School of Medicine Substance Abuse Policy and Procedure

The UC Davis School of Medicine strives to provide a safe and healthy learning and work environment for our medical students.  Additionally, School of Medicine faculty and students must also ensure the safety, health and welfare of the patients who are served by the University of California Davis Health System.

In any situation where student responsibility for patients is required, or may be required, the student may never risk patient welfare by acting under the influence of drugs, including alcohol. Of particular concern is the unauthorized use of drugs to which the student may have privileged access. Such drug misuse is a violation of societal trust and is viewed by the profession as an especially grave offense. The student who endangers patients or others through the use of alcohol or drugs, or who violates the trust of the special position granted to him/her, is subject to disciplinary action through the School of Medicine, independent of any action which may be taken by other authorities. Students who use drugs that produce physical dependence or students who excessively use alcohol may have associated, serious psychological problems requiring additional consultation.

The UC Davis School of Medicine is unequivocally opposed to substance abuse and prohibits the abuse, unlawful possession, distribution and illegal use of drugs and/or alcohol by students. This policy is intended to delineate disciplinary sanctions that the School of Medicine may impose on students who are suspected, or accused of, being under the influence of alcohol or illegal substances.

We recognize that medical students may bring with them, or develop, alcohol and other psychoactive drug use patterns and behaviors that may be diagnosed as abuse or dependence. The School of Medicine is committed to a program that will assist impaired students in regaining their health while protecting the well-being of patients as well as classmates, faculty, staff, residents, and fellows.

A. Routine alcohol and drug testing:  A critical part of medical education involves learning experiences in hospitals and other health care facilities. Use of these facilities in training is essential, and students must be able to complete their assigned rotations. Many hospitals and health care facilities have policies requiring drug testing and/or criminal background checks for employees, students and volunteers. Facilities that provide instruction to School of Medicine students may have, or may adopt in the future, drug testing and/or criminal background check policies. Some facilities mandate that students who test positive for drugs, or who have certain types of information in their criminal background checks, are ineligible to work in their facility.

Students who test positive on a routine drug test will be referred to the Associate Dean, Student Affairs (ADSA),^1,2 who will review their test results.  If a student refuses evaluation or consent to share the results of this evaluation, he/she may be subject to disciplinary procedures including eligibility of recommendation for dismissal.

Any questions or concerns about routine drug testing may be shared confidentially with the ADSA or the Associate Dean, Student Wellness (ADSW).

B. For cause testing To ensure compliance with institutional policies and to promote a safe and healthy work environment, the School of Medicine may require students to submit to drug and/or alcohol testing “for cause” based upon reasonable suspicion of substance abuse, b) the unauthorized use or possession of alcohol on campus or at a health care setting or c) the use of or possession of illicit drugs at any time. Reasonable suspicion of substance abuse may be based upon, but is not limited to, the following criteria:

1. Direct observation of drugs or alcohol use or possession and /or demonstration of physical symptoms of the influence of drugs or alcohol
2. A pattern of abnormal or erratic behavior, consistent with alcohol or drug abuse
3. Arrest or conviction for a drug or alcohol related offense; identification as the focus of a criminal investigation into illicit drug use, possession or trafficking
4. Evidence that a student has tampered with a previous drug or alcohol test
5. Possession of drug paraphernalia

Reporting persons must contact the ADSA and should document the exact reason why they suspect a violation (form available but not required).  Every effort should be made to document the behavior and how the behavior is affecting the student’s performance.  The reporting person should make every effort to document the specific facts that would lead a reasonable person to the conclusion that the student was using or was in possession of illicit drugs or unauthorized alcohol. Whenever possible, corroborating statements from other administrators, faculty, employees, or students as well as patients should be obtained.

If, in the judgment of the Committee on Student Promotions (CSP), a student is perceived to have had academic or professional difficulties arising from suspected drug and/or alcohol use, the CSP can vote to require drug testing for the student. In such instances, the report would come back to the ADSA and to CSP.

While awaiting definition of the facts of an alleged or established violation and of its significance, the ADSA must notify the student of the charges.

If in the judgment of the ADSA the student represents a clear and present danger to self or to others, the Associate Dean may take immediate steps to suspend the student. He/she may also take additional steps that, in his/her judgment may be necessary to minimize hazards to the student or to others, including securing emergency professional assistance.

1. Procedure: When determination to test for cause has been made, the student will be given instructions on how to obtain his/her drug screening³ for collection of urine sample to test for drugs and/or alcohol. Testing cost will be borne by the SOM. Testing will be done according to standard procedure for these settings.
   
   1. The School will direct the Drug Screening Report to be sent to the ADSA (and Chair of the CSP should the CSP mandate the drug/alcohol screening). Prior to making a final decision to confirm a positive test, the student will have the opportunity to discuss the test results and provide any documentation for a legitimate medical explanation for the positive test result.
2. Appeal and Retesting: Positive tests may be appealed by submitting a written request to the ADSA (and Chair of the CSP should CSP have mandated the screening) within three (3) business days after being informed of the positive test results. The student has the right to have a second test performed on the original specimen for qualitative presence only at a certified laboratory of his/her choice and all expenses of such retest will be the responsibility of the student.  The specimen transfer between laboratories will follow standard protocol.
3. Disciplinary/Actions: Any student who fails an alcohol or drug test will be subject to disciplinary sanctions and a disciplinary hearing before the Committee on Student Promotions (CSP). These sanctions could result in dismissal. An individual’s participation in, and successful completion of, an approved drug or alcohol counseling program coupled with his/her consent to random testing may be considered in the disciplinary process but does not ensure that dismissal will not occur.
   
   1. Any student who is given the option to participate in a rehabilitation program⁴will comply with the treatment and rehab requirements set forth below:
      
      1. Satisfactorily participate in a substance abuse assistance program or rehabilitation program approved by the ADSA for this purpose.
      2. Provide evidence satisfactory to the ADSA of continued outpatient therapy in an approved program appropriate to the treatment recommendation.
      3. Remain substance free after completing a rehabilitation program for chemical dependency and participate in random drug screening during rehabilitation and for the duration of their medical education at the School of Medicine.
      4. Failure to comply with these requirements may result in recommendation for dismissal.
4. Refusal to Consent to Testing: Any student who refuses to consent to an alcohol or drug test for cause or fails to provide an adequate specimen will be subject to discipline (as per c. above), up to and including recommendation for dismissal.
5. Confidentiality: Every effort will be made to keep the results of alcohol and drug testing confidential. Students should be aware that test results may be used for administrative hearings and court cases and may be sent to state and /or federal agencies as required by applicable law.⁵

The administration and faculty wish to assist students before they develop academic or legal problems related to alcohol and drugs.⁶ When a student is self-referred for treatment or counseling, no official report is made unless specific permission is granted by the student. Patient-physician confidentiality is carefully guarded. Students who wish to receive assistance may be referred to non-UC Davis affiliated providers by the Associate Dean, Student Wellness, the Sr. Associate Dean, Medical Education (SADME), the Associate Dean, Student Affairs, or by individual faculty members. Students should also be aware that the California Medical Association-sponsored "Physicians' Confidential Assistance Line" (213) 383-2691, a service for help with drug dependence or alcoholism, is available to them.⁷

The School of Medicine encourages students who have developed substance abuse problems to voluntarily identify themselves and to seek immediate treatment.

1. A student who voluntarily self-identifies as an abuser may be permitted to continue his/her current course of study without suspension, provided:
   
   1. This self-identification occurs PRIOR to any incident that is grounds for suspension or dismissal under institutional policy.
   2. The student immediately enters an approved treatment program⁸ for the drug or alcohol abuse.
   3. The student’s conduct and academic performance remain consistent with the demands of the curriculum and profession.
2. A student who voluntarily self-identifies as an abuser and who, by his /her own admission, by the testimony of approved abuse counselors, or by the determination of institutional authority is no longer capable of acceptable academic and professional conduct will be required to take a medical leave of absence from the School of Medicine.  Nothing in this paragraph will preclude the School of Medicine from suspending, dismissing or taking other appropriate action against the student for unacceptable academic performance or lack of professional conduct.

Students must notify the SOM of any drug or alcohol related arrests or convictions within ten (10) working days after charge of an offense. Failure to do so and subsequent notification during a required background check may result in disciplinary action including dismissal

References and Related Policies

1. UC Office of the President:  P & Section 380-18 8/22/12 (above)
   
   1. University of California Policy on Substance Abuse (http://www.ucop.edu/ucophome/coordrev/policy/11-01-90.html).
   2. Implementing Guidelines for the University of California Policy for Substance Abuse (http://www.ucop.edu/ucophome/coordrev/policy/12-10-90guide.html).
2. UC Davis Administration of Student Discipline (http://sja.ucdavis.edu/disciplinary-process.html).
3. UC Davis Policy & Procedure Manual (http://manuals.ucdavis.edu)
   
   1. Section 270-21, Sales, Service and Consumption of Alcoholic Beverages.
   2. Section 290-70, Controlled Substances. 
   3. Section 380-22, Drug and Alcohol Testing of Transportation Employees. 
   4. Section 390-30, Disruptive Behavior in the Workplace.
4. University of California Davis, Medical Center, Medical Staff Administration Policy 128--Impaired http://www.ucdmc.ucdavis.edu/medstaffwellbeing/pdf/impaired_medical_staff_12-09.pdf (PDF).
5. UC Davis Health System Resident Medical Staff (Resident Physicians & Clinical Fellows) Personnel Policy,    Policy 501.Physical Impairment and Substance Abuse. http://www.ucdmc.ucdavis.edu/hr/hrdepts/resident_program/rmsppm.pdf (PDF) 
6. United States Code (http://www4.law.cornell.edu/uscode/ 
   1. Drug-Free Schools and Communities Act, 20 U.S. Code 1011i. 
   2. Drug-Free Workplace Act, 41 U.S. Code Sections 701-707
   3. Schedule of Controlled Substances Act, 21 U.S. Code Section 812. 
7. Code of Federal Regulations (http://www.access.gpo.gov/nara/cfr/): 
   1. Drug and Alcohol Abuse Prevention Regulations, 34 CFR Part 86. 
   2. Drug-Free Workplace Requirements, 41 CFR Section 105-68.600 et seq. 
   3. Schedules of Controlled Substances, 21 CFR Part 1308. 
   4. Confidentiality of Alcohol and Drug Abuse Patient Records, 42 CFR Part 2
8. California law
   
   1. Drug-Free Workplace Act, Government Code Section 8350-8357. 
   2. Uniform Controlled Substances Act, Health and Safety Code Section 11000 et seq.

NOTE:  This policy was adapted from the medical school substance abuse policies of Texas A&M & UC San Diego.

_{¹CSP meeting 9/25/2013
²AAMC recommends that the Office of Student Affairs be responsible for Substance Abuse policies (https://www.aamc.org/download/46336/data/part5.pdf)
³Drug screening must be completed within 1 business day.
⁴Any rehabilitation program expense is the sole obligation of the medical student.
⁵If, for example, a student is prosecuted separately by a site.
⁶Problems, such as: arrest, usage on campus property, or intoxication in the classroom or health care setting.
⁷This sentence is from the UCSD policy.
⁸At his/her own expense.}