Administration Referrals for Residents

• NEWYORK-PRESBYTERIAN HOSPITAL
  GRADUATE MEDICAL EDUCATION
  POLICIES AND PROCEDURES
  TITLE: ADMINISTRATIVE REFERRALS FOR RESIDENTS

PURPOSE:

It is the Hospital’s position that impairing medical and psychiatric conditions, including substance abuse, are treatable illnesses and that it may be possible for an impaired resident to recover and safely return to work, if diagnosed and treated in time, and if provided a structured, monitored working environment on recovery.

In accordance with this position, any resident whose behavior or performance is observed to deteriorate must be referred to WorkForce Health and Safety (WHS) for evaluation.

The purpose of this policy is to detect untreated or sub optimally treated medical or psychiatric conditions, including substance abuse, that may affect a resident’s ability to safely perform his or her work, and to arrange for treatment where warranted.

This policy is not part of the disciplinary process.

SCOPE:

Any resident whose behavior or performance has deteriorated and there is a suspicion of an impairing medical or psychiatric condition.

An individual who voluntarily seeks help for any impairing condition before that condition causes a deterioration in performance or a hazard to patient safety does not need to notify the hospital or its representatives of such care and is not covered by this policy.

An individual may be independently referred under this policy notwithstanding his or her voluntary self-referral.

PROCEDURE:

1. The impaired resident is referred administratively to WHS by his or her Program Director because of deterioration in performance or other behavior that raises concerns about the ability to safely perform his or her job. a. Once referred for an administrative referral, the resident may not return to work until cleared by WHS to return.
2. It is not necessary to have proof of an impairing condition in order to make an administrative referral. Reasonable belief is sufficient grounds.
3. WHS performs a medical and screening psychiatric evaluation including a urine drug screen, and refers the individual to a psychiatrist for further evaluation. All personnel referred administratively undergo the same evaluation, with an emphasis on the differential diagnosis that might cause the reported behavior or deterioration in performance.
4. WHS and its consulting psychiatrist will determine whether a medical, psychiatric or substance abuse problem is the cause of the observed behavior and will report their findings to Legal Affairs and the GME Office.
5. If a resident is found to have an impairing condition, WHS or its consulting psychiatrist will arrange for treatment and follow-up.
6. If no impairing condition is found to explain poor performance or unacceptable behavior, then the individual’s Program Director, in conjunction with the GME Office will decide what steps to take next.

If found to be impaired, in order to return to work the resident must meet the following conditions:

1. The recovering resident obtains in writing from a treating practitioner or representative from a treating health care facility that he or she has successfully recovered from the impairment and is now able to return to work.
2. The recovering resident schedules a return-to-work evaluation in WHS and WHS determines whether the resident has successfully recovered and is no longer impaired.
3. If the resident is determined to be ready to return to work, he or she must sign a return-to-work agreement describing the conditions and obligations under which the recovering resident is allowed to work.
4. If random urine drug monitoring is a condition for return to work, the resident must come to WHS when called. Failure to keep an appointment can be grounds for corrective action.
5. All medical, psychiatric and performance information relevant to this incident will be held confidentially in a separate locked file in WHS. Summary findings relating to a resident’s fitness to work and any restrictions on job responsibilities belong in the personnel file.
6. The resident must remain in compliance with the administrative referral program.
   • The impaired resident who is administratively referred to WHS is expected to comply with all aspects of this policy, including but not limited to:
     • Initial evaluation
     • Drug testing
     • Answering telephone calls
     • Keeping appointments
     • Accepting treatment
     • Generally being readily available and cooperative with the program
   • The opportunity to return to work is contingent on such compliance and on successful recovery from the impairment.
   • Any deviation from or material breach of the return-to-work agreement is grounds for termination and will be referred to Legal Affairs and the GME Office for guidance and advice.

Approved by GMEC: November 2009
Approved by The Medical Board: May 2010