The Associate Who Smelled of Alcohol
Dr. D owns a busy Lincoln practice and employs Dr. E as an associate. On a Tuesday, Dr. E arrives at 8:05 a.m. for an 8:00 schedule, smells of alcohol, has slurred speech, and drops a trial lens. Dr. E says, 'I had a rough night; I'll be fine by 10.' Dr. D sends Dr. E home but does not notify the Board. To protect the practice, Dr. D marks Dr. E's two morning charts as 'examined by D.D.' and covers the patients. Dr. E returns the next week, sees patients for three weeks, and Dr. D notices that Dr. E is signing charts again. One of Dr. E's patients later has an elevated IOP of 34 mmHg with no documented referral. Dr. D confides in a colleague: 'I don't want to ruin her career; I'm trying to get her into a peer assistance program.'
1. Does Dr. D have a duty to report Dr. E to the Board? Analyze the mandatory reporting and unprofessional conduct issues.
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Dr. D should report. A licensee who reasonably believes another licensee is impaired or engaging in conduct that poses a risk to patients cannot keep that information private. Dr. E's presentation - alcohol odor, slurred speech, and a dropped instrument at the start of a patient day - is enough to trigger a good-faith report, even before proof of harm. The duty is not satisfied by sending Dr. E home for one morning or by intending to arrange peer assistance. A peer assistance program may be appropriate, but it does not replace the Board's role in protecting the public. Dr. D's failure to report while allowing Dr. E to return to patient care for three weeks is itself a potential unprofessional-conduct violation. The elevated IOP without referral is a red flag that the risk was not theoretical.
2. What about Dr. D's chart entries and decision to let Dr. E return?
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Dr. D's entries stating that he examined patients he did not examine are false records. Even if intended to protect patients or the practice, falsifying authorship is unprofessional conduct and can create billing and quality-of-care problems. Dr. D should have documented the actual situation factually, arranged coverage, and ensured that any patient seen by Dr. E was appropriately evaluated. Letting Dr. E return after one week without an independent fitness-for-duty evaluation or Board clearance put patients at risk. Dr. D cannot substitute his own informal monitoring for the Board's process. If Dr. D altered records after the fact, that is a separate serious issue. He should not change the existing record; he should add a truthful addendum if clarification is needed.
3. If Dr. D reports, what should the report contain, and what protections apply?
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The report should be factual and timely. It should identify Dr. E, the date and time of the observed behavior, the specific observations, the patients affected or at risk, the chart entries Dr. D made or corrected, and the steps taken to protect patients. Dr. D should not overstate or diagnose Dr. E; he should report what he saw and did. He should keep a copy of the report and document his own corrective actions. A good-faith report to the Board is generally protected and should not be treated as defamation. Dr. D should cooperate with the investigation and avoid discussing the matter unnecessarily with staff or patients. The priority is patient safety and an accurate record, not protecting the practice's reputation.