Colorado Physician Health Program

COMMUNITY reportJuly 1, 2009 through June 30, 2010

by

Sarah R. Early, PsyD, Executive Director

Doris C. Gundersen, 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 Highlights July 1, 2009 through June 30, 2010

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Board of Directors2009 – 2010

ChairJames Borgstede, MD

Vice-ChairGeorge Dikeou, Esq.

SecretaryThomas Currigan, Jr.

TreasurerLarry A. Schafer, MD

Director-At-LargeJohn Genrich, MD

Thomas G. Currigan, Jr.

Maureen J. Garrity, PhD

John H. Genrich, MD

Caroline M. Gellrick, MD

Jim Keller, PA-C

Debbie Lazarus

Michael Michalek, MD

Doug Speedie, MD

Steven Summer

Lawrence Varner, DO

• CPHP Board Director Officers: CPHP held annual officer elections and also welcomes three new Board Directors as of May of 2010:

• Jim Keller, PA a Physician Assistant at Lakeview Family Medicine, P.C. in Littleton, CO.

• Doug Speedie, MD Associate Medical Director at Rocky Mountain Health Plans (RMHP) in Grand Junction, CO

• Steven Summer, President and Chief Executive Officer of the Colorado Hospital Association

• CPHP Serves Rocky Vista University College of Osteopathic Medicine Students: CPHP entered into a service contract with Rocky Vista University College of Osteopathic Medicine for the academic year 09-10. Executive Director, Sarah Early, PsyD and Medical Director, Doris Gundersen, MD provided orientations to faculty and students on the importance of physician health and services CPHP offers. CPHP is excited about this collaboration to serve the medical students and aid in supporting wellness throughout their training years.

• CPHP Newsletter Distributed: The Summer 2010 edition of CPHP News was mailed to all active Colorado licensed physicians and physician assistants and various other medical entities throughout the state. CPHP appreciates COPIC’s generous sponsorship of CPHP News. CPHP is proud of this initiative in an effort to provide the Colorado medical community with informative physician health articles and to promote our 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.

• Spirit of Medicine Campaign: CPHP concluded the annual Spirit of Medicine fundraising campaign in 2008-2009 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 annual campaign. We are grateful to all of the generous contributors and especially want to recognize donors who provided a gift of $5,000 or more:

• Colorado Medical Foundation Trust• St. Mary’s Hospital and Medical Center• The Medical Center of Aurora • Colorado Permanente Medical Group (CPMG) – We wish to offer special

appreciation to CPMG as a long-time member of the LivingWell Giving Society

• Valley View Hospital – We would like to extend our appreciation as the newest member of the LivingWell Giving Society

All donors are recognized on the CPHP website, www.cphp.org, from the 2008-2009 campaign.

Patient Safety Advisory Committee

Judy HamCerebral Palsy of Colorado

Patty SkolnikColorado Citizens for Accountability

Ed Dauer, EsqColorado Patient Safety Coalition

Colorado Physician Health ProgramNational/international research and conferences

July 1, 2009 through June 30, 2010

Medical/Associate Directors

Medical Director

Doris C. Gundersen, MD

Medical Director Emeritus

Michael H. Gendel, MD

Associate Medical Directors

Mary Ellen Caiati, MD

Scott H. Humphreys, MD

Jay H. Shore, MD

Elizabeth Stuyt, MD

StaffExecutive Director

Sarah R. Early, Psy.D

Director of Clinical Services

Cae Allison, LCSW

Finance Manager

Denny Smith, CPA

Receptionist

Julie Fisher

Clinicians

Cindy Hudson, MA, CACIII

Lynne Klaus, LCSW, CACIII

Sally Moody, MSW, LCSW

Dwayne Spinler, MS, LPC, NCC, MAC

Compliance Coordinator

Joyce Muniz

Executive Assistant

Amanda Parry

Administrative Assistant

Tracy Sue Walters

Developmental Specialist

Todd Weiss

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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.

• CPHP Participates in Patient Safety Initiatives: CPHP has taken an active role in ensuring that Patient Safety is at our forefront of the organization, physician health programs and the Colorado medical community. In doing so, we have established a Patient Safety Committee that advises the Board of Directors and Staff on decisions. In addition, Doris C. Gundersen, MD Medical Director attended conferences concerning Patient Safety Initiatives:

• October 28-30, 2009 Citizen Advocacy Center (CAC) Annual Meeting in Orlando, Florida• November 13, 2009 Patient Safety Coalition Conference (PSC) in Denver, Colorado

• International Physician Health Efforts:• Research: During the Second Quarter, CPHP was asked to be interviewed as a premier

Physician Health Program by Michael Bonning, a junior doctor from Brisbane, Australia. Dr. Bonning has been awarded the International Winston Churchill Fellowship to research Physician Health Programs throughout the world. This data will be utilized to create a centralized Physician Health Program in Australia. CPHP appreciates the privilege to be recognized as a premier program.

• Canadian Conference on Physician Health: October 14-16, 2009, Sarah Early, PsyD, Executive Director, attended the inaugural Canadian Conference on Physician Health. This event included workshops and vanguard speakers from the physician health community.

• Federation of State Physician Health Programs (FSPHP): • FSPHP Annual Meeting: CPHP Medical Director and Executive Director attended

the FSPHP Annual Meeting in Chicago, IL from April 19-23, 2010. Sarah R. Early, PsyD, Executive Director presented on “Keeping Both Male and Female Physicians Healthy” and Doris C. Gundersen, MD, Medical Director presented on a panel “Disruptive Behavior Approaches”. In addition the FSPHP held a joint session with the Federation of State Medical Boards (FSMB) in which Dr. Gundersen co-presented on “Physician Health Programs and Licensing Boards: Partners for Patient Safety”. CPHP is pleased with the collaboration with the FSPHP and FSMB to collaborate on physician health related issues.

• Western Region FSPHP Annual Meeting: CPHP Medical Director, Doris Gundersen, MD and Executive Director, Sarah Early, PsyD attended the Western Region of the FSPHP Annual Meeting in Coeur D’Alene, Idaho on September 17-19, 2009. Dr. Gundersen participated on a panel presentation entitled Health Programs Under Siege: Report On The Recent California Citizen Advocacy Center. We welcomed the opportunity to collaborate with colleagues from other Physician Health Programs and gain valuable information about physician health related issues.

Colorado Physician Health Program

New referral Highlights July 1, 2009 through June 30, 2010

CPHP received 271 New Referrals in the Fiscal Year 2009-2010! In Fiscal Year 2008-2009, CPHP received 318 referrals. This is a 15% decrease when compared to 2008-2009 in New Referrals, and CPHP believes this is due to a decrease in referrals from the Colorado

Medical Board (CMB). All CPHP clients that attend an initial intake appointment complete a Treatment and Monitoring Agreement (TMA) and receive case management services.

The average active caseload throughout the four quarters of 2009-2010 was 446 participants. This represents a 5% decrease from the Fiscal Year 2008-2009 which had 465 active participants at any given time. CPHP attributes this decrease to the fervent effort of staff

members to provide efficient services.

Of the 271 New Referrals in the Fiscal Year 2009-2010, 64% were voluntary and 36% were mandatory.

44% of the New Referrals (N=118) that came to CPHP are able to utilize the Safe Haven Provision on medical licensure application/reapplication.

Yearly Comparison of New Referrals to CPHP 1986-Present

4N=271

Licensure of New Referrals

Of the total New Referrals this year, 74% had active Colorado Medical Licensure. The breakdown of

licensure is as follows; Medical license 59%, PA license 5%, Training License 10%, Applicant for Colorado licensure 15%, Out of State 3% and Medical or PA

Students 7%.

* = CMB License Renewal Years

Colorado Physician Health Program

Referral Specifications July 1, 2009 through June 30, 2010

The highest single source of New Referrals for the Fiscal Year 2009-2010 were Self at 43%. The second highest source of New Referrals was the Colorado Medical Board (CMB) at 17%. CPHP continues to be proud of the number of Self Referrals to the program demonstrating trust and confidence in CPHP.

76 out of the 271 New Referrals were “reactivated” thus, 28% 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 271 New Referrals in the Fiscal Year 2009-2010, 86 were in process at the time of this report, thus 185 were assigned a primary presenting

problem.

The majority of New Referrals presented with a Psychiatric Problem (26%), followed by a Behavioral

(14.5%), and lastly Substance Abuse (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 271 New Referrals in the Fiscal Year 2009-2010, 86 had not

completed an initial intake session at the time of this report, thus for 185 New Referrals, specialty information had been

collected.

For the Fiscal Year 2009-2010, there was a wide variety of specialties represented. The most frequently seen specialty at CPHP was Family Practice at 21% and Internal Medicine

at 16.5%.

Sources of New Referrals

Primary Presenting Problem New Referrals

Specialty of New Referrals

N=271

N=185

N=185

N/A = Student or PAOther =Forensic Medicine, Infectious Disease, Nuclear Medicine, Physical Rehabilitation, Radiation Oncology, UrologyOther Surgery = Plastic or neurological

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Anesthesiology9%

Emergency Medicine2%

Family Practice21%

Internal Medicine17%

N/A10%

OB/GYN6%

Orthopedic Surgery3%

Pediatrics5%

Radiology2%

Psychiatry5%

Dermatology2%

General Surgery5%

Otolaryngology2%

Neurology3%

Allergy/ Immunology3%

Other3% Other Surgery

2%

Colorado Physician Health ProgramDemographics, Treatment Referral and Relapses

July 1, 2009 through June 30, 2010

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Age of New Referrals

Gender of New Referrals35% Female

and 65% Male (N=185) Ethnicity of New Referrals

10% Asian4% Hispanic

1.5% African American1.5% Biracial

1% Native American82% Caucasian

(N=185)

56.5% Married15.5% Divorced 3% Separated

1.5% Widowed 3.5% Cohabitating

20% Single(N=185)

Marital Status

An Initial Treatment Category is assigned by the clinical team following the completion of the initial intake interview. Of the 185 New Referrals seen, eighty-eight were assigned initial treatment recommendations at intake (48%). Individuals may be assigned more than one category of initial treatment.

Of these 88 with initial recommendations, 70% percent of were provided a recommendation for psychiatric treatment. Twenty percent were provided a recommendation for substance abuse/dependence treatment, 9% were provided a treatment recommendation for a physical health matter and 1% were recommended to behavioral treatment.

Fifty-two percent of all clients evaluated were not given a treatment recommendation (n=97) as this was deemed unnecessary. Clients not given a treatment referral at the conclusion of the initial intake may have been referred for additional evaluation.

Initial Treatment of New Referrals

At any time during the Fiscal Year 2009-2010 there was an average of 141 clients being monitored via Urine Drug Screen (UDS) and/or other tissue screening.

_____________________________________

Seventeen clients experienced substance use relapse within the 2009-2010 Fiscal Year.

CPHP addresses any occurrence of relapse clinically and thoroughly assesses ability to safely practice medicine on an individual case basis.

______________________________________

CPHP identified two cases of diversion during Fiscal Year 2009-2010.

Colorado Physician Health Program

Inactivations and COUNTIES SERVED July 1, 2009 through June 30, 2010

“Inactivation” refers to when a case is closed at CPHP. During the Fiscal Year 2009-2010 there were 270 cases inactivated. Of these 270 inactivations, 33 referrals were declined, 4 did not complete an evaluations, 2 withdrew their CMB application, 2 declined evaluations, 14 completed consultation, 2 had their CMB order rescinded, 13 relocated, 1 was categorized as “Other”, and 1 unfortunately died therefore, 198 were evaluated. Of the 198 evaluated, 183 (92%) were inactivated with an outcome considered to be successful and/or satisfactory.

Inactivations

N=270

Region Number Percent

Adams 10 5.5%

Alamosa 1 .5%

Arapahoe 23 13%

Boulder 13 7%

Broomfield 1 .5%

Chaffee 1 .5%

Denver 54 29%

Douglas 8 4.5%

Eagle 2 1.5%

El Paso 13 7%

Elbert 1 .5%

Fremont 1 .5%

Of the 185 New Referrals seen for a full initial evaluation, regional data has been collected. During the Fiscal Year 2009-2010 New Referrals resided in 22 Colorado counties.

Counties that contain less than 10 physicians, based on a CMB listing of Colorado licensed physicians (obtained in September 2009) 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

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Length of Active Status at CPHP is depicted to the right. The majority of participants (63%) completed the necessary involvement with CPHP in one year or less. Last fiscal year 2008-2009, 67% of participants completed the necessary involvement of CPHP in one year or less.

Length of Active Status

N=270

Region Number Percent

Garfield 1 .5%

Jefferson 17 9%

La Plata 1 .5%

Larimer 5 3%

Mesa 4 2%

Moffat 1 .5%

Montrose 1 .5%

Out of State 20 11%

Pueblo 3 2%

Routt 1 .5%

Teller 1 .5%

Fiscal Year 2009-2010

N= 185 100%

Colorado Physician Health Program

REACTIVATIONS and REPORT REQUESTS

July 1, 2009 through June 30, 2010

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

Of the 271 New Referrals in Fiscal Year 2009-2010, 76 were Reactivations. This represents 28% of the total New Referrals. This is a 3% increase when compared to Fiscal Year 2008-09.

Referrals versus Reactivations

The highest single source of Reactivations for Fiscal Year 2009-2010 were Self at 44%. The second highest source of Reactivations was the CMB at 15.5%. 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 2009-2010, 63% came back to CPHP voluntarily, and 37% were mandated. The number of voluntary referrals last Fiscal Year was 42%.

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 76 Reactivations in Fiscal Year 2009-2010, 25 were in process at the time of this report, thus 51 were assigned a primary presenting problem.

The majority of Reactivations presented with a psychiatric problems (27%), followed by a substance abuse (19%).

Primary Presenting Problem Reactivations

Sources of Reactivations

N=75

N=51

CPHP processed 1572 requests for reports during the Fiscal Year 2009-2010. In Fiscal Year 2008-2009 CPHP received 1530 report requests. This shows an increase of 3% in report requests.

Report Requests

Colorado Physician Health Program

COMMUNITY OUTREACHJuly 1, 2009 through June 30, 2010

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• 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. 46 presentations were conducted this past year! This is a 9% increase in presentations compared to last Fiscal Year.

• 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 well-being. CPHP currently serves the following programs:

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

• Physician Assistant Training Programs • University of Colorado at Denver• Red Rocks Community College Physician Assistant Program

• Medical Schools • University of Colorado at Denver• Rocky Vista University College of Osteopathic Medicine

• CPHP and COPIC Continue Educational Collaboration: CPHP and COPIC have again partnered to continue the tenth series of educational presentations for Colorado physicians. Presentations are provided throughout Colorado on physician health topics.

• 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 Meeting and MidWinter Conference• Colorado Association of Medical Staff Services Conference• Colorado Chapter of the American Association of Pediatrics• Colorado Hospital Association Annual Conference• Colorado Medical Society Annual Conference • Colorado Psychiatric Society Colorado Nonprofit Association Luncheon• Colorado Patient Safety Coalition Conference and Executive Council Meeting• Colorado Rural Health Conference• Colorado Society of Anesthesiologists Conference• Colorado Society of Osteopathic Medicine Summer Conference and MidWinter Conference• Healthcare Reform Conference• Summit on Patient Safety & Substance Abuse in Colorado • UC Denver Graduate Medical Education Orientation• UC Denver School of Medicine Department of Psychiatric Grand Rounds• UC Denver School of Medicine Department of Psychiatric Student Lectures• UC Denver School of Medicine Orientation• UC Denver School of Medicine Student Wellness 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

• Medical Marijuana

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.

The majority of revenue that was generated at CPHPduring Fiscal Year 2009-10 was from the Peer Assistance Contract (76%). The next largest source of revenue was from Donations (12%) which were contributions to the CPHP annual Spirit of Medicine fundraising campaign.

Revenue Sources

AudiencesArkansas Valley Regional Medical CenterAspen Valley Hospital Avista Adventist Hospital Boulder Community HospitalCenter for Creative LeadershipColorado Medical SocietyColorado Patient Safety Coalition Colorado Personalized Education for PhysiciansColorado Permanente Medical Group COPIC Companies Colorado Plains Medical Center Colorado Psychiatric SocietyDelta County Memorial HospitalEstes Park Medical CenterEl Paso County Medical Society Exempla Good Samaritan HospitalExempla Healthcare AdministrationFamily Health West PracticeFort Collins Family Medicine ResidencyGunnison Valley HospitalLittleton Adventist HospitalMedical Center of AuroraMelissa Memorial Hospital Memorial Hospital in Colorado SpringsMercy Medical CenterMontrose Medical Center National Jewish Hospital Northern Colorado Medical Center Northern Colorado Rehabilitation Hospital Pikes Peak Hospice & Palliative Care Platte Valley HospitalPorter Adventist Hospital Poudre Valley HospitalRed Rocks Community College Physician AssistantsRocky Vista University College of Osteopathic Medicine

Colorado Physician Health Program

Community outreach Continued…July 1, 2009 through June 30, 2010

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Rose Medical CenterSt. Joseph’s Hospital

St. Mary’s HospitalSt. Vincent General Hospital

Sedgwick County HospitalSouthern Colorado Family Medicine Residency

Sterling Regional Medical Center Swedish Medical Center

UC Denver Anesthesiology DepartmentUC Denver Child Health Associate and Physician Assistant Program

UC Denver Graduate Medical EducationUC Denver Psychiatric Department

UC Denver Psychiatric StudentsUC Denver School of Medicine

Vail Valley HospitalValley View Hospital

Yampa Valley Medical Center