Human Resources: Healing vs. Safety

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Substance abuse liabilities must be addressed before help can be offered.

There is scant evidence to suggest that healthcare professionals are either more or less likely than the general public to develop substance abuse problems.

According to a study by the National Council of State Boards of Nursing, disciplinary actions for substance abuse represented about 25% of the 114,570 actions against 52,695 nurses in 2006. Those figures do not include nurses who entered diversionary programs to avoid discipline. The infractions ranged from writing illegal prescriptions to intentional wastage errors and drug diversions. About 9% of the cases involved criminal violations. While these are not insubstantial figures, they represent a small fraction of the approximately 3 million nurses now working in the United States.

The problem is large enough, however, and the patient safety and liability consequences are so potentially severe that most healthcare entities understand the need to have policies in place to deal with substance abuse.

While it sounds simple, there are gray areas, none more so than the question of when to fire an employee for substance abuse, and when to provide therapy and support. It used to be that substance abuse and addiction were viewed as a moral failing, which made the decision to terminate an employee easier. For the past several decades, addiction has been recognized as a disease. That makes it a little cold-hearted if the only guidance that healing professionals showed substance abusers in their ranks was the nearest exit.

Besides, healthcare professionals of all ranks are getting harder to find, and chasing away talented but troubled staff instead of offering them a way back to productive society is a lose-lose proposition.

"The common ground that all health professionals and hospitals share is that the first duty is to the patient and patient safety," says Cynthia Haney, a senior policy fellow with the American Nurses Association. "There is also a duty to make sure that one's colleagues are safe as well. Thirdly, the goal is to provide the involved healthcare professional, whether a nurse or physician or whoever, with the necessary services to help them overcome any impairment that might be affecting their performance."

Before a healthcare organization can worry about rehabilitation for an employee battling with substance abuse, however, it should first have procedures to address patient safety and liability, says Michael D. Malfitano, an attorney with the Tampa office of Constangy, Brooks & Smith, LLP.

"We recommend the healthcare entity, whether it is a hospital or a physician practice, does drugs tests, that they have a drug-free workplace program in place, and that they be very vigilant about diversion of drugs," Malfitano says. While it is admirable, healthcare organizations that keep admitted substance abusers on the payroll in the hope of helping them overcome their addictions face significant potential liability issues. Malfitano says it's critical that those employees are placed under strict supervision and, if possible, away from direct patient care.

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