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

• 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

None

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

• Health Insurance Portability & Accountability Act
– Privacy
– Security

• 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

• Electronic / Written / Oral Information
• 12 national priority purposes allowing disclosure of medical information

HIPAA applies to:
Doctors
Health Insurance Companies
Health Care Clearing House

• 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)

• Judicial & Administrative Proceedings
• Order from court / administrative tribunal
• Subpoena
• To protect the health and safety of inmates

• Cocaine/heroin/PCP
• Contagious
• Multiple (vs. 1 st ) DUI’s
• Homicidal
• Uncontrolled medical issue:
– diabetes
– seizures
– bleeding/clotting disorder

• Minimum Necessary
• To accomplish the intended purpose of the use/disclosure/request
• Not the whole record

• Genetic Information Nondiscrimination Act
• Acquisition of employee genetic information
• Unlawful
• If you already have it
– Keep it separate
– Not in regular accessible employee file

• Open the discussion
• This is first generation to DIE before parents

Poor Follow Up
RTW Without
Education
LEO’s
Illness/Injury causes improper RTW
Ill/Injured LEO’s get Hospitalized
Bad Discharge leads to Poor Follow Up
Complications
Delay Discharge
Hospitalized LEO’s get Complications

• Stress Levels
• PTSD / Depression
• Suicide Rates
• Divorce
On the Job Injury
&
Chronic Disease

• 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

• Your LEO’s get INJURED
• Your LEO’s are OBESE
• Your LEO’s get CHRONIC DISEASE

• Pursuit Issues
• Effecting Arrest
• Sprains and Strains

• #1 Cause: back injury / all cause injury
• Degenerative Joint Disease / Arthritis

• 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

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

Tobacco Abuse
Physical Inactivity
Poor Eating Habits
Obesity
Alcohol Abuse
Stress

• Off to the Hospital
• Vulnerable / Unprotected
• In Danger

• Hospital Acquired Infections
• Wrong Drug / Wrong Dose
• No Planned Follow Up

Hospital Acquired Infections
Skin / Soft Tissue
Blood
Urine
C. difficile Diarrhea
Ventilator

Medication Error
Wrong Medication
Wrong Dose

Poor / No Discharge Plan
No scheduled follow up
Poor pain management
Prescription compliance

RTW With
Illness/Injury
Education
LEO’s
Illness/Injury
No Complications + Liaison
Timely/Proper Discharge
Ill/Injured LEO’s get Hospitalized
Intervention
Mitigates Complications
Liaison provides
2 and 3
Intervention
Hospitalized LEO’s get Liaison

• Role is to standardize the process and improve care rendered
• Must have some medical knowledge
• PS/Occ Health/PA/NP/RN

• 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

• 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

• 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
• 1 st year follow up- doing great!

• 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

• 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

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

• 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

Are Productive Cops!

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

• 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

• 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

• Department Specific Data
• Unit Specific Data

• 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

• Sarah.Gamble@GreenwichCT.org
• 203-962-1009 office
• 11 Bruce Place / Greenwich / CT / 06830
• www.PrecinctMedicine.com