Mentally Ill EMTs/Paramedics

[Aidey]

So I have a general question for you all courtesy of one of my friends who volunteers at a combined Fire/EMS department. First a little background info, the department has about 60 or 70 members, there are 6 24 hour people (2 per shift) and everyone else is volunteer except for 2 chief officers and a couple of admins.

Several months ago one of her friends, a FF/MICP, starting having a lot of issues, and eventually showed up to a training class in a full blown manic episode. They were able to convince him to go to the hospital and he was admitted and diagnosed with Bi-polar disorder.

He took 2 months off from the department, got on meds, and from all accounts is stable and doing pretty well. Last week the chief dismissed him from the department on the grounds that his bi-polar disorder made him a risk to the safety of everyone else both co-workers and patients. He offered to get a letter from his psych saying he was ok to stay there, and to sign a contract saying he would stay on his meds and if he didn't they could dismiss him but the Cheif was having none of it and said there was no room for discussion. Since the state this happened in is an "at will" work state and he was a volunteer he has no legal recourse against the Chief.

Now, my question is, do you guys think this was fair? Should someone be blocked out of fire/EMS strictly because they have a mental illness?

 

[alphatrauma]

I'm going to side with the Chief here.

As nice as the "guy in question" may be, nobody's perfect. At some point everyone who MUST take a prescription will go off their meds. When disaster ensues, the first question that will be asked is, "did you know that he had a psych disorder?"


... judgment for the plaintiff

 

[JPINFV]

^
Then we might as well not hire anyone that has a seizure disorder, on permenant pain medication for chronic conditions, is diabetic, or essentially anyone else with a chronic condition requiring medication. Also we might as well not hire people who aren't sick because everyone comes down with temporary infectious diseases that could be spread before the person becomes symptomatic. After all, when someone gets a nosocomial infection...


To the OP, without knowing the patient's baseline or anything else about the patient, I can't make a decision one way or another. My gut instinct is to say that your chief is a panzy and doing the entire "Oh my gawd, someone has a psych disorder and thus are completely crazy" stupidity routine. Unless mental illness is a protected class, akin to skin color, sexual orientation, etc, there probably isn't much you can do about it except insure that he gets his unemployment insurance and help him find a new job.

 

[AJ Hidell]

You're screwed if you do and screwed if you don't. If someone is harmed by him, the department is liable. But if they don't accept him, they are quite probably guilty of an ADA violation and forced to both take him back and compensate him. Whether it is "fair" or not, this is a situation where an attorney should to be the final word.

Unfortunately, the unregulated nature of the fire service and EMS both leave us open to this kind of thing. Law Enforcement certifying agencies require a psych exam and clearance to be eligible for hiring. Since we have no such thing, each agency is on it's own.

 

[VentMedic]

^
Unless mental illness is a protected class, akin to skin color, sexual orientation, etc, there probably isn't much you can do about it except insure that he gets his unemployment insurance and help him find a new job.

Mental illness is within the Americans with Disabilities Act (ADA). However, it is not applicable in all situations.
http://www.nami.org/Template.cfm?Se...tManagement/ContentDisplay.cfm&ContentID=4862

 

[Meursault]

I can't comment on appropriateness without specifics, but I have a nagging feeling that this wasn't a very well-informed or considered decision.

As far as your general question, "mental illness" is a very broad category, and categorically excluding people is generally a bad policy. I hope it's not widely believed that all psych disorders put people at risk for harming patients or otherwise unfit to be in EMS. Individual evaluations are probably the best and fairest idea.

 

[Foxbat]

He offered to get a letter from his psych saying he was ok to stay there, and to sign a contract saying he would stay on his meds and if he didn't they could dismiss him

Sounds like the firefighter was given an opportunity and chose not to use it. Whose fault is it?

 

[Ms.Medic]

I agree with the chief as far as the ems/patient side of it goes. BUT, could they maybe have offered him a job just on the pumper ? MAYBE ? IDK, is it a department where if you run fire, you HAVE to run ems as well ?

 

[Sparky79]

Sounds like the firefighter was given an opportunity and chose not to use it. Whose fault is it?

If you read the OP, this is what the firefighter offered and the chief declined it.

My $0.02, the chief over reacted, but as others stated, without full details it is hard for us to judge completely.

 

[Foxbat]

My bad, I shoud've read more carefully.

 

[Sasha]

This is absolutely ridiculous. How sad that a people are still so ignorant about mental illnesses.

If he agrees to stay on his medication, I really don't see where the problem is. People with mental illness did not ask for it, just like people with cancer, diabetes, etc. did not ask for their diseases. Do we deny people with diabetes a job because they might have a hypoglycemic episode and crash the truck? Do we deny people with high blood pressure the right to work because they might rupture a vessel in their brain while working with a patient? No.

This is discrimination based on ignorance.

 

[jrm818]

^ ditto. Look around your service - I guarantee there's at least one fairly..eh...unhealthy looking person who works for you. There's a not insignificant chance they will have a massive MI and croak during a call..yet they're still working. Yet the chance that a bipolar provider will loose control of their condition excludes them??

I know of at least one case where a medic had to wear a halter monitor...while at work. I'd say there's' more of a chance that he has some sort of arrythmia pop up in the middle of a call than this guy will go off his meds and become uncontrolled..if, indeed, he can document that its well controlled.

the stigma attached to mental illness is powerful...and perverse. I feel for the guy, and my gut says that this is probably an ADA violation, although I really have no idea.

 

[akflightmedic]

Sorry but I agree with the chief and disagree with the above posts. Ignorance would be allowing the person to be on the department.

Anyone who knows anything about mental illness and bipolarism especially would agree. Hell any bipolar patient will agree the job is not for them.

A bipolar patient WILL come off their meds multiple times. First, bipolar does not mean you swing from a high to a low in minutes and that is a huge misconception many people have. It actually is able to be trended over weeks or even months. If a patient keeps a journal and has a person they can trust, it is plain as day when manic episodes are approaching or when lows are creeping in.

He is newly diagnosed. It will take a year just to understand how often his cycles will occur and if the meds will hold him steady through the transitions.

The reason a bipolar patient will come off their meds is they miss themselves. They like the highs of the manic episodes depsite the serious repercussions which typically follow. Every now and then they start to say they feel normal or they want to feel like their old selves, so what do they do? They discontinue the meds. It takes a very supportive network of family and friends to recognize some of the early subtle changes in order to support the patient and keep them from falling back down the slippery slope.

One of the main treatment therapies for bipolar patients is to maintain a routine, consistency. Emergency services is anything but.

I think the chief acted in the best interest of the department and the newly diagnosed patient. I know for a fact, in the state of Alaska, if you have been diagnosed with any mental disorder and take medications, you are precluded from holding a paramedic license.

 

[sir.shocksalot]

I have bipolar disorder, and I have been working well in the field for almost 2 years.

 

[akflightmedic]

I have bipolar disorder, and I have been working well in the field for almost 2 years.

And do you disagree with anything I said, regarding cycles and meds? Simply saying you are doing fine is not enough, because if you want to discuss this particular disorder in a honest format, then disagree with me and tell me why.

 

[sir.shocksalot]

And do you disagree with anything I said, regarding cycles and meds? Simply saying you are doing fine is not enough, because if you want to discuss this particular disorder in a honest format, then disagree with me and tell me why.

I agree with you partially, but it is really depends on the individual with the disorder. To say that every person will go off their meds at some point is incorrect, in the 4 years I have had the disorder I have never once stopped taking my meds. I am well aware of the dangers of discontinuing treatment, and in the interests of my coworkers, patients, and most importantly myself, I refuse to discontinue my medication. In regards to the mood swings I am well aware when they come and I have a lot of good support mechanisms in place to have good control.
I have faced a lot of discrimination for my disorder, but I think when properly managed by a responsible adult it has no effect on my career.

 

[devaE2]

I have to disagree w/ AKFlightMedic on some points.

First, there are several different classes of BiPolar. Some are characterized by severe mood swings and finding the right combinations of meds to keep them 'stable' can be a challenge. Other types are fairly benign and are easy to control.

Any decent psychatrist can tell if a person w/ BiPolar illness should or shouldn't be working in a stressful situation.

Will a person w/ this disorder go off their meds because they 'miss themselves' - probably at least once. Do they need a good support network? Can't hurt. Will a person w/ BiPolar II put a patient, co-worker, or themselves in harm's way? Doubt it.

I agree w/ a lot of what's been said about risks to patients due to EMS responders being diabetic, obese, etc. On our Engines we carry AEDs - primarily because a FF going down w/ a heart attack is a very real possibility - so who's the greater risk to patient or co-worker?

 

[trevor1189]

I know for a fact, in the state of Alaska, if you have been diagnosed with any mental disorder and take medications, you are precluded from holding a paramedic license.

That's ridiculous. What about people with depression or anxiety disorders? They just say sorry you take medicine for a psychiatric problem you can't be a medic??? :wacko:

 

[bstone]

If this guy gets a lawyer you can rest assured it'll end up in court.

I believe the chief was wrong. You can't fire someone for a legit medical condition that is under control. If he does something wrong then you can can him, but not before. The EEOC would have a field day with this.

 

[medic417]

Do we deny people with diabetes a job because they might have a hypoglycemic episode and crash the truck?

Yes. At least many services if they hire a diabetic will have a no driving clause for them.