Case StudyOccupational Health and Safety

Medical Intervention in Performance Issues

By October 30, 2008 No Comments


Case Presentation

A 49 year-old lead electrician, who had been employed for six years on an petroleum drilling site, received an unsatisfactory performance evaluation due to lateness. During a counseling session this employee claimed that medical problems were the reason for his lateness.

Clinical Evaluation

In a clinical evaluation on January 7, 1999 the following information was gathered. This employee has been late 6 times in the last year, 4 times in the last 3 months. All latenesses were over 2 hours. Employee was also noted to fall asleep during meetings.

Past medical history was positive for a history of low blood sugar in 1981, and a history of allergies and asthma

Employee denies current drug use. Does drink 2-3 beers/night. Medications include: over-the-counter cold tables, vitamins, antihistamines and asthma inhalers.

The physical exam was unremarkable.

Assessment at medical evaluation

Tardiness to work, drowsiness at work, the etiology is unclear.


Fasting chemistries

CBC -to rule out medical causes

Thyroid panel

Urine drug screen

Employee was put off work pending results of the above tests.


All blood work was within normal limits.

Drug screen was Positive

Amphetamine: 5474

Methamphetamine: 23577

Confirmed by GC/MS


Medicine review is significant for Vicks inhaler use. Employee denies drug use. The medical department referred employee to the Employee Assistance Program (EAP) for evaluation and treatment of possible over-the-counter medication abuse.


A return to work drug screen performed by medical on January 21 was negative. Employee returned to work on January 24. The supervisor called for a follow-up medical evaluation on February 6, when the employee was again very sleepy. A repeat drug screen and evaluation were performed.

The physical exam was negative. A repeat drug screen was done on February 6 with the employee off work pending results.

The results of the drug screen registered positive for Methamphetamine: 1734 and Dextroamphetamine: 571. Results could be consistent with inhaler abuse, so a special test for drug isomers was requested. In illegally manufactured amphetamines and methamphetamines the L (levo) forms of the drug are present.

The Isomer results received February 22 were L-methamphetamine – Negative, D-methamphetamine – 1813. The D-isomer is the illegal form

Current Status

Management was notified of the positive drug screen. Employee continued to deny drug use and refused further counseling. He was terminated on March 7.

Importance of medical evaluations

Medical evaluations of performance problems are invaluable because they can help sort out the root cause of employee performance problems. These evaluations can rapidly determine if there is a medical emergency present, and if employees are a danger to themselves or others. Employees can then be quickly routed to appropriate medical intervention. Sometimes, substance abuse is involved. Medical evaluation can make that determination. The medical department can then make appropriate referrals and follow-up for return to work and random drug testing.

The bottom line is: medical evaluations are an integral part of KEEPING THE WORKPLACE SAFE.

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