[Physicians and nurses subjected to disciplinary actions because of substance abuse. Ten years of experience with supervision in Copenhagen].
BACKGROUND
Medical Health Officers supervise medical staff on behalf of the Danish National Board of Health. The Board can impose disciplinary action on registered providers of health care.


METHODS
This retrospective investigation was based on case reports from 1 January 1989 to 31 December 1995 on medical staff under individual supervision because of alcohol or drug abuse, with a 3-year follow-up to 31 December 1998 in Greater Copenhagen (about 1.25 million inhabitants).


RESULTS
Altogether 173 health personnel were identified. Of these, 47 physicians and 91 nurses had disciplinary actions imposed on them because of abuse. In well over a third the abuse had lasted less than two years, whereas in a third it had lasted more than five years before admission to individual supervision. Half of both physicians and nurses had undergone psychiatric treatment before that time. Frequent disciplinary actions imposed were examination of urine passed without prior warning and controlled treatment of alcohol abuse. Difficulties in adhering to these conditions were found in one third to half of the cases. The Medical Health Officers notified the National Board of Health of breaches in 64%, often several times for each person. At the end of the follow-up period, 49% were still working. There was a statistically significant excess mortality in the group. Of the 26 dead, four had committed suicide and in a further 12 cases poisoning or abuse was a contributory cause of death.


CONCLUSIONS
Earlier detection, a tightening of sanctions, and improved treatment are recommended.
Hansen
Elisabet Tornberg
ET
Embedslaegeinstitutionen for Københavns Amt, Herlufsholmvej 37, 2., DK-2720 Vanløse.
Fouchard
Jan R
JR
Hoffmeyer
Jane H
JH
Rosdahl
Nils
N
D000328:Adult; D000368:Aged; D003718:Denmark / Q000453:epidemiology; D004647:Employee Discipline / Q000331:legislation & jurisprudence*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008503:Medical Staff / Q000331:legislation & jurisprudence* / Q000523:psychology; D008875:Middle Aged; D009740:Nursing Staff / Q000331:legislation & jurisprudence* / Q000523:psychology; D016272:Occupational Health / Q000331:legislation & jurisprudence*; D011363:Professional Impairment / Q000331:legislation & jurisprudence* / Q000523:psychology; D012189:Retrospective Studies; D015813:Substance Abuse Detection / Q000331:legislation & jurisprudence; D019966:Substance-Related Disorders / Q000401:mortality / Q000523:psychology / Q000534:rehabilitation; D013405:Suicide / Q000523:psychology