The Colleague Who Smells of Alcohol
At 8:15 a.m. at a multi-provider clinic in Santa Fe, Dr. T. observes a senior chiropractor, Dr. L., slurring words, bumping into a doorway, and smelling of alcohol. Dr. L. has four patients scheduled for 9:00 a.m., including a 72-year-old woman on warfarin and a 16-year-old athlete. Dr. L. says, 'I had a rough night; I'm fine. Don't make this a thing.' Dr. T. is an independent contractor who rents space in the clinic; the clinic owner is out of town. Dr. T. has no personal knowledge of prior impairment and does not know whether Dr. L. has a substance use disorder. Dr. T. asks what to do immediately, whether to report to the Board, and what to write in the record.
1. What should Dr. T. do before 9:00 a.m.?
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Patient safety comes first. Dr. T. should not allow Dr. L. to evaluate or adjust patients while he appears impaired. Dr. T. should intervene directly and privately, tell Dr. L. that he cannot safely treat patients in this condition, and arrange for the scheduled patients to be seen by another provider or rescheduled. If Dr. L. refuses, Dr. T. should escalate to the clinic owner, office manager, or the most senior person available and, if necessary, contact emergency services because impairment may be a medical emergency. Dr. T. should also try to keep Dr. L. from driving. The goal is not to diagnose Dr. L. or to punish him, but to prevent harm to patients and to get Dr. L. a safe evaluation. Documentation should begin immediately with objective observations.
2. Does Dr. T. have a duty to report Dr. L. to the Board or to an impaired-practitioner program?
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Dr. T. should take the report seriously because the Board's complaint and discipline process exists to protect the public, and many licensing schemes require or strongly encourage reporting of an impaired practitioner who may be treating patients. The safest course is to report the objective facts to the Board and ask about the approved impaired-practitioner program. If New Mexico's rules allow a confidential report to a Board-approved program in lieu of immediate Board discipline, Dr. T. should follow that route only if it adequately protects patients. Dr. T. should not promise secrecy or conduct an independent investigation. The report should be factual, not gossip: time, observed slurring, unsteadiness, odor, statements, and the steps taken to prevent patient contact. Confidentiality should be limited to those with a need to know.
3. What documentation and communication are appropriate for Dr. T.?
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Dr. T. should document objective observations and actions taken, not a diagnosis. A suitable note would record the time, that Dr. L. had slurred speech, unsteady gait, and an odor of alcohol, that he was not permitted to treat patients, that coverage was arranged, and who was notified. Dr. T. should avoid labels such as 'drunk' or 'alcoholic' and should not speculate about Dr. L.'s personal life. Communication should be limited to the clinic owner, the Board or impaired-practitioner program, and others with a need to know. Dr. T. should preserve the schedule and any messages about patient reassignment. If asked by patients, staff should give a brief, neutral explanation that does not disclose confidential health information about Dr. L.