The Impaired Associate
Dr. Reyes employs Dr. Kim as an associate. Over three weeks, staff notice Dr. Kim arriving late, slurring words during a Monday morning exam, and once leaving a patient mid-dilation. Dr. Kim admits to drinking 'a couple' the night before and says he has it under control. A patient later reports that Dr. Kim smelled of alcohol during her exam. Dr. Reyes is unsure whether to report, fire, or refer Dr. Kim to a treatment program. Dr. Reyes also worries that reporting will expose the practice to liability and that the patient's report is 'hearsay.'
1. Does Dr. Reyes have a reporting obligation, and to whom?
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Yes, likely. Most state practice acts and Board rules impose a duty on licensees to report an impaired colleague to the Board when there is reasonable cause to believe the colleague is practicing while impaired. Dr. Reyes is a licensee and an employer with direct observations.
What counts as reasonable cause:
- Direct observation of slurred speech during patient care.
- Leaving a patient mid-procedure.
- The patient's report of the odor of alcohol.
- Dr. Kim's own admission of drinking before work.
'Hearsay' objection: The patient's report is a firsthand observation by the patient, not hearsay, and it corroborates staff observations. Dr. Reyes should document it.
To whom: the Board, and, if the practice participates in a peer-review or impaired-provider program recognized by the Board, that program as well. Some states allow a confidential report to a diversion program in lieu of or in addition to a Board report; the Board's rules control.
Do not: ignore it, cover it up, or rely on a promise to 'handle it.'
2. What are Dr. Reyes's options regarding employment and patient safety while a report is pending?
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Immediate patient-safety steps:
- Remove Dr. Kim from direct patient care pending evaluation.
- Review and, where necessary, re-examine patients seen by Dr. Kim during the period of concern.
- Document all observations contemporaneously.
Employment options:
- Administrative leave pending evaluation is the safest interim step.
- Termination is lawful if consistent with policy and not retaliatory; however, firing alone does not satisfy the reporting duty.
- Referral to treatment: Dr. Reyes may refer Dr. Kim to an impaired-provider program, but referral does not erase the reporting obligation unless the Board's rules expressly permit confidential diversion.
Liability concerns: Dr. Reyes's exposure comes from failing to act - allowing an impaired provider to treat patients - not from a good-faith report. Good-faith reports are typically protected from civil liability under the reporting statute.
Documentation: keep a confidential file separate from the personnel file if the Board's rules require it.