NEW HAMPSHIRE and CONNECTICUT: How 2 States Meet National Guidelines

1. NEW HAMPSHIRE and CONNECTICUT: How 2 States Meet National Guidelines . Maureen Sullivan Dinnan JD, CEO, HAVEN, CT Sally Garhart, M.D., Medical Director, NH PHP

2. Myths/Stigma • Healthcare professionals aren’t allowed to be sick. • They don’t have addictions, mental health disorders, or medical issues. • They are immune to such illness. “ The Good Nurse The Good Doctor

3. Reality HCP suffer from mental health conditions at the same rate (or greater) as the general population. • Chemical Dependence:10% to 15%. • Depression: 6.7 % • Bipolar: 2.6% • Anxiety: 5.7% • Insufficient Sleep: 26.3%

4. REALITY • HCP suffer from chemical dependence at the same rate as the general population. • According to ADA, 1.5% of dentists have a drink before going into the office. • 2% of physicians currently practicing have an active substance abuse problem. Worley, “Our Fallen Peers: A Mandate for Change,” Academic Psychiatry, 32:1, pp. 8 – 12 (January—February 2008) • 6% of nurses are estimated to be practicing and suffering from substance use disorder.

5. Federation of State Physician Health Programs (FSPHP) Accountability Consistency Excellence (ACE) • National and International Member Programs • Goal: to respect individual state laws and recognize need for consistency within evidenced based practices • Not a mandate • Recognize the interests of stakeholders • Consequences when professional health is not addressed

6. Stakeholders each state / program is unique • Professionals • Regulators including DPH, DEA • Boards and Commissions • Employers, health systems • Hospitals, medical staffs • Colleagues • Credentialing organizations • Family, friends, neighbors • Patients or public

7. Risks of Impaired Practice • Patient harm • Loss of license • Loss of prescribing privileges • Malpractice suits • Financial ruin • Health compromise • Increased depression and despair • Divorce / Loss of family and social connections • Death – addiction is chronic and fatal if untreated

8. BOARD SANCTIONS • Civil Fine • Reprimand • Probation – Settlement (public) Terms: CME, practice supervisor, liaison, treatment or monitoring requirements • Suspension • Revocation

9. DRUG CONTROL SANCTIONS • Surrender state drug control registration • Surrender federal drug control registration • Restrict drug control registrations • Probation • Criminal prosecution

10. TOPICS • Conditions covered • Professional groups covered • Mandated Reporting • Terms and conditions for participation • Process if professional disagrees • Relation with regulators • Managing Noncompliance • Successful Completion

11. Organizational Structure

12. HAVEN: An Assistance Program Fees required for participation $ 5.00 of license funds is transferred to HAVEN.

14. 2018 HAVEN

16. NHPHP • Free • Mandated to assist NH healthcare licensees with Boards of Medicine, Dental Examiners, Pharmacy, Veterinarians and as of 7/01/19 Nursing • Impairment due to SUD, mental health, burnout, disruptive behavior and physical illness with assistance and resources for professional misconduct issues.

17. FY2019 NHPHP Licensed in NH / Assisted Contract - NHPHP 2 (0.1%) 0 – only BODE referrals 47 (0.59%) 3 (0.3%) 1 (0.1%) 7 (0.08%) 0 – start date is 7/1/19; 8 monitored by BON now (0.019%) Dentists 1370 / 2 Hygiene 1677 / 1 MD/DO 7930 / 35 PAs 869 / 2 Vets ** 800 / 2 Pharmacy 8631 / 2 Nursing 41,929

18. CT-MANDATORY REPORTINGEFFECTIVE OCTOBER 1, 2015 • Any healthcare professional or hospital shall within 30 days file a petition with DPH when the professional or hospital has any information which appears to show that a healthcare professional is or may be unable to practice medicine with skill or safety due to physical or mental illness. • Suspicion is sufficient; evidence is not required • Referring to HAVEN satisfies the mandatory reporting requirement. • See Conn. Gen. Stat. Sec. 19a-12e

19. CT Mandated ReportingSelf Report • Self report arrests due to alcohol or drug use not less than 30 days after the arrest. • Self report any disciplinary action taken against the professional not later than 30 days after the action.

20. CT Anonymous Referral • May keep identity of referring party anonymous to professional referred to HAVEN • must give HAVEN name and contact info in order for HAVEN to reach out to the professional. • In order to document satisfaction of the mandated reporting responsibility, HAVEN must have name and contact information for referring party.

21. NHPHP Anonymous Referral • NHPHP can take and keep identity of referring party anonymous to professional • “A little bird” source has convinced some providers to get a “good” SUD assessment • With email and telephone – “anonymous” status may be lost • NH is one “small town”

22. Qualified Immunity • State law provides that no professional, hospital or person providing information to the DPH or HAVEN shall be liable for damage or injury to the healthcare professional unless there is a showing of malice.

23. Eligibility decided by HAVEN or DPH? • allegations of actual patient harm • felony conviction • disciplinary action against license • consider time of action • nature of action – related • Absent any of the above, eligibility is determined by HAVEN MRC and no obligation to notify DPH

24. Evaluation Phase • Referral • First Meeting Initial Plan • Independent Evaluation and Record gathering • Medical Review Committee • Eligible or ineligible Contract or closed DPH or closed

25. NHPHP Evaluation / Referral • Referral source may be self, peer, employer, anonymous or Board / APU • Gather information from referral source • Professional completes and brings a copy of NHPHP Initial Interview Questionnaire • Meets with at least 2 NHPHP staff • Determine if multidiscipline assessment needed vs more info vs resources vs contract • Separate from the Board’s investigations

26. HEALTH AND WELLNESS CONTRACT • Terms and conditions based on individual needs • Common terms include: • Therapy by qualified licensed professional • Random drug tests and other biologic testing • Support groups • Employer/ Practice liaison reports • Continuing education • Term generally three to five years, but will vary depending on diagnosis • Quarterly meeting with HAVEN staff

27. NHPHP Agreement – SUD, mental health (MH), behavior • Agreement contents based on individual needs • Small state, personal connection • Requirements usually include: • Continuous 2 way releases • Therapy by doctoral level licensed professionals who agrees to report compliance quarterly • Random drug tests, NEVER “screens” • Soberlink • Possible: Support groups; IDAA for SUD; coaching • Monitor reports (may be unknown to employer) • NHPHP facilitated and individual meetings • Terms vary: 2 – 3 years (behavior, MH); 5 years (SUD); 10 years; several as long as licensed in NH

28. CT: Disagree with Contract Terms? • Represent to Medical Review Committee • Ask Oversight Committee for opinion • Meet with DPH DPH cannot change HAVEN terms. May elect to work with DPH. HAVEN IS A CHOICE….Nondisciplinary

30. CONFIDENTIALITY or NON PUBLIC • Need to know basis (employer needs to know) • All information shall not be disclosed in any civil or criminal case or any legal or administrative proceeding unless the participant waives confidentiality or unless otherwise required by law. • Noncompliance w/ HAVEN jeopardizes confidentiality • Referral to DPH

31. CT-Referral to DPH • Referral does not necessarily mean there will be disciplinary action • Meet with DPH liaison and participant • Review plan to address concern • May be given a confidential warning • Status report may be required that remains confidential • Interim Consent Order nondisciplinary suspension • Determination no longer eligible

32. NHPHP reporting requirements for all Boards • Non compliance with NHPHP monitoring agreement • A provider who endangers the public • A positive MRO-reviewed drug test • Requirements may change with BON rules currently being developed – program required in 2018 by NH House bill 1571

33. NH BOM licensee reporting requirements

34. Options to terminate or change NHPHP contract • Discuss with participant, NHPHP medical director and staff after recommendation from the treatment provider – 2 way discussion with tx is mandated • Reasonable modifications can be made! • Option for an appeal either to the NHPHP Board of Directors or to the Board which will violate “confidential” nature • NHPHP is voluntary – not disciplinary!

35. Return to Practice • Facilitated by HAVEN when sufficient data showing fitness is obtained • 85% return successfully (some retirement is considered successful outcome) • Supportive network inside and outside of work • Supportive Practice environment for reentry • High risk areas: anesthesia, OR, emergency departments and psychiatry • Practice liaison / engaged supervisor • Conditions Clear and based on individual need. e.g. narcotic restriction 6 months to 1 year; possible shift or hour restrictions…

36. NHPHP - Return to Practice • Approved by NHPHP after any time OOW • 90% of those contracted currently working in field – 1 has license but hasn’t found a pharmacy job • Ongoing discussions of workplace stressors at facilitated meetings and annual retreats • Restrictions are specific to each particular case • Emphasis on good self-care and not “over-working”

37. NH specific components designed to aid success • Profession specific facilitated group monthly meetings 1 evening a month • Optional 4 hour/week “Burnout Prevention Ski Group” that can replace the live evening meeting and open to all HCPs • Monthly self-reports • Yearly 6 hour CME / CEU retreat: recent topics – Leadership, Boundaries, Burnout, Mindfulness, DBT/CBT, Shame

38. CT-Components • Weekly Caduceus or healthcare professional anonymous support group meetings available. • Quarterly meetings with medical director or professional director • Developing optional peer specific buddy or mentor resource • Annual conference: Meeting the Challenges of Professional Health

39. Successful Completion • Medical Review Committee confirms successful completion. • Discuss with medical director or professional director self-care and plan for support when no longer have accountability. • Confirming correspondence of completion provided to participant. • Practice liaison is provided confirmation of completion upon request. • With authorization will provide confirmation to credentialing bodies or others upon request. • May return to HAVEN

40. FOR CONNECTICUT HEALTH PROFESSIONALS QUESTIONS (860) 828-3175 www.haven-ct.org

41. NH Professionals Health Program • Website: nhphp.org • Contact for questions: sgarhart@nhphp.org • 603-491-5036