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Recognizing Alcohol and Drug Impairment in the Workplace in Florida.

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018-.
2018 Oct 27.

Author information

1
Ball State University

Excerpt

Alcohol and drug use disorder is a troubling and significant problem for healthcare professionals. Without identification and appropriate treatment, impairment often progresses and compromises the workplace and patient safety. The danger is significantly worse when the impaired health professional is responsible for treating critically ill patients in the intensive care unit, emergency department, or operating room. Medical professionals must be able to recognize signs of this danger and protect against it, both for the sake of patients and the healthcare providers themselves. Health professional impairment is, unfortunately, a common problem in healthcare. Impairment results when a health professional, such as a physician, nurse, or allied health professional, is unable to provide competent and safe patient care because they are impaired by alcohol, prescription or nonprescription drugs, or mind-altering substances.  Impairment may also result from a psychological or neurologic condition that affects the health professional's judgment. As a result of this impairment, the health professional is unable to safely perform professional duties and responsibilities in the manner essential to their profession.  All health professionals need to understand and be aware of the safety issues that become apparent when a health professional is impaired as the care provided extends to other health professionals as well as the institution. Ultimately, it is important that all health providers are aware of the signs and symptoms of impairment and the state and institution requirements of reporting individuals suspected working while in an impaired state. Impaired health professionals often develop coping mechanisms that allow them to initially cover up their diminished capability to provide safe patient care. Eventually, they commit obvious mistakes, medication errors, or procedural errors that become readily apparent. But, initially these violations may be subtle and only an astute and observant fellow practitioner will notice a change in behavior or the signs and symptoms of impairment. Often, to obtain mind-altering substances, impaired health professionals will divert controlled substances, such as opioids and benzodiazepines, from a patient to themselves. This can result in a patient being under medicated and induce unnecessary suffering. Use of mind-altering substances over time also may result in the deterioration of the health professional's health. Use of stimulants, for example, may result in cardiovascular problems such as angina, hypertension, and myocardial infarction. Alcohol can lead to liver diseases such as cirrhosis. Patients are exposed to infectious diseases such as human immunodeficiency, hepatitis, and other blood-borne diseases. There are often coexisting mental diseases such as depression, suicide, and anxiety. Impairment can lead to traumatic injuries such as falls, fractures, and head injuries. Florida State and Federal Rules and Regulations Virtually all states include rules and regulations regarding the use of alcohol and drugs as the basis for disciplinary actions. Diversion of drugs from patients is dealt with particularly harshly. Almost all states also require reporting of health practitioners who are suspected of impairment. These rules and penalties vary from state to state. The Florida Nurse Nurse Practice Act [leg.state.fl.us, 2018] is provided as an example of typical state law in regards to the use of controlled substances and the necessary reporting. Each practitioner should consult the rules and regulations for their own profession. 464.018  Disciplinary Actions (h)  Unprofessional conduct, which shall include, but not be limited to, any departure from, or the failure to conform to, the minimal standards of acceptable and prevailing nursing practice, in which case actual injury need not be established [leg.state.fl.us, 2018]. Most states require the reporting of unprofessional conduct, whether it be by a physician, nurse, or allied health profession.  (i)  Engaging or attempting to engage in the possession, sale, or distribution of controlled substances as set forth in chapter 893, for any other than legitimate purposes authorized by this chapter [leg.state.fl.us, 2018]. All states and the federal government takes a dim view of health care practitioners who engage in the unlawful sale of prescription or nonprescription controlled substances. Penalties for violation can include fines and jail sentences. (j)  Being unable to practice nursing with reasonable skill and safety to patients by reason of illness or use of alcohol, drugs, or chemicals or any other type of material or as a result of any mental or physical condition. In enforcing this paragraph, the department shall have, upon a finding of the secretary or the secretary's designee that probable cause exists to believe that the licensee is unable to practice nursing because of the reasons stated in this paragraph, the authority to issue an order to compel a licensee to submit to a mental or physical examination by physicians designated by the department. If the licensee refuses to comply with such order, the department's order directing such examination may be enforced by filing a petition for enforcement in the circuit court where the licensee resides or does business. The licensee against whom the petition is filed shall not be named or identified by initials in any public court records or documents, and the proceedings shall be closed to the public. The department shall be entitled to the summary procedure provided in s. 51.011. A nurse affected by the provisions of this paragraph shall at reasonable intervals be afforded an opportunity to demonstrate that she or he can resume the competent practice of nursing with reasonable skill and safety to patients (j)  Being unable to practice nursing with reasonable skill and safety to patients by reason of illness or use of alcohol, drugs, opioids, or chemicals or any other type of material or as a result of any mental or physical condition. In enforcing this paragraph, the department shall have, upon a finding of the secretary or the secretary's designee that probable cause exists to believe that the licensee is unable to practice nursing because of the reasons stated in this paragraph, the authority to issue an order to compel a licensee to submit to a mental or physical examination by physicians designated by the department. If the licensee refuses to comply with such order, the department's order directing such examination may be enforced by filing a petition for enforcement in the circuit court where the licensee resides or does business. The licensee against whom the petition is filed shall not be named or identified by initials in any public court records or documents, and the proceedings shall be closed to the public. The department shall be entitled to the summary procedure provided in s. 51.011. A nurse affected by the provisions of this paragraph shall at reasonable intervals be afforded an opportunity to demonstrate that she or he can resume the competent practice of nursing with reasonable skill and safety to patients [leg.state.fl.us, 2018]. All states have varying rules in regards to the evaluation and prosecution of a health care practitioner that due to mental illness or illicit use of controlled substances places a patients safety at risk. Health professionals have been prosecuted for felonies for harming patients due to unprofessional and dangerous conduct. (k)  Failing to report to the department any person who the licensee knows is in violation of this chapter or of the rules of the department or the board; however, if the licensee verifies that such person is actively participating in a board-approved program for the treatment of a physical or mental condition, the licensee is required to report such person only to an impaired professionals consultant. Most states require health professionals who they believe are impaired to report to the appropriate authority. Failure to report may have negative consequences for the health practitioner that is aware of the impairment and yet fails to report to the appropriate authority. (l)  Knowingly violating any provision of this chapter, a rule of the board or the department, or a lawful order of the board or department previously entered in a disciplinary proceeding or failing to comply with a lawfully issued subpoena of the department. If the health professional knowingly violates the provisions, the consequence in most states is even more severe. All health professionals are obligated to be aware of the practice act rules and regulations in each of the states they hold a license. (m)  Failing to report to the department any licensee under chapter 458 or under chapter 459 who the nurse knows has violated the grounds for disciplinary action set out in the law under which that person is licensed and who provides health care services in a facility licensed under chapter 395, or a health maintenance organization certificated under part I of chapter 641, in which the nurse also provides services [leg.state.fl.us, 2018]. Most states have the right to specifically penalize a health professional who fails to report a health professional they know violate state laws. Besides the legal concerns, health professionals have an ethical and moral duty to patients to report a health professional with a diminished capacity to perform their duties. (4)  The board shall not reinstate the license of a nurse who has been found guilty by the board on three separate occasions of violations of this chapter relating to the use of drugs or opioids, which offenses involved the diversion of drugs or opioids from patients to personal use or sale [leg.state.fl.us, 2018]. In many states, the ongoing use of drugs or alcohol can result in the permanent loss of a medical license. It is crucial that all health professionals review the health practice act in each state where they hold a license, and that they comply with the reporting requirements. If one is unsure of the requirements, most institutions will provide an attorney or other professional to assist with understanding the reporting process. Most states have statutes designed to help healthcare practitioners identify and treat impaired health care providers. Virtually all state medical boards require that a healthcare provider suffering from alcohol or drug substance use self-report, and individuals aware of the problem must report their peers. Due to the fear of reprisal, most states have a mechanism whereby a provider can confidentially report a peer directly to an agency that can investigate and deal with the problem. Providing there has been no safety issues that directly affected a patient's care, the impaired practitioner can engage in treatment and rehabilitation and avoid board disciplinary action.  If a health profession is already under discipline, has been terminated from rehabilitation, has sold drugs, or is at continuous risk to the public, the practitioner is less likely to be given the opportunity to seek private treatment without public consequences. However, if there is no danger to the patients, even The Joint Commission supports treatment rather than punishment. To a certain extent, federal laws protect health professionals with substance use disorder. The Americans with Disabilities Act provides protection for healthcare providers in treatment and recovery programs for substance use disorder. It requires a "reasonable accommodation" for an individual who recognizes their alcohol or drug issues and participates in a rehabilitation program. Federal law does not consider a person to be disabled because they are using drugs. In addition, the Family Medical Leave Act requires employers to allow time off for qualified substance use disorder treatment. Courts and statutes usually protect health care providers' and medical boards' efforts to address substance use disorder issues, particularly if practitioners have successfully completed treatment. However, if a practitioner harms a patient while under the influence of drugs or alcohol or an institution knowingly fails to protect a patient, the consequences can be severe. Examples include the following: A court granted immunity to the director of an impaired practitioner program who suggested that healthcare professionals privileges be suspended until they completed substance use disorder evaluation and treatment. During a medical malpractice case, a healthcare professional refused to turn over substance use disorder treatment records; the court ruled those records were privileged and confidential. A court dismissed a hospital from a malpractice suit that claimed negligent credentialing due to a health professional prior alcohol and drug use. The court found the professional had completed successful treatment and had complied with a monitoring program for years, and the hospital acted reasonably in granting privileges. A  patient sued the hospital for improper credentialing because the health practitioner had committed malpractice in the past and was known by the hospital to be addicted to sedatives. The hospital was accessed punitive damages for negligent credentialing. A health professional admitted to being under the influence of an opiate during a surgical operation, and a large punitive verdict was awarded. Definitions Addiction: A substantial loss of self-control indicated by compulsive alcohol or drug use despite the desire to stop. It may involve cycles of relapse and remission, and if untreated, may result in disability or premature death Drug diversion: The transfer of a controlled substance, such as a drug, from a lawful to an unlawful channel of distribution and use. Substance use disorder: A disease of the brain which is characterized by the recurrent use of alcohol or drugs that result in functional impairment such as disability, health problems, and failure to meet responsibilities at home, work, or in school. Impairment: The inability or impending inability to provide safe, professional activities and duties due to a behavioral, mental, or physical disorder related to alcohol or drugs. Consequences of Healthcare Professional Impairment Patients: Decreased trust of health professionals. Infection from contaminated needles. Medical error victims. Reaction to wrong drugs. Undue pain. Peers: Discipline from failure to report. Legal liability from shared patients shared patient care. Stress from increased workload as a result of an impaired professional. Professionals: Accidental injuries. Billing and insurance fraud. Communicable infections from the use of unsterile drugs and needles. Felony prosecution. Heart disease. Liver disease. Malpractice actions. Institutions: Civil liability from failure to recognize an impairment. Decreased institutional reputation. Decreased revenue from diverted drugs. Poor work quality. Increased absenteeism. The increased cost of Workers’ Compensation.

Copyright © 2018, StatPearls Publishing LLC.

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