Reporting impaired pathologist

Q Our pathologist
shows signs of poor professional judgment. She is often late and
unavailable for necessary consultations. Her work is sporadic; we often
find errors. She is frequently distracted; more than once, a tech
looking for her found her napping. Concerns are that she may have drug
or alcohol problems. What is our responsibility toward her, the lab, and
our patients? She may be making mistakes (e.g., when reading slides)
where no one comes after to pick a possible error.

A Distractedness,
fatigue, tardiness, and poor performance are well recognized as red
flags for possible substance abuse. But they can be indicative of other
medical problems: depression, diabetes, brain tumor, medication effects,
and encroaching dementia. The good news is that what is causing the
problem is not lab staff’s responsibility to determine; responding to it

Individuals and institutions have long turned a
blind eye to such problems. Physicians are often unwilling to report a
colleague for possible substance abuse, recognizing the dire
consequences: loss of position, possibly even loss of the medical
license. Subordinates might believe that reporting a boss could be
risking their positions, especially if their concerns are deemed
unfounded by the institution and nothing is done.

A physician impaired for any reason
presents a serious risk to patients — increased in your situation
because the pathologist is primarily responsible for signing out
anatomic slides with no immediate oversight. A serious mistake (i.e.,
missing a cancer diagnosis) is significant; consequences to the patient
are substantial. As a result, for lab staff as well as the institution
to err on the side of caution is important.

Physicians have a responsibility to report
impaired colleagues to state licensing boards; the AMA’s Code of Ethics
further emphasizes that physician members are to report impaired,
unethical, or incompetent colleagues. In some states, an individual
with knowledge of an impaired physician who fails to make a required
report is himself subject to discipline
. Because being certain of
the facts is difficult and because an allegation of substance
abuse is devastating, some are reluctant to report for fear of being
sued for defamation if the allegation is wrong. State statutes that
require reporting impaired physicians may also provide immunity for
good-faith reporting.

Your institution’s handbook may require reporting
individuals who are or appear to be impaired, and may include examples
of behavior and physical appearance that can be viewed as reasonable
evidence: dilated/contracted pupils, slurred speech, sleepiness,
irritability, erratic behavior, alcohol on the breath. A policy should
also indicate to whom and in what form reports should be made.

If your pathologist is in a group practice, your
concerns could be brought legitimately to her manager and that
individual could take appropriate action, including making necessary
reports to the hospital. Prepare clear evidence of mistakes and note
dates on which unusual behavior was observed. Having the information
confirmed by several independent sources helps to avoid the appearance
that one individual “has it in” for this physician.

Whether this situation rises to the level that
requires reporting to the state licensure board is another issue to be
handled by hospital administration or the physician’s group. Certainly,
if impairment as a result of substance abuse or if mental illness is
confirmed, a report is needed. If the reported behavior represents a
transient, easily remedied reaction to external stressful circumstances
(i.e., divorce or family illness), reporting beyond the institution may
not be needed.

Proceedings to deal with an impaired physician,
whether by the state or in the hospital, take time and, to a certain
extent, will remain confidential. Institutional programs often allow an
employee/physician to work if there is no immediate risk to others, as
long as ongoing treatment/monitoring is in place. State licensing boards
have provisions for evaluation/monitoring, often for extended periods,
that allow a physician to work while getting help and re-establishing a
record of good health and reliability.

Any professional’s impairment should not be
subject for discussion, nor should his records be easily accessible.
Most institutions have particular rules about making notes of
communications and may require those to be confidential and sent to the
institutional attorney. Medical records may be protected; depending on
the reason for impairment, the physician may be entitled to protection
and accommodation by the lab staff under the Americans with Disabilities

Once the report is made, continue to monitor the
problems. If no apparent action is taken by the institution and problems
remain/increase, report again directly rather than through an
. If a situation arises in which this physician
impairment is significant enough that staff or patients are in immediate
risk of harm, Human Resources should be notified immediately.

Barbara Harty-Golder is a
pathologist-attorney consultant in Chattanooga, TN. She maintains a law
practice with a special interest in medical law. She writes and lectures
extensively on healthcare law, risk management, and human resource

“Liability and the Lab” is intended to provide risk management and human
resource management education; it is not intended to provide specific
legal advice. If you require legal advice, the services of an attorney
should be sought. Dr. Harty-Golder welcomes your questions, which can be
sent to her at
[email protected]. Unless
otherwise noted as “confidential” by readers, all queries will be
considered for publication without further notice to them. Names,
institution, city, and state will be removed before publication.