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Hello my name is John Hyatt. I am the Director of the Employee Assistance Program at the University of Texas M.D. Anderson Cancer Center in Houston.
Fortunately it does not happen often but occasionally an employee has serious problems functioning on the job and may even be a safety risk. He or she may be impaired or unfit to work because of a medical condition. As a supervisor what should you do in this case?
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In this training you will become familiar with how to recognize signs of possible impairment, or being unfit for duty, supervisor actions if an employee appears to be impaired, and what the impaired employee must do to return to work and comply with the institutional policy. This presentation outlines basic supervisory action steps but refer to the Fitness for Duty policy (Volume V) for specific procedural information and the scope of this policy.
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Before starting this presentation I would like to mention other supervisor presentations on this site, particularly one called EAP as a Management Tool; When and How to Refer your Employee. This module focuses on steps to take if your employee is experiencing a decline in job performance but is not impaired to the point where he or she needs to be taken off the job. This module discusses how to recognize signs of a troubled employee, intervene when their personal problems are affecting work, and make a formal supervisory referral to the EAP; also on how to become more resilient managing a troubled employee.
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Now back to our topic for this presentation; severe impairment or unfit for duty. Let me briefly define impairment and describe what a severely impaired employee might look like. Throughout this presentation I will be referring to signs of severe rather than mild to moderate impairment. I also use the word impairment and unfit for duty interchangeably.
Severe impairment is generally defined as the inability to perform essential job functions and interact safely and effectively with others. It may be caused by an emotional, psychological, medical, or other health condition such as alcohol or drug dependency. Impairment is not about having a bad day but behavior that is really out of character and alarming to others. The most likely trigger when an employee is unfit for duty is alcohol or drug abuse or serious mental illness.
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Now let's look at some examples. What does an employee who may be unfit for duty look like? Sometimes it can be hard to describe but often you will "know it when you see it". You and others are uncomfortable working with the employee or feel that you cannot trust him to work safely. Co-workers may complain, refuse to work with him, or even feel threatened by him. Often there are complaints by more than one co-worker about inappropriate behavior. You do not need to know what the problem is that may be causing this disruptive behavior. You do not have to be certain that the employee is impaired to take action and call for assistance.
Let's look at some examples of impaired behavior:
The behavior is grossly out of character: for example the individual may normally be defensive and moody but is now angry, threatening, paranoid, and not making sense.
Judgment is impaired: many of us experience stressful events in our lives that affect our concentration and our focus, but generally we are aware of it and we find ways to manage the situation or get help. If on the other hand your employee is functioning poorly, making mistakes, and is not aware of it, you have a problem.
Confused, unable to think clearly: you cannot trust her with patient care responsibilities. You try to talk with her and ask her what's going on and she gives you no plausible explanation. Her thoughts are disorganized. She is forgetting vital information to do the job, or is having serious problems with concentration or focus.
Unable to stay awake or alert: the employee could be over-medicated, having a drug reaction, or having a medical emergency.
Alcohol on breath: the smell of alcohol may or may not be accompanied by other signs, such as slurred speech, blood shot eyes, unsteady on feet, and mood swings.
Extreme changes in mood or even threatening: his talk, demeanor, or behavior is bizarre or threatening. Moods are unpredictable or inappropriate.
Unable to calm down: severely depressed, crying excessively, panicky, or talking about committing suicide. These are common examples of someone who may be severely impaired. Again it may be triggered by drug or alcohol use, or some type of psychological or medical condition.
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Now why take action as a supervisor? First of all you want to comply with the Fitness for Duty policy. You want to ensure a safe and healthy work environment, and you want to intervene to help an impaired employee. The purpose for the Fitness for Duty policy is to ensure that employees work safely and if they are severely impaired on the job, are handled appropriately. M.D. Anderson is also committed to making sure employees with medical problems receive help. Unfortunately some supervisors believe that an employee will always be disciplined or terminated under these circumstances and as a result are reluctant to follow procedures. The fact is that employees in most instances will be given an opportunity to get to get help but as you will see in a minute, they must follow through with getting help and that is mandatory.
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All right now, let's look at supervisor actions; general guidelines.
Is he impaired? You do not have to be certain: your decision to take action should be based on observations made by you and others and it must have occurred on the job. For example, the Fitness for Duty policy does not apply when there are reports that the employee got into some type of trouble over the weekend. Your decision to take action should also be based on concerns about her ability to function rather than whether or not you believe that she has a particular medical condition. In fact it may take days or longer for a medical evaluation process to be completed. If it turns out that there are problems but not severe enough for your employee to be taken off the job, other options may be available including a supervisory referral to the EAP.
Don't label when you deal with the employee; "I think you have a drinking problem:” avoid diagnosing or labeling the employee or accusing him of having a specific medical problem. For example, you may strongly suspect that he or she has a psychiatric disorder but keep this to yourself and only discuss what has been observed with your employee.
Take action when you see signs of possible impairment: remember we cannot take someone off the job unless there are active signs that the employee cannot function. If you call me and say that your employee came to work with alcohol on his breath and slurred speech last week, and there are no active signs now, we may not be able to take any action under the Fitness for Duty policy.
Consider the job duties when deciding what action to take: how quickly should you act? How safety sensitive is the job? It is one thing for an administrative person to be having hand tremors but quite another for a surgeon to have shaky hands. Obviously nodding off or falling asleep while dispensing medication or driving a shuttle bus requires your immediate attention.
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Now let's look at supervisor actions again; continued procedures. Always refer to the Fitness of Duty policy under Volume V.
If the individual is threatening or there's a medical emergency, call 911: always call 911 when there is an emergency such as, an employee who is threatening others or highly agitated and uncooperative. UT police will respond when the situation is threatening or out of control. If you think that the employee is medically unstable, such as trouble breathing or unconscious, the 911 dispatcher will send emergency medical help. Sometimes our emergency center can assist but always call 911 first.
Now remove the employee from his or her job duties: interview the employee if possible in a private but secure location and remind him that he must cooperate fully with procedures.
Ask the employee to explain why he or she appears to be unfit for work and document what is said: for example, she might say that she is taking a medication that's causing her to be groggy.
Complete the Supervisor Observation Checklist; you will find this attached or linked to the Fitness for Duty policy.
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Inform the employee that compliance is mandatory: the employee should be told that she must cooperate fully with all procedures and cannot return to work at this time. Failure to cooperate will result in discipline action up to including termination.
Do not allow the employee to drive: the EAP will consult with you regarding transportation arrangements and next steps.
Do not allow the employee to return to work without prior authorization by the Employee Assistance Program: even if he has a release from his own doctor.
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Always contact the Employee Assistance Program: you can contact the EAP by calling our main number 713-745-6901 or page me or Dr. Georgia Thomas; one of us should always be available even during non business hours.
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The employee must be evaluated for fitness for duty: the fitness for duty evaluation is coordinated by the EAP and it is independent of the employee's personal doctor.
The employee must complete any recommended medical treatment:
The employee must be monitored by the EAP: compliance with medical treatment and or other requirements such as drug and alcohol testing is mandatory.
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The most important thing to remember, if you think your employee may be unfit for duty, is to call 911 if there is an immediate threat or danger. If not, contact the EAP and follow the Fitness for Duty procedures. Thank you for reviewing this presentation.