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Morphine Pumps and Driving Apparatus

Today’s burning question: I am a firefighter paramedic in a volunteer fire department. One of our ambulance drivers  was recently put on a morphine pump, and many of us are concerned about whether he should be allowed to drive, or even respond at all. The fire chief and the fire board are allowing it because he has a note from his doctor. Is this legal?

Answer: Let me ask the same exact question, but in a different way:

I am a volunteer ambulance driver and unfortunately I have a morphine pump. It is a low dose – so low that my doctor has concluded I can still drive and more importantly still drive the ambulance. The fire chief and the fire board have reviewed my doctor’s note and are allowing me to drive. However some members are complaining and are trying to get the department to make me stop driving. If that happens can I sue them and the department for violating my rights?

Which of these two questions is the correct question?

All kidding aside – if his doctor knows he drives an ambulance and says he can safely do so with a morphine pump, I am not sure the department can stop him without violating the American’s with Disabilities Act, and probably state disability discrimination laws as well.

Personally I am astounded that a doctor would say that someone with a morphine pump can drive an emergency vehicle – but that being said – it is not the chief or the fire board’s role to overrule the doctor. One thought might be to have the department doctor (assuming you have one) contact the member’s doctor just to confirm the note is accurate and that the member’s doctor understands the demands of the position. NFPA 1582, Standard of Comprehensive Occupational Medical Program for Fire Departments, would be a good resource for the doctor to use in making the determination.

Comments - Add Yours

  • John K

    Curt – many patients can tolerate and function perfectly well with low doses of morphine in either oral form or infused through a pump. However most of those individuals are not driving emergency vehicles, operating power equipment or working at heights. In my current arena, employees on a narcotic medication are not allowed to work due to the inherent danger of their jobs and the potential for injury. They are usually placed in a light duty function until the medical condition clears and does not violate the ADA. This current issue is an “accident waiting to happen” scenario. The issue is possibly a lack of a comprehensive department policy related to working while taking any form of a narcotic pain medication. If an employee has a medical condition requiring a morphine pump it would appear a rational administration of policy (if the organization has one) to prevent driving an ambulance and not violate ADA. Possibly an administrative non driving position until the medical condition has resolved. Does that mean a patient care, non driving position? That too may have some challenges. This certaily would warrant a call to the Physician to discuss the alternative possibilities. Can the Chief call the Physician to discuss the employee’s medical information and not violaate HIPAA? I suggest a release from the employee first to allow the conversation between the Chief and the Physician to occur although the EE has disclosed his medical needs to the department. As far as I am aware, all states prohibit driving under the “influence.” This is a tough challenge for the department. I like Chip’s comment about a Department’s physician although those are rare as hens’ teeth. Great question.

    • http://firelawblog.com Curt Varone

      Thanks John

      Great info. I understand that most departments do not have a department doctor – but this is a perfect example of why a department needs one.

      And what is that old addage – the time to find a good doc is when you are healthy, not when you are sick? A fire department trying to (a) find a good doc while (b) stuck in the middle of a case like this – is going to have a problem because the doc needs to understand what we do, have some familiarity with NFPA 1582, and be willing to engage in a dialogue with another doc about what is in everyones’ best interests. That is a tall order for a doctor you find in the Yellow pages.

    • http://emtmedicalstudent.wordpress.com/ Joe Paczkowski

      Driving under the influence and driving while taking a narcotic pain medication is not the same thing, just like drinking a
      (1) beer then driving a car is not driving while intoxicated.

      California has one of the strictest rules regarding ambulance drivers (term used as a crew position to mean the person driving the ambulance) and requires ambulance drivers to be certified. While I think, but not sure, that fire departments are exempt, ambulance drivers in California have to pass the same medical standards as commercial drivers (along with a written test regarding applicable vehicle code statutes and basics of emergency driving), regardless of whether they are volunteer or paid and EMT or non-EMT. In regards to narcotics, the exception to the ban on ‘schedule 1, narcotics, amphetamines, and other habit forming drugs’ is a physician’s note.

      This forces the question, if a person can drive a much heavier and a manual transmission tractor trailer for hours on end while on a low dose opioid pump, why not a much lighter and automatic transmission ambulance?

      Link to form DL51 which is required to obtain an “ambulance driver certificate” from the California Department of Motor Vehicles.
      http://apps.dmv.ca.gov/forms/dl/dl51.pdf

      Info on the cert: http://dmv.ca.gov/dl/ambu_drvr_cert.htm

      • http://firelawblog.com Curt Varone

        Thanks Joe

        There are so many possible medical conditions, meds, exceptions, etc etc – it makes sense to leave it to the docs on a case by case basis.

    • http://MSpumps Robert Cavanaugh

      I would rather be attended to by EMTswho are being treated for any painful condition, taking morphine onlyshows me he is in pain and knows what  severe pain is. In my opinion he will have more ampathy then most.I have no problem withit at all, myself in a serios medical plight sm tired of people thinking I am trying to get a ""FIX" Robert C.

  • jason

    not to be sarcastic but morphine is an opiate. Does this mean an individual can inject a low dose of heroin into their system and still drive an apparatus. Or a prescription for medical marijuana? A doctors note should not be end all clearance to perform high risk activities that may cause detriment to others. I completely understand the other side of the argument regarding violation of rights. Would a ruling from 3 independent doctors be an adequate solution? the medical control physician for the service? Do the local protocols have a stipulation against performing procedures and/ or patient care while impaired?

    I understand it is only a low dose metered pump. But if this individual causes an injury at a ruled at-fault accident I’m sure the plaintiffs’ attorney will attack this issue.

    • http://firelawblog.com Curt Varone

      Jason

      Sarcasm is welcome here – so no apologies required!

      I agree with your reasoning and it goes to the question of why would a doctor want to expose him/herself to the potential liability by saying someone on a morphine pump can safely drive an emergency vehicle.

      Interesting you raise the issue of 3 independent docs… In my experience once 2 docs get together they usually reach a consensus on what is safe (provided they are not experts in a suit on opposite sides) – but having a 3rd neutral would be a good idea.

  • CJ Ewell

    I suspect the pump in question is actually implanted to deliver a VERY low dose of morphine to the spinal cord at the level of a pain causing lesion. This uses a much lower dose that what you would ever push IV for a patient with MI.
    That being said, this individual is probably much safer and more able to complete his or her duties with the pump in place and functioning that without it and distracted and limited by chronic pain. But, no one would have a ‘problem’ with that individual working while in pain, right?

    • http://firelawblog.com Curt Varone

      Great point CJ

      There are alot of new medical advances we are not aware of… maybe when we find out we are concerned unnecessarily. Another reason to leave it to the docs to figure out.

  • chris g

    I have a fentanyl pump now and I drive daily. Implanted pumps are MUCH less sedating then oral or patches of pain meds. Its less sedating then benedryl. That’s why his doctor ok’d it. I would be the first person to stop driving if I thought I was under the influence, before I wouldn’t drive for over an hour with 1 beer in me. Pain pumps are extremely safe, unless it breaks while implanted (which is less likely then an airplane crash) then your fine. All the replys here are from people who don’t know about pain pumps, but I do. Fentanyl is 10x stronger then morphine and my doctor ok’d me to drive. Hopefully.this helps, this is my honest view. Pain pumps at low to moderate doses are not sedating. Pills and patches/lozenges are sedating even in low amounts. Goodluck.

  • Wanda Hurst

    My question is, should an individual with a spinal infusion pump, that is going on a weekly basis to have the amount of medication increased, and taking oral narcotics for pain, be permitted to drive an automobile at all?