М.Жүсіп " Сарыарқа кімдікі?"

West Kazakhstan Marat Ospanov State Medical University

Student`s independent work

Faculty: General Medicine

Department: Information-communication systems andinformatics

Theme: Application of problem- oriented packet of application programs in professional area.

Performed by: Kaldybekylu A.

Group: 116A

Checked by:Umirzakova Zh.S

Aktobe-2018

OVERVIEW . The New York State Board of Regents, through the New York State Education Department’s Office of the Professions, operates a program for licensed professionals who have substance abuse problems. The Professional Assistance Program (PAP) was established by the New York State Legislature in 1985 as a confidential, treatment-based alternative to disciplinary proceedings. Professionals whose actions have not resulted in patient harm may voluntarily surrender their licenses while seeking substance abuse treatment. Those who are admitted to the PAP are granted immunity from Education Department charges of practicing while impaired and being a habitual user of alcohol or other drugs. The program is available to professionals licensed under Title VIII of the Education Law except for physicians, physician assistants, and specialist assistants.

The statute that created the Professional Assistance Program (PAP) also established a committee on drug and alcohol abuse to advise the Board of Regents on matters relating to practice by professional licensees who have drug or alcohol abuse problems. Later named the Committee for Professional Assistance, it currently consists of 35 members who are either experts in addictive illness or individuals with an interest in this field, one of whom serves as the Committee Chair. The committee works with the program staff on policies and procedures and keeps the Department informed of the major issues and innovations in the field. Committee members also serve on panels to determine admission and license reinstatement, and to develop treatment plans and monitoring requirements.

Professionals who enter the program agree to participate in acceptable substance abuse treatment and to be monitored for a minimum of two years after their license has been reinstated. Under a new statute the PAP established two pathways in the Program. The original pathway, now known as Prism, requires a period of license surrender of unspecified duration. When the professional and his or her treatment provider believe that he or she is ready to return to professional practice, the participant petitions the Committee to have the license reinstated. After meeting with the licensee and assessing all of the information, the Committee makes the determination as to whether resumption of professional practice is appropriate. The new pathway, known as Nurse 2 Nurse (N2N) only applies to nurses who are determined by the Committee to not be a threat to the health, safety and welfare of the public and who meet a number of criteria. License restoration in these cases can occur immediately. The N2N pathway serves two groups of nurses, each with distinct needs. It addresses the needs of licensees experiencing early signs of drug misuse and abuse and also assists licensees who are in strong recovery with a long history of sobriety.

Monitoring for both pathways of the PAP includes treatment reports, work-site reports, and random observed drug screens at specified frequencies. Other conditions may apply as appropriate to the individual situation and the recommendations of the treatment provider. Depending on the participant’s substance abuse history, the participant’s license may be restored with certain practice restrictions imposed in order to protect the health, safety, and welfare of the public. For example, a professional in a medical setting may not be allowed to have access to narcotics or be prohibited from working unsupervised. Discharge from the PAP is not automatic after the minimum two years of monitoring. Documentation supporting discharge must be provided to the PAP and the program staff evaluates the evidence and makes a determination.

Benefits to the Public.The PAP provides a benefit to the public by arranging for:

1. The immediate surrender of the professional’s license to the Department.

2. Approval of all treatment plans by a committee composed of experts on addiction and professional practice.

3. Routine monitoring of the professional while the license is surrendered.

4. Return to practice only after the Committee determines that it is safe for the public for the professional to resume practice.

5. Stringent monitoring of the reinstated licensee for an absolute minimum of two years of safe practice.

6. Strict practice conditions, including at a minimum: twice a week, random drug toxicology screens; monthly evaluation by both a treatment monitor and a worksite monitor; restricted access to narcotics; close supervision; and limited hours.

Benefits to the Licensed Professional

The professional with addictive illness benefits from:

1. Immunity from two potential charges of professional misconduct: practicing the profession while the ability to practice is impaired by alcohol or drugs; and being habitually drunk, or being a habitual user of narcotics or other drugs having similar effect.

2. Potential consideration of reduction of other charges or penalties in possible State Education Department, Department of Health or criminal proceedings.

3. Expert advice of the Committee for Professional Assistance in setting up a thorough and effective treatment program and in planning for the professional’s return to professional practice. Statistics. The most recent estimates are that 16% of the population will experience a substance use disorder. Research suggests that professionals, particularly those with ready access to prescription pharmaceuticals, are at greater risk. The positive news for professionals is that completion of drug treatment typically results in a much stronger recovery. Relapse rates for the general population reported in a 1991 federal epidemiological catchment area survey were greater than 5%. For professionals who successfully complete a structured program like the PAP, experts estimate only a 15-20% relapse rate. PAP data are consistent with that data. A PAP participant who relapses is immediately scheduled to meet with the Committee for Professional Assistance to re-surrender his/her license. In the N2N pathway, this involves transfer to the ProAssist pathway with its unspecified period of license surrender.

The PAP has assisted nearly 1200 licensed professionals since 1986. Currently, there are 770 practicing professionals being monitored by the PAP. Approximately 80% are nurses, 10% are pharmacists, and 5% are dentists. The remaining 5% include members of 15 other professions. Committee for Professional Assistance

The Board of Regents appoints members to the Committee for Professional Assistance. The Committee advises the Regents on matters relating to practice by licensed professionals with alcohol or other drug abuse problems and makes determinations on admission to the PAP and acceptable compliance with its requirements. The majority of Committee members have expertise in the field of chemical dependency.

A three-member panel of the Committee interviews applicants for admission to the PAP and considers petitions for license reinstatement. At all panel meetings, a member of the State Board for the licensee’s profession is also present, assisting by addressing issues which may be specific to that profession. By statute, a decision of the Committee requires a 2/3rds vote. When possible, the State Board member does not vote but participates in the deliberation and can have an effect on the final determination. These panel meetings are informal and confidential, and no transcript is made.

New Committee members are selected by the same process as State Board members. Although there is no statutory minimum or maximum for the Committee, the goal is to have sufficient numbers to handle eight days of panel meetings per month. That translates into approximately 35-40 members. Since panel meetings are held in Albany, New York City, Syracuse, Buffalo and Rochester, geographical distribution is also a strong consideration.

Admission

1. Prism

An applicant for admission to the Prism pathway must complete an application form, provide a diagnosis of addictive illness from a licensed health professional, and meet with a panel of the Committee for Professional Assistance. The criteria used by the Committee require that:

1. There has been no harm to the licensee’s patients or clients that has resulted from a problem of drug or alcohol abuse.

2. The applicant presents an acceptable program of treatment.

3. The applicant accepts all monitoring requirements including a minimum of two years of monitoring.

4. When appropriate, the applicant provides an acceptable plan for informing patients or clients of temporary withdrawal from practice.

5. The applicant agrees to total abstinence from mood-altering substances.

If an applicant accepts these conditions, the applicant signs a voluntary surrender document and surrenders all professional licenses. PAP sends confidential memos to the Office of Professional Discipline, the Department of Health, the Division of Professional Licensing Services and any state in which the applicant is licensed, informing that the licensee has surrendered his/her license to the program, but providing no other information.

1. Nurse to Nurse (N2N)

This pathway is ONLY available to LPN’s, RN’s, and Nurse Practitioners. For admission to the Nurse to Nurse (N2N) pathway; an applicant must complete an application form, provide a full psychological/social/chemical dependency evaluation from an Office of Alcoholism and Substance Abuse Services (OASAS) approved treatment provider (or a provider otherwise approved by the Committee), and meet with a panel of the Committee for Professional Assistance. The criteria used by the Committee require that:

1. There has been no harm to licensee’s patients or clients that has resulted from a problem of drug or alcohol abuse.

2. The applicant presents an acceptable program of treatment and/or education.

3. The Committee determines that there is no threat to the health, safety, and welfare of the public posed by the licensee continuing to practice.

4. The applicant accepts all monitoring requirements including a minimum of two years of monitoring.

5. The applicant agrees to total abstinence from all mood-altering substances.

If an applicant accepts these conditions, the applicant signs a voluntary surrender document and surrenders all professional licenses. The licenses are then immediately restored and the monitoring function begins. No notifications are made to any office or other entity without a waiver of confidentiality from the licensee.

Inactive Status Monitoring During the time that the professional has surrendered a license to the Prism pathway of PAP and is undergoing treatment, the individual must maintain contact with the program, at a minimum, reporting in writing quarterly (on January 1, April 1, July 1, October 1) on progress in recovery. The professional must immediately update the office of any change in living circumstances, such as an address or job change or modifications to treatment. While the license is surrendered, the professional may not work in any position requiring a professional license under any circumstances. In addition, the Committee usually prohibits working in a related position or a different job at the same location. Exceptions to this latter policy must be pre-approved by the program after consultation with the Committee.

Active Status Monitoring In Prism, when the treatment provider(s) and the participant believe that it is safe for the public and appropriate for the participant’s recovery to resume practice, the participant schedules another Committee panel meeting to discuss license reinstatement. Documentation to support this request must include at least four weeks of twice a week, random, observed toxicology reports and strong letters of support from the treatment provider(s). These letters may include recommendations for conditions that would both protect the public and support the professional (e.g. no night work, no overtime, no administration of narcotics for a specified period, etc.). The panel evaluates the documentation and the presentation and makes a decision whether to reinstate the license.

Monitors.After the license is reinstated, the PAP requires at least two years of monitoring. This monitoring function is the same for both the Prism and N2N pathways of the PAP. Although there are various monitoring functions, they may or may not all be carried out by the same monitor. The licensee is responsible for arranging for monitors who meet the program’s criteria. Monitoring is a process of the collection and reporting of data to determine abstinence from alcohol and other drugs and to support recovery. This process monitors the licensee’s practice, toxicology, and recovery. Those persons who accept these responsibilities are referred to as “Practice Monitors”.

• Practice Monitor Practice monitors are expected to meet with the participant on a regular basis (at least monthly), as decided by the PAP. They are critical in assessing the participant’s professional performance based on personal observation, attendance, relationships with co-workers, adherence to the back-to-work agreement, and workplace behavior. Practice monitors submit monthly reports and may also provide toxicology monitoring for the participant.

• Worksite Monitor A Worksite monitor is a Practice monitor who is obligated to observe the participant engaging in the practice of his/her profession. They are responsible for meeting with the participant at least once a week.

• Toxicology Monitor A Toxicology Monitor is a Practice monitor who reviews and reports the laboratory testing results from urinalysis screening, blood alcohol testing, Breathalyzer, hair analysis, and dermal patch analysis. Upon reinstatement of the license, PAP will determine the type of biological testing and minimum frequency of testing. In addition:

a) Urinalysis must include testing for the drugs marked on the monitor contract for this participant. Collection must be random and observed. Random means that the collections follow no particular pattern and that participants have no prior knowledge of when a screen will be collected. Requests for screens must be met within 12 hours. Observed means that there is visual observation of the urine sample collection. The PAP must approve any exceptions.

b) Failure to appear for a requested collection and refusal to provide a sample will be considered positive results, resulting in a meeting with the Committee for Professional Assistance.

c) Chain of custody procedures must be followed at the collection site. If the screen has a positive result, the sample must be retested for final confirmation using Gas Chromatography/Mass Spectrometry or another forensic method.

d) The laboratory used should be certified by the State or Federal government health authorities as a medical lab and should meet the original requirements of forensic laboratories.

e) Testing for alcohol should be included as a standard test in the urinalysis screen for all participants. Monitors are advised to collect specimens at different times of day. Immediate tests for alcohol may include breathalyzers, saliva strip, or Alco-sensors, and may be required on a case-by-case basis as determined by the PAP.

• Treatment Monitor A Treatment monitor is a Practice monitor who reports on the participant’s progress in treatment and recovery from substance abuse.

• Recovery Monitor Is a Treatment monitor and may be a counselor in the participant’s treatment facility. If the participant has been successfully discharged from treatment, the recovery monitor is usually a licensed health professional. Recovery monitors submit monthly reports, and may also provide toxicology monitoring for the participant.

Relapse The process of relapse often begins well before the actual use of drugs or alcohol. PAP requires monitors to notify the PAP by phone within 24 hours of any signs of relapse. The PAP defines relapse as any deviation from abstinence. Any use of a mood-altering drug without express understanding and approval from the participant’s treatment provider and the PAP is considered a relapse. Any relapse will result in a meeting between the participant and a panel of the Committee for Professional Assistance.

Criteria for Monitors

1. Be willing to become familiar with the impairment history of the PAP participant.

2. Have a basic knowledge of the disease of addiction, the recovery process, and the functioning of the PAP. This may be received through a New York State Nurses Association training course, a PAP training course, or special approval of education and experience from the Executive Secretary of the Committee for Professional Assistance.

3. Be familiar with the PAP participant’s terms of restoration of license.

4. Not be an advocate for, or close friend or family member of the PAP participant.

5. Be willing to meet with the PAP participant on a regular basis (at least monthly).

6. Accept the responsibility of completing PAP monthly report forms.

7. Routinely communicate with other monitors of the PAP participant.

8. Agree to notify PAP by phone, within 24 hours, of all incidents or indications of noncompliance, evidence of impairment, positive toxicology screens, or violation of any term of restoration of license.

9. Report any potential conflict of interest issues to PAP.

10. Arrange for PAP participant monitoring during periods of unavailability such as vacations of either the monitor or the participant or any payments if the monitor and the participant agree to a fee arrangement.

11. Notify the participant that the New York State Education Department is NOT responsible for enforcing any arrangement or any payments of the monitor and the participant agree to a fee arrangement.

12. Provide documentation to justify discharge of the participant when all requirements have been met and continue to monitor for the period between discharge application and formal approval by the PAP.

13. Agree to keep confidential all information about the participant and to share information only with the PAP and the other monitors for whom the participant has signed a waiver of confidentiality.

Out-of-Compliance Situation. A participant is deemed out-of-compliance when the program receives any information that he/she is relapsing or is failing to meet the requirements set by the Committee. The professional receives an immediate warning letter and, in situations involving relapse or if the non-compliance is not corrected immediately, the participant is required to attend a panel meeting. Outcomes of such meetings usually involve re-surrender of the license or additional requirements. In extreme cases of non-compliance, the panel may recommend a separate meeting to terminate the professional from the program.

Leaving the Program.

1. Voluntary Withdrawal - Since the PAP is a voluntary program, a participant may withdraw from the program at any time; however, this is a very rare occurrence. The program processes these withdrawals as removal from the program and, in the case of the Prism track, notifies the Office of Professional Discipline, The Division of Professional Licensing, the Department of Health, and any state in which the professional is licensed. EXAMPLE: This involved a professional who holds both an RN and a LPN license. After an injury, she became addicted to prescription painkillers and began stealing them from her employer. Although she was granted immunity to practicing while impaired and being a habitual user, she was prosecuted for related, but more serious misconduct charges. After successfully completing several years of probation as required by the discipline system, she voluntarily withdrew from PAP even though she only needed a few more months of monitored practice to be eligible for discharge. Since her addiction and misconduct were already public knowledge, she preferred the risk of further misconduct 5 charges to the rigorous monitoring and practice restrictions. Although the program staff attempted to convince her that it was to her advantage to stay in the program, she followed the advice of her private attorney and voluntarily withdrew.

2. Discharge - After two years of post-restoration practice in full compliance with the Committee and program requirements, a participant may apply for discharge. The participant should send all supporting documentation to the PAP for review and determination. The discharge is not complete until an official letter of discharge is issued. The program does not encourage automatic discharges after the minimum period, and often, participants prefer to maintain the structure and support remaining in the program provides. The average amount of time a participant spends in the program is three and a half years. EXAMPLE: One atypical discharge involved a professional who surrendered his license to the program for six years and pursued a career in an unrelated field. During that time, he worked hard on his recovery and maintained sobriety. He then decided to return to his original profession and, after he demonstrated considerable re-education, the Committee reinstated his license with a requirement that he practice only under close supervision provided by a fellow professional who would report regularly to the PAP. The reinstatement was very successful and, after two years of compliance with all requirements, the professional was successfully discharged. EXAMPLE: A more typical discharge involved a nurse who worked in a large institution. She had been obtaining multiple prescriptions from different physicians for various narcotic painkillers. She was confronted by her nursing director who in addition to taking personnel actions against the nurse, recommended she contact PAP. She had already completed in-patient treatment when she applied to the PAP, and the Committee assisted her in entering into an outpatient program near her home town. She relapsed once while her license was surrendered, but she continued to work on her recovery. Ten months after she entered the program, she applied to the Committee for reinstatement of her license. Her treatment provider strongly recommended the reinstatement and after discussing the nurse’s work plans with her, the Committee agreed. The nurse arranged for a staff member of the Employee Assistance Program at her institution to be her practice monitor at the worksite. After two and a half years of practice of full compliance with all requirements, she applied for and received discharge from the PAP. She continued working in the same institution where she was initially confronted and she is a valuable member of the nursing team.

3. Removal from the Program - Upon a vote by a panel of the Committee for Professional Assistance, the PAP may remove a participant from the ProAssist pathway of the PAP and refer the matter to the Office of Professional Discipline for appropriate proceedings, and the Committee may revoke the immunity from disciplinary action granted to the licensee for the following reasons:

(a) Failure to meet the conditions imposed upon acceptance into the program.

(b) Evidence that patient or client harm resulted from the licensee’s problem of drug or alcohol abuse.

(c) Other evidences that the licensee should not be permitted to continue in the program.

4. Termination – Termination from the Prism pathway of the PAP may result in the reopening of professional misconduct cases that were closed upon the licensee’s acceptance into the program. The PAP would also notify the Department of Health, the Office of Professional Discipline, the Division of Professional Licensing, and any state in which the participant is licensed of the removal from the program and the revocation of immunity. EXAMPLE: Recently, an RN was terminated from the program and her immunity was revoked by the Committee due to the professional’s refusal to abide by the practice restrictions imposed. In this case, after many months of successful practice, a lapse in judgment at the worksite by the RN resulted in a meeting with a panel of the Committee and the addition of several practice restrictions suggested by the member of the State Board for Nursing. After several weeks of practicing with the new restrictions, the nurse refused to comply. This was unusual because most Prism terminations are due to failure to 6 provide the routine monitoring required. This combined with refusal to re-surrender the license, or more typically, failure to respond to contact attempts by the PAP, would force the program to move to immediate termination and notification of the Office of Professional Discipline in order to protect the public.