An emergency medical technician has been placed on unpaid leave after racist comments surfaced of him comparing black patients to gorillas and claiming to take “immense satisfaction” as he “terrorized” an African American boy with a needle.

Alex McNabb, a part-time EMT in Patrick County, Virginia, made the statements on a white supremacist podcast called “The Daily Shoah.” McNabb is a frequent co-host of the podcast, whose title mocks the Holocaust.

The comments, which McNabb, 35, later claimed on Twitter to be a “work of fiction,” ignited a debate over whether he can render adequate care to vulnerable, minority and Jewish patients.

McNabb would not comment directly to CNN, beyond indicating in a tweet that he is undergoing a “character assassination attempt.”

Using an alter-ego named “Dr. Narcan” on the podcast McNabb repeatedly called black people “dindus,” a slur combining the words “didn’t” and “do” — a reference to black people who claim they are mistreated by the justice system.

In one podcast from October 4, 2016, first reported by the Huffington Post, McNabb tells of an emergency call to what he characterized as a black apartment complex that medics call “Ebola Alley.” Using the Dr. Narcan persona, he refers to a black woman as a “dinduisha” and called her a shaved “Harambe,” the name of a famous gorilla.

“This individual should never be involved in patient care at any level,” said Lock Boyce, the board of supervisors’ chairman of Patrick County. “Not as a physician, a nurse, an EMT. Not anywhere.” The rural, overwhelmingly white county in the Blue Ridge Mountains has a contract with McNabb’s employers.

Virginia’s Department of Health has opened a formal investigation into McNabb’s conduct after receiving a complaint late last month, a spokesperson said.

An attorney for McNabb’s employer, JEB Stuart Volunteer Rescue Squad, told CNN that McNabb was placed on unpaid leave Monday night, two days after news reports of his comments surfaced.

“We’ll cooperate (with the state),” said Wren Williams, JEB Stuart’s attorney. “I’ve cautioned against firing him outright yet because we don’t want to be sued for wrongful termination.”

Williams said McNabb’s future will rest with JEB Stuart’s board. The board held an emergency meeting Wednesday night where it affirmed the decision to place McNabb on unpaid leave until the state’s investigation concludes, he said.

Williams added that there is no indication so far that McNabb mistreated anyone in his care.

The case is testing the longtime protection for extremists whose words may be racist and offensive, but who are still shielded by free speech laws. In this case, McNabb’s occupation is front and center.

“He is making life-or-death medical decisions for residents of a variety of ethnicities, many of which do not fit his criteria for a white ethno-state,” said Keegan Hankes, a senior research analyst with the Southern Poverty Law Center. “Whether drawn from his experiences as an EMT or fiction, (McNabb’s statements) are tremendous cause for concern.”

Though McNabb has said on Twitter that “any resemblance to actual persons … is purely coincidental,” he told his podcast co-hosts in 2016, after describing a diabetic ER patient and a doctor who collects toenails, that “both these stories are real.”

Later in the same podcast, in a Dr. Narcan story that McNabb doesn’t label as fact or fiction, he speaks of “an unruly, young African American male child” who needed to have blood drawn.

“So, guess who volunteered to take (his) blood?” McNabb said. “Dr. Narcan enjoyed great, immense satisfaction as he terrorized this youngster with a needle and stabbed him thusly in the arm with a large-gauge IV catheter.”

The Virginia health department’s investigation will focus on whether “any alleged violations of Virginia’s EMS regulations have occurred,” the agency said in a statement. Those regulations stipulate that “EMS personnel may not discriminate … based on race, gender, religion, age, national origin, medical condition or any other reason.”

In a November podcast he said he hasn’t treated any patients differently based on race because “it’s a professional duty,” the Huffington Post reported.

Boyce, the Patrick County board chairman, said he will demand McNabb’s firing at a county board meeting next Monday. If McNabb is still employed, Boyce said he will seek “to suspend all county funds” paid to the JEB Stuart Volunteer Rescue Squad.

“This is not some backward county where we’re a bunch of white supremacists,” said Boyce, who says he’s heard from many people in the county outraged over the reports.

“We can’t sit here and say it’s their First Amendment right,” he said. “We have to say ‘no, this is the way to hell.'”