How to Deal With Doctors Who Get Drunk and High on the Job

A group of surgeons work in an operating theatre.
A group of surgeons work in an operating theatre. Jochen Sands—Getty Images

Doctors might be under the influence more often than you think. A California physican explains why mandatory drug and alcohol testing could be the solution

Larry was a doctor trainee at a hospital where I taught in Burbank. I recommended that he not passdue to his poor preparation and work habits. But he did, and set up a general practice nearby. He had trouble with it, though, and drifted into addictionmedicine over time, helping patients overcome their problems (he was said to have had a cocaine problem in his past). He later moved outside the immediate area, and word got around that he was a go-to localfor scoring prescription narcotics. People who encountered him thought he might be high. Eventually, the DEA entered his life, and he put a gun into his mouth and pulled the trigger.

An upcoming ballot initiative on malpractice caps in California includes a provision that would require physicians to be drug- and alohol-tested prior to practicing at any hospital, and require other health care practitioners to report any suspected abusers. This is packaged with other measures that appear punitive towards all physicians. But the drug-testing provision deserves scrutiny because, while drug testing is widespread in American business, and required of nurses and many medical workers, private doctors have not been routinely tested.

I’d like to tell you substance abuse isn’t a problem for doctors, but unfortunately, I’ve seen firsthand that there are physicians who practice while they are under the influence. And we physicians often find it hard to speak up when we see something. The attitude is all too often, If it isn’t my patient, it isn’t my problem.

I personally made it my practice never to have a drink at lunch or in the evening when I was on call. And because I was on call for most weekdays for 30 years, I never felt free to drink during my career. Sadly, that was not always what I encountered from my fellow physicians.

When I was a young ER physician new to a small community hospital in California, I called in a prominent surgeon to perform an emergency appendectomy. He arrived, reeking of alcohol. There was no other availablesurgeon, and a delay exposed the patient to significant risk. The surgery went ahead, and the patient did fine. But I asked around, and the surgeon turned out to be known as a boozer, frequently coming to the hospital drunk. This still haunts me, and I left that hospital rather quickly.

That was my first experience with the difficulty of dealing with physicians who abuse mind-altering substances. I didn’t make any sort of formal report on the surgeon; I would have felt intimidated. I passed the word along to colleagues, but that was all I did. Today, as a senior physician in the latter part of my career, I would hope that I’d do more.

But that was a case when I recognized a problem. It can be hard to recognize that a colleague has a substance abuse problem, even if you’re a trained observer of addicts. Among my professional pursuits, I was the director of a drug/alcohol program for a large medical group, and personally saw every patient who entered the program for several years.

In 1994, I hired an associate, Cindy, a graduate of a famous cancer center, looking for temp work. She was young, attractive, and very smart. But I was surprised by her poor work habits, and my staff reported strange behavior. Drugs from the office started disappearing. I just couldn’t believe Cindy was abusing drugs, until it became undeniable. (Although she denied it.) A year later she had her license revoked for drug use, unrelated to my experience with her.

Until a few years ago, the licensing board for physicians in California had a diversion program for those who were identified as having an abuse problem, which allowed such physicians to keep their licenses if they sought adequate rehabilitation. It had a 75 percent long-term success rate and allowed for anonymous reporting of suspected abuse. However, the licensing board, in its wisdom, recently discontinued this program as they felt that the board’s primary mission was patient protection, not physician rehabilitation. Funding should not have been an issue: the program was paid for by physician licensing fees, not by taxpayers. Nothing has appeared to take its place, and so California is without a confidential reporting system for doctors.

I’ve spoken with a number of practicing physicians recently, and surprisingly, I hear a lot of support for mandatory testing. This support may have less to do with protecting patients than with a feeling of impotence in dealing with colleagues who abuse drugs and alcohol.

Mandatory testing will cost a lot of money, and it is intrusive to the daily practice of medicine. But patient safety concerns justify such testing for physicians, just as air safety concerns justify testing for pilots. And even with testing in place, doctors should not be excused from their obligation to report colleagues, and the government should provide a way to make such reports confidentially.

None of this should be done by a deeply flawed ballot initiative; instead, the Legislature should craft a careful law that will work in practice.

Ken Murray MD is a retired Clinical Assistant Professor of Medicine from USC, and is a frequent contributor to the Southern California Bioethics Commitee Consortium. He writes on topics of end-of-life, ethics, and water. His writings have been published in media world wide in virtually all languages, and he speaks frequently on these subjects.


TIME Transportation

Teen Airplane Stowaway: ‘I Could See Through the Little Holes’

Abdi has given his first interview since the April flight

A teen stowaway who survived a ride from California to Hawaii in a passenger jet’s wheel well earlier this year told a California CBS affiliate Tuesday that he randomly selected the plane in which he hid during the five-and-a-half hour flight.

The interview was Yahye Abdi’s first since his harrowing journey, which has dumbfounded medical professionals — people typically quickly lose brain function when more 35,000 feet above the ground without oxygen or pressurization systems.

Abdi told KPIX the ride wasn’t scary, though he couldn’t believe he survived. “It was above the clouds, I could see through the little holes,” the teen said.

Abdi, a 15-year-old Somali immigrant, says he ran away from home in April because he was unhappy in California with his stepmom. The teen also said he wanted to see his mother, as the two have not been with one another since Abdi was 7-years-old.

“I only did it because I didn’t want to live with my stepmom,” Abdi said. “Second of all, I wanted to find my mom. I haven’t seen her since I was young.”

“I took that plane because it was the closest one I could find that was going to go West,” he added. The teen is currently staying in a foster home, he plans to move to Minnesota to live with his aunt.

His advice for kids thinking about hopping on planes: “They shouldn’t run away, because sometimes they will end up dying.”


TIME celebrities

Pippa Middleton Begins 3,000-Mile Charity Bike Ride Across U.S.

The sister of the Duchess of Cambridge embarks on a journey across America

Pippa Middleton is in for a long bike ride—one that will last eight days and span 12 states.

Along with her brother James, Middleton kicked off a 3,000 mile Race Across America on Saturday in San Diego to raise money for the Michael Matthews Foundation and the British Heart Association.

“Once we get going it’s non-stop, with very little sleep,” Middleton told The Daily Mail. “It’s nerve-racking but exciting and all for a great cause.”

TIME republicans

‘Murmur of Disbelief’ As Rick Perry Compared Homosexuality to Alcoholism

The question came days after the Republican Convention in Texas approved language supporting access to “reparative therapy” for gays and lesbians.

Texas Gov. Rick Perry prompted an awkward moment at a talk in San Francisco on Wednesday when he compared homosexuality to alcoholism.

The San Francisco Chronicle reports there was a “murmur of disbelief” among the audience members after Perry responded to a question about whether he believes homosexuality is a disorder:

Whether or not you feel compelled to follow a particular lifestyle or not, you have the ability to decide not to do that. I may have the genetic coding that I’m inclined to be an alcoholic, but I have the desire not to do that, and I look at the homosexual issue the same way.

The question came days after the Republican Party of Texas approved language supporting access to “reparative therapy” for gays and lesbians. At the talk on Wednesday, Perry said he did not know if such therapy works, the Chronicle reports.

[SF Chronicle]

TIME Education

Teacher Tenure Under Assault

Silicon Valley entrepreneur and founder of Students Matter David Welch makes comments on the Vergara v. California lawsuit verdict in Los Angeles, Tuesday, June 10, 2014.
Silicon Valley entrepreneur and founder of Students Matter David Welch makes comments on the Vergara v. California lawsuit verdict in Los Angeles, Tuesday, June 10, 2014. Damian Dovarganes—AP

Advocacy group behind lawsuit promises more

Teacher tenure went down in California—and that could just be the start.

The group that emerged victorious Tuesday in its legal challenge to public school teacher tenure rules in California quickly said it was eyeing similar lawsuits in other states.

“I think there will be a reverberation across the country,” said Theodore J. Boutrous, one of the lawyers who filed the Vergara vs. California lawsuit in cooperation with the education reform group Students Matter. “There are a number of jurisdictions that are prime candidates because they have the same sort of seniority-based layoff system or quick tenure and tough dismissal. New York is one, but there are other states, too.”

A California judge ruled Tuesday that the state’s teacher tenure policies, which include seniority rules that make it very difficult to fire ineffective teachers, amounted to a violation of the students’ constitutional right to an equal education. Judge Rolf M. Treu wrote that the evidence presented by Students Matter “shocks the conscience,” and that “the challenged statutes impose a real and appreciable impact on students’ fundamental right to equality of education and that they impose a disproportionate burden on poor and minority students.”

Boutrous said his group will focus first on defending a ruling that will almost certainly be appealed to the state Supreme Court. But he also said Students Matter is hoping to “engage with policymakers in New York and nationally to get this system fixed as soon as possible,” and the group is eyeing lawsuits in other states with similar teacher tenure laws, including New Jersey, Connecticut, Maryland, Minnesota, New Mexico, and Oregon.

If it holds up on appeal, the California ruling could be a watershed moment in education reform that could weaken tenure statues across the country. “This is gay marriage,” said Terry Mazany, who served as interim CEO of the Chicago Public Schools from 2010-2011. “Without a doubt, this could happen in other states.”

The National Education Association condemned the ruling, calling the lawsuit “yet another attempt by millionaires and corporate special interests to undermine the teaching profession.” In a statement Tuesday, NEA President Dennis Van Roekel said that the ruling “would make it harder to attract and retain quality teachers in our classrooms and ignores all research that shows experience is a key factor in effective teaching.”

Immediately after the ruling, teachers’ unions signaled they would appeal. “This will not be the last word,” American Federation of Teachers president Randi Weingarten said in a statement. “As this case makes it through an appeal, we will continue to do what we’ve done in state after state…No wealthy benefactor with an extreme agenda will detour us from our path to reclaim the promise of public education.”

California is rare in that it is one the five states with the shortest probation periods before teachers get tenure, and one of only 10 states that require school districts to consider seniority when laying off teachers (other states merely suggest it.) According to the National Council for Teacher Quality, a Washington-based organization that advocates for the reform of teacher evaluations, only California, Mississippi, North Dakota, South Carolina and Vermont have probationary periods of two years or less before a teacher gets tenure. Most states make teachers wait three years, but there are 10 states with four-to-five year waiting periods. And only California, Hawaii, Minnesota, New York, Pennsylvania, West Virginia, Kentucky, New Jersey, Oregon, and Wisconsin have rules that require districts to consider seniority when laying off teachers.

California teachers, in other words, get tenure more quickly and are harder to fire than teachers in other states.

Tenure itself is at the heart of the education reform debate roiling the country. Tenure originated in higher education, to protect professors from professional blowback for unpopular research, but tenure for K-12 teachers only took root in the 1960s as a way to protect educators from unjustified firings during an administration turnover. “It used to be you could be fired for arbitrary reasons, like if you got pregnant,” said Dr. William Koski, a professor at Stanford Law School who specializes in educational policy. “There was a belief that teachers needed to band together and protect themselves from these arbitrary and capricious firings, and so one of the primary early efforts of teacher’s unions was to protect teacher employment.” Teacher tenure soon became a key element of the union agenda, and most states have some form of public school tenure. Only Florida and North Carolina have no tenure at all, and Rhode Island has a modified form that allows teachers to be dismissed for bad performance.

Mazany said getting rid of teacher tenure could have unintended consequences, both positive and negative. It could cause collateral damage, he said, because “we really don’t have a set of tools and metrics to finely discern quality, and because abuse, favoritism and cronyism do exist.” And without tenure, teachers who disagree with principals and administrators are especially vulnerable, and higher-paid veteran teachers may have a “target on their backs.”

But Mazany also said eliminating teacher tenure could get rid of a “convenient scapegoat” for the problems in education. “The least effective teachers are disproportionately assigned to low income and minority students,” he said. “The teachers don’t make that assignment, the union doesn’t make that assignment, the district administration makes that assignment. You take away the bogey of tenure, so you no longer have that to blame.”

Some experts say the best analogy for understanding the current fight is the battle over school finance reform, which has been litigated in different states since the 1960s. “Those cases were basically saying you need to have equal resources in order to have equal educational opportunity,” said Jim Ryan, Dean of the Harvard Graduate School of Education. “This case is saying you have to have equally good teachers to have equally good opportunity. And like the finance litigation in other states, some lawsuits will be successful and some won’t.”

Regardless of their consequences, most agree that there’s nothing inherently malicious about teacher tenure it itself, despite what may be its negative consequences. “These types of provisions have a logic, and were well-meaning,” Mazany said. “Nobody said ‘lets set up teacher tenure to screw children.'”

TIME 2014 Election

Embattled State Senator Gets Nearly 300,000 Votes Despite Dropping Out

Leland Yee
California state Sen. Leland Yee, D-San Francisco, right, leaves the San Francisco Federal Building in San Francisco, March 26, 2014. Ben Margot—AP

Suspended California State Senator Leland Yee won nearly 10% of the vote on Tuesday, even though he dropped out of the race in late March

Nearly 300,000 Californians voted for Leland Yee in a Democratic primary Tuesday, leading the embattled state senator to garner 9.8% of the vote in a race to be named his party’s candidate for Secretary of State. But there’s just one problem: Yee dropped out of the race in March, but not before a deadline to remove his name from the ballot had passed.

The collection votes would hardly qualify Yee for a spot on the general election ballot. Still, the state senator — who plead not guilty to federal gun trafficking charges in April — finished second in the state’s Democratic primary. A total of 287,590 people voted for him.

The 65-year-old San Franciscan Democrat was indicted on federal gun trafficking and corruption charges in March. The charges followed a Federal Bureau of Investigations operation after which Yee was accused of accepting money from undercover agents to cover campaign debt. Yee also allegedly agreed to help the agents obtain illegal firearms.

Yee was suspended from the state senate without pay in March following the indictment.

Democrat Alex Padilla and Republican Pete Peterson will face one another in a general election this November.

TIME States

8 States Revving Up Efforts to Get More Electric Cars on the Road

Volkswagen e-up! electric automobiles.
Volkswagen e-up! electric automobiles. Adam Berry—Getty Images

The goal is to have 3.3 million "zero-emission vehicles" on the road by 2025.

Eights states announced Thursday a plan to get 3.3 million zero-emission vehicles on the road by 2025. From California to Maryland to Vermont, with some states in between, the goal is to incrementally increase the number of green cars driving on American highways.

The Zero Emission Vehicles Action plan outlines 11 “actions” that the eight states, including California, Vermont, Maryland, Rhode Island, New York, Oregon, and Massachusetts, will adopt in order to get the vehicles on the road. The steps include promoting the availability of zero-emission vehicles, promoting workplace charging and providing consumer incentives for buying green cars.

“This collaborative effort is an important step forward to ensure the success of our zero-emission vehicle programs. Transitioning our light duty transportation fleet to zero emission vehicles is essential if we are to achieve our long term air quality and climate goals,” said Gov. O’Malley in a statement.

About a quarter of the nation’s new cars are sold in the eight states adopting the plan, according to a press release on Maryland Gov. Martin O’Malley’s website. Still, it’s a lofty goal, given the lack of demand in the U.S. for zero-emission vehicles, which include battery powered, hybrid, and hydrogen-fuel cell vehicles. There are about 172,000 such vehicles already on the road, about half of which are in the eight states involved in the new plan.

TIME justice

California Prison Farm-to-Table Program May Help Keep Inmates Fed and Free

Inside The Richard J. Donovan Correctional Facility As California Readies $793 Million Prison Expansion Bond
An inmate walks through the yard at the Richard J. Donovan Correctional Facility in San Diego on March 26, 2014. Sam Hodgson—Bloomberg/Getty Images

Aside from feeding the prison population, the program aims to give participants a lower prison re-entry rate

Inmates at California prisons may soon be able to grow and serve their own food, in one of the most practical applications of the farm-to-table sustenance craze that has swept the foodie world.

A Farm and Rehabilitation Meals program is being launched at San Diego’s Richard J. Donovan Correctional Facility, reports the Huffington Post.

Provided prison health authorities grant approval, prisoners will be hired as farmers and instructed in sustainable agricultural practices. Their produce will be served in the prison cafeteria. If the program is successful, more institutions may soon follow suit.

“Within those spaces we’re going to teach community gardening, composting and water-wise gardening,” said Wehtahnah Tucker, the program’s coordinator and a California Correctional Health Care Services executive. “We’re purchasing a cistern, using gray water and capturing rainwater for use.”

The initial rollout, accommodating 20 inmate-farmers, will cost just $4,000, which will be funded by private donations. The hope is that participants will have a radically lower prison re-entry rate, which in California currently averages 61%.

“We wanted to create more opportunities for inmates to have a more meaningful experience while they’re here,” she said, “so when they leave, they cannot come back.”

[Huffington Post]

TIME society

‘Weed Fairy’ Hands Out Free Marijuana Around Seattle

Was she working alone, or was this a joint venture?

A magical creature known as the “Weed Fairy” made her way to Seattle this past weekend to flit around and give away free marijuana to “keep spirits high.”

This illustrious weed fairy — who we’d also dare call a goddess of ganj — is really a 23-year-old woman named Yeni Sleidi. She visits various cities to post flyers with nuggets of pot taped to them:

Originally from California, the Weed Fairy is only in Seattle for a few weeks, she told local Fox affiliate KCPQ. She has done the same thing in New York a few months back, and positive feedback encouraged her to keep it going. Naturally, though, some people are skeptical.

“I think people are a little worried, because this is something new, and suspicious,” Sleidi said. “But it’s real weed and it’s not dangerous. It will get you high.”

Since weed is legal in Washington and not New York, this time around Sleidi didn’t have to worry as much about keeping anonymous. Over the weekend, she managed to give away around 40 nuggets.

Now, if only if a Popchips Fairy would start doing the same thing. Make it happen, somebody.

TIME California

New Bill Would Require California Porn Stars to Wear Condoms

Some fear California's lucrative adult-entertainment industry would flee to other states, but the lawmaker behind the bill says it's a matter of workplace safety

“No glove, no love” is the basic translation of the California Assembly bill that passed on Tuesday, requiring porn stars to wear condoms during film shoots.

The bill, which now shoots over to the state Senate, would additionally require porn studios to provide regular testing for sexually transmitted infections and diseases.

Some industry workers say such regulations would cause the $6 billion adult-entertainment industry to flee California, but the assemblyman behind the bill called the issue a matter of workplace safety.

“Whether you work in agriculture, manufacturing, health care, food service or any other industry, all workers deserve a safe workplace to make a living,” said Isadore Hall (D-Compton), who has unsuccessfully tried to pass similar legislation twice before.

Los Angeles County voters approved a similar law in 2010.


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