1. The Virginia Health Practitioners’ Monitoring Program
700 East Franklin Street, Suite 300 Tower
Richmond, VA
Penelope P. Ziegler, M.D.
Medical Director

2. VA HPMP
Program established by Virginia General Assembly in 1997 as Health Practitioners’ Intervention Program (HPIP)
Chapter 25.1 of Title 54.1, passed in 2009 formally changed name from HPIP to Health Practitioners’ Monitoring Program (HPMP)
More accurately reflects primary role of program
Outreach and education about professional impairment, previously done by HPIP, now done by Department of Health Professions (DHP)

3. HPMP Operation
Operated by Virginia Commonwealth University, Department of Psychiatry, under a Memorandum of Agreement with DHP
Funding is via professional licensure fees; amount of funding is determined by DHP
Oversight and coordination
Monitoring Program Committee (MPC)
7 members appointed by the Director of DHP
Meets 6 times yearly or as needed to review program operation, policies, specific cases
DHP liaison/ program manager

4. What Is Practitioner Impairment?
Impairment refers to a practitioners’ inability to perform professional duties with skill and safety as result of an illness or other health issue
Substance use disorder
Psychiatric illness
Medical condition
Potential impairment refers to the diagnosis of a condition that, without treatment, could be expected to result in impairment

5. Epidemiology of Addiction (85-90% of HPMP cases) in Health Care Professionals
Alcohol abuse and dependence
No difference in overall incidence or prevalence
Usually have later onset, less antisocial behavior
Illicit drug abuse and dependence
Lower than in general population
Marijuana is most common drug of choice
Prescription drug abuse and dependence
Higher than in general population
Oral opioids are most common drug of choice in all health care professions 5

6. How Is Impairment Identified?
Changes in behavior
Extreme mood swings, temper outbursts
Lateness, cancels cases/ appointments
Documentation illegible or not completed
Falls behind in duties
Rounds late at night
Misses exams, deadlines for papers
Changes in appearance
Disheveled
Major weight loss or gain
Pale, plethoric or diaphoretic

7. Other Indicators of Addiction
Disappears while on duty or during cases
Requests weekend duty (drugs are at work!)
At workplace evenings, weekends off
Unreachable, cell phone/pager “didn’t work”
Alcohol on breath
Long sleeves even in hot weather
Appearing sick or calling off on Mondays 7

8. Virginia Reporting Requirements
Licensed practitioners, health care institutions, professionals associations and malpractice insurers are required to report to the appropriate Boards practitioners who may be mentally or physically unable to practice safely as the result of an apparent impairing condition
Any such person or institution making a report in good faith is immune from civil liability
Psychiatric facilities are required to report the inpatient admission of any licensed practitioners to the appropriate Boards
Interesting conflicts with State and Federal confidentiality statues, HIPAA, etc.

9. Assessment and Treatment Planning
When addiction or other impairment is suspected, careful evaluation is required
Is substance dependence a primary diagnosis?
Are other psychiatric disorders present which also require immediate treatment?
Are there medical conditions which will complicate the treatment and recovery?
Once diagnosis is established, treatment planning is next step
What type of treatment is needed?
What level of care is indicated for initial treatment? 9

10. Essential Elements of Treatment
Effective reduction of denial, resistance and intellectualization
Acceptance of chronic nature of disease and need for ongoing treatment
Relapse prevention which addresses issues specific to the professional’s practice
Re-entry stresses
Access to drugs
Need for monitoring
Dealing with Board issues, legal issues 10

11. How Are Health Care Practitioners Referred to HPMP?
By Board Order
By DHP staff during process of investigation
By colleague or peer
By physician, therapist
By treatment program
By employer, hospital
By attorney
By family, significant other, friend
By training program, school
Self-referred 11

12. Monitoring as an Alternative to Discipline
Eligibility
Active Virginia license or application
Impairing or potentially impairing condition
Advantages
Encourages early identification and referral to appropriate treatment
Preserves valuable professionals’ ability to return to practice following treatment with ongoing monitoring
Improves practitioner’s prognosis for recovery 12

13. Components of Monitoring
Participation Contract (PC)
Agrees to enter HPMP program
Agrees to abstain from alcohol and other drugs
Agrees not to practice until cleared to do so by HPMP
Agrees to provide all relevant medical records and releases
Recovery Monitoring Contract (RMC)
Agrees to continued abstinence if indicated
Treatment plan is specified in detail
Drug screening program is specified
Agrees to be responsible to:
Follow rules of HPMP
Provide timely reports
Provide drug screens when selected
Not to return to work until approved to do so by HPMP 13

14. Drug Monitoring
Random urine drug screens at individualized frequency and content (medical director is Medical Review Officer)
Third party administration of screening program provided by Affinity Online Solutions
Daily check in by telephone or online
Collection sites, billing, chain of custody forms provided by Affinity Online Solutions
System of alerts for missed calls, no shows, positive results, nonnegative results
MRO consultation available if requested
Lab services provided by LabCorp
Hair testing utilized on individual case basis 14