Part 2: Fitness for Duty and Mental Health

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Brent,

Here is the sad story you asked about. Although this case is only binding law in the 7th Circuit, it gives lessons for all of us.

The plaintiff in this case, Painter, worked for the Illinois Department of Transportation, also known as IDOT. She worked for the IDOT and the IDOT fired her. (Am I the only one whose brain keeps trying to add another “I” to this word?) Was this a stupid move? It all turns on the medical evaluations.

Painter apparently had social issues, or even personality problems. Coworkers complained about her constantly. She was possibly bipolar, paranoid, or had hypomania. She kept detailed logs about her (negative) interactions with coworkers. People were afraid of her and didn’t want to hang out with her.

So how did the IDOT respond? They ordered her to take a fitness for duty evaluation. She passed. However, the psychologist recommended reevaluation in 45 days, at which point he referred her to a mental health specialist. She started treatment with that specialist, so there was actually no report made back.

The next year, when she was transferred to another division, she again had trouble with coworkers. She continued to email her boss frequently and kept her log. IDOT put her on paid administrative leave and had her see a psychiatrist. He cleared her to return to work (without ruling out mental illness).

When she returned, people complained because she was argumentative. She made some people fearful, including her union rep. She was evaluated a second time by the psychiatrist, who concluded she was paranoid and unfit for duty. IDOT terminated her, and she sued, saying that IDOT violated the ADA by compelling her to take medical examinations (specifically, the psychiatric examinations).

The court looked at the legal requirements for a forced medical examination.

First, compelled medical examinations must be job-related and consistent with business necessity. What does that mean? An employer must have a reasonable belief based on objective evidence that a medical condition will impair an employee’s ability to perform essential job functions or that the employee will pose a threat due to a medical condition.

The court agreed that these conditions had been met, as Painter snapped, screamed, ranted, and behaved unprofessionally with everyone, as well as being paranoid, which is a risk factor for violence. Inquiries about psychiatric health are permitted, if they reflect concern for safety of others or the public. Even multiple exams are permitted, such as in this case. Ultimately, her case was dismissed.

How Would This Case Apply to Missions?

The toughest ADA cases are probably the ones that involve mental health issues. If an employee is potentially a threat (to others or self), it is pretty simple. You can require a medical/psychological examination. So if a missionary is suicidal, or perhaps a threat to the team, or her children, that would be a good reason to have an evaluation ASAP.

If the employee cannot perform essential job functions, you can have an evaluation as well.

But what are your essential job functions? Do they include getting along with coworkers or the team? Communicating in certain ways? Showing certain levels of spiritual maturity? Producing a certain amount of work? Once again, we see that to require performance of essential job functions, we must know what those are.

Brent, your second question relates to whether people who feel coerced do as well in psychotherapy—or perhaps a corollary question of whether therapists do as well when they have to treat these people! It seems that it may be a good practice to separate the fitness for duty medical/psychological evaluation from treatment. This could solve both problems, as people would possibly have a different attitude towards the treating provider, as opposed to the one doing the FFD evaluation.

The provider who evaluated this lady and then treated her did not provide the evaluation to IDOT. So I am throwing a question back to you. Would it be a conflict of interest, in your view, for someone to do an FFD evaluation, provide the employer a report, and then treat the patient? Under what circumstances would it be a conflict or not?