Office of the Secretary Human Capital and Diversity Office of Occupational Safety & Health Occupational Health and Medical Programs Division 1 Presented by Bob Garbe MPH, CIH

Medical Clearance Programs 2

3 Organization  DOI is an amalgam of 8 “Bureaus” with widely Diverse Missions.  5 (NPS, BLM, FWS, BIA, BOR) have Law Enforcement Officers  4 (NPS, BLM, FWS, BIA) have Wildland Firefighter  Other Job Classifications include Inspectors, Vessel Crew, Divers, ETC.

4 Organizational and Authority Structure  DOI Office of the Secretary, Assistant Secretary for Policy Management and Budget.  Deputy Assistant Secretary, Human Capital and Diversity  Office of Occupational Safety and Health Office is responsible for Medical Program and Policy, but does not dictate the implementation of program beyond wide policy concerns. GUIDANCE CONTAINED IN: Occupational Medicine Handbook

5 Medical Clearance Program Development and Implementation  Development - Team approach involving Subject Matter Experts in Safety, HR, Medical from both DOI level and bureau, including individuals working in candidate job classification and union representation as appropriate.  Implementation – Is the responsibility of the implementing agency, with generous offer of help from DOI including assistance with contract solicitation, consultation on Medical Review Boards, etc.

6 Medical Clearance Program Development and Implementation  Development In design and approval of Medical Standards and Medical Clearance Programs, DOI recommends a team based approach using Subject Matter Experts in Safety, Occupational Medicine, Human Resources, AND the work field of interest. This includes real time observation of the conditions of employment in an actual operation setting. The work product if such efforts are the Medical Standard itself, a “basis document” outlining the basis for the different elements of the standard, a “Job Table” summarizing the important facets of the work, and conditions under which the work is done, and the elements of a recommended medical examination and medical form(s).

7 Medical Clearance Program Development and Implementation  Implementation Implementation is the responsibility of the agency and can vary widely but within the boundaries of good medical practice and consistent with business necessity. DOI only steps in (recommends, cajoles, threatens, whines, etc.) if implementation in one agency jeopardizes the legal defensibility of the standard in another. Wide discretion and creativity is frequently needed to balance the needs (perceived or real) of the agencies and the boundaries of good medical practice.

8 Medical Clearance Program Development and Implementation  Problems Frequent perception is “just send then to their doctor to see if they can do their job” WIDE variety in medical data quality depending on source of medical support.  Send individual to personal physician with form and voucher.  Send individual to “doc in the box” with form and voucher.  Arrange contract for locating medical services, providing exam and reviewing results.

9 QUESTIONS Robert J Garbe, MPH, CIH (303)