In Treatment: Physicians and the Professionals Resource Network (PRN)

In an industry so concerned with serving others, physicians and other health professionals sometimes find that they are the ones being pushed towards a treatment program. According to a recent study, alcohol abuse is the most common reason for enrolling in a physician health program. Other reasons for treatment included opioid, stimulant and sedative abuse. However, not all physicians and health professionals that are referred to a health program are in need of rehabilitation services.

The Florida Department of Health’s Impaired Practitioners Program is administered by the Professionals Resource Network (PRN) and the Intervention Project for Nurses (IPN). IPN is responsible for all nurses and works with and through the Florida Board of Nursing. The Florida Board of Medicine and all other professional licensing boards in the DOH have contracted with and use the services provided by Professionals Resource Network (PRN).

We routinely work with physicians who are accused by employers, hospitals, competitors, terminated employees, or supervisors in graduate medical education (GME) programs of impairment due to drug or alcohol abuse, of mental impairment, of being a “disruptive physician” or of sexual boundary issues.

Our firm has extensive experience in representing physicians and other professionals accused of drug abuse, alcohol impairment, mental impairment and sexual boundary issue, as well as in dealing with the Professionals Resource Network (PRN), its advantages and disadvantages, its contracts, its personnel, and its policies and procedures.

We are also quite familiar with the interactions between PRN and the Board of Medicine. We have had a great deal of experience in working with the different psychiatrists, certified addictions professionals (CAPs) and evaluators which PRN routinely employs to perform its initial evaluations on physicians.

Our clients routinely include physicians and other health professionals who are alleged to be impaired because of drug abuse, alcohol abuse or mental or physical impairments. We routinely are consulted by physicians who have a DUI conviction, who have a positive result on a drug or alcohol test or who are accused of addiction or theft of drugs because of discrepancies in drug inventories, or for any other number of reasons.

We routinely consult with, advise and defend physicians facing all of the foregoing types of problems. It is crucial that the physician obtain qualified legal representation and advice immediately before speaking to hospital administrators or medical staff leaders about the matter, before giving a urinalysis sample, before reporting to PRN and before going for an evaluation by a psychiatrist or a certified addictions professional (CAP).

Furthermore, these types of allegations made against a physician are extremely serious because they are usually treated by the Department of Health as “Priority 1″ or “Fast Track” offenses. This means that the charges against the physician will usually be automatically considered for an Emergency Suspension Order (ESO) by the Department of Health. The investigation will be “fast and dirty” with a requirement that the DOH investigator have the entire investigation completed and the report in Tallahassee within 45 days. Then, unless a qualified, experienced attorney is able to immediately produce reliable documentation and other evidence showing the physician is not impaired and is not a threat to patient health or safety, the Surgeon General (formerly the Secretary of the Department of Health) will issue an Emergency Suspension Order (ESO). This suspends the physician’s license until all proceedings are completed and finalized (which often takes a year or more). The physician will be unable to work as a physician during any period when his or her license is suspended and, even if he or she has a license in another jurisdiction, since the suspension is a public record that is widely published and other jurisdictions are notified, he or she may find the license in the other states is also suspended.

However, even where the physician may actually have committed the offense, there are a number of administrative and procedural measures which an experienced health care attorney, one familiar with Board of Medicine and PRN cases, may be able to use to avoid a suspension. This will also prevent the matter from becoming public until much later in the process.

For the innocent physician or health professional, an experienced attorney familiar with such matters may be able to obtain additional drug testing, polygraph (lie detector) testing, scientific evidence, expert witnesses, evaluations by certified addictions professionals, character references, or other evidence which shows innocence.

PRN does have some advantages for the truly impaired physician. It provides an avenue of rehabilitation, monitoring and treatment for a truly impaired physician. It is an invaluable tool to assist a physician with a real problem to retain his ability to practice. Some physicians should not be practicing except through PRN. However, PRN also has some serious disadvantages and may, among other things, cause the physician to lose clinical privileges in a hospital; lose an employment position; require the physician to enter into long term inpatient rehabilitation; cause the physician to undertake extremely expensive treatment counseling and therapy; and impose very onerous burdens of time and money on the physician, as well as job limitations. Additionally, PRN routinely relies on Alcoholics Anonymous (AA) and its particular philosophy of coping with substance abuse, even though there may be competing schools of thought on the subject, some of which are equally or more effective.

In many cases, the physician who is the victim of a termination action by an employer, a complaint by a hospital or a complaint against his or her professional license involving allegations of drug abuse, alcohol abuse, or impairment, may view PRN as an easy way to avoid discipline. This is a complete fallacy. Such an apparent easy way out should be avoided at all costs.

If the physician is not truly an impaired provider or addicted to drugs or alcohol, there may be other alternatives that do not involve discipline. PRN is not “easy” and this is not an easy way out.

It is extremely important that before you “self-report” to PRN you contact an experienced health care attorney for advice.
If the physician is not truly an impaired provider or addicted to drugs or alcohol, there may be other alternatives that do not involve discipline.

It is extremely important that before you agree to go to the initial evaluation by a physician (or sometimes a psychologist or mental health counselor) specializing in addictionology (as PRN always requires), obtain legal advice.

Before you give any blood, urine, hair samples or other drug or alcohol testing, you should contact us for advice. We have access to the same or similar testing labs as PRN. We can arrange to have you tested first so that you will know whether or not you should have any concerns. For example, did you know that the use of certain prohibited drugs (including cocaine) will leave a residue in your hair which can be detected for months or longer after use? Are you aware that there are now tests being used which can tell if you have had one regular size alcoholic beverage within the past thirty (30) days? There are even tests being used now to test health care professionals for the illicit use of anesthetic gases such as Aldan.

We are consulted by just as many physicians who want to get out of the PRN Program after they agreed to enter it without proper legal advice. Even though at the time it seemed like a good idea, or the physician incorrectly thought there was no choice in the matter, it turns out to be a big mistake for that person. In most cases, it is not possible to leave the PRN Program after agreeing to it without giving up your medical license. And this can have some extremely adverse consequences for a physician, including a report to the National Practitioner Data Bank (NPDB), exclusion from the Medicare and Medicaid Programs and debarment from all federal government contracting.

We are told that 60 day, 90 day, and longer periods of inpatient drug or alcohol treatment may be required before the physician can return to work. Physicians accepted into PRN usually must sign a five year contract agreeing to monitoring, weekly counseling meetings, regular psychiatric visits, random urinalysis testing (with a mandatory call in every day of your life for the five year contract period), mandatory notification of all employers and hospitals where you have clinical privileges that you are in PRN, a strict prohibition on drinking any alcoholic beverage or taking any medication (even over the counter medications) without the prior approval of PRN, possible loss of your privilege to prescribe or administer narcotics, a possible requirement that you only work under the supervision of another physician, or other possible requirements.

The bottom line is: If you are accused of drug impairment, alcohol impairment, sexual boundary issues, sexual misconduct, or of being mentally or physically impaired, immediately contact an attorney experienced with PRN and Board of Medicine matters before doing anything else. Don’t risk losing your livelihood by taking the apparent only way out. There may be other options available for you. For more information about PRN and other legal matters concerning health professionals, visit www.TheHealthLawFirm.com.

IPN and Nurses

Please also see our latest post about IPN.

The Intervention Project for Nurses (IPN) is a program that provides close monitoring of nurses who are unsafe to practice due to impairment as a result of misuse or abuse of alcohol or drugs, or both, or due to a mental or physical condition which could affect the licensee’s ability to practice with skill and safety. Any person suspecting impairment of a nurse’s ability to provide safe nursing care may report this nurse to IPN and/or the Florida Department of Health (DOH). Under Florida’s Mandatory Reporting Law, all licensed nurses must report any suspected impairment in practice to IPN and/or the DOH.

Often a report against a nurse will be based totally on the suspicions of a supervisor, after observing a nurse at work who is actually exhibiting signs of illness or fatigue. Circumstances which are totally beyond the control of the nurse, such as a shortage of drugs from an inventory for which the nurse is not responsible, a higher use of a certain drug on a certain ward or shift, or other factors for which there is no concrete evidence of abuse or impairment can lead to a report being filed against a nurse.

These types of allegations made against a nurse are extremely serious because they are usually treated by the Department of Health as “Priority 1″ or Fast Track” offenses. This means that the charges against the nurse will usually be automatically considered for an Emergency Suspension Order (ESO) by the Department of Health. The investigation will be “fast and dirty” with a requirement that the DOH investigator have the entire investigation completed and the report in Tallahassee within 45 days. Then, unless a qualified, experienced attorney is able to immediately produce reliable documentation and other evidence showing the nurse is not impaired and is not a threat to patient health or safety, the Surgeon General (formerly the Secretary of the Department of Health) will issue an Emergency Suspension Order (ESO). This suspends the nurse’s license until all proceedings are completed and finalized (which often takes a year or more). The nurse will be unable to work as a nurse during any period when the license is suspended and, even if the nurse has a license in another jurisdiction, since the suspension is a public record which is widely published and other jurisdictions are notified, the nurse may find that licenses held in other states also suspended.

However, even where the nurse may actually have committed the offense, there are a number of administrative and procedural measures which an experienced healthcare attorney, one familiar with Board of Nursing and IPN cases, may be able to use to avoid a suspension. This will also prevent the matter from becoming public until much later in the process.

For the innocent nurse, an experienced attorney familiar with such matters may be able to obtain additional drug testing, polygraph (lie detector) testing, scientific evidence, expert witnesses, evaluations by certified addictions professionals, character references, or other evidence which shows that the nurse is innocent of the charges.

In many cases, the nurse who is the victim of a termination action by an employer or a complaint against his or her nursing license involving allegations of drug abuse, alcohol abuse, or impairment may view IPN as an easy way to avoid discipline. This is a complete fallacy. Such an apparent easy way out should be avoided at all costs.

If the nurse is not truly an impaired provider or addicted to drugs or alcohol, there may be other alternatives that do not involve discipline. IPN is not “easy” and should not be viewed as an easy way out.

It is extremely important that before a nurse “self-reports” to IPN or agrees to undergo the initial evaluation by an IPN recommended physician (usually one specializing in addictionology, as IPN always requires), an attorney who has experience with IPN cases is consulted for advice.

Before a nurse gives any blood, urine, hair samples or submits to other drug or alcohol testing, he or she should be aware that similar testing labs to the ones used by IPN exist. The nurse can arrange to be tested ny another lab first so that he or she will know whether or not the report will be problematic. For example, did you know that the use of certain prohibited drugs (including cocaine) will leave a residue in your hair which can be detected for months or longer after use? Are you aware that there are now tests being used which can tell if you have had one regular size alcoholic beverage within the past thirty (30) days? There are even tests being used now to test health care professionals for the illicit use of anesthetic gases such as Aldan.

IPN does have some advantages for the truly impaired nurse. It provides an avenue of monitoring, rehabilitation, monitoring and treatment. It is an invaluable tool to assist a nurse with a real problem to retain her ability to practice. Some nurses should not be practicing except through IPN.

However, IPN also has some serious disadvantages and may, among other things, cause the nurse to lose his or her job, require the nurse to enter into long term inpatient rehabilitation, cause the nurse to undertake extremely expensive treatment, counseling and therapy, and impose very onerous burdens of time and money on the nurse, as well as work limitations.We are consulted by just as many nurses who want to get out of the IPN Program after they agreed to enter it without proper legal advice. Even though at the time it seemed like a good idea, or the nurse incorrectly thought there was no choice in the matter, it turns out to be a big mistake for that person.

Some nurses are required to complete 60 day, 90 day, and longer periods of inpatient drug or alcohol treatment before being allowed to return to work. Nurses accepted into IPN must sign a five year contract agreeing to monitoring, weekly counseling meetings, regular psychiatric visits, random urinalysis testing (with a mandatory call in every day for the five year period), mandatory notification to all employers, a strict prohibition on drinking any alcoholic beverage, or taking any medication (even over the counter medications) without the prior approval of IPN, possible loss of your privilege to administer narcotics, possible loss of your privilege to access any prescription medications, and a possible requirement that you only work under the supervision of another registered nurse.

In most cases, it is not possible to leave the IPN Program after agreeing to it without giving up your nursing license. And this can have some extremely adverse consequences for a nurse, including a report to the National Practitioner Data Bank (NPDB), exclusion from the Medicare and Medicaid Programs, and debarment from all federal government contracting.
The bottom line is: If you are accused of stealing drugs, of sexual boundary issues or sexual misconduct, or of being impaired, immediately contact an attorney experienced with IPN and Board of Nursing matters before doing anything else.

For more information about IPN and other legal matters involving nurses, visit www.TheHealthLawFirm.com.