If you suspect a partner's impaired
Q: A physician in my group practice is under a lot of stress because of a nasty divorce, and I suspect he has a drinking problem. He's becoming belligerent with staff and a couple of colleagues are also starting to worry. So far, I'm not aware of any impact on patients. What are the implications for the group?
A: A doctor with an alcohol problem could be reported to the state licensing board and his license could be suspended or revoked. Similarly, the medical staff at your hospital may note his erratic behavior, and he could lose his privileges. Either scenario would certainly create extra burdens for the other members of your group, who'll have to cover his workload. Depending on your contractual arrangements, it could create financial burdens as well.
The situation also increases the danger of malpractice. The first skill to go in cases of alcohol impairment is judgment, with motor skills a close second. Diagnostic skills, close attention to detail, and judgment regarding tests, treatments, and prescribing are all likely to be weakened. Moreover, don't be too sure patients haven't noticed the doctor's belligerent behavior. If he's combative with assistants, he's likely to be short-tempered with patients as well. Alienating patients is what sends them to a plaintiffs' attorney when the clinical outcome is poor.
If a patient is injured or receives substandard care, a plaintiffs' attorney or perhaps a state licensing board will be sure to ask: What did you and the other doctors in the group know? Why didn't you take steps to rectify the problem? Were you covering up for him, allowing an impaired physician to put patients at risk to spare yourselves embarrassment?
Because the group shares some liability for the actions of an individual doctor, you can be sure that the practice will be named as a defendant in any litigation. If it's proven that you were aware the doctor was potentially endangering patients but you remained silent, medical authorities could sanction you as well.
Few doctors want to confront a colleague about a problem like this, but it's the right thing to do. You or another partner should recommend that he immediately get some help. That kind of intervention could motivate him to seek assistance. If he's resistant or in denial, the group may have to warn him that he could be kicked out.
What if pressure from the group doesn't work? Then you should consider reporting him to the state medical board or to a program for impaired physicians. (Often, an impaired physician won't enlist in a program until he's forced to.) Almost every state has such a program, and usually it's confidential, so the risk of disclosure and public embarrassment can be avoided.* The same confidentiality won't apply if the hospital curtails the doctor's privileges, or if someone files professional misconduct charges or makes allegations of malpractice.
Many physicians fear that turning in an impaired colleague will result in disciplinary sanctions instead of recuperative help. But experts in the field say that isn't so. Physicians do receive due process, and most programs aim to identify and correct problems early, and return the doctor to his professional career.
*See "Why is it so hard to report a problem doctor?" April 9, 2001.
The author, who can be contacted at 2402 Regent Drive, Mount Kisco, NY 10549, or at email@example.com, is a health care attorney who specializes in risk management issues. This department answers common professional-liability questions. It isn't intended to provide specific legal advice. If you have a question, please submit it to Malpractice Consult, Medical Economics magazine, 5 Paragon Drive, Montvale, NJ 07645-1742. You may also fax your question to 201-722-2688 or send it via e-mail to firstname.lastname@example.org.
Lee Johnson. Malpractice Consult. Medical Economics 2002;10:77.