1. Colorado Physician Health Program COMMUNITY report July 1, 2009 through June 30, 2010 by Sarah R. Early, PsyD, Executive Director Doris C. Gundersen, MD, Medical Director Colorado Physician Health Program The mission of Colorado Physician Health Program is to assist physicians, residents, medical students, physician assistants and physician assistant students who may have health problems which if left untreated, could adversely affect their ability to practice medicine safely.

2. Colorado Physician Health Program Program Highlights July 1, 2009 through June 30, 2010 2 Board of Directors 2009 – 2010 Chair James Borgstede, MD Vice-Chair George Dikeou, Esq. Secretary Thomas Currigan, Jr. Treasurer Larry A. Schafer, MD Director-At-Large John Genrich, MD Thomas G. Currigan, Jr. Maureen J. Garrity, PhD John H. Genrich, MD Caroline M. Gellrick, MD Jim Keller, PA-C Debbie Lazarus Michael Michalek, MD Doug Speedie, MD Steven Summer Lawrence Varner, DO CPHP Board Director Officers: CPHP held annual officer elections and also welcomes three new Board Directors as of May of 2010: Jim Keller, PA a Physician Assistant at Lakeview Family Medicine, P.C. in Littleton, CO. Doug Speedie, MD Associate Medical Director at Rocky Mountain Health Plans (RMHP) in Grand Junction, CO Steven Summer, President and Chief Executive Officer of the Colorado Hospital Association CPHP Serves Rocky Vista University College of Osteopathic Medicine Students: CPHP entered into a service contract with Rocky Vista University College of Osteopathic Medicine for the academic year 09-10. Executive Director, Sarah Early, PsyD and Medical Director, Doris Gundersen, MD provided orientations to faculty and students on the importance of physician health and services CPHP offers. CPHP is excited about this collaboration to serve the medical students and aid in supporting wellness throughout their training years. CPHP Newsletter Distributed: The Summer 2010 edition of CPHP News was mailed to all active Colorado licensed physicians and physician assistants and various other medical entities throughout the state. CPHP appreciates COPIC’s generous sponsorship of CPHP News. CPHP is proud of this initiative in an effort to provide the Colorado medical community with informative physician health articles and to promote our mission and services. Given the importance of this educational and outreach venture, we are committed to publishing CPHP News annually. CPHP News is also available for download from our website at www.cphp.org. www.cphp.org Spirit of Medicine Campaign: CPHP concluded the annual Spirit of Medicine fundraising campaign in 2008-2009 with successful results! CPHP utilizes fundraising to supplement expenses that exceed the Peer Assistance Budget. The Fundraising Committee led by Board Director Tom Currigan, Jr, coordinates and directs the efforts of this annual campaign. We are grateful to all of the generous contributors and especially want to recognize donors who provided a gift of $5,000 or more: Colorado Medical Foundation Trust St. Mary’s Hospital and Medical Center The Medical Center of Aurora Colorado Permanente Medical Group (CPMG) – We wish to offer special appreciation to CPMG as a long-time member of the LivingWell Giving Society Valley View Hospital – We would like to extend our appreciation as the newest member of the LivingWell Giving Society All donors are recognized on the CPHP website, www.cphp.org, from the 2008- 2009 campaign. Patient Safety Advisory Committee Judy Ham Cerebral Palsy of Colorado Patty Skolnik Colorado Citizens for Accountability Ed Dauer, Esq Colorado Patient Safety Coalition

3. Colorado Physician Health Program National/international research and conferences July 1, 2009 through June 30, 2010 Medical/Associate Directors Medical Director Doris C. Gundersen, MD Medical Director Emeritus Michael H. Gendel, MD Associate Medical Directors Mary Ellen Caiati, MD Scott H. Humphreys, MD Jay H. Shore, MD Elizabeth Stuyt, MD Staff Executive Director Sarah R. Early, Psy.D Director of Clinical Services Cae Allison, LCSW Finance Manager Denny Smith, CPA Receptionist Julie Fisher Clinicians Cindy Hudson, MA, CACIII Lynne Klaus, LCSW, CACIII Sally Moody, MSW, LCSW Dwayne Spinler, MS, LPC, NCC, MAC Compliance Coordinator Joyce Muniz Executive Assistant Amanda Parry Administrative Assistant Tracy Sue Walters Developmental Specialist Todd Weiss 3 CPHP prioritizes physician health research and interaction among the national and international community of physician health practitioners to promote best treatment practices for physicians and enhance public protection. All research efforts and conferences attended out of state are compensated through CPHP fundraising efforts. No Peer Assistance Funds are utilized for these activities. CPHP Participates in Patient Safety Initiatives: CPHP has taken an active role in ensuring that Patient Safety is at our forefront of the organization, physician health programs and the Colorado medical community. In doing so, we have established a Patient Safety Committee that advises the Board of Directors and Staff on decisions. In addition, Doris C. Gundersen, MD Medical Director attended conferences concerning Patient Safety Initiatives: October 28-30, 2009 Citizen Advocacy Center (CAC) Annual Meeting in Orlando, Florida November 13, 2009 Patient Safety Coalition Conference (PSC) in Denver, Colorado International Physician Health Efforts: Research: During the Second Quarter, CPHP was asked to be interviewed as a premier Physician Health Program by Michael Bonning, a junior doctor from Brisbane, Australia. Dr. Bonning has been awarded the International Winston Churchill Fellowship to research Physician Health Programs throughout the world. This data will be utilized to create a centralized Physician Health Program in Australia. CPHP appreciates the privilege to be recognized as a premier program. Canadian Conference on Physician Health: October 14-16, 2009, Sarah Early, PsyD, Executive Director, attended the inaugural Canadian Conference on Physician Health. This event included workshops and vanguard speakers from the physician health community. Federation of State Physician Health Programs (FSPHP): FSPHP Annual Meeting: CPHP Medical Director and Executive Director attended the FSPHP Annual Meeting in Chicago, IL from April 19-23, 2010. Sarah R. Early, PsyD, Executive Director presented on “Keeping Both Male and Female Physicians Healthy” and Doris C. Gundersen, MD, Medical Director presented on a panel “Disruptive Behavior Approaches”. In addition the FSPHP held a joint session with the Federation of State Medical Boards (FSMB) in which Dr. Gundersen co- presented on “Physician Health Programs and Licensing Boards: Partners for Patient Safety”. CPHP is pleased with the collaboration with the FSPHP and FSMB to collaborate on physician health related issues. Western Region FSPHP Annual Meeting: CPHP Medical Director, Doris Gundersen, MD and Executive Director, Sarah Early, PsyD attended the Western Region of the FSPHP Annual Meeting in Coeur D’Alene, Idaho on September 17- 19, 2009. Dr. Gundersen participated on a panel presentation entitled Health Programs Under Siege: Report On The Recent California Citizen Advocacy Center. We welcomed the opportunity to collaborate with colleagues from other Physician Health Programs and gain valuable information about physician health related issues.

4. Colorado Physician Health Program New referral Highlights July 1, 2009 through June 30, 2010 CPHP received 271 New Referrals in the Fiscal Year 2009-2010! In Fiscal Year 2008-2009, CPHP received 318 referrals. This is a 15% decrease when compared to 2008-2009 in New Referrals, and CPHP believes this is due to a decrease in referrals from the Colorado Medical Board (CMB). All CPHP clients that attend an initial intake appointment complete a Treatment and Monitoring Agreement (TMA) and receive case management services. The average active caseload throughout the four quarters of 2009-2010 was 446 participants. This represents a 5% decrease from the Fiscal Year 2008-2009 which had 465 active participants at any given time. CPHP attributes this decrease to the fervent effort of staff members to provide efficient services. Of the 271 New Referrals in the Fiscal Year 2009-2010, 64% were voluntary and 36% were mandatory. 44% of the New Referrals (N=118) that came to CPHP are able to utilize the Safe Haven Provision on medical licensure application/reapplication. Yearly Comparison of New Referrals to CPHP 1986-Present 4 N=271 Licensure of New Referrals Of the total New Referrals this year, 74% had active Colorado Medical Licensure. The breakdown of licensure is as follows; Medical license 59%, PA license 5%, Training License 10%, Applicant for Colorado licensure 15%, Out of State 3% and Medical or PA Students 7%. * = CMB License Renewal Years

5. Colorado Physician Health Program Referral Specifications July 1, 2009 through June 30, 2010 The highest single source of New Referrals for the Fiscal Year 2009-2010 were Self at 43%. The second highest source of New Referrals was the Colorado Medical Board (CMB) at 17%. CPHP continues to be proud of the number of Self Referrals to the program demonstrating trust and confidence in CPHP. 76 out of the 271 New Referrals were “reactivated” thus, 28% of New Referrals were previously seen at CPHP. A Primary Presenting Problem area which best represents the participant is identified by the clinical team following the completion of the initial intake interview. In an effort to better understand the relevancy of this data, CPHP has removed cases that are “in process” or have not yet been assigned a primary presenting problem. Of the 271 New Referrals in the Fiscal Year 2009-2010, 86 were in process at the time of this report, thus 185 were assigned a primary presenting problem. The majority of New Referrals presented with a Psychiatric Problem (26%), followed by a Behavioral (14.5%), and lastly Substance Abuse (13%). In an effort to reflect the true representation of specialties served, CPHP is reporting on cases where specialty information has been collected at the time of intake. Of the 271 New Referrals in the Fiscal Year 2009-2010, 86 had not completed an initial intake session at the time of this report, thus for 185 New Referrals, specialty information had been collected. For the Fiscal Year 2009-2010, there was a wide variety of specialties represented. The most frequently seen specialty at CPHP was Family Practice at 21% and Internal Medicine at 16.5%. Sources of New Referrals Primary Presenting Problem New Referrals Specialty of New Referrals N=271 N=185 N/A = Student or PA Other =Forensic Medicine, Infectious Disease, Nuclear Medicine, Physical Rehabilitation, Radiation Oncology, Urology Other Surgery = Plastic or neurological 5

6. Colorado Physician Health Program Demographics, Treatment Referral and Relapses July 1, 2009 through June 30, 2010 6 Age of New Referrals Gender of New Referrals 35% Female and 65% Male (N=185) Ethnicity of New Referrals 10% Asian 4% Hispanic 1.5% African American 1.5% Biracial 1% Native American 82% Caucasian (N=185) 56.5% Married 15.5% Divorced 3% Separated 1.5% Widowed 3.5% Cohabitating 20% Single (N=185) Marital Status An Initial Treatment Category is assigned by the clinical team following the completion of the initial intake interview. Of the 185 New Referrals seen, eighty- eight were assigned initial treatment recommendations at intake (48%). Individuals may be assigned more than one category of initial treatment. Of these 88 with initial recommendations, 70% percent of were provided a recommendation for psychiatric treatment. Twenty percent were provided a recommendation for substance abuse/dependence treatment, 9% were provided a treatment recommendation for a physical health matter and 1% were recommended to behavioral treatment. Fifty-two percent of all clients evaluated were not given a treatment recommendation (n=97) as this was deemed unnecessary. Clients not given a treatment referral at the conclusion of the initial intake may have been referred for additional evaluation. Initial Treatment of New Referrals At any time during the Fiscal Year 2009-2010 there was an average of 141 clients being monitored via Urine Drug Screen (UDS) and/or other tissue screening. _____________________________________ Seventeen clients experienced substance use relapse within the 2009-2010 Fiscal Year. CPHP addresses any occurrence of relapse clinically and thoroughly assesses ability to safely practice medicine on an individual case basis. ______________________________________ CPHP identified two cases of diversion during Fiscal Year 2009-2010.

7. Colorado Physician Health Program Inactivations and COUNTIES SERVED July 1, 2009 through June 30, 2010 “Inactivation” refers to when a case is closed at CPHP. During the Fiscal Year 2009-2010 there were 270 cases inactivated. Of these 270 inactivations, 33 referrals were declined, 4 did not complete an evaluations, 2 withdrew their CMB application, 2 declined evaluations, 14 completed consultation, 2 had their CMB order rescinded, 13 relocated, 1 was categorized as “Other”, and 1 unfortunately died therefore, 198 were evaluated. Of the 198 evaluated, 183 (92%) were inactivated with an outcome considered to be successful and/or satisfactory. Inactivations N=270RegionNumberPercent Adams105.5% Alamosa1.5% Arapahoe2313% Boulder137% Broomfield1.5% Chaffee1.5% Denver5429% Douglas84.5% Eagle21.5% El Paso137% Elbert1.5% Fremont1.5% Of the 185 New Referrals seen for a full initial evaluation, regional data has been collected. During the Fiscal Year 2009- 2010 New Referrals resided in 22 Colorado counties. Counties that contain less than 10 physicians, based on a CMB listing of Colorado licensed physicians (obtained in September 2009) are grouped into one category (Other) to protect the confidentiality of clients residing in those counties. Counties in this category include: Archuleta, Baca, Cheyenne, Conejos, Crowley, Custer, Dolores, Hinsdale, Jackson, Kiowa, Mineral, Park, Phillips, Rio Blanco, Saguache, San Juan and Sedgwick. Counties Served 7 Length of Active Status at CPHP is depicted to the right. The majority of participants (63%) completed the necessary involvement with CPHP in one year or less. Last fiscal year 2008-2009, 67% of participants completed the necessary involvement of CPHP in one year or less. Length of Active Status N=270RegionNumberPercent Garfield1.5% Jefferson179% La Plata1.5% Larimer53% Mesa42% Moffat1.5% Montrose1.5% Out of State2011% Pueblo32% Routt1.5% Teller1.5% Fiscal Year 2009- 2010 N= 185100%

8. Colorado Physician Health Program REACTIVATIONS REACTIVATIONS and REPORT REQUESTS July 1, 2009 through June 30, 2010 8 “Reactivation” refers to when a participant returns to CPHP after having been inactivated. Of the 271 New Referrals in Fiscal Year 2009-2010, 76 were Reactivations. This represents 28% of the total New Referrals. This is a 3% increase when compared to Fiscal Year 2008-09. Referrals versus Reactivations The highest single source of Reactivations for Fiscal Year 2009- 2010 were Self at 44%. The second highest source of Reactivations was the CMB at 15.5%. CPHP continues to be proud of the number of Self Referrals to the program demonstrating trust and confidence in CPHP. Of the Reactivations in Fiscal Year 2009-2010, 63% came back to CPHP voluntarily, and 37% were mandated. The number of voluntary referrals last Fiscal Year was 42%. A Primary Presenting Problem area which best represents the participant is identified by the clinical team following the completion of the initial intake interview. In an effort to better understand the relevancy of this data, CPHP has removed cases that are “in process” or have not yet been assigned a primary presenting problem. Of the 76 Reactivations in Fiscal Year 2009-2010, 25 were in process at the time of this report, thus 51 were assigned a primary presenting problem. The majority of Reactivations presented with a psychiatric problems (27%), followed by a substance abuse (19%). Primary Presenting Problem Reactivations Sources of Reactivations N=75 N=51 CPHP processed 1572 requests for reports during the Fiscal Year 2009- 2010. In Fiscal Year 2008-2009 CPHP received 1530 report requests. This shows an increase of 3% in report requests. Report Requests

9. Colorado Physician Health Program COMMUNITY OUTREACH July 1, 2009 through June 30, 2010 10 Community Presentations: CPHP conducted various presentations about CPHP and related physician health topics. Audiences included Medical and Professional Societies, Hospital Administration, Medical Staff Offices, Group Practices and Training Programs. 46 presentations were conducted this past year! This is a 9% increase in presentations compared to last Fiscal Year. Availability of Services: In addition to CPHP providing services to Colorado licensed physicians and physician assistants, contracts exist to provide services for residents, medical students and physician assistant students. CPHP is proud to assist medical professionals early in their career to promote personal good health and well-being. CPHP currently serves the following programs: Residency Programs University of Colorado at Denver St. Joseph Hospital Residency Program St. Anthony Family Medicine Residency Program Southern Colorado Family Medicine Residency Program St. Mary’s Family Practice Residency Program Colorado Health Foundation Transitional Residency Program at Presbyterian/St. Luke’s Hospital Denver Health Emergency Medicine Residency Program Fort Collins Family Practice Residency Program Physician Assistant Training Programs University of Colorado at Denver Red Rocks Community College Physician Assistant Program Medical Schools University of Colorado at Denver Rocky Vista University College of Osteopathic Medicine CPHP and COPIC Continue Educational Collaboration: CPHP and COPIC have again partnered to continue the tenth series of educational presentations for Colorado physicians. Presentations are provided throughout Colorado on physician health topics. CPHP Exhibits at Numerous Conferences throughout Colorado: CPHP strives to educate the medical community about our resources and services. CPHP utilizes these conferences to cultivate relationships and to educate about CPHP services within the medical community. Colorado Academy of Physician Assistants Meeting and MidWinter Conference Colorado Association of Medical Staff Services Conference Colorado Chapter of the American Association of Pediatrics Colorado Hospital Association Annual Conference Colorado Medical Society Annual Conference Colorado Psychiatric Society Colorado Nonprofit Association Luncheon Colorado Patient Safety Coalition Conference and Executive Council Meeting Colorado Rural Health Conference Colorado Society of Anesthesiologists Conference Colorado Society of Osteopathic Medicine Summer Conference and MidWinter Conference Healthcare Reform Conference Summit on Patient Safety & Substance Abuse in Colorado UC Denver Graduate Medical Education Orientation UC Denver School of Medicine Department of Psychiatric Grand Rounds UC Denver School of Medicine Department of Psychiatric Student Lectures UC Denver School of Medicine Orientation UC Denver School of Medicine Student Wellness Conference Client Services: Assessment Treatment referral Monitoring and support Family support Documentation Workplace and Referral Source Services: Consultation on identifying physicians who need assistance Consultation on making referrals Workplace consultations Educational presentations Medical Community Services: Promote physician health awareness Educational presentations Partnership with organizations to meet special needs Develop meaningful research on physician health Presentation Topics: Colorado Physician Health Program services Physician stress and stress management Substance abuse, addiction Professional boundaries Self-care and physician health issues Disruptive physician management Women in medicine Physicians in relationships and families Physician depression and suicide Occupational hazards of physicians Medical Marijuana CPHP SERVICES Address: 899 Logan St., Suite 410 Denver, CO 80203 Phone: 303-860-0122 Fax: 303-860-7426 www.cphp.org Office Hours: Monday – Friday 8:30 a.m. – 4:30 p.m. The majority of revenue that was generated at CPHP during Fiscal Year 2009-10 was from the Peer Assistance Contract (76%). The next largest source of revenue was from Donations (12%) which were contributions to the CPHP annual Spirit of Medicine fundraising campaign. Revenue Sources

10. Audiences Arkansas Valley Regional Medical Center Aspen Valley Hospital Avista Adventist Hospital Boulder Community Hospital Center for Creative Leadership Colorado Medical Society Colorado Patient Safety Coalition Colorado Personalized Education for Physicians Colorado Permanente Medical Group COPIC Companies Colorado Plains Medical Center Colorado Psychiatric Society Delta County Memorial Hospital Estes Park Medical Center El Paso County Medical Society Exempla Good Samaritan Hospital Exempla Healthcare Administration Family Health West Practice Fort Collins Family Medicine Residency Gunnison Valley Hospital Littleton Adventist Hospital Medical Center of Aurora Melissa Memorial Hospital Memorial Hospital in Colorado Springs Mercy Medical Center Montrose Medical Center National Jewish Hospital Northern Colorado Medical Center Northern Colorado Rehabilitation Hospital Pikes Peak Hospice & Palliative Care Platte Valley Hospital Porter Adventist Hospital Poudre Valley Hospital Red Rocks Community College Physician Assistants Rocky Vista University College of Osteopathic Medicine Colorado Physician Health Program Community outreach Community outreach Continued… July 1, 2009 through June 30, 2010 11 Rose Medical Center St. Joseph’s Hospital St. Mary’s Hospital St. Vincent General Hospital Sedgwick County Hospital Southern Colorado Family Medicine Residency Sterling Regional Medical Center Swedish Medical Center UC Denver Anesthesiology Department UC Denver Child Health Associate and Physician Assistant Program UC Denver Graduate Medical Education UC Denver Psychiatric Department UC Denver Psychiatric Students UC Denver School of Medicine Vail Valley Hospital Valley View Hospital Yampa Valley Medical Center