The Impaired Colleague
Dr. Lena Ortiz shares an office with Dr. Mark Chen. Over three weeks she notices that Dr. Chen smells of alcohol in the morning, has slurred speech, and has made repeated charting errors: he recorded the wrong intraocular pressure for one patient and prescribed a steroid drop without noting a history of herpes simplex keratitis. A technician tells Dr. Ortiz that Dr. Chen asked her to sign his name on a chart. Dr. Chen denies impairment and says his personal life is 'none of the office's business.' He is scheduled to see 18 patients tomorrow, including two postoperative cataract co-management visits. Dr. Ortiz is not his supervisor and does not own the practice. She worries about confidentiality and about damaging his career.
1. What are Dr. Ortiz's obligations regarding patient safety and reporting?
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Patient safety comes first. A licensee who has objective evidence that a colleague is practicing while impaired, or is making errors that endanger patients, cannot treat the matter as purely personal. Dr. Ortiz should document the specific observations: the alcohol odor on stated dates, slurred speech, the charting errors, and the technician's report that Dr. Chen asked her to sign his name. She should report the concern to the practice owner or medical director and ensure that Dr. Chen is not permitted to see patients until he is evaluated. If the practice does not act, she should report to the Board. Colorado's Board has a process for handling impaired licensees, and confidentiality does not protect conduct that creates a risk of harm to patients. The duty is not to diagnose Dr. Chen but to act on observable, documented facts and to protect the patients scheduled for care.
2. Can Dr. Ortiz keep this confidential because Dr. Chen is a colleague?
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No. Professional confidentiality protects patient information and appropriate peer-review communications; it does not require silence about a colleague's impairment when patients are at risk. Dr. Ortiz should share information only with those who need it to protect patients, such as the practice owner, a covering physician, or the Board. She should avoid gossip and avoid discussing the details with staff who do not need to know. If Dr. Chen enters a confidential treatment or monitoring program, that program may handle his clinical information separately, but Dr. Ortiz still must ensure that he is not practicing while unsafe. Damaging his career is a concern, but allowing him to continue seeing postoperative patients while impaired could cause far greater harm to patients and to his career. The appropriate balance is a limited, documented report to the people with authority to act.
3. What immediate steps should Dr. Ortiz take before tomorrow's clinic?
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Before the clinic, she should notify the practice owner or medical director in writing, arrange coverage for Dr. Chen's 18 patients, and ensure that the two postoperative cataract patients are examined by a licensed provider who can assess them. She should not sign charts for Dr. Chen or allow the technician to sign his name; that would be falsification. She should preserve the original records and make a contemporaneous note of her observations and the actions taken. If Dr. Chen refuses evaluation and the practice does not remove him from patient care, she should contact the Board promptly. She can also encourage him to self-report and seek treatment through an appropriate program, but encouragement does not replace the duty to protect patients. The immediate priority is that no patient is seen by an impaired provider tomorrow.