Colorado Physician Health Program Annual Report July 2006 - June 2007

1. Colorado Physician Health ProgramAnnual Report July 2006 - June 2007 Executive Director: Sarah R. Early, PsyD Medical Director: Michael H. Gendel, MD The mission of Colorado Physician Health Program is to assist physicians, residents, medical students, physician assistants and physician assistant students who may have health problems which if left untreated, could adversely affect their ability to practice medicine safely.

2. Table of ContentsAnnual ReportJuly 2006 - June 2007 • Referral Summary Page 3 • Number of New Referrals - Program History Page 4 • Source of New Referrals - Year-to-Date Page 5 • Primary Presenting Problem -Year-to-Date Page 6 • Specialty of New Referrals - Year-to-Date Page 7 • License Status of New Referrals - Year-to-Date Page 8 • New Referrals – Geographical Area - Year-to-Date Page 9 • Referrals & Reactivations 1993 - Present Page 10 • Reactivations - Year-to-Date Page 11 • Inactivations (Reasons/Outcome) - Year-to-Date Page 12 • Participants Documentation Requests Page 13 • Program Highlights Page 14-15 • Community Outreach Page 16 • Services Provided by CPHP Page 17 • CPHP Board of Directors and Staff Page 18 APPENDIX • Definition of Terms Page 20

3. Referral Summary July 2006 - June 2007 • New Referrals: CPHP continued to receive steady New Referrals throughout Fiscal Year 2006-07 with 241 New Referrals, representing the highest number of New Referrals for a medical license Non-Renewal Year. • Caseload:The average active caseload at any given period during Fiscal Year 2006-07 was 433 clients. This represents an increase of 7% compared to Fiscal Year 2005-06 (403 active client caseload). • Overview: Significantly, 64% of New Referrals came to CPHP voluntarily. 36% were mandatory referrals. There is a increase of 12% when compared to Fiscal Year 2005-06 which had 52% voluntary New Referrals. Of the total New Referrals this year, 56% had an active Colorado License, 15% had a Colorado Training License and 4% held Physician Assistant Licenses. 25% did not hold any license which includes 17% Applicants, 7% students and 1% out-of-state/non-medical licensed clients. CPHP served New Referral clients from 22 counties of residence throughout Colorado during Fiscal Year 2006-07. • Referral Source: The highest single source of New Referrals was Self referrals, representing 40% of New Referrals. The second highest source of New Referrals was the BME (18%). Administration (9%) was the third highest category of referral source. • Primary Presenting Problems of New Referrals: The three most common primary presenting problems among the 241 New Referrals were: Psychiatric at 32%, followed by Behavioral at 12% and lastly Substance Abuse at 11%. • Specialty of New Referrals: Internal Medicine (16%) is the most frequent specialty of New Referrals, followed by Family Practice (14%) and lastly Surgery (10%). • Reactivations: Of the 241 New Referrals, 47 were Reactivations. This represents 20% of the total New Referrals. • Outcome: Of 242 inactivations, 30 declined referral, 11 declined evaluation, 3 withdrew license application, 17 completed a consultation, 5 relocated, and unfortunately 2 died; therefore, 174 clients were evaluated. Of the 174 evaluated, 161 (93%) were inactivated with an outcome considered successful and/or satisfactory. CPHP is pleased with our continued high rate of satisfactory outcomes! • Documentation Requests: CPHP processed 1,319 report requests during Fiscal Year 2006-07. • Total Participants in CPHP History: Since the inception of the program in 1986, CPHP has served 2696 participants.

4. Annual Number of New Referrals Program History 1986 - Present • This graph shows the continued overall growth of New Referrals in the history of the program. CPHP continued to receive steady New Referrals throughout Fiscal Year 2006-07 with 241 New Referrals, representing the highest number of New Referrals for a medical license Non-Renewal Year. When compared to Fiscal Year 2004-05 (the last fiscal year that was not a BME license renewal year), CPHP experienced an actual growth of 25 cases, an increase of 12%. • When compared to Fiscal Year 2005-06, CPHP experienced an actual reduction of 49 cases, a decrease of 17%. While New Referrals were down compared to last Fiscal Year, the average active caseload continued to grow. The average active caseload at any given period during Fiscal Year 2006-07 was 433 clients. This represents an increase of 7% compared to Fiscal Year 2005-06 (403 active client caseload). • * = BME License Renewal Years

5. Source of New Referrals July 2006 - June 2007 Continued High Self & Voluntary Referrals Client Medical Profession N=241 Other = PhD Other = Attorney, PHP • During Fiscal Year 2006-07, the highest single source of New Referrals was Self referrals, representing 40% of New Referrals. This is an increase of 8% when compared to last year (32%). CPHP continues to be proud of the increased number of Self Referrals to the program demonstrating trust and confidence in CPHP. • Significantly, 64% of New Referrals came to CPHP voluntarily. 36% were mandatory referrals. There is a increase of 12% when compared to Fiscal Year 2005-06 which had 52% voluntary New Referrals. CPHP is proud of the high percentage of referrals that are voluntary, as this reflects the respect for the program among physicians within the state and medical community. CPHP attributes this high level of voluntary referrals to the relationship building efforts made in the community, the positive and caring approach of CPHP’s staff and provision of educational materials that normalizes physician experiences and illness. • The second highest source of New Referrals was the BME (18%). Administration (9%) was the third highest category of referral source. This is similar to the 2005-06 percentage of BME New Referrals at 24% and Administrative New Referrals at 12%. CPHP suspects the slight drop in BME referrals is due to Fiscal Year 06-07 being a non BME license year. CPHP appreciates the referrals received from the BME to assist physicians in evaluating potential health issues that may effect their ability to practice medicine safely. • Please note updated definitions in referral source categories. See page 22. • The pie chart on the right reflects the medical profession of CPHP clients. The majority of clients are Physicians without a resident status (66%). Residents (16%) comprise the second largest group served and Physician Assistants (6%) comprise the third largest group.

6. Primary Presenting Problem of New Referrals July 2006 - June 2007 N=163 • In an effort to better understand the relevancy of the primary presenting problem data, CPHP has removed cases that are “in process” or have not yet been assigned a primary presenting problem. Of the 241 New Referrals received during Fiscal Year 2006-07, 78 were in process at the time of this report, thus 163 were assigned a primary presenting problem. This fiscal year two primary presenting problems were added for increased clarification: DUI/DWAI and Domestic Violence. In previous years, clients seen for DUI/DWAI issues (absent a substance abuse primary presenting problem) or Domestic Violence would have been classified as Legal. • A primary presenting problem area which best represents the participant is identified by the clinical team following the completion of the initial intake interview. This does not mean that other problem areas are not present or being addressed with the participant at CPHP. Rather, the primary presenting problem is identified for data collection and reporting purposes. • The three most common primary presenting problems among the 163 New Referrals were: Psychiatric at 32%, followed by Behavioral at 12% and lastly Substance Abuse at 11%. • Using the same methodology of data collection, this representation has varied from Fiscal Year 2005-06 with the top three categories of Psychiatric at 26%, followed by Legal at 17% and lastly tied were Substance Abuse and Behavioral each at 14%. • When compared to last fiscal year, the primary presenting problem of Psychiatric increased 6%, Substance Abuse decreased 3% and Behavioral decreased 2%. Legal issues, which was not in the top three primary presenting problems this fiscal year, decreased 13%. This is likely due to the advent of the primary presenting problem of DUI/DWAI (at 9% this fiscal year) and Domestic Violence (1% this fiscal year). In previous years, clients seen for DUI/DWAI issues (absent a substance abuse primary presenting problem) or Domestic Violence would have been classified as Legal.

7. Specialty of New Referrals July 2006 – June 2007 Other = Allergy/Immunology, Dermatology, Ophthalmology, Preventative Medicine, Urology N/A = Student N=163 • In an effort to reflect the true representation of specialties served, CPHP is reporting on cases where specialty information has been collected. The data on specialty is collected at the time of intake. Of the 241 New Referrals received during Fiscal Year 2006-07, 78 had not completed an initial intake session at the time of this report, thus for 163 New Referrals, specialty information had been collected. • For Fiscal Year 2006-07 Internal Medicine (16%) is the most frequent specialty of New Referrals, followed by Family Practice (14%) and lastly Surgery (10%). • The percentage representation is similar to Fiscal Year 2005-06 with the three most frequent specialties of Family Practice (16%), followed by Internal Medicine (14%), Anesthesiology (10%) and Surgery (9%). • The specialty statistics among CPHP participants are only meaningful if there is a deviation from the specialty populations of practicing physicians in Colorado. CPHP does not posses current information to determine the significance of this data.

8. License Type of New Referrals July 2006 - June 2007 Other = Out of State and PhD N=241 • This pie chart shows the medical license type of each New Referral to CPHP at the time of referral. • Of the total New Referrals this year, 56% had an active Colorado Medical License, 15% had a Colorado Training License and 4% held Physician Assistant Licenses. 25% did not hold any Colorado license which includes 17% Applicants, 7% students and 1% out-of-state/non-medical licensed clients.

9. Colorado Counties Served by CPHP July 2006 - June 2007 ^ ^ * ^ * N * * * ^ * * * * * * * * * ^ ^ * * * * ^ ^ ^ ^ ^ ^ ^ * ^ * ^ ^ * ^ ^ = Other Other includes counties that contain less than 10 physicians, based on a BME listing (obtained in September 2005) of Colorado licensed physicians. These counties are grouped into one category (Other) to protect the confidentiality of clients residing in those counties. Counties in this category include: Baca, Cheyenne, Conejos, Crowley, Custer, Dolores, Hinsdale, Jackson, Kiowa, Mineral, Park, Phillips, Rio Blanco, Saguache, San Juan and Sedgwick. ^ = County Served * • CPHP served New Referral clients from 22 counties of residence throughout Colorado during Fiscal Year 2006-07. • The most frequent county of residence among New Referrals was Denver Countyat 32%.

10. Referrals & Reactivations1993 - Present • Of the 241 New Referrals, 47 were Reactivations. This represents 20% of the total New Referrals. This is a slight increase (1%) when compared to Fiscal Year 2005-06 at 19%.

11. ReactivationsJuly 2006 - June 2007 Referral Source Primary Presenting Problem N=47 N = 30 • “Reactivation” refers to when a participant returns to CPHP after having been inactivated. • Referral sources of reactivated clients are depicted on the left pie chart. Of 47 participants who were reactivated, 41% Self Referred. This represents a remarkable increase when compared to Fiscal Year 2005-06 when 28% of Reactivations Self Referred. • The second most frequent referral source among reactivated clients was the BME (26%). This is an increase of 3% when compared to last fiscal year in which BME Referrals comprised 23% of the Reactivation sample. • 66% of Reactivations voluntarily returned to CPHP during Fiscal Year 2006-07. There is a increase of 11% when compared to Fiscal Year 2005-06 which had 55% voluntary Reactivations. CPHP is pleased with the increase in voluntary referrals as this demonstrates trust and confidence in CPHP services. • Primary presenting problems of reactivated clients are illustrated on the right pie chart. These statistics reflect that Reactivations most commonly present with Psychiatric issues (27%), followed by Substance Abuse (13%). This distribution is similar to the Annual New Referrals (Psychiatric at 32% and Substance Abuse at 11%).

12. 242 Participants Inactivated (Reasons/Outcome)July 2006 - June 2007 Length of Active Status at CPHP N=242 • “Inactivation” refers to when a case is closed at CPHP. See updated definitions of inactivation reasons on page 22. • Of 242 inactivations, 30 declined referral, 11 declined evaluation, 3 withdrew license application, 17 completed a consultation, 5 relocated, and unfortunately 2 died; therefore, 174 clients were evaluated. Of the 174 evaluated, 161 (93%) were inactivated with an outcome considered successful and/or satisfactory. CPHP is pleased with our continued high rate of satisfactory outcomes! • Length of Active Status at CPHP is depicted on the right pie chart. The majority of participants (71%) completed the necessary involvement with CPHP in one year or less. Last fiscal year 2005-06, 57% of participants completed the necessary involvement with CPHP in one year or less.

13. Participants Documentation Requests July 2006 - June 2007 N= 1319 • CPHP processed 1,319 report requests during Fiscal Year 2006-07. This is an increase of 13% compared to Fiscal Year 2005-06 at 1,170 report requests.

14. Program HighlightsJuly 2006 - June 2007 CPHP 20th Anniversary Celebration: On September 6, 2006 CPHP hosted a celebration event at the Denver Botanic Gardens in honor of CPHP’s 20 years of service for the Colorado Medical Community. We enjoyed the opportunity to join with individuals who have been part of the vision, development, and growth of CPHP. Thank you Colorado Medical Community for your support during the past two decades. We look forward to continued collaboration to promote physician wellness. • CPHP Welcomes New CPHP Board Directors: At the May 15, 2007 Board of Directors meeting, CPHP welcomed three new Board Directors beginning their three year term. • Michael Calvin, PA, serves as physician assistant at Colorado Asthma and Allergy Centers in the Denver metro area. • Thomas Currigan is the Director of Community and Local Government Relations for Kaiser Permanente’s Colorado region. • John Genrich, MD, works as a pediatrician through his private practice in Colorado Springs. We are proud of the caliber of experience and talent that is represented by the newest additions to the CPHP team. Welcome! • CPHP Publication in Colorado Medicine: Michael H. Gendel, MD, CPHP Medical Director, and Sarah R. Early, Psy.D., CPHP Executive Director co-authored Assisting Physicians with Physical Health Problems, which was published in the November/December 2006issue of Colorado Medicine. In recent years, CPHP has assisted more physicians who are coping with solely medical or physical issues. This article addressed the difficulties many physicians face in receiving quality medical care, the difficulties in treating physicians as patients, the difference between illness and impairment, and lastly the use of the “safe haven” provision on the BME medical license application and reapplication. We are pleased to educate the Colorado medical community about CPHP services to assist physician physical problems. • Availability of Services: In addition to CPHP providing services to Colorado licensed physicians and physician assistants, contracts exist to provide services for residents, medical students and physician assistant students enrolled at University of Colorado Health Sciences Center Residency Program, Medical School, and Physician Assistant Program, St. Joseph’s Residency Training Program, St. Anthony’s Residency Training Program, Red Rocks Community College Physician Assistant Program, and Southern Colorado Family Residency Training Program for the 2006-07 academic year. We look forward to continued collaboration with these training programs for the 2007-08 academic year, in addition to commencing CPHP services for the St. Mary’s Family Practice Residency Program!

15. Program Highlights continuedJuly 2006 - June 2007 • Federation of State Physician Health Programs (FSPHP): CPHP continued active national involvement with the FSPHP during Fiscal Year 2006-07 with CPHP Medical Director, Michael H. Gendel, MD, serving as Immediate Past President of this organization. As always, CPHP welcomes FSPHP meetings as a forum for education and exchange of information among state physician health programs. • Western Region of the FSPHP Annual Meeting: CPHP Medical Director, Executive Director, and Associate Medical Directors attended the Western Region of the FSPHP Annual Meeting at Bryce Canyon, Utah September 21-23, 2006. CPHP representatives provided a panel presentation on the topic Physician Health Program Staff Health.International Meeting on Physician Health: CPHP Associate Medical Director and Executive Director attended the International Meeting on Physician Health sponsored by American Medical Association and Canadian Medical Association in Ottawa, Ontario, Canada from November 30, 2006 to December 2, 2006. • FSPHP Annual Meeting: CPHP Medical Director, Associate Medical Directors, Executive Director and Clinician attended the FSPHP Annual Meeting in San Francisco from April 30-May 4, 2007. Doris C. Gundersen, MD coordinated a panel where legal professionals including Colorado First Assistant Attorney General Claudia Brett Goldin presented on Legal Issues Facing Physician Health Programs. Michael H. Gendel, MD and Dr. Gundersen presented on the Assessment and Treatment of Post Traumatic Stress Disorder. • FSPHP and Federation of State Medical Boards Collaboration: Michael H. Gendel, MD presented on a joint panel session with FSPHP and Federation of State Medical Boards on Disruptive Physician Behavior on May 4, 2007. CPHP is pleased with the collaboration of these two Federations to best assist physicians and provide public protection. • Spirit of Medicine Fundraising Campaign: CPHP completed the annual Spirit of Medicine fundraising campaign with successful results! CPHP utilizes fundraising efforts to supplement expenses that exceed the Peer Assistance Budget. CPHP Board of Directors along with the Development Specialist and Staff work together to cultivate and extend fundraising efforts throughout the Colorado medical community. We appreciate all of our generous contributors. • Finance and Peer Assistance Budget: CPHP finished the fiscal year with a Year-to-Date Peer Assistance Net Loss of $31,636.44. Year-to-Date Revenue which is approximately $43,000.00 higher than anticipated, is largely due to Fee-For-Service revenue which is comprised of evaluation fees for out-of-state-clients.  Year-to-Date expenses were largely on target with Year-to-Date budget with the exception of increased expense in physician hours to meet clinical demands and Contract Labor-Administrative which is due to temporary employees to meet staffing vacancies.  The Net Loss was supplemented with cash reserves from the annual Spirit of Medicine campaign.

16. Community Outreach Highlights July 2006 - June 2007 • CPHP Responds to Medical Community Tragedy: On October 17, 2006, Michael H. Gendel, MD, Medical Director visited St. Mary’s Hospital in Grand Junction in response to a recent physician death in this community. CPHP appreciated Copic’s sponsorship of this specialized outreach effort. Dr. Gendel presented on Depression in Times of Stress in an effort to normalize mental health issues in physicians, identify warning signs in colleagues and utilize of CPHP as a resource. CPHP was pleased to have the opportunity to provide critical incident debriefing and education to the Grand Junction medical community in an effort to prevent future untimely physician deaths. • Completion of CPHP-Copic Physician Educational Seminar Series: CPHP and Copic successfully completed the fifth series of Physician Educational Seminar Series. Educational topics included: Physician Stress and Stress Management, Professional Boundaries and Physicians in Relationships and Families. Locations of the fifth series of presentations included: Aurora, Durango, Denver, Grand Junction, Montrose, Pueblo, and Thornton. CPHP appreciated the collaboration with Copic in this educational venture for the Colorado medical community. The sixth series is underway with the addition of another informative topic: Women in Medicine. • Targeted Community Outreach Initiatives: • Women in Medicine: Colorado Permanente Medical Group representatives and CPHP representatives, Sarah Early, Psy.D. and Doris C. Gundersen, MD collaborated to host a half day workshop addressing the issues faced by Women in Medicine. This is CPMG and CPHP’s second Women In Medicine Workshop. Dr. Gundersen, MD, CPHP Associate Medical Director, presented on the History of Women in Medicine: Context and Culture. Issues such as effective communication, prioritization and balance were addressed with the overall workshop goal of presenting concrete, effective tools to utilize in everyday life. We appreciate the opportunity to provide education in this area to Colorado physicians. • Physician Assistant Outreach: CPHP was pleased to exhibit at Colorado Academy of Physician Assistants (CAPA) Annual Summer Metro Meeting on August 25, 2006 in Denver and at the Colorado Academy of Physician Assistants Mid-Winter conference at Copper Mountain Resort on January 12-15, 2007. CPHP was delighted with the opportunity to outreach and inform the physician assistant population about CPHP services. • State-Wide Outreach: CPHP strives for direct contact with rural entities. Sarah R. Early, PsyD, Executive Director, undertook two Southern Colorado tours to visit area hospitals.  Dr. Early educated staff members at these hospitals as to scope and depth of services, how to make a formal referral, common myths regarding CPHP, and funding sources of CPHP.  In addition, on May 2-4, 2007 CPHP was exhibited at the Colorado Hospital Association’s 30th Annual Rural Hospital Conference held in Breckenridge. CPHP capitalized on this event by communicating and educating the CEOs and hospital administrators from Colorado rural hospitals about CPHP’s services. • Additional Community Presentations: CPHP conducted various presentations and exhibits about CPHP and related physician health topics. Audiences included Residency Programs, Medical and Physician Assistant Programs, Medical and Professional Societies, Spouse Alliance Groups, Medical Student Council, Medical Staff Offices, Group Practices, and Treatment Providers. CPHP was pleased to exhibit at the annual meetings/conferences for Colorado Medical Society, Colorado Society of Osteopathic Medicine, Colorado Health and Hospital Association, and Colorado Rural Health. • Community Meetings: Referral source meetings were held with community entities including hospital administration and medical staff offices; medical and physician assistant training programs; residency programs; and affiliate organizations. Issues addressed included: how CPHP and the organization may work best together, building relationships with referral sources and improving CPHP services. Workplace consultation continues to be an important element of CPHP services. CPHP participants and/or participants’ potential workplaces seek assistance from CPHP on identifying problems, intervention strategies, how to make referrals, and documentation. • Participant Monitoring Visits: CPHP Medical Director and Associate Medical Directors traveled to various areas in the state for client appointments outside of Metro Denver including Fort Collins, Grand Junction, Durango and Pueblo.

17. Services Provided by CPHP • Client Services: • Assessment • Treatment referral • Monitoring and support • Family support • Documentation • Workplace and Referral Source Services: • Consultation on identifying physicians who need assistance • Consultation on making referrals • Workplace consultations • Educational presentations • Medical Community Services: • Promote physician health awareness • Educational presentations • Partnership with organizations to meet special needs • Develop meaningful research on physician health • Presentation Topics: • Colorado Physician Health Program services • Physician stress and stress management • Substance abuse, addiction • Professional boundaries • Self-care and physician health issues • Disruptive physician management • Women in medicine • Physicians in relationships and families

18. CPHP Board of Directors and Staff

19. APPENDIX

20. Definition of Terms REFERRAL SOURCES For the purpose of this report, the following definitions are applied: Administrative (Admin): Dept. Heads, Directors, Partners, Presidents, CEO’s (which are not part of a hospital system). For example, Vail Clinic, CFO of a Radiology group, managed care such as Kaiser Permanente Attorney: Referrals made by a CPHP client’s attorney Board of Medical Examiners (BME): Any written referral made by the BME or required evaluations as part of the application or renewal process to Colorado Hospital: MEC, Medical Staff Offices, Quality Management, Chief of Staff, Credentialing Committees Malpractice: A malpractice company Medical School: Any referrals made by the Medical School Faculty, administration and personnel Peer: Any MD, DO, or PA that does not fit into another category Physician Assistant Program: Any referrals made by a Physician Assistant School Faculty, administration and personnel Proactive: Self referral who request services who will have or would likely have consequences with other entities or organizations if they do not follow Resident Program (Res Prog): Any referrals made by Residency Directors and personnel Self: Voluntary referrals who request services on their own and there are not consequences with other entities or organizations if they do not follow through Treatment Provider (Tx Prov): Professionals in community that provide treatment to CPHP participants Safe Haven: Client utilizing CPHP services to prevent disclosure on BME application/reapplication REASONS FOR INACTIVATION Application Withdrawn: Individual decides not to pursue a Colorado license after the application was submitted. Or, individual decides not to submit a Colorado license application. Consultation Complete:Referral Source other than self was provided program information, referral guidelines and options regarding specific new referral. Initial intake not completed at this time. No potential safety or patient safety issues identified. Deceased: Client deceased. Evaluation Completed (Eval Comp): Client completed evaluation, no treatment or monitoring recommended. Also used for out of state clients who will follow-up with treatment and/or monitoring in own state. Evaluation Declined (Eval Declined): Client referred for evaluation. Refused or declined to have evaluation or cannot be located. No patient safety issues identified. Evaluation Incomplete (Eval In Comp): Client begins evaluation process but does not comply with completion of CPHP evaluation. No potential safety or patient safety issues identified. Monitoring Completed (Mon Comp): Client has followed CPHP recommendations for treatment and/or monitoring. Monitoring no longer warranted. Monitoring Declined (Mon Declined): Client completed evaluation. Client declined CPHP recommendations for treatment and/or monitoring. No patient safety issues identified. Non-Compliance: Client did not comply with the completion of CPHP evaluation and/or did not comply with CPHP treatment and/or monitoring recommendations. Potential safety or patient safety issues identified. Other: Any reasons that does not fit another category Referral Declined:Self referral was provided program information, referral guidelines and options regarding specific circumstance. Initial intake not completed at this time. No potential safety or patient safety issues identified. Relocated: Client relocated after evaluation completed. No patient safety issues identified. Rescinded Order: BME rescinded the order for CPHP evaluation and individual is no longer required to have one. Client may or may not have completed an initial intake or received monitoring services.