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A call for standards in the treatment of impaired professionals

April 8, 2016
by Bob Coates, MDiv, LMFT, Laura Pulido, MSN, ARNP-BC, and Dino Eliadis, MBA
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A substantial number of licensed professionals such as physicians and lawyers experience addictive behaviors and other behavioral health crises. The interventions and best practices that are in place to ensure their care, treatment and recovery are facing growing scrutiny.

Virtually every state jurisdiction offers interventions for individuals who come forward for help rather than face licensure board sanctions. Usually, volunteer or not-for-profit entities formed by concerned licensure boards regulate the programs that help impaired healthcare professionals and members of bar associations move toward their safe return to their profession, meeting the public's expectations that these individuals have been vetted as safe. The trend has been to keep these professionals' treatment, as protected health information, out of the public eye. Yet there can be both positive and detrimental effects of this, for the public and for the affected individuals.

Before we go on, try to answer the following tough questions about your perception of impaired licensed professionals:

  • What words best describe your attitude about, for example, impaired physicians, lawyers and judges?

  • What would be your confidence level in an impaired professional returning to practice and working with your loved one?

  • Do you believe an impaired professional can return to higher levels of professionalism after treatment?

  • Do you believe impaired professionals' addiction ought to be made public in their profile?

  • Is there such a thing as “too much addiction” to be able to return to the profession?

How we answer these questions can be the proverbial elephant in the room. The onset of impairment in these valued professionals might require a “time out” to assess their health and their ability to meet the standards of their profession. When the need for lengthy interventions arises, adjudications result in the affected professional receiving proper guidance toward treatment and recovery.

Usually the public will never know if, and to what degree, the professional has been affected by impairment and recovery. Recognition of a professional’s impairment is not made public unless significant board action on his/her license has occurred.

The public’s trust also can be compromised by a lack of consistency among states' professional boards as to what constitutes “best practices” for the identification, treatment and monitoring of professionals' health issues, as well as treatment providers' willingness to agree with measurable treatment expectations. Provisions governing interventions, the treatment plan, length of treatment, frequency of screening for relapse, and conditions requiring extended treatment are not uniform.

Varying requirements for post-treatment monitoring of recovering professionals constitute one major source of concern. Usually, participants must call or check in online daily to see if they have been chosen to undergo a drug screen before 5 p.m. that day. While the number of tests varies by jurisdiction and program, we know that the average recovering nurse in the United States spends $10,000 a year meeting the drug screen requirement. There is something fundamentally wrong with a nurse being charged an average of $70 for the test with a $20 draw fee, especially when a test to run a 12-panel urine drug screen costs a lab around $8 to process. Nurses simply can’t afford those prices. Oftentimes they simply leave the profession rather than bear these costs.

Something must happen soon to standardize practices, profession by profession. Given ongoing moves in Congress and the professional community to encourage licensure portability from state to state in the healthcare and legal professions, it is in the best interest of healthcare boards and state bar associations to advocate consistent national standards for addiction identification, treatment and disease management.

Association efforts

Enter the newly formed American Academy of Professionals Health Programs (AAPHP) as a facilitator of collaboration between state jurisdictional entities and those providing the treatment. AAPHP came into existence Jan. 1, 2016 as an initiative to seek collaboration between healthcare recovery programs and lawyer assistance programs. It seeks to gain those entities' support in developing standards toward national best practices and an outcomes-focused approach to disease management for licensed professionals. Eventually, other scrutinized professionals will be included as the initiative matures.

Among the areas it is researching, AAPHP is examining practices of chronic pain management for affected healthcare professionals. It also has had discussions with the Department of Defense for returning military healthcare professionals whose addictions developed while the individuals were deployed in combat situations. Military adjudication of addictions, often considered as a disciplinary or even criminal matter, is radically different from civilian perception of addiction as disease management. AAPHP seeks to address the disparagement of these licensed professionals returning stateside to become reaccredited with healthcare boards, insurance payers, and credentialing entities.

AAPHP is in the process of surveying jurisdictional requirements for professional health programs, while at the same time seeking to contact each state's program to understand their expectations for treatment at various levels of care. The association is forming a professional standards committee and credentialing committee of esteemed academic, regulatory and treatment professionals who have demonstrated a commitment to best practices through years of service with state recovery programs.

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