When doctors get into trouble – because of substance abuse, mental health problems or sexual misconduct – they can often save their jobs if they seek treatment.
North Carolina has had a successful way of treating those physicians in a nondisciplinary and confidential manner for nearly three decades. But over the years, the ground rules for participating in the Physicians Health Program have not been updated, giving rise to concerns that it has become unfair to the doctors it’s supposed to help.
Earlier this year, six physicians claimed that doctors were intimidated into unnecessarily enrolling in treatment programs, which they didn’t think were effective and were primarily located out of state. They claimed there was a financial conflict of interest between the program and some of the treatment centers.
The state auditor’s office investigated and in April reported it couldn’t substantiate those complaints. But the audit did find that due process rights and anonymity could be compromised, there was inadequate oversight, and that the use of out-of-state treatment centers put an undue burden on physicians.
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In response, internal reforms have been made in recent months. A joint committee of the state Senate and House has also been looking into the issues, and next month it is expected to vote on a draft bill that would address those concerns and update the way the program is run.
Thomas Mansfield, general counsel for the N.C. Medical Board, said in an interview this week that the board takes the auditor’s recommendations seriously.
“We have almost 10 million people in our state. More and more are consumers of health care,” Mansfield said. “Physicians practicing safely and ethically is a no-kidding, life-and-death issue. It impacts almost all of us.
“Critically important is making sure physicians who have substance-related problems or mental health problems or physical health problems have a place to go where they can swiftly get effective help. The PHP (Physicians Health Program) outcomes are wildly successful.”
The program was established by state law in 1988 and gradually grew in scope. It’s now a joint venture of the N.C. Medical Society, the state’s professional organization, and the N.C. Medical Board, which licenses doctors. It is administered by a foundation of the Medical Society, with a budget of about $2.5 million, according to federal tax records.
It has treated 1,140 physicians in the 10 years ending in 2012, according to the audit. The program is overseen by a 15-member board of directors representing the Medical Society, the Medical Board and other health care provider organizations.
Participating in the Physicians Health Program doesn’t necessarily shield doctors from sanctions by the Medical Board, which are a public record. Disciplinary action is listed on the board’s website at ncmedboard.org.
When a case arises that might be handled in the program, there is a brief assessment process to determine what treatment, if any, a doctor needs. Sometimes a 96-hour assessment is required. Some doctors sign up for that themselves, and others are ordered to by the Medical Board, after a referral from the medical director and the clinical director. Doctors can choose from a list of treatment centers. Sometimes physicians have to pay for the treatment, which could run from $4,500 to as much as $46,000 for a 12-week treatment program.
After the state audit, the Medical Society and Medical Board made changes to address the concerns. For example, members of the Medical Board no longer sit on a committee that monitors participants’ progress, in order to ensure that physicians who participate anonymously in the program are not inadvertently identified because they are known to those members. About half of the participants are anonymous because they enrolled on their own.
The Medical Board says it has also instituted more stringent oversight measures, including ensuring in-state treatment centers are offered as options for doctors. The Medical Society also says it has taken additional steps to beef up oversight.
Auditors found the Medical Board didn’t periodically evaluate the program, and that the Medical Society didn’t require performance audits that might have discovered the concerns that were raised. The state audit also said the appearance of conflict of interest was created by allowing treatment centers to fund retreats for the program, allowing the program to pay scholarships directly to the centers for doctors that couldn’t afford it, and permitting the same centers to provide both assessment and treatment.
Some of the reforms will cost money, and the proposed legislation would increase the fees on medical license applications from $350 to $400, and increase the annual registration from $175 to $250.
The audit recommended the changes be written into the state law that established the program. A bill to accomplish that was introduced in the short session this year, but the legislature didn’t act on it before adjourning.
In the interim, a joint legislative committee has resurrected the issue and begun considering a similar bill that would be filed when the session begins in January. The committee is scheduled to meet again in January before the session begins.
“Draft legislation will be on the agenda,” committee co-chairman Rep. Tim Moffitt, a Republican from Asheville, said Tuesday. “We anticipate substantial discussion to make a decision.”