The Colleague Who Is Impaired
You share a suite with a licensed counselor who has begun arriving late, rescheduling clients at the last minute, and twice fallen asleep during sessions (a client mentioned it). Last week a client told you the colleague 'smelled like alcohol' in a morning session and 'got confused about my medication.' The colleague is well liked, has 20 years of experience, and is the only Spanish-speaking clinician in the practice, serving about 40 clients. You have not directly observed the impairment. The colleague dismissed your earlier gentle check-in as 'just stress.' Your state licensure board has a process for reporting impaired practitioners, and the practice has no formal policy.
1. What are your obligations, and what is the correct sequence of actions?
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Obligation: As a licensed professional you have a duty to protect clients from a colleague's impairment. Most states' codes and boards require reporting when there is reasonable belief that a practitioner is impaired and clients are at risk. The threshold is reasonable belief based on credible information - not direct observation by you personally.
Sequence:
- Document what you have - the client's report (with date and specifics), the late arrivals, the rescheduled sessions, the sleeping reports. Note what you observed versus what was reported to you.
- Direct, documented conversation with the colleague. State the specific concerns, not the conclusion. Ask about the alcohol report and the medication confusion. Offer the employee assistance program or board's confidential health program. This is not optional politeness; it is the intervention most likely to get the colleague into monitoring.
- Escalate if the behavior continues or the risk is immediate. If a client is currently in the colleague's care and impaired, act now - interrupt the session, ensure client safety, notify the practice owner.
- Report to the board if the colleague does not engage with help or if clients remain at risk. Reporting is protective, not punitive; boards have health programs designed for this.
- Do not gossip or surveil. Keep the circle small and the focus on client safety.
The 40 Spanish-speaking clients and 20 years of experience are reasons to route the colleague to help, not reasons to delay.
2. The practice owner asks you to 'keep it quiet until we find a replacement' because of the Spanish-speaking caseload. How do you respond?
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Decline. Client safety is not contingent on staffing convenience, and a delay that leaves impaired clinicians seeing clients is exactly the exposure the practice cannot accept.
Response to the owner:
- Name the risk plainly: a client has already reported alcohol and medication confusion. If a client is harmed during a hold, the practice, the owner, and you are all exposed.
- Offer the alternative that addresses the staffing concern: arrange coverage for the Spanish-speaking caseload (locum, telehealth interpreter-assisted services, referral agreements) while the colleague is diverted to evaluation and monitoring.
- Make clear that your own licensure obligates you to report regardless of the practice's preference, and that you will do so if the colleague remains in client contact without evaluation.
Record: document the owner's request and your response, factually and without editorializing. If you ultimately report to the board, note the date, the basis, and what you reported.
Principle: loyalty to a colleague or an employer does not override the duty to protect clients. The right move protects the colleague by getting them help and protects clients by removing them from contact until that happens.