Remember the horrible story out of New Hampshire last year about the radiology technician who went from hospital to hospital spreading hepatitis C?
Former hospital technician David Matthew Kwiatkowski was indicted on seven counts of obtaining controlled substances by fraud after at least 32 cath patients tested positive for a genetic sequence of the virus virtually identical to his.
Sadly, reports of drug problems among clinical staff are not new. Approximately 10% of the population has a substance use disorder, and the number among physicians may be as high as 15%, since their authority allows them greater access to prescription drugs.
But despite the potential harm an impaired colleague can cause, most healthcare workers turn a blind eye to a teammate's problems.
More than nine out of 10 (96%) of respondents agreed that physicians should report impaired or incompetent colleagues to relevant authorities, but nearly half (45%) who had witnessed impaired or incompetent colleagues said they had not reported them, according to a survey of physicians published in the Annals of Internal Medicine.
"The most dangerous physician is one that's not come to the attention of the organization, because over the course of their lifetime, 1 out of 10 doctors will have some significant problem with drugs or alcohol. So the percentage who are impaired at any one time is a smaller percentage, but even if it is three or 4 percent, that's scary," says William Norcross, MD, family medicine specialist and professor of clinical family medicine at UC San Diego Health System.
Norcross has served on the UCSD physician Well-Being Committee for eight years.
The Joint Commission requires healthcare organizations to have a system in place to manage practitioners with health concerns. These committees may operate under different names, but their ultimate job is to protect patients by being a confidential resource for staff members to turn when a colleague is in trouble.
"People hope when they go to a hospital or to a large medical group that there is a wellbeing committee somewhere and that they're doing this kind of work to make sure that the care that patients receive is safe. But I don't think that anyone can tell you, because it is so confidential, that across the board that it is happening in the same way and in the same quality from hospital to hospital," says Norcross.
For addicted clinicians, a large issue is that there is no transparency in the system, says Ethan O. Bryson, MD, an associate professor in the Departments of Anesthesiology and Psychiatry at Mount Sinai School of Medicine. Bryson recently spoke on the topic at the Association for Health Care Journalists conference in Boston. Bryson is the author of the book, Addicted Healers.
"Sometimes these physicians are pushed out the door because the hospital leadership doesn't want to deal with them, but nothing is reported to the state medical boards, and even [if it were], there is little communication [among] the state medical boards," says Bryson.
"But there's this culture in medicine that we are above everyone else's issues. Instead of going in for treatment, the administration might decide it's better to let them go," says Bryson. "We need to educate about the nature of addiction and how it should be treated. It needs to be a national discussion because the accountability will make these systems step up. It's a reactive system right now and it needs to be proactive."
Society places an enormous amount of trust in physicians, and when they fail in that trust, the fall from grace can be shattering. That's why many clinicians don't report their impaired colleagues or come forward themselves, says Norcross.
The reasons why physicians do not report their colleagues are fear that they themselves might be sued, and not wanting to ruin a colleague's career. A lack of information about how the committees work is a factor, says Norcross.
We can't count on addicted physicians to identify themselves, either. According to Norcross, only about 2% of physicians self-report their substance use disorder at UCSD.
The UCSD System Well-Being Committee often visits community hospitals to teach their physician health committees more about transparency and encouraging staff to come forward when they see an impaired colleague.
"If you're on staff and if you don't know what the committee does or that what you report is confidential, you won't use [it]. So that's one of the first challenges," says Norcross.
"But the sorts of things that people notice most commonly are abnormal behaviors. Doctors really work together a lot, especially in hospitals or big medical groups, and if one or more physicians notice that Dr. Jones after being a great physician after 5 or 10 years is suddenly not available for telephone calls at night, is coming to clinic late or is more disheveled than usual and patients are complaining about his behavior, those are the first signs."
Once a committee has a physician in treatment, that physician must remain under the committee's supervision for five years in a very intensive inpatient program for a few months then with regular check-ins, drug tests, and attendance at 12-step program sessions once the physician has returned to the workplace.
"Over five years, about 70% of physicians do well, but the other 30% either relapse and lose their license, or they die," said Norcross.
"Doctors admit that they sweep this issue under the bed. And we have to turn this around, because it's not just about doctors, but patients too. If our doctors are burning out and having these problems, we all need to work to make this better. Because we want doctors who are inspired by their profession, and unless we reach under the bed and pull this issue out and talk about it, it's not going to get better," Norcross said.
Chelsea Rice is an associate editor for HealthLeaders Media.
