Here is the AMA report from 1991 on this topic
<a href="http://www.ama-assn.org/ama/upload/mm/369/report_39.pdf" target="_blank">http://www.ama-assn.org/ama/upload/mm/369/report_39.pdf</a>
More state specific info for you (I see that you are in TX)
<a href="http://www.texmed.org/cme/phn/aap/impaired.asp" target="_blank">http://www.texmed.org/cme/phn/aap/impaired.asp</a>
<a href="http://www.texmed.org/cme/phn/ifp/introduction.asp" target="_blank">http://www.texmed.org/cme/phn/ifp/introduction.asp</a>
The AMA recommendations are summarized below.
I hope this helps you in what must be a very difficult situation. Take heart in knowing that you are not the first to face this, nor will you be the last.
A version of this Report was published as "Reporting Impaired, Incompetent or Unethical Colleagues" (J Miss St Med Assoc. 1992 May; 33(5):
176-7 ? 1992, All rights Reserved.
Summary-Guidelines for Fulfilling Reporting Obligations
The Council on Ethical and Judicial Affairs has developed a series of guidelines to assist physicians in
fulfilling their ethical obligation to report the potentially injurious conduct of colleagues.
Physicians have an ethical obligation to report impaired, incompetent, and unethical colleagues.
Physicians should be familiar with the reporting requirements of their own state and comply accordingly.
1. Impairment
a. Impairment should be reported to the hospital's in-house impairment program, if available. If no
in-house program is available, or if the type of impairment is not normally addressed by an
impairment program, e.g., extreme fatigue and emotional distress, then the chief of an appropriate
clinical service, the chief of staff of the hospital, or other appropriate supervisor ( e.g., the chief
resident) should be alerted.
b. If a report cannot be made through the usual hospital channels, then a report should be made to an
external impaired physician program. Such programs typically would be operated by the local
medical societies or state licensing boards.
c. Physicians in office-based practices who do not have clinical privileges at an area hospital should
be reported directly to an impaired physician program.
d. If reporting to an individual or program which would facilitate the entrance of the impaired
physician into an impaired physician program can- not be accomplished, then the impaired
physician should be reported directly to the state licensing board.
2. Incompetence
a. Initial reports of incompetence should be made to the appropriate clinical authority who would be
empowered to assess the potential impact on patient welfare and to facilitate remedial action, e.g.,
the chief resident, the chief of an appropriate clinical service, the chief of the hospital staff, or the
medical director of a group medical practice.
b. The individual who receives a report of incompetence should, in turn, notify the hospital peer
review body where appropriate. Physicians who receive reports of incompetence have an ethical
duty to critically and objectively evaluate the reported information and to assure that identified
deficiencies are either remedied or further reported to the state licensing board.
c. Instances of incompetence by physicians who have no hospital affiliation should be reported to
the local or state medical society.
d. Continued behavior that is potentially injurious to patients must further be reported to the state
licensing board.
e. If the incompetence is of a sufficiently serious nature as to pose an immediate threat to the health
of the physician's patients, then it should be reported directly to the state licensing board.
1. Unethical conduct. Unethical behavior (which does not fit into the category of either
incompetence or impairment) should be reported in accordance with these guidelines:
a. Unethical conduct which threatens patient care or welfare should be reported to the appropriate
authority for a particular clinical service, i.e., the chief resident, the chief of an appropriate
clinical service, or the chief of the hospital staff.
b. Unethical behavior which violates the provisions of the state licensing board should be reported
to the state licensing board.
c. Unethical conduct which violates criminal statutes should be reported to the appropriate law
enforcement authorities.
d. Examples of unethical conduct which do not fall into the above three categories, or unethical
conduct which has not been addressed through other channels should be reported to the local or
state medical society.
4. Where the impairment, incompetence, or unethical behavior of a physician continues despite the
initial report(s), the reporting physician should report to a higher or additional authority. In order
to aid physicians who report inappropriate behavior of colleagues in carrying out this obligation,
the person or body receiving the initial report should notify the reporting physician when
appropriate action has been taken.
5. Physicians should work to assure that state laws provide immunity to those who report impaired,
incompetent, or unethical colleagues.
6. In certain circumstances, an anonymous report may be the only practical method of alerting an
authoritative body to a colleague's misconduct. Anonymous reports of misconduct should receive
appropriate review and confidential investigation by authorities.
7. Principles of due process must be observed in the conduct of all disciplinary matters involving
physician participants at all levels. However, the confidentiality of the reporting physician should
be maintained to the greatest extent possible within the constraints of due process, in order to
minimize potential professional recriminations.
8. The medical profession as a whole must correct the misperception that physicians are not
adequately protecting the public from incompetent, impaired, or unethical physicians by better
communicating its efforts and initiatives at maintaining high ethical standards and quality
assurance.
