Impaired medical workers soon will face closer watch

From the Portland Tribune, February 4, 2010

Hundreds of Oregon medical providers suffering addictions or mental illness are beginning to confront a new reality: If they want to continue working, they are going to be under the authority of a new state agency intended to keep them under closer watch.

About 300 Oregon nurses, 100 doctors and 100 pharmacists suffer addictions or mental illness but continue to work while being watched by their special monitoring programs. During the next few months, they are being informed that they will have to sign new contracts with new guidelines if they wish to continue working.

Historically, state licensing boards have run their own programs for impaired professionals. The Oregon Medical Board has run its program for impaired physicians, and the Oregon State Board of Nursing has run what it called its nurse monitoring program.

The programs are seen as a way to get impaired health professionals to come forward and get treatment. The incentive is the understanding that if they do so, they will be allowed to continue working and their identities will be kept confidential.

The programs provide oversight in the form of urinalysis tests and checks to see that the enrollees are getting the treatment to which they had agreed. But that system will come to an end in July, when a new Health Professionals Program will take over monitoring the activities of all addicted health professionals in Oregon.

The old board-run programs will disappear, and the new oversight will be run through the Oregon Department of Human Services.

That, says state Rep. Ron Maurer, R-Grants Pass, is an important change. Health licensing boards are supposed to put protection of public safety as their first priority, Maurer says. But too often, boards running programs that allowed impaired professionals to continue working were confronting a conflict of interest between public safety and helping the addicted professional.

With DHS running the impairment programs for all health professionals, boards will no longer be involved in oversight. If a health professional in the DHS Health Professionals Program relapses or fails to continue treatment, program officials will report them to their licensing board for discipline.

Proof in the pudding

Problems with the monitoring program run by the nursing board were brought to light in as series of stories run by the Tribune in 2007 and 2008. Maurer says those stories – which revealed cases in which nurses were being allowed to remain in practice after stealing drugs and even abusing patients – inspired legislators to take a closer look at all the health professional impairment programs. The result was House Bill 2345, which established the new statewide authority.

“These treatment programs were letting providers become addicted or have relapses at peril to patients,” Maurer says.

Licensing boards are dominated by the professions they oversee, so, as an example, most members of the board that oversee doctors are doctors. The new authority removes that potential conflict of interest, Maurer says.

State Rep. Mitch Greenlick, D-Northwest Portland, who also pushed for the new oversight program, says that legislators found that different health licensing boards were holding licensees to different standards. The new authority should ensure uniformity of oversight among health professionals.

Not everyone is greeting the change with wholehearted approval. John Evans, president of the Medical Society of Metropolitan Portland, says he feels addicted physicians have been receiving adequate oversight under the program set up by the Oregon Medical Board.

Doctors are being punished for the lax oversight of the nursing board, he says.

“The old system had worked for years with a lot of success, with candidates coming back into practice,” Evans says. “We just have promises of this working in the future. But the proof will be in the pudding.”