1. Symptoms of Substance Use & Reasonable Suspicion Testing in the Workplace November 10, 2010 Dan R. Azar MD MPH QME MRO Alliance Occupational Medicine Milpitas & Santa Clara

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6. 6 Drinking, Driving and Death Underground August 31, 1991 August 31, 1991 Lexington Avenue subway derailment under Park Avenue Lexington Avenue subway derailment under Park Avenue smoky tunnel smoky tunnel hundreds of tons of mangled metal hundreds of tons of mangled metal dozens of bloodied passengers and dozens of bloodied passengers and here and there, body parts. here and there, body parts.

7. Alliance Occupational Medicine7 Worst New York City Subway Accident in 63 years. Five people killed Five people killed More than a hundred injured More than a hundred injured Motorman, 38-year-old had a history of alcohol abuse, Motorman, 38-year-old had a history of alcohol abuse, The level of alcohol in the motorman's blood strongly indicated that the motorman had a chronic drinking problem. The level of alcohol in the motorman's blood strongly indicated that the motorman had a chronic drinking problem. Why did supervisors at the NYC Transit Authority continue to allow him to operate trains? Why did supervisors at the NYC Transit Authority continue to allow him to operate trains?

8. Alliance Occupational Medicine8 Do we need a Substance Abuse Policy and Prevention Program? Safety Needs to be Every Employer’s Top Consideration Safety Needs to be Every Employer’s Top Consideration –Workers –Clients & Customers –Suppliers –General public To improve productivity/output To improve productivity/output To control input/production costs To control input/production costs To minimize employee theft and other wasteful behaviors. To minimize employee theft and other wasteful behaviors. To increase health and well-being of employees and their families To increase health and well-being of employees and their families –Health care insurance –Workers' compensation insurance and costs –General Liability insurance premiums;

9. Alliance Occupational Medicine9 An Effective Workplace Substance Abuse Policy Applies to everyone, including top managers. Clearly explains the organization’s drug testing policy. Outlines which tasks are "safety critical" Includes information about prevention, identification, treatment and rehabilitation. Includes information about education and training in the workplace. Addresses how treatment or evaluation referrals are made.

10. Alliance Occupational Medicine10 An Effective Workplace Substance Abuse Policy Encourages voluntary participation in substance abuse treatment, without job loss. Ensures participant confidentiality Describes the duties and responsibilities of the individual during and after treatment. Includes review of the policy at regular intervals. Consistent treatment from employee to employee

11. Alliance Occupational Medicine11 What Will the Policy Prohibit? Obvious: – –all illegal drug and alcohol use on company time will be prohibited Not so obvious: – –being at work with illegal drugs in system even though the use took place off the clock and off site? – –Same circumstances but with no visible impairment – –Criminal drug convictions without worksite use? – –What about mood altering prescription medications? – –What about OTC medications? – –What about medical marijuana? – –Hey, what about my 2 martini lunch?

12. Alliance Occupational Medicine12 What is Reasonable Suspicion? Must be based on a reasonable and articulated belief that the employee is under the influence of alcohol or drugs on the basis of specific observations concerning the – –appearance, – –behavior, – –speech, or – –body odors of the employee

13. Alliance Occupational Medicine13 Worsened Personal Appearance inappropriately dressed inappropriately dressed does not appear healthy does not appear healthy does not appear physically capable does not appear physically capable –slurred speech –unsteady gait –blood-shot eyes –sleepy appears unclean or unwashed at the beginning of work appears unclean or unwashed at the beginning of work no regular change of clothes no regular change of clothes offensive odors offensive odors –bad breath –body odor

14. Alliance Occupational Medicine14 Decreased Reliability extended weekends (Monday/Friday absences) extended weekends (Monday/Friday absences) consistently late consistently late leaves early leaves early absent from work area absent from work area excessive sick leave excessive sick leave takes unauthorized leave takes unauthorized leave repeated absences repeated absences misses deadlines misses deadlines doesn’t follow procedures doesn’t follow procedures

15. Alliance Occupational Medicine15 Loss of Problem Solving rarely follows through rarely follows through rarely checks for results rarely checks for results can't handle complex assignments can't handle complex assignments tends to ignore problems or delegate inappropriately; tends to ignore problems or delegate inappropriately; relies too heavily on others to complete the work; relies too heavily on others to complete the work; cannot define the problem cannot define the problem covers up the problem covers up the problem blames others blames others work frequently needs to be redone work frequently needs to be redone

16. Alliance Occupational Medicine16 Decrease in Job Knowledge skills are not current skills are not current doesn't understand regulations doesn't understand regulations misuses equipment misuses equipment doesn't retain instructions doesn't retain instructions needs constant supervision needs constant supervision doesn't understand or follow safety/security procedures doesn't understand or follow safety/security procedures requires frequent instruction or assistance requires frequent instruction or assistance learns very slowly learns very slowly unable to work independently unable to work independently

17. Alliance Occupational Medicine17 Decrease in Productivity –low volume of work –takes many breaks –wastes time –needs constant reminders to complete work –does not complete assigned tasks –overwhelmed by realistic workload –unavailable for extra work –cannot increase workload when needed –volatile and easily upset –inconsistent in the workplace

18. Alliance Occupational Medicine18 Poor Judgment –makes decisions without regarding available information –will not reverse decisions in face of mistakes –insensitive or tactless –does not use common sense –illogical reasons for behaviors –violates confidentiality –poor ability to size up situations –does not understand the whole picture –takes inappropriate actions –inattentive to safety procedures

19. Alliance Occupational Medicine19 Difficulty Working With Others –poor listening skills –inability to communicate –uncooperative –projects negative attitude to customers, co-workers, and the public –unable to resolve conflicts –openly mistrusts many people –edgy or easily and frequently angered or hurt by others –slows work of others –complains –hostile and argues frequently –stimulates complaints from co-workers –tends to blame others

20. Alliance Occupational Medicine20 The Well Intentioned Supervisor or Coworker… Overlooks the employee’s problem. Overlooks the employee’s problem. Pick up the slack & cover for the employee until he/she gets “their life back together.” Pick up the slack & cover for the employee until he/she gets “their life back together.” Coworkers pick up the additional workload created by a codependent manager. Coworkers pick up the additional workload created by a codependent manager. These “favors” ultimately hurt everyone including the employee who is using drugs or alcohol. These “favors” ultimately hurt everyone including the employee who is using drugs or alcohol.

21. Alliance Occupational Medicine21 Who is covering up…and why? Coworkers & supervisors cover up for the substance- abusing employee Coworkers & supervisors cover up for the substance- abusing employee Personal friendship or loyalty dissuade us from taking corrective action Personal friendship or loyalty dissuade us from taking corrective action Fear of confrontation: crosses personal boundaries Fear of confrontation: crosses personal boundaries Uncomfortable addressing a personal problem in the workplace – crosses professional boundaries. Uncomfortable addressing a personal problem in the workplace – crosses professional boundaries. We’re all worried about doing “the wrong thing” We’re all worried about doing “the wrong thing” Codependency: a tendency to behave in overly passive or excessively caretaking ways that negatively impact one's relationships and quality of life. Codependency: a tendency to behave in overly passive or excessively caretaking ways that negatively impact one's relationships and quality of life.

22. Alliance Occupational Medicine22 Lack of Action Increases Legal Liability of the Employer 1. Increased risk for on-the-job accidents. 2. Increased risk of damaging equipment or property. 3. Increased risk the employee will engage in inappropriate behavior. 4. Insufficient response to on the job impairment increases liability based on legal principle of negligence.

23. Alliance Occupational Medicine23 Codependency No More!* Do not insulate drug user from the consequences of his/her behavior Do not insulate drug user from the consequences of his/her behavior Hold the substance user responsible for his/her own behavior thereby promoting personal recovery. Hold the substance user responsible for his/her own behavior thereby promoting personal recovery. Doing the right thing the right way is challenging but rewarding. Doing the right thing the right way is challenging but rewarding. * Author: Melody Beattie * Author: Melody Beattie

24. Alliance Occupational Medicine24 Don’t Assume a Job Performance Problem is a Sign of Drug Abuse Lack of sleep Lack of sleep Other illness or health condition Other illness or health condition Side effects from prescription or OTC medication Side effects from prescription or OTC medication Anxiety or Depression Anxiety or Depression Mourning / Personal Loss Mourning / Personal Loss Accusing an employee of drug or alcohol use places the employer at increased risk of a lawsuit Accusing an employee of drug or alcohol use places the employer at increased risk of a lawsuit

25. Alliance Occupational Medicine25 Don’t Accuse Employee of Alcohol or Drug Use You are taking an unnecessary legal risk You are taking an unnecessary legal risk Instead, ask an employee whether he/she is “feeling all right?” Instead, ask an employee whether he/she is “feeling all right?” If you observe questionable behavior the employer is expected to make an inquiry If you observe questionable behavior the employer is expected to make an inquiry Record your observations. Record your observations. Document what you see, hear and smell. Document what you see, hear and smell. Do not give your opinion or diagnosis. Do not give your opinion or diagnosis. Do not document that which you do not want read back to you in deposition. Do not document that which you do not want read back to you in deposition.

26. Alliance Occupational Medicine26 One Symptom is Not Enough! Here are the 5 steps that should be under taken: Here are the 5 steps that should be under taken: –Observation (multiple dates okay) –Documentation (same day as observation) –Make a Plan (ask for help from HR) –Talk to the Employee –Follow-up

27. Alliance Occupational Medicine27 Observation supervisors are responsible for making sure employees meet certain minimum performance standards supervisors are responsible for making sure employees meet certain minimum performance standards take steps now to develop and communicate a set of objective job performance standards that explain your expectations. take steps now to develop and communicate a set of objective job performance standards that explain your expectations. Observe and document any time these standards are not being met (regardless of suspected cause). Observe and document any time these standards are not being met (regardless of suspected cause).

28. Alliance Occupational Medicine28 Documentation Train managers to document in specifics any time an employee is suspected of drug use while on duty: Train managers to document in specifics any time an employee is suspected of drug use while on duty: –appearance –actions –attitude Complete report within 24 hours of the observed behavior Complete report within 24 hours of the observed behavior Focus exclusively on the observed behaviors and the impact of those behaviors on work place or performance. Focus exclusively on the observed behaviors and the impact of those behaviors on work place or performance.

29. Alliance Occupational Medicine29 Make a Plan set your goals for the meeting set your goals for the meeting plan in advance plan in advance anticipate the employee’s possible responses anticipate the employee’s possible responses plan your reply plan your reply know what resources are available in advance for treatment know what resources are available in advance for treatment

30. Alliance Occupational Medicine30 Talk to the Employee have an appropriate second party attend as a witness have an appropriate second party attend as a witness preferably someone from employee relations and not a direct supervisor preferably someone from employee relations and not a direct supervisor document your meeting document your meeting limit your observations to specifics regarding job performance and/or objective signs of substance use. limit your observations to specifics regarding job performance and/or objective signs of substance use.

31. Alliance Occupational Medicine31 Pulling the Employee from Service With obvious signs of impairment (drowsy, careless, inattentive) remove from safety sensitive duties ASAP With obvious signs of impairment (drowsy, careless, inattentive) remove from safety sensitive duties ASAP –The operation of machinery / equipment –Medical or hospice care of a dependent Use a private office Use a private office Always have a witness present who is willing to document separately Always have a witness present who is willing to document separately Do not confront an impaired employee in public. Do not confront an impaired employee in public. Never argue, yell or threaten someone under the influence. Never argue, yell or threaten someone under the influence. Do explain and reassure. Do explain and reassure.

32. Alliance Occupational Medicine32 Follow Up When an employee has undergone substance abuse treatment and returned to the workplace: Offer no preferential or special treatment. Offer no preferential or special treatment. Give the individual plenty of feedback concerning his/her work Give the individual plenty of feedback concerning his/her work Continue to document observed behaviors Continue to document observed behaviors

33. Alliance Occupational Medicine33 Useful Internet Sites for Reasonable Suspicion http://transit- safety.volpe.dot.gov/Video/ReasonableSuspicion- HighQuality.wmv http://transit- safety.volpe.dot.gov/Video/ReasonableSuspicion- HighQuality.wmv http://transit- safety.fta.dot.gov/DrugAndAlcohol/TechnicalAssistance/R easonableSuspicion.asp http://transit- safety.fta.dot.gov/DrugAndAlcohol/TechnicalAssistance/R easonableSuspicion.asp http://transit- safety.fta.dot.gov/Publications/order/default.asp http://transit- safety.fta.dot.gov/Publications/order/default.asp http://workplace.samhsa.gov/FedPgms/Fed_DFWP.aspx http://workplace.samhsa.gov/FedPgms/Fed_DFWP.aspx http://www.workexcel.info/reasonable-suspicion- checklist/download.html http://www.workexcel.info/reasonable-suspicion- checklist/download.html

34. Alliance Occupational Medicine34 Signs and symptoms of alcohol and/or drug misuse: Odor of alcohol Odor of marijuana Slurred speech Flushed, swollen face Red or runny eyes or nose Pupils dilated or constricted, or unusual eye movement Lack of coordination Tremors or sweats Weariness, exhaustion Sleepiness Nausea Unauthorized possession of alcohol or illegal drugs Any other observation that creates a reasonable suspicion of being under the influence of drugs or alcohol at work

35. Alliance Occupational Medicine35 Thank You for Attending! Please Give us Your Feedback Alliance Occupational Medicine Milpitas CA 408-790-2900 Santa Clara CA 408-228-8400