the hospitalized officer

The Hospitalized Officer

Protect Your Investment

Sarah Mildred Gamble, DO

Police Surgeon / Greenwich Police Department / Greenwich / CT

Clinical Instructor- Columbia University College of Physicians and Surgeons, NY, NY

Me

• Board Certified Internal Medicine Physician• Police Surgeon- Greenwich, CT• Exclusive hospitalized patient care• Clinical Instructor for Internal Medicine-

Columbia University College of Physicians and Surgeons- NY, NY

Wife of S.W.A.T/S.R.U Officer

Disclosures

None

Objectives

• HIPAA Review• US Hospitals = Danger Zones• Why LEO’s get Hospitalized• Top 3 Hospital Dangers• Officer/Family Support Liaison • Chief Prevention Strategies

HIPPA

• Health Insurance Portability & Accountability Act

– Privacy– Security

Office of Civil Rights

• Enforce HIPAA Privacy– Protects individually identifiable health information

• Security Rule – National standard for electronic health information

• Confidentiality Provisions Patient Safety Rule – Protect identifiable information – Analyze patient safety events 

HIPAA Privacy

• Electronic / Written / Oral Information

• 12 national priority purposes allowing disclosure of medical information  

Oops, My Bad…

HIPAA applies to:

Doctors

Health Insurance Companies

Health Care Clearing House

Doc to Brass…

• Serious Threat to Health or Safety

• Prevent/lessen serious and imminent threat to a person/public

• Made to someone they believe can prevent/lessen the threat (Brass)

Doc to Brass…

• Judicial & Administrative Proceedings

• Order from court / administrative tribunal

• Subpoena

• To protect the health and safety of inmates

But if I Know…

• Cocaine/heroin/PCP • Contagious• Multiple (vs. 1st) DUI’s• Homicidal• Uncontrolled medical issue:

– diabetes – seizures – bleeding/clotting disorder

Just the Facts Ma’am

• Minimum Necessary

• To accomplish the intended purpose of the use/disclosure/request

• Not the whole record

GINA

• Genetic Information Nondiscrimination Act• Acquisition of employee genetic information• Unlawful• If you already have it

– Keep it separate – Not in regular accessible employee file

Health is Wealth

• Open the discussion

• This is first generation to DIE before parents

Extrapolate This…

LEO’s Illness/Injury

Poor Follow Up causes improper RTW

RTW Without Education

Ill/Injured LEO’sget Hospitalized

Hospitalized LEO’sget Complications

Complications Delay Discharge

Bad Dischargeleads to Poor Follow Up

LEO’s have Significantly Higher…

• Stress Levels• PTSD / Depression• Suicide Rates• Divorce

On the Job Injury

&

Chronic Disease

How Was GPD Last Year?

• Muscle/Bone (sprains/strains): – 54% – 90% while on the job

• Trauma: – 36%– 93% while on the job

• Atherosclerotic Disease: – 10%– 50% while on the job

Cold Hard Facts

• Your LEO’s get INJURED

• Your LEO’s are OBESE

• Your LEO’s get CHRONIC DISEASE

Physical Deconditioning Hurts!

• Pursuit Issues• Effecting Arrest• Sprains and Strains

Obesity Hurts!

• #1 Cause: back injury / all cause injury

• Degenerative Joint Disease / Arthritis

Chronic Disease Hurts!

• Incidence is on the rise 50%

• Using up – Medical benefits – Sick time / personal day / vacation time– Short term disability claims – Long term disability claims– Early retirement– Early pension

Chronic Disease

• CAD• Diabetes Type II• High Blood Pressure• High Cholesterol• COPD / Asthma

1/3 of All Cause Mortality

Tobacco Abuse

Physical Inactivity

Poor Eating Habits

Obesity

Alcohol Abuse

Stress

Injured/Ill LEO Must Go…

• Off to the Hospital

• Vulnerable / Unprotected

• In Danger

Top 3 Hospital Dangers

• Hospital Acquired Infections

• Wrong Drug / Wrong Dose

• No Planned Follow Up

Hospital Danger #1

Hospital Acquired Infections

Skin / Soft Tissue

Blood

Urine

C. difficile Diarrhea

Ventilator

Hospital Danger #2

Medication Error

Wrong Medication

Wrong Dose

Hospital Danger #3

Poor / No Discharge Plan

No scheduled follow up

Poor pain management

Prescription compliance

Break the Cycle!

LEO’s Illness/Injury

No Complications + LiaisonTimely/Proper Discharge

RTW With Illness/InjuryEducation

Ill/Injured LEO’sget Hospitalized

Hospitalized LEO’sget Liaison

Liaison provides2 and 3

Intervention

Intervention Mitigates Complications

Officer/Family Support Liaison

• Role is to standardize the process and improve care rendered

• Must have some medical knowledge

• PS/Occ Health/PA/NP/RN

Liaison Responsibilities

• Admission• Daily visits- communication• Educate LEO/Family (hand washing/meds/find a PMD)

• Discharge Planning• Weekly contact LEO on sick leave/light duty • Once LEO Full Duty… Can sign off case

No Liaison

• 55yo LEO no PMD to follow department physical results for 20 years

• Lost consciousness on patrol• Admitted: BS critical high, kidney failure, almost

complete vision loss• Contracted blood infection from central line• Prolonged stay for 2 weeks• Poor discharge- no PMD, blind,3 flights of stairs,

didn’t fill meds• END RESULT: Disability, dialysis, almost dead

With Liaison

• 26yo LEO emergency sx aggressive spinal tumor• Speak with NES / ONC day of admission• Translate to LEO and family progress/diagnosis• Tumor Board organized to discuss case• Second opinion arranged • NES no ins on follow up / assisted with billing• Narcotic management, physical therapy compliance,

light duty, full duty• 1st year follow up- doing great!

Liaison Leads Return to Work Program

• Within 7 days of discharge• Not if contagious or open wounds• Specific light duty for recovering LEO• For Patrol (SWAT/SRU stricter guidelines)• Narcotic Use Agreement• Establish PMD / Follow Up• Medication Compliance• Physical / Occupational Therapy Compliance

The Bottom Line is…

• Standardize care: policy and procedure• Human capital: investment to be managed• Money for REACTIVE CARE

– Barriers to health / Worsen clinical outcomes

• Money for PROACTIVE CARE– Educate– Diagnose early– High quality care

Chief Then Please…

• Be Responsible and Educate• Direct the Health Care• Keep them out of Danger!

Non Hospitalized LEO

• Physically fit: appropriate physical activity

• No tobacco / illicit drugs

• Preventative health

• Psychologically handle highly demanding job

• Safe and healthy work environment

• Respond positively to changes

Healthy Cops

Are Productive Cops!

What Are You Waiting For?

• Shoulder / Hip / Knee Replacement• Spinal Disc Herniation• Degenerative Joint Disease• Stroke / Heart Attack• Morbid Obesity• SUPER Morbid Obesity

Summary of Main Points

• LEO’s have high rates of Illness/Injury• Ill/Injured LEO’s go to the Hospital• Hospitals = DANGER• Officer/Family Support Liaison protects your

investment from Danger• Simple low cost education/screening breaks

the cycle

Our Team

• Contact # provided memo/email quarterly• Desk sergeant / dispatchers • 24 hour answering service• Email accounts- urgent vs. routine• Facebook- weekly health updates• Contact WITHIN department• Captain Hero

Areas for Future Research

• Department Specific Data• Unit Specific Data

References

• Violanti et al, BCOPS, Ann Epidemiol. Vol 16 no 2, Feb 2006• Kunen et al, JOEM, vol 51, no 9, Sept 2009• Stuart, COP, vol 21, no 5, Sept 2008• Loeppke et al, JOEM, vol 51, no 4, April 2009• Franke et al JOEM, 52(5):561-565, May 2010• www.healthypeople.gov• www.cdc.gov• www.fbi.gov• www.leoka.org• JOEM, 51(6):700-707, June 2009.• www.businessgrouphealth.org• US Department of Labor-Bureau of Labor Statistics. Occupational

Outlook Handbook, 2008-09 Edition • US Department of Labor-Bureau of Labor Statistics. Police and

Detectives. Washington, DC; 2008-2009 Edition • Ramey et al, AAOHN, vol 57, no 11 nov 2009• Franke et al, JOEM, vol 40, no 5, May 1998

Contact Me

• Sarah.Gamble@GreenwichCT.org

• 203-962-1009 office

• 11 Bruce Place / Greenwich / CT / 06830

• www.PrecinctMedicine.com