Nancy Smith, a nurse, completed the substance abuse treatment program to which her employee assistance program (EAP) had referred her six months earlier. It was now time for her to renew her nursing license. She completed her renewal application and indicated she had been treated for alcoholism. One month later, she was informed by the nursing board's impaired professional program (IPP) she would have to resubmit to an evaluation of their choosing, with possible additional treatment.
John Brown, a doctor, had a long history of substance abuse. He informed his supervisor of his problems and was referred to the medical board's IPP. Two months later he returned to work, but nothing was said about the referral to the IPP. The following year, one of his patients died, and the patient's family filed a malpractice suit.
During the investigation, Dr. Brown's treatment for substance abuse came to light. It was noted that the hospital's administrators had not referred him to the EAP, nor did they have any official documentation of the referral to the IPP. In addition, the hospital had not attempted to monitor his treatment compliance. Had the administrators referred Dr. Brown to the EAP and monitored his compliance, they would have discovered he had failed multiple drug screens and also been diagnosed with bipolar disorder. The patient's family filed suit against the hospital for neglect employment, along with the malpractice suit.
EMPHASIZING RISK MANAGEMENT
Alcohol use, abuse, and dependency impose a heavy burden on society. The costs for health care secondary to alcohol and substance abuse treatment, as well as for losses stemming from reduced workplace productivity, premature death, crime, and legal problems, number in the billions of dollars. (1) Workplace productivity losses alone are estimated to cost the United States $89.5 billion per year. (2) In addition, two million American workers report being victimized each year by workplace violence, costing employers billions of dollars. (3)
Behavioral risk management has become a major concern for both health care professional licensing boards as well as the health care industry in general. Multiple studies indicate many health care professionals are at risk of developing, or already are experiencing, substance abuse and dependency problems. McAuliffe and others, for example, reported that 59 percent of physicians had used psychoactive drugs in their lives, while one in four had abused prescription drugs and one in ten currently use drugs regularly. (4) Brown and others report that much remains to be done for the health care profession to both recognize and provide treatment for impaired health care professionals. (5)
A growing number of health care licensing boards are responding to substance abuse problems among health care professionals by establishing IPPs, while the health care industry is developing various internal programs. The impetus for these programs varies: The concern for public safety, for example, has pushed many licensing boards to increase the role they play in monitoring the treatment and care provided by their licensed professionals. While public safety is certainly a major concern, there are other issues that need to be considered, including increased litigation, liability risks, and costs resulting from the presence of impaired professionals in the workforce.
These issues have driven the development of many corporate risk management programs. Although the development of IPPs and internal risk management programs have run along parallel lines, limited attention has been paid to the need of these programs to interface and work together to meet the objectives of both. A primary challenge facing the health care industry and IPPs is to provide services that complement one another while also ensuring the professional's needs are met.
Employee assistance programs are in a unique …