Colorado Physician Health Program

1. Colorado Physician Health Program Annual report July 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.

2. Colorado Physician Health Program Program Highlights July 1, 2008 through June 30, 2009 • 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 giftsof $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. 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

3. Colorado Physician Health Program National/international research and conferences July 1, 2008 through June 30, 2009 • 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. 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

4. Colorado Physician Health Program New 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 HavenProvision on medical licensure application/reapplication. Yearly Comparison of New Referrals to the CPHP 1986-Present * = BME License Renewal Years 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%. 4 N=318

5. Colorado Physician Health Program Referral Specifications July 1, 2008 through June 30, 2009 Sources of New Referrals 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. N=318 Primary Presenting Problem New Referrals 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%). N=224 Specialty of New Referrals 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 bothat 16%. Gender of New Referrals 34% were Female and 66% were Male (N=224). N/A = Student or PA Other = 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. N=224 5

6. Colorado Physician Health Program Inactivations and COUNTIES SERVED July 1, 2008 through June 30, 2009 Inactivations “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. N=312 Length of Active Status 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. N=312 Counties Served 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. 6

7. Colorado Physician Health Program REACTIVATIONS July 1, 2008 through June 30, 2009 Referrals versus 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. Primary Presenting Problem Reactivations 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%. N=54 Sources of Reactivations 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. N=78 7

8. Colorado Physician Health Program Report requests and Financial Breakdown July 1, 2008 through June 30, 2009 Report Requests CPHP processed 1530requests 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. 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. 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. 8

9. Colorado Physician Health Program COMMUNITY OUTREACH July 1, 2008 through June 30, 2009 CPHP SERVICES • 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 Address: 899 Logan St., Suite 410Denver, CO 80203Phone: 303-860-0122Fax:      303-860-7426 www.cphp.org Office Hours: Monday – Friday8:30 a.m. – 4:30 p.m. 9

10. Colorado Physician Health Program Community outreach Continued… July 1, 2008 through June 30, 2009 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 N 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 10