| TOPICS OF INTEREST |
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| PHYSICIANS WITH SUBSTANCE ABUSE PROBLEMS |
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Physicians with Substance Abuse Problems
In the interest of the health, safety and welfare of the people of Oregon, the Oregon Medical Board is charged with protecting the public from the practice of medicine by unqualified, incompetent or impaired physicians. With this principle foremost in mind, the Board has adopted a policy of rehabilitating impaired physicians whenever possible.
A Diversion Program Supervisory Council has been established pursuant to ORS 677.615 for the purpose of developing and implementing a diversion program for chemically dependent licensees regulated under this chapter. The Council consists of seven members who are appointed and serve at the pleasure of the Board. The term of office is two years, and Council members are eligible for reappointment.
The Diversion Program Medical Director is appointed by the Supervisory Council, and administers the program under the control and supervision of the Council. The Medical Director serves at the pleasure of the Supervisory Council and is an employee of the Board, and as such, reports to the Executive Director of the Board.
The Diversion Program, referred to as the Health Professionals Program (HPP) was established as a confidential referral resource for rehabilitation. To maintain the confidentiality of its participants, the HPP office is located in Tigard, separate from the Board's office in Portland. Its services consist of case finding, interventions, referral for an acute treatment phase, and continuing care recovery monitoring.
Licensees experiencing substance abuse problems who have participated in HPP have experienced a rehabilitation rate of approximately 90 percent. Experience indicates that anything short of this standard of comprehensive treatment and monitoring leads to a markedly increased failure rate.
Within health care delivery systems, there is acute awareness of the need to identify substance abusers. Nearly all hospitals and other delivery systems (HMO's, IPA's, PPO's, etc.) require licensees to answer personal substance use and treatment questions. State law requires that all impaired licensees be reported to the Board.
Licensees with substance abuse problems are encouraged by the Board to seek comprehensive treatment before becoming impaired. The Board has adopted the following policy in the handling of licensees with substance abuse problems:
Self-referral: Licensees will be considered "true volunteers" when they have sought affiliation with HPP on their own or through an intervention of others without prior Board knowledge. The responsibility of individuals and organizations required by law to report impaired physicians may be discharged if the impaired physician enters HPP. Voluntary HPP participants require no further action relative to licensure, and they will not be reported to the Board so long as they successfully participate.
The Board will not be notified of the identity of voluntary participants in Diversion but will be kept informed of program information and statistics on an ongoing basis. HPP participants will not be reported to the National Practitioners Data Bank as disciplinary cases. There will be, however, a formal agreement between HPP and the licensee. This agreement is legally binding. The terms of this agreement will include standardized language acceptable to the Board as recommended by the Diversion Program Supervisory Council.
Board referral: At the discretion of the Chief Investigator or the Board's Medical Director in consultation with the Executive Director, licensees reported to the OMB for investigation and believed to have a substance related disorder may be offered an opportunity to participate in HPP. Disciplinary action may be utilized for licensees determined as inappropriate for HPP or requiring discipline in addition to HPP monitoring.
The Board accepts the Diversion Program Supervisory Council protocol for continuing care treatment and monitoring as its standard of the minimum required elements for monitoring:
- At least one weekly counseling meeting (individual or group) for the first two years of participation.
- A minimum of quarterly meetings with an assigned HPP monitoring consultant.
- A minimum of 25-30 random urine drug screens per year for the first two years.
- Individual counseling if recommended by the primary treatment provider or the therapy team.
- Treatment plan changes will be made in consultation with all therapy providers and the Diversion Program Supervisory Council when necessary.
- The Diversion Program keeps the Board apprised of its policies, procedures and protocols.
- HPP participants will be reported to the Board in accordance with the Diversion Council protocol for Relapse Management or upon failure to successfully complete the HPP Program.
Not all licensees with a chemical dependency problem will avail themselves of HPP; those who choose not to participate or do not comply with the terms of the agreement with HPP are subject to denial of license or discipline pursuant to ORS 677.190.
Chemical dependency does not have to be a condition that destroys a professional's career, personal life and professional standing. When in remission, chemical dependency does not adversely affect a physician's ability to practice medicine. With proper treatment and follow-up, chemically dependent licensees can continue their practice, often virtually uninterrupted.
In situations where a disciplinary action is necessary, it is often appropriate to reinstate a licensee as soon as their condition warrants it. The OMB has found that with proper in-patient treatment and good monitoring, a rehabilitation rate of approximately 90 percent is possible.
As the above policy indicates, self-referral is vastly superior to disciplinary action. By whatever method necessary, the Board strives to assure that licensees with chemical dependency problems receive appropriate treatment. In its effort to both protect the public and rehabilitate physicians, the Board encourages all licensees and their organizations to promote early intervention.
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