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  1. Jongo
    Cocaine Surgeons Remain at Work

    [imgl=white] View attachment 29205 [/imgl] THREE surgeons are continuing to work at Melbourne hospitals despite admitting to using cocaine.

    Western Health has confirmed that two surgeons still working at its hospitals and a trainee surgeon admitted to using cocaine at a private home outside of work hours three months ago.
    It said there was no evidence to suggest that any of the surgeons had ever been drug-affected while on the job.

    A senior hospital source said the trainee surgeon had been working there for six months when the drug use came to light. The trainee surgeon no longer works at Western Health but is employed at another public hospital.

    The other two surgeons are still working at Western Health while also operating at several private hospitals. The source said one of the surgeons was believed to be a frequent user.
    Western Health runs the Western Hospital in Footscray and the Sunshine and Williamstown hospitals.

    Cocaine is a stimulant that can produce feelings of euphoria and an increased heart rate. Its effects can last from a few minutes to a couple of hours and cause a person to feel exhausted once the initial ''rush'' has worn off.

    Western Health executive director of medical services Mark Garwood said the health service took ''a range of steps to ensure that no patient had been impacted in any way'' as soon as it became aware of the drug use.

    ''In addition, an immediate medical evaluation was undertaken to assess the individuals' capacity to continue to conduct their professional duties,'' he said.

    Dr Garwood said monitoring was in place to ensure high standards of patient care were maintained at all times, including weekly reviews of every case within the unit concerned. The health service would not say whether the surgeons were being drug tested.

    The spokesman said additional monitoring of the surgeons following the drug use ''included ongoing liaison with the Victorian Doctors Health Program to confirm that the surgeons involved are fit to practise and present no risk to patient safety.
    ''Extra support is also being provided by senior members of the unit.''

    The Victorian Doctors Health Program is an independent organisation that cares for doctors and medical students with health problems.
    It can receive referrals from the Medical Board of Australia, which has the power to restrict a doctor's registration to include requirements for drug screening and reports from treating specialists.

    A spokeswoman for the medical board said she could not confirm whether the board was investigating particular cases, but The Age has confirmed that there are no restrictions on the registrations of the surgeons involved.

    The board has the power to take immediate action to restrict a doctor's registration if it believes he or she poses an immediate risk to the health and safety of the public.
    Since July 2010, mandatory reporting rules have compelled health professionals and employers to report behaviour that puts patients at risk. This includes alcohol and drug use or sexual abuse.

    The senior hospital source said some surgeons were concerned about how the issue had been managed internally, including how long it took for the hospital to notify the medical board.

    The hospital said it responded to the drug use immediately. It said it was aware that the Royal Australasian College of Surgeons had referred the matter to the medical board for investigation.

    College spokesman John Quinn said the college had no disciplinary powers in the matter and the surgeons were receiving treatment from the doctors' health program.
    ''The college sees its role in this situation as to uphold the standards, maintain doctors' health and to be involved in rehabilitation and remediation rather than punishment,'' he said.

    Victorian Health Services Commissioner Beth Wilson said patient safety was the primary objective in such cases. ''We must make sure that doctors who are treating patients are capable of doing so in a safe and effective manner,'' she said.

    ''Any illicit drug-taking by a doctor is of great concern and must be investigated. Doctors must also be offered assistance if they do have substance abuse problems.''

    Kate Hagan and Julia Medew

    The Age : October 25, 2012


  1. mygfuses
    If they were pilots, they'd likely never fly again. Except as a passenger.

    Shows the differences between industries: aviation is adamant about intoxicated pilots, commercial-rated or otherwise. And rigorous in other ways: diabetics cannot hold a pilot's license, if they want to be at the controls of an aircraft (not commercial, at all) they must have a certified instructor in the seat next to them.

    The medical profession...they cover for each other.

    "Dr Smaque to surgery...calling Dr. Smaque."

    Doctors under the influence

    New law changes medical diversion programs

    By Markian Hawryluk / The Bulletin

    Published: December 09. 2010 4:00AM PST

    It's an almost unfathomable scenario: a doctor under the influence of alcohol treating patients, or a surgeon operating while abusing narcotics. But it happens. Doctors are human.
    They make mistakes both in patient care and in their personal lives. And all their medical knowledge or years of training cannot protect them against the diseases and afflictions that affect all of mankind, whether heart disease, cancer or addiction.
    As the medical establishment has come to view substance abuse as an illness, rather than a moral failure, programs have been put in place to encourage health professionals to come forward, to seek help before their addiction problems escalate and affect patient care with tragic consequences. Such diversion programs offer doctors a confidential safe haven, a way to get into treatment without losing their licenses or being exposed to their patients. The programs are intended to ensure doctors' addictions are behind them before they are entrusted again with patients' lives.
    Oregon had one of the first such diversion programs in the nation. The state's Health Professionals Program served as a model for many other states after it was introduced more than two decades ago. Over the years, nearly nine out of every 10 doctors enrolled in the program successfully completed their treatment and monitoring, and most returned to practice. And its founders maintain there was not a single case of patient harm attributable to a physician impaired while in the program.
    Yet despite its success, on July 1, the program was summarily ended and replaced with a monitoring program expressly forbidden by state law from providing any treatment. And now physicians are worried that the new program will discourage doctors from coming forward about their own addictions or those of a colleague. And that could represent a major step backward in protecting patients.
    “The Health Professionals program really was one of the better run, if not the best run, programs that I'd ever been involved in. I think it really did a good job of protecting the public, meeting the needs of the participants and really had remarkable outcomes,” said Glenn Maynard, a substance abuse counselor for more than 30 years and former chair of the supervisory council for the program. “To basically destroy that without a clear rationale — at least, not a clear rationale in my mind — it kind of defies logic.”
    ‘A better way'
    The Health Professionals Program grew out of a state committee created in the late '70s by the Oregon Medical Association to address concerns about alcoholism among doctors working in hospitals.
    “We started doing interventions, sending people to treatment,” said Dr. Kent Neff, a psychiatrist working at Providence Hospital in Portland at the time who chaired the committee. “But then people started relapsing, and we realized there needed to be a better way.”
    The medical association decided to fund what it called a monitored treatment program, where Neff and other addiction specialists could monitor physicians in recovery. The board initially turned 25 doctors over to the committee for monitoring.
    But suicide rates among doctors disciplined for substance abuse issues began to spike. Of the 43 physicians placed on probation in Oregon in 1977, eight committed suicide and two more made serious attempts. In response, the board and the medical association decided to create a formal diversion program, allowing physicians to seek treatment without first being reported to the board.
    In the first year, 80 percent of the doctors who enrolled in the program were sent there by the medical board. Within two years, it had flipped, Neff said, and 80 percent of doctors coming into the program were self-referred. The program was so successful, he said, that the medical board had expressed concern that it wasn't seeing as many disciplinary cases as it had in the past.
    “It can be managed quite successfully,” Neff said. “We've demonstrated that over and over again. We salvage a professional and we also create a safe environment for doctors to come forward.”
    But other professions weren't nearly as successful. Several years ago, a similar program run for nurses in Oregon became embroiled in scandal. Overwhelmed by a much larger caseload and insufficient resources, the nurses' monitoring program missed nurses who had relapsed. Legislators including Rep. Mitch Greenlick, D-Portland, became worried that all of the state's diversion programs were too lax and were in desperate need of tighter regulation.
    “All of them were being run completely differently,” Greenlick said. “The monitoring and the treatment role was getting all mixed up.”
    Greenlick was particularly concerned that the treatment programs bound by confidentiality laws couldn't tell a licensing board if a doctor or nurse had relapsed. State legislators debated what to do about the problem over several legislative sessions.
    “It really was a pretty soft program,” Greenlick said of the physician program. “If they would screw up and (the program manager) would talk to them, and decide that it was OK, then they were back taking drugs again while taking care of patients.”
    Last year, with a push from the governor's office, legislators led by Greenlick passed a new law creating a single monitoring program for health professionals. If the boards that license doctors, nurses, pharmacists and dentists want a diversion program for their licensees, as of July 1, they are required to use the new combined Health Professionals Services Program.
    Under the new program, the state contracts with a private organization, Reliant Behavioral Health in Portland, to monitor doctors, nurses and other health professionals for substance abuse and mental health problems. The law spells out exactly what infractions have to be reported to the licensing board.
    The law also makes a clear division between monitoring and treatment, stipulating that the licensee is responsible for his or her own treatment.
    “If they fail the monitoring program, regardless of what's going on in the treatment program, the board is informed,” Greenlick said.
    Officials from the new program declined requests for an interview, but offered a written explanation of the differences between the old and new programs.
    “The previous programs were largely based on therapeutic models,” Department of Human Services officials wrote. “The current program does not diagnose or treat participants in the program. The diversion agreements do contain a treatment element, but all therapeutic evaluations and treatment are provided outside the statutory program.”
    As of July 1, all of the participants in the old diversion programs were required to sign agreements with the new monitoring program or be reported as noncompliant to their board.
    A step backward?
    For many physicians in the old program, the shift raised major concerns.
    “It's a big change in the sense that the board and the state government have taken a turn away from a disease model of addiction, and toward one in which now it seems to be more of a punitive model,” said one Bend doctor in recovery who spoke on condition of anonymity. “It's turned from a focus on treatment of a physician with the disease of addiction with the end point having a better physician and a safer public, to just being a policing and monitoring function, which doesn't do much for treatment, and I don't believe does much for increasing the safety of anyone.”
    The doctor had entered the diversion program six years ago, after becoming addicted to pain pills legally prescribed to him for an injury. Knowing he needed help, he voluntarily entered the diversion program and completed a 60-day inpatient rehabilitation program in Newberg. Over the past six years, he has attended weekly group therapy sessions and taken random drug tests. He has never failed one. He has since been released from the program, but continues to attend group therapy sessions and to practice medicine.
    “There's no doubt in my mind that physicians need to be aware that they can hurt people if they're intoxicated. So what do you do with that reality? Do you just have them stop being physicians or do you get them real help?” he said. “But now, I would think twice about sending a friend to get involved with the program.”
    Many physicians formerly or currently in the program have expressed dismay about the change in approach and have vowed not to refer their addicted colleagues. The old program was seen as a way to treat physicians. And if the doctor entered the program voluntarily, rather than as a result of a complaint or incident, the medical board would never know.
    Under the new law, any slip-up, regardless of whether it's within the context of patient care, regardless of the circumstances, is reported to the licensing board.
    “I think that the main thing that needed to come out of this, and the purpose around the legislation, is public protection and consistency in what is reported as noncompliance,” said Holly Mercer, executive director for the Oregon Board of Nursing. “I think the statute did a pretty good job of that. There are statutory line items for noncompliance, and so all of the boards that are in this program have the same noncompliance reports coming through.”
    The boards then have some latitude in determining whether the individual has violated the compliance agreement and what to do about it. But those providers lose their confidentiality before the board.
    Mercer said the prior nursing diversion program was never meant to be a treatment program, but the board has heard complaints from nurses about a perceived lack of flexibility from the new program.
    “I think the hard part is how much room do you give them?” she said. “I think you always have to be cognizant of the public safety lens, because in the end, yes, we would all like to give them a lot of chances and give them the benefit of the doubt, but lines are crossed.”
    By clearly delineating what constitutes noncompliance, Mercer said, the new law gives nurses a better chance of avoiding problems.
    Learning curve
    But Neff and other individuals who ran the old program for doctors disagree about the hard-line stance set up by the new law.
    “There's a learning curve,” he said. “Some people who will do just great don't get it at first. And as long as they don't constitute a danger to the public, which has been demonstrated can be done safely, then it's much better in the long run to do it the other way. Something big has been lost, and time will tell how well it works.”
    Under the old diversion program for doctors, about 16 percent of those enrolled relapsed early in the program, but the recidivism rate declined as doctors were in the program longer. And more than half of the relapses were reported to program officials by the doctor himself.
    “The board let us work with people as long as they were safe to practice, or we would take them out of practice,” Neff said. “There was an in-between area where you could help somebody get on track without yanking their license. Now it's more likely to be cut and dried.”
    Neff fears that means physicians will cease to refer their colleagues to the new program.
    “Unless they trust that the doctor is going to be dealt with fairly and confidentially, it's very likely that many people will not refer,” he said. “You can't really tell easily upfront whether there's a problem or not. So people will opt for, ‘Well, it doesn't look so bad,' and they won't report, and an opportunity is missed to get somebody into recovery. It's going to be much less safe for the people of Oregon.”
    Jenn Steinberg, medical staff manager for St. Charles Health System in Bend, Redmond and Prineville, said she's heard many concerns from local physicians about the new program, and that there's a reluctance to refer people to the program.
    “If any of their associates need to get into (recovery) programs, they're telling them they probably want to get into something out of the state,” Steinberg said. “And that's the really sad thing about that. It's going to be a secret, and we don't want that to be a secret.”
    Under the old program, hospital officials knew which physicians were enrolled in the diversion program. The program relies on employers to help monitor those physicians when they return to work.
    “My understanding in talking to physicians is that they are concerned that their licenses will be affected. But that's from a physician standpoint. From the patient standpoint and the public standpoint, this is an excellent thing,” Steinberg said. “We all want to protect patients, but as with all things, it takes some time to get used to it.”
    Steinberg, who is also president of the Oregon Association of Medical Staff Managers, has heard from her counterparts in California that physicians there are not reporting impaired colleagues to the board. California eliminated its physician diversion program in 2008.
    “They're getting them into programs that are private and not reporting to the state, which is a huge risk to their license and to the hospital's liability,” she said. “You want to follow state law and I know this facility will follow the rules. They will report.”
    In a recent survey of doctors published in the Journal of the American Medical Association, a third of doctors nationwide said they would not report an impaired or incompetent colleague.
    Oregon physicians have complained to the Board of Medical Examiners and to state officials. But DHS officials said their hands are tied by the new law.
    “The goal is public safety, and it's statutorily driven,” said Keely West, a DHS spokeswoman. “We make some selections about implementation, but the statute limits what we can do.”
    Greenlick discounts the notion that the new program is overly punitive to doctors.
    “Substance abuse treatment programs actually work, but the main problem is getting people in treatment, and coercion ends up keeping people in treatment,” he said. “I'm not worried about having a fair amount of coercion in the program, because I think it will help those doctors get clean.”
    The Board of Medical Examiners, meanwhile, took no position on the new law. The board is formally a state entity and therefore reports to the governor and the state legislators.
    “Remember that to practice medicine is a privilege, it's not a right,” said Kathleen Haley, executive director of the medical board. “If there's an identified substance abuse problem that could cause impairment in the workplace, then if the physician wants to continue to practice, they have to cooperate with what the program believes will keep that individual safe relative to patient care. That's the board's primary concern, patient safety.”
    Haley said she's heard the complaints about the new program, but wants to give the contractor time before making a judgment about how it will work.
    “It's a new program; it's only been in operation since July,” she said. “I think we need to see over time. The contractor didn't have a lot of time to get up to speed and get 400 people signed up, and be ready to go with a flip of a switch. It was pretty abrupt for everyone.”
    Over a barrel
    Doctors are also concerned about the absolute power wielded by the diversion programs. When a doctor enters a program, he or she agrees to follow its directives. Doctors who were in either the old or new program say both programs offered little room for negotiations and no chance to appeal or argue your case.
    “After you sign agreements that they get to talk with your supervisor, they get to talk with your spouse, your family, your doctors, and they can say whatever they want to these people,” said a physician in the program practicing on the Oregon Coast, who shared her experiences on condition of anonymity. “You have no control over it anymore. Doctors that feel that they're unjustly in the program have learned that if they disagree with anything in their treatment plan, that they will be seen as noncompliant or in denial or in relapse, and there's kind of a conspiracy of silence all around that. If they go along with it, they'll get out in five years.”
    The doctor first contacted the old program four years ago, when a medication for an asthma attack exacerbated her depression. Clinically manic for the first time in her life, she took a leave of absence to get her health under control and contacted the diversion program to ensure her medical license wouldn't be at risk.
    At the time, the program didn't have a protocol for dealing with doctors with mental illness unless they had a chemical dependency problem. She was told the only way to get an authorization to return to work was to have the Board of Medical Examiners open a full investigation. Unaware of the potential consequences, she agreed.
    But when the board investigated, it issued a corrective action order, announcing the doctor's mental illness to the pubic. The local newspaper published the details. The board referred her to the Health Professionals Program, where she was mandated to participate in a 12-step recovery program and to discontinue two of the medications prescribed for her mental illness. She could not even choose her own psychiatrist or psychologist.
    When she tried to claim a right to privacy, autonomy and religious freedom — she objected to what she considered religious components in her mandated Alcoholics Anonymous treatment — she was threatened with a suspension of her license. She has an ongoing lawsuit against the board.
    She has since been released from the program, but the board's findings remain a blemish on her record.
    “I don't want to throw out the baby with the bath water; there are doctors whose lives have been saved by this system,” she said. “But there are doctors whose lives have been destroyed by it.”
    While physicians undoubtedly gain protections by voluntarily opting for diversion, many believe they must give up their due process rights to do so.
    “They're guilty until proved innocent,” one doctor said.
    When a local physician in the program received his new monitoring agreement to sign this summer, he was stunned to read the materials he received from Reliant Behavioral Health.
    “There were about 20 things we weren't supposed to do, including watching pornography in the office; not supposed to touch women in a sexual manner on their breasts, buttocks, between their legs. That's forbidden. We're not supposed to masturbate in front of patients, they're not supposed to masturbate in front of us. It was this bizarre litany of sexual things we weren't supposed to do with the patient,” he said. “I guess they figured that addiction and alcoholism are deviances, why not add another form of deviancy while they're at it?”
    The forms required him to release all medical records, including any genetic or HIV testing. The doctor called the board to complain, and within a few days was told simply that it had all been a big mistake.
    The irony, the doctor said, is that he sees two to three people a day who deal with their own or a family member's substance abuse issues. An estimated 10 percent of the population has an alcohol or drug addiction, and the number for doctors is no different.
    Addiction and alcoholism, it's the elephant in the living room, and their whole response is you're some kind of a deviant,” he said.
    The doctor believes he was the last physician in Central Oregon to have entered the Health Professionals Program two year ago. That is, until recently.
    “I know a couple of physicians like that who are attending AA, who are laying low because they don't want to enter this program,” he said in September. “But I don't blame them. If I knew what I was getting into, I would have tried some other option.”
    Only weeks later, one of those two physicians was arrested for driving under the influence and sent into rehab by the Board of Medical Examiners. Luckily, no one was injured in the incident.
    But despite the potential risk, the internist is still not ready to report other doctors or to force them into what he sees as a punitive program.
    “The notion is you're going to make the punishment onerous enough so that people aren't going to do it,” he said. “Well, that's not how it works. You're still going to have a problem with alcoholism. They're just not going to get help. And they're going to be a danger to themselves and a problem to their family. So really, all this big routine they've got going has just really made the whole thing worse.”
    Finding balance
    At the heart of the debate over the change is the fundamental question of how society should deal with addiction. Although society has always tried to discourage substance abuse with strong criminal penalties, addiction has been recognized as a disease process also requiring treatment. Diversion programs, then, must walk the fine line between establishing a deterrent and encouraging professionals to come forward when they have a problem.
    “In our culture, we've gone back and forth between those two positions,” said Maynard. “I think the structure of (the new program) is really, in my opinion, a very clear move of the pendulum away from treatment and toward punishment.”
    Maynard maintains that will discourage providers from voluntary participation. Doctors and nurses may try to handle the problem on their own and fail, or continue to try to hide their problem. And that could increase the risk of impaired providers causing patients harm.
    “I think that the net effect of this law is actually to put the public at greater risk,” Maynard said. “If I was a physician, I wouldn't want to be going into that program, which is really unfortunate, because I would have said the exact opposite before.”
    Previously, if a doctor came in on a voluntary basis, the program would help him stay sober and get his personal and professional life back, Maynard said. “Now that's not so much the case.”
    The statute provides for an independent audit of the new monitoring program after its first year, but Greenlick said it's unlikely the success or failure of the program will be evident so quickly. He hopes that in the long run the program will prove effective at identifying those providers who do relapse for appropriate discipline, and to encourage providers with problems to enter treatment voluntarily.
    “These boards have a big problem of balancing between protecting the public on one hand and enhancing the profession on the other. And this comes right at the interface of those two objectives,” he said. “Would it be useful if 10 percent of nurses were busted out and reported to the police because they were back stealing drugs out of patients' cabinets in nursing homes? Yeah, that would be a success. But it would also be a success if 90 percent of them weren't. You can't set any numbers, which makes for a very complicated analysis.”
    Previous analyses suggest, however, that diversion programs for physicians have been much more successful than programs for the general public. A study of court-mandated treatments for addiction found that while the participants do well during their treatment program, 48 percent of them relapse after their program has ended and 31 percent are re-arrested within one year. In contrast, a study of more than 900 physicians participating in 16 different state physician health programs found that 22 percent had failed urine tests in the five years after completing their treatment program. Only 19 percent were no longer practicing medicine.
    “Society invests a great deal in our physicians. Even through physicians end up with an average of $120,000, $150,000 in debt now, it costs far more than that to educate a physician. We have a looming physician shortage; these doctors can be salvaged, can be made into better physicians,” Neff said. “These doctors have a better understanding of addiction than most of us who are not in recovery. They have a leg up in dealing with patients, and I've seen dozens of physicians use their own knowledge of recovery to help patients get into recovery. There are a lot of reasons why we should deal with these doctors in a compassionate way.”

    Markian Hawryluk can be reached at 541-617-7814 or at mhawryluk@bendbulletin.com.
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