The Virginia Health Practitioners’ Monitoring Program

1. The Virginia Health Practitioners’ Monitoring Program 700 East Franklin Street, Suite 300 Tower Richmond, VA 23219 804-828-1551 866-206-4747 Penelope P. Ziegler, M.D. Medical Director

2. VA HPMP • Program established by Virginia General Assembly in 1997 as Health Practitioners’ Intervention Program (HPIP) • Chapter 25.1 of Title 54.1, passed in 2009 formally changed name from HPIP to Health Practitioners’ Monitoring Program (HPMP) • More accurately reflects primary role of program • Outreach and education about professional impairment, previously done by HPIP, now done by Department of Health Professions (DHP)

3. HPMP Operation • Operated by Virginia Commonwealth University, Department of Psychiatry, under a Memorandum of Agreement with DHP • Funding is via professional licensure fees; amount of funding is determined by DHP • Oversight and coordination • Monitoring Program Committee (MPC) • 7 members appointed by the Director of DHP • Meets 6 times yearly or as needed to review program operation, policies, specific cases • DHP liaison/ program manager

4. What Is Practitioner Impairment? • Impairment refers to a practitioners’ inability to perform professional duties with skill and safety as result of an illness or other health issue • Substance use disorder • Psychiatric illness • Medical condition • Potential impairment refers to the diagnosis of a condition that, without treatment, could be expected to result in impairment

5. Epidemiology of Addiction (85-90% of HPMP cases) in Health Care Professionals • Alcohol abuse and dependence • No difference in overall incidence or prevalence • Usually have later onset, less antisocial behavior • Illicit drug abuse and dependence • Lower than in general population • Marijuana is most common drug of choice • Prescription drug abuse and dependence • Higher than in general population • Oral opioids are most common drug of choice in all health care professions

6. How Is Impairment Identified? • Changes in behavior • Extreme mood swings, temper outbursts • Lateness, cancels cases/ appointments • Documentation illegible or not completed • Falls behind in duties • Rounds late at night • Misses exams, deadlines for papers • Changes in appearance • Disheveled • Major weight loss or gain • Pale, plethoric or diaphoretic

7. Other Indicators of Addiction • Disappears while on duty or during cases • Requests weekend duty (drugs are at work!) • At workplace evenings, weekends off • Unreachable, cell phone/pager “didn’t work” • Alcohol on breath • Long sleeves even in hot weather • Appearing sick or calling off on Mondays

8. Virginia Reporting Requirements • Licensed practitioners, health care institutions, professionals associations and malpractice insurers are required to report to the appropriate Boards practitioners who may be mentally or physically unable to practice safely as the result of an apparent impairing condition • Any such person or institution making a report in good faith is immune from civil liability • Psychiatric facilities are required to report the inpatient admission of any licensed practitioners to the appropriate Boards • Interesting conflicts with State and Federal confidentiality statues, HIPAA, etc.

9. Assessment and Treatment Planning • When addiction or other impairment is suspected, careful evaluation is required • Is substance dependence a primary diagnosis? • Are other psychiatric disorders present which also require immediate treatment? • Are there medical conditions which will complicate the treatment and recovery? • Once diagnosis is established, treatment planning is next step • What type of treatment is needed? • What level of care is indicated for initial treatment?

10. Essential Elements of Treatment • Effective reduction of denial, resistance and intellectualization • Acceptance of chronic nature of disease and need for ongoing treatment • Relapse prevention which addresses issues specific to the professional’s practice • Re-entry stresses • Access to drugs • Need for monitoring • Dealing with Board issues, legal issues

11. How Are Health Care Practitioners Referred to HPMP? • By Board Order • By DHP staff during process of investigation • By colleague or peer • By physician, therapist • By treatment program • By employer, hospital • By attorney • By family, significant other, friend • By training program, school • Self-referred

12. Monitoring as an Alternative to Discipline • Eligibility • Active Virginia license or application • Impairing or potentially impairing condition • Advantages • Encourages early identification and referral to appropriate treatment • Preserves valuable professionals’ ability to return to practice following treatment with ongoing monitoring • Improves practitioner’s prognosis for recovery

13. Components of Monitoring • Participation Contract (PC) • Agrees to enter HPMP program • Agrees to abstain from alcohol and other drugs • Agrees not to practice until cleared to do so by HPMP • Agrees to provide all relevant medical records and releases • Recovery Monitoring Contract (RMC) • Agrees to continued abstinence if indicated • Treatment plan is specified in detail • Drug screening program is specified • Agrees to be responsible to: • Follow rules of HPMP • Provide timely reports • Provide drug screens when selected • Not to return to work until approved to do so by HPMP

14. Drug Monitoring • Random urine drug screens at individualized frequency and content (medical director is Medical Review Officer) • Third party administration of screening program provided by Affinity Online Solutions • Daily check in by telephone or online • Collection sites, billing, chain of custody forms provided by Affinity Online Solutions • System of alerts for missed calls, no shows, positive results, nonnegative results • MRO consultation available if requested • Lab services provided by LabCorp • Hair testing utilized on individual case basis