SUBJECT: Fitness for Duty DATE: November 8, 2013 I. PURPOSE/SCOPE UPMC POLICY AND PROCEDURE MANUAL POLICY: HS-HR0721 * INDEX TITLE: Human Resources This policy applies to all United States based UPMC staff members, WorkSource staff members, students, volunteers, and contracted workers who have the responsibility to report to work fit for duty, to perform their jobs without undue risk to themselves or others, and to maintain fitness for duty throughout all hours of work or when on call. When a staff member exhibits work performance, behavior or any other action that appears to be inappropriate, or self-discloses current drug/or alcohol use, the provisions of this policy will apply. UPMC recognizes that staff members can become unfit for duty for reasons of emotional or mental impairment, because of chemical use, abuse/dependency or because of a medical condition due to illness or injury. UPMC recognizes that such forms of illness have effective treatment and rehabilitation. Assistance is available when it is determined to be appropriate and in accordance with this and other policies. For the purposes of this policy, emotional or mental impairment is defined as conduct or behavior substantially limiting a staff member s ability to perform his/her assigned job, or to perform in a manner that fails to maintain management s or the public s trust in his or her performance. Chemical impairment is defined as conduct or behavior in which consumption of alcohol or use of a chemical substance impairs the staff member s judgment or causes a deterioration of a staff member s work performance or behavior. Chemical dependency is defined as the continued consumption of alcohol or use of a chemical substance that may impair judgment and lead to a deterioration of a staff member s work attendance, performance or behavior, physical health, and/or social and family well-being. Links to policies referenced within this policy can be found in Section VII. II. LACK OF FITNESS FOR DUTY AND REASONABLE SUSPICION CRITERIA Fitness for Duty may be questioned through observations of a staff member s behaviors or physical symptoms, or through self-disclosure. As a result, the individual may be
PAGE 2 subject to appropriate medical examination and testing, which shall include, but not be limited to, drug and alcohol screening. If a supervisor reasonably suspects that a particular staff member is unfit for duty, that supervisor must consult with Human Resources and if appropriate, the nearest UPMC Employee Assistance Program (Life Solutions or other EAP) and/or Employee Health location prior to sending the employee for any testing. Observations may include but are not limited to the following: A. That the individual is, or may be unable to perform his or her duties or responsibilities and/or provide patient care safely and effectively; or B. Inappropriate behavior that may diminish co-workers or patients confidence in the individual s ability to perform his or her job satisfactorily; or C. Behavior generally associated with impairment including: appearance of confusion, uncontrollable outbursts, threatening gestures or speech, boisterous speech, drowsiness, staggering, dilated pupils, etc. and can include an odor of alcohol (Note: these may be symptoms of a non-intoxicated condition and should be evaluated with caution.) D. Listed below are examples of such behavior and performance that may provide a basis for fitness for duty testing; however, they are not to be considered as allinclusive: Acute episode(s) of interpersonal conflict Confusion regarding duties or work schedule Inability to complete coherent written documents or reports Changing or erratic work habits Documentation errors or missing documentation related to controlled substances Failure to comply with and document drug wasting policies and procedures Difficulty understanding or remembering directions A pattern of patient or staff complaints regarding behavior or performance Verbal or physical threats Involvement in the use or delivery of drugs without authorization Involvement in the unauthorized use, sale, possession, diversion or delivery of a drug while on duty or on UPMC property. Arrest or criminal charges of possession, sale, use or delivery of a drug, or of consumption of alcohol. Involvement in an accident, safety-related incident or a poor work-related accident record when reviewed with regard to type, frequency, and severity. Direct observation of drug or alcohol use, or the possession of a drug as defined in this policy. Evidence that a staff member has tampered with a previous drug test.
PAGE 3 Evidence of misuse of physician DEA numbers. Theft of prescription pads. Other information that upon review and investigation creates reasonable suspicion. III. PROCEDURE A. Observation 1. A supervisor, who personally observes behavior possibly indicating a lack of fitness for duty or reasonable suspicion, should immediately find another reliable witness such as another supervisor or security officer to observe/witness the behavior. A supervisor is a staff member with supervisory or managerial responsibilities who assigns work and contributes to hiring, dismissal and performance appraisal. In cases of imminent danger, the supervisor should send for such witnesses while immediately seeking out the involved staff member. 2. A non-supervisory staff member observing behavior indicating a possible lack of fitness for duty (defined above) on the part of a UPMC staff member on UPMC premises must report it immediately to: The supervisor in the area of the facility where the incident occurred; or The supervisor of the person who appears to be evidencing unfit behavior; or The observer s supervisor, whoever seems most appropriate and expedient. 3. Once the supervisor has been notified that a staff member s fitness for duty is in question, the staff member should be: Taken to a private area Confronted with the concern Escorted to a UPMC Employee Health location (see Employee Health Policy), Emergency Department, or other appropriate area for an evaluation and/or testing. It is necessary for all those undergoing fitness for duty testing to complete the Drug and Alcohol Screening Consent Form. If fitness for duty is in question outside of normal business hours, please contact UPMC Employee Health at 412.647.3695 and the nurse or practitioner on call can direct you. Assistance is available 24/7. Additionally, it is required that the testing site use appropriate Chain of Custody documents. Questions regarding these forms should be directed to UPMC Employee Health (412.647.3695). Contact HR as soon as possible.
PAGE 4 B. Self-Disclosure 1. When a staff member voluntarily self-discloses, the supervisor/designee: Observes whether or not the staff member appears to be currently unfit for duty. If staff member appears to be unfit, proceed with the standard Fitness for Duty testing process. If staff member does not appear to be unfit or cannot be observed (because he/she is not on duty), the staff member must be referred to EAP for assessment and referral for treatment and is not permitted to return to work until released by a treating provider. Provide the staff member with the telephone number of the UPMC EAP and instruct the staff member that he/she must contact the EAP as soon as possible, but not later than the next business day, to schedule an appointment. Call the EAP to notify the EAP that a Mandatory Referral has been made, to give identifying staff member information, and provide background information to assist in the assessment process. In all cases the supervisor is to contact Human Resources as soon as possible. C. Drug/Alcohol Screening 1. For cases of self-disclosure, this screening process is waived if the staff member does not appear to be unfit for duty. 2. The supervisor or appropriate delegate is to remain with the staff member until the conclusion of the testing and until the staff member is on his/her way home. 3. Upon arrival at the testing site determined by UPMC, the staff member must sign a consent form authorizing the release of the test results to UPMC Employee Health, Human Resources, EAP and his or her supervisor. Failure to give consent shall be considered a refusal to submit to testing and will subject the staff member to discharge. 4. A urine, saliva and/or blood sample will be required as part of the evaluation and/or testing. All tests will be handled according to the standards of control and collection as outlined in Employee Health s substance abuse testing policy, including off hour testing. At the time of this request, the staff member should be informed that these samples will be tested to determine whether the staff member has used drugs or alcohol and that the results may be released to the supervisor, Human Resources, UPMC Employee Health and EAP.
PAGE 5 5. If the staff member insists that he/she is unable to provide a specimen, he/she will be given three hours to do so. The staff member will be provided no more than 40 ounces of fluid during that period of time in order to prevent the specimen from being diluted. A staff member who is unable to provide a specimen within a three-hour time frame will be considered to have refused to submit to testing. Refusal to consent to testing will subject the staff member to discharge. 6. At the conclusion of the examination and testing, the supervisor will do the following: D. EAP Procedure a) Provide the staff member with the telephone number of the UPMC EAP and instruct the staff member that he/she must contact the EAP as soon as possible but not later than the next business day, to schedule an appointment. b) The supervisor/designee will advise the staff member that she/he will be suspended without pay pending the results of the drug/alcohol screening, EAP assessment and pending investigation. c) Transportation home will be arranged for the staff member by the supervisor or appropriate delegate. Should the staff member refuse this recommendation, the supervisor should document the conversation and notify the local police authorities immediately. d) Call the EAP to notify the EAP that a Mandatory Referral had been made, to give identifying staff member information, and provide background information to assist in the assessment process. e) Observers must document the incident, including observed performance or behavior problems (include real or potential risks), and other information supporting the conclusion of lack of fitness for duty. This document should be given to the staff member s supervisor, who will document the incident and resulting suspension. All information should then be forwarded to Human Resources for consultation. The EAP counselor will see the staff member within three working days for an initial assessment and will develop a treatment plan, which may include referral to the appropriate level of chemical dependency treatment and/or other appropriate treatment. A staff member given a mandatory referral to the EAP who does not call for an appointment and/or, show up for an appointment and/or who does not
PAGE 6 follow the EAP recommendations will be considered suspended pending investigation or may be discharged. E. Test Results 1. All test results will be sent directly to Employee Health and/or designee. The Medical Review Officer (MRO) should review positive tests. Test results are to be kept confidential except for their release to Human Resources, EAP and the staff member s supervisor by Employee Health, unless the staff member waives the right to confidentiality by filing an action against UPMC. 2. Depending on the results of the drug/alcohol screening and EAP evaluation, the staff member will be referred to the appropriate resources for chemical dependency treatment. Refusal by the staff member to be assessed or referred will be communicated to the supervisor, who is advised to consult with a Human Resources director or designee. 3. Where there is no evidence of chemical impairment or positive test result, but where Human Resource, in conjunction with the department manager, determines that the staff member s Fitness for Duty is still in question, the staff member will be evaluated by Employee Health and referred to the appropriate behavioral or physical medical experts as necessary. 4. A final decision regarding suspension or discharge should not be made until the test results have been received from the MRO and the department director consults with the Human Resources director or designee. 5. If the staff member s fitness for duty is no longer in question after the results of drug and alcohol testing have been reviewed, he or she shall be returned to work. IV. LAST CHANCE AGREEMENT 1. A UPMC WorkSource temporary staff member or a staff member in their initial orientation period is not eligible for a Last Chance Agreement. 2. If the staff member self-discloses or is determined to have been unfit for duty because of drug or alcohol use and under circumstances which do not warrant discharge, he or she will be returned to work under the terms of a Last Chance Agreement. 3. The director/department head, in consultation with EAP and Human Resources, will decide whether a staff member who has tested positive should return to his/her previous position. It is the responsibility of director/department head, in
PAGE 7 consultation with Human Resources, to evaluate if alternative placement for the affected staff member is necessary upon return to work. The placement may be within the respective department, division, or throughout UPMC. 4. Prior to return to work, the staff member, Human Resources representative, the EAP and the supervisor will sign a Last Chance Agreement in coordination with the UPMC Employee Assistance Program and Human Resources. Human Resources will generate the Last Chance Agreement and will arrange for the signing of the agreement. 5. The EAP will report compliance with treatment recommendations to Human Resources. 6. The staff member s supervisor will coordinate the random testing with Human Resources and Human Resources will be responsible for scheduling and monitoring the random testing. Upon return to work under the Last Chance Agreement, random testing will begin on day one. A staff member under terms of a Last Chance Agreement is responsible for paying the costs of random drug/alcohol screen, and will be required to sign an authorization to deduct the cost from the staff member s wages. 7. Failure to sign or abide by the conditions of the Last Chance Agreement will result in termination. 8. If a staff member voluntarily resigns from UPMC prior to the expiration of the Last Chance Agreement and are later rehired by UPMC the staff member will be required to fulfill the Last Chance Agreement commitment. Upon rehire the staff member would also be required to be assessed by the Employee Assistance Program (EAP) prior to their start date. V. RESPONSIBILITY TO REPORT IMPAIRED LICENSED MEDICAL PROFESSIONALS A. As required by state law, it is the responsibility of any hospital or health care facility to make a report to the appropriate board, when substantial evidence exists that a medical professional is using, diverting or stealing controlled substances. B. Reporting Responsibilities 1. Director/Department Head/Supervisor/Manager When the supervisor/manager has implemented fitness for duty testing and it results in a positive test, the supervisor/manager will: 1) inform the director/department head; 2) continue the appropriate investigations; 3) document findings of the investigation, and 4) maintain communication with EAP and Human Resources as appropriate.
PAGE 8 2. Life Solutions - a part of Community Care Behavioral Health provides EAP services to UPMC. Access to LifeSolutions is through the LifeSolutions National Call Center at (800) 647-3327. LifeSolutions staff is on-call 24 hours a day, seven days a week for emergencies. 3. EAP Acts as the liaison between Human Resources and the staff member to confirm compliance with recommended treatment. In situations where the staff member is a licensed medical professional, the EAP will also coordinate with the respective Impaired Practitioner Program with a signed release of information. 4. Human Resources Human Resources shall review and maintain a written record of all practitioners who are reported to either the impaired practitioner program or the State Board. Human Resources is responsible for ensuring that the initial and follow-up reports, to their State Board and/or designated impaired professional program, are completed. VI. CORRECTIVE ACTION Nothing in this policy shall limit UPMC s right to take corrective action or discharge a staff member. VII. POLICIES REFERENCED WITHIN THIS POLICY HS-HR0700 HS-HR0704 Employee Health Correction Action and Discharge Employee Health locations http://infonet2.upmc.com/health/employeehealth/pages/contacts.aspx SIGNED: Gregory K. Peaslee Senior Vice President, UPMC and Chief Human Resources and Administrative Services Officer ORIGINAL: October 1, 2000 APPROVALS: Policy Review Subcommittee: October 10, 2013 Executive Staff: November 8, 2013 PRECEDE: December 7, 2012 SPONSOR: Human Resources * With respect to UPMC business units described in the Scope section, this policy is intended to replace individual business unit policies covering the same subject matter. In-Scope business unit policies covering the same subject matter should be pulled from all manuals. Attachment
UPMC Employee Health Services DRUG AND ALCOHOL SCREENING CONSENT FORM Name ID# Employer Employee Representative Name Photo ID: Yes No In accordance with, and subject to the policies and procedures of University of Pittsburgh Medical Center (UPMC), I hereby consent to provide specimen(s) of the following: Urine Blood Other to UPMC or its designated agent. The sole purpose of this screening is to detect the presence of prohibited substances. I understand that the test results will be treated as confidential and will be released only in accordance with UPMC policies. Appropriate federal and state agencies will be notified where required by applicable law and regulations. I hereby release UPMC employees, directors, officers, contractors, and agents of the same, from all manner of actions, claims, damages, and expenses arising from, or related to, the results of this screening. I further understand that refusal to permit testing, or a positive result, may result in disciplinary action up to and including discharge. My signature acknowledges that I am voluntarily consenting to this screening. Executed this date: at AM PM Confirmation Signature: Refusal Signature: Witness Signature: UPMC EHS:9/08