In the last issue of The PBA Magazine, we identified ethical rules governing a physician’s conduct when acting as an “Industry Employed Physician” or “Independent Medical Examiner,” like the doctors at the department’s Medical Division and the Police Pension Fund’s (PPF) Medical Board. We explained that those medical professionals are charged with evaluating objectively the police officer’s health or disability and, to maintain objectivity, should not be influenced by the employer’s preferences.

Several situations, starting with the most egregious, highlight legitimate concerns police officers have about the present systems and processes. Specifically, they fail to insulate medical professionals in the NYPD and the PPF from the normal chain of command and other potential conflicts.

We recently had an officer who contended that he had developed a pulmonary condition as a result of line-of-duty exposures at two incidents. The officer applied for an accident disability retirement and appeared before and was reviewed by the Article II Medical Board, made up of three doctors. While his application was pending, the officer filed a civil suit against a private entity for injuries sustained in one of the incidents. In connection with the lawsuit, the officer was scheduled for an Independent medical examination to assess his condition. To his surprise, he was to be examined by one of the doctors at the PPF board, who only days earlier had asked him detailed questions about the incident and his medical condition in his PPF capacity. Did the doctor use information gained in the coercive setting of the board examination to aid the defendant in the civil litigation? At the minimum, the doctor’s appearance in both settings raised an obvious appearance of impropriety. While this appears to be a unique circumstance, the PBA maintains that doctors who work at the NYPD and the PPF should not be acting in other capacities that are potentially or actually detrimental to the interests of officers they examine in a departmental setting.

Another practice the PBA finds objectionable is when the NYPD brass issue memoranda and directives whose purpose and effect is to deprive NYPD and PPF doctors of the ability to exercise their discretion in considering the unique circumstances of an individual police officer’s case. These missives are disguised as “guidelines” directing physicians to return officers to full duty at a set date for a certain type of injury or illness. For example, the guideline may say that a police officer who suffered a broken bone should be returned to duty in “x” weeks.

Another variation (see graphic) is a memo that came a few months ago from Supervising Chief Surgeon Eli J. Kleinman reiterating to all district surgeons and clinic supervisors the policy “that all members of the service who are disapproved by the medical board and whose chronic condition has been deemed to have a fair or good prognosis are to be immediately returned to full duty, unless the member of the service has suffered a new injury or has undergone a recent surgery.” Is a finding of no permanent disability at the PPF akin to a determination that a member is fit to return to full duty? The answer is clearly no.

The PBA believes that directives of this nature are designed to deprive the examining physicians of the discretion to reach differing conclusions depending on the individual officers’ specific condition. Why is it that individuals who have undergone perhaps the most extensive and rigorous training of any professional require directives and “guidelines” to regulate their decision making? Do these same doctors apply these same standards when they examine patients in their private practices?

The PBA believes these types of directives potentially endanger the health and welfare of police officers and subject the doctors to claims that they have violated their governing professional standards. For this reason, the PBA has called on the department to rescind the policy.

Finally, we have seen department doctors, in response to police officers’ claims for LOD status in connection with WTC illnesses, advance positions that are remarkably similar to those being advanced by city lawyers on WTC-related issues. For example, department doctors have claimed that there is no relationship between a condition called sarcoidosis, which affects at least 22 of our members (based on self reports to the PBA WTC registry), and exposures at the WTC. According to department doctors, there is no “scientific” proof of a link. Now, even after a city autopsy linked sarcoidosis with exposures at the WTC, and other medical studies have reached similar conclusions, the department continues to maintain that there is no proof.

We have seen similar positions advanced by department doctors about other conditions that our members and their physicians say arose from WTC exposures. Should department doctors aid the city’s efforts to limit liability from WTC exposures or should they be neutral arbiters on issues such as causation, perhaps even erring on the side of finding causation, consistent with the public policy of the state to presume that certain illnesses are connected to WTC exposures? To the PBA, the answer is obvious. Again, the PBA has serious concerns about the possibility that the City’s WTC — related litigation strategy is driving Departmental decision-making in the area of health and treatment for our members. For that reason, the PBA recently sued the City on behalf of a member suffering from sarcoidosis as a result of WTC — related exposure. That case is pending in Supreme Court, New York County. In conclusion, the PBA believes that doctors practicing in the NYPD and at the PPF should be held to the same standards as doctors practicing elsewhere. Practices that serve to interfere with the doctors’ individual exercise of discretion or that violate ethical or other rules of the medical profession should be abandoned. Doctor’s discretionary judgments should not be influenced by budget, policy or operational concerns of the City or Department.