ALCOHOL AND CONTROLLED SUBSTANCE ABUSE DIVERSION
PURPOSE
Abuse of drugs and alcohol by healthcare providers can have serious adverse effects on patient safety and the health and well-being of those who abuse such substances. It also impacts performance and safety of others in the workplace. The purpose of this policy is to identify expected housestaff conduct, guide investigations of suspected substance abuse and drug diversions, and guide disciplinary actions taken stemming from the abuse of alcohol and controlled substances by housestaff to protect patients and others in the work environment.
POLICY
MCWAH does not tolerate the use of alcohol and/or controlled substances without a valid prescription from a treating physician in the workplace. MCWAH has a zero tolerance policy for the diversion of controlled substances, pharmaceuticals and medical supplies. Failure to comply with this policy will result in disciplinary action that may include termination from the training program.
All housestaff employed by MCWAH are covered by this policy regardless of the training site.
1. Housestaff must report to work fit to practice and must not be under the influence of alcohol or any drug that impairs his/her ability to perform his/her job duties. Being fit to practice also means not reporting to work impaired from the effects of previous use of alcohol or controlled substances.
2. The use of a controlled substance prescribed by a treating physician is permitted as long as it does not impair in any way the ability of the housestaff to perform his/her duties safely.
3. Housestaff must refrain from practicing if prescribed or over the counter medication(s) impairs his/her performance or judgment.
4. Housestaff have the duty to report the use or suspected use of alcohol or controlled substances by anyone in the work environment.
5. Housestaff may never manufacture, distribute, possess, sell, or purchase non-prescribed controlled substances at any time or at any place.
6. Housestaff are required to cooperate in investigations regarding any suspected use of alcohol or controlled substances and/or drug diversion. The investigation may include drug testing and/or search of housestaff property on the premise of any affiliated hospital. Depending on the circumstances, housestaff may be placed on an Administrative Leave during the investigation. Whether the Leave will be paid shall be determined based on the outcome of the investigation. If the housestaff is found to have been unfit for duty, then the leave of absence shall be unpaid.
7. The Program Director may request that housestaff undergo testing and/or an evaluation for drug and/or alcohol any time there is apparent cause or a reasonable suspicion that his/her performance may be affected by such and/or the Program Director believes there may be or has been a serious risk of harm to patients and/or staff. Apparent cause or reasonable suspicion may be based upon observations, missing controlled substances or information obtained from others. (See procedure for testing and evaluation below.)
8. The Program Director must notify the MCWAH DIO, or his/her designee, as soon as possible regarding the intent to test housestaff. The Program Director must provide the MCWAH DIO or his/her designee an update following the testing.
9. The Program Director must document in a separate health record, kept with the training file the reason or rationale as to why s/he requested the testing, the date and time the testing was done, the outcome of the test and any disciplinary actions taken.
10. Housestaff who are unfit for duty because of the use of alcohol or controlled substances will be disciplined and may be terminated from the training program.
11. Housestaff who refuse to submit to testing and/or an evaluation as required by this policy may be immediately terminated from the training program.
12. Housestaff who have been found to have diverted drugs or to have used alcohol or controlled substances while at work will be disciplined and may be terminated from the training program. This also includes housestaff working in an impaired state resulting from a prescribed controlled substance.
13. Where MCWAH has determined that there is a reasonable suspicion that a housestaff was working under the influence of alcohol and/or controlled substances (prescribed or otherwise) s/he shall be offered a medical evaluation for acute intoxication and the risk of withdrawal. This assessment shall be voluntary on the part of the housestaff.
14. The use of drugs or alcohol while working is considered unprofessional behavior that must be reported to the Wisconsin Medical Examining Board. Housestaff will be encouraged to self-report and to provide MCWAH with proof of such a submission. At the end of two weeks if MCWAH has not received confirmation that the housestaff has self-reported his/her unprofessional conduct, MCWAH will submit a written report to the Wisconsin Medical Examining Board regarding the housestaff’s use of alcohol, controlled substances or the diversion of drugs in violation of this policy.
15. MCWAH reserves the right to report any instance of drug diversion to the appropriate law enforcement authorities and other regulatory bodies as may be appropriate.
16. Housestaff who have problems with the use of alcohol or controlled substances will be encouraged to undergo rehabilitation, preferably at a facility that has an impaired professional program.
17. Housestaff who enter drug and alcohol treatment will be required to apply for a leave of absence from the program (unpaid except to the extent of any accrued paid leave is available). This leave of absence will be conducted in accordance with any applicable laws and regulations pertaining to the state and/or federal Family Medical Leave Act, and/or disability laws, which may apply to the situation and are further described under separate MCWAH policy or the Housestaff Handbook. Housestaff will be required to submit a Fitness for Duty Report from his/her treating provider prior to being allowed to return to work. Housestaff eligibility for board certification may be impacted by a leave of absence. (See MCWAH’s Leave of Absence policy)
18. Continued employment and training of housestaff known to have abused alcohol and controlled substances in violation of this policy will be at the discretion of the Program Director and MCWAH DIO & Executive Director. The decision to allow housestaff to resume training will take into consideration:
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The facts involved in the specific instance including an assessment by MCWAH of state and federal disability regulations.
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Whether the housestaff diverted controlled substances.
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The clinical practice requirements of the specialty.
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Continued treatment by a provider in an impaired professional rehabilitation program and continued compliance with his/her recommendations.
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Receipt of a satisfactory fitness for duty evaluation by an appropriate professional. MCWAH reserves the right to have the housestaff undergo a Fitness for Duty examination conducted by an independent medical provider selected by the Program Director and the MCWAH DIO & Executive Director.
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Enrollment in the Wisconsin Professional Assistance Program.
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Agreement to submit to on-going drug and/or alcohol tests.
19. Any housestaff in an alcohol and substance abuse rehabilitation program must authorize the release of The Wisconsin Department of Safety and Professional Services’ Professional Assistance Therapy Reports to the Program Director and MCWAH's DIO & Executive Director concerning his/her rehabilitation progress and compliance with its program requirements. The release of such medical information shall be required to continue training in the graduate medical education program.
20. MCWAH reserves the right to require housestaff who have abused alcohol and controlled substances to sign an agreement that specifies expected conduct in order to continue the training program. This agreement is referred to as a “Last Chance Agreement.”
21. Individual graduate medical education training programs may initiate non-discriminatory, program-wide testing and evaluation for alcohol and controlled substances with the prior approval of the Designated Institutional Official (DIO) & Executive Director.
PROCEDURE FOR TESTING AND EVALUATION
1. The Program Director shall alert the MCWAH DIO, or his/her designee, of the identified need for drug testing.
2. The Program Director shall contact the MCW Occupational Health Office and arrange for the testing for alcohol and controlled substances.
3. The Program Director shall alert the MCW Director of Resident and Student Mental Health Services of the potential need for drug testing and the facts of the situation so that the Director may assist in facilitating a referral to a medical provider trained in addictionology for evaluation and/or for placement at an inpatient facility.
4. The required drug testing will consist of whatever methodologies are appropriate for identification of the suspected abuse as determined by MCW Occupational Health in consultation with the Program Director and the MCWAH DIO & Executive Director.
5. Before a drug and/or alcohol evaluation or test is conducted, the Program Director will inform the housestaff to be tested of the opportunity to disclose information that s/he believes may support a legitimate use of a specific drug and, either before or after testing, submit medical documentation thereof. Legitimate use of drugs does not preclude further actions under this policy. The policy is directed at abuse and impairment regardless of the legitimacy or legality of the usage.
6. The refusal of testing and evaluation may be grounds for immediate termination.
7. The housestaff will be escorted to the testing point by the Program Director or his/her designee. If the housestaff is at an off-campus site, arrangements will be made to escort and transport the housestaff back to campus for testing.
8. Following testing, if there is a reasonable suspicion that the housestaff has been under the influence of alcohol or controlled substance, the Program Director shall recommend that the housestaff speak to the Director of Resident and Student Mental Health Services for referral to a provider that specializes in addiction therapy to assess for the risk of withdrawal related to alcohol or drug cessation. Reasonable suspicion may still be present in the absence of negative test results or a delay in receiving test results due to processing times. Whether the housestaff chooses to complete this evaluation is entirely at the option of the housestaff.
9. If the housestaff elects to complete the evaluation, the housestaff shall be provided transportation to a recommended facility. If the housestaff refuses to be medically evaluated, the Program Director shall arrange for the housestaff to be transported to their residence.
10. If there is a reasonable suspicion that the housestaff worked while under the influence of alcohol or controlled substances or diverted drugs, the Program Director and MCWAH shall place the housestaff on an Administrative Leave pending the outcome of the tests. See process describe in the Evaluation of Housestaff and Progressive Management of Substandard Performance policy.
11. Results of the testing and evaluation will be reported to the housestaff, the Program Director and the MCWAH DIO & Executive Director. Any housestaff who refuses to agree to release the results of this evaluation and testing to the Program Director and to the MCWAH DIO shall be subject to termination.
12. Test and evaluation results will be accessible to appropriate personnel, but shall otherwise be retained and kept confidential as required by law. (See MCWAH's Fitness for Duty Evaluation policy.)
13. All costs associated with testing for drugs and controlled substances will be allocated to the respective MCW Department.
This policy was approved by the MCWAH Graduate Medical Education Council on April 16, 2012. The original policy was approved on October 18, 2004, and a revised policy was approved on July 18, 2011.