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A Diversion Program for Licensees of the Oregon Medical Board
Many people believe that health professionals are immune from addiction and mental health problems by essence of their intelligence and education. In reality, exposure, easy availability and familiarity with medications often lead predisposed health professionals to develop chemical dependency at a rate equal to or in excess of the general population rate of 10-15% lifetime incidence. Depression is also as common in health professionals as in the general population, with a lifetime prevalence of 13%. Suicide is found in higher rates for physicians, especially female physicians.
Chemical dependency is a primary disease process requiring exposure to alcohol or drugs. There is frequently a genetic predisposition. The disease is characterized by continued substance use in spite of adverse consequences and ultimately impacts every aspect of one's life. Mental health conditions having biological, psychological and social causes also affect health professionals. Health professionals often sacrifice all other areas of their lives to conserve their professional identity and ability to practice. As other areas of their lives deteriorate, the workplace is usually the last arena impacted.
For substance use disorders, symptoms of deterioration in the professional's personal or professional life may include stress, anxiety or depression which are often attributed to situational factors (e.g., relationships, finances and work) rather than substance use. Chemical dependency is a diagnosis we avoid making for a variety of reasons. It is a subject we avoid discussing/confronting. Yet, once identified and adequately treated, addiction does not impair the professional's competence and need not impact the professional's credibility or continued ability to practice medicine. Timely identification, diagnosis and intervention may be career and life saving.
For mental health conditions, many barriers exist that prevent health professionals from accessing treatment. The medical culture does not encourage health professionals to seek help or admit vulnerabilities. Fears of stigma, discrimination, loss of confidentiality, licensing problems, and career damage all serve as barriers to effective treatment. Peers and family may be reluctant to refer their colleague or family member based upon concerns about ruining not only their reputation but their career and financial stability. HPP was created in an effort to diminish there fears and permit confidential access to treatment while protecting patients my making certain a practitioner’s medical condition is stable when actively practicing
History and Background
Through a cooperative effort of the Oregon Medical Association (OMA) and the OMB, the Health Professionals Program ("HPP") was established in 1989 by action of the Oregon Legislature (Senate Bill 1032). On January 1, 2009, HPP began to offer services to licensees with mental health conditions. HPP's purpose is to provide a therapeutic avenue for OMB licensees to access treatment confidentially and with protection from professional investigation and/or disciplinary action based on the diagnosis of a substance use disorder or mental health condition. Thus the HPP offices are at a location different from the Oregon Medical Board.
HPP is a resource for licensed practitioners of the OMB, (physicians, podiatrists, physician assistants and acupuncturists) their families, colleagues or other professional affiliates. The program is administered by a Medical Director under the supervision of an independent seven-member Supervisory Council.
Who May Access Services
Licensees needing assistance are encouraged to contact HPP voluntarily. Colleagues, clinic or hospital staff, administrators, family members or patients are also encouraged to contact HPP if there are symptoms of deterioration in a professional's personal or professional life which may be attributable to a substance use disorder or mental health condition. Confidentiality and anonymity of the referring individual can be assured if desired.
When a report of concern is received by HPP, further exploration and inquiry are handled in a very discreet manner. Obtaining corroborating information and assessing its reliability are essential in determining whether or not there is reasonable cause to suspect impairment. Without this assurance, no action is taken. Once an individual is identified with possible substance use disorder or serious mental health condition, a referral is made for an independent multi-disciplinary evaluation and treatment when recommended. While the cost of evaluations, primary treatment and continuing care and therapy are borne by the participant, there is no charge for the services of HPP which are licensee fee supported.
Confidentiality
The threat of professional investigation, possible public disclosure and potential disciplinary action against the license of a physician or allied health professional can serve as powerful deterrents to seeking treatment for substance use disorders and mental health conditions. The fear of loss of professional status may be even as ominous for the family members. Disciplinary action does little to intervene in the disease process and may frequently be counterproductive to identification and professional reintegration. Treatment has proven to be effective for both the individual and society.
Under the Oregon Law (ORS 677.655), the records of HPP participants are confidential and shall not be subject to public disclosure or be admissible as evidence in any judicial proceeding. HPP records are further protected from disclosure under Federal confidentiality rules (42 CFR part 2). Past or present Supervisory Council members, employees, contractors, and clients are bound by the confidentiality guidelines specified in these laws.
Types of Services
HPP services include confidential consultation, intervention, assessment, referral, recovery monitoring, relapse/recurrence management, education and research, and education services for hospitals, medical staffs and medical societies. HPP will facilitate the intervention for individuals identified with possible substance use disorder or serious mental health condition, conduct an initial assessment and refer for a multi-disciplinary evaluation and/or treatment as recommended. HPP staff members are available for professional presentations and also work cooperatively with Physician Health Programs throughout the country in assisting participants relocating to another state.
Continuing Care Monitoring
Once a licensee diagnosed with substance use disorder or mental health condition has completed a primary phase of treatment, an HPP agreement for continuing care monitoring is implemented. Standard monitoring is for a minimum of five years and includes an individualized plan of therapeutic recovery activities as well as random urine toxicology screening. Evidence of recovery is obtained through behavioral observations, monitoring reports, evidence of healthy choices, and active participation in recovery activities. Objective documentation is gained through drug testing.
Advocacy and Support
Advocacy and support are vital to those in recovery. Recognizing that chemical dependency and mental illness, when in remission or adequately treated, do not compromise competency, HPP advocates for the right of health professionals to continue practicing when there is documentation of recovery from chemical dependency or stabilization of a mental health condition. HPP advocacy provides confidence that reasonable measures have been taken to ensure a participant's ability to practice professionally without ongoing impairment from chemical dependency or mental illness.
Areas in which HPP advocacy is appropriate include:
- Workplace reintegration
- Professional credentialing or other professional privileges
- Malpractice insurance coverage
- Professional licensing and regulating agencies
- Utilizing and maintaining personal insurance benefits
- Law enforcement agencies
HPP Mission Statement
The Mission of the Health Professionals Program (HPP) is to protect the public health through maintenance of the health of licensees of the Oregon Medical Board. To fulfill this mission, HPP is dedicated to facilitating confidential and effective intervention and assessment for potential substance use disorders and mental health conditions, and treatment and monitoring for licensees with these disorders.
For more information about HPP's services or to obtain a brochure, please contact the Health Professionals Program by phone at (503) 620-9117 or email to H.P.P@state.or.us.
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