Impaired Colleague and Mandatory Reporting
Dr. Kim and Dr. Patel share a New Jersey dental suite. On a busy Tuesday, Dr. Kim sees Dr. Patel slurring words and nodding off between patients. A vial of hydrocodone from the emergency kit is missing, and Dr. Patel denies taking it. Dr. Patel has three patients scheduled, including one sedation case. Dr. Kim confronts Dr. Patel, who becomes tearful and says, 'I can handle it.' Dr. Kim is unsure whether to report to the Board of Dentistry, call the police, refer Dr. Patel to the Professional Assistance Program, or simply send the patients home. The suite has no written impairment policy. Dr. Kim asks what immediate steps to take, what to report and to whom, and how to document the event.
1. What immediate patient-safety steps should Dr. Kim take?
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Patient safety comes first. Dr. Kim should immediately remove Dr. Patel from patient care, cancel or reassign the scheduled patients, and arrange coverage by an unimpaired dentist. The sedation case should not proceed. If Dr. Patel appears impaired and refuses to stop, Dr. Kim should call emergency services or security as appropriate and document the observations. Dr. Kim should not let Dr. Patel drive if impaired; arrange transportation. The missing hydrocodone should be secured and an inventory documented. This is not a matter of handling it informally while patients are at risk.
2. What should Dr. Kim report, to whom, and what role does the Professional Assistance Program play?
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Dr. Kim should report the impairment to the New Jersey Board of Dentistry if there is an immediate risk to patients or if Dr. Patel continues to practice. New Jersey also has a Professional Assistance Program for impaired professionals; a referral can be confidential and can lead to monitoring, treatment, and a practice restriction agreement. Dr. Kim can encourage Dr. Patel to self-report to the Board and PAP, but Dr. Kim should not rely on a promise to get help as a substitute for protecting patients. If Dr. Patel is a licensee and the conduct constitutes professional misconduct, the Board has authority to investigate and impose conditions. The police are not the first call unless there is a crime in progress or diversion; report suspected drug diversion to the Board and, if required, law enforcement.
3. How should Dr. Kim document the event, and what are the disciplinary consequences for each dentist?
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Dr. Kim should write a contemporaneous, factual note: date, time, observed behavior, statements, missing vial, patients affected, actions taken, and who was notified. Avoid conclusory labels like drunk or addict; describe behavior. Keep the report confidential and share only with the Board, PAP, or legal counsel. The office should adopt an impairment policy, train staff, and audit controlled substances. Board discipline for Dr. Patel may include suspension, probation, treatment monitoring, and restrictions; for Dr. Kim, failure to act could be unprofessional conduct.