Presentation

Report
2012 USPHS Scientific and Training
Symposium
CDR Scott J. Salvatore
[email protected]
 Safety
of examinee
 Co
workers and other military and federal
employees
 Public
citizens
 Liability/legal
 Provider’s
actions
license
 U.S. Army
Medical Research Institute of
Infectious Diseases
 Mission: core
mission is to protect the
warfighter from biological threats and
investigate disease outbreaks and threats
to public health




Personnel- approximately 800
• 25% Military
• 37.5% Civilian Employees
• 37.5% Contractor Employees
Professional staff
• > 150 Ph.D.’s
• > 20 DVM’s
• > 15 MD’s approximately
• Nearly 300 laboratory technicians
Personnel registered with CDC BSAT: >500
Personnel with access to BSAT: 30 % of USAMRIID
employees
Biosurety is defined as the combination of
security, biosafety, agent accountability,
and personnel reliability needed to
prevent unauthorized access to select
agents of bioterrorism.

1. Army Regulation 50-1 – Biological Surety
2. MEDCOM Regulation 40-55, latest edition - Guidance on
occupational health practices for the evaluation and control of
occupational exposures to biological select agents and toxins (BSAT)

3. Army Regulation 40-6 – Medical Record Administration and Health
Care Documentation

4. 42 USC 126 - Equal opportunity for individuals with disabilities (to
include reasonable accommodation)


5. H.R. 493 - Genetic Information Nondiscrimination Act (GINA)
6. 42 CFR (Code of Federal Regulations)-pertaining to release of
drug/substance abuse records.

 Identifies
the purpose, concept, and
responsibilities for the biological
surety program
 Establishes
procedures for the biological
personnel reliability program
 Reliability assessment
Persons who do not meet BPRP standards will not perform
BPRP duties. The certifying official will make a
judgment on the reliability and suitability of an individual
for a BPRP duty position.

The following sources of information the certifying official
will use to determine that the
individual is qualified for the BPRP:
(1) Initial interview.
(2) Personnel Security Investigation (PSI).
(3) Personnel records review.
(4) Medical evaluation.
(5) Drug testing.

The following are the general suitability and reliability standards
expected of all BPRP members:
“Individuals will be mentally alert, mentally and emotionally stable,
trustworthy, physically competent, and free of
unstable medical conditions. This includes dependability in
accepting responsibilities and effectively performing in an
approved manner, flexibility in adjusting to changes in the
working environment, good social adjustment, ability to
exercise sound judgment in meeting adverse or emergency
situations, physical ability to perform duties required by the
position, and positive attitude toward BPRP duties and the BPRP.”

Current diagnosis of drug/substance or alcohol
dependence

Alcohol-related incidents/abusing alcohol

Medical condition.
(1) Any significant mental or physical medical condition,
medication usage, or medical treatment, which may result
in—
(a) An altered state of consciousness.
(b) Impaired judgment or concentration.
(c) Increased risk of impairment if exposed to biological
agents.
(d) Impaired ability to safely wear personal protective
equipment required for the biological surety position
(e)Suicidal Behavior
 Inappropriate
behavior:
attitude, conduct, or
 “Poor
attitude or lack of motivation. Poor
attitude can include arrogance, inflexibility,
suspiciousness, hostility,
flippancy toward BPRP responsibilities, and
extreme moods or mood swings.”
 Aggressive/threatening
behavior
 Issue
of judgment and reliability in
context of safeguarding classified
national security information/material
 Guidelines
do not require a formal
diagnosis of a disorder for there to be a
concern
 Examination
to determine whether
incumbent employee is able to safely and
effectively perform his or her essential
job functions.
(IACP, 2009)
 Threshold
for examination
• Ruling out issues retaliation, organic physical causes,
administrative issues
• Identify relevant clinical questions
• Unfitness v. unsuitability or misconduct
• Higher threshold for civilian FFD exam to link fitness to a
psychological condition
• OPM: two prongs to determine fitness: inability to perform job
essential job functions or posing a direct threat

5 CFR
Federal Agency may order an employee to
submit to a psychiatric or psychological
examination only when:
1. “…physical exam indicates no explanation for
behavior or actions…”
2. “psychiatric or psychological examination is
specifically called for in a position having
medical standards or subject to an established
medical evaluation program”
 In
FFD of police officers, public safety and
direct threat are always implicated in the
judgment of fitness.
 Employer
may preemptively require an FFD
without showing that an employee’s job
performance has suffered as a result of health
problems (Brownfield v. City of Yakima, Cody v.
CIGNA Healthcare of St. Louis).
 Obtain
Informed Consent and
Authorization for Release of Medical
Information
 Describe
nature, scope of evaluation,
limits of confidentiality, and who will
receive findings.
 Methods
of evaluation
 Multiple
sources information (behavioral
and clinical)

Standard of Practice in Forensic Evaluations
 Central
(not collateral):
o
Medical records
Performance evaluations
Interviews with informants (supervisor, spouse, co worker, etc.)
Personnel Security Investigation (PSI)
Supervisor /co worker questionnaires
o
Job description/analysis
o
o
o
o
 Clinical
Interview:
• Pertinent History
• Symptoms (if relevant)
• Individual psychiatric history (per GINA)
• Personal/developmental, Educational, Legal,
Military, Marital, Occupational, Social, Work
Relations, Habits, Substance Use, Stress
Management
• Mental Status
 Gambling
 Sexual
behavior
 Finances
 Safety attitudes/practices
 Threats to co workers
 Grudges toward U.S. Govt.
 Allegiance to U.S./Foreign
influence/preference
 Passive v. active threat
 Violence risk assessment
 Additional
Concerning Behaviors from National
Science Advisory Board for Biosecurity:
• Working off hours
• Security Breaches, accessing computer/email passwords
• Unexplained absences
• Mention of plans to commit acts of violence to persons, property
• Lab work that doesn’t correspond to official project
• Sabotaging colleagues’ research
• Risk taking behaviors
• Unexplained, significant decline in performance
• Merit Systems Protection Board
 Psychological Testing
MMPI 2, MMPI-RF, PAI, CPI, MCMI-III, 16PF.
 Self
Report Measures (e.g BDI)
 Employee
 Referral
Safety Inventory (e.g. ESI)
to specialist (e.g. neuropsyche)
 National
Academy of Sciences and the
National Science Advisory Board for
Biosecurity:
 Lack
of efficacy for personality
assessment tools, polygraph and
integrity tests for identifying ‘insider
threat.’
 Genetic
Information Nondiscrimination
Act of 2008
 Prohibits
use of genetic information and
tests to discriminate in employment
 Applies
to applicants and employees
 Military
v. civilian evaluations
 Assess
Response Style
• Reliable/honest
• Malingering
• Defensive
• Dishonest
• Uncooperative
 Existence
of a mental disorder or
condition.
 Pattern
of behaviors relevant to
guidelines
 Qualified
for BPRP (fit)

Medical Restriction (qualified with
accommodations)
• When performance of BPRP duties may be impaired by a temporary medical
condition (including medication for the condition) or psychological condition
including short term stress.
• Restriction is a caution based on possibility of impairment and not assessment
of unreliability (not to exceed 180 days)
• Suspension
 Certifying official determines that the individual’s reliability is suspect.
 When medical condition becomes prolonged
 Later option for reinstatement or disqualification
 Disqualification
 Certifying Official determines that an individual does not meet the reliability standards
(including medical conditions.
 Separation from employment /service may be appropriate if BPRP certification is a
condition of employment.
• Reinstatement/requalification – reevaluation
Reinstated or request for requalification (substantive evidence that the
cause of disqualification no longer exists)
Remission of symptoms
Treatment and supporting documentation
Special Procedures for alcohol abuse/dependence
*The individual successfully completes an initial intensive rehabilitation, if prescribed, followed by a
1-year period of strict compliance with aftercare requirements, regular and frequent participation in
meetings with Alcoholics Anonymous or a similar organization, and abstention from alcohol.
• *Mental health evaluation and a favorable prognosis by the CMA.
 Consult
 Consult
 Consult
 Finally, document
consultation.
 Americans
with Disabilities Act of 1990—
--pursuant to the federal ADA (ADA) employers may require a preemployment medical examination to determine if an applicant can
effectively and safely perform the job requirements of the position they
are seeking.
--if employer requires applicants to undergo pre-employment
psychological screen, the evaluation must be given to all applicants in
that job class
--for medical examination about potential impairment, exam may
administered only applicant has received conditional offer of
employment
-- v. American Airlines



Designed to assess worker’s psychological resilience and
attitudes toward lab safety and personal responsibility who work
in BSL 4.
Four behavioral areas identified for potential risk of
accidents/injuries: clinically elevated levels of depression, anxiety
(stress), substance abuse, and high risk safety attitudes.
Positive screen may necessitate more comprehensive
psychological evaluation.

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