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Hostile Psychiatric Examinations
Janet Louise Parker
B.S., M.S., D.V.M.
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Administrative
• Initial Complaint – Anonymous
• Peer Review - identified behaviors
• Monitoring & Surveillance
• Lack of Notice
• Lack of Due Process
• Disregard for Civil Rights
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Criteria for
Administrative Hearing
• Fraud or Felony
• Professional misconduct or moral turpitude
• Incompetence or unprofessional conduct
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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.”
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Work-Related Medical
Examinations
• Objectivity
• Confidentiality
• Disclosure of Potential or Perceived Conflicts
of Interest
• Altered Responsibilities and obligations
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“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.
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“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.
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Conflict of Interest
• Contractual arrangements
• Receive payment from 3rd parties – the state,
insurer or employer
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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)
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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.
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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.”
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Privacy
1) Physical - individuals and their personal spaces
2) Informational - specific personal data
3) Decisional - personal choices
4) Associational - family or other intimate
relations
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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
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Fitness for Duty Exam
Do
No
Harm?