1. Office of Medical Services Medical Structures and Functions in the FBI David S. Wade, MD, FACS Chief Medical Officer of the FBI 10 Jun 13

2. Office of Medical Services UNCLASSIFED

3. Office of Medical Services Workers’ Compensation Unit (WCU) Health Care Programs Unit (HCPU) Employee Assistance Unit (EAU) Office of Medical Services Chief Medical Officer Human Resources Division (HRD) Composed of Six Sections A strange place for medical …. UNCLASSIFED

4. Office of Medical Services The Main Thing The principal focus of OMS is READINESS It is our raison d'être UNCLASSIFED

5. Office of Medical Services OMS Mission Optimize the health status of the workforce to enable and enhance FBI mission accomplishment

6. Office of Medical Services Health Care Program Unit Principle Responsibility –Responsible for a medically ready force (Fitness for Duty) –Responsible for a ready medical force (Operational Medicine) Other functions –Operates two outpatient clinics –Drug Deterrence Program –Wellness UNCLASSIFED

7. Office of Medical Services Fitness for Duty (FFD) Necessary for Special Agents and select Professional Staff positions. Critical element of maintaining a “fit and healthy force” FFD exams performed by security-cleared contract vendors and FOH FFD exams forwarded to FBIHQ for processing Make determinations concerning the ability to carry out the requirements of the position.

8. Office of Medical Services The Challenge Federal Law Enforcement has the requirement for individuals who can engage in vigorous, demanding activity. The duty of organizational physicians/nurses is to ensure a medically ready force. ADA/Rehab Act pushes against the above vectors. UNCLASSIFED

9. Office of Medical Services Job Task Analysis A critical element in our current era of regulations and litigation Must be done with a rigorous, scientific methodology to withstand legal challenges Time consuming and costly Could there be a core set of essential functions for Federal law enforcement? UNCLASSIFED

10. Office of Medical Services Medical Mandates Program Program for Special Agents (SAs) that is the FBI equivalent of the military’s Limited Duty Boards, Medical Boards, and Physical Evaluation Boards Used when agents become ill or injured and are not able to perform essential functions of the Special Agent position Medical Mandates Evaluation Board, composed of senior SAs at the SES level, makes fitness for duty recommendation to DAD of HRD UNCLASSIFED

11. Office of Medical Services Program Impact (Summary: 122 MMEB Cases) Reduction in time to recommended administrative action from 8 years (2003) to 32 months (2012) 75 (61%) Returned to Full Duty (Exc. to Policy: Substandard Vision [10], Anticoagulation Risk [16]) 30 (25%) Normal Retirement 8 (7%) Medical Disability Retirement 5 (4%) Pending or Referred to Directors Office 4 (3%) Deceased/Removal 122 (100%) UNCLASSIFED

12. Office of Medical Services Psychological FFD Psychological FFD managed by Health Care Programs Unit (not an EAP function) Assess the mental fitness to safely perform essential functions and ability to hold a security clearance. Ordered when employee exhibits... “otherwise unexplainable irrational, bizarre, or aberrant behavior or conduct, preventing performance of essential functions or calls into question employee’s trustworthiness to maintain security clearance.”

13. Office of Medical Services Operational Medicine HCPU manages program of providing medical support to FBI tactical operations Based on military special forces model –Operator/medic ~400 OPMED personnel ~80:20 ratio of BLS to ALS Utilizes TCCC principals Provides medical services while subjects in custody Care Under Fire course during New Agent Training (self care and buddy care) UNCLASSIFED

14. Office of Medical Services Workers’ Compensation Unit Complicated, highly regulated program directed through the Department of Labor Mission is to get the injured employee back to work The FBI’s WCU is one of the most cost efficient programs in the Federal Government. –FBI is an organization of 37,000 employees, 14,000 of whom are Special Agents –~1,100 new claims filed each year –Annual “charge back” to DOL is ~$14M UNCLASSIFED

15. Office of Medical Services Employee Assistance Unit Exists to help employees with life stressors so they can better perform their jobs Workplace conflicts, family conflicts, grief, mental illness, financial stress Crisis Intervention Program –Help divisions deal with crises –Horrific crime scenes, co-worker deaths, manmade or natural disasters

16. Office of Medical Services Employee Assistance EAU Employee Assistance Program Crisis Intervention Program Chaplains Program Be all you can be! Peer- based system UNCLASSIFED

17. Office of Medical Services Why People Utilize EAP Problems at work – 26.4% Emotional cases – 20.1% Family issues – 11.6% Marital – 8.2% Financial stressors – 6.6% Grief or loss – 9.1% Management Referral – 7.0% FY 12 Utilization figures UNCLASSIFED

18. Office of Medical Services Questions/Comments?