Medical Directors

In substance abuse treatment centers, the medical director is responsible for overseeing all medical services delivered by a provider. Some of these responsibilities include developing and revising facility policies, implementing procedures that provide a means for the detection and referral of health problems, and oversight of both medical and non-medical personnel. Given the significance of these duties, a capable and qualified medical director is essential—not only to treatment center operations but also to the safety and welfare of its patients.

Legal Requirements for Facilities

Under Florida’s administrative rules governing substance abuse service providers, “[a] provider may not operate without a medical director on staff at any time”—the foregoing directive applying to only those facilities offering certain treatment components including detoxification, inpatient and residential treatment, and medication-assisted treatment for opioid addiction. Still, providers operating components that are not among those listed (e.g., outpatient treatment), must have “access to a physician through a written agreement who will be available to consult on any medical services required by individuals involved in those components.” Under the rules, these consulting physicians effectively take the place of a medical director and must adhere to all of the same requirements and restrictions. In other words, Florida law requires that all substance abuse treatment providers, regardless of the type of treatment offered, designate a health care professional to oversee and be responsible for medical services.

Necessary Qualifications and Responsibilities

Persons eligible for the position of medical director include health care practitioners that hold an active Florida license in the practice of either medicine or osteopathic medicine. Furthermore, the physician’s medical license must be free from any encumbrances, including suspension and non-renewal.

Not unlike other kinds of health care facilities, a medical director at a substance abuse treatment center can delegate many of his or her duties to other personnel. Vital functions in the overall care of patients, like consulting, diagnosing, and treating, can be performed by either a nurse practitioner or a physician assistant—depending on the type of activity. Ideally, the use of these “physician extenders” is meant to positively impact patients in a treatment facility: increasing the number of patients seen, expanding the services offered and improving overall patient satisfaction. Ultimately, however, the medical director maintains overall responsibility for the oversight of the physician extenders and even other physicians treating patients at a facility.

The Problem of “Absentee” Medical Directors

In some cases, although a treatment center will formally appoint and employ a properly credentialed physician as medical director, the appointee remains largely absent from the facility. Either through complete delegation of responsibility to a physician assistant or nurse practitioner or simply avoiding responsibilities altogether, some medical directors qualify as such in name only. For instance, a substance abuse treatment center might engage a physician for its medical director position in order to obtain initial licensure, then only require the director to come to the facility once every few weeks—if at all. In the meantime, virtually all of the medical director’s responsibilities are delegated to other practitioners or personnel in an effort to reduce facility operation costs.

Of course, the delegation of responsibilities to physician extenders and non-medical personnel can be beneficial and may even be necessary for some facilities to continue operation. However, implementing the use of personnel subordinate to the medical director is not meant to replace their existence entirely. This can lead to a critical breakdown in patient safety outcomes in substance abuse treatment facilities. Therefore, it is essential that a medical director actively review and oversee all medical services provided at each treatment facility.

Choosing a Treatment Provider

When researching treatment programs, either for oneself or a loved one, it is important to ensure the facility will provide proper medical care; this is especially true for those seeking treatment for co-occurring mental health disorders. In order to help facilitate admission to a medically appropriate facility, it is helpful to know some about the medical director—the person responsible for administering and overseeing medical services.

The Florida Department of Health’s website (http://www.floridahealth.gov/) is an excellent place to start when researching a facility’s medical director. Specifically, the “license lookup” tool allows users to ensure the validity of a practitioner’s license and view other information, including the existence of any disciplinary history.

Finally, before selecting a treatment program ask how often you will see a physician and when you will meet the Medical Director.

Susan Ramsey is both an attorney and a (retired) RN. Ms. Ramsey’s professional experience began as a Registered Nurse in the Intensive Care Unit at Yale New Haven Hospital. While pursuing her Bachelor’s Degree, she was a counselor with the New Haven Rape Crisis Program. During her time with the Program, Ms. Ramsey counseled sexual assault survivors and performed seminars for local police departments, universities, and high schools. During her time working as a registered nurse, Ms. Ramsey decided to attend law school. Ms. Ramsey graduated from CUNY Law School, and has practiced law in several different State and Federal Courts. She is a Florida Heath Care Risk Manager and a member of the Palm Beach County Sober Home Task Force. Susan is Pro Bono Counsel for the Florida Association of Recovery Residences.

Ms. Ramsey actively litigates cases involving catastrophic injuries and wrongful death on behalf of survivors, cases include injuries suffered by victims of professional product liability and medical negligence.