[MCOH-EH] MCOH-EH Digest, Vol 250, Issue 158 [occ-env-med-l] Surgeons with seizure disorders

[Harriman, Kathleen (CDPH-CID-DCDC-IMM)]

In Minnesota there is a state law requiring that licensed HCP with HIV, HBV or HCV be evaluated by the Minnesota Department of Health. In instances where it is complicated to evaluate the professional practice of an infected HCP to determine whether any restrictions on practice are necessary, MDH consults practitioners in the same field (typically from another geographic region so there aren't concerns about competing practices, etc.). Perhaps something like this would be reasonable for a surgeon with a seizure disorder as peers are likely in the best position to assess the issues that might arise. 

Kathleen Harriman
California Department of Health
Richmond, CA 

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Today's Topics:

   1. Re:  [occ-env-med-l] Surgeons with seizure disorders
      (Buchta, William G., M.D.)
   2.  AUTO: Kim Mccracken is out of the office. (returning Fri
      11/13/2015) (KMccracken at mcleodhealth.org)


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Message: 1
Date: Thu, 12 Nov 2015 03:30:48 +0000
From: "Buchta, William G., M.D." <Buchta.William at mayo.edu>
To: "Orford, Robert R., M.D." <rorford at mayo.edu>,
	"occ-env-med-l at listserv.unc.edu" <occ-env-med-l at listserv.unc.edu>
Cc: MCOH/EH <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] [occ-env-med-l] Surgeons with seizure disorders
Message-ID: <c10f8b$1rci51 at ironport10.mayo.edu>
Content-Type: text/plain; charset="utf-8"

If occ docs can?t make the most erudite evaluation of a surgeon?s fitness to return to work, then who can?  The liability insurer, as Tee suggests?  Even that should not play into our conclusion based on a risk assessment.  To answer Gary?s original question, it might seem incongruous to allow a surgeons to ply their trade in the deep recesses of an abdomen when they are not even allowed to drive a mini-Cooper a mile to work.  I can understand that even though it may be overly conservative.
However, compared to a pilot or truck driver, a surgeon never works alone, at least in a bona fide surgical suite, and a lot of what they do is outside the gloves and gown.  Frankly, I would be more concerned about the cognitive blunting from his/her anti-seizure medication than I would be of a brief seizure.   There is always the option of medical restrictions:   back up at all times while in the surgical suite, clinic duties only with no surgical or on-call duties, avoidance of certain types of delicate surgery (vascular, eye, neuro, etc.).
Surely there are general principles, but each case should stand on its own merits.

My thoughts,

Bill Buchta
Rochester, MN

From: Orford, Robert R., M.D.
Sent: Wednesday, October 14, 2015 11:00 PM
To: occ-env-med-l at listserv.unc.edu
Cc: MCOH/EH
Subject: Re: [MCOH-EH] [occ-env-med-l] Surgeons with seizure disorders

By chance, the very next email I looked at after this one was ?Why Docs Won't Take Sick Time? http://www.hcplive.com/conference-coverage/idweek-2015/why-docs-wont-take-sick-time?utm_source=Informz&utm_medium=HCPLive&utm_campaign=Trending_News_10-14-15  As physicians, we are both the gatekeepers and the drivers of the sickness absence and fitness for duty systems. This makes it difficult for us to make decisions if the illness or injury affects us or a member of our own profession. There is fairly clear guidance on seizures in other safety sensitive positions (pilots, truck drivers etc.) and I think this guidance can be applied to surgeons and other safety sensitive positions in health care.

I don?t see that this post has been cross-posted to the MCOH List, so I will do so since this is a topic of mutual interest and MCOH members will undoubtedly have both opinions and experience with similar cases.

Bob Orford
Scottsdale, AZ

From: bounce-36805482-6838936 at listserv.unc.edu<mailto:bounce-36805482-6838936 at listserv.unc.edu> [mailto:bounce-36805482-6838936 at listserv.unc.edu] On Behalf Of Tee Guidotti
Sent: Wednesday, October 14, 2015 2:37 PM
To: Orford, Robert R., M.D.
Subject: Re: [occ-env-med-l] Surgeons with seizure disorders

I agree with individualizing the evaluation and guidance. This may not be as alarming as it sounds if the surgeon has a reliable aura well in advance, if the seizure is absence, if there is backup, and he or she is not doing major surgery. Then again, I would not want to have to explain a misadventure to a patient's family under the circumstances of an unpredictable Jacksonian  seizure disorder.

The other side of this is the liability issue. Regardless of the fitness for duty and accommodation aspect of what is obviously a safety-sensitive position, would the liability insurance carrier and loss control accept this?

TLG

TLG

On Wed, Oct 14, 2015 at 4:04 PM, Upfal, Mark <mupfal at dmc.org<mailto:mupfal at dmc.org>> wrote:
Does anyone have any experience or know of any literature regarding surgeons with seizure disorders, and guidelines for returning to work/operating?

Has anyone seen the situation in which a surgeon must have someone else drive him/her to work due to a state reguation based driving restriction, but continues to operate?

How long should a surgeon be seizure-free before operating?



Mark Upfal, MD, MPH
Corp Medical Director, DMC Occupational Health Services
4201 Saint Antoine, UHC 4G-3
Detroit, MI 48201
(313) 993-0509
www.dmc.org/ohs<http://www.dmc.org/ohs>

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Message: 2
Date: Thu, 12 Nov 2015 04:00:59 -0500
From: KMccracken at mcleodhealth.org
To: MCOH/EH <mcoh-eh at mylist.net>
Subject: [MCOH-EH] AUTO: Kim Mccracken is out of the office.
	(returning Fri	11/13/2015)
Message-ID:
	<OF0CF4DAC9.8BC2C0C2-ON85257EFB.003187AD-85257EFB.003187AD at mcleodhealth.org>
	
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I am out of the office from Wed 11/11/2015 until Fri 11/13/2015.

I will respond to your message when I return.


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End of MCOH-EH Digest, Vol 250, Issue 158
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