Handling an impaired physician situation

From a reader:

I could use some feedback on a very sticky situation in my practice.　 We have a physician that is in the middle of a mid-life crisis.　 This once "top doc" has become incresaing dysfunctional and disruptive to our practice.　 He is constantly running 2 to 2 1/2 hours behind schedule resulting in disgruntled patients.　 Production has dropped due to patients leaving without being seen.　 We can not put same-day appointments on his schedule due to how far behind he is constantly running.　 Daily work such as dictation, lab review, and correspondence is not being completed.　 At this time he is 3 months behind in ditation.　 Lab results are not reviewed for many, many weeks whereas we used to call his patients the very next day with results.　 The staff is frustrated because he has upset the apple cart and our daily work routines have been disrupted.　 His once happy-go-lucky demeanor has been replaced by anger and a mean spirit.　 Staff avoid interacting with him as much as possible.　 We have had a meeting with him which has resulted in no change.　 He clearly has a lack of insight into how much his behavior has effected the practice, staff, and patients.　 He has placed blame on everyone and everything else, not taking any responsibility.　 There have been a few times he has come in for work several hours late due to over sleeping because he had been up all night.　 Rumor has it that his home life is strained.　 The other doctors in the practice feel that he is profoundly depressed.　 We have asked him to be evaluated for depression and other medical conditions and he has refused.　 I believe that there is nothing good at the end of this road we are on.　 Something bad is bound to happen to him, a patient, or the practice eventually.　 The other partner in the practice (there are only two partners) feels that she is too close to the situation to deal with it.　 They have been in practice together for 20 years.　 Ignoring the situation is not the answer. What would you do?

So I ask my readers, "What  would you do in this situation?" I would suggest seeking the advice of counsel.　 Particularly since this doctor has an affect on the business partnership. The attorney may suggest help from the practice's malpractice carrier, its state medical board, etc. Most State Medical Societies or State licensing boards have an section to aid with physician health issues. They are designed to be the physician advocate. Sometimes this may involve "forced" entry into treatment to maintain licensing. The hospital that you maintain priviledges with should also have an program for physician health.