Effort Helps Doctors

PEER GROUP HELPS PHYSICIANS RECOVER FROM DRUG ABUSE

Just before Thanksgiving 1989, the lifeless body of a 29-year-old
physician was discovered in a doctors' lounge at Ruby Memorial
Hospital in Morgantown.

An autopsy revealed the anesthesiologist, Dr. Thomas Cianciolo, died
of asphyxiation after injecting a hallucinogenic drug. The medical
examiner also found traces of a second anesthetic drug with
morphine-like effects.

Stunned family members sued, saying hospital staff negligently
overlooked signs of drug abuse in the third-year resident in training.

"He would be here if somebody didn't look the other way," Cianciolo's
mother said in a deposition.

The case ultimately was settled for an undisclosed
amount.

Even then, some states had proactive programs aimed at helping
drug-abusing doctors.

Nearly 14 years later, all have such programs except Nebraska and West
Virginia, said Dr. Brian McDevitt, a Mingo County family practitioner
and medical director of the West Virginia Professional Advocacy Group
Effort.

"We are so far behind other states," McDevitt said.

McDevitt said hospitals and the state Board of Medicine don't do
enough to help rehabilitate impaired physicians.

His private organization advocates for and monitors recovering health
professionals, including physicians, pharmacists and nurses.

"WV-PAGE strives to facilitate and promote the health and well-being
of impaired professionals through a supportive, non-threatening
program run by peers," the group's brochure says. "Early intervention
is advantageous, before serious consequences occur."

Indeed, success is possible if the physician seeks help and sticks
with the recovery process, said Dr. C.R. Sullivan, an addiction
specialist at Chestnut Ridge Hospital, part of West Virginia
University Hospitals.

"A recovering physician is sometimes the best doctor you're going to
find," Sullivan said. "I know several who are absolutely terrific
doctors. The bigger issues are those still trying to keep hidden. It's
a constant issue. The problem is those you don't know about."

Sullivan said 7 percent to 10 percent of physicians end up with drug
or alcohol problems.

Dr. David Dodd, director of the Tennessee Medical Foundation's
Physician Health Program, said some physicians turn to chemicals for
relief from emotional turmoil.

"Many physicians are so idealistic and perfectionistic and
work-addicted in the name of healing everyone else that they don't
know how to handle their personal and emotional lives," Dodd told the
American College of Physicians Observer. "Much of this is a byproduct
of the obsessive-compulsive traits engendered by the education and
training process of medicine."

Many doctors in West Virginia keep their substance abuse secret and
don't seek help, fearing repercussions from the state Board of
Medicine, McDevitt said.

"Nationally, West Virginia has the reputation for being very
punitive," McDevitt said. "Unfortunately, because of their beliefs,
they act in a way that is harmful to physicians, rather than in a way
that's understanding and compassionate."

By state law, a physician may go to the Board of Medicine and sign a
voluntary and confidential agreement to go inactive and enroll in a
treatment program, said Ron Walton, executive director. If the
physician fulfills requirements - often monitoring by another doctor
and attendance at 12-step meetings - he will receive no discipline and
may regain his license.

The state Board of Osteopathic Medicine has a similar
policy.

Currently, the medical board is monitoring five physicians with
voluntary agreements. The osteopathic board has just released two
physicians on the agreements, spokeswoman Cheryl Schreiber said.

On license renewal applications for both boards, physicians must
disclose if they have received treatment for substance abuse problems.

The Federation of State Medical Boards of the United States, composed
of 70 separate boards of medicine, reports 77 physician health
programs - those for impaired physicians - exist. Of those, 22 are
directed by boards themselves; state medical associations sponsor 31;
and there are 24 others not associated with either.

Lisa Robin, vice president of leadership and legislative services for
the federation, said boards of medicine should help impaired
physicians get well.

"This is a problem in our society," Robin said. "It falls under the
disciplinary areas of the board to manage all sorts of problems
licensees would have. Managing impaired physicians is one area of
responsibility."

For years, the West Virginia State Medical Association offered its
members help in recovery through a special committee. But since the
long-time chairman, Dr. Thomas Haymond, died a few years ago, the
committee has not been active.

"Doctors are human just like everyone else," Executive Director Evan
Jenkins said, noting that patient care is paramount.

As part of its review of hospitals, the Joint Council for the
Accreditation of Healthcare Organizations mandates that hospitals
offer a process to encourage physicians to get help.

Hospitals have an obligation to protect patients from harm, the
council's standard says.

"The purpose of the process is assistance and rehabilitation, rather
than discipline, to aid a physician in retaining or regaining optimal
professional functioning, consistent with protection of patients," the
standard says.

Though it has not been implemented yet, Charleston Area Medical Center
has a new physician wellness program, which places a mentor with the
physician asking for help. The process stresses assistance and
rehabilitation rather than punishment.

"They can self-report without fear of losing their privileges," said
Dr. Glenn Crotty, CAMC's chief operating officer.

McDevitt stressed that doctors with substance abuse problems are sick,
not bad.

"The Board of Medicine doesn't go after a physician with diabetes or
high blood pressure, or gambling problems, or depression," McDevitt
said. "We have to recognize that stress levels they work under right
now are critical. Impairment percentages in the population are going
up. People are not learning how to cope with the stress. They're
seeking another way."

McDevitt said some physicians are impaired but never
detected.

"Statistics say 10 percent of physicians need to be monitored," he
said. "In order to have that, you need to have a diversion program
that is trusted and utilized."

The state Board of Medicine recently disciplined a local physician for
a matter other than substance abuse. But the physician said he has
struggled with alcohol and asked the board to start a proactive
physician health program to help him and others.

"They say they don't have the money," the physician said. "I say they
can't afford not to."