Risk Management Considerations When Evaluating Fitness for Duty
Know your state law and proceed carefully when evaluating a physician’s fitness for duty and deciding when you have an obligation to report a physician.
In a previous article, I addressed risk management considerations when treating fellow physicians. In this article, I will take a closer look at risk management considerations when a psychiatrist faces completing a fitness-for-duty evaluation request or a reporting obligation to a state-licensing board regarding an ill or impaired physician.
Treating or working with a physician when you have concerns about his or her abilities to practice medicine resulting from an illness or impairment can be difficult. You may face the question of whether you should report the physician.
First off, it is important to know your state laws on reporting obligations, and if you have any questions, contact your risk management or legal professional. Under your state law, your obligations may include the following:
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Reporting to the medical board and society.
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Notifying the peer review body at a hospital.
Having to report a fellow physician who is incompetent is intended to not only protect patients but also help ensure that the individual receives appropriate assistance from a physician health program or other service to be able to practice safely and ethically.
Prior to reporting a physician, however, it is important to obtain advice particularly since confidentiality may be compromised, and the report could potentially impact the physician’s ability to practice medicine.
You also may be engaged in performing an evaluation for a physician concerning fitness for duty. In 2004, APA developed a set of guidelines for psychiatrists on performing “fitness-for-duty” evaluations of physicians. These guidelines may be a helpful tool when you are performing a fitness-for-duty evaluation and are faced with the decision to report a colleague to a specific state board.
Some important risk management considerations when performing an evaluation are the following:
Informed consent: It is important for the examining psychiatrist to obtain informed consent from the physician to be evaluated (PTE). Engage in a comprehensive discussion concerning these points:
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The limitations of confidentiality.
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The purpose and process of the evaluation.
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A complete and comprehensive psychiatric and mental status exam will be performed.
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Collateral contacts may need to be interviewed.
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The evaluation does not establish a treatment relationship.
Expertise: The referral source and the PTE should feel confident that the examiner has the expertise to competently evaluate for the illness or impairment in question. To avoid questions of bias, the examiner should not have a previous personal or professional relationship with the PTE.
Evaluation and licensure: Each state board has a state practice act that outlines the circumstances by which the governing board can order an evaluation of a licensee. This information is available to every physician applicant in all states. A report to the state should be complete and comprehensive, as the board has the final authority regarding whether the physician can continue to practice.
There may be potential liability risks for the examining psychiatrist, especially if the physician is found “fit for duty” and the patient subsequently suffers an untoward incident. If you have questions about evaluating colleagues or reporting obligations, obtain risk management or legal advice. ■
APA’s Resource Document Guidelines for Psychiatric “Fitness for Duty” Evaluations of Physicians can be accessed here.
This information is provided as a risk management resource and should not be construed as legal, technical, or clinical advice. This information may refer to specific local regulatory or legal issues that may not be relevant to you. Consult your professional advisors or legal counsel for guidance on issues specific to you. This material may not be reproduced or distributed without the express, written permission of Allied World Assurance Company Holdings, GmbH, a Fairfax company (“Allied World”). Risk management services are provided by or arranged through AWAC Services Company, a member company of Allied World.
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Psychiatrics News
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Published online: 29 October 2018
Published in print: October 20, 2018 – November 2, 2018
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