Imperial County Municipal Code Ch. 3.24 Medical Evaluation System

A. The county of Imperial has undertaken to develop and maintain professionally validated medical standards for county employment based upon medical standards developed by nationally recognized medical specialists and consultants in the fields of occupational health, law, medicine and management. In addition, the county of Imperial has undertaken to survey the medical requirements of all county job classifications and to develop medically related job profiles for all classifications. The county of Imperial establishes a medical evaluation system based on such professionally validated medical standards and policies and procedures recommended by medical experts and consultants in the above fields of specialization. This system shall be known as the "Imperial County Medical Evaluation System."

B. The primary purpose of the system is to identify medical conditions and any related physical limitations of prospective employees and current employees in order to assure their placement in work they can perform without endangering themselves or others, and to avoid an imminent and substantial risk of injury, illness or aggravation of existing disorders for such persons.

C. Other purposes of the system are:

1. To comply with the letter and intent of laws prohibiting discrimination based on physical handicap or medical condition;

2. To further the efficiency of the county service by implementing validated medical standards for all county employment;

3. To provide documentation and policies and procedures for a legally defensible system in cases of individual challenges to the system;

4. To reduce future financial losses to the county in workers' compensation, disability retirement and employee health benefits programs.

D. The system is intended, primarily, to be utilized to assist the county in making employment placement decisions. The system shall be utilized to determine medical eligibility for employment, for making reasonable accommodation determinations under the county's employment of the handicapped policy, and for placing reasonable limitations or restrictions on the job duties of county applicants or employees otherwise qualified for employment.

E. The county of Imperial shall bear the expense of all medical evaluations required of applicants or employees under the system.

(Prior code § 24370)

A. All job applicants and county employees shall be subject to the medical standards utilized in the county's medical evaluation system in order to be designated as qualified for county employment.

1. The term "employee", as used in this chapter, shall include all types of temporary and permanent employees of the county, including "employee", "officers", "temporary employee", "permanent employee", "extra help", "intermittent", "limited term", "part-time", "seasonal", and "special assignment" employees, as defined in Chapter 3.04. 2. Pre-Placement Medical Evaluations. Every offer of employment for a permanent, temporary, or other type of position in the county service shall be made contingent upon the person receiving the offer medically qualifying for such employment based on the results of a pre-placement medical evaluation given by a county physician or other medical examiner authorized by the county health officer.

The county's director of human resources may establish special rules and/or exceptions for extra help employees who are being hired for a specified limited duration of time.

3. In-Service Medical Evaluations. All county employees shall be subject to the policies and procedures of this chapter pertaining to in-service medical evaluations.

B. Medical standards shall be applied uniformly to all applicants and employees and to all pre-placement and in-service medical evaluations.

C. An applicant or employee required to undergo a medical evaluation shall not be placed in the job until a complete, accurate medical diagnosis has been made and assessed in relation to established medical standards.

1. Medical evaluations shall be completed in a timely fashion, pursuant to the requirements of Section 3.24.060 of this chapter.

2. The county's director of human resources may authorize exceptions to the stated placement policy, provided such an exception is requested by the recruiting/employing department head, and the applicant/employee is provided written notice by the director of human resources that his or her on-going employment status is conditional upon being approved for employment following completion of the applicant's/employee's medical evaluation.

a. Applicants placed in employment under such exception policy shall be hired as and retain the status of extra help employees until they are either approved or disqualified for employment by the county health officer or approved for reasonable accommodation hiring by the county's director of human resources.

b. Employees placed in employment under such exception policy shall retain their regular employment status until they are either approved or disqualified for employment by the county health officer or approved for employment with restrictions/limitations by the county's director of human resources.

(Prior code § 24371)

A. It is the policy of the county of Imperial to utilize professionally validated medical standards in making all medically related employment decisions affecting job applicants and employees. Medical examiners shall comply with the policies and procedures of Sections 3.24.090 through 3.24.120 of this chapter in applying such standards in individual cases.

B. It is recognized that the medical standards and job profiles adopted by the county as professionally validated are not intended to be all-inclusive and are subject to limitations in the fields of medicine and job analysis. Medical examiners will be required to use some amount of independent judgment in making medical evaluations, and some medical conditions may require further evaluation before an employment decision may be made. However, it shall be the policy of the county of Imperial to adhere to the application of professionally validated medical standards established under the medical evaluation system to the maximum extent feasible to assure that fair and legally defensible decisions are rendered at all times.

(Prior code § 24371.1)

Medical evaluations under the system shall be based upon the following general principles:

A. Medical examinations used to make employment decisions must be specifically related to the job for which the applicant/employee is being considered.

B. Employment policies which result in blanket exclusions because of a particular handicap are to be avoided, where possible.

C. Applicants/employees shall not be medically disqualified due to a condition creating a future risk of injury. The sole medical question shall be whether the applicant/employee can presently perform the essential functions of the job in question without endangering him or herself or others, and avoid an imminent and substantial risk of injury, illness or aggravation of existing disorders for such person.

D. Disqualification due to medical condition shall be based on the criteria of present probable risk of injury or incapacity which is imminent and substantial.

(Prior code § 24371.2)

The medical evaluations conducted under the medical evaluation system shall result in the following types of status designations for applicants/employees evaluated:

A. Medically qualified: Those applicants/employees who are found to be in good health, with no medical conditions which would indicate otherwise for the job classification for which they are being considered. Normally, no follow-up medical evaluation would be required, other than the county's normal in-service re-evaluations.

B. Conditionally qualified: Those applicants/ employees qualified to perform the job, but who have specific medical conditions or job restrictions or limitations which, in the opinion of the county health officer, must be specially accommodated by the employer and the applicant/employee if the employee is to perform his or her job safely. Also, those applicants/employees who, in the opinion of the county health officer, require periodic follow-up or surveillance (such as for mild hypertension or obesity).

C. Conditionally disqualified. Those applicants/ employees who have a medical condition which currently prevents them from safely working in the job class, but which condition can or may be corrected with appropriate treatment or evaluation (examples: hypertension, unrepaired hernia, mental depression).

D. Medically disqualified: whose applicants/ employees who have a medical condition which is not likely to be corrected and which prevents them from meeting the medical requirements for their jobs.

(Prior code § 24371.3)

A. The county health officer shall be responsible for providing for and the conduct of all medical examinations on behalf of the county. The county health officer may authorize other medical practitioners to perform or assist in the performance of such medical examinations but shall supervise such examinations and shall be responsible for the determinations resulting therefrom.

As used in this chapter, the terms "county physician," "medical examiner" and "examining physician" means either the county health officer, a physician employed by the county or another physician performing services for the county as authorized by the county health officer.

B. The county health officer shall be responsible for the administration of the policies and procedures relating to the application of validated medical standards to individual medical evaluations provided for in Section 3.24.090 of this chapter and relating to medical evaluations involving difficult diagnoses provided for in Section 3.24.130 of this chapter.

C. To preserve the confidentiality of the applicant's/employee's medical conditions, the county health officer shall report to the county's director of human resources only those results of the medical examination which are pertinent to making an employment decision and are reasonably sufficient to allow the director of human resources to explain such decision to the applicant/employee. The report shall avoid specific details of medical diagnosis, but shall be sufficient to assist the director of human resources in assessing the applicant's/employee's capability to fulfill job requirements safely, without illness or injury. The report shall also provide information needed to insure that, where appropriate, adequate work restrictions are noted or accommodations are made.

Such reports may be telephoned to the department of human resources in order to avoid time delays in placement of applicants/employees; however, such telephone reports shall be followed immediately with written documentation from the county health officer to the director of human resources.

D. The county health officer shall give high priority to conducting and completing the medical evaluations of job applicants and county employees. In order to further the efficiency of county operating departments which are recruiting employees, and to assure fairness to job applicants and county employees required to undergo medical evaluations, it is the policy of the county that, barring special circumstances in individual cases, all medical evaluations of applicants/employees shall be promptly scheduled upon request, and shall be completed within five working days after the date of initial examination. "Special circumstances," as used in this section, shall included but not be limited to treadmill and electrocardiogram tests and other procedures conducted outside the county health department.

E. The county's medical examiners are authorized to act as the county's agents with respect to the communication of findings resulting from a medical evaluation. The medical examiner, in his or her discretion, may notify an applicant/employee to discuss positive findings, but shall be cautious not to create a physician/patient relationship with an applicant/employee. Medical examiners are cautioned that if a medical examiner goes beyond informing the applicant/ employee of the conditions and the necessity to seek further medical care, that such examiner may well be establishing a physician/patient relationship.

F. The county's medical examiners are herein specifically authorized to discuss findings in detail with applicants/employees who have been disqualified or conditionally disqualified and are not satisfied with the notices or explanations provided the applicants/employees by the county. The medical examiner shall document all communications with applicants/employees involving their medical evaluations.

(Prior code § 24372)

A. The county's director of human resources shall be responsible for the administration of all county-wide personnel policies and procedures established pursuant to this chapter.

B. The county's director of human resources shall assure that the county's policy that all job applicants and employees must comply with medical standards in order to be designated as qualified for employment is incorporated into all appropriate written and printed materials, including job applications and announcements and bulletins, where other examination material is listed.

C. Pre-Placement Medical Evaluations. The county's director of human resources shall provide for the administration of a pre-placement medical evaluation system which provides for:

1. Job offers which are conditional upon the successful completion of a pre-placement medical examination;

2. Pre-placement medical evaluations which occur after an offer of a job has been made to a qualified candidate;

3. Procedures wherein the job candidate is: (a) advised of the purpose of the medical evaluation; (b) required to sign a consent form, agreeing to take the examination; (c) required to complete a medical history form designed to assess the candidate's current medical condition; (d) notified of the appeals rights of applicants;

4. For each new hire in county service, a copy of the Imperial County medical evaluation system policy as provided by the provisions of this chapter, either as part of an employee handbook or as an individual document, including appeals rights of employees. The director shall require that the applicant read and certify by signature that he or she read and understands the policy prior to commencement of employment. The certification shall be filed in the new hire's official personnel file.

D. In-Service Medical Evaluations. The county's director of human resources shall provide for the administration of the county's in-service medical evaluations pursuant to the policies and procedures provided for in Sections 3.24.180 through 3.24.250 of this chapter.

E. The director of human resources shall provide for an information and recordkeeping system which identifies and tracks reasonable accommodation and conditionally qualified applicants/employees, provides a mechanism for insuring that work restrictions and limitations are clearly delineated and documented, that all concerned parties are informed of such restrictions/limitations, and assures that such restrictions/limitations are periodically re-evaluated; and assures medical re-evaluations of employees changing positions, as appropriate.

F. The director of human resources shall establish and administer policies and procedures providing for reasonable time limitations and opportunities for future employment for both applicants and employees designated as conditionally disqualified who subsequently submit proof of treatment or that their conditions are cured/stabilized. When such applicants/employees have submitted such proof as is satisfactory to the county health officer, they shall be reclassified as medically qualified or conditionally qualified, whichever is appropriate.

G. The county's director of human resources shall carefully document all cases wherein a job applicant is not hired due to failure to agree to or comply withy approved reasonable accommodation measures, or wherein a county employee is suspended or terminated from county employment for refusing to agree to or comply with reasonable approved medical limitations/restrictions placed on their job duties.

H. The county's director of human resources shall establish policies and procedures for and shall administer the provisions of Section 3.24.170 of this chapter, pertaining to restrictions/limitations which apply only to potential future employment changes by county employees.

I. The county's director of human resources shall establish and administer all policies and procedures necessary to handle: (a) discrimination complaints based on medical conditions and handicapped matters; (b) the appeals rights of applicants/employees pursuant to Section 3.24.270 of this chapter; and (c) liaison with federal and state compliance agencies for such matters.

J. The director of human resources shall review the need for and make recommendations regarding coordination of the system with employee wellness, health maintenance, and incentive programs and other preventive medical services programs, such as use of employee assistance program services, as may be required or appropriate in furtherance of the provisions of this chapter.

(Prior code § 24373)

A. The county's director of human resources is authorized to:

1. Determine all instances wherein, and the extent to which, a job applicant who has been conditionally offered county employment or a present county employee shall be medically evaluated for county employment purposes;

2. Review and approve or modify all disqualification recommendations of the county health officer;

3. Make all employment determinations providing for reasonable accommodation to job applicants or providing for medical limitations/restrictions on the job duties of county employees;

4. Deny employment to any job applicant who refuses or fails to comply with any of the provisions of this chapter;

5. Require department heads to suspend or terminate, for insubordination, the employment of any county employee who refuses to comply with any of the provisions of this chapter;

6. Require departments to provide alternative employment for medically disqualified employees, pursuant to the provisions of subsection (A)(3) of this section.

B. The director of human resources may require additional medical evaluations of applicants/employees, either by the county health officer, outside medical doctors or specialists, and/or by the county's medical standards consultants.

C. In cases wherein county employees have been classified as medically disqualified after an in-service medical evaluation and such employees qualify for and desire alternative employment in the county service pursuant to the provisions of Section 3.24.260(D) of this chapter, the director of human resources shall have the authority to make final determinations whether such alternative employment is available in the county service, to place such employees in such alternative employment, and to determine the terms and conditions of such alternative employment.

(Prior code § 24373.1)

A. The application of validated medical standards by medical examiners shall include: (1) review of the appropriate job profiles for the type of position for which the applicant/employee is being evaluated; (2) determination of the type of medical examination to perform in each such evaluation; (3) performing the medical examination, taking into account the applicant's/employee's previous medical history, any medical reports generated in the course of any worker's compensation proceeding, and all current screening tests, and identifying and recording all medical conditions encountered; and (4) applying the proper validated medical standard or standards to the medical condition or conditions identified, to determine whether the applicant's/employee's condition or conditions is/are acceptable or disqualifying for county employment.

B. The county health officer shall be viewed as the county's expert in medical assessment. If in doubt as to an assessment, the county health officer shall consult the county's medical standards consultants to provide background on relevant standards. In addition, if the medical examiner experiences difficulty in diagnosing a specific condition, he or she shall immediately either contact the applicant's/employee's physician, or a medical specialist, as well as the county's medical standards consultant, as appropriate, for assistance.

The medical examiner shall attempt to complete the diagnosis within five working days as provided for by Section 3.24.060(D) of this chapter; if the examiner cannot do so, he or she shall comply with the policies and procedures for handling these types of cases provided for in Section 3.24.130 of this chapter.

C. In applying medical standards, the medical examiner shall take into account any environmental factors relating to the specific employment under consideration which may be disqualifying for the condition in question (examples: working outdoors; working in summer heat.)

D. All medical evaluations conducted shall include, as a routine part thereof, an opportunity for the job applicant/county employee to submit additional information to the medical examiner which may clarify the status of the medical condition or conditions being evaluated, may indicate that particular applicant/employee is an exception to the norm utilized by the system for that particular condition, or may indicate that reasonable accommodation is available.

(Prior code § 24374)

A. If an identified medical condition is acceptable under requisite validated standards, the medical examiner shall classify the applicant/employee as medically qualified, shall immediately record that information and immediately report the same to the department of human resources.

B. If an applicant/employee has a condition which is not disqualifying for the current job under consideration, but would be for other types of jobs in the county service, the county director of human resources shall apply the provisions of Sections 3.24.170 and 3.24.180 to such applicant/employee.

(Prior code § 24374.1)

A. The medical condition identified in the examination may only limit the applicant/employee from performing certain non-crucial tasks in the current job classification, or an applicant/employee may be able to perform crucial job tasks if some help is provided. In these instances, the county's director of human resources, pursuant to the county's handicapped policies and procedures as provided for in Section 3.16.070, may determine to make an accommodation for the applicant/employee.

B. In such cases, the medical examiner shall classify the applicant/employee as conditionally qualified, and contact the county's director of human resources and review the available options. If the applicant/employee is approved for placement by the county's director of human resources, the medical examiner shall discuss the limitations/restrictions with the applicant/employee, and shall carefully document the information relating to such limitations/restrictions in the medical records of the applicant/employee, and upon forms adopted for this purpose by the county director of human resources. Such forms shall include employee agreement to such limitations/restrictions, and notification that violation thereof may result in disciplinary action or termination of employment.

C. Some individuals (such as persons with hypertension) may need to be monitored continually to assure there is no worsening of their conditions. Such persons shall be classified as conditionally qualified and shall be governed by the policies and procedures provided for in Section 3.24.230 of this chapter for periodic medical evaluations.

D. All applicants/employees classified by the county health officer as conditionally qualified as the result of a medical evaluation shall be subject to the provisions of Sections 3.24.140 through 3.24.170 of this chapter.

(Prior code § 24374.2)

For all medical disqualification determinations, including conditionally disqualified determinations, the examining physician shall carefully support his or her diagnosis of the medical conditions or conditions responsible for the disqualification. Documentation in the medical record shall include, at a minimum, interview notes, diagnostic information, records of test results, evidence that the disqualification is supported by the application of professionally validated medical standards established by the county, and evidence that the applicant/employee has been given every reasonable opportunity to meet the medical requirements of the job.

A. For those instances involving unclear areas of medicine, extra care shall be taken to document that an expert opinion was obtained and taken into account but the weight of the evidence demonstrates that the applicant/employee is unable to perform the job safely, without an imminent and substantial risk of injury to himself or herself or others.

B. In all clear cases of disqualification, the examining physician shall provide a brief explanation to the applicant/employee, either at the end of the examination or at a later date, as appropriate. Such explanation shall be limited to a brief description of the disqualifying limitation(s). The physician shall take care to avoid the creation of a physician/patient relationship.

C. A disqualification report shall be prepared by the examining physician for the county's director of human resources. The report shall present the medical facts and demonstrate the physician's use of valid medical standards to come to a final determination. The report shall carefully delineate the medical standards and specific job requirements taken into consideration in making the final determination. The report shall contain, at a minimum: (1) the job classification involved; (2) the medical findings pertinent to the disqualification, (3) the medical standards taken into consideration; (4) the applicable job demands, and (5) a list of typical job tasks requiring the abilities in question.

1. The director of human resources shall provide all official notifications of medical disqualifications to applicants/employees and shall be responsible for all formal communications between the county and the medically disqualified applicant/employee.

2. All disqualification letters prepared by the director of human resources shall contain, at a minimum: (a) the job class applied for; (b) the purpose of the examination; (3) the physical findings which disqualify the individua1;(4) the tasks which are involved in the required abilities; and (5) the appea1 options of the applicant/employee.

D. If the medical examiner finds that a disqualifying condition is one which can be easily corrected through further treatment, the applicant/ employee shall be classified as conditionally disqualified. Such an applicant/employee shall be eligible to be reexamined after providing proof that he or she has received appropriate treatment and the condition is repaired or controlled to the point where it no longer poses a hazard. Such applicants/employees may then be placed into county employment pursuant to policies and procedures established pursuant to the provisions of Section 3.24.070(F) of this chapter.

E. Evaluations Involving Professional Medical Disputes.

1. If a disqualification determination of the county health officer is disputed by an applicant or employee, the applicant or employee has been given the opportunity to produce additional relevant material or records, and the county health officer remains satisfied that all relevant materials have been fairly evaluated, the officer's decision of disqualification shall be final.

2. If a disqualification determination of the county health officer is disputed in writing by the applicant's/employee's personal physician, and the county health officer thereafter continues to believe such disqualification is proper, the officer shall seek a further opinion on the matter, either from an appropriate medical specialist or the county's medical standards consultant. If the determination of the county health officer is not supported by the written opinion of either an outside medical specialist retained by the county or the county's medical standards consultant, the county health officer shall not disqualify the subject applicant/employee. In such instances, the county health officer shall approve such applicant/employee for employment, either with or without reasonable medical limitations/restrictions, as appropriate, as determined by the county health officer in consultation with county's director of human resources.

(Prior code § 24374.3)

A. When the medical examiner experiences difficulty in diagnosing a specific condition, and cannot complete the diagnosis within five working days as provided for in Section 3.24.060(D) of this chapter, the following policies and procedures shall apply:

1. In handling difficult-to-diagnose cases, the county health officer shall effect the most timely dispositions possible under the circumstances, taking into account delays occasioned by the need to obtain medical records not then in the possession of the county health officer. The county health officer shall take into account such considerations as the nature of the medical conditions being diagnosed, the safety of the applicant/employee and others, fairness to the applicant/employee, and the needs of the recruiting department.

2. If the county health officer determines that a particular medical evaluation cannot be completed in a timely manner, but determines the above-indicated considerations weigh in favor of placement in employment at least on a temporary basis, the county health officer shall conditionally qualify the applicant/employee for such employment. Such determination shall take into account the provisions of Section 3.24.140(C) of this chapter.

3. If the county health officer determines that a particular medical evaluation cannot be completed within a timely manner, and determines the above-indicated considerations weigh against placement in employment even on a temporary basis, the county health officer shall conditionally disqualify the applicant/employee for such employment.

B. In all such cases, the county health officer shall carefully document the medical record of the applicant/employee, and indicate therein the specific reasons such applicant/employee is either conditionally qualified or conditionally disqualified. The county health officer shall immediately discuss the matter with the applicant/employee and immediately report his or her determination to the department of human resources.

(Prior code § 24375)

A. Every reasonable effort shall be made by the county health officer and the county's director of human resources to determine that an individual applicant/employee is medically and physically acceptable for county employment. Such efforts may include placing an applicant/employee on the job but requiring reasonable medical or physical restrictions or limitations upon the tasks performed, taking into consideration any undue hardship on the county. Each such case shall be evaluated on an individual basis.

B. In all cases wherein the county health officer has classified an applicant or employee as conditionally qualified pursuant to the definition of Section 3.24.050, the county health officer shall identify necessary medical and/or physical restrictions or limitations that might be placed on such applicant's or employee's job duties so that such individual may perform his or her job safely despite the existence of the medical condition or conditions resulting in the conditionally qualified designation.

C. If the county health officer cannot identify reasonable job restrictions or limitations for such applicants or employees that may allow such individuals to perform their jobs without endangering themselves or others, and to avoid an imminent and substantial risk of injury, illness or aggravation of existing disorders for such persons, such individuals shall not be designated as conditionally qualified, but shall be designated as either conditionally disqualified or as medically disqualified.

D. If the formulation of reasonable limitations/ restrictions for an applicant/employee designated as conditionally qualified may be feasible, the county health officer shall consult with the county's director of human resources thereon, and the county's director of human resources shall determine whether such limitations/restrictions are in fact feasible for the job in question, taking into consideration possible undue hardship to the employer, and, if so, the specific limitations/restrictions to be imposed upon the applicant/employee.

E. The determinations of the county's director of human resources shall be final in all such cases, and such applicants/employees shall be placed in or returned to county employment only on the basis approved by the director of human resources.

F. If an applicant or employee designated as conditionally qualified is not to be allowed to commence or return to county employment on a limited/restricted basis, the applicant or employee shall be re-classified as either conditionally disqualified or medically disqualified by the county health officer.

G. Revised Job Descriptions for Individuals. Where appropriate, in the discretion of county's director of human resources, a revised job description shall be prepared for the position occupied by an applicant afforded reasonable accommodation or by an employee classified as conditionally qualified and approved for work with medical limitations/ restrictions and said revised job description shall be made a part of the subject applicant's or employee's personnel record. Such revised job descriptions shall be prepared in all instances wherein the county-wide approved job classification descriptions of affected jobs have become substantially inapplicable or inappropriate to the subject applicants/employees, and could become the bases for misunderstandings or disputes in future job performance, workers' compensation, disability retirement or similar matters.

If, in the discretion of the director of human resources, a letter agreement with the applicant/employee and department head will suffice to document such future job duties requirements, the director of human resources may prepare and require such a letter agreement in lieu of a revised job description statement.

H. The county's director of human resources shall carefully document all cases wherein the director approves the employment of an applicant under the reasonable accommodation provisions of the county's handicapped employment policy, or approves the continued employment with job restrictions/ limitations of a current county employee classified as conditionally qualified after an in-service medical evaluation. The director shall adopt appropriate forms and otherwise assure that: (1) such applicant's medical records carefully identify the medical condition or conditions involved and the medical limitations/restrictions required of the applicant; (2) the applicant agrees in writing to such medical limitations/restrictions; and (3) written notice is provided to and acknowledgment is received from the employing department head that the subject medical limitations/restrictions shall be enforced.

(Prior code § 24376)

A. In cases wherein a job applicant is conditionally qualified for employment, the restrictions/limitations on employment are based on medical conditions which are permanent in nature, and the applicant qualifies as a handicapped person, such applicant and job shall be evaluated for reasonable accommodation pursuant to the policies and procedures of the county's handicap policy as contained in Section 3.16.070.

B. If such applicant does not qualify as a handicapped person under this policy, evaluation for reasonable accommodation for such applicant shall be at the discretion of the director of human resources and pursuant to the policies established pursuant to Section 3.24.140(A) of this chapter.

C. If the applicant is not to be afforded reasonable accommodation as determined by county's director of human resources, and the medical condition on which the conditionally qualified designation is based is permanent in nature, the applicant shall be re-classified as medically disqualified by the county health officer. If the subject medical condition is not permanent in nature, the applicant shall be re-classified as conditionally disqualified by the county health officer.

D. As used in this chapter reasonable accommodation has the meaning which is given that term under federal and California law. Nonexhaustive examples of what may be considered reasonable accommodation include: (1) making existing facilities used by employees readily accessible to and usable by individuals with disabilities; and (2) job restructuring, part-time or modified work schedule, reassignment to a vacant position, acquisition or modification of equipment or devices, appropriate adjustment or modification of examinations, training materials on policies, the provision of qualified readers or interpreters, and other similar accommodations for individuals with disabilities. An accommodation is not reasonable where it requires such significant difficulty or expense as to constitute an undue hardship on the county, when considered in light of the following factors:

1. The nature and cost of the accommodation needed;

2. The overall financial resources of the facility or facilities involved in the provision of the reasonable accommodation; the number of persons employed at such facility; the effect on expenses and resources, or the impact otherwise of such accommodation upon the operation of the facility;

3. The overall financial resources of the county; the overall size of the business of the county with respect to the number of its employees; the number, type and location of its facilities; and

4. The type of operation or operations of the county, including the composition, structure, and functions of the workforce of the county; the geographic separateness, administrative, or fiscal relationship of the facility or facilities in question to the county.

(Prior code § 24376.1)

In all instances, wherein the county's director of human resources has determined that a county employee classified as conditionally qualified on the basis of an in-service medical evaluation may continue his or her employment only in compliance with specified job limitations/restrictions, such county employee shall be employed only on such basis.

A. If such employee refuses to agree to such specified job limitations/restrictions, and the medical condition on which such limitations/restrictions are based is permanent in nature, the employee shall be re-classified as medically disqualified by the county health officer. If such medical condition is not permanent in nature, the employee shall be re-classified as conditionally disqualified by the county health officer. In such instances, the policies and procedures of Section 3.24.260 of this chapter shall be effected by the county health officer, the county' s director of human resources, and the employee's department head.

B. If such an employee agrees to, but subsequently fails or refuses to comply with, such reasonable job limitations/restrictions, without good cause, the employee's department head shall terminate such employee from county service for insubordination.

(Prior code § 24376.2)

A. In cases wherein identified medical or physical restrictions/limitations of a job applicant or a county employee are based on a medical condition which is permanent in nature, such restrictions/limitations do not apply to the applicant's/employee's current job, but may be hazardous in other types of jobs in the county service, the applicant/employee shall be classified as medically qualified for current employment by the county health officer.

B. Such applicants/employees shall be advised of the restrictions/limitations of his or her medical conditions which may affect future employment opportunities in the county service, and such restrictions/limitations shall be carefully documented in the medical records of the applicant/employee. The policies and procedures established by county's director of human resources pursuant to Section 3.24.070(H) of this chapter shall apply to such applicants/employees.

C. The county's director of human resources shall maintain appropriate records and review procedures regarding such applicants and employees to insure that whenever such employees change or attempt to change jobs in the county service having different medical standards that appropriate medical evaluations and/or job restrictions/limitations are considered for such new employment.

(Prior code § 24376.3)

A. The primary intent of in-service medical evaluations shall be to insure that all county employees can safely perform their job duties, without endangering themselves or others, and to avoid an imminent and substantial risk of injury, illness or aggravation of existing disorders for such persons. The county and its department heads shall treat all employees in a consistent, equal and fair manner in dealing with in-service medical evaluation matters. Such evaluations shall not be utilized in a punitive manner.

B. Whenever an in-service medical evaluation results in a determination that an employee is only conditionally qualified or is conditionally disqualified for his or her position in the county service, the policies and procedures of Sections 3.24.140 through 3.24.170 of this chapter shall be followed.

C. Whenever an in-service medical evaluation results in a conditionally disqualified or medically disqualified classification of an employee, the county health officer, the county's director of human resources, and the employee's department head shall follow the policies and procedures provided for in Section 3.24.260 of this chapter.

D. If an employee is directed by his or her department head to complete a scheduled in-service medical evaluation as authorized pursuant to the provisions of this chapter and the employee refuses or fails to do so, without good cause as determined by the department head, the employee's department head may immediately suspend such employee from county employment, without pay, for insubordination, and take any other personnel or disciplinary actions deemed appropriate. Any county employee who, without sufficient excuse, fails to complete such an in-service medical examination within thirty (30) calendar days after written notice to the employee of such requirement, may be terminated from county employment for insubordination.

(Prior code § 24377)

A. Requests for return-to-work examinations shall be directed to the county health officer by the county's director of human resources. Return-to-work medical evaluations may be of three types: (1) return-to-work from a workers' compensation illness or injury; (2) return-to-work from a non-industrial illness or injury; and (3) return-to-work from an extended leave of absence.

B. The primary purpose of a return-to-work medical evaluation shall be to determine whether an employee has a medical condition which impacts on the employee's ability to perform on the job without imminent and substantial risk of injury to the employee or others.

C. The medical criteria for making return-to-work medical determinations shall be the same criteria as applied to preplacement medical evaluations.

D. The degree of complexity of the return-to-work medical evaluation may differ depending upon the circumstances of the leave, contacts/inquiries with or between the department head, county health officer, the employee's personal physician, and/or the county's director of human resources, and/or any changes in job demands.

E. If an employee refuses or fails to complete a return-to-work medical examination, he or she shall be subject to the provisions of Section 3.24.180(D) of this chapter.

(Prior code § 24377.1)

When an employee wishes to return to work following a workers' compensation illness or injury, the county shall determine whether the employee shall be allowed to return to work, considering, as appropriate, any documentation generated in the worker's compensation process. Such employee shall have the affirmative obligation to supply the county health officer with all medical documentation generated or used in the course of the worker's compensation process. Such determination by the county shall be made pursuant to the provisions of this section.

When a department head wishes to return an employee to work following a workers' compensation illness or injury, but such employee is unwilling to return to work, the department head shall follow the provisions of subsection (B)(4) of this section.

A. When the workers' compensation process has determined the employee has no permanent disability for workers' compensation purposes, the return-to-work evaluation shall consider: the presence/absence of work restrictions, length of absence, and concern regarding the ability to perform the job without endangering him or herself, and to avoid an imminent and substantial risk of injury, illness or aggravation of existing disorders for such person.

1. If the county's workers' compensation staff believes that work restrictions are not required, and a medical assessment has been made, and there has not been an absence of more than thirty (30) calendar days, the employee shall be returned to work.

2. If the county's workers' compensation staff believes that work restrictions are required, or there has been an absence of more than thirty (30) calendar days, or there exists any question by the department head, workers' compensation staff, or the county health officer regarding the employee's ability to perform his or her job safely, then a review of the medical records from the workers' compensation case and, as necessary, a return-to-work medical evaluation, shall be conducted by the county health officer.

B. When the workers' compensation process has determined that there is a permanent disability for workers' compensation purposes, the county shall determine whether the employee is able and willing to return to the job held at the time of the injury/illness.

1. If, during the workers' compensation and vocational rehabilitation process, input is requested regarding potential placement of the employee in a new county position, the county health officer shall determine whether the job demands of the new position are compatible with the employee's restrictions and medical condition by applying the appropriate medical standards as if the determination was a pre-placement evaluation for the new position.

2. If during the workers' compensation and vocational rehabilitation process, placement of the employee in the position last held by the employee is encouraged, the return-to-work evaluation shall be handled on the same basis as any other return-to-work evaluation required pursuant to Section 3.24.180 of this chapter.

3. If it is determined the employee is able and willing to return to the job held at the time of the injury/illness, the employee shall be provided a date and time to return to work.

4. If it is determined by the county health officer the employee is able to so return to his or her job, but the employee is unwilling to do so, the director of human resources shall proceed on the basis of apparent employee insubordination pursuant to applicable ordinances and policies.

5. If it is determined by the county health officer that the employee does not meet the medical standards for his or her job, the department head, in consultation with the county's director of human resources, shall consider the options of: (a) vocational rehabilitation (if the employee is classified as medically disqualified); and (b) complying with the policies and procedures of Section 3.24.140 (if the employee is classified as conditionally qualified) or Section 3.24.260 (if the employee is classified as conditionally disqualified or medically disqualified), respectively, as appropriate.

(Prior code § 24377.2)

A. All employees who have been absent from work on account of nonindustrial illness or injury for a continuous period of time exceeding thirty (30) calendar days, or absent for any reason for a continuous period of time exceeding one hundred and twenty (120) calendar days, whether or not such absence is job-related, shall be required to take a return-to-work medical examination given by a county physician before being allowed to return to work.

B. If an employee refuses to return to his or her job following a return-to-work medical evaluation, he or she shall be subject to the provisions of Section 3.24.200(B)(4) of this chapter.

(Prior code § 24377.3)

A. Any county department head may, in his or her discretion, at any time, request a fitness-for-duty medical examination for any employee whenever such department head has reason to believe that such employee may have become unfit for duty due to physical handicap or mental condition or that such employee may require medical limitation/restrictions placed on his or her job duties.

B. When a department head obtains knowledge of a medical condition of an employee which might affect the employee's job performance, the department head shall promptly take steps to determine whether the employee is performing as expected with no difficulties. If the department head has cause to believe that an employee's job performance has deteriorated due to a medical condition, the fitness-for-duty medical evaluation procedure provided for herein in this section shall be followed.

C. When an employee's work performance declines suddenly or over time, department heads shall insure that their supervisory staffs consider not only attitude or personal difficulties but also medical and/or psychological problems as possible underlying or contributory causes of the performance difficulty.

D. Special attention shall be given by department heads to utilizing fitness-for-duty medical evaluations whenever an employee may be claiming or feeling stress on the job.

E. Fitness-for-duty medical evaluation referrals shall be for cause and shall consider medical confidentiality, employee rights to privacy, and due process. As used in this section, "for cause" means the department head has assessed the employee's ability or inability to perform essential functions of the job as well as indications that the employee's difficulty may be related to a medical or psychological condition.

Such assessments should be based on observations and evaluations of supervisory staff regarding such matters as inability to perform or changes in performance; changes in physical characteristics of the employee, such as slurred speech, wandering concentration, condition of eyes, gait or posture, and changes in overall behavior which is inappropriate under the circumstances, such as demonstrations of hostility, anger, significant mood swings, or complaints about physical conditions or environment.

F. If a department head has reasonable cause to believe that an employee is working under the influence of alcohol or a drug, or that an employee's private use of alcohol or a drug is affecting the employee's work performance, the department head shall comply with the county's formally established drug abuse policy.

G. If an employee refuses or fails to complete a fitness-for-duty medical evaluation, he or she shall be subject to the provisions of Section 3.24.180(D) of this chapter.

(Prior code § 24377.4)

A. The county health officer and the county's department heads are authorized to utilize periodic medical evaluations for employee wellness and preventive medical purposes. The term "periodic" evaluations, as used in this section, is intended to refer to medical evaluations required based on some automatic or periodic legal or policy requirement; they are distinguished from fitness-for-duty evaluations (Section 3.24.220(A)) in that the latter are based on a perceived need to evaluate a particular employee at a particular time because a department head reasonably believes that such employee may have become unfit for duty or that the employee may require medical limitation/restriction to be placed on his or her job duties. There are five types of such evaluations, as provided for hereinbelow.

B. Medical Surveillance Evaluations. Medical surveillance examinations are for those employees who have been identified as having medical conditions which have a potential job impact and/or who have been provided restrictions/limitations on their job duties. Such medical surveillance, or periodic medical follow-up, shall be required for all conditionally qualified employees. The purpose of medical surveillance is: (1) to insure the employee is working within his or her job restrictions/limitations; (2) to insure the subject medical condition has not worsened; and (3) to document any degeneration and possible job relationships.

C. OSHA Medical Evaluations. The State of California Occupational Health and Safety Act (OSHA) requirements which provide that periodic evaluation of employees are required to be performed by employers shall be strictly complied with by department heads.

D. Safety Position Medical Evaluations. Each person employed in a safety position shall be required to take and pass a medical examination appropriate to such position given by a county physician during and before the completion of his or her twelfth month of employment in such safety position. Thereafter, each such employee shall be required to take and pass a safety position medical examination during the same calendar month in which the employee completed his or her twelfth month of employment in each of the next succeeding four years. Successful completion of the first year of employment in a safety position shall not be deemed to occur until such safety employee has actually taken and passed the appropriate safety membership medical examination required preceding the completion of his or her twelfth month of employment in a safety position.

As used in this chapter, the term "safety position" is one the primary duties of which would qualify the holder thereof for the status of safety member within the Imperial County employees' retirement system. A "safety employee" is one who holds a safety position, whether or not the employee is eligible for or actually holds the status of safety member within the retirement system.

The Imperial County board of retirement may require a safety member to be re-examined at any time or from time to time. Safety employees also may be required to take such medical evaluations at either the request of the department head or the board of supervisors.

County employees required to take periodic safety position medical evaluations pursuant to this subsection shall have all the rights and privileges, as well as the duties and requirements, of other county employees under the medical evaluation system. They may be medically qualified, conditionally qualified, conditionally disqualified, or medically disqualified for employment in their safety positions based on the results of periodic safety position medical evaluations, and depending upon the type of medical evaluation determination made, such employees shall be fully subject to all the appropriate related provisions of this chapter.

E. Wellness Medical Evaluations.

1. Periodic health evaluations conducted as an employee benefit to insure the health and long-term employability of the county's workforce may be provided by the county under the county's employee health plan or otherwise. Medical conditions identified during these examinations shall be followed up by treating physicians under the employee's health plan or the county's workers' compensation program, as appropriate.

2. Employees with chronic degenerative conditions at the time of hire, or at the time of a re-evaluation, may be referred for follow-up to insure continued support from a wellness perspective and a preventive approach directed toward changing and improving their behavior so that such conditions do not begin to impact job performance in the future. Included in such referrals and follow-ups may, for example, be employees with mild hypertension, who at hire or other evaluation were not restricted from performance of any job duty.

3. Application of medical standards, in such cases, will not become necessary unless and until an employee's degenerative condition has degenerated to a state where performance is affected or the risk of injury to the employee or others becomes present, imminent and substantial. If these types of developments do occur, the employee's department head shall request a fitness-for-duty evaluation pursuant to the provisions of Section 3.24.220.

(Prior code § 24377.5)

A. The medical evaluation system shall apply to the transfers and promotions of county employees to new positions. All offers of employment for transfers and promotions to new positions shall be made contingent upon and subject to the requirements of this section.

B. If the physical demands of the new job are equal to or less than the demands on the job currently held, a medical evaluation shall not be required.

C. If the physical demands of the new job are greater than that of the old job, the county employee applying for the change of position shall take a pre-placement medical evaluation for the new job.

D. If the employee is only conditionally qualified for the new job, the employee shall continue to be employed in his or her present position unless and until a reasonable accommodation is afforded and accepted by the employee for the new job. If the employee is conditionally disqualified for the new job, the employee shall continue to be employed in his or her present position unless and until the conditionally disqualifying medical condition is clarified or corrected. If the employee is medically disqualified for the new job, the transfer or promotion shall not be effected.

(Prior code § 24377.6)

The board of supervisors reserves the right to require any appointive officer to take a medical evaluation for the purpose of determining whether the officer is fit to perform the duties of his or her office when the officer has been absent from duty for an extended period of time due to illness or disability or at any time when the board has reason to believe an appointive officer is suffering from illness or disability which interferes with the officer's ability to perform the duties of his or her office.

(Prior code § 24377.7)

A. Cases will arise wherein a county employee attempting to return to work after an absence, illness or injury, or an employee receiving a periodic medical evaluation or an evaluation at the request of a department head, will be found, after medical evaluation, to be disqualified to return to or continue county employment, either temporarily or permanently. If the disqualifying condition is temporary in nature, the employee shall be classified as conditionally disqualified. If the disqualifying condition is permanent in nature, the employee shall be classified as medically disqualified.

B. If the medical examiner determines that a county employee is conditionally disqualified or medically disqualified, the employee shall be provided an opportunity to submit to the county health officer information clarifying the status of the disqualifying condition. Where appropriate, the employee's personal physician should be asked to supply information to clarify diagnosis and prognosis, as well as information which might indicate the employee is an exception to the norm used under the medical evaluation system.

C. If an employee is found by the county health officer to be medically disqualified from his or her employment after an in-service medical evaluation, the employee's department head shall suspend the employee from county employment due to medical disqualification. The suspension shall be with pay if the employee has accrued to his or her credit any paid leave benefits (sick leave, compensatory time for overtime worked, vacation time, administrative leave, etc.) and the employee consents to use of such paid leave benefits; otherwise, such suspension shall be a leave without pay.

1. If the medical disqualification of the employee is based on a medical condition which is determined by the county health officer to be temporary in nature, or which, in the opinion of the county health officer, may be resolved with treatment, medication, or other corrective action by the employee, the county health officer shall classify the employee as conditionally disqualified and shall so notify the employee and his or her department head, and the employee's suspension shall be for a duration of time appropriate to allow the employee to recover from or resolve the medical condition. The suspension of the employee shall be lifted by the department head if and when the employee passes a return-to-work or fitness-for-duty medical evaluation pursuant to the provisions of this chapter, or is otherwise classified as medically qualified or conditionally qualified by the county health officer. If such a conditionally disqualified employee does not take steps to resolve the medical condition creating such classification, the department head shall treat the employee as a disabled employee on leave of absence without pay, pursuant to the provisions of Section 3.08.270(I).

2. If the medical disqualification of the employee is based on a medical condition determined by the county health officer to be permanent in nature, the county health officer shall classify the employee as medically disqualified, and the employee's department head shall immediately suspend the employee from county employment due to medical disqualification.

D. In all instances wherein a county employee has been suspended due to a medical disqualification classification, the employee's department head, in consultation with the employee and county's director of human resources, shall, as expeditiously as possible, determine whether the suspended employee may be placed in available alternative employment in the county service.

1. It shall be county policy to provide alternative employment in the county service to all such medically disqualified employees, if such alternative employment is available in the county service, if the employee is medically qualified for such alternative employment, and the employee desires such alternative employment. In such matters, the county's director of human resources shall exercise the authority granted pursuant to Section 3.24.090(C) of this chapter. All county department heads shall cooperate with the director of human resources in attempting to obtain alternative employment for such employees.

2. If such employees who are permanently medically disqualified to substantially and safely perform the duties of their positions cannot be re-assigned to positions with duties they can safely perform, or if such employees do not desire such available re-assignments, such employees shall either be retired for disability or service if they qualify for such benefits, or be terminated from employment due to medical disqualification if they do not qualify to apply for such benefits.

3. It shall be the duty of the employee's department head to initiate one of the two actions authorized in subsection (D)(2) of this section, as soon as the department head is informed of the permanent medical disqualification of the employee and the determination of the director of human resources that such employee cannot be re-assigned to alternative employment, or that the employee refuses all such re-assignments.

4. It shall be county policy to immediately initiate applications for retirement benefits in all cases involving county employees who are permanently medically disqualified for their employment and who are not afforded or do not accept alternative county employment.

5. Such an employee shall be immediately advised by the employee's department head that the employee may be eligible for service or disability retirement, and referred to the retirement administrator to apply for benefits. If such employee refuses or fails to immediately apply for such retirement benefits, the employee's department head shall immediately apply for disability retirement on behalf of the employee.

a. If a permanently medically disqualified employee applies for disability retirement benefits, or has such application submitted on his or her behalf, and the Imperial County retirement board subsequently determines that such employee is not permanently disabled to perform the duties of his or her position pursuant to the provisions of the 1937 County Employee's Retirement Law, county's director of human resources, in consultation with county counsel, shall determine the appropriate action to be taken on behalf of the county and the affected employee. Actions in such instances may include: (1) re-instating the subject employee to his or her former county employment; (2) making other county employment arrangements for the employee agreeable to the employee; or (3) seeking reconsideration and/or judicial review of the decision of the Imperial County retirement board.

b. If a permanently medically disqualified employee applies for disability retirement benefits, or has such application submitted on his or her behalf, and the Imperial County retirement board subsequently determines that such employee is permanently disabled to perform the duties of his or her position pursuant to the provisions of the 1937 County Employees' Retirement Law, but is capable of performing other duties in county service, the director of human resources shall:

i. If the disability is service connected, immediately initiate a suitable rehabilitation evaluation referral for the employee pursuant to Section 31725.6 of the Government Code. Every reasonable effort shall be made to rehabilitate such employee to a position in Imperial County service which such employee is willing and able to perform. Before commencing any rehabilitation program, and again before the employee commences work in the employee's new position, the county health officer shall determine whether the job demands of the new position are compatible with the employee's restrictions and medical condition by applying the appropriate medical standards as if the determination were a pre-employment evaluation for the new position; or

ii. If the disability is nonservice connected, make every reasonable effort to transfer, reassign or change such employee to a position in Imperial County service which such employee is willing and able to perform, pursuant to Section 31725.5 of the Government Code, which section is made effective in Imperial County.

c. If an employee previously retired for disability is subsequently determined by the board of retirement to be no longer so incapacitated, the county health officer shall determine whether the job demands of the position to which reinstatement is sought are compatible with the employee's restrictions and medical condition by applying the appropriate medical standards as if the determination were a pre-employment evaluation for the position. The provisions of subsection (D)(5)(a) of this section shall apply in cases of dispute regarding such determination by the board of retirement.

(Prior code § 24378)

A. Medically Disqualified Applicants/Employees. Any job applicant or county employee who has been classified as medically disqualified for county employment may appeal-such disqualification decision to the county's employment appeals board on the bases provided for by the provisions of this section.

B. Conditionally qualified Applicants/ Employees—Conditionally Disqualified Applicants/ Employees.

1. Applicants and county employees who have been conditionally qualified or conditionally disqualified for employment, shall not have such appeal rights.

2. Conditionally qualified and conditionally disqualified applicants and employees shall comply with the provisions of Section 3.24.140(C) through (F) and Section 3.24.070(F), respectively, of this chapter. Such applicants and employees shall have no appeals rights under this section unless and until they have been formally designated as medically disqualified by the county health officer.

C. Bases For Appeals. Appeals filed pursuant to this section shall be based only on a request to review one of the following determinations:

1. Whether a particular medical condition as determined by the county health officer, actually exists;

2. Whether the application of a medical standard or standards used by the county health officer in the individual examination process is appropriate and job-related;

3. A contention that the complainant represents an exception to the norm utilized by the county's medical evaluation system; or

4. That reasonable accommodation is available to an applicant who qualifies for such accommodation under the county's handicap policy, that an undue hardship would not result to the county if such accommodation is provided, and that such accommodation has been unreasonably denied or applied to the particular applicant's job.

D. All appeals of the above types of determinations by the county health officer or director of human resources shall be supported by an independent medical examination report, obtained at the applicant's/employee's own expense, submitted by the complainant with his or her appeal. The report shall provide only information relevant to the nature and extent of the medical condition(s) which relate to the complainant's disqualification. Information regarding the complainant's ability to perform the job, with the medical condition(s), should be avoided, since the county's job/medical standards information is not available to the independent medical examiner.

E. All such appeals shall comply with the following procedural requirements:

1. Informal Resolution.

a. All requests for board review shall be preceded by an attempt by the complainant to resolve the matter complained of on an informal basis. Whether the complainant is a job applicant or a county employee, the applicant/employee shall attempt to informally resolve the complaint with the county's director of human resources. Such requests for informal resolution shall be made in writing to the director of human resources within five working days after the applicant/employee is notified of his or her disqualification.

b. In informal attempts to resolve complaints, the county's director of human resources shall provide the complainant the opportunity to present any additional medical or job-related information that might clarify the status of the disqualifying medical condition, indicate that the complainant is in fact an exception to the norm utilized by the system, or that the disqualifying condition can be reasonably accommodated. This opportunity to present additional medical or job-related information shall be in addition to any such opportunity that may have been afforded the complainant by the county health officer before the final disqualification determination was made by the officer.

c. If the director of human resources cannot resolve such a complaint informally, and the complainant desires to continue with his or her appeal, and the complainant meets all the requirements of subsections A, C and D of this section, the director shall set the matter for hearing before the county's employment appeals board.

2. Employment Appeals Board Hearings.

a. All hearings before the employment appeals board involving medical disqualification determinations shall be conducted as closed hearings not open to the public. Such hearings shall be closed to accommodate the presentation of medical information relevant to the appeal.

b. Employment appeals board hearings shall provide complainants the opportunity to submit information that by a preponderance of the evidence demonstrates that a medical condition does not preclude employment or that a medical condition can be accommodated. The employment appeals board is authorized to determine by the weight of the evidence presented at hearing whether the relevant medical conditions exist, whether medical standards have been properly applied, and/or whether such conditions can be reasonably accommodated. The employment appeals board may also determine that a particular complainant has submitted sufficient medical or job-related information to indicate that individual is, in fact, an exception to the norm utilized in the county's medical evaluation system.

c. At such appeals hearings, the county's director of human resources is authorized to provide staff presentations to the board demonstrating the methodologies utilized in establishing and applying medical standards in the county's medical evaluation system and to provide staff reports to the board on job demands and accommodation possibilities.

(Prior code § 24379)

A. The records of medical examinations shall be retained by the county health officer. Physical examination reports are confidential in nature, and shall only be available for inspection by the county s director of human resources, county counsel, the retirement administrator, the county's workers' compensation administrator, or their designees.

B. A report providing only a summary of medical evaluation findings pertinent to the applicant's/ employee's employment status shall be sent to the department of human resources. Medical records shall not be kept as part of the official personnel file which is open to inspection. Supervisors, managers and department heads shall be informed of work restrictions or necessary accommodations, but shall not have access to medical documents. Risk management, safety and/or internal health care professionals shall be informed of conditions which may require emergency treatment.

C. Medical examination records shall not be copied or released to any individual or organization for any purpose, unless pursuant to court order. Authorization for release of medical information by a provider of health care shall be valid if it complies with the format outlined in appropriate state statutes.

D. Any claim, grievance, appeal, suit, administrative action, or the like filed by an applicant or employee against the county or the Imperial County employees retirement system constitutes a waiver of the confidential nature of the examination records, and is therefore consent to use the records insofar as such records are material to the claim.

E. Medical records shall be stored by the county health officer in such a manner as to provide the maximum level of confidentiality and security. Medical examination reports and supplemental information shall be retained for at least five years after the date of separation from county service. Medical records of county employees exposed to toxic substances or harmful physical agents shall be kept for at least thirty (30) years after the date of separation from service.

F. A provider of health care that has created medical information as a result of employment-related health care services to an employee conducted at the specific prior written request and expense of the county may disclose to the county that part of the information which:

1. Is relevant in a lawsuit, arbitration, grievance, or other claim or challenge to which the county and the employee are parties, and in which the patient has placed in issue his or her medical history, mental or physical condition, or treatment, provided it may only be used or disclosed in connection with the proceeding;

2. Describes functional limitations of the patient that may entitle the patient to leave from work for medical reasons or limit the patient fitness to perform his or her present employment, provided that no statement of medical cause is included in the information disclosed.

(Prior code § 24380)