Thursday, March 13, 2014

Drug Testing the Medical Staff

Corporations have, over the past several decades, become extremely wary of either hiring or tolerating drug use in their employees but one group seems to have ignored this trend. The group, of course, is comprised of medical staff or medical professionals who have admitting privileges. These individuals, it seems, are above reproach when it comes to addiction and few wish to challenge them with random drug tests.

During my tenure in the medical world, I’ve seen some incredible examples where drug testing would have helped not only the patients but the staff members who were addicted. Take, for example, the physician who had been an anesthesiologist (among the group at greatest risk for addiction), began using leftover drugs from patients to help himself through many hours of work and then was caught. He was remanded to treatment, his license was suspended for a time and then he got it back and went into a different specialty. Yes, he had to do another residency, but he managed that well and seemed to be doing fine.

The end of that “fine” period came when he was at a rehab hospital under supervision because of his prior addiction. Everything was going quite well and there were no complaints from staff or patients. The one fly in the ointment was a local pharmacist who called the physician supervisor of this doc and asked the reason he had ordered so many addictive medications for his patients. After all, didn’t the hospital supply all the patients’ needs, so what was the reason for these scripts?

Fast forward a day or two and it was discovered that the former-addict doc was tearing prescriptions from the back of his supervisors prescription pad and then making them out for himself or some individual he was paying. In fact, this is a trick quite familiar to many addicts and used whenever a prescription pad is left on a desk. Clever, yes, but where does this doc go from there and what would he do next? No one knows because he left the hospital and all was kept quiet.

Addicts can be quite capable of passing themselves off as perfectly normal and you may even know some addicts. One of your docs may be an addict but may not admit it to him/herself or to anyone else. Just as alcoholics do, they “know” how to use their substance of choice and they can stop anytime they wish. Sure they can.

Consider one scenario that could be applied to the example of the script-snatching doc. He may have gone to another state where they may not have been too diligent in terms of background checks. There he could just pick up his prior activities and go unnoticed until he slipped up and took too much of something. It has happened with docs who have done far worse things such as killing patients (on purpose) or sexually assaulting women (and being asked to “go on vacation”).

One physician managed to work at three or four hospital centers (killing patients at each one) before a medical school dean got curious and called a prior employer. He’s in jail now after being found guilty of multiple intentional homicides of patients. The sex offender doc went to another state where he, undoubtedly, is still practicing as a psychiatrist. Docs hate to give other docs a bad reference.

A recent article in The New York Times (March 12, 2014) dealt with just this question of drug testing docs and noted that: By federal law, many workers in transportation or other safety-sensitive areas are already subject to random drug tests. These include pilots, school bus drivers, truck drivers, flight attendants, train engineers, subway operators, ship captains and pipeline emergency response crews.” So, why is it so different with people who hold people’s lives and health in their hands every day? The case has been well established that drug addiction is an equal employment disorder (call it “disease” if you wish) and no one is above its grip.

In hospital and medical offices the opportunities and the lure of addiction couldn’t be more evident. Patients come in for procedures requiring some sort of medication relief and there’s some left over. Who accounts for all of it and where is it stored? Do they have lock boxes the way they do for sharps? I don’t think I’ve ever seen an ampule or bottle of any medication in a lock box. I have seen them lying on tables in open procedure rooms where anyone could have access.

Would you put a candy addict at work in a candy store? Who bears the blame here; the addict or the system? I’d say both should share it equally. Any system that refuses to adequately protect its patients and employees from addiction harm is remiss in its duties.  For Pete sake, we’ve seen plenty of persons in religious orders who are addicts, so should physicians be held as somehow above this desire? If anything, they are more vulnerable and they need more protection.

We know that even those physicians who are in recovery are still liable to slip. The Times article noted that a 2008 study found that “802 doctors with a history of substance abuse who were monitored for five years showed that 65 percent remained free of drug or alcohol use.” But that means that 35 percent of them weren’t drug or alcohol free and where are they?

It’s no longer a case of “physician heal thyself” because they can’t do it alone. Monitoring must be incorporated into the medical system for everyone.