Washington Health Professional Services (WHPS)

2. Washington Health Professional Services (WHPS)

3. Chemical Dependency A primary, chronic neurological disease, with genetic, psychological, and environmental factors influencing its development and manifestations. • Neuro-chemical changes • Craving • Impaired control over use • Continued use despite consequences

4. Illness v. Impairment Illness and impairment exist on a continuum with illness predating impairment, often by years. • Illness is the existence of a disease. • Impairment is a functional classification implying the inability of the person affected by the disease to perform specific activities.

5. Health Professionals • Rates of substance misuse mimic the general population (10 – 15%). • Higher rate of prescription drug misuse. • The ANA estimates that 6-8% of nurses misuse substances sufficient to impair practice.

6. Risk Factors • Family, environmental • Job stress • Achievement oriented • Familiarity with medications • Sense of immunity • Access to medications • Lack of education

7. High Risk Practices • ICU • ER • PACU • Anesthesiology • Oncology • Psych

8. Disease Continuum • Typically the workplace is the last place that substance use manifests itself. • Disruptions in family, personal health, and social life occur while the workplace remains unaffected. • Even small intrusions into the workplace should be taken very seriously.

9. Uniform Disciplinary Act RCW 18.130.180

10. Unprofessional Conduct • Dishonesty • Misrepresentation • Negligence • Credential restricted in another state • Practicing beyond scope • Gross misdemeanor or felony conviction • Illegitimate use of controlled drugs • Use of illegal drugs • Abuse of patient/sexual contact with patient

11. Reporting WAC 246-16-200 • When a patient has been harmed a report to the department is required. • When there is no patient harm, reports of inability to practice with reasonable skill and safety due to a mental or physical condition may be submitted to one of the approved impaired practitioner or voluntary substance abuse programs.

12. Reporting (2) The license holder does not have to report when he or she is:     (a) A member of a professional review organization as provided in WAC 246-16-255; (b) Providing health care to the other license holder and the other license holder does not pose a clear and present danger to patients or clients; or     (c) Part of a federally funded substance abuse program or approved impaired practitioner or voluntary substance abuse program and the other license holder is participating in treatment and does not pose a clear and present danger to patients or clients.

13. ADA Protections • An individual who has successfully completed treatment (incl. EAP) and is no longer using drugs illegally • An individual in treatment and is no longer using drugs illegally • An alcohol dependent individual who can perform essential job functions and practice safely. * Drug tests may be required to confirm sobriety

14. Programs • Washington Physicians Health Program • Physicians, PAs, dentists, podiatrists, veterinarians • Washington Recovery Assistance Program for Pharmacists • Pharmacists, pharmacy technicians • Washington Health Professional Services • Everybody else

15. Mission • Safely return the practitioner back to practice

16. Role Statutory Authority RCW 18.130.175

17. Referral Process • Voluntary- Employer or self referral • Agreement to Practice Under Conditions - Criminal background concerns • In Lieu of Discipline – Referred as an alternative to license discipline • Discipline – Referral under legal order

18. Washington Health Professional Services • Non-punitive approach to recovery from chemical dependency • Abstinence based • Rigorous Monitoring • Quicker identification of relapse behaviors resulting in intervention

19. WHPS • Established in 1988 • Stand-alone program in DOH • Is not a treatment program • Serves 70+ health professions • 525 – 550 clients in active monitoring

20. Monitoring Program • Receives reports of substance misuse and professional impairment. • Provides a structured, environment for recovery using an abstinence model. • Supports twin goals of protecting the public and returning the professional safely back to practice.

21. Program Components • Intake – Chemical dependency evaluation • Treatment – Generally Intensive Outpatient Treatment • Recovery - Continuing care, self-help (AA, NA), peer support groups • Monitoring - 3-5 year contract, random drug screening, workplace restrictions and monitoring, prescription medication monitoring, reporting of non-compliance

22. Drug Screening • Random, observed urine screens • 12- 24x/yr. • ETG/ETS testing • Hair, nail, blood testing • For cause testing • Client absorbs cost

23. Worksite Monitoring • Prior job approval • Employer notification • Employment contract • Work restrictions • Worksite Monitor • Scheduled reports

24. CRNA • Inpatient treatment preferred • Connect with WANA peer advisor • No access to controlled or abusable substances for at least 12 months. • May consider personal alcohol, marijuana use • Fitness for duty evaluation • Use of medication assisted treatment considered

25. “Health professionals have a right and an obligation to ask for help when they are struggling with impairment. When they request assistance, they deserve the same care and respect that they give their own patients and clients every day.” P. Bradley Hall MD

26. John Furman, PhD, MSN, CIC, COHN-S Executive Director Washington Health Professional Services 360-236-2880 John.Furman@doh.wa.gov