By Kris Arnold, Chief Medical Officer, ArLac Global Health Services; Medical Director, Boston, Massachusetts, Police Department; and Vice Chair, Police Physicians Section, IACP
any agencies have denied employment to an applicant based on a medical decision. Some have even terminated officers based on medical conditions other than incapacitating injuries. What was the medical basis of such decisions? What guidance did an evaluating physician have in making determinations?
Currently, there is very little well-developed guidance on the issue of medical evaluation of law enforcement officers. The vast majority of states have, at best, cursory statements regarding vision and hearing, often with a general statement to the effect of “being free from any medical conditions that would prevent the person from performing the duties of a police officer.” Such statements give no objective guidance to health-care providers who examine law enforcement professionals to make individualized job-associated evaluations. This leads to inconsistent decisions: one agency will deny employment based on a medical condition, whereas the neighboring agency will accept. Such inconsistency often results in complaints such as that filed by an applicant to the Northampton, Massachusetts, Police Department last year. Gregory Hennick, a 22-year-old diabetic, was denied employment because he uses an insulin pump to manage his diabetes. Since 2002, state regulations had prohibited new police hires with insulin pumps.1
Although Massachusetts is one of the few states with more detailed guidance for medical evaluation decisions, this case reflects the need for constant reassessment of the guidance in light of medical developments.
Guidance Task Group
Several physician members of the American College of Occupational and Environmental Medicine (ACOEM) Public Safety Medicine Section formed a task group five years ago to address the issue of inconsistent guidance across the country. These physicians have many years of experience working with law enforcement and other public safety agencies. They are all members of the IACP Police Physicians Section.
To develop medical evaluation guidance with the greatest relevance to the job performance issues presented by the law enforcement profession, the task force invited representatives from various stakeholder groups. Law enforcement labor organizations (the National Association of Police Organizations and the Fraternal Order of Police), an association of city managers (the International City/County Management Association), and two police management organizations (the IACP and the National Association of Women Law Enforcement Executives) have joined in the development process. The final product is Guidance for Medical Evaluation of Law Enforcement Officers, which is being published in sections as they are completed and approved. It will debut as a subscription service through the American College of Occupational and Environmental Medicine by mid-2009.
The educated and motivated law enforcement officer (LEO) with well-managed diabetes mellitus can be capable of safe and effective job performance.
—From the ACOEM’s Guidance for Medical Evaluation of Law Enforcement Officers
To ensure that the most up-to-date scientific information was used as a basis for developing the guidance, the task group engaged advisory panels from relevant physician specialty and patient advocacy groups. These have included, among others, the American Diabetes Association and the American College of Cardiology.
Task Group Concerns
The task group has met multiple times in each of the past five years. Many hours were invested in developing a set of physiologically descriptive job tasks that represent the necessary functions of a patrol officer in a variety of settings. Once this was accomplished, the task group turned to developing medical guidance for individualized evaluation of specific medical conditions as they relate to these job functions.
Several principles have framed the development of the guidance. A primary concern of a medical evaluation regarding functioning in the workplace is the ability to perform the job’s tasks safely. Many medical conditions adversely affect the safe performance of various law enforcement activities if they are not well managed. Yet the same conditions may have little or no effect on safe performance when well managed. This concept is reflected in the opening statement of each section of the guidance.
In the law enforcement profession, the safe performance of job activities takes on an added dimension in that the safety of the public at large as well as that of coworkers is likely to be directly influenced by an officer’s job performance. This is especially important for those who are provided with the means to use deadly force in the performance of their duties.
The task group has given particular attention to the concept of “sudden incapacitation” as a central basis for developing the guidance. For example, in the case of diabetes, one possible such adverse situation would be impaired consciousness due to hypoglycemia (low blood sugar). A person with poorly controlled diabetes (as demonstrated through evidence of recurrent episodes of hypoglycemia) would have an increased risk of such an event, particularly if confronted with unexpected high-energy physical activity without the chance to consume sugar before engaging in the activity. This would pose an increased risk of a sudden inability to perform certain police patrol job tasks (such as maintaining control of one’s weapon). Patrol duties involve many situations in which officers might not have the opportunity to consume a sugar source shortly before engaging in intense physical activity. However, diabetic persons adhering to a well-established, appropriate treatment regime will be able to lower their risk of hypoglycemia and sudden incapacitation. With this lowered risk, they may be able to perform safely and effectively all the tasks of a law enforcement officer. All of the development work on the guidance has been based on the goal of defining medical management parameters that will allow safe and effective performance of patrol duty job functions.
Putting the Guidance to Use
Following the filing of the complaint mentioned earlier, Massachusetts sought and obtained prepublication access to the guidance section on evaluation of law enforcement offcers with diabetes. The Human Resources Division has used the guidance as the basis for revising its standard for acceptance of recruit applicants with diabetes.
Due to intense interest on the part of various stakeholders, physicians, jurisdictions, and the law enforcement community, ACOEM has decided to release sections of the guidance that are already completed and approved. Currently, the introductory sections, including listings of job tasks as well as sections on diabetes and cardiovascular disorders, are approved and should be available through the ACOEM within the next few months. These sections have been formally approved by the IACP Executive Committee. Sections on vision, hearing, and medications should also be available within the coming months. The task group will continue to add sections and update the document on a routine basis.
A session on Guidance for Medical Evaluation of Law Enforcement Officers will be presented by the IACP Police Physicians Section at the Annual IACP Conference on November 9, 2008. Readers should feel free to attend if they would like additional information.
The task group welcomes inquiries and comments regarding the guidance. Readers should direct their e-mail messages to firstname.lastname@example.org. ■
1Jessica Fargen, “Would-Be Cop Sues over Medical Ban,” Boston Herald, May 15, 2007.