Care of Prison Inmates by Impaired Disciplined Physicians

To the Editor: The recent article by Mr Skolnick¹ examining care of prison inmates by impaired disciplined physicians was both informative and controversial. We were disconcerted to learn that some state boards provided restricted licenses to physicians who appeared to have persistent character flaws in personal and professional judgment. However, it may be important to distinguish between impaired and disciplined as the terminology relates to functional capacity. Impaired implies an enduring condition, which without effective treatment is not amenable to remission (eg, mental illness, drug addiction). As it relates to functional capacity, it is a status that, if not in remission, renders the practitioner unable to provide competent medical services. Disciplined is a status designated by the medical board and incurred as a result either of the consequences of unarrested impairment or of a specific infraction. Thus, whereas an impaired physician would be unable to render competent medical services, the functional capacity of a disciplined physician would not necessarily compromise his or her functional capacity to provide competent medical care.