Organizational Responsibilities and a Troubled Physician According to the American Medical Association (AMA) an impaired physician is unable “to practice medicine with reasonable skill and safety due to mental illness, physical illness, including but not limited to deterioration through the aging process, or loss of motor skill or excessive use or abuse of drugs, including alcohol” (API, 2011).
The scenario presented for this assignment involves Dr.Smith a talented and skillful cardiac surgeon on staff at a local community hospital, who is currently engaged in a divorce. On multiple incidences, hospital staff members observed Dr. Smith to be intoxicated. On one of these occasions, a nurse observed him the night before he was scheduled to operate, inebriated, and notified her supervisor. On the morning of surgery, Dr. Smith called in sick. There is great concern on the part of the hospital administration that Dr. Smith may perform surgery in an impaired state, noting he recently has made errors during surgery.
A Health care organization’s ultimate responsibility is to the patients it serves, and to make certain that physicians, either employed or privileged, are competent and functioning appropriately while providing quality patient care (Ohlsen, 2006). Under the doctrine of corporate negligence, “the hospital is liable if it fails to uphold the proper standard of care owed the patient, which is to ensure the patient’s safety and well-being while at the hospital” (Pozgar, 2010, p. 242). Hospitals hold certain nondelegable duties unrelated to the negligence an employee may commit.
Two nondelegable duties include monitoring the quality of care rendered by the medical staff, and hiring and keeping competent physicians (Pozgar, 2010). Allowing Dr. Smith to operate with the knowledge that he has committed errors during the performance of surgery and seen in an impaired state, places the organization at risk under the corporate negligence doctrine (Pozgar, 2009). In the case of an impaired physician, health care organizations are ethically bound to protect the patients (Palmer & Hoffman, 2007).
The authority of the hospital is dependent on the relationship between the hospital and physician. Hospitals are liable for the negligent acts of its employees based on the respondeat superior doctrine. Normally, organizations are not liable for negligent acts of independent contracted physicians, but the sheer existence of a contractual relationship does not eliminate the potential liability. “In Gonzales v. Nork & Mercy Hospital, the hospital was found negligent for failing to protect the patient, a 27-year-old man, from acts of malpractice by an independent, privately retained physician.
” “It was found that the hospital knew or should have known of the surgeon’s incompetence because the surgeon previously had performed many operations either unnecessarily or negligently (Pozgar, 2009, p. 99). The existence of a joint venture between Dr. Smith and the hospital guarantees joint liability for any negligent act (Pozgar, 2009). A health care organizations responsibility to the community and patients they serve is paramount, but they also have a legal and ethical responsibility to state licensing boards and professional organizations to report impaired physicians.
The American Medical Association (AMA) code of ethics requires physicians to report an impaired physician and deems it unethical for professionals to practice when under the influence of a controlled substance or alcohol (AMA, 2003). Each health care worker is also subject to legal and ethical standards. As a result, the nurse had a duty to report Dr. Smith’s behavior (Sollins, Rempher, Schwartz, & Mokwunye, 2009). Once she informed her supervisor of Dr. Smith’s impaired state, the hospital had a legal an ethical obligation to investigate the allegations to determine their validity.
As an administrator, I would conduct a proper investigation based on the hospital bylaws and policies and in consultation with the legal department and risk management, to determine the basis of the allegation of Dr. Smith’s impairment. Other helpful resources include organizational code of ethics such as the American College of Health Care Executive (ACHE) code of ethics. It is important the hospital substantiate any claims prior to taking action, to avert legal action if the basis of the claim is unfounded (Sollins, Rempher, Schwartz, & Mokwunye, 2009).
The medical staff process is relevant in dealing with these issues and is best able to evaluate performance and practice, as well as lead the investigation and evaluation of alleged impairment (Ohlsen, 2006). According to Ohlsen (2006), one-third of all physicians at some point in their career will have a condition resulting in impairment. Therefore, having a medical staff process in place to monitor and evaluate clinical behavioral performance, and identify impaired physicians is imperative (Ohlsen, 2006).
Children’s Hospital of The Kings Daughters (CHKD) uses members from the credentialing committee and professional staff to conduct impaired physician investigations (Ruth Jackson, personal communication, May 27, 2011). Investigation should include interviews with individuals who witnessed the incident or have information pertinent to the allegations, review of any pertinent documents, a meeting with Dr. Smith to ascertain if there is health related reasons for his behavior, potential drug or alcohol screening, and a potential physical/psychiatric examination.
It is important to remember that certain medical conditions can mimic intoxication and these should be ruled out. The findings of the investigation will determine the course of action. If the investigation concludes that there was no basis for the claim, no action would be taken. If the investigation determines Dr. Smith to be impaired, it must also be determined if the nature of the impairment is a disability under the American Disability Act (ADA). We will assume that Dr. Smith does not have an ADA qualifying disability.
Consequently, the hospital may take any of the following actions depending on the results of the investigation: 1) modify, restrict or terminate clinical privileges, 2) require Dr. Smith to participate in a rehabilitation program as a condition of continued appointment and clinical privileges 3) require Dr. Smith to take a leave of absence until he completes rehabilitation, 4) random drug and alcohol screening (Ruth Jackson, personal communication, May 27, 2011). Based on the legal and ethical issues of this case, I would advise the hospital Chief Executive Officer (CEO) to forgo a joint venture until Dr.
Smith impairment resolves his impairment. Most joint ventures mean the costs go to the hospital, and the profits are split with the partner physician. Consequently, the hospital bears a greater risk. Hospitals enter into joint ventures with physicians due to the volume or margin they can bring. Since the hospital is already assuming most of the risk, to partner with a physician whose is drinking and could potentially commit a negligent act, or have his license restricted thereby limiting his ability to bring business to the joint venture is too risky.
I would further advise the CEO based on the findings of impairment to take some action regarding Dr. Smith’s privileges. At a minimum, his privileges should be restricted to protect patients and the hospital from liability. I would mandate he enter a rehabilitation program and submit to random alcohol screening. To be compliant with state and licensing boards, the hospital should report Dr. Smith’s impairment. Once Dr. Smith is rehabilitated, reinstatement of full privileges should occur, and it is reasonable to revisit the joint venture opportunity.
Recognizing an impaired health care worker can be difficult. Although there are many signs, behaviors are not always definitive and therefore may be overlooked (Palmer & Hoffman, 2007). Recently I was in the position of having to report a co-worker for what I deemed suicidal behaviors. Although the organization did not have a clear process for this type of behavior, we were able to help this individual get the help she needed. References AMA (2003). Reporting Impaired, Incompetent, or Unethical Colleagues.
Retrieved May 27, 2011, from http://www. ama-assn. org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinoin9031. page American Physicians Insurance Company (API) (2011). The Impaired Physician. Retrieved May 27, 2011, from http://www. api-c. com Ohlsen, J. D. (2006). The Board’s Role with Impaired Physicians. Trustee, 59(6), 32-33. Palmer, L. , ; Hoffman, L. A. (2007). Detecting and Preventing Substance Abuse in Health Care Professionals. Critical Care Alert, 15(1), 5-8. Pozgar, G. D. (2010). Legal and Ethical.