The Virginia Health Practitioners

1
The Virginia Health Practitioners Monitoring
Program

• 700 East Franklin Street, Suite 300 Tower
• Richmond, VA 23219
• 804-828-1551 866-206-4747
• Penelope P. Ziegler, M.D.
• Medical Director

2
VA HPMP

• Program established by Virginia General Assembly
  in 1997 as Health Practitioners Intervention
  Program (HPIP)
• Chapter 25.1 of Title 54.1, passed in 2009
  formally changed name from HPIP to Health
  Practitioners Monitoring Program (HPMP)
• More accurately reflects primary role of program
• Outreach and education about professional
  impairment, previously done by HPIP, now done by
  Department of Health Professions (DHP)

3
HPMP Operation

• Operated by Virginia Commonwealth University,
  Department of Psychiatry, under a Memorandum of
  Agreement with DHP
• Funding is via professional licensure fees
  amount of funding is determined by DHP
• Oversight and coordination
• Monitoring Program Committee (MPC)
• 7 members appointed by the Director of DHP
• Meets 6 times yearly or as needed to review
  program operation, policies, specific cases
• DHP liaison/ program manager

4
What Is Practitioner Impairment?

• Impairment refers to a practitioners inability
  to perform professional duties with skill and
  safety as result of an illness or other health
  issue
• Substance use disorder
• Psychiatric illness
• Medical condition
• Potential impairment refers to the diagnosis of
  a condition that, without treatment, could be
  expected to result in impairment

5
Epidemiology of Addiction (85-90 of HPMP cases)
in Health Care Professionals

• Alcohol abuse and dependence
• No difference in overall incidence or prevalence
• Usually have later onset, less antisocial
  behavior
• Illicit drug abuse and dependence
• Lower than in general population
• Marijuana is most common drug of choice
• Prescription drug abuse and dependence
• Higher than in general population
• Oral opioids are most common drug of choice in
  all health care professions

6
How Is Impairment Identified?

• Changes in behavior
• Extreme mood swings, temper outbursts
• Lateness, cancels cases/ appointments
• Documentation illegible or not completed
• Falls behind in duties
• Rounds late at night
• Misses exams, deadlines for papers
• Changes in appearance
• Disheveled
• Major weight loss or gain
• Pale, plethoric or diaphoretic

7
Other Indicators of Addiction

• Disappears while on duty or during cases
• Requests weekend duty (drugs are at work!)
• At workplace evenings, weekends off
• Unreachable, cell phone/pager didnt work
• Alcohol on breath
• Long sleeves even in hot weather
• Appearing sick or calling off on Mondays

8
Virginia Reporting Requirements

• Licensed practitioners, health care institutions,
  professionals associations and malpractice
  insurers are required to report to the
  appropriate Boards practitioners who may be
  mentally or physically unable to practice safely
  as the result of an apparent impairing condition
• Any such person or institution making a report in
  good faith is immune from civil liability
• Psychiatric facilities are required to report the
  inpatient admission of any licensed practitioners
  to the appropriate Boards
• Interesting conflicts with State and Federal
  confidentiality statues, HIPAA, etc.

9
Assessment and Treatment Planning

• When addiction or other impairment is suspected,
  careful evaluation is required
• Is substance dependence a primary diagnosis?
• Are other psychiatric disorders present which
  also require immediate treatment?
• Are there medical conditions which will
  complicate the treatment and recovery?
• Once diagnosis is established, treatment planning
  is next step
• What type of treatment is needed?
• What level of care is indicated for initial
  treatment?

10
Essential Elements of Treatment

• Effective reduction of denial, resistance
  and intellectualization
• Acceptance of chronic nature of disease and
  need for ongoing treatment
• Relapse prevention which addresses issues
  specific to the professionals practice
• Re-entry stresses
• Access to drugs
• Need for monitoring
• Dealing with Board issues, legal issues

11
How Are Health Care Practitioners Referred to
HPMP?

• By Board Order
• By DHP staff during process of investigation
• By colleague or peer
• By physician, therapist
• By treatment program
• By employer, hospital
• By attorney
• By family, significant other, friend
• By training program, school
• Self-referred

12
Monitoring as an Alternative to Discipline

• Eligibility
• Active Virginia license or application
• Impairing or potentially impairing condition
• Advantages
• Encourages early identification and referral to
  appropriate treatment
• Preserves valuable professionals ability to
  return to practice following treatment with
  ongoing monitoring
• Improves practitioners prognosis for recovery

13
Components of Monitoring

• Participation Contract (PC)
• Agrees to enter HPMP program
• Agrees to abstain from alcohol and other drugs
• Agrees not to practice until cleared to do so by
  HPMP
• Agrees to provide all relevant medical records
  and releases
• Recovery Monitoring Contract (RMC)
• Agrees to continued abstinence if indicated
• Treatment plan is specified in detail
• Drug screening program is specified
• Agrees to be responsible to
• Follow rules of HPMP
• Provide timely reports
• Provide drug screens when selected
• Not to return to work until approved to do so by
  HPMP

14
Drug Monitoring

• Random urine drug screens at individualized
  frequency and content (medical director is
  Medical Review Officer)
• Third party administration of screening program
  provided by Affinity Online Solutions
• Daily check in by telephone or online
• Collection sites, billing, chain of custody forms
  provided by Affinity Online Solutions
• System of alerts for missed calls, no shows,
  positive results, nonnegative results
• MRO consultation available if requested
• Lab services provided by LabCorp
• Hair testing utilized on individual case basis