Employer trying to refuse a waiver?

[Ddestiny, BSN, RN]

This is a situation I am attempting to help a patient through. I am hoping someone with more experience can point me in the right direction, as I have never experienced someone trying to question the recommendation of an employee's physician.

I work in a physician's office. We have a female patient that works in a law enforcement-type career where they typically wear bullet proof vests. However, this patient has, for the last two years, had a waiver to keep her from being required to wear it d/t a medical condition that causes muscle spasms in her chest, often multiple per hour.

I'm sure there will be people that will say "Muscle spasms are better than a bullet in the chest". I doubt that anyone will disagree with you. However, the patient is aware of and accepts responsibility for the risks.

A letter has been written each year stating that it is the medical recommendation of her physician that she NOT be required to wear a vest. This year was the first time the doctor I work for wrote it, as this lady has unfortunately been moved from one doctor to another (the first doctor that started this moved out of state, the second doctor was recently "let go" from the practice, and now we are her third doctor. Mind you, we still have all of the documentation from her prior physicians).

At no time in any of the prior letters has the diagnosis been spelled out as to what is causing her problem, it has just been written that it causes her pain and discomfort. For the first two years, this seemed to work. Now suddenly, one of her bosses (who has been there the entire time) is trying to get more information. "WHY is she needing this?"

There are a lot of sordid details I'm going to leave out for the sake of keeping this from being a novel, so long story short...We don't feel that he needs to know. The patient doesn't want him to know. Is there any legal right for him to have this information?

Obviously I'm aware of HIPAA, but I know there are situations where employers are given information about an employee's medical condition (i.e. FMLA, workman's comp). I don't want to assume incorrectly here. The patient says she thinks this is more an issue of this guy's personality and that it's not going to go away by being ignored. i wish I could point to a specific law that says "medical diagnoses are not required to be given when providing a waiver for safety equipment" or something like that.

If she is willing to accept responsibility for injury or death from not wearing the vest, and she has a doctor's note, shouldn't that be the end of it?

I can't really think of any kind of equivalent that would be applicable to the medical field other than when someone refuses their Hep B series, at which point it's just a "sign on the dotted line" and you're done.

It seems like the boss is trying to cause an issue with this employee. Why does it matter now, when it's been in place for the last two years? She's going to retire in 2 years so she's expensive to pay, and she's the only female there. Hmm...

Has anyone ever experienced a situation where a boss has tried to overrule doctor's recommendation for a waiver? He hasn't gotten to that point yet, but why else would he "need" the information? Does one boss's non-medical opinion really trump the doctor's?

[KelRN215, BSN, RN]

This is a situation I am attempting to help a patient through. I am hoping someone with more experience can point me in the right direction, as I have never experienced someone trying to question the recommendation of an employee's physician.

I work in a physician's office. We have a female patient that works in a law enforcement-type career where they typically wear bullet proof vests. However, this patient has, for the last two years, had a waiver to keep her from being required to wear it d/t a medical condition that causes muscle spasms in her chest, often multiple per hour.

I'm sure there will be people that will say "Muscle spasms are better than a bullet in the chest". I doubt that anyone will disagree with you. However, the patient is aware of and accepts responsibility for the risks.

A letter has been written each year stating that it is the medical recommendation of her physician that she NOT be required to wear a vest. This year was the first time the doctor I work for wrote it, as this lady has unfortunately been moved from one doctor to another (the first doctor that started this moved out of state, the second doctor was recently "let go" from the practice, and now we are her third doctor. Mind you, we still have all of the documentation from her prior physicians).

At no time in any of the prior letters has the diagnosis been spelled out as to what is causing her problem, it has just been written that it causes her pain and discomfort. For the first two years, this seemed to work. Now suddenly, one of her bosses (who has been there the entire time) is trying to get more information. "WHY is she needing this?"

There are a lot of sordid details I'm going to leave out for the sake of keeping this from being a novel, so long story short...We don't feel that he needs to know. The patient doesn't want him to know. Is there any legal right for him to have this information?

Obviously I'm aware of HIPAA, but I know there are situations where employers are given information about an employee's medical condition (i.e. FMLA, workman's comp). I don't want to assume incorrectly here. The patient says she thinks this is more an issue of this guy's personality and that it's not going to go away by being ignored. i wish I could point to a specific law that says "medical diagnoses are not required to be given when providing a waiver for safety equipment" or something like that.

If she is willing to accept responsibility for injury or death from not wearing the vest, and she has a doctor's note, shouldn't that be the end of it?

I can't really think of any kind of equivalent that would be applicable to the medical field other than when someone refuses their Hep B series, at which point it's just a "sign on the dotted line" and you're done.

It seems like the boss is trying to cause an issue with this employee. Why does it matter now, when it's been in place for the last two years? She's going to retire in 2 years so she's expensive to pay, and she's the only female there. Hmm...

Has anyone ever experienced a situation where a boss has tried to overrule doctor's recommendation for a waiver? He hasn't gotten to that point yet, but why else would he "need" the information? Does one boss's non-medical opinion really trump the doctor's?

No, that's not necessarily enough because the employer might not or might no longer consider this to be a reasonable accommodation. If they feel that she cannot do her job with the restrictions placed upon her by her physician, they cannot allow her to work. I know I was once on a lifting restriction at work and I needed a letter from my doctor AND to be cleared by Occupational Health. If they disagreed with the restrictions or if my supervisor felt that I couldn't work within the confines of the restrictions, I wouldn't have been allowed to work. So I would say that you likely don't have to disclose the reason but that the employer also doesn't have to allow the employee to work.

[BrnEyedGirl, BSN, MSN, RN, APRN]

Perhaps this patient needs to consult with a lawyer. I can't imagine how knowing the diagnosis should matter to the employer. Is he insinuating that with a diagnosis he will somehow be more qualified to decide if not wearing the vest is necessary? Does he think he should be allowed to make the decision based on a diagnosis? It sounds like this employer is just being nosey! I could understand if this was somehow a work comp issue. I work in ER and if we place a patient off work for any reason other than a work comp injury we NEVER include a diagnosis or symptom, just that the patient was seen on such and such date and requires to be off work thru such and such date. I would love to hear how this works out!

[KittyLovinRN]

I could understand if this was somehow a work comp issue.

Hubby is a police officer, I asked his opinion.

It COULD become a work comp issue if she's not wearing the vest. The vest is designed to stop bullets, she could easily return to work after an incident if she's wearing the vest...not so if she's not wearing it. Not saying she would necessarily die but she would require A LOT of medical treatment and recovery time costing the department quite a bit of money.

[roser13, ASN, RN]

It's possible that this boss is following the rules more closely than his predecessor. To further your analogy, a vaccine refusal these days is a bit more complicated than just "signing a waiver." You must have a stated reason (i.e., egg allergy) in order to be waived, or seek employment elsewhere. I can certainly understand the employer's reluctance to allow an employee to put herself in harm's way (while opening the department up to a potential lawsuit) without knowing the exact reason why.

I agree that your patient may well need to seek legal advice.

[Esme12, ASN, BSN, RN]

I think that this is something the physician that you work for needs to negotiate and the legalities and paperwork. without knowing the policies and procedures of the department itself and the wearing of protective gear ....it is impossible to give an opinion.

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