Vignettes and Resources

1. Vignettes and Resources Karen Miotto, M.D.Director of the UCLA Addiction Medicine ServiceClinical ProfessorDavid Geffen School of Medicine at UCLASemel Institute of Neuroscience and Human Behavior

2. Case Study: Impaired Resident • Program director received a call from a surgeon at UCLA, stating that a UCLA resident appeared drunk/high when he entered the surgical suite. The surgery was postponed, upsetting the surgeon who insisted that the PD take action against the resident.

3. How should a PD respond? • Go out and have a drink • Go out and have a drink with the resident • Tell all your friends about your day • Tell the resident to return for surgery when she is sober • Review the medical staff health policy and take appropriate action

4. Medical Staff Policy • According to medical staff policy, impairment must be assessed in terms of imminent danger to patients.

5. If no imminent danger to patients is present • The observing staff member should complete a “report of observed behavior” form and submit it to the Chief of Staff or their designee.

6. If potential imminent danger is present • 1) Observer should notify supervisor or department head. • 2) If supervisor or department head confirms a presence of imminent danger to patients, the Chief of Staff and chief medical officer should be called. • 3) The Chief of Staff or designee will meet with impaired individual and take appropriate action.

7. What action may the Chief of Staff or Chief Medical Officer take? • No action • Initiate Disruptive Physician Policy • Refer to the Medical Staff Health Committee for an evaluation • Request a consent for obtaining blood, urine, or health sample for drug testing • Failure to comply with drug test may be grounds for termination.

8. What action may the CoS or CMO take? • No action • Initiate Disruptive Physician Policy • Refer to the Medical Staff Health Committee for an evaluation • Request a consent for obtaining blood, urine, or health sample for drug testing

9. Before and After the Diversion Program • The diversion program provided monitoring and treatment for impaired physicians. • State of California Medical Board Diversion Program closed on June 30, 2008 • Leverage treatment was successful if MD did not make progress in diversion, he/she would lose their license • After Diversion Program • Medical Staff Health Committees assume responsibility for oversight of treatment and monitoring

10. Case Study: Impaired Resident • UCLA resident admits to a drinking problem since medical school. • Treatment Plan • Evaluation by the Medical Staff Health Committee • Sent for detoxification and 30-days inpatient • Returns to work half-time and participates in outpatient treatment

11. Case Study: Impaired Resident • Treatment Plan Continued

12. Case Study: Angry Fellow • Nurse manager called Hematology-oncology PD to inform him that a fellow was acting inappropriately and rudely with the RN and residents • PD went to see fellow and found him yelling at the father of a patient as well as the resident • PD intervened and spoke with fellow and resident separately. Resident discloses that this happens often and the fellow is known to have “anger issues”. Fellow said this was a unique situation and he’s just burned out.

13. How should a PD respond?

14. Yell at the fellow so he knows what it feels like? • Yes • No • No, but wish I could.

15. Follow your instinct and avoid any conflict. • Yes • No

16. Remember to discuss it with the fellow at your scheduled meeting next month • Yes • No • Maybe

17. How should a PD respond? • Follow guidelines from Disruptive Physician Policy

18. Levels of Disruption Physician Policy Based on Severity • Level I: Physical violence or other physical abuse including sexual harassment involving physical— contact legal council Level II: Verbal abuse such as yelling, swearing, or cursing; threatening, humiliating, sexual or otherwise inappropriate comments directed at a person or persons, or physical violence or abuse directed in anger at an inanimate object • Level III: Verbal abuse directed at-large, but has been reasonably perceived by a witness to be disruptive behavior as defined above.

19. Disruptive Physician’s Policy • PD interviews physician and takes appropriate action. PD can: • Determine no action is warranted • Issue a warning • Requires a written apology to the complainant • Refers member to the Medical Staff Health Committee • Initiates corrective action pursuant to the Housel Staff Policies and Procedures • Fill out confidential report form

20. Negative contributors Demands on time and energy Career dissatisfaction Psychosocial stressors Poor communication with attendees and colleagues Feeling devalued Isolation Resiliency factors Successful time management Competence Psychosocial support Clear communication and feedback Mentoring Community Minimizing Burnout

21. For Whatever Reason…. • The UCLA Compliance Hotline • (1-800-296-7188) • Communicated to all staff and faculty, and displayed in common areas. The calls are answered by an external vendor and managed by the Chief Compliance and Privacy Officer. • All calls to the compliance hotline are kept confidential.

22. For Confidential Matters… Depression/Anxiety/Anger? Alcoholism? Drug Abuse? Severe Stress? Completely Confidential Doctor-to-Doctor Assistance through California Medical Association Call: (650) 756-7787 (northern California) (213) 383-2691 (southern California)

23. The Matrix Institute on Addictions • Call: (800) 310-7700 • Available for motivational interviewing and substance abuse treatments • Locations • Inland Empire • San Fernando Valley • West Los Angeles • Los Angles

24. The End Contact Information: Karen Miotto, M.D. kmiotto@mednet.ucla.edu (310) 206-2788