QUESTION:
“A physician recently smelled of alcohol and was behaving oddly while conducting rounds. The physician refused a screening test, so the Medical Staff leadership imposed a precautionary suspension. Is there a better way?”
ANSWER:
Yes! First, all hospitals should have a Practitioner Health Policy to govern health issues affecting privileged practitioners. Such a policy is required if your hospital is accredited by the Joint Commission, and it’s a best practice in any event. A Practitioner Health Policy allows Medical Staff leaders to identify practices and procedures that work in your setting, and can then be applied in a consistent manner (which helps to avoid allegations of discrimination).
Your Practitioner Health Policy should have a section dealing with responses to immediate threats, such as the one you describe above. The first step is for the Policy to identify who may respond to handle such situations. We recommend that a broad group of Medical Staff leaders be authorized to take the steps described in the Policy, to ensure that someone is always available.
The Policy should then identify who, and how many, individuals may request a practitioner to undergo a screening test to identify a possible impairment. Ideally, two Medical Staff leaders will make such a decision (or a Medical Staff leader and an administrator such as the CMO). Having two individuals involved in the decision protects them from allegations of bias, and should enhance the credibility of the process in the eyes of the practitioner under review.
To answer your specific question, if the practitioner refuses to cooperate with a screening test, the Practitioner Health Policy should say that the individual automatically relinquishes clinical privileges pending further review by the Leadership Council (or whatever committee handles health issues). This is not a permanent fix – potentially impaired practitioners would not be permitted to simply move out of town and subsequently harm themselves or others. Instead, it’s a method of buying time to persuade the practitioner to cooperate with the review process without imposing a suspension. A suspension causes the situation to feel more confrontational, which sends the wrong message when the goal is to help a colleague. A suspension also starts the clock ticking for hearings and NPDB reports, which can detract from efforts to constructively deal with the health issue.
For more information about how to deal with practitioner health issues, please join us in Orlando, FL from September 19 – 21, 2021 for the Peer Review Clinic. For more information, click here.