Curious to get others' thoughts on this...

[hijinx]

I searched thoroughly (using the less-than-stellar advanced search function) for a similar thread(s) but the only ones that popped up regarding this issue pertained to residency or licensing applications.

I wanted to see if there are others here who are aware of similar cases and, if so, what their outcome/disposition was. Has anyone here ever known or heard of a resident who's been arrested (all while a resident) for multiple DUIs and other charges related to their substance-abuse, admitted multiple times for inpatient rehab, relapsed following each and every admission, had their medical license revoked indefinitely due to the failure to comply with the medical board requirements for reinstatement after each offense, AND still been allowed to remain in the program? By "in the program", I mean a position has been reserved until if/when their license is reinstated even if that may be several years down the road.

Despite the fact the resident's struggles with substance-dependence were already known to the program, they were promoted to the next level without any requirement for remediation, and allowed to continue practicing (and supervising junior residents) even though it was already becoming apparent to others in the program that their ability to practice was impaired.

Just wanted to gather other thoughts on the matter.

 

[dragonfly99]

Wow,
No I have not.
In fact had a friend who was sent away/out of town to a rehab type place (despite no substance abuse issues and no diagnosable psych conditions other than a purported "personality disorder" that I think was highly questionable). Also was kept out of residency for quite some time and threatened with being fired. There were no substance abuse issues or legal problems, or patient care/patient harm issues.

Someone is cutting this resident a huge amount of slack. Either he has powerful friends/advocated in the department, or they are afraid of legal problems if they fire the person.

 

[Frozen]

Wow,
No I have not.
In fact had a friend who was sent away/out of town to a rehab type place (despite no substance abuse issues and no diagnosable psych conditions other than a purported "personality disorder" that I think was highly questionable). Also was kept out of residency for quite some time and threatened with being fired. There were no substance abuse issues or legal problems, or patient care/patient harm issues.

Someone is cutting this resident a huge amount of slack. Either he has powerful friends/advocated in the department, or they are afraid of legal problems if they fire the person.

The FMLA protects people while in treatment for up to 3 months from being fired.

Being fired and losing medical licence for DUIs is a different beast. I once had to help with drug testing for a urologist who had a history of showing up to work intoxicated and people were harmed by it, yet if he was allowed to enter treatment and pass a series of drug tests to get his medical licence back. America is all about 2nd chances, hell our last president was a coke (not the pop) and alcohol addict.

 

[hijinx]

Wow,
No I have not.
In fact had a friend who was sent away/out of town to a rehab type place (despite no substance abuse issues and no diagnosable psych conditions other than a purported "personality disorder" that I think was highly questionable). Also was kept out of residency for quite some time and threatened with being fired. There were no substance abuse issues or legal problems, or patient care/patient harm issues.

Someone is cutting this resident a huge amount of slack. Either he has powerful friends/advocated in the department, or they are afraid of legal problems if they fire the person.

Wow, that may be even stranger than the scenario I mentioned. If the guy had no diagnosed substance-dependence or psychiatric conditions, what exactly were they rehabbing? Better yet, what kind of rehab center does one go to for a personality disorder? I wasn't aware there were rehab centers for that. That sounds super sketchy on the part of your program.

I defintely agree that this resident has been cut some major slack. I don't know what's gone on behind the scenes with the program administration but I've never heard of someone being given that many chances. Not only that, they were promoted with what I can only assume was some pretty lax supervision since their impairment was noted by other residents (who weren't even on the same rotations) long before the program.

The FMLA protects people while in treatment for up to 3 months from being fired.

Being fired and losing medical licence for DUIs is a different beast. I once had to help with drug testing for a urologist who had a history of showing up to work intoxicated and people were harmed by it, yet if he was allowed to enter treatment and pass a series of drug tests to get his medical licence back. America is all about 2nd chances, hell our last president was a coke (not the pop) and alcohol addict.

I was not aware that FMLA afforded individuals that protection. Though, this isn't simply an issue of someone with a history of substance-dependence and abuse with a single arrest or charge who has entered inpatient treatment and complied with the conditions set forth by the board. We're talking multiple inpatient admissions, multiple relapses, and multiple arrests within a single year.

Certainly, these individuals deserve second chances and an opportunity to have their licenses restored, but how many chances is too many? How many people in medicine, especially in residency, get second chances let alone four or five? How many residents do you know or have heard of who were terminated or let go by their program for infractions which were much less serious and did not involve legal, licensure, or even clinical competence or academic issues without being given second chances? The bias here is glaring and, to me, represents a clear abuse of power. The program was clearly negligent in this case and, if a malpractice case were to have ever been brought against the institution, I cannot imagine what their defense would have been.

 

[Smurfette]

I'm guessing the program is afraid of a lawsuit if they fire this person. As another poster stated, this person has protections under FMLA.

If this individual has had his medical license revoked, the odds of finding employment after residency is not good (this is an understatement). And if there have been multiple revocations, the outlook is downright dismal unless a hospital is desperate. Even if they can get hired, getting malpractice insurance will also be a HUGE problem as they'd be high risk.

 

[JaggerPlate]

hell our last president was a coke (not the pop) and alcohol addict.

I heard he ate babies too.

 

[Law2Doc]

I heard he ate babies too.

Yep. What do you think "no child left behind" campaign was all about. The munchies.

 

[JaggerPlate]

Yep. What do you think "no child left behind" campaign was all about. The munchies.

The babies just hate our freedom.

 

[NotAProgDirector]

This whole story really doesn't make sense:

1. There is no such thing as "holding a spot for a person". Residents get promoted from one year to the next. If I have a resident in year 2 who loses their license, then gets it back in 3 years, that position is long gone as I've taken new PGY-1's who over the years have filled my program. Could I consider taking such a person back once they have cleaned up their life? Sure, if a spot is open. Can I "make an extra spot" for someone I really want? Sometimes, it depends on funding and RRC training caps.

2. I can't see how a resident can continue in a program when their license has been revoked. Having a license would be a requirement of employment.

3. The FMLA does protect employee positions, but only if the employee goes out on leave before something "bad" happens. If you show up for work drunk I can fire you, and you then can't say that you're out on leave. If you voluntarily come to me and tell me you have a substance problem, and that you need to go on leave, but your performance (from my standpoint) was fine, then your position is safe for 3 months. FMLA does not erase prior unsatisfactory behavior.

 

[HondoCrouch]

hell our last president was a coke (not the pop) and alcohol addict.

As was our current one.

 

[JaggerPlate]

As was our current one.

He just loves his ciggies.

 

[chocomorsel]

Sounds like he's got something on somebody and is using it as blackmail or he truly knows someone in high places.

This is medicine and connections are big in medicine.

Do you truly have first hand evidence that this is really going on? Or is this something you heard from a friend of a friend of a cousin of yours?

 

[hijinx]

I heard he ate babies too.

Yep. What do you think "no child left behind" campaign was all about. The munchies.

Dudes, I'm always up for having good fun, but if you're going to hijack the thread please make your "witty" banter at least mildly entertaining. I wasn't aware it was amateur night.

This whole story really doesn't make sense:

1. There is no such thing as "holding a spot for a person". Residents get promoted from one year to the next. If I have a resident in year 2 who loses their license, then gets it back in 3 years, that position is long gone as I've taken new PGY-1's who over the years have filled my program. Could I consider taking such a person back once they have cleaned up their life? Sure, if a spot is open. Can I "make an extra spot" for someone I really want? Sometimes, it depends on funding and RRC training caps.

I can see your point if the program were to accept up to their cap for each incoming intern class then eventually that position would no longer be available. However, some programs (such as the one I'm talking about) usually have openings for the particular PGY level of the resident and the program director can choose not to fill that position--even if there are qualified residents to fill that position--to "reserve" a position for whomever they desire. Effectively, that is equivalent to "holding" a position.

In this case, the resident had been out of training for almost a year before the decision to revoke was made (it was previously suspended). Yet, the program director has still chosen not to fill the position. That, though, is not why I say the resident's position has been reserved. I say that because the resident is still listed on updated resident lists (meaning they are still considered to be part of the program) for that PGY level but is not scheduled for any rotations since they have no license.So, it's not a simple clerical error.

2. I can't see how a resident can continue in a program when their license has been revoked. Having a license would be a requirement of employment.

I tried to clarify that in my original post when I defined "in the program" to mean that their position seems to have been safeguarded until if/when their license is reinstated which will not be for at least a couple of years.

3. The FMLA does protect employee positions, but only if the employee goes out on leave before something "bad" happens. If you show up for work drunk I can fire you, and you then can't say that you're out on leave. If you voluntarily come to me and tell me you have a substance problem, and that you need to go on leave, but your performance (from my standpoint) was fine, then your position is safe for 3 months. FMLA does not erase prior unsatisfactory behavior.

I don't know exactly how you would define "bad" but, at least in my experience thus far in medicine, there seems to be quite a low threshold for that definition. This resident self-reported to the board initially, and, subsequently, was required to submit to inpatient treatment. If you define "bad" as arriving hours late or not at all for rounds and unexplained absences, then, no, they did not go out on leave prior to their impairment affecting patient care. I did not work personally with the resident so I can not say whether the resident was completely sober or hungover at any time they were actively providing patient care. That part, though, is based on hearsay. The sequence of events tends to support their assertions though.

Several posters have mentioned FMLA as a possible reason. I very much doubt what was a deterrent to termination since, in this particular case, they were willing to wait >7 months and the resident was--before the last relapse where the license was revoked indefinitely--scheduled to commence rotations after that period.

 

[hijinx]

Here's my big questions about this story:



Both these paragraphs are pretty absolute statements about something that, presumably, you don't actually have direct knowledge. Why do you think that a spot has been "reserved" indefinitely?

Admittedly, my knowledge of this is rather indirect but I have explained my reasoning in the previous post for why I have reason to believe the resident's position has been reserved. The new resident schedule and updated list of residents was made well after the resident's license was revoked. The program, therefore, knew that the resident would not be able to rejoin the program for that year and yet they remain on the schedule. I cannot at this point say that it's been reserved indefinitely but certainly this resident has been accomodated quite nicely; more so than many other residents have. I would think that we can all agree on that.

How do you know that he/she was promoted despite ongoing substance abuse? How do you know that no remediation or supervision was ordered?

Not quite sure what you mean by this, but it's pretty self-explanatory really. The resident was PGY-X and was promoted at the same time along with their class to PGY-Y despite the fact that they were noted by other residents to likely be impaired and not able to safely and competently provide patient care and, shortly thereafter, re-entered treatment.

It may be "obvious" to everyone that this guy was impaired, but that doesn't make it true. Maybe he was getting the weird personality changes that come when long-term substance abusers detox. Or maybe "everyone" was so used to seeing this guy high that when he was sober you thought he was weird?

As I mentioned previously, these weren't personality quirks. Regardless of whether the resident was impaired because they were under-the-influence of some substance or because they were going through some sort of withdrawal doesn't matter; if it limits or, in any way, affects their ability to function and provide safe patient care, it represents an "impairment" and must be addressed by the program. Finally, if the resident wasn't impaired, they wouldn't have had to re-enter inpatient treatment for relapsing. That much is not in doubt.

Plus, supervision takes many forms. Chart review, second looks at patients from an attending, requiring counter-signatures, extra classes, mandatory treatment. There are many ways you can be remediated without it being publicly advertised to the whole facility.

Obviously I don't know the circumstances here, but I'm not entirely sure that the story you're hearing is necessarily fact. As you yourself mention, a lot of it just seems kind of beyond belief.

I can't say for sure that there was no remediation. However, if they were being remediated prior to their promotion--and I can only imagine that successful remediation would have been a requirement for them to be promoted--I cannot imagine how they could've been promoted seeing as how there were clear problems which were known to others in the program prior to the new academic year.

Also, I can't imagine there was no supervision, but obviously it had to have been lax for their problems to have been made aware to so many before the resident had to re-enter inpatient treatment.

 

[dragonfly99]

Someone likes this resident (despite the fact that he's an alcoholic and/or drug addict)
and/or the program is afraid of a lawsuit if they fire the person (perhaps a bit of both?). That is my best guess.

At any rate, I would leave this alone if I were the OP. Stewing about it is not going to get you anywhere, or get your anything good. If the person comes back as a trainee and starts doing things that are unsafe, then you have to do something, but if he's not back for a year or two you may not even be around any more.

I agree w/some of the other posters...I think it will be hard for this guy to get a job after residency, even if he does manage to get through. This is particularly true if he's a surgeon or something...his history has so many red flags in terms of risk of liability.