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QUESTION
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Through a social contact unrelated to my dental practice, I have become aware that another dentist in my area has become addicted to controlled substances. As a concerned colleague, what actions, if any, should I take? What is required of me ethically in addressing this situation?
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ANSWER
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The answer is based on how compelled you are to help save a colleague’s life.
It is estimated that 10 to 20 percent of practicing dentists suffer from addictive illness.1 It can be a chronic, progressive and fatal disease. It threatens their patients’ welfare, their ability to practice and their very lives.
The requirements and restrictions placed on a dentist who has knowledge that a colleague is addicted to controlled substances or alcohol are formalized in the profession’s ethics. The ADA’s Principles of Ethics and Code of Professional Conduct2 assists dentists in upholding the high ethical standards that underlie the public’s trust. The ADA "calls upon dentists to follow high ethical standards which have the benefit of the patient as their primary goal."
Does a dentist have an obligation to protect the public from a peer who is known to abuse controlled substances, alcohol or chemical agents that impair the ability to practice? Does a dentist have any obligation to help a colleague who is abusing controlled substances? A dentist may have specific reporting obligations defined in state law, or imposed by a practice venue (that is, hospital, school or clinic) or contractor.
The ADA code states:
It is unethical for a dentist to practice while abusing controlled substances, alcohol or other chemical agents which impair the ability to practice. All dentists have an ethical obligation to urge chemically impaired colleagues to seek treatment. Dentists with first-hand knowledge that a colleague is practicing dentistry when so impaired have an ethical responsibility to report such evidence to the professional assistance committee of a dental society.2
According to the ADA code, then, the dentist’s ethical obligation is to report evidence of impairment to the peer assistance committee of a dental society. The code does not mandate that dentists report impaired colleagues to their states’ professional licensing agencies. Nonetheless, the ADA urges professional assistance committees to report impaired colleagues to the appropriate regulatory body when the impaired dentist does not agree to accept assistance. The ADA ethical guideline is predicated on the belief that the professional is impaired owing to a disease process, that of addictive illness. It supports programs with a goal of rehabilitation, rather than prosecution or professional censure.
Practicing while impaired is classified throughout the country as professional misconduct. However, each state takes a different approach. New York state education law defines professional misconduct as "practicing the profession while the ability to practice is impaired by alcohol, drugs, physical disability, or mental disability" and "being habitually drunk or being dependent upon, or a habitual user of, narcotics, barbiturates, amphetamines, hallucinogens, or other drugs having similar effects."
A professional convicted by the New York state education department based on such conduct would be subject to disciplinary sanctions ranging from reprimands to suspension or revocation of the professional’s license to practice.
New York law also establishes a "diversion" program as an alternative to its disciplinary process. This alternative is available to professionals when no patient harm is alleged to have resulted as a consequence of the professional’s substance abuse. Diversion programs direct doctors into treatment as an alternative to professional discipline. New York has no laws applicable to professionals that mandate reporting.
There are numerous legal, moral and ethical issues surrounding a dentist’s involvement in getting help for a colleague abusing controlled substances. The impaired colleague faces a myriad of potential legal, social, personal, health and professional problems, as well as the potential for patient harm. Often, referral to a peer assistance program can help mitigate these adverse consequences of substance abuse. (ADA members can call the members-only toll-free number and ask for Ext. 2622. Nonmembers can call 1-312-440-2622.)
According to an ADA survey, all but four states offer some type of peer assistance program.3 Dental societies in 42 states offer volunteer, staff or contracted programs. Twenty-two states offer "diversion" programs through their state dental licensing boards. Thus, in all but eight states, dentists can comply with the ethical guidelines to refer a colleague who is practicing while impaired to a peer assistance committee of a dental society—within their own state. In four of those states, dentists can exercise professional self-regulation and ethical conduct by referring a colleague to an established peer assistance group outside of the professional association. Alternately, any dentist concerned about an impaired colleague can contact the Dentist Well-Being Programs of the ADA Council on Dental Practice for assistance in meeting his or her professional and ethical responsibilities to assist an impaired colleague and protect the public. All such communications are confidential.
| Reporting an Impaired Colleague: Some Legal Considerations A dentist may have specific reporting obligations defined in federal or state law, or imposed by a practice venue (that is, a hospital, school or clinic) or contractor. In most cases, state law will govern whether and when a private practitioner has a duty to report an impaired colleague—and absent a duty to report suspected cases, a dentist may risk being sued for filing what turns out to be an erroneous report. Furthermore, other legal issues may become significant—for instance, if the impaired practitioner is a partner, associate or employee, or if the office accepts federal funds such as Medicaid. Any dentist considering reporting a colleague should consult with his or her private attorney regarding pertinent federal and state law.
—American Dental Association Division of Legal Affairs
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