OSHA & Junk
Opiates vs Opioids
"-iates" are natural -Poppy, Codeine, Morphine, Heroin "-ioids" are synthetic -Hydromorphone, Oxycodone, Methadone, etc
English common law
"the honorable lord will care for his laborers" -framework for US worker's comp -during the Industrial revolution
Maximum possible worker's comp check per week
$1,000 -may be reduced if receiving other gov't help
Unholy Trinity of defense
(CAME OUT OF ENGLISH COMMON LAW) -Contributory negligence -Fellow Servant rule -Assumption of risk (death contracts) *TO PROTECT EMPLOYER*
How long do patients get to produce a urine sample
*4 min* -may be given 40 oz water if they still can't urinate after that time
Compliance EAP
*LEAST EXPENSIVE* method to comply with regulations -monitoring conditions set by: DRUG-FREE WORKPLACE ACT, DOT, & state regulations (drug/alcohol testing, counseling for abusers, MRO)
Alcohol lab screening
*Saliva test* 1st Confirmed with Breath screening -if result = 0.02 then *MUST REPEAT* in 15-30 min
Who pays for coverage of injuries in worker's comp
*THE EMPLOYER* - pays for premiums -even if the worker was harmed by another worker while on the job -employee is NEVER considered "at fault" for their injury -age is NOT an exemption
Leading cause of death in agriculture (4 most common)
-*Tractor rollovers* (transportation) -Run-overs -Stuck in machinery -Falls (from height or wet surfaces)
What services do EAPs provide?
-Assessments -Referrals -Short-term counseling (3-8 total sessions) -Legal advice -Financial counseling -Follow up (employees AND families) *ALL CONFIDENTIAL*
Who gets a drug test?
-Future employee Pre-employment screen -Someone suspected of impairment -Current employee for random testing -Driver who was cited or involved in accident -Employees returning to duty after being on leave -Those with a previous positive result
Deaths of teens on farms
-Machinery-related -Motor vehicle-related -Drowning
EAP counseling
-Marriage/family -Financial -Psych (stress, anxiety, depression) -Workplace conflict -Drug/Alcohol -Eating disorders -Coping with chronic illness/Bereavement
Medical care benefits for worker's comp includes
-Meds -Supplies -Hospital tx -Casts/Braces/Prosthetics
Permanent disfigurement covered by worker's comp
-Neck -Face -Head -Hand
Why are EAPs underutilized?
-Stigma ("mental health patient") -Fear of lack of confidentiality (getting fired) -Lack of motivation -Shame -Unaware of treatment options -Fear of commitment to treatment (skeptical that it helps)
Permanent losses covered by worker's comp
-Thumb, Finger, Hand, Arm -Foot, Toe -Sight, Hearing
Types of EAPs (KNOW THESE)
1. Full service 2. Integrated program 3. Wrap-around 4. Compliance 5. Peer-assistance programs
Age most affected by drug addiction
18-29 -frontal lobe not fully developed
Worker's accident insurance
1st modern system of worker's comp
How long can THC last in the system/urine?
30-90 days!
Normal urine temperature
90-100 deg F
False positives for Methamphetamines
ADHD meds Weight loss meds Vicks inhaler
ADA
Americans with Disabilities Act -protections for employees with physical or mental impairment that limits 1 or more activities *EMPLOYERS CANNOT DISCRIMINATE* -must be record of this disability
Monitoring of worker's comp
Big Brother is Always Watching + OSHA -Tracks # and severity of claims -Audits do occur -May get premium discounts (if low # of claims)
Downside to Employers utilizing EAPs
COST -many smaller businesses cannot afford it -BUT healthier workers = more efficient workers & better business
CEAP
Certified Employee Assistance Professional -trained (certified) person to deal with employee drug problems -helps employees thru hard times
Breath Alcohol Technician
Certified person who performs EtOH breath screenings
Possible outcomes from Pre-placement exams
Cleared. Pending clearance. Not cleared. Based on if patient is *healthy enough* to work +/- accommodations AND if patient does *not* represent a direct *threat* to self/others
Process for drug testing
Collect the specimen Test it Review it Report it
Checks for valid urine sample
Color Specific gravity (>1.003) Creatinine (>5) Chromium Nitrates Aldehydes
Critical element to the success of an employee assistance plan
Confidentiality -strict federal/state regulations -info must NOT be shared with employer
Outlook for EAP services
Continue to evolve & will likely provide many more services in the future (INCREASING marketplace competition, workplace demands, health reform, & lower cost with 3rd party EAPs)
Pennsylvania Worker's Comp Act
Covers: -medical expenses -wage-loss compensation -death benefits
DER
Designated Employer Representative -removes employee with + drug screen from duty
False positives for PCP
Dextromethorphan (OTC cold medicines) Tramadol
Regulated drug testing
Done by: -DOT -Nuclear Regulatory Commission -Dept of Defense *ALL SAMPLES MUST BE SENT TO HHS LAB* -collection must be monitored, 45 mL minimum Drugs: Pot, Cocaine, Opiates, Amphetamines, PCP
False positives for Marijuanna
Dronabinol (Marinol) Hemp-containing foods (CBD) *Patients cannot use Medical Marijuanna and still pass the DOT screening*
Occupational Alcohol Programs
EAP from 1940s -addressed ALCOHOL abuse only -referred by coworkers
False positives for Cocaine
ENT, Ophthalmic, Dentist treatments Bromptons' solution
Integrated program EAP
Emphasis on BEHAVIORAL HEALTH -*COMBO* of in-program service + referrals -more common with LARGE companies/unions
EAPs
Employee Assistance Programs -address employee substance abuse (& other psych health issues) -a form of employee paid benefit
Farmers & worker's comp
Employees NOT covered if: -Farmer pays <$1,200 in wages per yr OR -employee works <30 man-work-days per yr
Negligent infliction of emotional stress
Employer cannot use a drug test in order to invade an employee's personal privacy
Invasion of privacy
Employers cannot go around telling others about the results of an employee's drug screen
Reasonable accommodation for disability
Ex: scheduling, station modified, training, interpreters -so employee enjoys equal employment opportunity -info must be stored in SEPARATE medical file -managers can know accommodation but NOT the Dx
Documentation for Worker's comp
FULL NAME OF PATIENT & EMPLOYER Mailing address Location of work Payroll info Classification of job held Type of benefits
Wrap-around EAP
Focused on Mental Health Services -used by *SMALLER* business employers -uses 3rd party contracts
Managed behavioral heath care/EAPs
From 1990s on -EAP that addresses WIDE variety of personal concerns (not just drugs/alcohol) -SELF referral
How well do physicians recover from drug abuse?
Great! They have high recovery rates with Physician Health Programs
Alternatives to URINE for drug screening
Hair/nails Saliva
What have company managers found to improve the "bottom line"?
Helping troubled employees, rather than punishing them -these companies use EAPs!
ADA & drug use
I don't really get it but... ADA probs can't protect you from a failed drug screen if you ARE NOT yet an employee
DOT Disqualifications
IDDM Seizure disorder Uncontrolled HTN Implanted defibrillator Monocular vision Hearing loss (40+ db in both ears) On Methadone, Chantix, or Recreationals Loss of limb Sleep disorder
Designated provider's list
If a worker becomes injured, there is a list of WHO they can go see in order to have care that is covered in the first 90 days -6 options must be given (3/6 must be physicians) -Employer cannot mandate who the employee sees -Employee entitled to 2nd opinion (for surgeries) -Employee match switch provider's on the list
Instant drug screen results
If negative = can tell employee If positive = must be confirmed by HHS lab -*NEVER TELL EMPLOYEE OF POSITIVE RESULT*
Worker's comp covers...
Illness Injury Disease
Goal of EAP
Improve workplace environment Maximize employee work performance by affecting health
Positive drug screen with deemed reasonable explanation
In the record it is recorded as a NEGATIVE result
IME
Independent medical examination -the insurance company mandates a second opinion from an unbiased physician -EMPLOYER MUST COMPLY (jail time!)
Occupational disease list
KNOW THESE: -Name of disease -Agent causing it -Source of the agent -Disease syndrome -Prevention
Entitlements for Worker's comp *(KNOW THESE)*
Lost wages (total vs partial) Death benefits Specific loss benefits (fingers, toes, etc) Medical care
How many follow-up drug screens for an employee who previously tested positive?
MINIMUM *6* over the course of a year -always performed randomly -always with DIRECT observation
MRO
Medical Review Officer -must be a PHYSICIAN -confirms positive results for drug testing -reviews potential reasons for false positives *FOR POSITIVES - must offer employee another chance ON THE SAME SAMPLE*
Timing of Pre-placement exams
Must be conducted POST-OFFER -an exam cannot affect the decision on whether or not to hire
Alcohol screening result of 0.040
Must be removed from duty & undergo SAP evaluation -per DOT rules
Can you add on testing for cancer or TB during pre-placement screening?
NO - the employer is paying -must be relevant to the job -if you find something, let the patient know to go get it checked out!
Blood testing for alcohol
NOT permitted for work screenings -use other tests
NIOSH
National Institute for Occupational Safety and Health -part of CDC -provides guidance on hazardous chemicals & exposures -has a subset devoted to AGRICULTURAL hazards
NLRA
National Labor Relations Act -rights for unions -employer cannot demand a new drug screening without going thru the union first
NCCI
National counsel on compensation insurance -helps determine compensation & classification (Pennsylvania does NOT use them)
Findings during pre-placement exam
No legal obligation to inform the patient -but ETHICAL obligation still exists
High risk workers according to worker's comp
Oil/gas workers Healthcare works
Public Pension Insurance
Origins of Disability compensation
Who isn't covered by worker's comp?
Owners & Family members Farm hands Independent contractors Railroad workers Some federal government employees
False positive for Opiates
Poppy seeds
Most common exam performed in occupational medicine
Pre-placement exam -common for Department of Transportation
Types of worker's comp that the employer chooses
Private State-run Self insurance (usually too costly)
Peer assistance EAP
Program based on *MEMBERSHIP*, not set by employer -for workers of small businesses, contractors, or those geographically dispersed *ASSURES CONFIDENTIALITY* - not an in-house work service
Social insurance
Programs to APPEASE THE MASSES
Full service EAP
Provides everything from crisis management to child care assistance -internal (company-run) or external (3rd party) *EXPENSIVE*
False positives for Amphetamines
Pseudophedrine/Ephedrine Propranolol/Atenolol Levodopa/Carbidopa ADHD medications Didrex (for obesity)
ADA Mental impairment includes
Psych disorder Intellectual disability Seizure disorder Organic brain syndrome Learning disability (Dyslexia)
Types of drug panels
SAMHSA - 5 drugs (Regulated) Others are not regulated
Pre-placement exam format
Self-assessment questionnaire (Hx) Physical exam Labs (urine drug screen)
SEAP
State Employee Assistance Program -free service for PA state employees/families -includes *4* face to face sessions -discounted legal services
SAMHSA
Substance Abuse and Mental Health Services Administration -defines drug testing procedures
SAP evaluation
Substance abuse professional evaluation -if an employee has + drug screen, must see professional before returning to any duties -develops a remediation plan -in charge of post-monitoring of employee upon return
Low risk workers according to worker's comp
Teachers
Reasons for urine sample rejection
Temperature out of normal range Specimen ID mismatch No collector name & signature Tamper seal broken Insufficient volume (<45 mL)
If you're not an approved provider for worker's comp...
Their visit will not be covered -warn them of this 1st! -do initial assessment only
If employer uses "Unregulated" drug testing
Then employer must have clear policy & inform employees what would happen if they had a positive drug screen -they cannot use gov't forms for testing!
GOAL of pre-placement exams
To help people perform their duties safely -NOT to exclude people from working
Ways to prevent fake urine collection
Turn off water to sink & toilet Bluing dye in toilet Check for adulterants Direct observation (DOT requires this)
Exceptions to pre-offer pre-placement testing rule
Urine drug screens Functional capacity screening (strength/agility)
Pre-placement exam testing
Vision, Hearing, Toxicology, Infection titers, CXR, Spirometry -consider exposures -must be relevant to job
When should employee seek EAP help?
WHENEVER THEY HAVE A PROBLEM (you name it) -also to prevent things from becoming a problem
Does an injury in the parking lot count for worker's comp?
YES -so do CME conferences, seminars, & site vists
Muck-rakers
journalists or writers who alerted the public to wrongdoings in politics and business Helped establishment of: -FDA (1906) -Meat Inspection Act (1906) *ULTIMATELY PUT IN STATE'S CONTROL*
State Worker's Insurance Fund
state-run insurance carrier
