Impaired Healthcare Professionals in the news

Dear Friends and Colleagues:

Attached you find an article from the Sunday edition of the Miami Herald regarding the issue of impaired healthcare professionals.
Despite the apparent criticism of an opaque system that appears (for the public at least) to protect impaired practitioners Dr.Pomm points out the obvious success rate of the monitoring system.
I think that we need to proactively monitor our own profession and report those who truly need assistance and support.
We should not leave it up to the public or the lawyers to judge us but be proactive in the pursuit of protecting our patients and our profession.
I am looking forward to your comments.
Yours
Bernd

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Posted on Sun, Mar. 16, 2008
Healthcare practitioners with drug problems hidden by the system

BY JOHN DORSCHNER AND PATRICK DANNER
In August 2006, the former wife of a Broward psychologist sent a letter to state authorities saying she had visited his home 'and saw cocaine paraphernalia, an empty bottle of Oxycontin and a small Ziploc bag . . . with `whitish-beigy' colored small rocks,'' according to a court document.

That event started an investigation and later a lawsuit against ''John Doe, Ph.D.'' The psychologist's name has not been revealed. The Department of Health won't say if he's still practicing. ''Everything about this case is confidential,'' says spokeswoman Eulinda Jackson.

The case is another example of how far state regulators will go to protect healthcare professionals.

''Doctors like to protect other doctors,'' says Sidney M. Wolfe, a physician with the Washington-based Public Citizen consumer group which has published a series of studies on how lax regulatory groups are in disciplining healthcare professionals.

In the case of the unknown psychologist confidentiality is key in order to get professionals to seek help, says Raymond Pomm, head of the group that handles the impaired physicians' program. ``If we don't protect them, they won't come knocking on the door.''

But court records reveal John Doe, Ph.D. refused to participate. Pomm's program, Professional Resource Network, asked him to respond to his ex-wife's allegations. He didn't. In October 2006, PRN sent him a certified letter. He didn't respond. Over the next year, PRN kept repeating the request.

Finally, in November, the Department of Health sued ''John Doe Ph.D'' in Broward Circuit Court to compel him to submit to a mental and physical test. Wherever his real name appeared in court documents, it was blacked out. The psychologist has yet to respond.

''It's always been troubling to me that the profession protects itself to the detriment of the public,'' says Ervin Gonzalez, a Coral Gables lawyer who has represented patients in malpractice lawsuits. ``The profession closes in and has star chamber-type proceedings that no one knows about or hears about. I think it should be in the sunshine. I think it should be transparent.''

Gonzalez says doctors generally are allowed to continue to practice while the Department of Health brings such actions. That due process is a fundamental right, but ''after there is a probable cause finding and evidence of a legitimate risk to the public, then I think the public should know,'' he says.

That means making the physician's name public at that point so patients can decide for themselves. ''It's a matter of great public importance, I believe,'' Gonzalez says.

According to the state's Medical Quality Assurance Division, 127 complaints were received in fiscal 2007 concerning Florida's 3,571 licensed psychologists. In 12 cases, investigators found there was probable cause that state rules had been violated. Final outcome: No licenses revoked, one suspended and 11 psychologists were fined.

State officials have asked that the John Doe Ph.D. file be sealed completely, but the judge has yet to make a decision and a hearing last month was postponed. The state statute governing such cases requires that the psychologist's name be kept confidential in court documents and proceedings be closed to the public. But nothing in the statute says that the entire file must be sealed.

The attorney for the Health Department in the case, Cynthia L. Jakeman, did not respond to a request for comment.

Pomm says PRN has a ''very strict'' program of testing and compliance, and the doctors are highly motivated because they don't want to lose their licenses. He says 87.2 percent of medical doctors and osteopathic physicians successfully complete the program and never relapse -- a far better success rate than most rehab programs.

''We see 9.3 percent relapse one time, 1.7 percent relapse two times only and 1.8 percent three times or more. These are very good rates,'' says Pomm.

However, ''before July 1, 2005, there was a loophole,'' in which practitioners who had successfully completed the program and were thought to have relapsed could not be forced to take a urine test. ''We fixed that with legislation,'' says Pomm. Under the present PRN program, if a practitioner misses a urine test or a group counseling session, ``we basically pull them out of practice.''

In the case of John Doe Ph.D., court filings hint at multiple problems. One document indicates he successfully completed a PRN program in January 2006. In a filing in a custody battle for his children, he said he had been ''clean'' of ''hard-core'' drugs from August 2000 to April 2006, ``when he began taking a prescription of oxycodone for chronic neck, back and right knee pain.''

On Aug. 5, 2006, he said he was in an opiate detox program. Less than three weeks later, his ex-wife notified PRN of seeing drug paraphernalia in his home.

When the Health Department sued John Doe Ph.D., it stated ''probable cause existed to believe that respondent was unable to practice psychology with reasonable skill and safety,'' which appears to indicate that the department was asking the psychology board to suspend his license. However, in the minutes of that board's regular meetings, available on the Internet, there is no indication of any Broward psychologist being suspended for drug allegations.

Arthur Levin of the Center for Medical Consumers in New York says ''it's just crazy'' for regulators to protect the identity of a healthcare practitioner who refuses to cooperate. Levin appreciates the need for confidentiality. ``I live with somebody who is in recovery. But it's a little different in the case of a professional.''

Some believe impairment problems are not as critical with a psychologist as they would be with, say, a heart surgeon, but Michael Herkov, a clinical psychologist and a professor at the University of North Florida, says psychology also involves life-and-death decisions.

''Psychologists don't just listen,'' says Herkov. ``Bartenders listen. Psychologists are involved in the diagnosis and treatment of mental disorders. . . . More people die each year from suicide than do from homicide. Decisions have to be made. Do you have to be hospitalized immediately? . . . These are situations with serious consequences.''

Court records show it's unusual for the Department of Health to sue a John Doe to demand the taking of mental and physical exams. There are only four such cases in Miami-Dade and Broward counties over the past five years. The other two cases in Broward involve John Doe, MD and Jane Doe, LPN (licensed practical nurse).

In Miami-Dade, the lone such case involves a Jane Doe, RN (registered nurse). There is no indication of what the case was about or how it was resolved.

When a consumer hears rumors about a practitioner and drug use, such allegations are virtually impossible to check out.

Some months ago, a person called a Miami Herald reporter and named a Miami-Dade cosmetic surgeon who continued to practice while having drug problems. The caller gave detailed information, such as saying the surgeon relapsed six times in rehab programs.

On the Department of Health website, the surgeon is indicated as having a ''clear/active license.'' No disciplinary actions are listed.

When a reporter asked Pomm about the surgeon, he said he couldn't say anything about specific doctors.