New Program Offers Help Without TMB Discipline
Tex Med. 2010;106(12):43-46.
By Crystal Conde
When Lubbock neurosurgeon Lloyd Garland, MD, was coming to terms with alcoholism 18 years ago, he turned to the Lubbock-Crosby-Garza County Medical Society's Physician Health and Rehabilitation (PHR) Committee for help. Sober for 17 years, Dr. Garland says his experience with addiction makes him the ideal physician to be medical director of the Texas Physician Health Program (TXPHP). Dr. Garland took the post last year.
"The local medical society first met with me as I began to admit I had a problem with alcohol and helped me get started on the path to recovery. My activities in the TXPHP are my way of paying back for my miracle," he said.
Senate Bill 292 established TXPHP during the 2009 legislative session. The program helps impaired physicians, physician assistants, acupuncturists, and surgical assistants get treatment for their problems through a monitored recovery program. The program accepts self-referrals or referrals from an individual, a PHR committee, a physician assistant organization, a state physician health program, a state acupuncture program, any hospital or hospital system licensed in Texas, a residency program, the Texas Medical Board (TMB), the physician assistant board, or the acupuncture board.
TXPHP is the newest health and rehabilitation offering for impaired physicians and other health professionals licensed by TMB. Physicians needing help still can turn to the Texas Medical Association Committee on Physician Health and Rehabilitation and their local county medical society PHR committee. (See "Programs Coordinate to Help Physicians.")
Dr. Garland adds that it's not just substance abuse problems that qualify under TXPHP. Health professionals suffering from psychiatric problems or illnesses such as Alzheimer's disease, heart disease, stroke, tremors, and other health complications can be monitored under the program.
"TXPHP looks at the whole picture to allow doctors to be functioning members of society. We don't want to lose these physicians," he said.
The program costs $1,200 a year per participant. This is in addition to medical costs such as required evaluations, primary treatment, continuing care, and monitoring fees.
To view TMB rules governing TXPHP, visit the TMB website [PDF].
Forms to report substance abuse disorders and other conditions are available on the TXPHP website. After submitting the forms to the TXPHP office, physicians can expect to hear from the program within 10 business days. For more information, call (512) 305-7462.
No TXPHP Discipline
Physicians and other health professionals can report themselves to TXPHP confidentially and receive help in lieu of an investigation and disciplinary action by the medical board. That's crucial to the program's success, says Brian D. McDaniel, DO, chair of the TMA PHR Committee and a general surgeon in Victoria.
"A healthy physician is more likely to provide excellent patient care. Assuring the health and well-being of our physicians in Texas requires a confidential reporting mechanism. I believe the TXPHP is a step in the right direction to accomplish that," Dr. McDaniel said.
The new state-level monitoring program isn't in the business of disciplining doctors.
"Physicians now don't have to hide from the TMB for fear of losing their license. The TXPHP is on the physician's side and focuses on monitoring doctors who need help to return them to medical practice safely," he said.
Before this year, Texas physicians receiving assistance for impairment faced the difficult decision of reporting themselves to TMB. Physicians still need to tell TMB about any conditions that could impair them when they renew or apply for their medical license. Once the board has that information, it can consider whether the impairment falls within the scope of TXPHP. The license application requires physicians to report an arrests, even if they weren't convicted, and to disclose any physical, mental, or neurological condition in the past five years that impaired their behavior, judgment, or ability to function in school, work, or other important life activities.
Dr. McDaniel says physicians who face felony charges for their actions, injure a patient while impaired, or have sex with a patient or patient's family member cannot participate in the program and are dealt with by TMB.
Nevertheless, Dr. McDaniel says most physician health problems qualify for the program.
"The fear of adversarial action by the TMB most likely contributed to under-reporting and inadequate treatment of physician health problems," he said.
TMB Executive Director Mari Robinson, JD, says the board plays only an administrative role in TXPHP. The board helps the program with processing payments, setting up computers, and other administrative functions.
"Unless the TXPHP is required to report a case to us, the program's decision making is independent of the board," Ms. Robinson said.
Ms. Robinson says TXPHP provides physicians with the option of referring themselves or an impaired colleague to a third party. Previously, she explains, physicians could voluntarily refer themselves only to TMB and receive a nonpublic, nondisciplinary order.
"One of the advantages of the new program is if a doctor's potential impairment issue comes to the attention of the board before any patient safety violations occur, TMB can refer the doctor to the TXPHP without issuing a disciplinary order," she said.
Since fiscal year 1999, TMB has issued 556 rehabilitation orders. During fiscal year 2009, the board issued 99. Ms. Robinson says Senate Bill 292 eliminated TMB's authority to offer rehabilitation orders.
To view TMB's enforcement statistics for the past 10 years, visit the TMB website.
Once physicians realize the level of discretion in self-reporting, Dr. McDaniel says, the number of reports may increase.
TXPHP already has its hands full. As of September, Dr. Garland says, the program had received 279 referrals. Of those, 208 were physicians, and 178 had agreed to treatment and monitoring and had paid the fee. TXPHP is reviewing the remaining referrals to determine whether the practitioners involved qualify for services under the program, Dr. Garland says. As of August, about 20 percent of referrals were unresolved and sent back to TMB.
Participants Must Follow Agreements
Dr. Garland says physicians in TXPHP must sign an agreement that stipulates the conditions of treatment under the program.
"Practicing quality medicine without potential risk to patients is what the agreement is all about," he said. "One of the motivating forces is that TXPHP is committed to patient safety and well-being."
Agreements for minor problems typically run from six months to a year. Health professionals dealing with more extensive concerns may be monitored for up to five years. The terms of participants' agreements vary.
For example, Dr. Garland says, a physician who is caught driving while intoxicated more than once and doesn't acknowledge a drinking problem may be required to undergo a 96-hour in-patient evaluation. Dr. Garland says he gives participants several options of physicians or facilities for evaluation. To continue TXPHP monitoring, the physician would be required to follow the recommendations and treatment plan developed by the evaluation center.
Additional provisions of the agreement may require the participant to attend Alcoholics Anonymous meetings and to have a work-site monitor. In addition, the physician may have to undergo a psychiatric evaluation. The psychiatrist would send regular reports to TXPHP.
If a physician violates the agreement, the TXPHP governing board must report the violation and the circumstances surrounding it to TMB. In addition, the TXPHP governing board must report an individual who has been referred by the medical board or a third party to the program but does not enter into an agreement for services.
Ms. Robinson says TMB can refer the individual back to TXPHP to continue treatment or pursue disciplinary action. Disciplinary orders can include fines, requirements for more treatment and monitoring, or license revocation.
Crystal Conde can be reached by telephone at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by e-mail at firstname.lastname@example.org.
Meet the TXPHP Board
An 11-member board appointed by Texas Medical Board President Irvin Zeitler Jr., DO, oversees the Texas Physician Health Program (TXPHP). The members are:
- Brady Allen, MD, Dallas;
- Eugene Boisaubin, MD, Houston;
- Mary Boone, LCSW, LCDC, Austin;
- Ronald Brenz, DO, San Antonio;
- Judy Googins, MD, Tyler;
- John Jackson, MD, Fort Worth;
- Alison Jones, MD, Austin;
- Helaine Lane, Houston;
- Anand Mehendale, MD, Kerrville;
- Melinda Moore, PA-C, Sugar Land; and
- Russell Thomas Jr., DO, Eagle Lake.
Programs Coordinate to Help Physicians
To help monitor impaired physicians and get them into appropriate treatment, the Texas Physician Health Program (TXPHP) collaborates with the physician health and rehabilitation committees of county medical societies and the Texas Medical Association Committee on Physician Health and Rehabilitation (PHR), says Lloyd Garland, MD, TXPHP medical director. He says the committees have established trust in the local medical communities.
The TMA PHR Committee, established in 1976, is available to all physicians, residents, and medical students in Texas. Brian D. McDaniel, DO, chair of the TMA PHR Committee and a general surgeon in Victoria, says the committee helps to ensure safe patient care by promoting the health and well-being of Texas physicians.
TMA's PHR Committee educates the medical community through continuing medical education activities and publications and operates a random statewide drug screening program. The committee collaborates with county medical society PHR programs in the state to arrange interventions when appropriate and to recommend approved facilities for evaluation and treatment. In addition, TMA's committee advocates for the physician while maintaining confidentiality and the highest ethical standards.
Problems addressed by TMA's committee include stress and burnout, substance use disorders, psychiatric problems, disruptive behavior, sexual misconduct and boundary issues, physical and cognitive impairment, aging and retirement, and physical illnesses.
Anyone may report a concern about a physician, resident, or medical student by calling the 24-hour hotline at (800) 880-1640 or (512) 370-1640. For more information about the PHR Committee's services, contact Linda Kuhn, TMA Physician Health and Rehabilitation program manager, by e-mailing Linda Kuhn or by calling (800) 880-1300, ext. 1342, or (512) 370-1342.
County medical society committees are available to assist physicians free of charge, too. James Maynard, MD, an Austin psychiatrist, is cochair of the Travis County Medical Society's PHR Committee, which has been helping physicians for more than 20 years. Dr. Maynard, who has been on the committee since 1990, says the group helps about 10 physicians per year acquire the appropriate treatment.
"We get referrals from hospital medical directors, concerned nurses and staff members, concerned family members, and colleagues," Dr. Maynard said. "We usually set up an intervention and then help the impaired doctor get into the appropriate treatment. We coordinate with the treatment center and then usually have the doctor on contract with us for follow-up monitoring for several years."
The Travis County Medical Society's committee follows the guidelines set up by TMA's PHR Committee and collaborates with the group at times. For example, the medical society's PHR Committee may monitor a physician, but TMA's PHR Committee may manage a physician's drug screening.
About half of the state's county medical societies have a PHR committee. For county medical societies that don't have a committee or that need assistance, TMA PHR Committee's 15 district coordinators – one to represent each of the TMA councilor districts – can help.
TMA's PHR Committee, district coordinators, and county medical society PHR committees respond to referrals. Once a physician has been referred, county medical society PHR committees and/or district coordinators assemble an intervention team to begin the process of getting the impaired physician into treatment.
To contact the PHR committees of the county medical societies, telephone Linda Kuhn, TMA Physician Health and Rehabilitation program manager, at (800) 880-1300, ext. 1342, or (512) 370-1342.
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