Colorado Physician Colorado Physician Health ProgramHealth Program

Annual reportAnnual reportJuly 1, 2008 through June 30, 2009

by

Sarah R. Early, PsyD, Executive Director

Michael H. Gendel, 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.

Colorado Physician Health Program

Program HighlightsProgram Highlights July 1, 2008 through June 30, 2009

Board of Directors2008 – 2009

ChairStephen Dilts, MD

Vice-ChairJames Borgstede, MD

SecretaryCaroline M. Gellrick, MD

TreasurerLarry A. Schafer, MD

Director-At-LargeBruce H. Wilson, MD

Director- At- LargeMaureen J. Garrity, PhD

Michael Van Buren Calvin, PA

Thomas G. Currigan, Jr.

George D. Dikeou, Esq

John H. Genrich, MD

Alfred D. Gilchrist

Debbie Lazarus

Michael Michalek, MD

Lawrence Varner, DO

2

•New CPHP Medical Director: CPHP Board of Directors is pleased to announce Doris C. Gundersen, MD, as Medical Director effective July 1, 2009. After a nationwide search, Dr. Gundersen was selected to succeed Michael H. Gendel, MD, who served in this role for ten years. Dr. Gundersen has served as CPHP Associate Medical Director since 2000. For a complete biography please visit www.cphp.org. Dr. Gendel will remain active in the physician health field and will assume the role of Medical Director Emeritus at CPHP. He plans to continue to work with CPHP for the next several years.

•Patient Safety Committee Formation: On February 17, 2009, CPHP Board of Directors created a Patient Safety Advisory Committee. This committee consists of several members of the medical community active in patient safety initiatives. The committee members include Patty Skolnik, Director for the Colorado Citizens for Accountability, Judy Ham, CEO of Cerebral Palsy of Colorado and Edward Dauer, Esq. with the Colorado Patient Safety Coalition. CPHP utilizes this committee to address issues regarding public protection and to provide a forum of objective discussion on CPHP’s policies and procedures in regard to patient safety. CPHP is very pleased of this addition to provide comprehensive, well-considered services to ensure safety to all of Colorado. On June 17, 2009, CPHP representative Doris C. Gundersen, MD, Associate Medical Director, and Ms. Skolnick, attended the Citizen Advocacy Center Annual Meeting in San Francisco, CA. Several members of the Federation of State Physician Health Programs also attended to impart the importance of physician health programs in enhancing patient safety as well as to learn the patient safety issues that are currently being addressed. CPHP is glad to be a part of these essential discussions.

•Spirit of Medicine Campaign: CPHP completed the annual Spirit of Medicine fundraising campaign 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 campaign. We appreciate all of our generous contributors and especially want to recognize our donors who provided gifts of $5,000 or more:

•Centura Health•St. Mary’s Hospital and Medical Center•The Medical Center of Aurora•Colorado Permanente Medical Group (CPMG) – We extend special appreciation to CPMG as a charter member of the LivingWell Giving Society•Valley View Hospital – We would like to express our appreciation for their membership as the newest member of the LivingWell Giving Society

All donors are recognized on CPHP website, www.cphp.org, from 2007-2008 campaign.

•CPHP Newsletter Distributed: The Summer 2009 edition of CPHP News was mailed to all active Colorado licensed physicians and physicians assistants and various other medical entities throughout the state.  CPHP Education and Outreach Committee chaired by Board Director Mike Calvin, PA, directed this publication effort. CPHP is proud of this initiative in an effort to provide the Colorado medical community with informative physician health articles and to promote CPHP’s 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.

Colorado Physician Health ProgramNational/international research and conferencesNational/international research and conferences

July 1, 2008 through June 30, 2009

Medical/Associate Directors

Medical Director

Michael H. Gendel, MD

Associate Medical Directors

Mary Ellen Caiati, MD

Doris C. Gundersen, MD

Scott H. Humphreys, MD

Jay H. Shore, MD

Michael S. Sturges, MD

Elizabeth Stuyt, MD

Staff

Executive Director

Sarah R. Early, Psy.D

Director of Clinical Services

Cae Allison, LCSW

Director of Finance

Karen Chipley, MBA

Receptionist

Megan Curry

Clinicians

Lynne Klaus, LCSW, CACIII

Christine Lewis, MA, EdS, LPC

Sally Moody, MSW, LCSW

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.

•Kaiser Permanente Grant supported National Research Meeting: CPHP hosted a National Research Meeting for Physician Health Researchers on April 17, 2009 in Denver, thanks to the generous support from Kaiser Permanente. Researchers prominent in the field of physician health across North America attended. The purpose of the meeting was to develop coordinated national research projects to scientifically evaluate physician health matters. The efforts put forth by this conference will ultimately inform others through publication of best practices and to guide public policy. CPHP extends appreciation to Kaiser Permanente for supporting this research. •Publications:

•Elizabeth Stuyt, MD, Doris C. Gundersen, Jay H. Shore, Elizabeth Brooks, and Michael H. Gendel published “Tobacco Use by Physicians in a Physician Health Program, Implications for Treatment and Monitoring” in the March 2, 2009 issue of American Journal of Addiction. Dr. Stuyt’s spearheaded this study and her interest in tobacco use by impaired physicians has been a driving campaign across the country to examine the link between tobacco and sustained recovery. In fact her research and advocacy efforts have prompted several national physician inpatient treatment center to go tobacco-free. •Dr. Gendel, along with four other physician health authors published “How are Addicted Physicians Treated? A National Survey of Physician Health Programs” in the July 2009 edition of the Journal of Substance Abuse Treatment. This article educates as to the various treatment practices and success of addicted physicians monitored by physician health programs.

•Physician Health Conferences:•International Conference on Doctor’s Health: CPHP Medical Director, Executive Director, and Associate Medical Directors attended the International Conference on Doctor’s Health in London, England November 17-19, 2008. CPHP provided the following research presentations:

•“Tobacco Use by Physicians in a Physician Health Program, Implications for Treatment and Monitoring” – Authors: Libby Stuyt, Doris Gundersen, Jay Shore, Elizabeth Brooks and Michael Gendel•“Physician Boundary Issues in a Physician Health Program: A 19-Year Review” – Authors: Jay Shore, Elizabeth Brooks and Michael Gendel •“Blueprint Project, Colorado Site: A study of physicians with substance use disorders followed by the Colorado Physician Health Program” - Authors: Michael Gendel, Jay Shore and Elizabeth Brooks •“Gender Differences and Predictors of Reactivation at a Physician Health Program, Implications for Outreach and Intervention” – Authors: Nahid Hotchkiss and Sarah Early

•Western Region of the Federation of State Physician Health Programs (FSPHP) Annual Meeting: CPHP Medical Director and Associate Medical Directors attended the Western Region of the FSPHP Annual Meeting in Seattle, WA September 4-6, 2008. Associate Medical Director, Elizabeth Stuyt, MD provided a presentation on the topic “Tobacco Use by Physicians in a Physician Health Program, Implications for Treatment and Monitoring.” •Federation of State Physician Health Programs (FSPHP) and CPHP Involvement: CPHP Medical Director, Associate Medical Directors and Executive Director attended the FSPHP Annual Meeting in New Orleans, LA from April 27-30, 2009. Doris C. Gundersen, MD, Associate Medical Director presented on “Research Projects & Future Directions.”

We welcomed the opportunity to learn about physician health research and activities from around the world at these conferences.

Colorado Physician Health Program

New referral HighlightsNew referral Highlights July 1, 2008 through June 30, 2009

CPHP received 318 New Referrals in the Fiscal Year 2008-2009! This is the largest number of annual New Referrals in CPHP history! In Fiscal Year 2007-2008, CPHP received 276 referrals. This shows a 15% increase in New Referrals.

The average active caseload at any given period during this quarter was 465 participants. This represents a 2% increase from the Fiscal Year 2007-2008 which had 457 active participants at any given time.

Of the 318 New Referrals in the Fiscal Year 2008-2009, 53% were voluntary and 47% were mandatory.

25% of the New Referrals (N=80) that came to CPHP are able to utilize the Safe Haven Provision on medical licensure application/reapplication.

Yearly Comparison of New Referrals to the CPHP 1986-Present

4

9%

7%

14%

3%

65%

2%

0 50 100 150 200 250

Medical

PA

Training

Applicant

OOS

Student

N=318

Licensure of New Referrals

Of the total New Referrals this year, 77% had active Colorado Medical Licensure. The

breakdown of licensure is as follows; Medical license 65%, PA license 3%, Training License

14%, Applicant for Colorado licensure 7%, Out of State 2% and Medical or PA Students 9%.

0

50

100

150

200

250

300

350

85*-86

86-87

87*-88

88-89

89*-90

90-91

91*-92

92-93

93*-94

94-95

95*-96

96-97

97*-98

98-99

99*-00

00-01

01*-02

02-03

03*-04

04-05

05*-06

06-07

07*-08

08-09

* = BME License Renewal Years

Colorado Physician Health Program

Referral SpecificationsReferral Specifications July 1, 2008 through June 30, 2009

3%

.5%

.5%

7%

9%

26%

1.5%

6%

4%

34%

8%

.5%

0 20 40 60 80 100 120

Administration

BME

Family

Hospital

Proactive

Medical School

Self

Residency Program

PA Program

Peer

Treatment Provider

Other

1%

.5%

.5%

1.5%

1.75%

4.5%

2%

7%

6.25%

11%

24%

7%

16%

2%

13%

2%

0 10 20 30 40 50 60

Stress

Behavioral

Family

DUI/DWAI

Physical/Medical

Psychiatric

Legal

Work Stress

Substance Abuse

Psychiatric/Substance

Professional Boundaries

Domestic Violence

Career

Emotional

Financial

Other

The highest single source of New Referrals for the Fiscal Year 2008-2009 were Self at 34%. The second highest source of New Referrals was the BME at 26%. CPHP continues to be proud of the number of Self Referrals to the program demonstrating trust and confidence in CPHP.

75 out of the 318 New Referrals were “reactivated” thus, 24% 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 318 New Referrals in the Fiscal Year 2008-2009, 94 were in

process at the time of this report, thus 224 were assigned a primary presenting problem.

The majority of New Referrals presented with a psychiatric problem (24%), followed by a

DUI/DWAI (16%), and lastly a behavioral problem (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 318 New Referrals in the Fiscal Year 2008-2009, 94 had not completed an initial intake session at the time of

this report, thus for 224 New Referrals, specialty information had been collected.

For the Fiscal Year 2008-2009, there was a wide variety of specialties represented. The most frequently seen specialty at CPHP was Family Practice and Internal

Medicine both at 16%.

Sources of New Referrals

Primary Presenting Problem New Referrals

Specialty of New Referrals

N=318

N=224

N=224

34% were Female and 66% were Male (N=224).

Gender of New Referrals

N/A = Student or PAOther = Allergy/Immunology, Hematology/Oncology, Neurology, Ophthalmology, Orthopedics, Otolaryngology, Physical Medicine and Rehabilitation, Podiatry, and Spinal Cord Injury Other Surgery = Plastic Surgery, Neurological Surgery, and Thoracic Surgery. 5

Pathology3%

Radiology5.5%

Psychiatry3%

Other surgery3%

Other6%General Surgery

4%

Pediatrics7%

Orthopedic Surgery

4% OB/GYN7%

N/A10%

Internal Medicine

16%

Family Practice16%

Emergency Medicine

5.5%

Anesthesiology10%

Colorado Physician Health Program

Inactivations and COUNTIES SERVEDInactivations and COUNTIES SERVED July 1, 2008 through June 30, 2009

Deceased 1%

Rescinded Order

1%Non-Compliance

3%

Evaluation Imcomplete

1%Monitoring Complete

30%

Monitoring Declined

6%

Other1%

Referral Declined

9%

Application Withdrawn

1%

Consultation Complete

5%

Evaluation Complete

32%

Evaluation Declined

7%

Relocated4%

“Inactivation” refers to when a case is closed at CPHP. During the Fiscal Year 2008-2009 there were 312 cases inactivated. Of these 312 inactivations, 27 referrals were declined, 2 did not complete an evaluations, 3 withdrew their BME application, 22 declined evaluations, 14 completed consultation, 2 had their BME order rescinded, 12 relocated, 3 categorized as “Other”, and 2 unfortunately died therefore, 225 were evaluated. Of the 225 evaluated, 197 (88%) were inactivated with an outcome considered to be successful and/or satisfactory.

Inactivations

N=312

RegionRegion NumberNumber PercentPercent

Adams 15 7%

Arapahoe 25 11%

Boulder 23 10%

Broomfield 4 2%

Clear Creek 1 .5%

Denver 66 30%

Douglas 12 5%

El Paso 19 9%

Fremont 1 .5%

Garfield 1 .5%

Jefferson 15 7%

La Plata 1 .5%

Of the 224 New Referrals seen for a full initial evaluation, regional data has been collected. During the Fiscal Year 2008-2009 New Referrals resided in 23 Colorado counties.

Counties that contain less than 10 physicians, based on a BME listing of Colorado licensed physicians (obtained in September 2008) 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

6

Length of Active Status at CPHP is depicted to the right. The majority of participants (67%) completed the necessary involvement with CPHP in one year or less. Last fiscal year 2007-2008, 63% of participants completed the necessary involvement of CPHP in one year or less.

Length of Active Status

1-2 Years15%

2-3 Years8%

3-4 Years3%

4-5 years1% 5+ Years

6%

0-3 Months16%

4-6 Months20.5%

7-9 Months20%

10-12 Months10.5%

N=312

RegionRegion NumberNumber PercentPercent

Larimer 7 3%

Logan 1 .5%

Mesa 2 .5%

Montezuma 1 .5%

Morgan 1 .5%

Otero 1 .5%

Other 1 .5%

Out of State 15 7%

Pitkin 2 .5%

Pueblo 4 3%

Summit 1 .5%

Fiscal Year 2008-2009

N= 224 100%

Colorado Physician Health Program

REACTIVATIONSREACTIVATIONS July 1, 2008 through June 30, 2009

7

110 137 143 119 130 112 153 132187 175 184 170

234 194 218 2401821 24

22 18 16

4732

29 38 46

5647

5878

45

050

100150200250300350

1993-1994

1994-1995

1995-1996

1996-1997

1997-1998

1998-1999

1999-2000

2000-2001

2001-2002

2002-2003

2003-2004

2004-2005

2005-2006

2006-2007

2007-2008

2008-2009

Referrals Reactivations

“Reactivation” refers to when a participant returns to CPHP after having been inactivated.

Of the 318 New Referrals in Fiscal Year 2008-2009, 78 were Reactivations. This represents 25% of the total New Referrals. This is an increase in 4% when compared to Fiscal Year 2007-08.

Referrals versus Reactivations

2%

4%

7%

2%

7%

5%

11%

15%

9%

15%

4%

17%

2%

0 2 4 6 8 10

Stress

Behavioral

Family

DUI/DWAI

Physical/Medical

Psychiatric

Legal

Work Stress

Substance Abuse

Psychiatric/Substance

Professional Boundaries

Domestic Violence

Career

1.5%

11%

37%

5%

10%

27.5%

4%

4%

0 5 10 15 20 25 30 35

Administration

BME

Hospital

Proactive

Medical School

Self

Residency Program

Other

The highest single source of Reactivations for the Fiscal Year 2008-2009 were BME at 37%. The second highest source of Reactivations was the Self at 27.5%. 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 2008-2009, 42% came back to CPHP voluntarily, and 58% were mandated. The number of voluntary referrals shows an 8% decrease for Reactivations when compared to last Fiscal Year.

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 78 Reactivations in the Fiscal Year 2008-2009, 24 were in process at the time of this report, thus 54 were assigned a primary presenting problem.

The majority of Reactivations presented with a behavioral problem (17%), followed by a DUI/DWAI or psychiatric problems both at 15%.

Primary Presenting Problem Reactivations

Sources of Reactivations

N=78

N=54

Colorado Physician Health ProgramReport requests and Financial BreakdownReport requests and Financial Breakdown

July 1, 2008 through June 30, 2009

8

CPHP processed 1530 requests for reports during the Fiscal Year 2008-2009. In Fiscal Year 2007-2008 CPHP received 1331 report requests. This shows an increase of 13% in report requests.

Report RequestsOne-Time

Status22%

BME Evaluation5%

Credentialing12% Standing

Status32%

BME Quarterly19%

BME Interim/ Addendum

10%

N=1530

Financial Summary

CPHP finished the Fourth Quarter and Fiscal Year with a Year-to-Date Peer Assistance Net Loss of $64,105.92 versus a Year-to-Date Budgeted Loss of $87,251.00. Year-to-Date

Revenue is largely on target with Year-to-Date Expenses approximately $22,800.00 less than budget primarily due to staff shortages. The Net Loss was supplemented with cash

reserves from the annual Spirit of Medicine campaign.

Contracts4%

Peer Assistance Contract

75%

Donations16%

Honorarium&

Presentation Fees

1%

FFS3%

Reports, Chart

Copies & Interest

1%

Revenue Sources

The majority of revenue that was generated at CPHP during Fiscal Year 2008-09 was from the Peer Assistance Contract (75%). The next largest source of revenue was from Donations (16%) which were contributions to the CPHP annual Spirit of Medicine fundraising campaign.

Colorado Physician Health Program

COMMUNITY OUTREACHCOMMUNITY OUTREACHJuly 1, 2008 through June 30, 2009

9

•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 wellbeing. CPHP currently serves the following programs:

•Residency Programs • University of Colorado Health Sciences Center • St. Joseph Hospital Residency Program • St. Anthony Family Medicine Residency • Southern Colorado Family Medicine Residency • St. Mary’s Family Practice Residency Program • Colorado Health Foundation Transitional Residency Program at Presbyterian/St. Luke’s Hospital• Denver Health Emergency Medicine Residency• Fort Collins Family Practice Residency

•Physician Assistant Training Programs • University of Colorado Health Sciences Center • Red Rocks Community College Physician Assistant Program

•Medical School • University of Colorado Health Sciences Center

•CPHP and COPIC Continue Educational Collaboration: CPHP and COPIC have again partnered to continue the ninth series of educational presentations for Colorado physicians. Presentations are provided throughout Colorado on the subjects listed to the left.

•COPIC Financial Assistance Fund: COPIC Companies provide CPHP with the Financial Assistance Fund to directly assist CPHP physician clients that would otherwise be unable to afford our services. Their generous donation of $20,000 is greatly appreciated. Thank you!

•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. 42 presentations were conducted this past year!

•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 Annual Summer Metro Meeting •Colorado Academy of Physician Assistants Mid-Winter Conference •Colorado Association of Medical Staff Services Conference•Colorado Chapter of American Academy of Pediatrics •Colorado Hospital Association Annual Conference•Colorado Medical Society Annual Meeting •Colorado Non-Profit Association Conference•Colorado Rural Health Conference •Colorado Society of Anesthesiologists Conference •Colorado Society of Osteopathic Medicine Annual Winter Meeting•Colorado Society of Osteopathic Medicine Summer 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

CPHP SERVICES

Address:899 Logan St., Suite 410

Denver, CO 80203Phone: 303-860-0122Fax:      303-860-7426

www.cphp.org

Office Hours:Monday – Friday

8:30 a.m. – 4:30 p.m.

Audiences

American Academy of Pediatrics Colorado Chapter

Aurora Medical Center

Avista Adventist Hospital

Centura Health Administration

Center for Personalized Education for Physicians

Center for Creative Leadership

Child Health Associate/Physician Assistants Training Program

Children’s Hospital Department of Psychiatry

Children’s Hospital Medical Executive Committee

Colorado Academy for Physician Assistants

Colorado Association for Medical Staff Services

Colorado Association for Nonprofit Organizations

Colorado Acute Long Term Hospital

Colorado Board of Medical Examiners

Colorado Hospital Association

Colorado Health Foundation Transitional Year Fellows

Colorado Nurses Health Program

Colorado Medical Society

COPIC

Colorado Rural Health Association

Colorado Society of Osteopathic Medicine

Colorado Permanente Medical Group

Delta County Memorial Hospital

Denver Health Hospital

Exempla Good Samaritan Hospital

Federation of State Physician Health Programs

Fort Collins Family Practice Residency

Grand River Hospital in Rifle

McKee Medical Center

Memorial Health System

North Suburban Medical Center

Longmont United Hospital

Lutheran Medical Center

Memorial Health System

McKee Medical Center

Parkview Medical Center

Parker Adventist Hospital

Porter Adventist Hospital

Presbyterian/St. Luke’s Hospital

Colorado Physician Health Program

Community outreachCommunity outreach Continued…July 1, 2008 through June 30, 2009

N

10

Red Rocks Community College

Rocky Mountain Vista University

Rocky Mountain Society of Gastroenterology Nurses

Spalding Rehabilitation Center

Southern Colorado Family Practice Residency

St. Anthony Summit Medical Center

St. Anthony’s Residency Program

St. Joseph’s Residency Program

St. Mary’s Hospital

St. Mary-Corwin Hospital

Swedish Hospital

UCHSC Anesthesiology Department

UCHSC Department of Psychiatry

UCHSC Graduate Medical Education

UCHSC Neurosurgery Department

UCHSC School of Medicine

Veterans Affairs Hospital Denver