In 1981 and 1982 Dr. Mitchel Fagin, an anesthesiologist, was dismissed by two New York hospitals because he was a drug addict. At one of the hospitals he had nearly killed a surgical patient. Yet a third hospital hired him for emergency room duty, dismissing him when nurses reported irregularities in his handling of narcotics. Unlike the previous employers, the third hospital reported the dismissal to a state agency that investigates medical misconduct. Dr. Fagin's license has now been revoked, and the three hospitals have received citations-a disciplinary action that does not involve fines but may affect their ability to obtain state approval for programs or buildings-from the New York State Department of Health. The first two hospitals should have reported the dismissals, the state asserts, and the third should have checked more carefully before hiring him. Dr. Fagin's case is unusual only because it was reported on the front page of The New York Times (October 13, 1983) and because hospitals were publicly criticized for their inadequate management of the case. For every case like this one, there are thousands of others in which a physician's addiction or alcoholism is not recognized or is covered up. Dismissals or withdrawal of admitting privileges are usually handled informally, leaving the hospitals' reputations intact but also leaving the doctors free to practice elsewhere. No one knows exactly how many physicians are practicing despite alcoholism, drug addiction, or psychiatric disorders; estimates range from 5 to 12 percent of the 485,000 licensed physicians in the United States. The American Medical Association (AMA) estimates that there are 10,000 alcoholic physicians and that 7 to 8 percent of doctors are now or will become alcoholics. While the alcoholism rate