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Office of Graduate Medical Education

GME POLICY ON IMPAIRED RESIDENTS

Physician Impairment: The GME Committee has adopted the following policy that describes how physician impairment, including that due to substance abuse, will be handled. Educational programs for residents regarding physician impairment, including substance abuse are given at orientation for new residents and also during the academic year by Committee for Physicians Health (CPH) staff at program grand rounds.

Impairment is defined as "the inability to practice medicine with reasonable skill and safety due to physical or mental illness, loss of motor skills or abuse of drugs including alcohol" (American Medical Association).

It is professional misconduct to practice medicine while impaired. New York State includes within the definition of professional misconduct the following: (1) practicing the profession while the ability to practice is impaired by alcohol, drugs, physical disability, or mental disability; and (2) being habitually drunk or being dependent on, or a habitual user of narcotics, barbiturates, amphetamines, hallucinogens, or other drugs having similar effects.

The SUNY Downstate Medical Center recognizes that drug addiction, mental disability and alcoholism are illnesses. The University will take all reasonable steps to protect the confidentiality of the employee who seeks voluntary treatment or is referred for treatment by his/her supervisor subject to applicable legal constraints and the provisions of this policy.

The CPH will provide confidential evaluation, treatment planning, and monitoring for physicians who voluntarily enroll. CPH generally does not report participating physicians to the Office of Professional Medical Conduct (OPMC) of the New York State Department of Health unless 1) on initial evaluation the physician is an imminent danger to the public, 2) the physician refuses to cooperate with CPH, or 3) the physician does not follow the treatment plan and/or does not respond to treatment.

Voluntary Self Referral for Drug/Alcohol Treatment in the Absence of Performance Issues A resident who is concerned that he/she may have a problem with impairment may contact CPH directly (1-800-338-1833) or may discuss the issue with a faculty member, the program director, the Department Chair or the Associate Dean for GME (ADGME).

If a resident brings a concern about his/her own potential impairment to the attention of any of these individuals, the individual so notified must notify at least one of the others, and at least two of these individuals must meet with the resident to determine an appropriate course of action. The meeting with the resident must occur as soon as possible but within two business days.

For residents who require further voluntary evaluation and possibly treatment, the Program Director and/or Chair should notify the Associate Dean who will arrange for referral to CPH. A resident who has enrolled in a CPH approved treatment program may be permitted to return to work with agreement of CPH and in accordance with the "Return to Work Section" of this policy.

Referral for Drug/Alcohol Treatment by Others in the Context of Performance Related Concerns When a resident is experiencing performance related problems or engaging in suspicious behavior, and impairment is suspected, the program shall have the right to require the resident to undergo further evaluation. Suspicious behavior is defined as any instance in which another resident, faculty member, other hospital employee, patient or patient's family, or other person witnesses inappropriate behavior by a resident during the exercise of his/her professional duties. These incidents may include, but are not limited to, perceived problems with judgment, behavior, speech, emotional outbursts, depression, alcohol odor or other evidence of substance abuse.

Suspicious behavior may be reported to the resident's attending physician, residency program director, Department Chair or CPH. Reports to the resident's attending physician should be brought to the attention of the residency program director and Department Chair.

Upon receiving such a report, the residency program director and Department Chair should conduct an interview with the resident within 2 business days. If both the Program Director and Department Chair agree that the report has no foundation and that there are no performance concerns with respect to the resident, no further action will be taken.
If the Program Director and Department Chair believe the report has foundation, they shall further evaluate the situation. In assessing the situation, the program director and Chair may require the resident to undergo further testing (psychiatric evaluation and/or drug or alcohol testing). If a decision to require testing is made, the Program Director or Department Chair should contact the ADGME to arrange for this testing. Results of the tests will be reported directly to the Department Chair.

The Program Director may allow the resident a personal leave (Leave of Absence) or if necessary the program director may suspend the resident from clinical duties while the situation is investigated if it is felt that further training will put patients, the resident, or other hospital staff at risk. If a decision to suspend the resident during the investigation and evaluation period is made, this should be communicated in writing to the resident with a copy to the GME Office. A suspension or restriction of clinical privileges must be reported to the New York State Health Department. If, after evaluation, it is believed that the resident needs further evaluation to eliminate the concern, the matter will be referred to the GME Office. The resident will be offered the opportunity to voluntarily enroll with CPH, which will arrange for an intake evaluation. The GME Office will assist the resident in enrolling in CPH. If, after evaluation, both the program director and Department Chair determine that the resident does not require treatment or rehabilitation, they shall address the resident's performance problems in accordance with departmental evaluation standards and related institutional policies (Evaluation Policy and Disciplinary Procedures and Appeals Policy).

Return to Work: If treatment or rehabilitation is recommended by CPH and the resident enrolls in a CPH-approved treatment program, the resident will be required to waive his/her right to confidentiality to the extent that: the ADGME will be notified as to whether the proposed treatment plan limits the resident's ability to work, and if so, will be provided with a description of the limitations, the ADGME will be notified periodically whether the resident is participating in the treatment plan and whether treatment has been successful; and any other information needed by the ADGME to assess the resident's continued fitness to work. Whether a resident will be allowed to return to work or complete his/her residency will be evaluated on a case-by-case basis, taking into consideration the recommendations of the treatment program, the limitations, if any, on the resident's ability to practice and expected duration of the limitations, whether reasonable accommodations can be made by the residency program, the circumstances that give rise to the initial report of potential impairment (i.e. whether any serious incidents or violations of law occurred), and whether patient and staff safety can be maintained.

Refusal to Cooperate: If a resident who self-reports potential impairment or is determined by his Program Director and Department Chair to require further evaluation refuses to enroll with CPH, the ADGME will be obligated to report the resident to the OPMC. In addition, the ADGME may terminate the resident's clinical privileges and may terminate the resident from the residency program. The resident shall have the right to appeal the decision to terminate him/her from the program pursuant to the appeal procedures set forth in the Resident Disciplinary Procedures and Appeals Policy.

Approved by GMEC 9/12/96
Reviewed and re-approved by GMEC 6/16/10