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Section 9: Behavioral Health Statement

The School of Medicine acknowledges and understands the demands associated with residency training. It has created, through the Faculty Staff Assistance Program (FSAP), a support system for residents, which all residents are invited and encouraged to utilize. Section 8 of this Manual describes the services available from the FSAP and how to access these services. If a resident experiences excessive stress or anxiety, or if a resident begins to over use alcohol or use other mood altering drugs, or if a resident recognizes these behaviors in colleagues - don't hesitate, get help by contacting the program director or by calling FSAP at 404.727.4328.

This Section outlines the Behavioral Health Policy and Procedures adopted by the School of Medicine, along with the requisite steps a resident must follow in asking for a release from duty to address behavioral health issues. (Physical health issues, like behavioral health concerns, may quality for Medical and/or Family Medical leave. Leaves of absence for health concerns should be requested pursuant to the procedures detailed in Section 4 of the Manual.) Information is also included on the steps required for a resident to return to duty. Read this important information closely and remember that the School of Medicine is committed to providing appropriate assistance to the resident suffering from a behavioral health issue as well as its commitment to provide a safe environment for patients, hospital staffs, visitors, and other physicians.

9.01 Physician Impairment and Substance Abuse

 The Emory University School of Medicine is committed to providing, through its Residency Training Program, the highest levels of graduate medical education, patient care, and research. To realize this commitment, the School of Medicine has developed programs and policies dedicated to advancing the personal and professional development, health, and well being of its residents.

The purpose of this policy is to ensure that all residents are fit for duty and work free from harm to themselves and others. The School of Medicine is committed to providing appropriate and compassionate support to any resident who experiences mental, emotional, or physical health problems, including those who also require professional assistance to deal with substance abuse, psychiatric, or behavioral health issues. It is therefore the policy of the Emory University School of Medicine and its Residency Training Program (RTP) that residents be afforded the opportunity to seek and obtain professional assistance at the earliest indication of need. In addition, it is the policy of the School of Medicine and the Residency Training Program to grant a resident a release from duty when such release is medically recommended and medically necessary to support the resident's health and recovery. These policies are designed to create an environment where residents are encouraged to request assistance whenever they believe they are suffering from an impairment that affects their fitness for duty. Specific guidance for releases from duty for behavioral health issues is provided because behavioral health impairments are not always readily identifiable, yet create the same safety concerns as those created by any other impairment.

When a release from duty is needed in order for the resident to obtain inpatient or outpatient treatment for a behavioral issue, including a psychiatric condition, psychological issue, or substance abuse, such a release shall be requested and processed as stipulated in the provisions of this policy.

The Faculty Staff Assistance Program (FSAP) is available to assist residents as well as Emory faculty and staff in dealing with any issue or concern that is affecting or may affect that individual's ability to live or work in a healthy, productive manner. The FSAP facilitates the ability of its clients to discover options and manage resources that enhance health, productivity, and behavior.

Referral and Assessment Provisions

Emory encourages residents to seek professional assistance at the earliest indication of physical or emotional problems related to job performance or safety. Professional assistance is generally accessed in one of the following ways:

The FSAP is available to provide coaching and consultations on when and how to make a referral, and to assist leadership as well as peers and colleagues on ways to encourage self-referral. Emory reserves the right to mandate a resident's participation in this process where circumstances indicate that a fitness for duty examination is appropriate. Residents are expected to fully cooperate in Emory's efforts to receive a fitness for duty examination. Disciplinary action, including termination from the Residency Training Program, may result from a resident's refusal to cooperate with the process.

When a resident comes to the FSAP through self-referral or other means, the FSAP will work with the resident in confidence, to the extent appropriate or permitted by law, to assess the nature of the concern or issue, to determine the cause, and to identify a plan of action. When the result of an assessment leads to the determination that a release from duty is indicated to obtain further evaluation, inpatient or outpatient treatment for a substance abuse, psychiatric, or behavioral health issue, the following provisions will apply.

Requesting a Release from Duty - Procedure

It is the responsibility of the resident to request in writing an authorized release from duty as soon as possible. The request shall be submitted to the resident's department chair or program director, shall be accompanied by a certification from the health care provider attesting to the medical necessity of the release, and shall specify the beginning date of the time away from duty and the anticipated return date.

The request shall also acknowledge that the resident is aware of and will follow the policy and provisions set forth by the School of Medicine and Residency Training Program for returning to duty. This includes a provision related to the resident's responsibility to arrange to have his/her treating provider supply the FSAP and the chairperson (or program director by designee) with timely and sufficiently detailed information regarding his/her condition and any restrictions to the resident's performance when he/she returns. This also includes a provision explaining that the chairperson will determine the resident's ability to safely and effectively continue training within the residency training program based upon the consideration of medical evidence.

Authorizing a Release from Duty

The resident's department chair shall review the request and supporting documentation, and determine whether to grant the resident's request for a release from duty. In the absence of a specific request, the department chair or program director may release a resident from duty where objective evidence suggests that the resident's continuation of work would pose a direct threat to him/herself or others. In such circumstances, the resident shall be referred to the FSAP for a fitness for duty evaluation as otherwise described in this policy. The resident is expected to fully cooperate in these efforts to obtain a fitness for duty evaluation. Disciplinary action, including termination from the Residency Training Program, may result from a resident's lack of cooperation.

9.02 Return to Duty Policy

When an Emory University resident is absent from the training duties of his/her residency training program (RTP) to obtain assistance for behavioral health concerns, including inpatient or outpatient psychiatric treatment, psychological treatment, treatment for substance abuse (including but not limited to treatment for alcohol abuse), or a similar condition that may impact job performance or safety, that resident may resume duties in the RTP based on medical evidence demonstrating the ability to perform the essential functions of his/her duties. Each qualifying resident may be required to submit a return to duty plan prior to his/her return to the RTP in the event that medical evidence demonstrates an ongoing restriction that may impact job performance. This plan must be developed and approved in accordance with the guidelines provided in this policy. The FSAP will serve as the liaison between the resident, the RTP, and the resident's treatment team during the development, implementation, and management phases of the return to duty plan.

Creation and Approval of the Return to Duty Plan

The chairperson of the resident's department or the resident's RTP program director by designation of the chairperson will work with the FSAP in developing any applicable return to duty plan. The chairperson, program director, and FSAP may consult with the Associate Dean for Graduate Medical Education or his/her designee of Emory University's School of Medicine at any time during the process of developing and implementing the return to duty plan. The chairperson will make the final decision as to the contents of the return to duty plan based on medical evidence. Prior to making this decision, the Chairperson may, when deemed appropriate, engage the services of a medical consultant external to the University for the purpose of obtaining additional medical evidence concerning the individual's fitness for duty. Communication with the medical consultant will be coordinated through the FSAP. Discussions among the resident, the chairperson, the program director, and FSAP will occur before the resident resumes training program responsibilities to assure the resident's signed agreement and commitment to complying with each provision of the return to duty plan.

Content of the Return to Duty Plan

At a minimum, each return to duty plan should include some, or all, of the following elements, as appropriate to the particular resident's needs and the needs of the RTP:

Responsibility of Resident

Any resident who is absent from his/her training duties to obtain psychiatric, psychological or substance abuse treatment and who desires to return to the RTP may be required to meet the following responsibilities. Any resident desiring to return to the RTP may be required to arrange to have his/her treatment provider release in a timely manner information to the chairperson, program director, and the FSAP concerning the nature and scope of the resident's condition as it relates to job performance, any limitations on the resident's ability to perform essential job functions, evidence suggesting that the resident may pose a direct threat, and the provisions of the resident's continuing care program as it relates to or impacts his/her RTP duties. This information will be used to assist the determination of whether the resident is eligible to resume training in the RTP. The resident's failure to meet these responsibilities will result in his/her inability to return to the RTP.

If a resident is allowed to return to the RTP and if that resident has a return to duty plan, he/she must comply with each provision in the return to duty plan until he/she has fulfilled the requirements for release from any continuing care program and any other treatment coordinated by the resident's treatment provider. In addition, the resident must comply with each provision of his/her continuing care program, as developed by the resident's treating provider, and must have arranged to have the treating provider release information to the resident's chairperson, program director, and FSAP concerning the resident's compliance with the continuing care program, if applicable. The RTP and FSAP will make reasonable efforts to coordinate the resident's training schedule and responsibilities with his/her continuing care program commitments. Finally, the returning resident is expected to meet each of the RTP's performance and conduct standards. The resident's failure to meet any of these responsibilities may result in discipline, up to and including the dismissal of the resident from the RTP.

Residency Credit

Upon returning to the RTP after receiving treatment, each resident's eligibility to receive credit for any portion of the residency year in question will be evaluated by the resident's chairperson and program director. In determining the resident's qualification to receive training credit, the chairperson and program director will evaluate the resident's performance prior to receiving treatment, the length of time the resident performed within the residency year prior to leaving the RTP for treatment, the length of the treatment, the length of time remaining in the residency year upon the resident's return to duty, the training received by the resident, and the training missed by the resident while receiving treatment.

Confidentiality

All medical information concerning the resident's absence from the RTP to receive treatment and his/her subsequent return to the RTP, including information provided by the resident's treating provider, will be treated as a confidential record. Medical information concerning the resident, including psychiatric and/or psychological information, will only be disclosed by the chairperson, program director, and FSAP to the resident's other supervisors when, and if, an accommodation or work restriction may be needed by the resident. However, the chairperson, program director, and FSAP will continue to have the right and may have the duty to disclose additional medical information to the appropriate entities and individuals for any other lawful purpose.

Record Keeping

All medical records and other documentation concerning the resident's absence from the RTP to receive treatment and the resident's return to the RTP, including information from the resident's treating provider, will not be maintained in the resident's personnel file, Graduate Medical Education file, or RTP file. Instead, the documentation will be collected and maintained in a separate medical file, which is secured in a locked area in the University's Department of Human Resources or the FSAP.