The Professionals Resource Network PRN The Impaired Practitioners

The Professionals Resource Network (PRN) The Impaired Practitioner’s Program for the State of Florida

The Florida Medical Association, Inc. 1874

Department of Health Board of Chiropractic Medicine Chapter 460

Types of Impairment Substance Abuse Substance Dependence Physical Infectious Disease Psychiatric Axis I/II Disruptive Psychosexual

Criteria for Substance Abuse A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12 -month period: (1) recurrent substance use resulting in a failure to fulfill major role obligations (2) recurrent substance use in situations in which it is physically hazardous (3) recurrent substance-related legal issues (4) continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance

Criteria for Substance Dependence A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring within a 12 -month period: (1) tolerance (2) withdrawal (3) the substance is often taken in larger amounts or over a longer period than was intended (4) there is a persistent desire or unsuccessful efforts to cut down or control substance use (continued)

(5) a great deal of time is spent in activities necessary to obtain the substance, or recover from its effects (6) important social, occupational, or recreational activities are given up or reduced because of substance use (7) the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance

Lying: “Time - Dose - Frequency” A Conscious Process

Lying Denial “Time - Dose - Frequency” Unconscious - is honestly unaware of effects drugs are having

Lying Denial “Time - Dose - Frequency” Unconscious - is honestly unaware of effects drugs are having Anger Specific to General

Lying Denial “Time - Dose - Frequency” Unconscious - is honestly unaware of effects drugs are having Anger Bargaining Specific to General Danger Point

Lying “Time - Dose - Frequency” Denial Unconscious - is honestly unaware of effects drugs are having Anger Specific to General Bargaining Danger Point Depression Tendency to Isolate - Often misdiagnosed by physicians as reason for drug use

Lying “Time - Dose - Frequency” Denial Unconscious - is honestly unaware of effects drugs are having Anger Specific to General Bargaining Danger Point Depression Tendency to Isolate - Often misdiagnosed by physicians as reason for drug use Acceptance Beginning of Recovery Process

Signs Of Personnel Drug Use • • • Frequent breaks “Working all the time” “Hanging around” department “Balanced Anesthesia” techniques (Anesthesia) High drug use on cart (or high waste) (Anesthesia) Long sleeves (Bandages, injuries) Change in charting Change in personality Change in lifestyle/family life “Tired” alternating ambitious-grandiosity Reasons for problems

“You’re a doctor 24 hours a day You can’t escape. ” - Debra Paul Orlando Sentinel November 9, 1986

“I don’t want my 13 month old son to grow up to be a doctor. ” - Debra Paul Orlando Sentinel November 9, 1986

“It wasn’t like he did it all the time - It wasn’t like every day - It was more for escape - like to sleep you know. ” - Debra Paul Orlando Sentinel November 9, 1986

“He could stop at anytime - He wanted to. And he would too. ” - Debra Paul Orlando Sentinel November 9, 1986

Debra Paul Died at Age 27

AFFECTIVE DISORDERS

Major Depression At least five for a two week period 1. 2. 3. 4. 5. 6. 7. 8. 9. Depressed mood Anhedonia Weight loss/gain (anorexia/hyperphagia) Insomnia/hypersomnia Psychomotor disturbance Diminished energy Diminished self-esteem/guilt Impaired concentration Recurrent thoughts of suicide

DYSTHYMIC DISORDER

BIPOLAR DISORDER

Manic Episode At least three for a one week period 1. 2. 3. 4. 5. 6. 7. Inflated self-esteem Insomnia while feeling rested Talkative/pressure Flight of ideas Distractible Increased goal-directed activity Excessive pleasurable activity

Bipolar I Major depression/manic Bipolar II Major depression/hypomanic Lifelong chronic illness with licensure-long implications

SUICIDE

ALCOHOL ABUSE, Family-of-Origin Control Group (JAMA, May 1987, Vol. 257)

ALCOHOL ABUSE, Family-of-Origin Suicide Group (JAMA, May 1987, Vol. 257)

DRUG PROBLEMS EVER Control Group (JAMA, May 1987, Vol. 257)

DRUG PROBLEMS EVER Suicide Group (JAMA, May 1987, Vol. 257)

VIOLENCE TO SPOUSE Control Group (JAMA, May 1987, Vol. 257)

VIOLENCE TO SPOUSE Suicide Group (JAMA, May 1987, Vol. 257)

SELF-PRESCRIPTION Control Group (JAMA, May 1987, Vol. 257)

SELF-PRESCRIPTION Suicide Group (JAMA, May 1987, Vol. 257)

SUICIDE TALK Suicide Group (JAMA, May 1987, Vol. 257)

ANXIETY DISORDERS

PERSONALITY DISORDERS

BORDERLINE PERSONALITY DISORDER

NARCISSISTIC PERSONALITY DISORDER

THIS IS NO ORDINARY PERSON YOU’RE DEALING WITH!

ANTISOCIAL PERSONALITY DISORDER

SUPEREGO LACUNAE

DISRUPTIVE PRACTITIONERS

PSYCHOSEXUAL DISORDERS

Mission “Protecting the public by maintaining the health and integrity of the practitioner, the profession and the health care team. ”

PROCEDURE

CALL THE FLORIDA MEDICAL FOUNDATION IMPAIRED PRACTITIONERS PROGRAM.

PRN Referral Sources DOH (Boards) Licensure Evaluations DOH Disciplinary Evaluations Anonymous/ Confidential Self-referral *Others = friends, family, co-workers, hospitals, attorneys, etc.

Non-confidential Licensure Referral DOH (Board/Council) Evaluation No Diagnosis and/or sufficient remission No monitoring required Active Diagnosis and/or present/imminent impairment Remission but continued risk of impairment Further evaluation or treatment required Monitoring Advocacy if monitored Advocacy No advocacy until safe to practice

Non-confidential Disciplinary Referral (DOH) Evaluation No Diagnosis and/or sufficient remission *Unsafe to practice Safe to practice but Safe to treatment indicatedpractice but monitoring Further evaluation indicated or treatment Monitoring Safe to practice Return to practice after determined safe No monitoring Monitoring *These individuals might already be restricted from practice. If not, once evaluation proves impairment, withdrawal from practice will be required.

Non-confidential Licensure Referral DOH (Board/Council) Evaluation No Diagnosis and/or sufficient remission No monitoring required Active Diagnosis and/or present/imminent impairment Remission but continued risk of impairment Further evaluation or treatment required Monitoring Advocacy if monitored Advocacy No advocacy until safe to practice

Confidential/Anonymous Report No verifiable evidence of impaired behaviors No further action/long term observation

Confidential/Anonymous Report Appears safe to practice but verifiable behaviors that indicate potential impairment Intervention Telephone Letter Evaluation (continued)

Confidential/Anonymous Report (cont’d) “Evaluations” No signs of impairment No further action required Long term observation Potential for impairment Significant impairing confirmed and no Tx/Tx condition diagnosed needed: safe to practice Monitoring Withdrawal from practice Treatment Monitoring

Confidential/Anonymous Report Appears impaired to practice with verifiable behaviors Intervention Telephone In person Withdrawal from practice Evaluation

Confidential/Anonymous Report (cont’d) “Evaluations” Safe to practice and Safe to practice but no need for Tx but needs treatment potential for impairment confirmed Monitoring Significant impairing condition confirmed Treatment Monitoring

Comprehensive Evaluation MEDICAL PSYCHIATRIC CHEMICAL ABUSE/ADDICTION PSYCHOLOGICAL FAMILY STRESS PEER INTERACTION OTHER COLLATERAL

When behavior is induced by disease, treating the disease changes the behavior.

Treating and monitoring of disease is NOT punishment

CONTRACTS

Monitoring a health care worker is preventing harm to more than one person

Statistics 2000 2001 2002 Intakes 5 14 8 2 7 5 Chemical Dependency 3 12 7 Psychiatric 2 1 -Board Referrals 0

Statistics (cont’d) 2000 2001 2002 Evaluations 7 17 16 Treatment 2 5 8 New Contracts 6 13 14

Statistics (cont’d) 2000 2001 2002 Under Contract 25 33 38 Relapses 6 4 2 Turnovers 1 3 1 Successful Completions 4 1 6

5 -Year State-Wide Outcome Study Gold MS, Pomm R, Kennedy Y, Jacobs W, Frost-Pineda K Society for Neuroscience, San Diego CA, 2001 “After 5 years 92% were drug free”

1 -800 -888 -8 PRN 1 -800 -888 -8776