Doctors and DUIs: What to do if you’ve had one too many

Just like every other segment of the population, Colorado physicians are not immune from making the mistake of drinking and driving. Unlike other segments of the population, however, a DUI or other alcohol related offense can result in professional discipline. So, what do you do if you are a licensed health care provider who gets a DUI?

The Colorado Medical Practice Act requires that all physicians report within 30 days any “adverse action” by a law enforcement agency that would constitute grounds for discipline under the Medical Practice Act. Although it is arguable that a first-time offense of drunk driving or other related offense would not constitute grounds for discipline and would not, therefore be reportable, under the MPA, the wiser course is to report the action to the Medical Board within 30 days of any conviction. A physician would be required to report the conviction during the next licensing cycle regardless, so it makes sense to self-report early. Like many things, the failure to report could result in greater discipline than the act itself.

Doctors should be aware, however, that once the matter is self-reported, the Medical Board will require the licensee to undergo an evaluation with the physicians’ health program, CPHP, and will issue a complaint letter to the physician to investigate the matter. A great deal of the Board’s decision making with respect to possible discipline will depend on the outcome of the CPHP report. If the report identifies an underlying physical or mental disability, discipline is likely and could include treatment and monitoring. Given the potential downside, the best course of action if you have one too many is to call a cab or get a ride. The trip to pick up your car the next day will be significantly less of a hassle than the damage caused to your license.

Tips for Ending the Physician-Patient Relationship With Problem Patients

One question I get from time to time is how a doctor may discharge “problem patients” and end the physician-patient relationship. Doctors who terminate the relationship improperly can face disciplinary charges for patient abandonment or worse. Medical Board complaints for patient abandonment are generally the result of poor communication and typically are the product of a doctor moving to a new practice group; the closing of a medical practice; or a physician moving to a new city. I’ll deal with closing and departing from a medical practice in another post. The issue today is the “problem patient” — one who is disruptive, non-compliant, delinquent or simply has a personality clash with the physician or staff. Discharging these patients should be done with care.

The physician-patient relationship is not a life-long commitment for either the doctor or the patient. With the exception of certain requirements of EMTALA (the Emergency Medical Treatment and Active Labor Act of 1986), physicians are not obligated to accept every patient who seeks his or her services. Once the doctor-patient relationship is established, however, a doctor must follow certain guidelines when discharging a patient to avoid abandoning the patient. Colorado Medical Board policy 40-02 sets out the procedural guidelines for discharging a patient. The Medical Board recommends that:

  • Any discharge be in writing and sent to the patient via certified mail;
  • In the discharge letter, the doctor agrees to provide 15-30 days of provisions coverage while the patient finds a new doctor;
  • The physician provide information for referral to new physicians, if possible; and
  • The letter notify the patient that the patients’ records will be sent to the new physician upon receipt of a written authorization from the patient.

Keeping in mind that problem patients are being discharged for a reason, care should be taken to make sure that a physician minimizes the risk of being charged with abandonment or worse by virtue of the discharge. Even where procedural guidelines are followed, physicians must take care that all discharges are for non-discriminatory reasons, not in violation of anti-discrimination laws such as the Americans with Disabilities Act, and do not jeopardize the welfare of the patient. Thus, a discharge letter should also explain the reasons for discharge in clear and concise language, taking care to spell out the non-discriminatory basis for ending the relationship. A properly prepared discharge letter can eliminate many headaches for the doctor down the road.

WYOMING: Supreme Court Upholds Revocation of Privileges for “Disruptive Physician”

One of the primary reasons doctors receive Medical Board complaints is communication with patients, but also with hospital and office staff as well. Although many believe that treatment of hospital staff cannot result in discipline or privileging issues, a recent Wyoming case illustrates otherwise.

On February 24, 2001, the Wyoming Supreme Court upheld the St. John’s Medical Center’s revocation of medical staff privileges of a physician described as “disruptive.” Significantly, both sides agreed that only the doctor’s behavior toward staff, not the quality of care to patients was at issue. The case illustrates the high standards placed on physician behavior.

The physician, an orthopedic surgeon, was described to have “repeated instances of behavioral issues” with hospital staff. When the doctor applied for reappointment to the staff, he entered into a “Medical Staff Reappointment Agreement” that identified behavioral concerns and placed conditions on reappointment. Several months after reappointment, the entire operating room staff signed a petition refusing to work with the surgeon. Subsequently, the Medical Executive Committee summarily suspended and ultimately terminated the surgeon’s privileges. The physician challenged the revocation of his privileges on several grounds, including his right to due process, and the hospital’s decision to bypass its “Disruptive Practitioner Policy.” The Wyoming Supreme Court ultimately upheld the hospital’s decision. In reaching its decision, the Court quoted the Oregon Supreme Court’s holding in Huffaker v. Baily, 540 P.2d 1398 (Ore. 1975):

The factor of ability to work smoothly with others is reasonably related to the hospital’s object of ensuring patient welfare. This conclusion seems justified for, in the modern hospital, staff members are frequently required to work together or in teams, and a member who, because of personality or otherwise, is incapable of getting along, could severely hinder the effective treatment of patients…. Hospitals uniformly consider cooperativeness an important factor, and in these circumstances it seems questionable whether this court should gainsay the hospitals’ experience and judgment in this matter.

Copyright Miller | Kabler, P.C., Attorneys-at-Law