How to handle substance abuse in a colleague. (Never Confront the Person Alone).

Last year, Dr. Dana Ware was stunned when a fellow physician arrived for work clearly impaired.

"If he came into the ER as a patient, you would say, 'this person is under the influence of something,'" recalled Dr. Ware, a family physician at Seneca District Hospital, Chester, Calif. "He was so high. His eyes were glazed, and he was staring off."

With the hospital's administrator and director of nursing present, she told him, "I have to relieve you of your duty."

He staggered around, sat down, and said, "I'm shocked."

"So am I," Dr. Ware replied.

A local pharmacist revealed that the young physician--who had a locum tenens arrangement at the hospital--had been filling out prescriptions for a narcotic and Ritalin in other people's names. Dr. Ware kept him at the hospital under observation, but the next day he disappeared.

She phoned colleagues from his previous job and his residency program, who knew about his propensity for substance abuse but had never taken action. She reported the incident to the Medical Board of California, which said it had never heard of him.