When an Employee or Coworker Is Under the Influence: A Guide for Healthcare Professionals

If you suspect a coworker or employee is under the influence at work, what are your options? For healthcare professionals, addressing these situations requires balancing ethical obligations, legal responsibilities, and patient safety. Here’s how to proceed.

Learning that your employee or coworker may be under the influence at work can be alarming. It might feel easier to ignore the issue or hope someone else will handle it, but healthcare professionals have ethical and legal duties that require taking action. Knowing the right steps can help protect your patients, your practice, and your team.

Understanding Your Ethical and Legal Obligations

If your employee or coworker is under the influence at work, patient safety is likely your first concern. Impaired clinicians have harmed patients and, in some cases, faced felony prosecution as a result. 

While you may worry about damaging a colleague’s career, addressing the issue early may actually help preserve it, especially if the situation is resolved before it results in patient harm. For example, many state professional boards, such as the Illinois Department of Financial and Professional Regulation, provide programs like the  “Care, Counseling, & Treatment Agreement.”  Under such agreements, healthcare providers who self-report can seek treatment without automatically risking licensure loss, as long as they comply with treatment requirements.

If the employee or coworker is unwilling to self-report, your awareness of impairment may obligate you to report dangerous and inappropriate behavior. Some state practice acts mandate reporting impairment to the appropriate professional authority, and some states offer anonymous options for making reports. Reporting rules are highly state-specific, so check with your professional board and review applicable state laws to understand your responsibilities and the consequences of inaction.

Ultimately, if a licensed healthcare professional places patients in unsafe situations by being under the influence, it’s crucial to take action before patient harm occurs.

Internal Guidelines for Addressing Substance Use in the Workplace

Identifying substance use in the workplace can be uncomfortable and often places employees in difficult positions. If a peer suspects a coworker may be under the influence, they might feel conflicted—unsure whether to approach the individual first, report the situation, or avoid involvement. As we’ve discussed, turning a blind eye is not an acceptable solution. However, a direct confrontation may not be helpful. Instead, the peer should enlist the help of higher-ups to determine the next steps.

For supervisors, the responsibility often requires a more direct approach. Before taking action, supervisors should thoroughly review the policies in the employee handbook to address the situation in line with organizational guidelines. If an employee appears impaired, a private, respectful conversation can open the door to discussing professional obligations, encouraging self-reporting, and offering resources for support. 

Building a Drug- and Alcohol-Free Workplace Policy

Clear, established policies and an employee handbook are crucial for handling such situations with consistency and professionalism. If your organization doesn’t have formal guidelines on addressing substance use, consider establishing them to ensure that all team members know their obligations and available resources.

For more information on the purpose and importance of an employee handbook, see our video, “Do You Really Need an Employee Handbook for Your Independent Healthcare Practice?”

To prevent situations where employees are coming to work intoxicated or under the influence, also ensure the practice has clear policies supporting a drug- and alcohol-free environment. Educate employees on these policies, and incorporate training on:

• The dangers of drug and alcohol abuse in the healthcare setting
• How to recognize the signs and symptoms of drug and alcohol abuse
• Reporting procedures
• Available treatment options

Training and education communicate your expectations for a safe, professional workplace and provide a framework for handling breaches of your policies. Establishing robust policies not only safeguards your practice but also reinforces the trust that patients place in their providers.

Can You Terminate an Employee For Being Intoxicated or Under the Influence At Work?

If you’re an employer, dealing with an impaired employee might lead you to consider termination. But can you legally fire this employee? Do you need to give notice?

Supervisors can consult the employee’s employment contract to determine whether the conduct violates specific terms that would subject the employee to disciplinary action or termination. For example, an employment contract may allow for immediate termination when an employee is intoxicated, under the influence, or otherwise unable to perform their duties properly.

But what if such language is not explicitly written in the employee’s contract? If you’re in an at-will employment state, you may still be able to terminate at any time and without cause, explanation, or prior warning. However, before proceeding with termination, check state employment laws and consult an attorney to ensure compliance.

See our related blogs: “Why Use an Employment Contract?” and “Which Employees of a Healthcare Practice Should Be Covered By Employment Contracts?”

The Importance of Documentation

Even if you are uncertain about possible intoxication or substance abuse, thorough documentation is essential. Record specific instances where the employee appeared to be under the influence, as well as any conversations you’ve had with the employee or coworker about their behavior. Detailed notes can provide valuable support if you need to make a report, helping to protect yourself, the practice, and your patients.

Get Legal Support

Before a critical situation arises,  it’s essential to understand your options, your obligations, and the steps to help an impaired employee or coworker. A knowledgeable healthcare attorney can guide you through your state’s laws, clarify your responsibilities, and assist in crafting policies that align with your practice’s goals and legal requirements.

Reach out to Jackson LLP Healthcare Lawyers to learn more. If you operate in one of the states where we have licensed attorneys, we can help you develop employment contracts, staff policies, and employee handbooks appropriate for your practice. We offer a free consultation to help you determine if we’re a good fit.

This blog is made for educational purposes and is not intended to be specific legal advice to any particular person. It does not create an attorney-client relationship between our firm and the reader and should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.