ASSOCIATION Lessons learned: Protecting your practice from addiction threats
“If you’re not seeing addictive disease in your ranks, you’re not finding it,” according to Dr. Greg Gable, executive director of the healthcare professionals program at Caron Treatment Centers, during a session on addiction in practice at the 2018 AAEP Annual Convention.
AAEP Wellness Subcommittee Chairman Dr. Rob Franklin moderated the session and is intimately familiar with the topic as owner of or partner in three equine and four small animal practices in Texas.
In 2014, just 12 days after being hired at one of his small animal practices, an associate operating under Dr. Franklin’s DEA license overdosed on ketamine at work. In that limited time, technicians had indicated an increase in ketamine orders. Staff also noticed a different demeanor with the associate than when she previously worked part time relief shifts at the practice.
Those clues “put us on alert but we weren’t sure how to deal with it,” said Dr. Franklin. “The lesson I learned is to be direct with the person you’re concerned about. Require a drug test and have conversations with the person in question early on instead of waiting for them to try to find rock bottom in your clinic.”
When informed of the overdose, Dr. Franklin abruptly returned home from vacation to find himself entangled in months of investigations by the Drug Enforcement Agency (DEA), local police and the Texas Board of Veterinary Medical Examiners, which probed all seven of his practices.
With the immense stress of his license and livelihood being thrown into limbo, Dr. Franklin scrutinized current processes at his practices and implemented six protocols to mitigate the likelihood of a recurrent event.
1. Background check At a cost of just $5 to $10, a background check is an inex- pensive way to dig into an applicant’s history to discover incidents that can tip you off to potential problems, such as a previous citation for driving under the influence or possession of illegal drugs.
2. Pre-employment drug screen In addition to drug testing potential hires, including successful passage of a drug screen (and background check) as a requirement in job postings creates a natural filter on prospective candidates with substance abuse problems.
3. Random drug screen agreement Reserve the right to randomly drug screen employees. The screen should be more comprehensive than the standard
AAEP News May 2019 III
test in order to look for the types of medications on hand in the practice. Include appropriate language in the employee handbook and require new employees to sign off on their first day.
“Random drug screening is not something we do once a quarter or anything like that,” said Dr. Franklin. “It’s really based on whether we’re having any issues with our drug count or with behavior. If we’re not sure where it’s coming from, we’ll test everyone. If there’s one employee we’re concerned about, we may just test that individual.”
4. Individual DEA licenses
A misstep by an associate operating through an owner’s DEA license could jeopardize the owner’s ability to practice. Individual licenses hold everyone accountable to the highest authority. “It’s worth the $700 every three years,” said Dr. Franklin.
5. Strict log keeping
Log keeping needs to be a shared responsibility. It can be a practice manager and lead technician, but there must be two sets of eyes on it. Dr. Franklin’s practices use the AAHA controlled substances log, which is simple to use and formatted to the DEA’s preference, unlike spiral notebooks.
6. Monthly controlled substances audit Dr. Franklin contends that the DEA’s requirement for a controlled substances audit every two years creates vulner- abilities. “We count everything and make sure the logs are watertight once a month. It’s very easy to stay on top of it when you make it a monthly checklist item.”
According to Dr. Franklin, maintaining vigorous records, strong protocols and clear employee manuals and operating agreements between partners “really clears the air and reduces your liability if something happens with an employee.”
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