Q&A with Donald Lefkowits, MD, president, Colorado Medical Board
Featured in the Aug-Oct 2021 Colorado Medicine Colorado Medicine.
Chet Seward, Colorado Medical Society chief strategy officer, sat down with Donald Lefkowits, MD, Colorado Medical Board president, to talk about a new policy passed by the CMB that ensures confidentiality of peer assistance counseling for Colorado physicians (a top CMS priority), why readers should be aware of the new policy, and what happens next.
Chet Seward: Let’s start by introducing you and framing the issue.
Donald Lefkowits, MD: I joined the Colorado Medical Board in 2015 and began a two-year term as president of the board last year. I first started taking care of patients in Colorado in September of 1980. About a month or two before the pandemic started, after 40 years in the ER, I retired from full-time emergency medicine. I'm doing a little bit of urgent care work and I'm still in touch with many of my colleagues. In my many years in medicine, I've never seen anything like this, the stress that our providers are under – especially frontline providers, critical care doctors, hospitalists, ER doctors, PAs who do those roles – the loss of life, the fear for their own safety. It has put our providers under a level of strain that has never happened before, at least not in my career. Now more than ever, I think there's a need for many to turn for help.
I have colleagues who suffer right now from post-traumatic stress disorder (PTSD) because of what they've seen and what they've had to deal with these last 18 months. Turning to others for help is not something that comes naturally to physicians; they tend to see it as a sign of weakness, they tend to see it as something that that may hurt their reputation. I hope that the Colorado Medical Board (CMB) can create an atmosphere where licensees feel safe, encouraged and supported to look for help when they need it; that they'll do so early, before concerns rise to a level that may jeopardize patient safety or their own safety; and that they get help so they can return to or stay in the safe practice of medicine, because that's the way we support our citizens in the best way that we can.
CS: Why is ensuring the confidentiality of peer assistance services so important for physicians and the CMB?
DL: The goal of the medical board is to keep the public safe, and the best way to do that is to ensure that we have healthy physicians who are supported, educated and able to practice currently competent medicine for all of our Colorado citizens. As is the case with any stressful career, physicians and other professionals we license are apt to run into medical or psychological problems that could interfere with their ability to practice. This pandemic has been extraordinarily stressful on physicians. We want them to feel that it's comfortable, safe and appropriate, when they are struggling, to seek help. It's clear in our discussions with our licensees that if a physician turns to a peer assistance provider to seek help, and that leads to a report to the Colorado Medical Board, they're far less likely to seek that help.
Speaking based on my experience on the Board, we're a very pro-active, rehabilitative, board. When physicians are struggling, we do everything we can to protect the public, but to also help physicians get back to safe practice. We recognize our physicians in the state as resources; we want to save careers; we want to allow them to return to practice with the appropriate support. But the perception clearly is that a report to the board jeopardizes their career, and so without confidentiality, they're far less likely to seek help, rather than if they know that seeking help can be treated confidentially.
CS: What changed regarding the policy that would threaten that confidentiality?
DL: Last year, it was time to renew our contract with our current peer assistance provider. Without knowledge of or consultation with the board, Department of Regulatory Agencies (DORA) staff proceeded to go through a request-for-proposal (RFP) process and selected a new vendor, unknown to the board, to become the new peer assistance provider for all of our licensees. It appeared to our licensees that the ability to seek peer assistance confidentially might be lost. It wasn't discussed with the board, and the medical community was pretty upset that this happened without the Board’s knowledge.
To make a long story short, the RFP awardwas appealed and t p eventually overturned by an administrative law judge and a new selection process, led by the board, was started the first of the year. In the meantime, there has been a significant period of time when it was not at all clear that continued confidentiality would be an option. Appropriately, that really raised the alarm within the medical community. After more than 6 months of meetings and deliberation, a subcommittee of the board recommended, at an emergency meeting on July 20th, that the new contract for peer assistance be awarded to our current provider and that recommendation was accepted, unanimously, at the emergency meeting.
CS: How was the new policy created?
DL: Colorado Medical Society was one of many, many organizations that raised the alarm about how and why this process was flawed and the urgent need to codify confidentiality protections, especially since Colorado has been held up in the past as a national standard for safe and effective confidential peer assistance.
The board felt like it was important, regardless of who the peer assistance provider would be going forward, that we memorialized in policy the fact that the board believes in confidential peer assistance. We wanted to ensure that peer assistance in a confidential manner would still be available and guaranteed to most licensees seeking help.
We started the process of policy development. It involved taking the Medical Practice Act (MPA) and trying to interpret it in a way that could establish a policy to assure confidential peer assistance, but still maintain the statute and the parameters of the statute in regard to monitoring a physician's behavior, placing patient safety as the top priority. We came up with a draft, circulated it, and had a number of stakeholder feedback opportunities, both in writing and in video calls. We made additions, corrections, and a variety of changes based on that feedback, then circulated a second draft. It was close to a six-month process, but we felt that it was worth our time and effort to try to make this as appropriate a policy as we could, taking into account the needs and the concerns of our stakeholders. The full board adopted the policy – 10-28 Confidential Assessment and Monitoring of Voluntary Treatment through the Designated Peer Health Provider – at our May 19, 2021 meeting.
The goal of the new policy is to make it clear to our licensees that, yes, you can seek help and we encourage you to do it early. If you self-report and seek help from our peer assistance provider, your identity will be kept confidential, and you can get the help that you need without it needing to be disclosed to the board or any other licensing agency. It also tries to clarify, as specifically as possible, the circumstances when confidentiality might not be available, mostly revolving around if laws have been broken or patients have been harmed. The board feels that in those circumstances, given the requirements of the Medical Practice Act, the board needs to alerted.
CS: So what are the key things about this process and new policy that physicians should know?
DL: First, I’ll re-emphasize that even if a licensee is known to the board because of concerns about the safe practice of medicine, the board really tries hard to work with the licensee to create an avenue for return to safe practice. We recognize that the board's primary responsibility is public safety, as it should be, and that one of the ways to keep the public safe is to have access to care. The way that we can ensure access to care is to maintain the ability of our licensees to practice safely. So, when a licensee is struggling, we don't want to punish. We want to create an environment where that licensee maybe needs to step back from practice, but they're able to engage in a program of treatment and monitoring to ensure that they are able, at some point in the future, to return to safe practice.
In general, medical boards around the nation are seen as punitive and strict. It's important that that our licensees know that the Colorado Medical Board will make every effort to rehabilitate, to support and to help a physician return to safe practice, within reason, if we're able to do so.
Finally, I want to publicize the fact that there is now a policy in place ensuring confidential peer assistance and that our licensees should get help when they need it. Regardless of who may be our peer assistance provider in the future, because of this new policy, licensees will understand right from the get-go when they enroll in peer assistance what the conditions are and whether they qualify for confidential peer assistance. If our licensees feel like they are in need of support, whether due to a psychological problem, a medical problem, a substance abuse problem, a relationship problem, if they believe that there's any chance that their ability to practice safely may be in jeopardy, I encourage them to seek assistance through the peer assistance provider, knowing that in most circumstances, they can do so confidentially.
CS: That’s a good way to end this. Physicians can be patients too. In those instances, taking care of them appropriately, as this new policy provides, is critical so that they can get back to safely caring for their patients. Thank you, Dr. Lefkowits, for your commitment to patient safety, for your dedication to the profession and for your leadership on the board in tackling this issue.
DL: Thank you very much for having me. ■