Does returning a recovered addicted physician to active anesthesiology practice do more harm than good?

Abstract

Dr. Edwards was a gifted anesthesiologist. He graduated top of his medical school, and after completing his residency at a major academic center, he stayed on in the department as a junior attending. He was well liked at work; often taking on extra-shifts and offering to give breaks. However, unbeknownst to others, he had become addicted to fentanyl. He started to have mood swings and explosive episodes of anger. Over time, Dr. Edwards would go to increasingly incredulous lengths to obtain his drug of choice. Occasionally, a colleague might become suspicious after Dr. Edward’s patient reported a large amount of pain in the recovery room despite liberal narcotic use documented on the patient’s chart. Finally, during one shift, Dr. Edwards was discovered rummaging through a sharps container for unused narcotic. He admitted to other troubling behaviors such as replacing narcotics intended for patients with saline or esmolol and to using up to 1000 µg of fentanyl in a single injection to relieve his withdrawal symptoms.