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Health
Professional
Wellness
and Recovery
Programs
Topics Covered on This Page
Statewide Physician Recovery Program
Programs For
Nurses
JCAHO Requirements
About
the Author
By
Madeleine Mongan, Esq.
Vermont Medical Society
Physicians and other health
care practitioners are not immune from health problems, including
illness related to alcoholism or dependence on other substances.
Practitioners who participate in recovery programs have a very high rate
of success. However, practitioners may experience denial that prevents
them from being able to confront and address their own health problems.
Similarly, colleagues may be reluctant to confront other practitioners
because they are unaware of the resources and probability of successful
treatment.
As a result of untreated
illness, practitioners may jeopardize their license to practice their
profession. Unprofessional conduct for physicians, nurses and other
health care professionals includes impairment related to the use of
drugs or alcohol.
To provide resources to
address this problem, in 1999 the Legislature allocated a portion of the
licensing fees for physicians, physician assistants, and podiatrists to
support a recovery program designed to monitor recovering
chemically-dependent licensees for the protection of the public.
(Anesthesiologist assistants were later added to the program.) In
response, the Vermont Medical Society created the Vermont Practitioner
Health Program (VPHP), a confidential recovery program for physicians
(MDs and DOs), podiatrists, physician assistants, and anesthesiologist
assistants. In 2004, the Nursing Board created a program for
chemically-dependent nurses.
In addition to programs
offered by professional associations and licensing boards, the Joint
Commission on Accreditation of Health Care Organizations (JCAHO) in 2001
began surveying hospitals for compliance with a new standard regarding
physician health. The standard focuses on the availability of
assistance and rehabilitation, separate from discipline.
Is there a statewide recovery program for
physicians in Vermont?
The Vermont Practitioner Health Program (VPHP) was established by
the Vermont Medical Society in 1999. It offers a monitoring and
recovery program for Vermont physicians and other practitioners licensed
by the Vermont Board of Medical Practice (VBMP).
Who is eligible to
participate in the VPHP program?
Health care practitioners licensed or certified by the Vermont Board
of Medical Practice who are impaired or at risk of impairment by the use
of drugs, including alcohol, are eligible to participate. Osteopathic
physicians are also eligible.
How is the VPHP program
operated?
The VPHP program is managed by a medical director who is a physician
and a case management team, made up of physicians, physician assistants,
and podiatrists -- a number of whom have personal experience with
recovery.
What services does VPHP
offer?
VPHP will assign a case management team to a participant, made up of the
medical director and one other member of the case management team. The
team works with the participant to design an individual monitoring and
recovery program for the participant. VPHP does not provide individual
treatment services directly, but supervises the development of
individual recovery and monitoring programs for participants.
Typical programs will include
evaluation, addiction treatment, fluid monitoring and participation in
support groups such as A.A., N.A. or Caduceus. Participants also have
workplace monitors and are required to disclose their substance-related
illness to all their treatment professionals. The elements of a
participant’s program are spelled out in a monitoring agreement. VPHP
also offers other services as needed, including intervention, intake
evaluation, and information and referral.
The VPHP program conducts
regular outreach and education to better equip medical professionals and
other health care professionals to recognize the possible indications of
impairment.
What is the relationship
of the VPHP program and the Vermont Board of Medical Practice?
VPHP is separate from the VBMP. Under a protocol developed by the two
organizations,
VPHP only discloses the identity of participants to the VBMP when there
is patient injury, risk of patient injury, criminal acts, uncorrected
failure to abide by the terms of the monitoring agreement, or relapse to
the use of alcohol or drugs. In cases where a participant is already
subject to a VBMP investigation, order or stipulation, the VPHP program
works in coordination with the VBMP to design and implement the recovery
program for the health care practitioner.
How is the confidentiality of the program’s
participants protected?
VPHP has been established as a peer review program of the VMS. Under
Vermont law peer review activities of the program are confidential. With
the exception of the circumstances that trigger reporting to the VBMP,
VPHP will not release any information concerning participants to an
employer, health plan, hospital or any other party without a signed
release from the participant.
Under federal law, records
relating to the identity, diagnosis, prognosis, or treatment of any
patient that are maintained in connection with the performance of a
program or activity relating to substance abuse education, prevention,
training, treatment or rehabilitation may not be disclosed without “an
appropriate order of a court of competent jurisdiction… after
application showing good cause.” Good cause exists if “(1) other ways of
obtaining the information are not available or would not be effective;
and (2) the public interest and need for the disclosure outweigh the
potential injury to the patient, the physician-patient relationship, and
the treatment services.”
How is the VPHP program
funded?
The administrative costs of the VPHP program are funded by a
surcharge on licensing fees and by a VMS foundation dedicated to the
health of physicians and their families. Participating health care
professionals pay their own evaluation, treatment, and monitoring
expenses.
Where can I find more information about the
VPHP recovery program?
The program is operated by the Vermont Medical Society and can be
reached confidentially by mail at Vermont Practitioner Health Program,
P.O. Box 133, Montpelier, VT 05601-0133. The confidential phone number
for the VPHP program is 802-223-0400 and the confidential fax number is
802-223-4393.
Is there a similar program for nurses?
The Board of Nursing established by rule a non-disciplinary alternative
in situations involving chemical dependency, provided that the nurse
agrees to voluntarily participate in a program of treatment and
rehabilitation. In order to participate, nurses must voluntarily request
admission to the program, agree to undergo a comprehensive assessment at
their own expense, and agree to comply with a contract prepared by the
alternative committee of the nursing board.
Records pertaining to a
nurse’s participation are confidential, although information about the
nurse’s participation is provided to the nurse’s employer to ensure work
site monitoring.
Nurses are not eligible to
participate in the program if: they have been convicted of a felony
related to chemical dependency; caused actual or potential patient harm;
created an imminent danger to the public; diverted controlled
substances; or have a recent history of failed treatment for chemical
dependency.
Where can I find more
information about the Board of Nursing program?
Information is available from the Vermont Board of Nursing, in the
Office of Professional Regulation of the Secretary of State. Phone
802-828-2819.
Does the JCAHO standard require
hospitals to establish physician health programs?
JCAHO requires the hospital medical staff to implement a process to
identify and manage matters of individual physician health that is
separate from the medical staff disciplinary function.
The purpose of the process is
assistance and rehabilitation, rather than discipline, and to aid a
physician in retaining or regaining optimal professional functioning,
consistent with protection of patients. However, if the physician is
unable to safely perform the privileges he or she has been granted, the
medical staff leadership will take appropriate corrective action.
The process should include the
following seven elements:
- Education of staff about
illness and impairment recognition issues;
- Self-referral or referral
by other staff;
- Referral of the
practitioner to internal or external resources for diagnosis and
treatment of the condition or concern;
- Maintenance of the
confidentiality of the physician, except as limited by law, ethical
obligation, or when the safety of a patient is threatened;
- Evaluation of the
credibility of a complaint, allegation or concern;
- Monitoring of the affected
physician and the safety of patients until the rehabilitation process
is complete; and
- Reporting to medical staff
leadership when a physician is providing unsafe treatment.
How are hospitals in Vermont meeting this
standard?
Hospitals may develop their own education and monitoring programs to
address physician health, or they may utilize statewide programs such as
the Vermont Practitioner Health Program, to meet this requirement. For
example, Fletcher Allen Health Care has its own long-standing Medical
Staff Professional Wellness Committee.
Resources:
http://www.vtmd.org/vphp/2004%20VPHP%20Brochure.pdf
Physicians: 26 V.S.A. § 1354
(a)(5)
http://www.leg.state.vt.us/statutes/fullsection.cfm?Title=26&
Chapter=023&Section=01354
Nurses: 26 V.S.A. § 1582
(a)(5)
http://www.leg.state.vt.us/statutes/fullsection.cfm?Title=26&
Chapter=028&Section=01582
Osteopathic physicians: 26
V.S.A. § 1842 (b)(1)
http://www.leg.state.vt.us/statutes/fullsection.cfm?Title=26&
Chapter=033&Section=01842
Other health care
professionals: 3 V.S.A. § 129a (a)(5)
http://www.leg.state.vt.us/statutes/fullsection.cfm?Title=03&
Chapter=005&Section=00129a
http://vtprofessionals.org/opr1/nurses/forms/nursingrules.pdf
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About the
Author
Madeleine
Mongan
is counsel and vice president for policy for the Vermont Medical
Society,
representing the interests of the physicians who live and practice in
Vermont.
She works with the Vermont Legislature, state agencies and insurers on
health care policy and provides education and technical assistance to
Vermont physicians on legal issues. Her practice addresses a range of
health law issues including confidentiality, licensing, managed care,
public health, contracting, and fraud and abuse. She represents Vermont
physicians on the steering committee of the Vermont Bar Association Drug
Policy Committee, the Area Health Education Centers Advisory Board, and
the Vermont Health Resource Allocation Plan Board. She is a member of
the American Health Lawyers Association and the Vermont Bar Association
where she co-chairs the Health Law Committee. She received her B.A.
from the University of Delaware, M.A. from Stanford University and J.D.
from the University of California at Davis.
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