The Associate Who Smells of Alcohol
At 8:00 a.m., Dr. Brooks arrives at the clinic and finds his associate, Dr. Nguyen, slurring her words and smelling of alcohol. She drops a trial frame and laughs it off, saying she had “one drink last night.” She is scheduled for 14 patients, including a 6-year-old with suspected amblyopia and a postoperative cataract patient. Dr. Nguyen insists she is fine and asks Dr. Brooks to “just cover for me for an hour.” Later, she asks him to sign her continuing education attestation for a conference she did not attend. Dr. Brooks is a co-owner of the practice and has no written impairment policy.
1. What should Dr. Brooks do immediately to protect patients?
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Patient safety comes first. Dr. Brooks should not allow Dr. Nguyen to examine or treat patients while she appears impaired. He should remove her from clinical duties, arrange coverage for her scheduled patients, and reschedule or reassign the 6-year-old and the postoperative patient to a qualified optometrist. He should not let her drive herself home if she appears intoxicated; arranging transportation or a safe escort is appropriate.
Dr. Brooks should document objective observations: the time, the slurred speech, the odor of alcohol, the dropped trial frame, and her statements. He should avoid conclusory medical labels in the record and avoid discussing the matter in front of patients. He should also preserve the schedule and any incident documentation. The immediate goal is to prevent harm, not to conduct an investigation or diagnose her.
2. Does Dr. Brooks have a duty to report Dr. Nguyen to the Board? Explain the factors.
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Dr. Brooks should treat this as a potential impairment and reporting issue. A licensee who is practicing while impaired poses a risk to patients, and North Carolina Board rules and the professional obligation to protect the public may require reporting unprofessional conduct or impairment that affects patient care. The fact that Dr. Nguyen is a co-owner or associate does not excuse the duty. Dr. Brooks should check the specific Board reporting requirements and consult the practice’s attorney promptly.
Reporting is not the same as making a medical diagnosis. Dr. Brooks can report the objective observations and the fact that Dr. Nguyen was removed from patient care. He should also encourage her to seek evaluation through an impaired-professional program or employee assistance program. If she denies impairment and returns to practice without evaluation, the risk increases and the case for reporting becomes stronger. The continuing education falsification request is a separate integrity issue and should not be signed or ignored.
3. How should Dr. Brooks handle the request to sign the continuing education attestation?
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He should refuse. Signing an attestation for a conference Dr. Nguyen did not attend would be false and could constitute unprofessional conduct or fraud on the Board. Dr. Brooks should not sign, should not ask another employee to sign, and should document that the request was made and declined. He should tell Dr. Nguyen that she must complete the required continuing education herself and attest truthfully.
If the practice has a compliance process, he should route the issue to the appropriate person and keep the documentation confidential. The CE issue should be handled separately from the impairment issue, but both should be addressed promptly. Retaliation against Dr. Nguyen for seeking help would be inappropriate, but allowing false attestations or impaired practice would expose patients and the practice to serious risk.