Redress of Grievance – Mega thread [MERGED]

[MedCorps]

MedCorps,
CF H Svcs Gp Instruction 5020-20 Disclosure of Personal Health Information
CF H Svcs Gp Instruction 5020-26 Unacceptable Use and Disclosure of Personal Health Information
Is there more of a description of these somewhere?

Hop on the DWAN.  On the CMP // CF H Svcs Gp page you will find a policy page.  They are all in our policy repository. 

Cheers,

MC

 

[MedCorps]

It would be interesting to hear from the medical side how they would even deal with high-blood pressure... I mean its one thing to fail a medical but its another to give restrictions / etc. Does everyone with high-blood pressure need medical restrictions? TCATs? Was this person's blood pressure so severely high that just having them walk out of the clinic put them at risk of a heart attack? Too many questions.

Curious though, if the member didn't leave with a chit that had MELs on it, what are the limitations listed on the TCAT?

I will take a swing at this.  Someone with more recent / extensive CDU time feel free to jump in....

So someone has high blood pressure.  The question that needs to be asked is... does this members high blood pressure:

1. Restrict their geographic employment
2. Restrict their occupational employment

Geographic Employment:

So if the treatment of the high blood pressure is going to:

1. Require a scheduled follow up more often then 12 months but no more frequently than every six months.
2. Require anti-hypertensive medications, where the the unexpected discontinuance will not create an unacceptable risk to the member's health and/or safety.
3. Require a specific medical evaluation before being sent on a tasking.
4. Be an assessed risk and level of care required equates to a “Green” area on the Medical Risk Matrix

See here for the risk matrix: http://www.forces.gc.ca/en/about-policies-standards-medical-occupations/caf-medical-risk-matrix.page

Then they are going to go from a G2 to a G3. 

If the treatment of the BP is going to:

1. Require monitoring more than ever 6 months
2. be an assessed risk and level of care required equates to a “Yellow” area on the Medical Risk Matrix. This could come into play if the hypertension is co-existing with some other medical conditions.

Then they are going to go from a G2 to a G4.

Occupational Employment:

If the BP does not affect the member from fully participating in common military tasks then they will remain a O2. 

The management of hypertension (high BP) has a bunch of modifiers but most importantly how high is the BP. In the absence of end-organ damage you are going to want 3-6 sequential BP measurements over a period of weeks a few months so you can make a definitive diagnosis.  As such a G4(T6) while you are doing the work ups. 

For stage I or II hypertension you are going to want treat it with some lifestyle modification (weight loss, eating, salt restriction, exercise, alcohol reduction), try some medication(s) to lower BP and maybe do some more diagnostics to rule out some other less common serious causes.  Again, you are going to want to see the patient again within 6 months so you can see if the BP is decreasing, check for medication side effects, see how they are doing with lifestyle modification and possibility conduct additional workups for something more sinister or a secondary cause. As such a G4(T6). 

If lifestyle modification alone reduces BP back to normal levels then the person can resume G2O2.  If medications stabilize the situation then G3O2 is likely fine.  If you cannot get the BP under control, they have situations of hypertensive urgency, have co-morbidity then a more restrictive category is likely warranted.

What you do not want to happen is a person who has stage II hypertension to starts a new medication and because they are not on T-cat the chain of command sends them off somewhere on tasking and you do not get a chance to frequently monitor the BP reduction progress and adjust as required. Maybe it is working, maybe they still have hypertension and the medication is not touching it or maybe it is making them hypotensive, with a low BP. A worse situation is that you start a new medication and the person is sent off and develops an adverse reaction to the medication (such as metabolic complications). The T-Cat just limits your geographical employment until we know you are good to go again. The member not on T-Cat is employable within the full confines of their permanent category by the chain of command. 

I hope that is of some interest / help.

MC

 

[Gunplumber]

Ok I am just about to give up helping this guy. The Redress has been written. He has gone through all the process material. All he needs is proper references as his were too generic. This is what we are asking.
Remember this is a Class A reservist. He is not going to get follow on treatment or anything. He is trying to write a redress that will have some impact. 'what is the redress sought' He can not ask for the job as it is gone. He cant ask for money as he didn't get the job. He cant get medical care because he is Class A, he can not get medication as he is Class A. He has to grieve the things that can get "redress sought" like the dissemination of his personal information. The only things he can realistically seek on this redress is that the MO and CDU did things by the book and then if not, he wants them to be admonished for not doing it.
Questions:
Can the Tcat be redressed? ie It is the MOs opinion that the BP was a problem for the job even though before and after the appointment the members BP is in normal ranges.
Should the CDU have given out the members Tcat or just the limitations?
Should the CDU have given the employer the Tcat info before sending it to the member or his unit?

 

[ModlrMike]

Questions:
Can the Tcat be redressed? ie It is the MOs opinion that the BP was a problem for the job even though before and after the appointment the members BP is in normal ranges.

Highly unlikely. Much would depend on the specific clinical information the decision was based on, ie: how high was the BP to start with. There's a distinct difference between 150/95 and 200/100. Contesting the MO's opinion is a very challenging task.

Should the CDU have given out the members Tcat or just the limitations?

They're part and parcel of the same thing. The CF 2088 provides both the category and the limitations, because the later is based on the former, and it's a two part system.

Should the CDU have given the employer the Tcat info before sending it to the member or his unit?

It shouldn't matter. The distribution of the CF 2088 is top down. That being said, under ideal circumstances the member should have been aware of the TCat and limitations prior to leaving the MO's office. I find it unusual that they were not. It was always my practice to inform members if I were recommending changes to their categories or limitations prior to them leaving the office.

Notwithstanding the TCat and limitations, the employer still has the option to ignore the medical advice and accept the risks associated with that decision. One of the cornerstones of the MEL process is that the medical folks lay out the limitations, and the employers manage the personnel IAW those limitations. The final decision is up to the employer, so I don't think using the MO angle is going to be any more successful.

 

[Harris]

Remember this is a Class A reservist. He is not going to get follow on treatment or anything. He is trying to write a redress that will have some impact. 'what is the redress sought' He can not ask for the job as it is gone.

Actually, I've seen plenty of redresses asking for a position someone didn't get.  In all of the successful cases one of two things happened:
1. The member was given the position he applied for and the person who originally got it was removed; or
2. The member was "found" as similar position for the same timeframe.

He cant ask for money as he didn't get the job.

Agreed, but he can ask for the position.  Realistically I think that is a dead end until he gets his T-Cat changed as the hiring authority followed the rules.

He cant get medical care because he is Class A, he can not get medication as he is Class A.

True that he can't get medical care at a CDU, nothing prevents him from getting medical care from a civilian provider, even if it is a walk in clinic.

He has to grieve the things that can get "redress sought" like the dissemination of his personal information. The only things he can realistically seek on this redress is that the MO and CDU did things by the book and then if not, he wants them to be admonished for not doing it.
Questions:
Can the Tcat be redressed? ie It is the MOs opinion that the BP was a problem for the job even though before and after the appointment the members BP is in normal ranges.
Should the CDU have given out the members Tcat or just the limitations?
Should the CDU have given the employer the Tcat info before sending it to the member or his unit?

Not sure if a T-Cat can be redressed, but I am 100% sure he can ask to have a 2nd opinion from a different medical provider.
Yes the CDU can give out the T-Cat info.  It is what tells the CO (or employing agency) what the limitations are.  That is the whole point of a T-Cat, it gives limitations while not listing the conditions that caused those limitations.
Not sure if this breaks any rules or not, but the end result would have been the same in any case.  A T-Cat is a T-Cat regardless of who sees it first.  In this case once the CDU put the member on a T-Cat, he is no longer eligible to apply for a Class B.  Do I think this is fair?  Absolutely not.  However I will also point out that wavers/exemptions can and have been made.  I've got a Capt on a T-Cat who is on Class B ATM.  It took the Div Commander to do so however.

Another question I have is has the member given the CO a notice of intent to grieve yet?  Normally just doing this can get many problems sorted out as no one wants to go the formal route if it can be fixed informally first.

The last question I have is does the member believe he was the bast candidate for the position?  If he gets his T-Cat removed does he believe he would have been given the position over the person that did get it?  If the answer is no, I'm not sure there is any reason to go after that position.

Hope this helps.

 

[Gunplumber]

The CoC has been informed that the member will be putting in a redress. Weather or not it has made it up to the CO I don't know. It was 100% that he had the job. The member saw another civilian doctor at NDMC two days after the Part 2 medical and was told the limitations had no effect on the job being applied for. Its very low stress and not physical. He later got an email from the doctor saying she had just seen that the member had been put on a Tcat and that her recommendations didn't matter any more.

 

[dapaterson]

The CoC has been informed that the member will be putting in a redress. Weather or not it has made it up to the CO I don't know. It was 100% that he had the job. The member saw another civilian doctor at NDMC two days after the Part 2 medical and was told the limitations had no effect on the job being applied for. Its very low stress and not physical. He later got an email from the doctor saying she had just seen that the member had been put on a Tcat and that her recommendations didn't matter any more.

Once brought in on class B the individual can be retasked; if the individual can not perform the full range of tasks required by the general and occupational specifications, there is risk to both the individual and the organization.

 

[Gunplumber]

The member had been doing the job for the last 5 months. He passed a Force test and does cardio running and weights every second day. I repeat again. The members BP was high at the Part 2 Medical but is not always high.

 

[Bzzliteyr]

One thing that can be asked in a redress is a review of policy with perhaps recommendations for change.

My grievance was denied as I asked for monies lost but that did not prevent the CDS from making a well worded statement to my chain of command on the lack of administrative follow through on administering a C&P. That might help the next soldiers that are placed on one.

 

[ModlrMike]

The member had been doing the job for the last 5 months. He passed a Force test and does cardio running and weights every second day.

None of which necessarily eliminates the possibility of hypertension. Eighty percent of people with HTN have essential, or primary hypertension; the cause of which is difficult to discern, although lifestyle factors do feature prominently.

I repeat again. The members BP was high at the Part 2 Medical but is not always high.

Notwithstanding, the MO clearly thought the member required such follow up as to result in a TCat. It is the MO's responsibility to ensure the good health of the member. It is impossible for any of us to have an accurate opinion on the case as we're not privy to the clinical details. I wager the member had other instances of HTN that we're unaware of which resulted in the category . No MO/PA is going to diagnose someone with HTN worthy of a category from a single visit - at least I wouldn't, and I doubt I'm unique in that.

It will be difficult to have the TCat overturned by arguing the MO erred in determining what is best for the member's health.

 

[Eye In The Sky]

My  :2c: here.

IF the member has a bonafide "redress sought", (1) find him a decent Assisting Member if possible and (2) have them both read the link I provided above as a start if the AM has no experience or the AM course as a minimum. 

IF the member is just really wanting to lodge a complaint and doesn't actual have a "redress sought" part that is clear, or it doesn't exist at all, reconsider the redress and find the right way to lodge a complaint vice a grievance.

 

[Gunplumber]

So it certainly seems like this redress will be a waste of time. I seriously cant see that it is ok for someone else to know your med cat and information before you do. The member still has not received the Docs or even know what the limitations are yet. I think its time for me to get out of the military when this sort of crap goes on.

 

[PuckChaser]

So it certainly seems like this redress will be a waste of time. I seriously cant see that it is ok for someone else to know your med cat and information before you do. The member still has not received the Docs or even know what the limitations are yet. I think its time for me to get out of the military when this sort of crap goes on.

There likely was nothing said other than "member does not meet employment category, and has been placed on a TCat". I strongly, strongly doubt any private medical information was shared without the member's consent. That's a big medical no-no.

What we're also getting here, is your account  of a friend's account of his situation. That's one half of a story with a whole whack of moving parts. He may think he's got the shaft, but I doubt the MO let him leave without explaining the seriousness of high blood pressure. The CAF was looking out for the member's health and the CAF's liability if they employ someone outside their medical category.

 

[MedCorps]

I seriously cant see that it is ok for someone else to know your med cat and information before you do. The member still has not received the Docs or even know what the limitations are yet. I think its time for me to get out of the military when this sort of crap goes on.

That is the rub.  It is not the members Med Cat, it is the CAF's Med Cat. 

It is the members medical information (clinical condition) but the Med Cat is an occupational health and employment tool that is owned by the machine not the member.

There still should have been some discussion between the member and the MO / MD / NP / PA prior to this just showing up down in the platoon room one day, like hey we you are going to have to do some follow up / lifestyle changes / medications and come back and see me (or your civilian MD) in X amount of time. Again, hypertension that warrants a T-Cat is generally not a onetime monitoring event and there must have been something leading up to this (or co-morbilities) that we do not know about. 

MC

 

[captloadie]

Is the member sure that the TCAT is actually directly related to his High Blood pressure? Have they gone in to ask what is in their medical file? I had a subordinate who was placed on a TCAT, and an AR/MEL was initiated. We all believed it was for a recent medical issue, and were not concerned about the outcome, believing it was a low risk item. As it turns out, when they reviewed his file to approve the TCAT, they discovered a previous medical condition on his file that should have been reviewed by DMED POL but had fallen through the cracks and his file had never been forwarded. We, and the member, only realized this was the case because we called to ask if his current MELs would DAG him red for a short tasking where medical support was limited. That was when, we were informed that the current review was not due to his current medical situation, but a previous issue.

 

[CountDC]

Funny but I can agree with a lot of the various comments from people here as a lot of them I have seen (captloadie one was similar to one we had in the last year).  One area I do not fully agree with is from the medical members.  I and others I work with have been surprised when suddenly presented with MELs at the unit months after our last med appt as we were not made aware of any issues.  We have been told everything looks good by the doctor at the time.

If this mbr insists on redressing then he should request compensation based on the redress going his way - the cat overruled (it has happened once with a PCAT that I can think of off the top, moved from high risk to low risk) and that he would have been hired if the cat did not exist. This will actually give the board something to consider and make recommendation on.

 

[Eye In The Sky]

I may be wrong, but I don't think even the CDS has the authority to grant redress in the form of monies.  ???

 

[CountDC]

Agree he can't just say pay the bloke $2k but in 2 cases I know of the direction was the mbr be put on Class B for a set period which did in a sense provide money.  Mind you the mbr did work Class A during the period so it was a change from Class A status to Class B Status for the period and the member then recieved pay for the days paysheets had not already been submitted for.

Direct money compensation he can refer to another group though.

 

[jitterbug]

Submitted a grievance, IA confirmed received, 4+ months later IA has not responded to grievance.  Assisting officer has attempted contact multiple times.  What should be done now?

 

[ballz]

If I were the AO, I would call up the correspondent you have had at the IA (the DG's usually have staff dealing with this stuff). I'd remind them they are overdue and that their obligations require them to provide an updated timeline, and if it's not satisfactory to you, you can have your grievance forwarded to the Final Authority, essentially skipping the IA because they took too long.

Have you received disclosure from the Grievance Analyst yet?