Voluntary Medical Support of a State Police Agency:

Challenges and Opportunities

IACP

October 26, 2014

Dr. Bradley S. Feuer, Esq.

Chief Surgeon

Florida Highway Patrol

FHP Troop Surgeon Program:Defining the Medical Unit Intent

Afford physicians opportunity to volunteer community service and serve the citizens of the state

Method Utilize existing structure, function and scope of auxiliary

as entry point to facilitate sworn status

Vision Statement The members of the voluntary medical unit are

committed to:

Volunteering time and effort to the FHP Maintaining certification as auxiliary troopers* Working to advance the health and safety of the individual

troopers and troop as a whole Providing services with professionalism

*New, non-sworn status pathway may allow physicians to join without need to maintain certification

Program History 2001: Approached FHP 2003: Sworn in as Auxiliary Trooper 2005: Policy Approved 2006: Troop Surgeon Program Launched 2010: Troop L Demonstration Project Deemed

Success; New applicants sought 2012: Troop Surgeons sworn/appointed

Troops F, L 2014: Troop Surgeons being appointed

Troops D,E

Dr. George F. Chandler First Superintendent of the Department of State Police

for the State of New York Surgeon and soldier, with no previous police training or

experience Coined the name State Trooper Introduced many innovations including the wearing of

pistol on a belt outside of uniform. Organized first police school in the nation to be certified

by a state education board. Resigned as Superintendent to return to medical

practice

VOLUNTARY MEDICAL UNIT:CHALLENGES

LIABILITY

2005 Florida Statutes Title XXIII

MOTOR VEHICLES Chapter 321

HIGHWAY PATROL

321.24(5) Notwithstanding any other law to the contrary, any volunteer highway patrol troop surgeon appointed by the director of the Florida Highway Patrol and any volunteer licensed health professional appointed by the director of the Florida Highway Patrol to work under the medical direction of a highway patrol troop surgeon is considered an employee for purposes of s. 768.28(9).

RECRUITING QUALIFIED, COMMITTED VOLUNTEERS

INTENT/MOTIVATION

Feuer’s Rule of Volunteerism People generally volunteer for one of three

reasons: Seek Personal GainEmotionally Unstable or Personality

DisorderAltruistic Tendencies*

*What we are seeking!

Leadership ExperienceLaw Enforcement/Military Background

PreferredAvoid “political appointments” and

paper prestige

Recruitment Goals

Minimum Requirements-Troop Surgeon

Board certification in specialty Healthcare leadership and management experience Proven respect of peers Demonstrated effective and productive communication skills Demonstrated knowledge of and familiarity with healthcare

resources Desire to donate time and resources to attend to the needs of the

Troop, including 24/7 availability and attendance at local and distant meetings and training

Clear medical license Clean malpractice closed-claims history

BACKGROUND SCREENING

Background Screening Includes

Full criminal background (including sealed/expunged)

Interview with spouse, neighborsDrug screenPsychological TestingPolygraph

Required Application Documents Include:

High School DiplomaCertified Driving Records from State

DMV of every state ever licensedAll materials that would be required

of application to a medical staff

Advantages of Sworn Medical LEO

Safety during tactical operations Training Operations when rescue transfer may not be

available or tactically feasible Enhance ability to evaluate operations and make

health and safety recommendations to administration

Depth of training and recertification commitment ensures high level of commitment/motivation

Sworn Status

Required for TS serving as members of TRT or other specialized operational teams

Requires minimum of one year riding in the right front seat with a trooper for at least one 8-hour shift per month. Thereafter, sworn troop surgeons should ride at least one 8-hour shift per calendar quarter.

Challenges of Sworn Pathway

Enhanced Screening Requirements Basic Aptitude Test (BAT)* Physical Agilities Test (PAT)* Medical Exam, including height/weight

Training 319 hours

Continued Recertification

Addressing the Challenge of Training Commitment: Non-Sworn Alternative

Non-sworn pathway

Same application process, Background investigation, PAT, Polygraph process and medical credentialing as sworn

No formal training or enhanced screening requirements Minimum one 2-hour observational-only "ride-a-long"

required per calendar quarter.

POST-APPOINTMENT IMPLEMENTATION CHALLENGES

Troop Surgeon Activation: Overutilization Direct calls from troopers regarding personal and

family needs e.g., uncle in town with chest pain

Calls from command regarding extended medical issues e.g., health needs of traffic victim

Solution Activation only by command

Activation limited to direct trooper issues

Troop Surgeon Activation: Underutilization Limiting activation to command necessitates proper

mindset of commander as well as relationship in which commander will call during off hours Command must be personally comfortable enough

with surgeon to call when needed 24/7

Command must be educated as to scope and function of Troop Surgeon program

Over-Recruitment

Members of command may be quick to refer their private physician as a “reward” or “honor” Limit appointments to need of troops Maintain strict credentialing and commitment

standards

OPPORTUNITIESREALIZED

Florida Statutes 401.30 (4) (e) deems discussions during a critical incident stress debriefing to be considered privileged communication under s. 90.503. Under F.S. 90.503, a person who consults, or is interviewed by, a psychotherapist, or person authorized to practice medicine, for the purposes of diagnosis or treatment, has a privilege to refuse to disclose, and to prevent any other person from disclosing, confidential communications

CISM Team Leadership and Statutory Protection

CIPS

Development and Operations of Critical Incident Peer Support Team Team formed, trained and operational

Troop-> Region-> Model for state Coordinated multiple call-outs including:

Suicide Post Hurricane Stress Line of Duty DeathOff-Duty DeathsDeath of Trooper’s Children Trooper Involved ShootingsMass Casualty Incidents

Chief Surgeon Called to Scene When Five Killed in Florida Turnpike WreckTuesday March 13, 2007

ST. CLOUD, Fla. -- Heavy fog caused a 13-vehicle wreck on Florida's Turnpike that killed at least five people Tuesday and included a fire truck and sheriff's cruiser headed to an earlier crash, officials said.

Four others were injured, Osceola County spokeswoman Niki Whisler said, with two airlifted for treatment, including a sheriff's deputy.

Smoke from nearby brush fires mixed with morning fog had caused the first wreck; the second wreck happened just after 8:30 a.m. when a patch of fog quickly appeared on the road. The victims were from three different vehicles -- a Chevrolet Trailblazer, a BMW and a tractor-trailer.

"According to witnesses, the fog rolled in between the two crashes," he said. "Before the smoke cleared from the second crash it had rolled out."

Officials shut down a 51-mile part of the turnpike to work the accident. Portions of that stretch were also closed Monday because of brush fire smoke.

The accident happened at mile marker 209 in southern Osceola County.

Improvement inTrooper Health Reduce Absenteeism and Sick Days

Initiate educational programs on health and wellness, including smoking cessation, exercise, weight loss, nutritional guidance and stress reduction Multiple Presentations at District Meetings Health Screenings

Offer house and hospital visitation for sick troopers

Trooper Education Enhance troopers’ knowledge of medical issues

pertinent to duty Presentations at District Meetings

Post-HurricaneH1N1 Communicability of infectious disease Health maintenance

Regular Articles in state PBA Magazines Roll Call; The Florida State Trooper

e.g. Influenza, Diet, CISM

Medical Care Fostered relationships with area hospitals

Hurricane Sheltering Hurricane Escorts

Facilitated access to hospitals and physician practices

Established relationships with trauma centers Facilitated university and community

consultation in complex cases. Hand surgeon Emergency neurosurgery consultation

PPE Screening

Escorts: Evacuation of Patientsin Advance of Hurricane; Materials and Personnel Post-Hurricane

Emergency Care Facilitate provision of the highest quality of care to

troopers when injured in the line of duty Surgeons on call 24/7 to respond to injured

troopers; coordinate medical care with treating physicians

Serve as liaison to facilitate communication between injured troopers (and their families) and medical teams Numerous call-outs, responding to area hospitals for

acute illness and injury

Resource to Command on Health Issues

Auxiliary trooper fitness for duty BOI in steroid abuse investigation Medical aspects of agency policies

e.g. IFAKs, Narcan Multiple background memoranda to state attorney on

“drug-cocktail” impairment, leading to prosecution of cases that were going to be dropped. Result: Plea bargains to include jail time and fines

Represent Patrol Serve as Patrol’s Community Representative on

Issues Pertaining to Healthcare: Interface with state and local medical societies

Attended meetings of PBCMS, FMA, HERCMet with local, state and federal legislators Interacted with hospital administrations

Trooper identity issueRequest for transfer escorts

Law Enforcement Memorial Keynote speaker at Broward County Law

Enforcement Officers’ Memorial Service at Broward Community College’s Institute of Public Safety

FHP Troop Surgeon-Palm Beach County Schools Multi-Year Seatbelt Project

Facilitated distribution of holiday gifts, from aux troopers, to hospitalized children

Medical Direction TRT/SRT

Provide immediate advanced field medical support, including administration of intravenous fluids and medications, to members of Tactical Response Team Troop Surgeon serves as Medical Director of TRT DMO has attended SWAT school, is embedded with TRT,

acts under medical direction of Troop Surgeon Troop Surgeon on alert for all training and operations Future involvement of sworn Troop Surgeons

Troop Surgeon: Life Saver

Program Development

Surgeons now/pending: D (ns) E (ns) F (ns) L (s)

Candidate applying for: K (s) C (ns)

Thank you!