Transcript of 2012 USPHS Scientific and Training Symposium CDR Scott J. Salvatore scott.salvatore@amedd.army.mil.
- Slide 1
- 2012 USPHS Scientific and Training Symposium CDR Scott J.
Salvatore scott.salvatore@amedd.army.mil
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- Safety of examinee Co workers and other military and federal
employees Public citizens Liability/legal actions Providers
license
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- 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
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- Personnel- approximately 800 25% Military 37.5% Civilian
Employees 37.5% Contractor Employees Professional staff > 150
Ph.D.s > 20 DVMs > 15 MDs approximately Nearly 300 laboratory
technicians Personnel registered with CDC BSAT: >500 Personnel
with access to BSAT: 30 % of USAMRIID employees
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- Biosurety is defined as the combination of security, biosafety,
agent accountability, and personnel reliability needed to prevent
unauthorized access to select agents of bioterrorism.
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- 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.
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- Identifies the purpose, concept, and responsibilities for the
biological surety program Establishes procedures for the biological
personnel reliability program
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- 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.
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- 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.
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- 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
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- Inappropriate attitude, conduct, or behavior: 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
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- 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
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- Examination to determine whether incumbent employee is able to
safely and effectively perform his or her essential job functions.
(IACP, 2009)
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- 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
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- 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
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- 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 employees job
performance has suffered as a result of health problems (Brownfield
v. City of Yakima, Cody v. CIGNA Healthcare of St. Louis).
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- 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
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- Multiple sources information (behavioral and clinical) Standard
of Practice in Forensic Evaluations Central (not collateral): o
Medical records o Performance evaluations o Interviews with
informants (supervisor, spouse, co worker, etc.) o Personnel
Security Investigation (PSI) o Supervisor /co worker questionnaires
o Job description/analysis
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- 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
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- 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
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- 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
doesnt correspond to official project Sabotaging colleagues
research Risk taking behaviors Unexplained, significant decline in
performance Merit Systems Protection Board
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- Psychological Testing MMPI 2, MMPI-RF, PAI, CPI, MCMI-III,
16PF. Self Report Measures (e.g BDI) Employee Safety Inventory
(e.g. ESI) Referral to specialist (e.g. neuropsyche)
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- 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.
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- 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
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- Assess Response Style Reliable/honest Malingering Defensive
Dishonest Uncooperative
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- Existence of a mental disorder or condition. Pattern of
behaviors relevant to guidelines Qualified for BPRP (fit)
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- 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 individuals reliability is suspect.
When medical condition becomes prolonged Later option for
reinstatement or disqualification
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- 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.
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- Consult Finally, document consultation.
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- Americans with Disabilities Act of 1990 --pursuant to the
federal ADA (ADA) employers may require a pre- employment 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
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- Designed to assess workers 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.