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

[mclanzi at aol.com]

Kathleen,

That is very helpful information.  Thanks.

Maria

Maria Lanzi, MS, MPH, ANP-BC



-----Original Message-----
From: Harriman, Kathleen (CDPH-CID-DCDC-IMM) (CDPH-CID-DCDC-IMM) <Kathleen.Harriman at cdph.ca.gov>
To: mcoh-eh <mcoh-eh at mylist.net>
Sent: Thu, Nov 12, 2015 3:10 pm
Subject: Re: [MCOH-EH] MCOH-EH Digest, Vol 250, Issue 158 [occ-env-med-l] Surgeons with seizure disorders


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 

-----Original
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Subject: MCOH-EH Digest, Vol 250, Issue 158

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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)


----------------------------------------------------------------------

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>
	
Content-Type:
text/plain; charset=US-ASCII


I am out of the office from Wed 11/11/2015
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I will respond to your message when I
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