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 He seems withdrawn lately, and irritable.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.
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?
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