

We are a country operating under laws that protect certain rights and freedoms. Those rights generally don’t disappear because you have a certain profession.

As doctors, we are used to giving up a lot of what we are likely legally entitled to (ADA accommodations, for instance) IMHO because we have been conditioned throughout training to think this is normal.

 

[VA Hopeful Dr]

Agreed. But what is the LEGAL implication of these things?

We are a country operating under laws that protect certain rights and freedoms. Those rights generally don’t disappear because you have a certain profession.

As doctors, we are used to giving up a lot of what we are likely legally entitled to (ADA accommodations, for instance) IMHO because we have been conditioned throughout training to think this is normal.

I mean, lots of them kinda do. And they do because having a medical license isn't a protected right.

 

[HemeOncHopeful19]

Several things.

I met an attorney that does nearly exclusively DUI cases at a local business club meeting. He said to never do a field sobriety test because it's the officer's word against yours and that the officer can have lots of leeway to say you're drunk. He said that it could be cold, dark, rainy, and you are on a rocky surface with pebbles such that even someone who didn't drink all year could fail. He said it was ok to do blow or get a blood test.

Rereading the thread I am compelled to point out I might not have great faith in a DUI attorney who advised me it was “ok to do blow!”

 

[TulaneUnderdog]

This is off-topic but my criminal attorney did shake his head and facepalm as he heard my narrative and watched the film. He noted "rookie" mistakes I did including confessing, consenting to FST that he said "is designed to make even sober people fail", and speaking even after hearing Miranda rights. Even my demeanor and approach, saying I should just be adamant and say, "You pulled me for speeding. Can you write my ticket and I'm good to go or is there something else officer?"

 

[anonperson]

Agreed. But what is the LEGAL implication of these things?

We are a country operating under laws that protect certain rights and freedoms. Those rights generally don’t disappear because you have a certain profession.

As doctors, we are used to giving up a lot of what we are likely legally entitled to (ADA accommodations, for instance) IMHO because we have been conditioned throughout training to think this is normal.

What rights?

Being a physician or an NBA player is not a right.

He wasn't being threatened with jail time just the inability to be a licensed physician. That's still a big deal but his freedom wasn't being threatened.

 

[Crayola227]

You can still be convicted of driving impaired even if you are below the legal limit of intoxication in some states. If the DA can show your driving was that bad, such as with video evidence, you can still get hit with some type of charge.

.08 or whatever the limit in the state is not some magical line.

Fair. But for the sake of argument, let's say you were below the limit and pulled for matching a description. No issues with your driving, no failed tests. Not a tiny amount of alcohol. Charges and arrest dismissed. This is where the OP is besides the speeding, which does make this worse.

I'm the first one to talk about moral turpitude, but I think this with an otherwise clean record (med school, background check, residency performance so far, no MH issues, on and on) I think where there is literally no crime besides a traffic ticket, no reason to think impairment at work, extra monitoring might be warranted and that's it.

It's like, they are trying to clean up docs' acts, which going by past stories of the good ol days, needed to happen, while also not just ending a doc with MH or SUD's careers which also happened. Both completely worthy goals, but now we've up with something totally twisted.

Which is about where the state of healthcare delivery is. It's always a cruel irony to me where the system turns on its very provisioners (but not admin of course).

 

[Gonio5]

The bottom line of this thread is how to approach a DUI stop?
Scenario 1: did not drink
Scenario 2: did drink but not actually impaired
Scenario 3: Very drunk

Provisional answers?
Scenario 1: Be polite. Explain when appropriate that you have not been drinking. Do not do the field sobriety test. Uncertain about breathalyzer.
I have heard of an elderly driver (patient) being stopped. Maybe was driving too slowly? He explained and was let go with only conversations taking place.

Scenario 2: Be polite. When asked questions, say that the conversation appears confrontational so decline to answer any question. No field sobriety testing. Be prepared to be arrested.
2A: could do breathalyzer.
2B: refuse breathalyzer but show the officer your own breathalyzer, assuming that you already tested yourself before driving.

EDIT: I just read on an attorney's website that in at least one state, there is an optional roadside breath test and a required one at the police station. Automatic suspension if refuse the station test. If that is correct, then a strategy of asking if you can voluntary come with the police (to avoid arrest) and blow into the machine at the station might be the best strategy. That attorney website also said one has a right to confer with an attorney at the station prior to blowing. If one seeks delay, this is a possibility but, in retrospect, one probably would think that they should have avoided drinking at all to save the potential minefields.

Scenario 3: you're in huge trouble. Maybe resign to the fact you will be arrested. Try to get a blood test and also delay, in the hopes there is metabolism of the blood alcohol.

 

[TulaneUnderdog]

I know some of you are awaiting an update, ill fill yall in but there isnt movement.

Criminal arena: I still am going through with FFDE but since UF has a great forensics psychiatry, I paid my criminal attorney extra to file all the court documents, provide the story on paper, and offer his phone number to tell them my case. Im also filing for factual innocence of arrest to emphasize that all record of arrest post-dismissal was wrongfully committed. My attorney said while im back to work to collect faculty evals up to eval date documenting no signs of abnormal
behavior/inebriation.

Academic arena: Im back to work! All credit to my amazing PD whom I now owe my life of servitude to. It goes to show that 3 years of working 80h/week kissing arse and not ****ing up ends up paying off. He admitted to me during my shift that he had to pull so many strings to convince them to pull me and that they were pissed off to do that while im still technically questionably unfit to work. He is insuring i graduate but boy do i work my ass off to make up my absence. No weekends for me anymore.

My physician-hood arena: Medical attorney will hold off to escalate to Board while I am compliant with PHP. He disagrees with FFDE but will work around it. He still suggests taking it to Board but will wait on FFDE results first which he says will be “incriminating”. Also said I should see my own private Addictionologists and pay my own eval to counter it too but I probably won’t. Board still not aware because I have been “compliant” to my PHP as I filed FFDE (in order to work). The earliest date scheduled is in late April. PHP is pissed also by how late that is. They didnt even believe me and they called UF and they confirmed thats all they got. They can succ it. Im playing their own game; maybe they can see thats a consequence of their asinine nature of recommending only 4 Eval programs 100s miles away from this state for concern of an impaired Resident

 

[Crayola227]

Did you look into if the hospital would take a FFDE from someone else to allow you to work?