One of your employees has succumbed to addiction. What should you do?
One day, you notice it: A good employee has stopped being good. Her work, once so exemplary, has steadily deteriorated, although she’s weirdly possessive about it. What’s amiss? A derailed love life and no one to go home to? Financial troubles, enough to make her embezzle? Perhaps. Then, the tip-off: No one is bigger buddies with all the drug reps than she, and, most tellingly, she eagerly volunteers for snoozefest tasks like drug audits.
All signs point to a drug-using employee. What now?
Unfortunately, there’s no easy answer to this question. Rose Samaniego, practice coordinator with Oncology Consultants in Houston, knows this all too well after having found herself facing the above scenario a few years ago while at a previous practice. The employee - an experienced RN - had become addicted to her husband’s back pain pills, which she’d been pilfering to cope with life stressors. One day, while on a rare day off due to some unavoidable minor surgery, a fake prescription arrived at the practice for the employee. Busted.
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The drug-seeking patientDealing with problem patientsDr. Difficult
Certainly, such felonious behavior is legitimate grounds for dismissal, but taking that immediate, drastic step did not feel right to Samaniego or the practice’s physician. “We were a family; it wasn’t just an employee,” she says.
They opted to try to help the employee instead of dismissing her. Samaniego offered the embarrassed staffer counseling and assistance with finding drug rehab services. She accepted the help at first, but then resisted, saying she could solve it on her own. But she couldn’t. In the end, she lost both her job and her marriage.
Anytime you lose an employee for this reason, it’s a tragedy, but not just for that person. “If you have an abuser, it’s like an iceberg,” says 30-year veteran practice administrator Chris Kelleher of Columbia-based South Carolina OB/GYN Associates. “You’re only going to see the tip of the problem. … Ninety percent of the stuff is under the water. It’s what you don’t see that’s really scary.”
So true. With substance abusers you have a serious clinical liability issue on your hands, possibly unbeknownst to you for months. Critical bits and pieces might get left out of patients’ charts or follow-up duties such as calling patients regarding test results might not get done. This undermines the care that you’re giving - perhaps with dire consequences.
Confidence within your practice can suffer lethal blows in terms of working relationships, too. “There’s such a trust between the physician and the nurse. The physician looks at the nurse as a physician extender - lots of autonomy,” says Kelleher. “You get an impaired employee, and that creates a huge chasm between trust and liability.”
Discovering you’ve got a doped-up employee immediately presents you with some quandaries. “Because we are healthcare providers,” says Kelleher, “we have a dual sword: We care [about the drug-using employee] because as healthcare providers, that’s what we do. But we also have a responsibility to the patients to do no harm.”
You also have a responsibility to yourself. Prescriptions written in your name can jeopardize your license. If you do nothing, you may be sending a “watch my practice” red flag to the authorities.
Finally, what about the rest of your hard-working, drug-free staff? “It does impact the other members, who have to double-check the other employee,” says Kelleher. That fosters resentment. After all, what’s their reward for picking up the slack? More work.
So again: What to do?
If you’ve actually got a drug user:
As for pressing charges with the police, do you have to? Yes and no. There’s nothing on the books saying you must. However, “on the DEA report, there’s a question that says, ‘What law enforcement agency did you report to?’” says healthcare attorney Lourdes Martinez, a partner with the New York City-based Garfunkel, Wild, & Travis law firm. If you leave that blank, you could be leaving yourself open to a legal stinkeye. Report the incident as a theft, she says.
The best way, though, is a pre-emptive strike at the problem:
Broach this subject during interviews. That way, the employee - if you hire him - can never claim he “didn’t know.”
People caught in addiction are by definition bad at self-advocacy. If you can smooth a path to redemption for your employee, then do so. But do it wisely; don’t sacrifice yourself, says Blake. “The bottom line is you need to protect your livelihood and your practice if you have any hope of being strong for your family and for helping this employee.”
Shirley Grace is a former associate editor with Physicians Practice. She can be reached via firstname.lastname@example.org.
This article originally appeared in the April 2009 issue of Physicians Practice.