Hi Alan,

Firstly I would agree with your view that, in view of his LFTs, he is likely
to still be drinking heavily.

It is problematic if you do not have a policy in place that covers such
eventualities since the employee could sight discrimination.  This is why I
always find robust policies are essential.  The policy then should be
mentioned within and form an integral part of the contract of employment.

Saying that I did have a similar situation during my OH practice with a
previous employer where we had no drugs policy.

I was managing a guy who was a carpenter and had been diagnosed with
Bipolar.  We eventually got him back to work following assessment and
medication but his symptoms were often exacerbated by the use of cannabis
leading to absence.  Clearly a manic man with a chisel can also be safety
critical!

In the end what we did, in addition to education and support, was agree with
him that to aid the management of his condition we would undertake random
urine drug screening.

We developed a consent form for this which basically stated that he agreed
to the testing, as part of the management of his condition, and that if
positive results were found that this information could be released to his
line management team to that effect.

It worked very well.  He abstained from cannabis us and found the overall
package to be beneficial to him.

I am not sure if your employee would agree to such a programme but, as you
say, if he does not then you would have little choice but to restrict him
from safety critical work.

I hope that this helps.

With my very best wishes,

Stuart.
----- Original Message -----
From: "Swann, Alan B" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, December 12, 2002 6:59 PM
Subject: montiring for poossible alcohol misuse


> Dear all,
> Your esteemed opinions please: am I going too far?
>
> I was referred an electrician for fitness assessment because of recurrent
> short-term absence. He ascribed much of this to depression &  'stress'
> caused by his new manager. He was aggrieved that a newly appointed manager
> wanted him to let the manager know he was in each day and what work he had
> on!
> He stated that following a month's treatment with an anti-depressant from
> his GP things had settled and he was fine. Certainly he was not clinically
> depressed at the assessment. I've advised he is fit to reliably attend
work.
> Asking about alcohol, he told me he used to drink heavily, including 3-4
> pints at lunch-time but had cut down in recent months to 3 pints at night.
> None during the day.
> His GGT is over 500, with moderate elevation of ALT, Bili & ALP.
> I think it is likely that he is still drinking heavily & may possibly be
> still drinking during the day (though no evidence at clinic assessment) If
> he is, I consider him a safety risk: if under the effects whilst at work
he
> may mess up wiring.
> I've said that I want to see him after Christmas to recheck LFTS. If his
GGT
> is falling then fine, it fits with his story of reform and he's fit. If
> still elevated, I want to check for evidence of him being under the
> influence at work by checking his breath alcohol. I've told him this and
> that, if he refuses, I'll advise his manager that he is unfit for safety
> sensitive work until I have more information (I'd get him referred via his
> GP to a liver specialist & ask for an opinion.)
>
> Is it reasonable for the company MO to impose & implement a random test
> regime in this situation, or am I getting into a policing role that I
> shouldn't be?
>
> Our current alcohol policy (written by a well-meaning but tee-total
> Methodist academic!) does mention no drinking on safety-critical tasks but
> nothing about any monitoring procedures.
>
> Your thoughts please.
>
> ps Colophony solder: Thanks for the myriad of esponses We're going to
survey
> known current users & ask about levels of use (time & amount used),
current
> control measures, symptoms & LFTs. Once completed e'll use this info to
help
> produce guidance on control measures & to set a pragmatic level for
periodic
> health surveillance.
>
>
> Dr. Alan Swann, BM, AFOM
> Director of Occupational Health
> Occupational Health Service
> Imperial College Health Centre
> Watts Way
> London
> SW7 1 LU
> Tel:    +44 (20) 7594 9385
> Fax:    +44 (20) 7594 9407
> http://www.ad.ic.ac.uk/occ_health/ <http://www.ad.ic.ac.uk/occ_health/>