Anesthesiologist accused of getting high while treating patients

[GaseousClay]

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Money sucking lawyers out for blood now. Class action lawsuit pending. Not sure they can prove direct harm given a supervision model and he was unlikely doing his own cases ever.

San Diego Doctor Accused of Getting High While Treating Patients: Lawsuit

A class-action lawsuit filed in federal court in San Diego claims a lack of proper supervision and procedures allowed a local doctor to get high while treating patients. The complaint – filed on Jan. 24 – claims the UC San Diego Medical Center played a years-long game of “Russian Roulette by...

www.nbcsandiego.com

 

[coffeebythelake]

Money sucking lawyers out for blood now. Class action lawsuit pending. Not sure they can prove direct harm given a supervision model and he was unlikely doing his own cases ever.

San Diego Doctor Accused of Getting High While Treating Patients: Lawsuit

A class-action lawsuit filed in federal court in San Diego claims a lack of proper supervision and procedures allowed a local doctor to get high while treating patients. The complaint – filed on Jan. 24 – claims the UC San Diego Medical Center played a years-long game of “Russian Roulette by...

www.nbcsandiego.com

Agree that unless there was demonstrable harm to patients this is meritless from a legal perspective. However if this dude was taking drugs at work he should lose his license.

 

[deleted126335]

Money sucking lawyers out for blood now. Class action lawsuit pending. Not sure they can prove direct harm given a supervision model and he was unlikely doing his own cases ever.

San Diego Doctor Accused of Getting High While Treating Patients: Lawsuit

A class-action lawsuit filed in federal court in San Diego claims a lack of proper supervision and procedures allowed a local doctor to get high while treating patients. The complaint – filed on Jan. 24 – claims the UC San Diego Medical Center played a years-long game of “Russian Roulette by...

www.nbcsandiego.com

BS. This will cost a fortune. Patients will claim excruciating pain that was inadequately treated because this guy diverted meds and/or was too high to recognize. Nightmares, PTSD, can’t get out of bed, loss of consortium for their loved ones, etc., etc.


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[AdmiralChz]

Supervision absolves you of NO responsibility. This guy is finished.

 

[GaseousClay]

He gave up his license years ago from this. Lawyers have been spending all this time searching for people to join in the money grab.

 

[okayplayer]

I’m going to take an unpopular view. Don’t divert opiates and this is a non issue. He was stealing from patients. He may have even exposed them to communicable diseases. I think people who steal narcotics from patients should go to jail for that.

I also don’t think welcoming people with this history back to practice is a good idea. Find a new way to make a living.

I understand not everyone feels this way and that “addiction is a disease.” Well, this is my opinion.

 

[ucladoc2b]

I actually knew this doctor while I was a medical student (And for that matter the chairman being deposed). They were always really nice to work with and cared a bunch about resident/medical student education.

I hope he recovers and is able to move on with his life. It’s a very sad situation.

 

[Dave1980]

I’m going to take an unpopular view. Don’t divert opiates and this is a non issue. He was stealing from patients. He may have even exposed them to communicable diseases. I think people who steal narcotics from patients should go to jail for that.

I also don’t think welcoming people with this history back to practice is a good idea. Find a new way to make a living.

I understand not everyone feels this way and that “addiction is a disease.” Well, this is my opinion.

Ok boomer

 

[pgg]

I understand the argument that if you allow no path back to practice, no one will ever self-report and get help. And that this may put the anesthesiologist and other patients at risk for a longer period of time.

However I've never been able to get past the airplane analogy (is there anything an airplane analogy can't do for anesthesia thought experiments?) ...

If an Air Force F35 pilot comes up positive on a drug screen, he'll never fly an F35 again. There's no path back to "practice". There's no grace period for self reporters. The military has just decided that whatever the theoretical benefit to the pilot or the people/property he might hurt by flying while impaired because he's afraid to self report, that possible benefit isn't worth risking an aircraft worth $XX million. All this despite the fact that the military itself has a huge sunk cost in training that pilot, and a practical selfish interest in keeping pilots flying.

Is the Air Force wrong to think this way? Should we be lobbying Congress to force the Air Force to give these pilots a second chance? I suspect few if any people are cool with the idea of letting any recovering addict climb into the cockpit of a heavily armed and expensive warplane.

Are airplanes and the lives of people on the ground more valuable than people in an operating room?

 

[deleted87051]

The medical board proceedings list endless red flags and too many second chances over a 10 year span. The doctor is lucky to be still alive.

Doctor Alerts—4patientsafety.org

4patientsafety.org

 

[VA Hopeful Dr]

I understand the argument that if you allow no path back to practice, no one will ever self-report and get help. And that this may put the anesthesiologist and other patients at risk for a longer period of time.

However I've never been able to get past the airplane analogy (is there anything an airplane analogy can't do for anesthesia thought experiments?) ...

If an Air Force F35 pilot comes up positive on a drug screen, he'll never fly an F35 again. There's no path back to "practice". There's no grace period for self reporters. The military has just decided that whatever the theoretical benefit to the pilot or the people/property he might hurt by flying while impaired because he's afraid to self report, that possible benefit isn't worth risking an aircraft worth $XX million. All this despite the fact that the military itself has a huge sunk cost in training that pilot, and a practical selfish interest in keeping pilots flying.

Is the Air Force wrong to think this way? Should we be lobbying Congress to force the Air Force to give these pilots a second chance? I suspect few if any people are cool with the idea of letting any recovering addict climb into the cockpit of a heavily armed and expensive warplane.

Are airplanes and the lives of people on the ground more valuable than people in an operating room?

The military until just a few years ago didn't allow openly gay men/women to serve at all. Are they really the example you want to use?

What do commercial airlines do about pilots with substance abuse problems?

 

[pgg]

The military until just a few years ago didn't allow openly gay men/women to serve at all. Are they really the example you want to use?

Despite that moral failing, one thing the military is good at is risk management. Yes, they're the example I want to use.

What do commercial airlines do about pilots with substance abuse problems?

I wasn't sure. I tried to look it up. Clear information wasn't easy to find. There was this sorta-sensationalist Fox News article that included, in part

Discipline varies based on the offense, but even in the most egregious cases, pilots can make it back into the cockpit. In 1990, Northwest Airline Pilot Norman Prouse was arrested after flunking a sobriety test following a flight from Fargo to Minneapolis. Prouse, who had reportedly drunk 15 rum and cokes the night before, served jail time but was rehired by by the airline, first at a ground job, then later as a commercial pilot.

The federal agency often moves to revoke the certificates of pilots caught flying with blood alcohol levels above the limit. (FAA)
“Pilots have two certificates, a medical certificate and an airman certificate. In cases such as that, we typically take separate action to revoke their certificates,” Lunsford said. “After revocation, pilots must wait at least one year to reapply and must start over from the beginning, first earning a private certificate, then an instrument rating and so on.”

That seems quite a bit more rigorous than physician path back to practice. If you have more current or correct information, I'd be interested in it.

I'm open to changing my mind about this but my N=small personal anecdotal experience favors a hard exit, at least from our specialty.

 

[VA Hopeful Dr]

Despite that moral failing, one thing the military is good at is risk management. Yes, they're the example I want to use.




I wasn't sure. I tried to look it up. Clear information wasn't easy to find. There was this sorta-sensationalist Fox News article that included, in part

That seems quite a bit more rigorous than physician path back to practice. If you have more current or correct information, I'd be interested in it.

I'm open to changing my mind about this but my N=small personal anecdotal experience favors a hard exit, at least from our specialty.

I have no idea how the commercial folks handle it, my question was genuine in that I didn't know the answer.

The bold I could probably get behind (though I think having leeway for certain cases to have exactly 1 more chance might not be unreasonable), for some reason I thought you were saying a permanent revocation of a general medical license.

I do think, in general, we're too lenient on this. Someone earlier mentioned the numerous red flags this guy had. When I was applying for my licence I went through and read the last few years of board orders for my state. One was a guy who had his licence suspended for substance issues 5 times before he finally gave up and just surrendered it. That seems a bit much to me, but I also don't love a one strike and you're out policy either. There's got to be a better middle ground in there somewhere.

 

[GravelRider]

Why are we upset about this? This guy shouldn’t have been practicing...end of discussion. Institutions have a history of protecting bad behavior when their own reputation is on the line (e.g. Penn State). I, for one, welcome this lawsuit and any other lawsuit that holds an institution responsible for covering up behavior that is harmful to the public.

 

[GaseousClay]

Why are we upset about this? This guy shouldn’t have been practicing...end of discussion. Institutions have a history of protecting bad behavior when their own reputation is on the line (e.g. Penn State). I, for one, welcome this lawsuit and any other lawsuit that holds an institution responsible for covering up behavior that is harmful to the public.

If there was a cover-up then yes, but from all reports no one knew this was going on until he overdosed. From what I heard from people familiar with this, everything was out in the open and he was immediately dismissed.

 

[GravelRider]

If there was a cover-up then yes, but from all reports no one knew this was going on until he overdosed. From what I heard from people familiar with this, everything was out in the open and he was immediately dismissed.

Well then the lawsuit will go nowhere and UCSD has nothing to fear. Although, somehow I doubt there was no cover-up or that they did their due diligence to ensure that this guy wasn’t a continued danger to the public.

 

[Mikkel]

 

[PieOHmy]

BS. This will cost a fortune. Patients will claim excruciating pain that was inadequately treated because this guy diverted meds and/or was too high to recognize. Nightmares, PTSD, can’t get out of bed, loss of consortium for their loved ones, etc., etc.


Sent from my iPhone using SDN mobile

yes but there would have to be proof like PACU records, post-op pain scores etc etc..

 

[Piebaldi]

I’m going to take an unpopular view. Don’t divert opiates and this is a non issue. He was stealing from patients. He may have even exposed them to communicable diseases. I think people who steal narcotics from patients should go to jail for that.

I also don’t think welcoming people with this history back to practice is a good idea. Find a new way to make a living.

I understand not everyone feels this way and that “addiction is a disease.” Well, this is my opinion.

The guy should probably not practice anymore yes, but if the lawyer needs to go fishing for "victims" clearly there is a problem. The law should be about justice - not about a payday.

 

[GravelRider]

The guy should probably not practice anymore yes, but if the lawyer needs to go fishing for "victims" clearly there is a problem. The law should be about justice - not about a payday.

On what planet do you live on where justice motivates instead of money?

 

[Piebaldi]

On what planet do you live on where justice motivates instead of money?

While most lawyers are greedy bastards the INTENT of the law is to provide justice. Whether that happens or not is different.

 

[deleted126335]

While most lawyers are greedy bastards the INTENT of the law is to provide justice. Whether that happens or not is different.

Justice, to the extent that it occurs, is an occasional byproduct of the adversarial process. Individual attorneys' duty is to advocate for their clients. That's the intent of the process.

P.S. It's OK to hate them for doing their job.

 

[PieOHmy]

Justice, to the extent that it occurs, is an occasional byproduct of the adversarial process. Individual attorneys' duty is to advocate for their clients. That's the intent of the process.

P.S. It's OK to hate them for doing their job.

Its a class action lawsuit.. The lawyer brought this on and found clients.. scumbag

 

[PieOHmy]

Its a class action lawsuit.. The lawyer brought this on and found clients.. scumbag
Im 2020 one should not be using narcotics on anybody. I havent given a drop of narcotic in 2 years.. ALL blocks and ketamine drips baby. Oh and lidocaine infusion. ERAS all the way. Plus I limit my fluids.

 

[GravelRider]

While most lawyers are greedy bastards the INTENT of the law is to provide justice. Whether that happens or not is different.

Institutions are not held to the same standards of justice that individuals are. The corporation that kills hundreds of people by dumping toxic waste in a drinking supply isn’t charged with murder. They get fined and sued. Large institutions only respond to financial threats. I wish that weren’t the case, but such is life.

Its a class action lawsuit.. The lawyer brought this on and found clients.. scumbag

Or is the institution the scumbag for covering for a person that put people’s lives in danger? I guess the nature of scumbaggery is in eye of the beholder.

 

[deleted126335]

Its a class action lawsuit.. The lawyer brought this on and found clients.. scumbag

Legal capitalism.


Sent from my iPhone using SDN mobile

 

[chocomorsel]

I understand the argument that if you allow no path back to practice, no one will ever self-report and get help. And that this may put the anesthesiologist and other patients at risk for a longer period of time.

However I've never been able to get past the airplane analogy (is there anything an airplane analogy can't do for anesthesia thought experiments?) ...

If an Air Force F35 pilot comes up positive on a drug screen, he'll never fly an F35 again. There's no path back to "practice". There's no grace period for self reporters. The military has just decided that whatever the theoretical benefit to the pilot or the people/property he might hurt by flying while impaired because he's afraid to self report, that possible benefit isn't worth risking an aircraft worth $XX million. All this despite the fact that the military itself has a huge sunk cost in training that pilot, and a practical selfish interest in keeping pilots flying.

Is the Air Force wrong to think this way? Should we be lobbying Congress to force the Air Force to give these pilots a second chance? I suspect few if any people are cool with the idea of letting any recovering addict climb into the cockpit of a heavily armed and expensive warplane.

Are airplanes and the lives of people on the ground more valuable than people in an operating room?

Come on. It’s not about people here. Let’s be real. It’s about the $XX million plane they really care about.

Let’s be real on this one.

Although in anesthesia, it’s hard to work with hard drugs when you are an addict. Just a matter of time before you kill yourself.

 

[T-burglar]

The ‘decent’ studies on the subject suggest that 75-90% of anesthesiologists with addictions are apparently still sober at 10 years.

This is with involvement in WeLl developed PHPs (which not every state has).

Physicians should be allowed to attempt re entry with a careful plan like in this model PHPs. imagine for a minute you were the one with the cursed genome and craved the experience of drug use. And count yourself as incredibly lucky that you aren’t cursed that way.

 

[Urzuz]

How can you sue someone for not administering an "appropriate" amount of pain medication during a surgery? If a patient wakes up in 10/10 pain because I decided only 50 mcg of fentanyl was appropriate during a specific surgery does that open me up for litigation?

Now as for practicing while under the influence and diverting opioids? Throw the book at him. But to retroactively prosecute him for providing inadequate pain medication during a surgery is nonsensical.

 

[epidural man]

How can you sue someone for not administering an "appropriate" amount of pain medication during a surgery? If a patient wakes up in 10/10 pain because I decided only 50 mcg of fentanyl was appropriate during a specific surgery does that open me up for litigation?

Now as for practicing while under the influence and diverting opioids? Throw the book at him. But to retroactively prosecute him for providing inadequate pain medication during a surgery is nonsensical.

ERAS hocus pocus today is all about no opioids. He could just claim he was ahead of his time and doing what all the talking heads today say we should be doing.

 

[epidural man]

Money sucking lawyers out for blood now. Class action lawsuit pending. Not sure they can prove direct harm given a supervision model and he was unlikely doing his own cases ever.

San Diego Doctor Accused of Getting High While Treating Patients: Lawsuit

A class-action lawsuit filed in federal court in San Diego claims a lack of proper supervision and procedures allowed a local doctor to get high while treating patients. The complaint – filed on Jan. 24 – claims the UC San Diego Medical Center played a years-long game of “Russian Roulette by...

www.nbcsandiego.com

You really can't trust anesthesiologists in San Diego.

 

[Mikkel]

ERAS hocus pocus today is all about no opioids. He could just claim he was ahead of his time and doing what all the talking heads today say we should be doing.

"They only prescribe ibuprofen and acetaminophen in Europe for pain control."

 

[Crabbygas]

I'm surprised the lawyers haven't made this a thing already. Think about it. All they have to do is troll the medical (and Nursing) boards for somebody who gets suspended for using drugs, find out where they worked, put out an ad and boom! Easy money.

 

[okayplayer]

I'm surprised the lawyers haven't made this a thing already. Think about it. All they have to do is troll the medical (and Nursing) boards for somebody who gets suspended for using drugs, find out where they worked, put out an ad and boom! Easy money.

Don't divert opiates! You will sleep well at night guys.

 

[T-burglar]

I understand the argument that if you allow no path back to practice, no one will ever self-report and get help. And that this may put the anesthesiologist and other patients at risk for a longer period of time.

However I've never been able to get past the airplane analogy (is there anything an airplane analogy can't do for anesthesia thought experiments?) ...

If an Air Force F35 pilot comes up positive on a drug screen, he'll never fly an F35 again. There's no path back to "practice". There's no grace period for self reporters. The military has just decided that whatever the theoretical benefit to the pilot or the people/property he might hurt by flying while impaired because he's afraid to self report, that possible benefit isn't worth risking an aircraft worth $XX million. All this despite the fact that the military itself has a huge sunk cost in training that pilot, and a practical selfish interest in keeping pilots flying.

Is the Air Force wrong to think this way? Should we be lobbying Congress to force the Air Force to give these pilots a second chance? I suspect few if any people are cool with the idea of letting any recovering addict climb into the cockpit of a heavily armed and expensive warplane.

Are airplanes and the lives of people on the ground more valuable than people in an operating room?

Good post . Another point that’s made in the studies of PHP (physician health program) mediated re entry for addicted anesthesiologists is that each case is considered on a case by case basis. I personally think a blanket one strike you’re out, even for warplanes, is too harsh. People make mistakes, and people can redeem themselves. One of my favorite attendings was a diverter of opioids as a trainee but I live in a state with a really good PHP and he redeemed himself.

We talk a lot about white privilege in this country and to have empathy for those less fortunate. Not being born an addict is also a privilege. Our empathy usually extends to very visible congenital disease too and people will say thank god I wasn’t born with a disability when they see a CP kid or fetal alcohol syndrome.

For some reason empathy is harder to stir when we see the child of an alcoholic , obviously born with a disease, lose control of their addiction to narcotics. It is no different than CP and deserves empathy.

 

[deleted480308]

The ‘decent’ studies on the subject suggest that 75-90% of anesthesiologists with addictions are apparently still sober at 10 years.

This is with involvement in WeLl developed PHPs (which not every state has).

Physicians should be allowed to attempt re entry with a careful plan like in this model PHPs. imagine for a minute you were the one with the cursed genome and craved the experience of drug use. And count yourself as incredibly lucky that you aren’t cursed that way.

If your genomes make you divert narcotics while treating patients, then screw you and your genomes. You don’t get to be a doctor anymore.

Some things really don’t deserve a redo

 

[deleted480308]

Good post . Another point that’s made in the studies of PHP (physician health program) mediated re entry for addicted anesthesiologists is that each case is considered on a case by case basis. I personally think a blanket one strike you’re out, even for warplanes, is too harsh. People make mistakes, and people can redeem themselves. One of my favorite attendings was a diverter of opioids as a trainee but I live in a state with a really good PHP and he redeemed himself.

We talk a lot about white privilege in this country and to have empathy for those less fortunate. Not being born an addict is also a privilege. Our empathy usually extends to very visible congenital disease too and people will say thank god I wasn’t born with a disability when they see a CP kid or fetal alcohol syndrome.

For some reason empathy is harder to stir when we see the child of an alcoholic , obviously born with a disease, lose control of their addiction to narcotics. It is no different than CP and deserves empathy.

You are wrong about military aviation, you show up under the influence you should definitely be grounded immediately and discharged. The stakes are too high for you to be an unreliable user

 

[pgg]

Good post . Another point that’s made in the studies of PHP (physician health program) mediated re entry for addicted anesthesiologists is that each case is considered on a case by case basis. I personally think a blanket one strike you’re out, even for warplanes, is too harsh. People make mistakes, and people can redeem themselves. One of my favorite attendings was a diverter of opioids as a trainee but I live in a state with a really good PHP and he redeemed himself.

We talk a lot about white privilege in this country and to have empathy for those less fortunate. Not being born an addict is also a privilege. Our empathy usually extends to very visible congenital disease too and people will say thank god I wasn’t born with a disability when they see a CP kid or fetal alcohol syndrome.

For some reason empathy is harder to stir when we see the child of an alcoholic , obviously born with a disease, lose control of their addiction to narcotics. It is no different than CP and deserves empathy.

One strike and you're out is harsh. I agree.

And I'm not totally opposed to a return to practice or the cockpit for selected people, for whom we have solid evidence based data that relapse is comparable to the population's baseline. I don't know what the data says that looks like, beyond the classic big 3 risk factors for relapse (not a self reporter, concomitant psychiatric diagnoses, and opioids). But I generally feel that return ought to be the exception rather than the assumed rule for everyone.

Anesthesiology is a special case, too, for access reasons. It's simply impossible to do this job and not have potent opioids pass through your hands day in, day out. The mortality rate for relapsed opioid abusers isn't insignificant. I know we all want to be nice and help these people, but are we really helping them by facilitating their access to something with a nontrivial probability of killing them?

It's also worth considering that even "one strike" isn't the end of the world for these people. Career changes happen to normal people who aren't addicts all the time, and the world keeps on spinning. An anesthesiologist could retrain for a specialty where there's a nurse or pharmacy layer between him and opioids. A pilot could decide he likes selling cars. A setback, absolutely; tragic, sure. End of the world? Geez, how many threads do we have in this forum about "paths out of medicine" and early retirement and escape from this job? There's life after work.

And last, obviously we're all products of our experiences. As I'm approaching the midpoint of my career and think about the handful of people I've known to divert and be caught, I can't point to even one who I thought should've returned to practicing anesthesia. One in particular I was sure would be dead within a year or two. But I have to admit, we're pushing a decade now and he seems to be doing fine. So happy to be wrong about him so far, but I still wish he was selling cars instead.

 

[PieOHmy]

One strike and you're out is harsh. I agree.

And I'm not totally opposed to a return to practice or the cockpit for selected people, for whom we have solid evidence based data that relapse is comparable to the population's baseline. I don't know what the data says that looks like, beyond the classic big 3 risk factors for relapse (not a self reporter, concomitant psychiatric diagnoses, and opioids). But I generally feel that return ought to be the exception rather than the assumed rule for everyone.

Anesthesiology is a special case, too, for access reasons. It's simply impossible to do this job and not have potent opioids pass through your hands day in, day out. The mortality rate for relapsed opioid abusers isn't insignificant. I know we all want to be nice and help these people, but are we really helping them by facilitating their access to something with a nontrivial probability of killing them?

It's also worth considering that even "one strike" isn't the end of the world for these people. Career changes happen to normal people who aren't addicts all the time, and the world keeps on spinning. An anesthesiologist could retrain for a specialty where there's a nurse or pharmacy layer between him and opioids. A pilot could decide he likes selling cars. A setback, absolutely; tragic, sure. End of the world? Geez, how many threads do we have in this forum about "paths out of medicine" and early retirement and escape from this job? There's life after work.

And last, obviously we're all products of our experiences. As I'm approaching the midpoint of my career and think about the handful of people I've known to divert and be caught, I can't point to even one who I thought should've returned to practicing anesthesia. One in particular I was sure would be dead within a year or two. But I have to admit, we're pushing a decade now and he seems to be doing fine. So happy to be wrong about him so far, but I still wish he was selling cars instead.

many people are judging based on their personal beliefs.
There are known addicts who return to anesthesia (many) who do fine. Why cant that be extended to all addicts with proper monitoring?
By advocating the one strike rule is I think playing god.

 

[deleted480308]

many people are judging based on their personal beliefs.
There are known addicts who return to anesthesia (many) who do fine. Why cant that be extended to all addicts with proper monitoring?
By advocating the one strike rule is I think playing god.

“You don’t get to steal and take a patient’s meds while you are responsible for keeping them alive that day” is playing God? That’s too far for you?

Exactly what would someone have to do to lose a license forever in your mind?

 

[pgg]

many people are judging based on their personal beliefs.
There are known addicts who return to anesthesia (many) who do fine. Why cant that be extended to all addicts with proper monitoring?
By advocating the one strike rule is I think playing god.

Some do fine, some don't.

Every judgment call for every factually fuzzy or morally fuzzy issue is a risk/benefit assessment. That's true of all things, but in cases involving a vulnerable public (surgery patients, airline passengers, etc) the only risks and benefits that matter are those that concern the potential victim:

• Risk: The addicted physician who is allowed to return to practice may relapse and harm a patient.
• Benefit: If addicts are never allowed to return to practice, self-referral may become less common.

Explicitly not listed:

• Benefit: The addict worked hard to get that far and deserves a second chance.

I also wonder if the alleged increase in self-reporting rates when return to practice is possible is really evidence based. I suspect that people who self-refer do it for reasons related to self-preservation and basic human decency and integrity. I'm skeptical that the 2nd order potential benefit of eventual return to practice is a major factor in that decision. I think people who self-refer are thinking "Oh **** I'm out of control and need help and I don't want to die" or perhaps "Oh **** I'm out of control and need help or I may kill someone" rather than "I could probably keep using for a while and get away with it but I'll probably get caught eventually and since I would like to practice medicine at an unspecified future time and self-referral improves the odds the medical board will let me and this facility will un-suspend my credentials I suppose I ought to check in to rehab" ...

The reason people who self-refer have a better prognosis for returning to practice is because, despite being addicts, they have a threshold level of insight and integrity. If there was no path back to practice, they'd probably still self-refer because of those qualities.

Anyway, as for this "playing god" notion, the entire reason licensing boards and hospital credentialing committees exist is to protect the public from quacks, charlatans, incompetents, and other assorted hazards to good care and patient safety. I think that's a better arrangement than any kind of fuzzy handwringing notion that making these hard decisions to protect the public is playing god.

 

[VA Hopeful Dr]

Some do fine, some don't.

Every judgment call for every factually fuzzy or morally fuzzy issue is a risk/benefit assessment. That's true of all things, but in cases involving a vulnerable public (surgery patients, airline passengers, etc) the only risks and benefits that matter are those that concern the potential victim:

• Risk: The addicted physician who is allowed to return to practice may relapse and harm a patient.
• Benefit: If addicts are never allowed to return to practice, self-referral may become less common.

Explicitly not listed:

• Benefit: The addict worked hard to get that far and deserves a second chance.

I also wonder if the alleged increase in self-reporting rates when return to practice is possible is really evidence based. I suspect that people who self-refer do it for reasons related to self-preservation and basic human decency and integrity. I'm skeptical that the 2nd order potential benefit of eventual return to practice is a major factor in that decision. I think people who self-refer are thinking "Oh **** I'm out of control and need help and I don't want to die" or perhaps "Oh **** I'm out of control and need help or I may kill someone" rather than "I could probably keep using for a while and get away with it but I'll probably get caught eventually and since I would like to practice medicine at an unspecified future time and self-referral improves the odds the medical board will let me and this facility will un-suspend my credentials I suppose I ought to check in to rehab" ...

The reason people who self-refer have a better prognosis for returning to practice is because, despite being addicts, they have a threshold level of insight and integrity. If there was no path back to practice, they'd probably still self-refer because of those qualities.

Anyway, as for this "playing god" notion, the entire reason licensing boards and hospital credentialing committees exist is to protect the public from quacks, charlatans, incompetents, and other assorted hazards to good care and patient safety. I think that's a better arrangement than any kind of fuzzy handwringing notion that making these hard decisions to protect the public is playing god.

I think the medical boards also take into consideration:

Benefit: we get a doctor back taking care of patients

Its not about the individual so much as just losing a doctor when, in most fields, we're not exactly in a surplus situation. At least, that's how it was explained to me by the board when I applied for my license initially (my state requires you meet with a board member prior to being granted a license).

That aside, I'm not sure I buy into the thinking of "oh **** I may kill someone". If that was really one of the major concerns, they'd also voluntarily surrender their license and wouldn't necessarily use the state's professional help program as those are usually more expensive and more invasive than most addiction treatment options out there (there's a whole thread about this over in General Residency). I think the idea of getting help AND not being barred from practicing forever likely go hand in hand.

 

[T-burglar]

If your genomes make you divert narcotics while treating patients, then screw you and your genomes. You don’t get to be a doctor anymore.

Some things really don’t deserve a redo

What do you think about the systems in place to allow controlled re entry for addicted commercial pilots?

They are similar to PHPs and achieve roughly the same success approaching 90% sustained sobriety at 10 yrs

More (un)surprising lack of empathy from physicians of all people. Do you think all physicians with a psychiatric diagnosis that could theoretically affect judgment should be simultaneously ejected from their profession that they worked so hard for tomorrow?

I’ve seen plenty of dangerous physicians that probably had no psychiatric diagnosis. Life isn’t black and white. On a case by case basis, a good doctor that temporarily succumbs to their disease can return to practice successfully , this has been studied and shown. How do you respond to that? Aside from knee jerk disgust over a disease you obviously don’t understand

 

[deleted162650]

They are similar to PHPs and achieve roughly the same success approaching 90% sustained sobriety at 10 yrs

Is that for all physicians, or for opioid using anesthesiologists?

I feel the latter is a special case.

I’m not opposed to physicians with addiction issues returning to work within the guidelines/oversight of a PHP. However, I feel that allowing an opioid addicted anesthesiologist to return is a mistake. Access makes relapse all too easy. Retrain in another specialty - sure.

 

[PieOHmy]

Is that for all physicians, or for opioid using anesthesiologists?

I feel the latter is a special case.

I’m not opposed to physicians with addiction issues returning to work within the guidelines/oversight of a PHP. However, I feel that allowing an opioid addicted anesthesiologist to return is a mistake. Access makes relapse all too easy. Retrain in another specialty - sure.

would you support the idea that they are disabled then? and should collect disability payments until they are 65. a 40 year old would collect 12k per month for 25 years with cost of living adjustments. you would have a lot of anesthesiologists dipping into the till

 

[pgg]

Is that for all physicians, or for opioid using anesthesiologists?

I feel the latter is a special case.

I’m not opposed to physicians with addiction issues returning to work within the guidelines/oversight of a PHP. However, I feel that allowing an opioid addicted anesthesiologist to return is a mistake. Access makes relapse all too easy. Retrain in another specialty - sure.

Agreed. Anesthesia + opioids is a special case. I'd be surprised if 90% returned successfully.

A psychiatrist returning to psychiatry might even be a net advantage to everyone given their experience.

An anesthesiologist retraining for virtually any other specialty would be better. Actually, the very process of doing another residency is probably beneficial, as it's years of closely supervised and cosigned work.

 

[deleted162650]

would you support the idea that they are disabled then? and should collect disability payments until they are 65. a 40 year old would collect 12k per month for 25 years with cost of living adjustments. you would have a lot of anesthesiologists dipping into the till

Ooooooh, I don't know - that's a good point. Many would argue that addiction is a psychiatric disease, and in that case it's up to the language in your DI policy. I still don't think many people are gonna start diverting and putting their lives at risk just to cash in on their DI policy.

I maintain however, that allowing an anesthesiologist to return to the OR is bad for both their own long-term sobriety, and patient safety.

 

[PieOHmy]

I maintain however, that allowing an anesthesiologist to return to the OR is bad for both their own long-term sobriety, and patient safety.

Then they collect disability on their own occ policty.

 

[deleted162650]

Then they collect disability on their own occ policty.

Ya, what's your point. If that's the language in the policy, and no exceptions are made for addiction then so be it. That's between them and their carrier - no sweat off my back.

 

[pgg]

would you support the idea that they are disabled then? and should collect disability payments until they are 65. a 40 year old would collect 12k per month for 25 years with cost of living adjustments. you would have a lot of anesthesiologists dipping into the till

Some own occ disability insurance providers will cover mental health including addiction.

Mine (Mass Mutual) has a 24 month limit to the benefit.

However conversely, the DI-equivalent coverage that the military gives me through its medical retirement system wouldn't. They'd kick me out. If I was already eligible to retire, they might allow me to retire with benefits. Maybe. (I've seen it happen.)

Some cover substance abuse disorders for some specialties but exclude anesthesiology. Some have riders available to provide that coverage.

Naturally, if you're willing to pay a high enough premium you can insure just about anything. But for the most part mental health and substance abuse disorders are generally covered, albeit usually with limitations.