Immediate Action Required: Report and Remove from Clinical Duties
You must immediately report your intoxicated colleague to the appropriate hospital authority (chief of service, chief of staff, or hospital impairment program) and ensure they are removed from patient care responsibilities. 1
Your Professional and Ethical Obligation
Patient safety is the paramount professional obligation that supersedes concerns about colleague relationships or potential career consequences for the impaired physician. 1
Practicing medicine under the influence of drugs or alcohol constitutes clear evidence of unsafe practice that is widely recognized as requiring immediate intervention. 1
Physicians have an explicit ethical obligation to report such behavior in accordance with legal requirements in each state. 1
Specific Reporting Pathway
Report to these authorities in order of availability:
- The hospital's in-house impairment program (if available) 1
- The chief of pediatrics or relevant department chief 1
- The chief of hospital staff 1
- External impaired-physician programs through medical societies or state licensing boards 1
Critical Actions to Take Immediately
Do not allow the colleague to provide patient care under any circumstances while intoxicated. 1
Ensure immediate coverage for the call duties by contacting appropriate backup personnel or supervisors. 1
Document the observation objectively, including specific behaviors, time, and circumstances that led to your concern. 1
Act promptly to protect patients from poor practice - delays in reporting can result in patient harm or death. 1
What NOT to Do
Do not confront the colleague alone or attempt to "handle it informally" - this is a systems-level patient safety issue requiring institutional response. 1
Do not allow concerns about "destructive gossip" or colleague relationships to delay reporting - confidentiality protections exist for physicians under investigation. 1
Do not wait to gather more evidence or confirm your suspicions - the immediate risk to patients requires action based on reasonable clinical observation. 1
Understanding the Context
The medical profession has historically shown reluctance to report colleagues whose performance falls below minimum standards, but alcohol or drug impairment represents a clear-cut situation where this reluctance must be overcome. 1 This is distinct from performance issues related to stress, burnout, or communication failures that might warrant a more nuanced approach. 1
Your colleague will be protected from rumors during any investigation, and communication should be governed by confidentiality rules until charges are proven or the physician is exonerated. 1 However, your primary duty is to the patients who would be under this colleague's care, not to the colleague's immediate comfort or career concerns. 1
After Reporting
The institution's peer review body and impairment program will handle the investigation and remediation. 1
Your role ends with the report - do not engage in speculation or discussion with other staff beyond what is necessary for patient safety. 1
Be prepared to provide factual testimony if requested by the appropriate review bodies. 1