IN SHIELDING ADDICTED DOCTORS, PROGRAMS PUT PATIENTS AT RISK

When stories broke this month that one of Vice President Cheney's doctors
had a history of abusing prescription narcotics, the news surprised the
Washington board that regulates physicians.

The doctor's problems came as a shock, even though he had been placed in a
drug-treatment program in 1999, run by the Medical Society of the District
of Columbia, and monitored since then. During one 30-month stretch, he
spent $46,000 on various drugs, The New Yorker magazine reported this
month. The physician continued to practice until recently, when a hospital
placed him on leave.

Licensing boards such as the one in Washington are supposed to be the
public's eyes and ears for spotting risky doctors. Yet they too often are
kept blind and deaf in cases of substance abuse.

Few states inform their licensing authority when a doctor seeks assistance
for substance abuse, according to an informal survey by the Federation of
State Medical Boards, a group representing regulators. Programs that keep
this information confidential do so to protect doctors' privacy and
encourage them to seek help, but it means regulators are kept in the dark
unless doctors fail their treatment or harm someone in their care. By then,
it's too late for some unsuspecting patient.

Federal rules provide better protection for the public when truck and bus
drivers are involved. Motor carriers must randomly test 50% of their
drivers for the use of controlled substances each year, and 10% for alcohol
use, according to federal regulators.

The rules for doctors, who hold lives in their hands, should be at least as
strict after they acknowledge a substance-abuse problem. But too many
doctor-health programs prize doctor privacy over public safety.

The Federation of State Medical Boards recommends just the opposite -- that
a licensing-agency staff member be told of a doctor's abuse from the start.

An innovative program in New Jersey suggests that addicted doctors won't
avoid such programs as long as the process strikes a reasonable balance.

When a physician enters the New Jersey program, his or her case is
reported, using a confidential code number, to a review board that includes
members of the licensing authority. That board follows the physician's
progress and, if a relapse occurs, determines what action to take.

That procedure hasn't deterred New Jersey doctors from volunteering for the
program, which takes in an average of 100 new cases a year, according to
Louis Baxter, its medical director.

New Jersey's system is also an improvement over systems used in a few
states, most notably California, where the substance-abuse-monitoring
program is run as part of the licensing authority. Regardless of how much
confidentiality such programs promise physicians who enter voluntarily,
that surely is a deterrent to seeking help. The California system also has
earned criticism for failing to take action after a doctor relapsed,
according to news reports.

On the positive side, the situation was much worse 20 years ago. So few
programs existed then for addicted doctors that they had no place to turn.
But in the 1980s, medical societies began creating programs, and most
states have one today -- a vast improvement for both physicians and patients.

Doctors who suffer from substance abuse deserve a chance to get better. But
their treatment should not come at the expense of public safety.