Hostile Psychiatric Examinations

Janet Louise Parker

B.S., M.S., D.V.M.

Administrative

• Initial Complaint – Anonymous

• Peer Review - identified behaviors

• Monitoring & Surveillance

• Lack of Notice

• Lack of Due Process

• Disregard for Civil Rights

Criteria for

Administrative Hearing

• Fraud or Felony

• Professional misconduct or moral turpitude

• Incompetence or unprofessional conduct

Disruptive Physician

• “Reporting Impaired, Incompetent, or

Unethical Colleagues,” provides a broad frame

for “INTERVENTION”

• Mechanisms “to assess the potential impact” of

such behavior and “to facilitate remedial

action.”

Work-Related Medical

Examinations

• Objectivity

• Confidentiality

• Disclosure of Potential or Perceived Conflicts

of Interest

• Altered Responsibilities and obligations

“Industry Employed Physician”

(IEP)

• Physicians- employed by businesses or

insurance companies for the purpose of

conducting medical examinations.

• Employment, pre-employment, and work-

related examinations, monitoring employees

health.

“Independent Medical Examiners”

(IMEs)

• Not employees - independent contractors

• Provide medical examinations for employees or

others within the realm of their specialty

• Contractual obligations to the business or

insurer and depend on these parties for

payment.

Conflict of Interest

• Contractual arrangements

• Receive payment from 3rd parties – the state,

insurer or employer

Physicians Health Program

• The Health Care Quality Improvement Act42 U.S.C. § 11133(a)(1)(C)

• “Impaired” physician's status

• The state medical association

• A sanction reportable to the National

Practitioner Data Bank (NPDB)

Patient-Physician Relationship

• To care for patients and to alleviate

suffering

• To place patients’ welfare above the

physician’s own self-interest and above

obligations to other groups

• To advocate for the patients’ welfare.

Hippocratic Oath:

“What I may see or hear in the course of the

treatment or even outside of the treatment in

regard to the life of men, which on no account

one must spread abroad, I will keep to myself,

holding such things shameful to be spoken

about.”

Privacy

1) Physical - individuals and their personal spaces

2) Informational - specific personal data

3) Decisional - personal choices

4) Associational - family or other intimate

relations

Corruption in the Process

1) Dishonest testimony is often regularly (and

unthinkingly) accepted;

2) Statutory and case law standards are frequently

subverted;

3) Insurmountable barriers are raised to insure

that the allegedly “ correct" social end is met

4) Original Complaint Sealed to Prevent

Discovery

Fitness for Duty Exam

Do

No

Harm?