A formal neutral assessment by a state physician health program could be one of the recommendations at this point. These assessments can be done at centers which specialize in assessing the disruptive physician.

The assessment consists of multidiscipline team and is designed to determine if any psychiatric disorders are at the base of this behavior, in particular chemical dependency and Axis II Cluster B personality disorders. A personality disorder is described as an enduring pattern of behavior that deviates markedly from the expectations of the individual’s culture. The characteristics are:

• Pervasive
• Onset in childhood or early adulthood
• Stable over time
• Inflexible
• Lead to distress or impairment

The Cluster B personality disorders particularly involved are:

• Narcissistic
• Borderline
• Histrionic
• Paranoid

Other psychiatric problems include:

• Bipolar - cyclothymic
• Major depression
• Dementia
• Schizoid personality - schizophrenia

If there is no change or recurrence of the unacceptable behavior, the next step is to go to a formal hearing held in careful adherence to the hospital and medical staff bylaws. Close consultation with the hospital and staff’s attorneys is vital at this stage as the most frequent cause for overturning a decision is failure to follow procedures as outlined in the bylaws. Care must be taken to adhere to the 14th amendment “due process” requirements.