Workforce Health

1
Workforce Health SafetyMental Health Resources

• Jaclyn Vorenkamp, MD, MPH

2
Occupational Psychiatry

• Scope
• Psychiatric evaluations on entry to the workforce
• Support systems evaluations
• Treating provider
• Prescriptions
• Stress management
• Social networks
• Mental health programs available to residents
• EAP services
• Support groups
• Medical review of urine drug tests
• Administrative Referrals
• Staffing
• Psychiatrist
• Psychologists
• Psychiatric Nurse Case Managers

3
EAP (Employee Assistance Program)

• Services
• Counseling and referrals for life stresses, such
  as financial problems, elder care, child care,
  conflicts at work, domestic abuse, housing
• Counseling and referrals for treatment for mental
  health concerns including substance abuse
• Free to the resident
• Voluntary Program
• Self-referrals only
• Confidential
• No information of any kind is shared with the
  employer

4
EAP Providers

• Workforce Health Safety at NYP/CU
• EAP Consortium at NYP/WC
• How to refer
• Offer contact information to resident during
  supportive encounter
• Stress the voluntary nature of the referral
• It must be alright with you if the resident
  declines to use the service or to seek help
  elsewhere

5
Administrative Referrals

• Purpose
• Identify medical or psychiatric conditions or
  addictions that have led to a deterioration in
  performance or behavior
• Undiagnosed
• Suboptimally treated
• Optimally treated with progression
• Arrange for treatment in cases where it is needed
• Return the resident to a working environment
  conducive to continued recovery
• Monitor the residents recovery after returning
  to work

6
Administrative Referrals

• Impairment that becomes visible by affecting
  performance or behavior provides us with an
  opportunity to help a colleague who otherwise
  might not seek help
• Impaired residents are often in denial regarding
  the seriousness of their condition
• May not know how to access care for themselves,
  or they may be afraid to
• You can prevent patient harm or a ruined career
  by reporting a colleague who may be impaired

7
Outcomes

• Since 2002, we have seen 71 physicians
• 8 had no findings and were returned to work
• 2 had end stage disease and retired
• 4 were unable to achieve a sustained recovery and
  their contracts were not renewed
• 57 successfully completed treatment and returned
  to work
• Success rate for those referred for treatment
  93
• Recidivism rate 0

8
Definition of Impairment

• Any condition that adversely affects judgment or
  cognition, or the physical skills or conditioning
  required to safely and competently perform ones
  work so that the risk to patient safety cannot be
  mitigated

9
Program

• Every referral undergoes a medical exam,
  psychiatric exam, blood work and a drug screen
• Consultations with treating providers
• Specialist evaluations
• All referred residents are put off duty pending
  the results of the evaluation
• Cooperation with the program is a condition of
  continued employment or affiliation

10
Findings

• If there are no findings to support impairment,
  the physician is referred back to the clinical
  department without restrictions
• The clinical department may then consider further
  action depending on the circumstances of the case
• If there are findings of treatable impairment,
  WHS will arrange for treatment
• WHS coordinates closely with the NYS Committee
  on Physicians Health to ensure optimal support
  during treatment and recovery
• If there are findings of untreatable impairment,
  WHS will seek to arrange an accommodation
  wherever feasible

11
Return to Work

• RTW requires evidence of successful completion of
  a recommended treatment program, recovery from
  the impairing condition and the willingness of
  the residency program to take the resident back
• WHS works with CPH and with the clinical
  department to develop a RTW plan that supports
  sustained recovery
• The resident signs an agreement that may include
  urine drug screens and practice monitors,
  generally for the duration of the residency
• Relapses are grounds for non-renewal

12
Disciplinary Process

• The administrative referral is separate from the
  disciplinary process and is intended to be made
  in a firm but supportive fashion
• WHS plays no role in reporting physicians to the
  OPM or in disciplinary actions a department may
  take against a resident for criminal activity or
  other breaches of conduct
• The decision to report a physician to the OPM is
  made by the VP of Medical Affairs in conjunction
  with the Office of Legal Affairs and depends on
  the circumstances of the case

13
Confidentiality

• The Hospital has an obligation under Title 10 of
  the NYS Health Code to assure that the workforce
  is free of medical and psychiatric impairment ,
  including substance abuse, that may pose a threat
  to patient safety
• Individuals representing the Hospital may be
  apprised of the health status of an employee or
  affiliate who poses such a risk only on a
  need-to-know basis

14
Confidentiality

• The nature of the shared information is
  restricted to
• Whether there is an impairment
• The nature of the impairment as it relates to the
  persons ability to work
• Whether the impairment is treatable
• How long the treatment is expected to last
• When the person has recovered
• The evidence for recovery
• Whether recovery is sustained
• Whether drugs were diverted from patients
• Anything else pertinent to the individuals
  ability to work

15
Confidentiality

• Kinds of information not shared
• Specifics of the impairing disorder or condition
• Medication regimens
• Details of private lives
• Other conditions not bearing on the ability to
  work

16
How to Make an Administrative Referral

• It is enough to have a reasonable suspicion that
  a resident is impaired to consider making a
  referral. It is not necessary to make a
  diagnosis first
• Discuss the merits of the case with the program
  director, or with the VP of Medical Affairs
• Refer to the Director of WHS
• The identity of the person alleging impairment in
  a colleague is kept confidential

17
Contact Information

• Jaclyn Vorenkamp, MD, MPH 212-297-5447
• Joanne Moore, MD 212-305-7590
• Leslie Kondratowitz, RN 212-305-0861
• Mary De Santis, RN 212-746-7362
• EAP Consortium 212-746-5890
• EAP NYP/CU 212-305-0861