Impairment & Substance Abuse


PREAMBLE

Physicians must conduct patient care activities as fully in control of their manual dexterity and skills, mental facilities, and judgment as possible. Similar conditions pertain to students of medicine and those who teach them, whether the teachers are physicians or not. Lack of such control (generally termed IMPAIRMENT) has many causes, some of which are preventable at some stage of development. This statement of policy pertains particularly to the misuse or abuse of chemical substances, as a potentially preventable cause of impairment and to illegal activities pertaining to chemical substances.

The implications and consequences of impairment are considerable, especially in circumstances in which patient care activities and the education of physicians are conducted. The School of Medicine recognizes its responsibility to endeavor to provide an optimal environment for patient care, education and research. Therefore, the School of Medicine, as a matter of policy, will regard faculty and student misuse or abuse of chemical substances, or any other activity known so promote impairment, as misconduct subject to proscription. However, impairment as a condition will be considered an illness for which remedial or ameliorative efforts will be offered.

This document is intended to outline the ways in which the School of Medicine will implement and administer this policy.

PURPOSES

The primary purpose of this policy is the protection of patients, faculty, and students. The attainment of this primary goal requires the accomplishment of additional or related objectives:

  1. The identification of impaired individuals, and the offering or rehabilitation when possible.
  2. The identification of individuals whose activities form a behavior pattern likely to lead to impairment, and the interruption of such patterns of behavior before impairment occurs.
  3. The development of measures (e.g., educational programs) to assist all faculty and students to avoid activities likely to lead to the development of preventable impairment.
  4. The proscription of activities which are illegal, and which may subject the involved individual, other individuals, and the School of Medicine to legal penalties or consequences, in addition to deterioration of the atmosphere and circumstances under which the care of patients and the educational program are conducted.

DEFINITIONS AND SCOPE

DEFINITIONS

The following are definitions and explanations, qualifications, or stipulations regarding certain terms as used in this statement of policy:

  1. Chemical substance MISUSE will be defined as the self-administration of any chemical for any reason other than its intended proper use. Chemical substance ABUSE will be defined as the personal use of any chemical substance that is specifically proscribed by law or by regulation pursuant to legal authority (e.g., Schedule I drugs); the personal misuse of any legally controlled substance; or the personal use of any normally legal chemical substance (e.g., alcohol) in a manner that produces significant impairment or that produces the likelihood of the development of impairment.
  2. IMPAIRMENT will refer to any condition, regardless of cause, which interferes with the individual's ability to function as normally expected. Impairment may exist in one or in multiple domains, including psychomotor activity and skills, conceptual or factual recall, integrative or synthetic thoughts processes, judgment, attentiveness, demeanor, and attitudes as manifested in speech or actions, in this document, the term impairment will include addiction to and/or physical dependence upon any chemical substance(s) misused or abused, as defined above.
  3. MEDICAL STUDENT will refer to any individual formally enrolled in the University of Alabama School of Medicine in pursuit of the M.D. degree, either alone or in combination with any other degree, regardless of the specific location of the student (e.g., campus or program assignment).
  4. RESIDENT will refer to any individual enrolled in any post-M.D. program under the purview of the School of Medicine in permit of qualification for specialty or subspecialty board certification. As such, this term will include individuals sometimes referred to as "fellows", "associates", "physicians-in-training", or any analogous or equivalent term(s).
  5. FACULTY will refer to any individual who holds a formal faculty appointment in the University of Alabama School of Medicine, regardless of status (full-time, part-time, or voluntary), condition of tenure, or primary departmental or other affiliation.

SCOPE

This policy will pertain to medical students, residents and faculty of the University of Alabama School of Medicine. Since individuals in these categories may have varying relationships to the School and to other entities, it is necessary to delimit the authority of the School of Medicine.

The School shall have the authority (within the limits of University roles and regulations) to establish the necessary qualifications, circumstances and conditions for application and admission to and continued enrollment in the education programs under in purview, for appointment to the faculty; and for the retention of a faculty appointment.

Residents are students in programs under the purview of the School of Medicine, and are also typically employees of a hospital or other entity. In the latter capacity, they may be subject to other or additional policies pertaining to employees; those policies may contain different provisions, and may be more or less stringent than this policy. In many or most cases, residents are also licensed physicians and fall under the purview of various legally established licensing bodies. The authority of the School of Medicine shall be limited to the admission to and continued enrollment of the resident in the educational program.

With regard to medical students and residents, the provisions and procedures of this policy are considered to pertain to "nonacademic behavior" and will be distinct and separate from policies and procedures pertaining to academic performance, except in instances in which unsatisfactory academic performance is found to result in whole or in part from impairment.

Faculty members may also have additional obligations or relationships. Those who are physicians are subject to rules and policies pertaining to hospital staff privileges and are subject to review by medical licensing bodies. They may have additional contractual or other relationships to other entities pertaining to the practice of medicine or to the conduct of laboratory or clinical research. The authority of the School of Medicine over members of the faculty shall be limited to appointment to and retention of faculty status in the School and to activities conducted in the course of faculty duties.

Some of these relationships may not be severable. For example, hospital staff privileges may require faculty appointment (and vice versa), and the practice of medicine and/or the conduct of research may be integral parts of the duties of faculty members.

The extent to which confidentiality regarding impairment can legally be maintained also will vary among these categories of individuals. Alabama law requires that physicians, hospitals, and clinics report M.D. personnel (including residents and other post-M.D. students) who are licensed to practice medicine and who are impaired, or suspected of being impaired, form any cause, including drug and alcohol abuse (Titles 34-24-59 and 34-24-361, Alabama Code). There are no legal reporting requirements for medical students and non-physician faculty members, unless they perform illegal acts.

It is now legally permissible to report licensed physicians to the Alabama Impaired Physicians Program, rather than to the Board of Medical Examiners. If that is done, the Impaired Physicians Program will protect the confidentiality and the license of the practitioner, provided he or she complies with the treatment program designated by the Impaired Physicians Program.

The School of Medicine has now entered in to a contractual agreement with the Alabama Impaired Physicians Program, under which the Impaired Physicians Program will assume similar responsibilities for medical students, unlicensed residents, and non-physician faculty members of the School of Medicine. The activities under this contractual arrangement include investigation, intervention, treatment, and maintenance programs for chemical substance abuse and impairment that may be the result.

PROVISIONS AND PROCEDURES

Medical students and residents enrolled in, and faculty members of the University of Alabama School of Medicine will become subject to the procedures and consequences of this policy if and when there is reason to conclude that the individual is impaired as a result of chemical substance abuse, or that he or she may be abusing chemical substances, even if not obviously impaired. The direct observation of chemical substance abuse or observations of aberrations in performance and/or behavior may be cause for this conclusion.

Further, any such individual shall become subject to the procedures and consequences of this policy upon conviction of any illegal act pertaining to chemical substances. It is the responsibility of each individual subject to this policy to inform the Dean of the School of Medicine within five days of any conviction related to chemical substances (see section IV.D.).

Upon making observations leading to the above outlined conclusions, any School of Medicine faculty member, resident or student will be expected to, and any other individual may, notify the Office of the Director of the Alabama Impaired Physicians Program. The director will arrange for appropriate investigation and intervention.

OFFICE OF THE DIRECTOR: TELEPHONE (205) 263-6441 OR (800) 239-6272

HELP-LINE: TELEPHONE (205) 263-3947

FURTHER ACTIONS AND CONSEQUENCES

If an individual is found to be an abuser of chemical substances, further actions and consequences will depend upon the full circumstances. Some of the major options for further action are:

  1. If the individual is found to be an occasional, recreational, or experimental abuser of chemical substances, but has no evidence of significant ongoing impairment, he or she will be placed on probation by the Dean upon satisfaction from the Impaired Physician Program. The individual will be subject to continuing surveillance, including the possibility of repeated unannounced mandatory substance testing. A substantiated violation of probation will constitute grounds for dismissal from the School of Medicine.
  2. An individual who is found to be impaired as a result of chemical substance abuse will come under the treatment and surveillance provisions of the Impaired Physicians Program. Beyond services normally offered by Student Health or similar Services or by the Impaired Physicians Program and support provided by available health insurance coverage, the cost of the treatment program will be responsibility of the individual. If rehabilitation attempts are successful, the individual will be subject to continuing surveillance. Any subsequent substantiated violation of this policy will constitute grounds for dismissal from the School of Medicine.
  3. An individual found to be impaired as a result of chemical substance abuse who is unable or unwilling to enter and to comply with a treatment program, or who is not rehabilitated after reasonable efforts, will be subject to dismissal from the School of Medicine.
  4. Although this policy pertains primarily to the personal misuse and abuse of chemical substances, it is further the policy of the University of Alabama School of Medicine that the violation by a medical student, resident, or faculty member of any state or federal statue, or regulation established pursuant to such statue, pertaining to the manufacture, improper possession, sale or other distribution of chemical substances is strictly prohibited. Such violation, if substantiated, will subject the offering individual to dismissal from the School of Medicine, in addition to any other legal consequences that may result. An individual who fails to notify the Dean of the School of Medicine within five days of a legal conviction pertaining to chemical substances will be subject to dismissal from the School of Medicine.

RECORDS

In this section relating to Records, the following specifications and provisions will pertain:

  1. References to FACULTY FILES in this document pertain to files maintained in the Office of the Dean. An individual faculty member may review the contents of his or her file upon written request to the Dean.
  2. References to STUDENT FILES in this document pertain to files maintained in the Office of the Dean in the case of residents, and maintained in the Student Records section of the Office of Student Services in the case of medical students. An individual resident may review the contents of his or her file by written request to the Dean. Medical student files are maintained in accord with the UAB Student Records Policy.
  3. Entry into the Impaired Physicians Program, or into a chemical substance treatment program approved by the Impaired Physicians Program will be entered into the student or faculty records. Success or failure of treatment or rehabilitation efforts will also be entered into the pertinent record.
  4. If a medical student enters and successfully completes a chemical substance abuse treatment program, those facts will be communicated to the director of the residency program with which the student is matched following graduation from the School of Medicine. If a medical student does not receive the M.D. degree because of failure successfully to complete a chemical substance abuse treatment program, that fact will be communicated to any institution or other entity making inquiry regarding the former student's performance, provided that the former student authorities a release of information. Similar disclosures will be made regarding any individual covered by this policy to the medical licensure body of any state to which certification is made by the School of Medicine as required for consideration of the individual for license to practice medicine. Failure of any resident or faculty member successfully to complete a chemical substance abuse treatment program, and resulting dismissal for this reason, will be communicated to any institution or other entity making inquiry regarding the individual's performance, provided the individual authorizes a release of information. Similar disclosures will be made regarding any individual dismissed from the School of Medicine as a result of illegal activities related to chemical substances.
  5. Activity restrictions imposed as a result of actions under this policy will be communicated to individuals or entities (e.g., residency program director, student preceptor, hospital quality assurance or similar committee, liability risk management) on a confidential need-to-know basis.
  6. Probation resulting from chemical substance abuse without impairment will not be entered into student or faculty records unless and until there is a substantiated violation of probation. Communications regarding probationary status will be made only to the person or persons charged with the responsibility for surveillance of the individual under the terms of probation.

The overriding consideration in all cases will be the safety of patients or others and the safety of the individual in question.

CANDIDATES FOR ADMISSION OR FACULTY APPOINTMENT

Candidates for admission as medical students or residents to any program of the School of medicine and candidates for appointment to the faculty of the school of medicine will require to provide (among all other items of information) a statement that he or she does or does not abuse chemical substances as defined herein. Further, he or she must indicate any prior legal convictions pertaining to the use, possession, sale or other distribution of illegal or legally controlled substances pertaining to or related to the abuse of alcohol or any other chemical substance; and the consequences of any such convictions.

Failure to provide the above required information, past legal convictions for activities related to illegal or legally controlled substances, and/or information or evidence that reasonable establishes a past pattern of chemical substance abuse will be grounds to decline to accept the candidate for admission to a program or for appointment to the faculty. However, prior legal convictions related to chemical substances will be considered along with all other information pertaining to the individual, and will not produce automatic disqualification for admission or appointment. Discovery that false or fraudulent information was provided prior to matriculation or to appointment to the faculty will be grounds for dismissal.

IMPAIRMENT FROM OTHER CAUSES

This policy pertains primarily to the subject of chemical substance abuse and impairment that may be a result. It shall be the responsibility of the Dean to deal with impairment resulting from other causes in accord with principles contained herein. In so doing, he will seek the advice and guidance of the School of Medicine Committee on Impaired Students and Faculty as he deems necessary or advisable.

POLICIES PERTAINING TO ALCOHOL USE

The University of Alabama at Birmingham and each of its educational units, including the University of Alabama School of Medicine, has established policies pertaining to the use and serving of alcoholic beverages. Medical students, residents, faculty members and others are expected to behave in accord with those policies. Students, residents, faculty members and others who participate in the planning or organization of events which will involve the serving of alcoholic beverages are expected to comply with all applicable institutional policies, as well as with laws and governmental regulations pertaining to the subject, and to be aware of issues of personal liability that may be involved.

ADMINISTRATION AND DUE PROCESS

Upon notifications by the Impaired Physicians Program that an individual covered under the terms of this policy warrants probation or dismissal, the Dean will refer the matter to the Faculty Council of the School of Medicine, who will then advise the Dean regarding the appropriate action. The individual will be notified of the recommendation(s) of the faculty Council, and will be given a period of at least then (10) working days in which to notify the Dean of his or her intent to appeal the recommendation. Appeal will be directly to the Dean of the School of Medicine, whose decision will be final. No further avenue of appeal will be offered by the School of Medicine..