Five Things You Need to Know Before Talking to PRN

Monida Felder Rodriguez

The decision to contact PRN (Professional Resource Network), and to undergo an evaluation through PRN is not just a costly one, but one that can lead to years of monitoring for drug or alcohol use, required changes to established medications, polygraph examinations, and potentially loss of your healthcare license. While it is the right decision for some licensees, and may in some cases be the only way to avoid action against your license, many of the people who have been evaluated, sent to treatment, and who signed monitoring contracts with PRN could have avoided it altogether. This article is intended to provide some information about this program so you know what may happen once that call to PRN is made. Note that all the information below is based on the personal experiences of the author, and represent her opinions based on her experiences with PRN. PRN disagrees with many of the statements made below.

The Professional Resource Network (PRN) is the designated impaired practitioner consultant for a number of healthcare professionals (other than nurses, who are handled by a similar agency, the Intervention Project for Nurses). Thus, any time there is an allegation of impairment made against a health care provider, he (or she) is typically referred to PRN for an evaluation. Similarly, if an applicant for a health care license has had any prior issues with impairment, has a recent DUI, or has indicated they have undergone any type of treatment for mental health or substance abuse, he is advised to get an evaluation through PRN.

In addition, PRN has reached out to all the medical schools and many hospitals, giving presentations regarding their services, and has encouraged these facilities to refer anyone with various issues to them, including not just substance abuse, but also sexual boundary issues, and disruptive behavior. As a result, we have seen more hospitals requiring physicians to self-report to PRN for an evaluation for issues that normally would be handled internally at the hospital.

1) PRN has a number of financial relationships that some believe may affect their recommendations.

PRN receives almost all of its funding from the Department of Health (DOH) for serving as its consultant. Pursuant to its most recent contracts with the DOH, PRN is to be paid several million dollars for its services each year. In return, PRN must have at least 500 participants in the program. If it has fewer participants, it is paid less under the contract. Thus, PRN has an incentive to keep participants in the program for as long as possible. In the past, monitoring contracts were for a period of two years (some with release after a year of compliance) for a diagnosis of substance abuse, and for five years for a diagnosis of dependency. Current contracts all appear to be for a period of at least five years, and include provisions that state that PRN can extend the contract at their discretion, if they feel it is warranted. No rationale for extending the length of the contracts has been given. It is clear that PRN has a strong financial incentive to keep as many participants (at least 500) in the program at all times, and that may be affecting how long participants are kept in the program. In addition, PRN’s Assistant Medical Director, Martha Brown, M.D., is an Associate Professor at the UF collect of Medicine’s Department of Psychiatry and the Addiction Medicine Group and Florida Recovery Center (FRC) (from PRN”s website). Many licensees who contact PRN are referred to the University of Florida for evaluations or treatment. These evaluations and the inpatient or outpatient treatment that is often required after an evaluation are typically not covered by insurance, and the cost is typically around $1,500.00 - $2,000.00 for an evaluation, and can be $25,000.00/month or more for inpatient treatment (which often lasts for 90 days). Accordingly, every time PRN refers a person to the University of Florida for a costly evaluation, they are referring them to the very institution in which PRN’s Assistant Medical Director serves as an associate professor. The relationship between UF and Dr. Brown is not disclosed to people who are referred there.

2) Failing to comply with PRN’s demands once a contract is signed is essentially an automatic disciplinary violation.

A number of years ago, if someone voluntarily signed a monitoring contract with PRN, and they decided they no longer needed monitoring after a period of time, they could decide not to continue to be monitored and leave PRN. In that situation, PRN would send a letter to the healthcare practitioner’s Board notifying them the licensee was no longer in compliance with his contract. The Board would investigate, and close the case if there was no evidence showing the licensee was currently unable to practice with skill and safety. PRN was not happy about practitioners quitting its program without consequence, and requested a change to the disciplinary statutes so that a participant could be disciplined for failing to comply with the terms of their monitoring contract (without good cause), whether they continued to be impaired or not. That change was made, and the new disciplinary language, coupled with the current language in PRN’s contracts that allows them to extend the term of the contract at will, essentially forces participants to remain in PRN for years, regardless of whether they truly need it. Furthermore, there is no way to get an opinion outside of PRN as to the necessity of their services – if they decide you need to stay, you are basically stuck, or risk disciplinary action against your license.

3) An evaluation through a provider associated with PRN is not an evaluation by an independent provider free to make recommendations they deem appropriate.

PRN only uses people to perform evaluations who are willing to work within their requirements. They will not accept an evaluation by anyone they do not associate with, no matter how stellar their reputation. Providers are trained by PRN at an annual meeting they are required to attend every year. Any provider who refuses to make recommendations as mandated by PRN is essentially fired. Refusal to go along with PRN’s desires when writing an evaluation can result in a significant loss of income for these providers, who not only perform evaluations, but often also provide treatment for participants. As these evaluations are not covered by insurance, those remaining evaluators who agree to do as PRN says get a substantial amount of business from PRN referrals. It is not surprising that almost no evaluations come back saying a practitioner is safe to practice without PRN monitoring.

4) If PRN feels you violated the contract, you will be required to undergo another evaluation and possibly additional inpatient treatment, even if PRN is in error.

For example, if after signing your contract, you decide to commit to healthy eating and exercise, and drink 8 glasses of water as recommended, there is a possibility that your drug test result may be invalidated for low creatinine. If that happens more than once, you may be referred for another evaluation to determine whether you are really trying to hide a positive test result.

Likewise, if you miss a drug test because you would lose your job if you left one more time to get a drug test (they typically require tests 48 times the first year of a contract), you could be required to undergo another evaluation. You absolutely will be required to have another evaluation if you ever have a positive test for alcohol or drugs. There is essentially no way to meaningfully contest PRN’s decision to require another evaluation or more treatment, even if you have shown absolutely no sign of being impaired.

5) There are some medications PRN does not like, and will not allow you to take if you want to continue working, whether they are effective for you or not.

Even if you have been taking a certain medication for years, do not abuse it, and need it, PRN feels that certain medications can potentially be a problem, and will not allow you to continue taking them once you are under contract with them. Those medications include any types of stimulants, as well as other types of medications that would result in a positive drug test. If a medication contains alcohol, that is generally also not permitted. Participants have been told they had to stop taking certain kinds of prescribed medications or stop working, even if informed by the participant’s physicians they need to continue taking the medication.

As you can see, the decision to contact PRN should be carefully considered. Once you call them, if you decide not to get evaluated, or do not comply with their requests, they will report you to the Department of Health. Often, at that point, the DOH does not have enough to file charges against a licensee. However, if you go get an evaluation, and the evaluator states that he believes you are currently impaired, it is much more difficult to convince DOH to close the case. For all these reasons, we strongly recommend that you contact an attorney with experience dealing with PRN prior to contacting them or prior to getting an evaluation. Feel free to contact our office for a free phone consultation to discuss any issues you may be having with PRN.

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