DUI: Doctors Under the Influence…and the Consequences (Part 2)

In Part I of this 2-part series on DUIs among physicians, I highlighted the fact that physicians are not immune from substance use disorders or DUIs. According to the National Survey on Drug Use and Health, 5.5% of health care workers in the U.S. had a current substance use disorder1 and numerous studies have shown that the prevalence of substance use disorders among physicians is similar to the general population. National statistics document that alcohol is the most common drug of choice among Physician Health Program participants (55% alcohol, 33% opioids) 2.

So, it is not surprising that physicians are arrested for DUI. We don’t have good statistics on the incidence of DUI arrests among physicians, however, we can estimate. Based on FBI data showing a bit over 1 million DUI arrests in 20173, we can extrapolate based on how many physicians there are relative to the general population (approximately 1:350) that, on average, about 2,800 physicians are arrested for DUI per year. We know that DUI is one of the most common causes for medical licensing board discipline of physicians. It is a significant problem.

How severe are the consequences of a DUI offense for a physician?
Many physicians have little idea of the severe consequences, both criminal and/or administrative, that will be imposed should they be arrested for DUI. A physician, or any other licensed health professional who is arrested or convicted for DUI, depending on the particular state and board, should know that their license and thus their career and livelihood, could be in jeopardy.

Defending against a DUI is very costly, involving not only the need for a criminal attorney but also the need for an administrative law attorney. The process can go

on for years causing significant stress for the physician and their loved ones. Should a restriction on the medical license be imposed, such as probation (which in some states is routine), the physician can lose their job and have difficulty finding another, lose their specialty certification, lose their PPO provider status and essentially be unemployable. Having a restricted medical license is a very significant event.

The Federation of State Medical Boards, who provide guidance and support to state medical boards and to which all state boards are members, currently has no specific policy statement to guide boards on how to handle DUIs among physicians. States vary widely in their approach to physician DUIs. This particularly came to my attention working in California where DUIs are prosecuted aggressively. A colleague from another state mentioned that for first time DUI offenders (if BAC is <.15) there is usually no action, not even a recommendation for an evaluation. He was asking that I help convince their medical board to at least recommend a clinical evaluation to rule out an alcohol use disorder. I became curious to explore how diverse DUI management is from state to state.

What happens if I do not report my DUI offense?
I conducted a survey of state Physician Health Programs (PHPs) to determine how DUIs are handled. Of 46 states queried, 29 responded. This survey showed that most states do have some type of requirement that licensees self-report arrests and/or convictions. Self-reporting of misdemeanors are required in 45% of states whereas 55% require reporting of felony arrests. Once convicted, 82% require reporting of misdemeanor convictions and 93% require reporting of felony convictions. If the self-report is not performed (within the specified time limit, usually 10 to 30 days) then that becomes another cause for disciplinary action, i.e. failure to self-report.

Self-Reporting Requirements of DUIs to State Medical Boards (boards vary between 10 and 30 day requirements for self-report):

• 45% – 55% require self-reporting a DUI arrest depending on whether it is a misdemeanor or felony DUI arrest
• 82% – 93% require self-report of a DUI conviction depending on whether it is a misdemeanor or felony DUI conviction

Why should a physician with a DUI be evaluated?
The rationale for referring a physician with a DUI for an evaluation is to determine if they have a diagnosable substance use disorder. If so, that would warrant treatment and aftercare including monitoring. This makes sense because someone with a substance use disorder is likely to continue to drink alcohol excessively, have further problems and could be a risk to patients. In the survey, only 52% of state boards required clinical evaluation for first time DUI offenders.

52% refer physicians with a first time DUI for clinical evaluation (to rule out substance use disorder which might require treatment)

What do the state PHPs think about their board’s policies regarding physician DUIs?
Finally, the state PHPs, being in a good position to have an opinion regarding whether their board has an appropriate overall policy regarding physician DUIs, 72% opined that their board is balanced and reasonable. A total of 6% felt that their board was excessively punitive or overly concerned about DUIs and 21% indicated that their board was too lax or not concerned enough.

Re: actions taken by their medical board:

• 3% of PHPs believe their board is excessively punitive
• 3% of PHPs believe their board is overly concerned
• 72% of PHPs believe their board is balanced and reasonable
• 14% of PHPs believe their board is not concerned enough about DUIs
• 7% of PHPs believe their board is too lax and not concerned about DUIs

Sample of comments from participating PHPs surveyed included the following:

“[Our] medical board [is] not concerned enough regarding DUIs and not motivated to discuss with [the] Physician Health Program (PHP). [The] PHP experience indicates need for evaluation.”

“I have written the Board of Medicine requesting at least an evaluation or a [state] PHP referral for years! What can I say?”

“First DUI is pretty much a hand slap; often suggested they report to the PHP but not mandatory. Second DUI makes participation in PHP mandatory.”

“The difference between felony and misdemeanor is typically determined by BAT level. Felony always results in license probation.”

“The board is not typically notified of DUIs so they rely heavily on self-reports or reports from concerned colleagues, etc.”

“Our board does not refer physicians for evaluation for a low-level DUI with no other behaviors identified in the arrest record. They most commonly would refer out for evaluation for any high level DUI, or any occasion where there are a second or more DUI[s] disclosed in their history of holding a [state] license.”

“[The] medical board refers to our PHP; we either send them for a local assessment by an addiction doc [or] if there is more than one arrest and we are concerned, will send for [a] professionals multi-disciplinary eval.”

“Our board is overly aggressive with physicians and attempts to revoke or suspend their license after a single DUI and most often puts them on probation for 3-7 years which can be devastating.”

While this is a limited survey and may not be scientifically sound, several takeaway points can be made:

There is a dramatic variation in how state medical boards handle DUIs among their licensees. While most state PHPs believe their medical board is balanced and reasonable, about 1/4th of PHPs believe their board to be either overly punitive or not concerned enough about DUIs among licensees.

Conclusion
A DUI is a significant event. According to one study of 658 DUI offenders using DSM-5 criteria, 46% of 1st time DUI offenders had a substance use disorder. It makes sense that physicians with a first DUI should undergo evaluation. If a diagnosis is made, then appropriate treatment and monitoring recommendations should be recommended. Medical boards vary widely in how they manage DUIs. The Federation of State Medical Boards should develop a specific policy statement regarding handling of DUIs.

References:

1. https://www.samhsa.gov/data/sites/default/files/report_1959/ShortReport-1959.pdf
2. DuPont RL, McLellan AT, Carr G, Gendel M, Skipper GE. How are addicted physicians treated? A national survey of physician health programs. JSAT 37 (2009) 1-7.
3. (Federal Bureau of Investigation (FBI). Department of Justice (US). Uniform Crime Reports. Washington (DC): FBI; 2017. Available at https://ucr.fbi.gov/crime-in-the-u.s/2016/crime-in-the-u.s.-2016/tables/table-18)

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