ATTACHMENT B

AMERICAN DIABETES ASSOCIATION

STATEMENT OF PROBLEM AND SUBSTANTIAION FOR PROPOSAL

The American Diabetes Association (“Association”) submits this statementon the diabetes provisions of NFPA 1582 Standard on Comprehensive Occupational Medical Program for Fire Departments, 2003 Edition and the proposal to modify this standard.[1]

The American Diabetes Association

The Association is a nationwide, nonprofit, voluntary health organization founded in 1940. It consists of people with diabetes, health professionals who treat people with diabetes, research scientists, and other concerned individuals. With over 400,000 general members, over 18,000 health professional members, and over 3 million contributors, the Association is the largest non-governmental organization that deals with the treatment and impact of diabetes. The Association establishes, reviews, and maintains the most authoritative and widely followed clinical practice recommendations, guidelines, and standards for the treatment of diabetes.[2] The Association also publishes the most authoritative professional journals concerning diabetes research and treatment.[3]

The mission of the Association is to prevent and cure diabetes and to improve the lives of all people affected by diabetes. Related to the NFPA 1582 Standard, this mission requires supporting a system that provides rigorous safety standards to protect fire fighters with diabetes and the public, while not unduly denying people with diabetes the same rights granted to other Americans.

Assessment of Fire Fighters with Diabetes

The Association strongly opposes blanket bans that automatically disqualify all individuals with diabetes, or with insulin-treated diabetes, from a given occupation. Such bans are incompatible with the current science and treatment of diabetes, as well as contrary to both federal and state civil rights law. Indeed, case law throughout the United States, including multiple decisions by the United States Supreme Court, requires individual assessment rather than blanket prohibitions based on the presence of medical conditions such as diabetes.

The Association firmly believes that each person with diabetes can and should be individually considered for employment based on the requirements of the specific job, the particular qualifications of the individual, and the capacity of that individual to fully and safely perform that job. The Association has adopted the following policy:

Any person with diabetes, whether insulin-dependent or non-insulin dependent, should be eligible for any employment for which he or she would be otherwise qualified.[4]

Because the effects of diabetes are unique to each individual, it is inappropriate to consider all people with diabetes the same. Factors to be weighed in an individual assessment include the individual’s medical condition, treatment regimen (medical nutritional therapy, oral glucose-lowering agent, and/or insulin), and medical history, particularly in regard to the occurrence of incapacitating hypoglycemic episodes. Id.

While the Association does not believe that every person with diabetes is qualified to perform the duties of a fire fighter, it likewise believes that a blanket ban of all people who use insulin is unsupportable. Based on its knowledge of diabetes and diabetes managements, as well as information about the duties involved in fire suppression, the Association is convinced that a protocol can be developed to identify those people with diabetes who can successfully perform fire fighting duties. Such a protocol should be stringent – to ensure safety – but its requirements should be firmly rooted in sound medical and scientific knowledge and the experience of current fire fighters with diabetes.

Movement Toward a Process for Reasonable Individual Assessment

The current version of NFPA’s Standards with respect to individuals with diabetes is inconsistent with the above-stated approach. Most importantly, the Standard sets up a blanket ban by prohibiting any individual with insulin-treated diabetes from obtaining a position as a fire fighter. The current document fails to establish a protocol for reasonable assessment of an individual with diabetes whether such an individual is a candidate or incumbent and whether insulin-treated or not. In addition, the explanation of diabetes and diabetes management found in Annex A does not reflect the most recent advancements in the management of diabetes.

The Association is pleased to have had the opportunity to meet with the NFPA 1582 Task Group on several occasions to provide medical expertise that it believes will enable NFPA to revise its diabetes standards to provide for an individual assessment that is consistent with both anti-discrimination law and the safety of fire fighters with diabetes, their colleagues, and the public. The material submitted by the Association in this proposal derives, in most aspects, from a document developed prior to and during a meeting of the NFPA Task Groupin May, 2004. As such, it cannot accurately be viewed as simply the position of the Association based upon our knowledge of diabetes and diabetes management, but rather reflects a process of collaboration and compromise between the 1582 Task Group and the Association. In addition, following the May meeting, the Association made several proposed changes to the standards language itself (reflected in Attachment A) and has supplied suggested text for the accompanying physician’s guidance and annex.

The Association applauds NFPA for its ongoing review of these provisions and is convinced that collaboration between NFPA and the Association will provide the necessary expertise to develop a reasonable individual assessment protocol for individuals with diabetes who wish to become or continue to serve as fire fighters. A workable protocol based on current medical science will benefit people with diabetes through increased employment opportunities and benefit both fire departments and the public through an increased labor supply of qualified fire fighters.

1

[1] These provisions are found in section 6.18 (evaluation of applicants) and section 9.6.2 (evaluation of incumbents).

[2]American Diabetes Association: Clinical Practice Recommendations 2004, Diabetes Care 27: Supp. I, 2004.

[3]The Association publishes four professional journals with widespread circulation: (1) Diabetes (original scientific research about diabetes); (2) Diabetes Care (original human studies about diabetes treatment); (3) Clinical Diabetes (information about state-of-the-art care for people with diabetes); and (5) Diabetes Spectrum (review and original articles on clinical diabetes management).

[4]American Diabetes Association, Hypoglycemia and Employment/Licensure (Position Statement). Diabetes Care 27:S134 (Supp. 1), 2004.