Doctors Under the Influence

Doctors are the people we trust to look after us. From day-to-day care to chronic disease management and life-saving surgery, they’re our go-to people for whatever ails us. Sometimes, it’s easy to forget that doctors are just human beings like the rest of us, and they can have all the same problems we have, including addictions to drugs and alcohol.

Under regulations laid out by the Department of Transportation (DOT), anyone and everyone who is involved in the transportation industry in the United States is subject to drug testing as a condition of employment. Under Canadian law, testing isn’t mandatory but it’s still widely enforced by industry. Any number of non-government institutions in the United States also mandate drug testing as a condition of employment. But who monitors the doctors?

Doctors and Drugs

TODAY investigative journalist Jeff Rossen informs us that government studies indicate that at any given time, about one in every ten practicing doctors is battling an addiction to either drugs or alcohol. Worse, many perform surgery while under the influence, resulting in injury and even death to patients who have no way of knowing what manner of substance their doctor may be abusing. Sadly, television’s Dr. Gregory House, with his Vicodin addiction, isn’t just a figment of a talented writer’s imagination.

Rossen uses as an example Dr. Stephen Lloyd, a practitioner in the state of Tennessee, who actually had the courage to speak out about his own addiction problem, even knowing that he could be setting himself up for malpractice suits by former patients. Like Dr. House, Lloyd’s drug of choice was Vicodin – up to a staggering hundred pills a day.

As an internist, Dr. Lloyd had no trouble getting narcotics – he had access to Vicodin, and since practically all his friends were also doctors, there was no shortage of people who were willing to write prescriptions for him. He says that none of his patients had any idea that he was using, and as far as he knows, he never harmed a patient while he was under the influence.

Dr. Christopher Duntsch, however, who considered himself to be Dallas’s top neurosurgeon, did. More than a dozen of his former patients allege that he botched their surgeries so badly that they ended up partially or completely paralyzed. One of his assistants alleges that he frequently drank while on duty, and a friend alleges that he also used cocaine and LSD.

When testifying in the many lawsuits brought against him, Dr. Duntsch has denied wrongdoing, but persistently invokes the Fifth Amendment. He refused to be interviewed by Rossen, but did tell him, off the record, that he never took drugs or drank before surgery. The state medical board revoked his license on the basis that he had violated the accepted standard of care.

Duntsch has not been charged with a crime, and the state medical board did not find any evidence he was on drugs or alcohol during surgeries. His license was revoked because he “violated the standard of care.”

Is There Real Accountability?

In the absence of federal law regarding drug testing for doctors, right now all that can be done in the United States is to rely on medical boards to monitor doctors. The problem is at least as severe in Canada. According to an article by Dr. J.A.L. Gilbert of the Royal Alexandra Hospital of Medicine in Edmonton Alberta, in Canadian Family Physician, it’s estimated that 15% of Canadian doctors are addicted to drugs, alcohol, or both. He states that addiction in doctorsypically begins at a later age (30-40) than it does in other segments of the population, and also peaks later (50-65). As in the US, the problem is often not dealt with until it becomes so severe it ends up being a matter for the hospital disciplinary board because it can no longer be ignored.

Will There Ever Be Accountability?

In California, lawmakers have proposed random drug tests for any doctor who has hospital privileges. It would also be mandated after what’s known as “preventable deaths” and other major physician errors. The proposed law is based on the FAA (Federal Aviation Administration) drug testing program for airline pilots.

Given the number of doctors currently practicing, the problem could end up being less having the law in place than having enough qualified drug and alcohol test technicians to administer the program. Fortunately, training is available, and the benefit is two-fold – increased employment, and more effective monitoring of doctors with substance abuse issues.

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