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Riblett

Colleague Not Fit for Duty (Blood Sugar) advice needed

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Conflicted in this scenario so I am putting out for the masses to advise. I'll keep it fairly to the point.

Scenario: You have a new EMT join your volunteer squad who is a non-insulin dependent diabetic. They take oral hypoglycemic agents. This EMT has experienced multiple incidents involving low blood sugar while on duty or otherwise present at the station. Incidents have been varied in severity, but all resulting in inability to function in a patient care role. This EMT is considerably overweight and is openly engaging in crash dieting and you think the two are obviously connected. They have also been treated at the ER for fluid/electrolyte issues.

They have been mandated by the chief to check their blood sugar every two hours while on duty; seems compliant. Also been mandated to consume a meal BEFORE reporting for duty, since they may have a call right at shift change and be unable to eat. They habitually fail to eat prior to reporting for duty and seem very hesitant to eat unless they start to feel sick.

As a squad officer, what do you do?

1. At what point do you suspend them from duty? Is there any possibility that doing so could be considered discriminatory?

2. What conditions would you put in place if you were to allow them to return? (written contract, perpetual third rider status, MD letter, etc)

3. At what point do you consider contacting family/parents, etc due to suspected life threatening eating disorder? Age 19.

You also have some suspicions of histrionic/Munchausen type behaviors.

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If it were up to me I'd send him home because if he's not properly taking care of himself then he's going to wind up hurting himself, his patient, or his partner. I don't see how it could be considered discrimination simply because he's not fit for duty.

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If you haven't already start documenting these episodes immediately. Everything. From not checking his/her sugar to not eating to questionable behaviour. Write it all down. Time. Date. Episode.

Do you have the capacity to suspend this person? Based only on what you've written here, if you do have that capability, suspend him/her immediately pending a medical clearance. If this is medical in nature and you have enough documentation all pertaining to concerns regarding this individual's capacity to function safely then there shouldn't be any discrimination taking place. Confirm that, however, with your squad's legal counsel.

This person, at a minimum, needs medical clearance from an independent physician. Can you require a psychological clearance as well? A written contract for behaviour would be helpful but if s/he's not following his verbal agreements now it would need some serious oversight to ensure s/he is keeping up. Regular and routine follow ups would be needed for continued medical clearance. This person should not be allowed to complete a crew. Riding at least as a third person should be a minimum requirement.

What about the eating disorder has you concerned for this person's life?

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Thanks for the insight, Mike.

To answer your question, the severe electrolyte deficiencies resulting in hospitalization has me very concerned.

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If "THEY" are not always capable of treating a pt then "THEY" certainly can't be allowed to drive. PERIOD End of discussion.

require a full medical evaluation by a DR. who can be retained by the service to provide confidential evals for them.

Document

Document Document

Everything and keep copies in the persons personnel folder.

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Riblett, you need to secure the advice of a competent HR specialist as well. The reason I say this is that they will know the ins and outs of this type of thing and they've seen it time and time again. They will know what is and is not acceptable for you or your service to do in regards to making this person do.

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Medical assessment is key here, but here is one more piece of advice.

Never treat his hypoglycemia at the station without transport. If a Dr sees regular ER visits for hypoglycemic episodes he will freeze his drivers licence until he has a period of normoglycemia, (usually 1 year here). Treating him without transport is simply enabling.

As a side note: How about station-wide physical fitness requirements? Mandatory workout time? Annual fitness checks?

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Never treat his hypoglycemia at the station without transport.

I like this. Think s/he's hypoglycemic? Check a BGL and transport if low. Do that often enough and it'll raise an awful lot of questions.

Treating him without transport is simply enabling.

Agreed. However, there becomes a fine line between self treatment, individual treatment and assault especially if a BGL comes back normal. This goes back to your original words: "Medical assessment is key...". Just be wary so as to avoid legal troubles.

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do not bother with the parents, as the person is 19 and no longer a minor. Agree with the no driving portion as should a wreck occur, they will ask a lot of "what did you know when did you know it questions"

As far as sending them home hard judegement call. Whoever said being an officer was going to be easy ? Thats why they pay you the big bucks, or at least let you have a cool title and extra gold on your collar.

Whatever you decide, DOCUMENTATION is mandatory to protect against any lawsuit that may come later.

Good luck

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I think by some of the comments that you made in the end of your post that there are other issues besides the hypoglycemia. I am surprised that no one brought up ADA. Like HIPAA is is greatly misunderstood. It says that you have to make a reasonable accommodation, but in the end, they must still do the job. The fact that you allow them to have food and time to treat his blood sugar should be compliance. I believe if I were in your shoes I would start the documentation trail with the lack of compliance of the Chief's request. Use progressive discipline and if non compliant and you send them home, you may be able to use your attendance policy here too. If necessary, you may be able to supply your documentations and concerns to a physician of your choosing and require that employee to have a fitness for duty evaluation done. Of course if you require them to go to your physician, you will have to pay for it. If they are not deemed fit for duty, or progressive discipline takes effect, you can remove the employee from the roster. It is reasonable to question division making and ability to drive your vehicles with frequent episodes of altered mental status in the face of non compliance.

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