4/3/2013 Executive Medical Director, West Virginia Medical Professionals Health Program, (WVMPHP) President, West Virginia Society of Addiction Medicine (WVSAM) Diplomat, American Board of Addiction Medicine, (ABAM) 4/3/2013 2 1 4/3/2013  Evolution  Structure & Function  Program Statistics  Future Thinking 1970’s – Physicians Health Conference “The Sick Physician” 1980’s – SMA Authorization – WV Interested Others 1990’s – FSPHP Formed – WV Organized Medicine interested – PHP analog 2000’s – West Virginia State Medical Assoc. Senate Bill No. 573, March 8, 2007 West Virginia’s Medical Professionals Health Program 4/3/2013 4 2 4/3/2013 THE DEADLY SILENCE DENIAL FEAR IGNORANCE AMBIVALENCE MYTHS 3 4/3/2013 Physicians have a right and an obligation to ask for help when they are struggling with potentially impairing ILLNESS. When they request assistance, they deserve the same care and respect they give their own patients everyday. 4 4/3/2013  Fall 2005 – PHP Task Force  March 8, 2007 – Passage of Senate Bill # 573  July 1, 2007 – Effective date of SB # 573  August 17, 2007 – WVMPHP Incorporated as an Independent Not-for-Profit 501(c) 3  November 2007 – WVMPHP / WVBOM /WV Bd Osteo operating under Agreements “to be executed”  Spring, 2008 – WVMPHP / WVBOM / WV Bd Osteo Agreements executed  May 1, 2010 – Licensure Fee (partial funding) 5 4/3/2013 West Virginia Medical Professionals Health Program Mission Statement: To protect healthcare consumers through seeking the early identification and rehabilitation of physicians, surgeons, and other healthcare professionals with potentially impairing health concerns including abuse of mood altering drugs including alcohol, mental illness or physical illness affecting competency so that physicians, surgeons, and other healthcare professionals so afflicted may be treated, monitored and returned to the safe practice of their profession to the benefit of the healthcare profession and the patients we serve. • Federation of State Physician Health Programs – www.fsphp.org • Federation of State Medical Boards, Impaired Physician Policy – www.fsmb.org • American Society of Addiction Medicine, 11 Physician Health Policies – www.asam.org 6 4/3/2013 Senate Bill # 573 – March 8, 2007  Voluntary / Confidential  Provided PHP existence  Protected Records  Immunity  Funding WV State Medical Association  WV Mutual Insurance Company  West Virginia Hospital Association (HCA)  Individual Physicians  Solicitations  Hospitals, Licensure Fees, Participant Fees, Grants, etc.  4/3/2013 14 7 4/3/2013 *FSPHP Data 15 4/3/2013  WVMPHP Board  WVMPHC of Directors – Fiduciary Case Management - Participants 8 4/3/2013         WV State Medical Association – 2 WV Mutual Insurance Company – 3 WV Hospital Association – 2 WV Podiatric Medical Association – 1 WV Society of Addiction Medicine – 1 WV Association of Physician Assistants – 1 WV Society of Osteopathic Medicine – 1 WV Citizen – WVMPHP Board Appointed - 1           WVMPHP Board Approved Addiction Psychiatry Psychiatry Addiction Medicine Family Medicine Recovery Physician Assistant Podiatry Geography Personal Experience 9 4/3/2013 MOU 29% Formal contracts 71% 59% independent legal authority based on specific law *FSPHP Data Dupont et al 2009 4/3/2013  19 *JANUARY 14, 2008 – West Virginia Board of Medicine officially signed an agreement with the West Virginia Medical Professionals Health Program. (Renewed 1-14-2012)  *May 16, 2008 – West Virginia Board of Osteopathic Medicine officially signed a similar agreement. (Renewed 1-14-2012) * Licensure Renewal Applications –Grant anonymity / confidentiality 10 4/3/2013 *FSPHP Data 21 4/3/2013 Physicians Physician Assistants Podiatrists Licensees Others Non-discriminatory 4/3/2013 22 11 4/3/2013 SUDs – 100% (12% exclusively) Mental Illness – 85% Behavioral Problems – 79% Physical Illness – 62% *FSPHP Data 23 4/3/2013 Substance Abuse * Mental Illness * Behavioral Health, Leadership, & Boundaries Stress and Burnout Physical Illness Neurological Deficits Other Disorders Intervention Education Advocacy 4/3/2013 *WVMPHP 24 12 4/3/2013 4/3/2013 25 "Try to remember that though God has wrought miracles among us, we should never belittle a good doctor or psychiatrist. Their services are often indispensable in treating a newcomer and in following his case afterward." ~Alcoholics Anonymous, 4th Edition, The Family Afterward, pg. 133~ 13 4/3/2013 a “Provider of treatment” a place of refuge simple or easy tolerant of unwillingness, dishonesty or denial the decision maker of diagnoses or impairment 4/3/2013  Supportive, structured, monitored environment of recovery to a total abstinence model  It is a State wide, multifaceted rehabilitation and monitoring program with twin goals of protecting the public and helping physicians with substance abuse disorders and mental illnesses improve their lives and careers  Safe haven alternative to licensure restriction leading to early detection of potentially impairing conditions  Reasonable way out of a difficult problem 4/3/2013 27 28 14 4/3/2013 Honest, concerned and compassionate  Able to be completed  Recovery monitoring and documentation  Supportive of physician and their families  Networking opportunities with colleagues experiencing similar issues  Educational programs  Assists with guidelines, statues and regulations  Assistance with interventions  Referral sources  4/3/2013 29 Consultation on physician well-being issues  Expert testimony for Boards, hospitals, groups, committees, etc.  Advocacy via documentation of recovery activities, abstinence and compliance  Confidential  Helps protect the public  4/3/2013 30 15 4/3/2013      Refer medical professional to the WV Medical Professionals Health Program A comprehensive evaluation will be done. A treatment plan is constructed based on the evaluation and treatment recommendations of treatment professionals. An agreement with the WVMPHP is executed. The individual is monitored throughout the duration of the agreement and provided assistance, guidance and support with EARNED ADVOCACY. Program Statistics* Growth 1000%+ Abstinence/Success rate 90% *Nov. 26, 2012 Active n=68 All n=111 16 4/3/2013 4/3/2013 33 4/3/2013 34 17 4/3/2013 180 160 140 120 Projected 100 80 Participants 60 40 20 0 2007 2008 2009 2010 2011 2012 Maturity New per year 2005 = 34 (range 0-150) Monitored under an agreement = 138 (range 9-541) *FSPHP Data * 36 18 4/3/2013 2005-FSPHP Data: $538,000 avg annual (range $21,000 - $1.5 million) WVMPHP Data: 2007- $14,600 2008- $91,700 2009- $190,300 2010- $291,500 2011- $339,400 2012- $464,362 2013- $565,711 (projected) Licensing Board 50% Range 0-100 Average 2007 to 2012 : $231,977 Average 2007 to 2013: $279,653 (projected) Participant SMA Hospital 16% 10% Malpractice Carriers 9% Range 0-100 Range 0100 6% WVMPHP: 2007- Range 0-70 Hosp + HCA Range 0-45 Other 9% Range 0-100 100% 2008- 3.5% 26% 55% 15.5% 2009- 8.8% 58.6% 24.9% 7.6% 2010- 45.2% 14.4% 2011- 76.6% 20.5% 2012- 53.6% 25.4% 40.2% 0.1% 2.5% 18.5% *-States with licensure fee surcharge receive 60-70% of annual budget from this source. 2.4% 38 19 4/3/2013 Education – 4700 / 74 +  Participants – 71 / 120  Phone inquiries - TNTC  Board referrals  Returned to work  Prior issues  Impairment – initial / disabled  Out of State License retention– many  Active – Currently under an active agreement (CRCA, MHRCA, LOU, Reciprocal) as of November 26, 2012 - n = 68 All – Having ever been assigned a case number/under active agreement - n = 111 (signed E&T) Qualifying illness – Mental and/or Addictive Illness consistent with an ICD-9 Post-Graduate Physicians (PGP) – Physicians having completed residency 20 4/3/2013 Active All Students/Residents 14 (20%) 21 (19%) Physician Assistants 8 (12%) 12 (11%) Allopathic Physicians* 42 (62%) 68 (61%) Osteopathic Physicians* 4 (6%) 10 (9%) TOTAL PHYSICIANS* 46 (68%) 78 (70%) *PGP Active All Family Practice Emergency Medicine Internal Medicine General Surgery Radiology Anesthesia OB-GYN 13 (19%) 6 (9%) 6 (9%) 6 (9%) 6 (9%) 5 (7%) 4 (6%) 23 (21%) 9 (8%) 8 (7%) 8 (7%) 7 (6%) 6 (6%) 6 (6%) Other 22 (32%) 44 (39%) 21 4/3/2013 Active ADDICTIVE MENTAL All 62 (91%) 100 (90%) 6 (9%) 11 (10%) *41 (66%) of active participants were PG physicians with addictive illness. *68 (68%) of all participants were PG physicians with addictive illness. *91% of all participants with mental illness were PG physicians Active CRCA (SUD) – MHRCA (Psych) – LOU (Zero Tolerance) – Reciprocal (Other State) – All 47 (69%) 7 (10%) 7 (10%) 7 (10%) 58 (52%) 12 (11%) 12 (11%) 12 (11%) 3/7 always reciprocal 6/12 always reciprocal Evaluation Only – 17 (15%) *5/17 – Signed E&T Agmt & lost to follow-up 22 4/3/2013 Male Active 59 (87%) All 93 (84%) Female 9 (13%) 18 (16%) Active All Average Age 43 44 Median Age 44 45 23 4/3/2013 Self *26% Fellow Physicians *20% Families/Spouses Boards of Medical Licensure *21% Friends Hospitals *14% Nurses *FSPHP Data Other *17% 47 4/3/2013 Licensure Boards Employer Hospital School/Residency Other PHP Other Active 19 (28%) 7 (10%) 11 (16%) 10 (15%) 7 (10%) 14 (21%) All 46 (41%) 8 (7%) 14 (13%) 13 (12%) 10 (9%) 20 (18%) (Family, colleague, treatment provider) 24 4/3/2013 51 (82%) had co-morbid psychiatric illness* Depression – 37 (73%) Anxiety – 21 (41%) PTSD – 8 (16%) Bi-Polar – 6 (12%) ADD – 1 (2%) MULTIPLE DX – 23 (45%) *Active Participants Active n=62 Alcohol Alcohol + Drugs Drugs Alone 25 (40%) 21 (34%) 16 (26%) All n=100 46 (46%) 32 (32%) 22 (22%) 25 4/3/2013 Opiates Marijuana Amphetamines Benzodiazepines Polysubstances Active All n=16 n=22 7 (44%) 2 (12%) 0 (0%) 0 (0%) 7 (44%) 9 (41%) 3 (14%) 1 (4%) 0 (0%) 9 (41%) Intensive Outpatient/Outpatient – 13 (19%) Residential – 55 (81%) – 90+ days – 44 (80%) 26 4/3/2013 Active Illness /Sentinel Events 40 (59%) Initial Permanent Active 17 (25%) 1 (1%) *Impairment unrelated to the Qualifying illness *1 All 55 (50%) All 26 (23%) 5 (5%) *3 27 4/3/2013 Level I Active 3 (4%) All 5 (5%) Level II 5 (7%) 11 (10%) Level III 2 (3%) 3 (3%) 14% 18% Non-compliance Active 90% All 87% *Active – Level II/III were singular events All – Level II/III: 2 (3); 1 (2) 28 4/3/2013 Active All Status changed 12 (18%) 24 (22%) Intake: licensed unlicensed 47 (69%) 21 (31%) 74 (67%) 37 (33%) 11-26-12 : licensed unlicensed 52 (76%) 8 (24%) 78 (70%) 33 (30%) *15/111 (14%-ALL) entered program unlicensed & then got licensed *8/68 (12%-Active) entered program unlicensed & then got licensed Inter-state Active 11 (16%) All 20 (30%) Continued working or Returned to work 56 (82%) 87 (78%) 29 4/3/2013 Inter-state Licensees – 68/8207 = 0.83% Inter-state Licensees + trainees – 68/10,200 = 0.67% Intra-state Licensees – 68/5963 = 1.14% *Excludes licensed retirees Graduated Agreement Evaluation Only Retired / WV Lic Lapsed Incomplete due to Relapse/ WV Lic / Refusal Evaluation w/drew WV Lic app Early Termination – w/Lic Bd approval Disabled Deceased Jail 11 12 5 6 3 2 2 1 1 30 4/3/2013 MRO Negative UDS Review Distressed Behavior Professional Boundaries Jail Board Issues > PHP Benefit Refused •Independence •Hospitals need REVENUE •Groups need PARTNERS •Spouses need their SPOUSES •Families need INCOME •Doctors LAWYER up •State Boards Discipline AFTER the fact 4/3/2013 62 31 4/3/2013 Physicians with potentially impairing conditions who come forward are given the opportunity for evaluation, rehabilitation, treatment and monitoring without disciplinary action in an anonymous, confidential and respectful manner. 63 4/3/2013 Early detection Thorough assessment & evaluation Abstinence based treatment Long-term monitoring Documentation (abstinence, compliance, etc.) 4/3/2013 64 32 4/3/2013 Sponsor Family Psychiatrist Board Malpractice Carrier PCP Participant Work Monitors 12-Step Meetings Counselor Hospital Drug Tests ***A single agency, the WVMPHP, and the committed individuals who work in the WVMPHP, have a continuous, ongoing relationship with the ill medical professional for a period of years. 4/3/2013 66 33 4/3/2013  West Virginia  Other PHP stats (GA/TX)  Project Blue Print 2  Evidence-based financials WV Medical Professionals Health Program 680 Genesis Blvd., Ste 201 Bridgeport, WV 26330 Phone: 304-933-1030 Cell Phone: 304-677-9283 Email: [email protected] [email protected] Website: www.wvmphp.org 4/3/2013 68 34 4/3/2013 • • • • • • • • Federation of State Physician Health Programs – www.fsphp.org McLellan, et al. Drug Dependence, a Chronic Medical Illness. JAMA, October 2000 Domino, et al. Risk Factors for Relapse in Health Care Professionals with Substance Use Disorders. JAMA, March 2005 McLellan, et al. Five Year Outcomes in a Cohort Study of Physicians Treated for Substance Use Disorders in the United States. BMJ, November 2008 DuPont, et al. How are Addicted Physicians Treated? Journal of Substance Abuse Treatment, March 2009 Skipper. The Value of Physician Health Programs. Alabama Board of Medical Examiners Newsletter, December 2009 Federation of State Medical Boards, Impaired Physician Policy – www.fsmb.org American Society of Addiction Medicine, Physician Health Policies – www.asam.org THANK YOU 35