Ethical dilemma: Dealing with an associate veterinarian's addiction

Dr. James Herse has owned a thriving small animal practice in suburbia for the last 18 years. He employs three veterinarians and a staff of 15. Office morale is high and there's little turnover. The staff member with the least tenure has worked at the practice for four years. The senior associate, Dr. Higgins, joined the practice 13 years ago.

Marc Rosenberg

Dr. Herse's practice has a reputation for excellent, compassionate veterinary care. He is the sole owner and believes the secret to his practice's success is rooted in his allegiance to his clients and staff. When his chief receptionist exceeded her personal day limits in order to assist a friend with a tragedy, Dr. Herse was supportive and did not penalize her. When one of his technicians needed a loan for a car, he helped her out.

And when Dr. Higgins was in a severe car accident, Dr. Herse tailored her schedule to accommodate her personal and medical needs. Dr. Herse's compassion and accommodation resulted in Dr. Higgins returning to work full time, although she continued to have lower back issues that prevented her from lifting patients.

Anita, the chief technician, is responsible for drug inventory, ordering and tracking. She mentioned to Dr. Herse that there was a tramadol discrepancy in her logs. In addition, the amount of Valium tablets on premises and tracked meticulously was not aligning with her usage and dispensing logs. Finally, Dr. Herse discovered that Dr. Higgins had prescribed Percocet for her dog's arthritis discomfort.

These findings initiated a conversation between Dr. Herse and his associate. Dr. Higgins admitted that her post-accident back pain had led to a full-blown addiction to painkillers. She resorted to taking and prescribing these medications from the practice without Dr. Herse's knowledge. The veterinarians mutually agreed that Dr. Higgins would seek the assistance of a substance abuse program for healthcare professionals. Fortunately, Dr. Higgins' insurance coverage included such assistance. She voluntarily notified the state veterinary board of her situation and accepted a temporary suspension of her license until an independent medical body declared she was no longer displaying addictive and destructive behavior.

Dr. Herse found himself at a crossroads. He respected Dr. Higgins as a veterinarian and a friend. He had worked alongside her for 13 years. Now he had to decide whether he would accept his colleague back into the practice when her rehabilitation was complete or discharge her for the admitted theft and deception. He strongly believes his primary obligation is to the practice, clients and employees. But he also thought that allowing Dr. Higgins to return to work after her rehabilitation would place her in an unacceptably tempting environment. The clinic had a pharmacy with controlled substances. Fighting addiction is a difficult struggle without the added temptation of controlled substances being easily available. With a heavy heart, Dr. Hearse informed Dr. Higgins that he would no longer employ her at his veterinary facility.

After successful rehabilitation, Dr. Higgins regained her license to practice and regretted that she could not return to her original place of work. Technically, Dr. Herse terminated Dr. Higgins for theft and deception. Dr. Herse believed he had to put the well-being of the practice before the needs of any one staff member. Did Dr. Herse deal with this ethical dilemma in the most appropriate way?

Dr. Rosenberg's response

Some of you may think Dr. Herse is being insensitive to his employee's addiction. After all, Dr. Higgins dealt with her problem responsibly and regained her right to practice veterinary medicine. When a valuable colleague makes a mistake and then works hard to overcome it, that colleague's work history and dedication to the practice should be taken into consideration before making decisions about whether to terminate that employee or not.

However, Dr. Herse has a valid point in that a drug-laden environment, such as a veterinary hospital, could be very tempting for someone trying to avoid contact with addictive substances.

It's not ethically inappropriate to retain Dr. Higgins or to discharge her. On one hand, Dr. Herse had an employee who stole from him. On the other hand, it's admirable to reach out to an employee who is fighting a battle with addiction. In my mind, the deciding factor was the practice owner's obligation to the health and well-being of his practice.

Note: All names presented in this column are fictitious.

Dr. Marc Rosenberg is director of the Voorhees Veterinary Center in Voorhees, N.J. He is a member of the New Jersey Board of Veterinary Medical Examiners.