General Information
Fact Sheet
The Alabama Professionals Health Program was established and is authorized by the Board of Medical Examiners. The purpose of the program is to encourage early referral of medical professionals (including residents, medical students and physician's assistants) who have problems that could lead to impairment. The program is confidential and non-punitive. The goal is to provide a clinical mechanism to obtain appropriate assistance prior to having significant impairment that could damage the professional's career or harm patients.
Frequently Asked Questions
Alcohol on the Breath, AOB
A physician at the clinic where I work frequently smells of alcohol in the morning. She’s a very good doctor but I know she has a problem. Is there any way I can help her?
A Concerned Nurse
Answer:
When a physician has alcohol on their breath you are usually seeing the “tip of the iceberg.” Most physicians with alcohol problems will have trouble in every other part of their lives before it shows up at work. If possible, it would be helpful, to ask the doctor to submit to a breathalyzer test or blood alcohol one of those mornings. You will probably have to obtain the support of leadership at the clinic to do this. APHP can be of help. This can be a difficult process but the outcome for physicians who receive treatment and monitoring is very good (>90%) and the prognosis without intervention is poor. It’s worth the effort!
Depression in a Medical Staff Member
I am the President of our local Medical Staff. A physician answered yes to a question about psychiatric care on his staff reappointment questionnaire. When I spoke with him I discovered he is being treated for depression and is doing well. Do I need to report him to you or what should I do now?
Thanks
Response:
If a physician receives psychiatric care and is doing well, you should obtain verification from his/her treating physician that he/she is doing well. You do not need to report this to anyone else. We certainly don’t want to discourage anyone for receiving appropriate treatment. It is especially important that medical professionals not treat themselves. If, however, a professional is not getting appropriate care or is not responding, we might be able to assist. We would suggest an evaluation and treatment when indicated. We can monitor and document his/her compliance to treatment when necessary. Please feel free to call our office to discuss this further if necessary.
Sincerely, Dr. Skipper
Disruptive Behavior
Question:
We have a problem at our hospital with a very disruptive, angry physician. He is an excellent physician but his verbal abuse of staff and other professionals has got to stop. Can APHP help?
Answer:
Complaints of disruptive behavior among physicians appear to be increasing. This problem is very costly in time and money to the hospital and can lead to a decline in quality of staff and medical care. It is important for the Medical Staff Bylaws to contain wording that clearly define inappropriate behavior and its consequences. It is important to document in writing all incidents and complaints. If there are incidents involving patient care or if the Medical Staff is willing to take action then the APHP can help. We can help by participating in a meeting with the physician. We can refer the physician for intensive evaluation to look for physical or psychiatric problems that might be present. Call the APHP office and we can supply additional information on this difficult subject.
Hydrocodone Abuse
Question:
I’m very concerned about a colleague I believe is prescribing hydrocodone for himself. I received a call from a pharmacist who was also concerned. I've noticed a change in his personality. He is missing more workdays than previously and I know he’s having difficulty in his marriage. I’ve asked him about this and he denies everything. What can I do?
Answer:
It sounds like your associate may have a problem with hydrocodone dependence. He needs help to avert disaster. Hydrocodone has become the number one most abused and diverted drug in the United States. This problem does not go away by itself. The Alabama Professionals Health Program receives many such calls and we can help. I will speak with your associate and let him know that significant confidential concerns have been expressed. (I will not need to give your name unless you are willing to participate.) I will tell him about our APHP program, which is totally voluntary. The first step in participating in the APHP is to undergo an evaluation. I will suggest that he receive a thorough evaluation (at one of the evaluation programs that specializes in helping physicians) to clear up our concerns. This will be the beginning of a solution. The success rate with this type of problem is extremely high and someday he’ll thank you. Thanks for your willingness.
JCAHO Standards (MS 4.8)
We understand new JCAHO standards require that every hospital Medical Staff have a physician wellness committee. Is this true and how does this affect how we work with you?
Answer:
According to the JCAHO: “Each hospital does not have to create its own process when, in fact, such a program is available through the state board of medicine or state medical association. As long as the hospital's medical staff policy describes how referrals are made and results are monitored, that would meet the intent of the new requirements, and they would NOT have to set up another committee.” That having been said, the APHP encourages the formation of local Physician Health Committees who work as a team with our program. If you need further information regarding this issue please contact our office.
Obtaining Assistance from APHP
I’m a physician practicing in Alabama. I’m currently enrolled in an alcohol treatment program following an incident with my wife, who insisted I go. I realize now that I am an alcoholic. I’ve never had any professional credentials or licensing problems. The treatment center is suggesting I enroll in your program. Please tell me why I should.
Answer:
Congratulations on facing your need for recovery and accepting help. There are at least two primary benefits to your participating in our program: 1. When you fill out your license renewal and/or other applications you will be asked if you have been treated for alcoholism. It would behoove you to participate in monitoring to allay Board or other concerns. These agencies have confidence in our program and we can support you. 2. Additionally, your prognosis is much improved if you are committed to long-term monitoring. (The success rate with monitoring is greater than 90%.) Our program is confidential and thorough. We would be happy to work with you.
Poppy seeds and urine testing
My urine drug screen test was positive for morphine but I didn’t use any drugs. Is something wrong with the test? Can you explain?
Answer:
Urine drug testing is very accurate. Unfortunately poppy seeds contain very small amounts of opiates and can cause a positive urine test for morphine and codeine. Technically, this is not a “false positive” since the opiate content is real, however, it does not necessarily indicate that you have used medicinal morphine. Current federal guidelines state that a urine morphine level of less than 2000 ng/ml may be due to poppy seeds. Additionally certain ratios of morphine to codeine levels in the urine suggest poppy seeds. Therefore a Medical Review Officer will need to review the results for interpretation. If you are involved in a urine drug testing program it is wise to avoid poppy seeds!
Pain Management and Prescribing
“What is the big deal about prescribing pain medications for people in pain?” “Will I get in trouble if I prescribe too many pain meds?” “I’ve never seen anyone get addicted when their pain is controlled adequately.”
Answer:
You are asking questions that concern many physicians. On the one hand we are told that we’re not providing enough pain relief for chronic pain sufferers and on the other hand we hear about doctors losing their medical license, or going to jail for excessive prescribing. Many agencies are interested in these issues, including the Medical Licensure Commission, the Board of Medical Examiners, local police, the Alabama Bureau of Investigation, the new Statewide Drug Abuse Task Force, the DEA, the FDA, the US Congress, to name a few. No wonder physicians are apprehensive! There are many looking over our shoulders.
Why are drugs scheduled? Physicians are very familiar with dangerous medications (e.g. Digoxin, NSAIDS, etc). We know about side effects. Why the special emphasis regarding these scheduled drugs.
The answer: Many physicians don’t understand addiction. Physicians often tend to either underestimate the potential for addiction, giving drugs too freely, or they tend to overreact and not give drugs when needed.
So, we need to manage pain appropriately, understand and manage addiction better and find the elusive balance between the two.
Referring
Our credentials committee has concerns about a physician on our staff. We have discussed calling you to ask for your assistance. The question we have disputed is “How bad does it have to get before we call you in to work with us.” What’s the answer?
Answer:
It is difficult sometimes to decide when to take action. Remember, when we get involved all we are ever going to recommend is that the physician undergo an appropriate clinical evaluation. The type and intensity of the evaluation can be designed to fit the circumstances. Remember also that it is important to utilize evaluators that are not selected by the physician but by our program because we utilize experienced evaluators with a proven track record of fairness and objectivity. Don’t hesitate to call and discuss concerns, without mentioning names if necessary, so that we might work together more effectively. The answer is “The sooner the better.”
Reporting Law
I’m Chairman of the Physician Wellness Committee at our hospital. Is there a requirement that we notify you and involve your program if we have a physician with “problems” that we’ve assisted and are monitoring locally?
Answer:
Alabama Code 34-24-360 (which is sometimes called the “snitch law”) requires reporting of any physician…”who may be unable to practice medicine with reasonable care and safety to patients by reason of illness, drugs, inebriation…. To encourage early referral the law that created the Alabama Physician Health Program, APHP, provides that reporting to the APHP fulfills this requirement. If there’s any question whether this applies, to reduce your liability, the best idea is to give us a call. We can discuss the issue and assist you in making a decision.
Medical Practice Act (Codes 34-24) – Written 1972
Section 34-24-361(b) Any physician or osteopath holding a certificate of qualification to practice medicine or osteopathy in the State of Alabama shall and is hereby required to, and any other person may, report to the board or the commission any information such physician, osteopath, or other person may have which appears to show that any physician or osteopath holding a certificate of qualification to practice medicine or osteopathy in the State of Alabama may be guilty of any of the acts, offenses, or conditions set out in Section 34-24-360 (see below), and any physician, osteopath, or other person who in good faith makes such a report to the board or to the commission shall not be liable to any person for any statement or opinion made in such report.
Section 34-24-360 The Medical Licensure Commission shall have the power and duty to suspend, revoke, or restrict any license to practice medicine or osteopathy in the State of Alabama or place on probation or fine any licensee whenever the licensee shall be found guilty on the basis of substantial evidence of any of the following acts or offenses:
(1) Fraud in applying for or procuring a certificate of qualification to practice medicine or osteopathy or a license to practice medicine or osteopathy in the State of Alabama.
(2) Unprofessional conduct as defined herein or in the rules and regulations promulgated by the commission.
(3) Practicing medicine or osteopathy in such a manner as to endanger the health of the patients of the practitioner.
Spouse Concerns
My husband is a physician who is having problems and is now undergoing an evaluation away from home that you requested. He may be having problems but we need him. I am here with our small children and I’m very upset about what is going on and our future. I don’t understand what is happening. Please help me. I am very upset.
Response:
Thank you for contacting us. We want to assist you and explain what is happening and support you and your family in any way possible. Remember the goal is for your husband to receive the help he needs. Your family will benefit from his evaluation and treatment. Please call us so we can discuss the details.
Fact Sheet
The Alabama Professionals Health Program was established and is authorized by the Board of Medical Examiners. The purpose of the program is to encourage early referral of medical professionals (including residents, medical students and physician's assistants) who have problems that could lead to impairment. The program is confidential and non-punitive. The goal is to provide a clinical mechanism to obtain appropriate assistance prior to having significant impairment that could damage the professional's career or harm patients.
- Anyone may contact the program to discuss concerns and/or receive information about policies, procedures, and/or statistics (Anonymous inquiries are accepted.)
- We receive approximately 70 referrals per year (many are self-referrals)
- We become actively involved in approximately 3/4 of the referrals
- Participation by the troubled professional is voluntary (we are authorized by the Medical Board to assist professionals in lieu of medical board investigation or disciplinary action).
- If there is a potential or real problem related to impairment, we recommend a thorough clinical evaluation for diagnostic purposes.
- We refer individuals who need evaluation to experienced programs that work with physicians and other professionals who have a track record of competence and success. (We currently recommend more than a dozen such programs nationally. More than half are in the southeast.)
- We can assist individuals when needed by providing ongoing monitoring to document their recovery and well-being.
- We are engaged in research to better understand stress and burnout among professionals and instances of malpractice while actively involved in or after completing treatment and/or monitoring.
Frequently Asked Questions
Alcohol on the Breath, AOB
A physician at the clinic where I work frequently smells of alcohol in the morning. She’s a very good doctor but I know she has a problem. Is there any way I can help her?
A Concerned Nurse
Answer:
When a physician has alcohol on their breath you are usually seeing the “tip of the iceberg.” Most physicians with alcohol problems will have trouble in every other part of their lives before it shows up at work. If possible, it would be helpful, to ask the doctor to submit to a breathalyzer test or blood alcohol one of those mornings. You will probably have to obtain the support of leadership at the clinic to do this. APHP can be of help. This can be a difficult process but the outcome for physicians who receive treatment and monitoring is very good (>90%) and the prognosis without intervention is poor. It’s worth the effort!
Depression in a Medical Staff Member
I am the President of our local Medical Staff. A physician answered yes to a question about psychiatric care on his staff reappointment questionnaire. When I spoke with him I discovered he is being treated for depression and is doing well. Do I need to report him to you or what should I do now?
Thanks
Response:
If a physician receives psychiatric care and is doing well, you should obtain verification from his/her treating physician that he/she is doing well. You do not need to report this to anyone else. We certainly don’t want to discourage anyone for receiving appropriate treatment. It is especially important that medical professionals not treat themselves. If, however, a professional is not getting appropriate care or is not responding, we might be able to assist. We would suggest an evaluation and treatment when indicated. We can monitor and document his/her compliance to treatment when necessary. Please feel free to call our office to discuss this further if necessary.
Sincerely, Dr. Skipper
Disruptive Behavior
Question:
We have a problem at our hospital with a very disruptive, angry physician. He is an excellent physician but his verbal abuse of staff and other professionals has got to stop. Can APHP help?
Answer:
Complaints of disruptive behavior among physicians appear to be increasing. This problem is very costly in time and money to the hospital and can lead to a decline in quality of staff and medical care. It is important for the Medical Staff Bylaws to contain wording that clearly define inappropriate behavior and its consequences. It is important to document in writing all incidents and complaints. If there are incidents involving patient care or if the Medical Staff is willing to take action then the APHP can help. We can help by participating in a meeting with the physician. We can refer the physician for intensive evaluation to look for physical or psychiatric problems that might be present. Call the APHP office and we can supply additional information on this difficult subject.
Hydrocodone Abuse
Question:
I’m very concerned about a colleague I believe is prescribing hydrocodone for himself. I received a call from a pharmacist who was also concerned. I've noticed a change in his personality. He is missing more workdays than previously and I know he’s having difficulty in his marriage. I’ve asked him about this and he denies everything. What can I do?
Answer:
It sounds like your associate may have a problem with hydrocodone dependence. He needs help to avert disaster. Hydrocodone has become the number one most abused and diverted drug in the United States. This problem does not go away by itself. The Alabama Professionals Health Program receives many such calls and we can help. I will speak with your associate and let him know that significant confidential concerns have been expressed. (I will not need to give your name unless you are willing to participate.) I will tell him about our APHP program, which is totally voluntary. The first step in participating in the APHP is to undergo an evaluation. I will suggest that he receive a thorough evaluation (at one of the evaluation programs that specializes in helping physicians) to clear up our concerns. This will be the beginning of a solution. The success rate with this type of problem is extremely high and someday he’ll thank you. Thanks for your willingness.
JCAHO Standards (MS 4.8)
We understand new JCAHO standards require that every hospital Medical Staff have a physician wellness committee. Is this true and how does this affect how we work with you?
Answer:
According to the JCAHO: “Each hospital does not have to create its own process when, in fact, such a program is available through the state board of medicine or state medical association. As long as the hospital's medical staff policy describes how referrals are made and results are monitored, that would meet the intent of the new requirements, and they would NOT have to set up another committee.” That having been said, the APHP encourages the formation of local Physician Health Committees who work as a team with our program. If you need further information regarding this issue please contact our office.
Obtaining Assistance from APHP
I’m a physician practicing in Alabama. I’m currently enrolled in an alcohol treatment program following an incident with my wife, who insisted I go. I realize now that I am an alcoholic. I’ve never had any professional credentials or licensing problems. The treatment center is suggesting I enroll in your program. Please tell me why I should.
Answer:
Congratulations on facing your need for recovery and accepting help. There are at least two primary benefits to your participating in our program: 1. When you fill out your license renewal and/or other applications you will be asked if you have been treated for alcoholism. It would behoove you to participate in monitoring to allay Board or other concerns. These agencies have confidence in our program and we can support you. 2. Additionally, your prognosis is much improved if you are committed to long-term monitoring. (The success rate with monitoring is greater than 90%.) Our program is confidential and thorough. We would be happy to work with you.
Poppy seeds and urine testing
My urine drug screen test was positive for morphine but I didn’t use any drugs. Is something wrong with the test? Can you explain?
Answer:
Urine drug testing is very accurate. Unfortunately poppy seeds contain very small amounts of opiates and can cause a positive urine test for morphine and codeine. Technically, this is not a “false positive” since the opiate content is real, however, it does not necessarily indicate that you have used medicinal morphine. Current federal guidelines state that a urine morphine level of less than 2000 ng/ml may be due to poppy seeds. Additionally certain ratios of morphine to codeine levels in the urine suggest poppy seeds. Therefore a Medical Review Officer will need to review the results for interpretation. If you are involved in a urine drug testing program it is wise to avoid poppy seeds!
Pain Management and Prescribing
“What is the big deal about prescribing pain medications for people in pain?” “Will I get in trouble if I prescribe too many pain meds?” “I’ve never seen anyone get addicted when their pain is controlled adequately.”
Answer:
You are asking questions that concern many physicians. On the one hand we are told that we’re not providing enough pain relief for chronic pain sufferers and on the other hand we hear about doctors losing their medical license, or going to jail for excessive prescribing. Many agencies are interested in these issues, including the Medical Licensure Commission, the Board of Medical Examiners, local police, the Alabama Bureau of Investigation, the new Statewide Drug Abuse Task Force, the DEA, the FDA, the US Congress, to name a few. No wonder physicians are apprehensive! There are many looking over our shoulders.
Why are drugs scheduled? Physicians are very familiar with dangerous medications (e.g. Digoxin, NSAIDS, etc). We know about side effects. Why the special emphasis regarding these scheduled drugs.
The answer: Many physicians don’t understand addiction. Physicians often tend to either underestimate the potential for addiction, giving drugs too freely, or they tend to overreact and not give drugs when needed.
So, we need to manage pain appropriately, understand and manage addiction better and find the elusive balance between the two.
Referring
Our credentials committee has concerns about a physician on our staff. We have discussed calling you to ask for your assistance. The question we have disputed is “How bad does it have to get before we call you in to work with us.” What’s the answer?
Answer:
It is difficult sometimes to decide when to take action. Remember, when we get involved all we are ever going to recommend is that the physician undergo an appropriate clinical evaluation. The type and intensity of the evaluation can be designed to fit the circumstances. Remember also that it is important to utilize evaluators that are not selected by the physician but by our program because we utilize experienced evaluators with a proven track record of fairness and objectivity. Don’t hesitate to call and discuss concerns, without mentioning names if necessary, so that we might work together more effectively. The answer is “The sooner the better.”
Reporting Law
I’m Chairman of the Physician Wellness Committee at our hospital. Is there a requirement that we notify you and involve your program if we have a physician with “problems” that we’ve assisted and are monitoring locally?
Answer:
Alabama Code 34-24-360 (which is sometimes called the “snitch law”) requires reporting of any physician…”who may be unable to practice medicine with reasonable care and safety to patients by reason of illness, drugs, inebriation…. To encourage early referral the law that created the Alabama Physician Health Program, APHP, provides that reporting to the APHP fulfills this requirement. If there’s any question whether this applies, to reduce your liability, the best idea is to give us a call. We can discuss the issue and assist you in making a decision.
Medical Practice Act (Codes 34-24) – Written 1972
Section 34-24-361(b) Any physician or osteopath holding a certificate of qualification to practice medicine or osteopathy in the State of Alabama shall and is hereby required to, and any other person may, report to the board or the commission any information such physician, osteopath, or other person may have which appears to show that any physician or osteopath holding a certificate of qualification to practice medicine or osteopathy in the State of Alabama may be guilty of any of the acts, offenses, or conditions set out in Section 34-24-360 (see below), and any physician, osteopath, or other person who in good faith makes such a report to the board or to the commission shall not be liable to any person for any statement or opinion made in such report.
Section 34-24-360 The Medical Licensure Commission shall have the power and duty to suspend, revoke, or restrict any license to practice medicine or osteopathy in the State of Alabama or place on probation or fine any licensee whenever the licensee shall be found guilty on the basis of substantial evidence of any of the following acts or offenses:
(1) Fraud in applying for or procuring a certificate of qualification to practice medicine or osteopathy or a license to practice medicine or osteopathy in the State of Alabama.
(2) Unprofessional conduct as defined herein or in the rules and regulations promulgated by the commission.
(3) Practicing medicine or osteopathy in such a manner as to endanger the health of the patients of the practitioner.
Spouse Concerns
My husband is a physician who is having problems and is now undergoing an evaluation away from home that you requested. He may be having problems but we need him. I am here with our small children and I’m very upset about what is going on and our future. I don’t understand what is happening. Please help me. I am very upset.
Response:
Thank you for contacting us. We want to assist you and explain what is happening and support you and your family in any way possible. Remember the goal is for your husband to receive the help he needs. Your family will benefit from his evaluation and treatment. Please call us so we can discuss the details.
