Impaired Colleague and the Duty to Protect Patients
Dr. D shares an office suite with Dr. E, another licensed chiropractor. On a Tuesday morning, Dr. D smells alcohol on Dr. E's breath and sees Dr. E slurring words and stumbling. Dr. E has 14 patients scheduled that day and has already adjusted 5, including a 70-year-old with osteoporosis and a 6-year-old with asthma. Dr. D asks Dr. E to stop seeing patients. Dr. E refuses, saying, 'I only had two drinks last night; I'm fine,' and threatens to sue Dr. D for defamation if Dr. D tells anyone. Dr. D knows Dr. E has been through a divorce and has missed several days recently. Dr. D also knows that Dr. E's own chiropractor has been treating Dr. E for 'stress' and that Dr. E has not signed a release. The clinic has no written impairment policy. Dr. D wonders whether to call the Board, the police, or Dr. E's spouse.
1. Does Dr. D have a duty to act or report Dr. E? To whom?
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Yes. Dr. D has a duty to protect patients from an impaired colleague. The immediate duty is to prevent Dr. E from treating the 14 scheduled patients; Dr. D should remove Dr. E from patient care, arrange coverage, and document the objective observations: odor of alcohol, slurred speech, stumbling, and refusal to stop. Dr. D should report the impairment to the Oklahoma Board of Chiropractic Examiners; a good-faith report is protected, and the Board has the authority to investigate and impose restrictions. Dr. D may also encourage Dr. E to enter a treatment or monitoring program, but voluntary treatment does not erase the duty to report if the impairment continues. Calling the police is appropriate only if there is an immediate emergency; calling Dr. E's spouse is not a substitute and may unnecessarily breach privacy.
2. Does Dr. E's threat of a defamation suit or confidentiality limit Dr. D?
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No, not as a reason to stay silent. A defamation claim requires a false statement; Dr. D's report should be factual and limited to observed behavior, not speculation. Reports to the Board are typically protected by a good-faith privilege, and Dr. D does not need Dr. E's release to report impairment. Dr. D should not disclose details to Dr. E's spouse unless necessary for safety, and should not repeat the information to coworkers beyond those who need it to protect patients. The threat of a lawsuit does not override the duty to protect patients. Dr. D should keep a written record of the observations and the report, and avoid making accusations of alcoholism or mental illness that he cannot substantiate.
3. What immediate steps should Dr. D take?
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Dr. D should first interrupt care and tell Dr. E that he cannot see patients in this condition. Dr. D should arrange coverage for the 14 patients, offer to reschedule or have another licensed chiropractor see them, and document the disruption. Dr. D should make a contemporaneous note of the objective findings, the time, the patients already treated, and the request to stop. Dr. D should contact the Board, and if Dr. E is a danger to self or others, call emergency services. Dr. D should encourage Dr. E to get a medical evaluation and enter a monitored program. Follow-up should include confirming Dr. E is not treating patients until cleared and cooperating with the Board. The reasoning is patient protection first, documentation second, and remediation third.