Transcript THE PHYSICIANS RESOURCE NETWORK (PRN)

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
Denial
“Time - Dose - Frequency”
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
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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
*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
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”
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