What Happens When Surgeons Abuse Alcohol?

It is likely that some of the approximately 428,500 doctors in Germany have addiction. They conduct patient consultations, perform surgeries, respond to emergency ambulance calls, and administer anesthesia. Accordingly, the medical associations frequently become aware that one of their members may have a dependency disorder. They respond with assistance and, depending on the case, with sanctions.

An Austrian Surgeon

An ongoing case in Austria highlights the challenges that arise in such situations. Despite having a blood alcohol level of 0.126 g/dL, a surgeon in Salzburg operated on three patients. Some colleagues apparently were aware of his condition, but the patients were unaware. Because there was no concrete evidence of endangerment, the Salzburg Public Prosecutor’s Office has already closed the investigation against the surgeon. “There were no complications, no errors in the operation,” Ricarda Eder, the office’s spokesperson, told the news publication Heute.

The surgeon’s intoxication became known by chance. Before arriving at the hospital, the surgeon was involved in an accident with a cyclist. A police check revealed a blood alcohol level of 0.126 g/dL, leading the surgeon to surrender his car keys and driver’s license.

The case is now in the hands of the Salzburg Medical Association, and an investigation is ongoing. When the news publication Salzburg Nachrichten (SN) first reported on the case at the end of August, the association’s president, Karl Forstner, was unaware of the incident and reacted with surprise. Typically, the association would be informed if the public prosecutor’s office was investigating a physician. Moreover, lawyers usually report such incidents to the medical association.

“Operating in an intoxicated state is fundamentally unacceptable, regardless of whether something happens or not,” Forstner told the SN. A doctor should not perform any actions if they cannot fully utilize their competence. “I also expect a colleague to say, for example, after a strenuous night shift: ‘I am not fit enough for the operating room’.”

A German Surgeon

Heavily intoxicated, with a blood alcohol level of 0.229 g/dL and with uncoordinated movements, a surgeon began performing an emergency appendectomy until his team intervened. Now, the Osnabrück District Court has sentenced him to 9 months’ probation.

The 56-year-old surgeon had appealed against a previous ruling by the Osnabrück District Court, which had sentenced him to 10 months’ probation. The surgeon’s lawyer argued that it could only be considered as negligent bodily harm. He referred to the patient’s consent for the operation and the principle that patients usually do not choose their surgeon.

The court did not agree. As a patient, one must be able to trust that the operating surgeon is not under the influence of alcohol, said the presiding judge. “No one would allow themselves to be operated on by a drunken surgeon.”

Partly because in the appeal hearing, the surgeon finally apologized to the patient, the court reduced the sentence by 1 month. The lawyer also promised to pay a compensation of €3000. The hospital had separated from the surgeon after the incident and filed a report.

Obligation to Report

“Overall, medical associations learn about criminal proceedings against their members through the so-called Notification in Criminal Matters (MiStra),” explained Tobias Langenbach, spokesperson for the State Medical Association of Baden-Württemberg, Germany. The obligation to report for members of healthcare professions involved in criminal offenses is regulated under MiStra No. 26.

In case of a justified suspicion of a breach of professional ethics by a member, the lawyers of the district medical association may initiate disciplinary proceedings (§ 20 Disciplinary Court Rules), Langenbach explained. The association’s lawyers review violations of the professional code. They conduct investigations and assess whether the suspicion of a professional misconduct by the physician can be confirmed. If so, they are responsible for prosecuting before the relevant disciplinary court.

If there is a suspicion of a criminal offense, cases may also be handed over to the public prosecutor’s office by the association. The professional judicial process is then suspended until the criminal investigations are completed.

An association will not always resume a professional judicial process after the completion of criminal investigations. For example, if the member in question has an obvious addiction disorder that led to the misconduct, the association may, in consultation with the member, try to integrate them into an addiction intervention program to “help instead of punish,” said Langenbach. The goal is to enable the member to lead a life free from addiction in the future.

Assistance and Sanctions

State medical associations may need to take punitive measures, such as when a doctor treats patients while under the influence of drugs. Graduated sanctioning options range from a reprimand to a warning to a fine. At the end of the escalation scale is a determination of unworthiness to practice the medical profession, which is issued by the professional court.

If there is a suspicion that the doctor is no longer medically fit to practice, the chamber is obliged to report this suspicion to the licensure authority. It is then the responsibility of the authority to decide between the right to professional freedom and patient protection and to decide whether a dependency disorder necessitates a suspension or even revocation of the license.

The judiciary has clearly established that a zero-tolerance policy applies to alcohol at work for medical practice. Even if the physician is inconspicuous in their work, the license may be revoked in case of a confirmed addiction disorder, as any risk to patients’ well-being must be avoided.

For the decision of the licensure authority, the so-called “post-offense behavior” is crucial, according to the North Rhine Medical Association. If a physician decides to participate in an intervention program or a similar program and can demonstrate their abstinence over an extended period, this often plays a significant role in the assessment by the licensure authority.

High Addiction Risk

Medical associations assume that doctors are more prone to addiction than other professional groups. Time pressure, above-average workloads, and increased patient expectations play a role. In addition, the high level of responsibility, fear of making medical errors, and the increase in administrative tasks also contribute to the problem.

The data on the frequency of addiction disorders among doctors in Germany are poor, however. The prevalence of addiction disorder in the general population is around 3%-4.5%, and these figures can be extrapolated to the medical profession.

An online survey conducted by researchers at the Klinikum rechts der Isar at the Technical University of Munich, Munich, Germany, in 2018 found that a significant portion of physicians exhibit problematic drinking behavior. Approximately 23% of doctors in Germany consume dangerous amounts of alcohol. Risk factors include being childless, long working hours, working in surgical fields, and specifically for women, the position of a resident physician.

Alcohol is the most common substance leading to addiction, with about 70% of addiction disorders among physicians being alcohol-induced. Dr Siegmund Drexler, drug and addiction officer of the Hessen Medical Association, and colleagues pointed out in the German Medical Journal that the rate of medication addiction in the medical profession is suspected to be higher than in the general population. Case reports indicate a specific vulnerability.

The taboo surrounding addiction disorders in the medical profession remains strong. According to the medical associations, early intervention is crucial. In Baden-Württemberg, more than 10 years ago, this led to the establishment of the Physicians’ Health Commissions at the district medical chambers and the development and adoption of an intervention program for addicted physicians at the state level under the motto “Help before punishment.”

The structured intervention program offered by the Hamburg Medical Association for over 20 years, based on clarification, therapy, and aftercare, served as a model.

The Federal Medical Association has listed all intervention programs offered by the state medical chambers.

This story was translated from the Medscape German edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.