You are a paramedic working for a large EMS service that runs EMT-B/EMT-P units. Your long time friend, Paul, works for the same agency, but on a different truck, because he also is a medic. You both went to medic school together about 7 years ago. The both of you have often complained about how you guys are being run into the ground doing B.S. calls, being forced to do quick turn-arounds, feeling that you don't have enough time to be the good quality medics you want to be. The job just seems mundane at times with the EMS abusers, and overly stressed at others, to say the least. However, you hear Paul is really getting burned out. He seems withdrawn lately, and irritable. His partners state he becomes distracted on calls. Once recently, his partner identified him making a medication error before it was administered. No big deal. The best doctors and nurses have made at least one medication error or come close to it. But it is his persona lately that seems to bring it to light.
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When you see him at work or off duty, you gently explore his psyche and express concern, but he just blows you off. Once, between shifts, in the locker room, you notice an unopened vial of morphine in his book bag. You don't say anything initially but when you realize that no narcs are missing from the trucks, your curiosity gets the best of you and you confront him. He states his wife is having severe back pain and taking the morphine home to her. He refuses to give you a straight answer as to where he obtained it from.
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However, a couple of days later, you notice a few ecchymotic areas on his left forearm, and when questioned, he tells you he simply banged his arm, though they look like previously butchered IV sticks. About a week later, he admits to using some of the morphine himself due to the stresses of the job and to help him rest off of work. You empathize with him as recently he was first on scene to a family murder-suicide, then was handed a badly burned body of child from a burning housing project. The child died within a week and it was much publicised as the child was left alone so the mother could go smoke crack. He just last week got assaulted by a crack addict, that got him half a day in the local ED for medical clearance. He assures you he is in control and handling things well by himself.
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His personality, however, only gets worse, and though he assures you he is not using the narcotics, you strongly suspect he is still abusing drugs. Still, he continues to function as a medic without glaring mistakes, as he once had a reputation for being one of the most competent. Yet, the rumors are flying around the agency that he is getting short with his partners, and almost abusive with patients, and rude with families. Of course, these are the folks that "abuse the system", but this is still not professional behavior representative of the agency or the EMS community as a whole. You feel the need to confront him again, admitting you suspect he is still using drugs and under stress. He tells you that you are full of crap and for you to mind your own business. He then cuts off all further contact with you.
Since he is a friend and fellow co-worker, you wish to intervene but you are not sure how to go about it. You are mature enough to know that stepping on fellow co-workers doesn't get you anywhere and you sure don't want to get your friend in trouble. You still feel that you have an obligation to raise your concerns. Maybe a nudge to your QI committee to look into his calls or at least his behavior on calls.
Should you report your suspicions to your supervisors, telling everything you know?
He would then most certainly know who told on him, jeopardizing your friendship. He could deny everything and threaten legal maneuvering in response to what he says is a hollow charge, since there is no hard proof against him.
What if you are wrong, and he is dragged off for a drug test, and tests clean?
If you intervene, and he does test positive, he will be black-listed as a drug abuser, and possibly lose his career, though your agency is civil service and will offer D&A rehab. What if the organization is not that large to offer that? Is the stigma he will get a concern? Will he be allowed to work as an ALS provider afterward?
There is no proof he harmed any patients but wonder if he has a good probability of doing so in the future. His behavior is becoming more rude to all around him and this may be the only thing that could bring him down. He may end up getting reprimanded or even fired for his unprofessional behavior. But don't we all have bad periods in our lives?
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So how do you sort through your duties as a friend and colleague, but considering your duties to society as well?
Resources:
Flynn, Eileen P. 2000, Issues in health care ethics, Prentice Hall
Weiss, Gregotry L, Lonnquist, Lynne E. 2009, The sociology of health, healing, and illness, 6th Ed., pg.178-179, Pearson Prentice Hall
8 comments:
Good post Shaggy.
Obviously this could not be a matter that you ignore. You first approach the friend/drug abuser, which was done. If he does not respond to this intervention you move forward. It would be appropriate to possibly get his family involved if you are that close to him. If not, it would be necessary to move up the chain of command.
You are being a better friend by confronting his problem, and not just ignoring it. By approaching him first, he was given a chance to quit without reprimand.
If all else fails, give up, and party with him. haha.
What do you mean by "move forward" exactly? Does this mean reporting him? All you can report is you saw him with a vial of a narcotic. It was not missing from any of the trucks so it is not an issue to the ambulance service. His behavior is abnormal, but seriously, how many other jerks do we work with who are like that? Hmmm. Why are they like that? I'm digressing.
I do agree with your plan and would take the same exact approach. Many large companies like our hospital have Employee Assistance Programs, with contracted services like Lifesolutions. I am not sure how much employees utilize this benefit.
Is this one who should lose his career as a medic if he admits to a problem and needs help? Should he be forced to resign? In many large cities, and at our hospital, if a provider admits to a problem (usually after being caught), they are offered D&R and get to keep their job, pending their rehab. Is that something that we can feel comfortable with?
What about smaller companies that don't have resources like EAP or offering D&R? This guy would certainly be canned, but then again, if his attitude would continue downward, that alone would cost him a job.
Well you would report everything you have seen. Allow the person above you to make the decision to peruse it. If you were wrong, at least the stress of the situation would be relieved. Eventually a good friend would forgive you.
Now as far as letting them keep their job. I have mixed feelings on this. It is a fact that most drug abusers who get help eventually relapse.
I will answer your question with a question. If you were Mrs.Tiger Woods, would you take him back after he is released from sex rehab?
On the other hand, everyone makes mistakes...
I think that Adam is on the right track as far as how to initially handle the situation. As far as letting them continue to be an ALS provider, I think a way could be worked out to ensure that they do not relapse. Perhaps frequent random drug testing. I'm not sure. It would be a touchy situation. Plus the rumor mill would do a number on their reputation.
YOU have to have a chat with him away from work, I know you've already done this but this time don't be so "gentle". Calmly, yet firmly, tell him directly your suspicions and that he must get help. Phrase it like a 911 call with a hypothetical patient based on him; how would he react to the patients "symptoms"?
In addition advise him that it is only a matter of time before management becomes aware (if they're not already!) and, if caught, the consequences will be much worse than if he voluntarily submits to an EAP. If he's acting the way you describe, supervisors WILL eventually get suspicious, if he doesn't do something to be caught in the act first.
If he gets treatment he can still be a medic but he must volunteer for it, if he gets "caught" then discipline is the issue.
Good luck...
Though this is a hypothetical patient, I did have have an EMT partner about 15 years ago who I found with morphine. He claimed it was for his wife or mother-I can't remember. I was gullible then and turned a blind eye, but later I had to speak to him when his behavior changed and he started missing work. I approached a supervisor who felt there was not much to go on other than my word, since everyone seemed to be having emotional issues. He showed up drunk one day and I convinced him to go home "sick". He stated he was trying to change when I sat down with him, but he would later do a disappearing act-a no call no show. He got a job again at an EMS agency servicing the upper middle class. He did a disappearing act there and dropped from the radar.
I just figured that this is not an uncommon issue in large metro services, or even in small ones.
Is the person addicted?
Is the person a recreational user?
Is the person using morphine at all?
On what should we base our conclusions?
If we believe that he is abusing drugs, what should we tell management after we make further attempts to persuade him to get help voluntarily and he refuses?
Adam,
It is a fact that most drug abusers who get help eventually relapse.
I do not have any statistics on this and have not looked into it, but what do you base that on? What do you mean by relapse - using one time, using a few times, using full time?
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