Tag Archives: prn

Will Florida Board of Medicine Follow Board of Pharmacy’s Lead and Recommend PRN Evaluations for Applicants Before Application is Considered?

Lance Leider headshotBy Lance Leider, J.D., The Health Law Firm

At the February 12, 2014, Florida Board of Pharmacy meeting, some board members expressed frustration with the fact that applicants for licensure with prior mental health or substance abuse related issues had not been evaluated by the Professionals Resource Network (PRN) prior to the consideration of their applications by the Board.  The applications were scheduled for consideration, but applicants were told to come back after they had PRN evaluations.  This recommendation by the Board of Pharmacy could have potentially serious consequences for applicants.

So far, the Board of Pharmacy is the only Board we are aware of to make such a recommendation. We are waiting to see if the Board of Medicine or other professional boards follows suit.

No Statutory Requirement to Get Preemptive PRN Evaluation.

The Board of Pharmacy’s recommendation that any applicants with “positive health history responses” seek out a PRN evaluation prior to submitting the application is not a course of action we would recommend for nurses, doctors, pharmacists or any healthcare provider.  There is no statutory requirement that an applicant with past or present drug or alcohol issues be evaluated by PRN prior to submitting an application to any professional board.

Issues with Submitting to Preemptive PRN Evaluation.

Submitting to a PRN evaluation places the applicant at the mercy of the organization and its appointed evaluator.  If an applicant is deemed by PRN to require monitoring there is likely no way that a license of any kind will ever be issued without the blessing of PRN.

Typically PRN monitoring contracts last for five years.  They require, among many other things: daily check-ins for drug and alcohol screens; frequent mental or substance abuse evaluations; weekly support meetings; possible restrictions on practice type and location; psychiatric following; total abstinence from all non-approved medications; total abstinence from alcohol; and notification of present and future employment.

In a word, PRN contracts are onerous.

Submitting to a PRN evaluation before your application is considered by the Board may serve to effectively waive your right to individual consideration of your application.  If PRN says you need to be monitored, there is likely no way that the Board of Medicine will grant you a license that is not conditional on your participation in the program.

Your license will likely be listed as “Active/Obligations” instead of “Clear/Active.”  This means that any member of the public, coworker, employer, insurer, etc., can look you up and see that you are under some kind of practice restriction.  While the exact conditions of your obligation may not be publicly available, you can bet that questions will come.

The Alternative to a Preemptive PRN Evaluation.

Because no Board has the right to force you to have a PRN evaluation prior to considering your application, there are several things that you can do to avoid the program.  The Board of Medicine is required to review every application on its own merits.  This means that you can supplement your application with recommendations and evaluations from your own physicians.

The Board of Medicine often considers the recommendations of treating physicians and counselors as evidence that an applicant is safe to practice. What this means is that you can obtain your own evaluation outside of the PRN program.  Such an evaluation would not have the potential of locking you into a monitoring contract before you have even applied.

A health care professional’s career rides entirely on his or her license to practice. It is not advisable that you face the Board of Medicine without at least consulting with a health law attorney.

Contact a Health Law Attorney Experienced in the Representation of Physicians and Other Health Care Providers Before the Board of Medicine.

The Health Law Firm and its attorneys are experienced in dealing with the Board of Medicine, PRN, and license applications.  Our attorneys can help you get your application and supporting documentation together and present it to the Board in the most effective way possible.

Our firm has extensive experience in representing physicians, nurses, pharmacists 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.

For more information please visit our website at http://www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Comments?

What do you think about the recommendation made by the Board of Pharmacy to get a preemptive PRN evaluation? Do you think any other board will make the same recommendation? Please leave any thoughtful comments below.

About the Author: Lance O. Leider is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone:  (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2014 The Health Law Firm. All rights reserved.

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.

Avoiding the ‘Disruptive Physician’ Label

Physicians are often unfairly labeled as “disruptive physicians” by hospitals, health care institutions, employers or economic competitors of theirs in a health care setting.  This label can be assigned to the most skilled, compassionate and innocent physician.  Unless immediate action is taken by the physician to counter this false labeling, it may result in extremely serious repercussions, loss of income and tremendous expense.

There has been a concerted effort among hospitals to identify and take action against “disruptive physicians.”  This has been encouraged by the Joint Commission.  Often a complaint will be made to the state licensing board or regulatory authority and investigated as an alleged violation of the medical practice act or as other grounds for discipline.  Far too often a physician will be intimidated into reporting himself or herself to a treatment and monitoring program for impaired physicians in order to avoid an investigation or complaint.  Most often, this is the wrong move to make.

We have seen, first-hand, attempts being made to label a physician as a “disruptive physician” because he or she refused to allow unnecessary and expensive invasive procedures to be performed on his/her patients by another physician in a hospital setting.  We have seen attempts made to label a doctor as a “disruptive physician” because he refused to provide a drug seeking addict (who was hospitalized after a gunfight with police) with additional narcotics.  We have seen attempts made by an economic competitor of a physician, who had been able to obtain election as president of the medical staff, to label a physician as a “disruptive physician” in order to drive her off of the hospital staff, thereby eliminating her competition with him.  We have seen competing medical groups form an alliance with administrators at a for-profit hospital, to label a physician competitor as a “disruptive physician” and enlist the aid of nursing staff to document every alleged transgression of the physician.  We have experienced instances where hospital nursing staff was instructed to scrutinize every act of a surgeon on the staff and to write up every perceived action of this doctor that might possibly be considered to be inappropriate any respect (even “rudeness”).  We have represented surgeons labeled as “disruptive physicians” because they cancelled an elective surgery after the scheduled surgery on their patient was delayed three hours because hospital staff did not come in on time and other surgeries started late.

Often physicians reacting to protect their patients from other physicians, or who may attempt to correct incompetent nursing staff, are labeled as “disruptive” because of their comments or actions.  Physicians who are somewhat demanding or who are perfectionists (as many, naturally, are), are often unfairly labeled as “disruptive.”  We have seen the most highly skilled subspecialists, whose only major concern is their patients care and safety, branded as a “disruptive physician” by hospital staff.  Almost all of the alleged “disruptive physicians” we have represented or been consulted by have been neurosurgeons, orthopedic surgeons or trauma surgeons.  We have also seen the label applied to physicians most often in smaller, more rural hospitals and communities where the nursing staff may be less than totally competent.

It is extremely important that a physician be sensitive to the possibility of being labeled a “disruptive physician” and the possible consequences this can bring.  It may result in the initiation of peer review proceedings to terminate clinical privileges and medical staff membership.  It may result in a complaint to the state licensing board against the physician.  We have handled a number of cases where complaints were made (even “anonymous” complaints”) to the state impaired physician program, resulting in a long, expensive battle with psychiatric experts and psychologists, in order to refute the allegations.

It is necessary that any allegation made that insinuates that the physician is a “disruptive physician” be immediately, but objectively, countered.  A neutral, factual rebuttal is often all that is required.  However, sometimes an economic competitor, or an unfriendly hospital administrator, will attempt to push the matter to extremes in an attempt to get rid of the physician, to make his or her job easier.  It may be advisable to obtain the services of an experienced healthcare attorney in fashioning a responsive or even formulating a strategy for a long-term defense in such situations.

In some cases, it may be advisable to have the client evaluated by an appropriately experienced psychologist or psychiatrist or other mental health professional ahead of time, in order to have expert evidence immediately available that the physician does not have a personality disorder or other impairment.  This may be used to head off any complaint to or from the state licensing board or impaired physician program.

In Florida, especially, we have seen an increase in referrals to the state impaired physician program for allegedly “disruptive physicians” where a cottage industry seems to have arisen in making such diagnoses and preparing treatment and monitoring plans for them.  We have been involved in at least one case where a prominent, successful surgeon was forced to undergo testing, evaluation, and psychoanalysis, by a major hospital (while he was excluded from practicing there), over a course of approximately two years, with the threat of disciplinary action by his state licensing board if he refused to “cooperate.”  Finally, after spending tens of thousands of dollars on the recommended psychiatric and psychological evaluations, and after spending tens of thousands of dollars in attorney’s fees, it was decided he had no such problems, he was not a “disruptive physician” and there was no probable cause for any disciplinary action against him.

In some cases, it may even be necessary for the physician to take the extreme measure of suing the hospitals and the individuals who are behind such action.  We have been required to do this on behalf of clients in a number of different cases.  Often, this is the only way to get the truth of the matter out, especially when it related to economic competitors of the physician who may be in control of the hospital’s medical staff.

We expect to see even more of this type of accusation being made against physicians in the future as a result of recent publicity encouraging the reporting of and action against “disruptive physicians.”

On July 9, 2008, the Joint Commission published the following alert to health care organizations:

Sentinel Event Alert;  Issue 40, July 9, 2008
Behaviors That Undermine a Culture of Safety

Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators and managers to seek new positions in more professional environments.  Safety and quality of patient care is dependent on teamwork, communication, and a collaborative work environment. To assure quality and to promote a culture of safety, health care organizations must address the problem of behaviors that threaten the performance of the health care team.
 
For the entire text and greater detail on detection, analysis, and prevention, as provided to health care organizations by the JCAHO, you may refer to:
http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm

We believe that, as a result of the foregoing, we will see a much greater attempt on the part of hospitals to identify and discipline physicians on hospital staffs as “disruptive physicians” through hospital peer review procedures, and through reports to state licensing boards and the organizations that were established to monitor physicians with substance abuse problems (such as the Professionals Resource Network (PRN) in Florida).

Any correspondence, warning, letter or counseling a physician receives that mentions the word “disruptive” or makes such an insinuation, should be taken very seriously by the physician.  It should be responded to immediately, with facts, in an objective and dispassionate manner without attempting to “blame” anyone else.  We would also encourage you to immediately seek the counsel of a board certified health law attorney experienced in handling such matters.

For more information about this and other legal matters concerning healthcare providers, visit www.TheHealthLawFirm.com.