Public Risk November/December 2014

Published by the Public Risk Management Association

www.primacentral.org

NOVEMBER/DECEMBER 2014

Leading and Operating

in UNCERTAINTY THE NEW SKILL SET FOR AN EVER-CHANGING WORK WORLD

SPECIAL EVENTS: Entertainment Contract Concerns

HOW RISK MANAGERS CAN GUIDE INJURED WORKERS ALONG THE RIGHT PATH

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Volume 30, No. 10 | Nov/Dec 2014 | www.primacentral.org

The Public Risk Management Association promotes effective risk management in the public interest as an essential component of public administration.

PRESIDENT Regan Rychetsky, ABCP Director, HHS Enterprise Risk Management and Safety Texas Health and Human Services Commission Austin, TX

CONTENTS

PAST PRESIDENT Betty Coulter Director of Risk Management and Insurance University of North Carolina at Charlotte Charlotte, NC PRESIDENT-ELECT Dean Coughenour, ARM Risk Manager City of Flagstaff Flagstaff, AZ

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Terri Evans Risk Manager City of Kingsport Kingsport, TN

6 LEADING AND OPERATING IN UNCERTAINTY

The New Skill Set for an Ever-Changing Work World

By Steven Gaffney

DIRECTORS Ed Beecher Risk Manager City of Pompano Beach Pompano Beach, FL

Scott Kramer Risk Manager Montgomery County Commission Montgomery, AL Amy Larson, Esq. Risk and Litigation Manager City of Bloomington Bloomington, MN

12 SPECIAL EVENTS:

Entertainment Contract Concerns

By Kenny Smith

Scott Moss, MPA, CPCU, ARM-E, ALCM P/C Trust Director CIS Salem, OR Tracy Seiler, ARM-P Director of Risk Management Services Texas Association of Counties Austin, TX NON-VOTING DIRECTOR Marshall Davies, PhD Executive Director Public Rick Management Association Alexandria, VA

15 HOW RISK MANAGERS CAN GUIDE INJURED WORKERS ALONG THE RIGHT PATH

EDITOR Jennifer Ackerman, CAE Deputy Executive Director 703.253.1267 • jackerman@primacentral.org

By Robert Hall, MD

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ADVERTISING Donna Stigler 888.814.0022 • donna@ahi-services.com Public Risk is published 10 times per year by the Public Risk Management Association, 700 S. Washington St., #218, Alexandria, VA 22314 tel: 703.528.7701 • fax: 703.739.0200 email: info@primacentral.org • Web site: www.primacentral.org Opinions and ideas expressed are not necessarily representative of the policies of PRIMA. Subscription rate: $140 per year.

Back issue copies for members available for $7 each ($13 each for non-PRIMA members). All back issues are subject to availability. Apply to the editor for permission to reprint any part of the magazine.

IN EVERY ISSUE 4 News Briefs | 19 Advertiser Index | 20 Member Spotlight

POSTMASTER: Send address changes to PRIMA, 700 S. Washington St., #218, Alexandria, VA 22314.

Copyright 2014 Public Risk Management Association Reprints: Contact the Reprint Outsource at 717.394.7350.

NOVEMBER/DECEMBER 2014 | PUBLIC RISK

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Message from PRIMA President Regan Rychetsky, ABCP

THE PRIMA ADVANTAGE

P

RIMA has a tremendous responsibility to provide its members with exceptional public risk management educational programs, products and services.

If you have not visited the website in a while, I would like to direct all new risk managers, and even the experienced folks, to the Risk Manager’s Briefing Kit (Briefing Kit).

PRIMA has created the Briefing Kit to assist risk managers in the task of raising awareness about risk management for decision-makers and managers. The kit provides tools that will educate and inform about risk management’s impact and the importance of having a strong risk management program in place. It provides information on key risk management concepts that can be used with a variety of audiences ranging from employees to elected officials.

The Briefing Kit contains sample documents, PowerPoint presentations, job descriptions and checklists. The Briefing Kit is broken down into a number of sections that allow documents to be found quickly and easily. It contains specific resources targeted to new risk managers, risk managers who are new to an organization or public risk management, and risk managers who want to make the most of their time with the decision-makers of their entity.

The resources include ready-to-use tools that include predeveloped presentations, frequently asked questions, and a variety of resources and guidance to help you communicate clearly with executive management.

The Briefing Kit includes presentations on: • Loss Prevention including the basics of a loss prevention program and the components of loss prevention designed for your presentation to executive management.

• Risk Management Executive Overview that addresses questions like: What is risk management? Why is risk management important? How is it evolving? What are the benefits? This is always helpful when addressing your executive management on the benefits of your risk management program. There are also overview

notes that provide detailed information to accompany your presentation.

• Risk Transfer that provides detailed information to educate you on the process of risk transfer and to know when and when not to transfer the risk. Again, detailed notes accompany your presentation.

• Risk Management Basics Presentation PowerPoint that includes the top ten places to look for risk within your entity and includes the podcast series of five-15 minute MP3 files concentrating on the basics of risk management.

The Briefing Kit also includes helpful resource documents, such as: • Questions Every New Risk Manager Should Ask that may serve as a working guide for reviewing critical functions of your risk management program. These questions may provide insight and can serve as a starting point for reviewing your risk management programs and determine areas you may need to shore up or add to your existing risk management program.

The Briefing Kit is only one of the helpful resources available to our members on the PRIMA website. I hope you take the time to review the PRIMA Website and find helpful resource information to improve your risk management program.

Remember to thank those who have served and are serving in our military forces and first responder organizations.

Regards,

PRIMA has created the Briefing Kit to assist risk managers in the task of raising awareness about risk management for decision-makers and managers. The kit provides tools that will educate and inform about risk management’s impact and the importance of having a strong risk management program in place.

Regan J. Rychetsky, ABCP 2014–2015 PRIMA President Director, HHS Enterprise Risk Management and Safety Texas Health and Human Services Commission

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News Briefs

NEWS

BRIEFS THE GOVERNOR OF FLORIDA REALLY WANTS TO KEEP HIS EMAIL SECRET After striking out in Florida court, Gov. Rick Scott has hired a California law firm to fight the subpoena ordering Google to release details about private email accounts believed to be used by the governor and his staff to conduct public business, writes The Miami Herald.

COLORADO COURT WEIGHS LEGALITY OF FIRING FOR OFF-THEJOB POT USE A Colorado Supreme Court hearing that will have major implications for marijuana and the workplace ended with the state's most esteemed justices mostly scratching their heads, reports the Denver Post.

The debate topic was this: If it isn't illegal to use medical marijuana, does that make it a "lawful" activity for which employers can't fire you?

How the justices answer that question will, for the first time, define whether employers must tolerate medical-marijuana use by their employees and will set whether medical-marijuana patients have any job protection for their cannabis use. The outcome also has implications for recreational marijuana use, which presents similar questions.

California attorney John A. Hartog filed a petition in Santa Clara County court attempting to quash the release of what could be potentially embarrassing details about the use of Gmail accounts held by the governor and two of his staff.

The decision to carry the fight to California came after Tallahassee Circuit Court Judge Charles A. Francis twice ordered the governor and his lawyers to stop fighting the request for basic information from Tallahassee attorney Steven R. Andrews.

Andrews is seeking documents that identify the IP address of the Gmail accounts held by the governor, first lady Ann Scott's former assistant Sarah Hansford, and Scott's former assistant Brad Piepenbrink.

He alleges that the accounts were opened to allow staff to circumvent Florida's public records law and believes the petition filed in California is an "attempt to delay the release until after the election." He is not asking for the content of the emails but wants information that identifies when the accounts were opened and by whom.

"It seems they have something to hide,'' Andrews said. "Why would the governor spend so much money on California lawyers to stop this from getting to court? If I was a cynic, I would say there's a political motive to this."

The governor's office responded with a statement.

In an era of more permissive state laws on marijuana, the justices' decision could significantly affect whether people take advantage of those laws. An attorney for Brandon Coats, a quadriplegic who was fired for medical-marijuana use and who brought the case, said if the justices rule strictly against patients, "that means our medical-marijuana amendment is really just for the unemployed."

"It's no secret that this case, and its multiple companions, is simply Andrews seeking out revenge for his personal grudge against the Cabinet and state government," said Frank Collins, the governor's communications director.

Vance Knapp, an attorney who is not connected to the case but has followed it closely, said a ruling in favor of Coats could throw employment law "into chaos."

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PASADENA EXPERIMENTS WITH 'DONATION METERS' TO HELP THE HOMELESS It's a quandary faced by anyone who's been asked for money by a homeless person: Will my spare change stave off hunger or support an addiction?

Being ready to rescue isn’t what it used to be.

Pasadena is now testing an alternative to giving to the panhandler.

Fourteen repurposed parking meters across the city will collect change for nonprofits that serve the homeless.

Pasadena is the first city in Los Angeles County to try the donation meters, though Los Angeles has been talking about trying them out in downtown. Officials don't expect to raise huge sums of money: The two meters currently in place raised just $270 over three weeks.

But the meters are rooted in a more controversial idea - that putting money directly into the hands of homeless people is not an effective way to help them.

Some homeless advocates say the donation meters lack the human element normally found in charitable giving and monopolize money that might have gone to genuinely needy people.

"If we would get serious about addressing the actual economic and social issues that we find so off-putting, we wouldn't need meters," said Paul Boden, director of the Western Regional Advocacy Project, a homelessness advocacy group.

Pasadena officials said their main goal is to raise awareness —but the meters could reduce panhandling somewhat.

The view on the streets of Pasadena is mixed.

Dorothy Edwards, 56, used to panhandle by the Target in eastern Pasadena. She'd use the money to buy food for her dog, rain gear and tents. Buying her own supplies helped her feel independent, but the money also made it easier for her to stay homeless, she said.

But other homeless people are wary of the idea. Holly Johnson, a woman panhandling on Lake Avenue, said that nonprofits don't always spend money on what homeless people need. Granola bars are pointless for people without healthy teeth, as is canned food without a can opener.

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NOVEMBER/DECEMBER 2014 | PUBLIC RISK

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LEADING AND OPERATING IN

UNCERTAINTY The New Skill Set for an Ever-Changing Work World

By Steven Gaffney

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ncertainty. We have all confronted it at some point in our careers. Matrix organizations, multiple bosses, dotted- and solid-line reporting, internal and external customers, budget cuts and economic issues are all factors that contribute to an ambiguous work environment. In fact, many of my executive clients cite uncertainty and ambiguity as a top source of frustration, challenges and wasted time and money. Surprisingly enough, it does not have to be.

Uncertainty can also bring great opportunity—for those who see the possibilities. Our ability to manage, operate and lead in an ambiguous environment separates the best from the rest on an individual and organizational level.

I am not saying clarity is a bad thing or that we should not strive for it. I am simply acknowledging that it is not always possible to achieve. Get clarity when you can, but when you cannot, choose to embrace the opportunities uncertainty creates for you to shine.

One key to coming out on top is to see the major benefit of uncertainty. Namely, it can serve as a forcing function that engages the mind. If everything is always clear-cut and provided for us, we can become lazy—on both an individual and organizational level. But when things are not clear, there are opportunities to forge new territories, stake one’s claim, make suggestions and seize the moment. While some entities are constantly in a reactive mode, waiting to see how the world is changing, what the economic trends specifically dictate and what customers say they want, others are creating and shaping opportunities.

Look at Apple®. They did not wait until people said they wanted something like an iPad. Apple created it and now others are scrambling to get in on that market—a market Apple defined. In an ever-changing marketplace of technology, Apple continues to create products that generate demand. They are not tossed about by commonly perceived limitations or paralyzed in reactive mode awaiting clear instructions.

After all, even customers (internal customers included) want us to suggest innovative ideas and take initiative. We do that by uncovering hidden needs rather than simply reacting to what customers say they need. If a customer says they want X, we will usually give them X. Yet the value of uncertainty is that it forces us to probe, allowing us to find hidden needs and deliver what our customers truly desire.

This ability to chart your own course and not be dissuaded by common limitations can be the key to even individual

success. If I had told you 10 years ago that I was going to write a 500-page children’s book, you might have suggested I have my head examined. After all, children do not normally read that much, right? Yet look at the success J.K. Rowling’s Harry Potter series had with children. She looked beyond the preconceived limitations of children’s literature and saw an opportunity. In doing so, she pioneered the way for juvenile fantasy fiction.

Whether we are leading, managing, idea-generating, servicing customers, or creating new ideas, we should expect to do it in an often ambiguous and rapidly changing environment. That requires proactive rather than reactive behavior to seize the moment and take action.

One common syndrome we see in the workplace is the “Deer in the Headlights Syndrome,” and it is one of the most frequent complaints I hear from leaders. They say that employees are frozen—like a deer caught in the headlights—waiting for clear direction, rather than being proactive with ideas, suggestions, actions and solutions. Books like Seth Godin’s Linchpin are now suggesting that people who are just waiting to be told what to do are often the most replaceable.

In some industries, they are even the ones whose jobs are being outsourced overseas.

It has never been more critical to meet uncertainty head-on and create new opportunities. The individuals who can do so in a quick, effective manner will increasingly become the go-to people, while the organizations that do so will come out on top time and again.

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Leading and Operating in Uncertainty

7 STRATEGIES TO IMPLEMENT IN AN AMBIGUOUS ENVIRONMENT Nearly 20 years of surveying the work environment of top governmental agencies and Fortune 500 organizations has shown me that with the right mentality and some key strategies, we can overcome the challenges of uncertainty and capitalize on the opportunities it presents. The following seven strategies can help you and your organization embrace those opportunities. ➊ Eliminate Half-Baked Ideas. An ambiguous environment presents incredible opportunities. The way to seize those opportunities is by suggesting quality ideas that are well thought out. Some people mistakenly believe that others do not want to hear their ideas.

They complain that they have tried making suggestions and their ideas were rejected. That may be, but ideas are often rejected because they are half-baked and the person hearing them lacks the time to shape and invest in those ideas. So whether or not the idea is inherently good, it is denied.

Interestingly, I have found we are often closer to getting a “yes” than we realize. Test it out. Next time you get a “no” to one of your ideas, ask, “What would you need to see to change your mind?” You may find that with a few adjustments you can get the “yes” you are looking for. Remember, those who create ideas are often the most valuable players and they can thrive in ambiguous times. ➋ Take the Reins. Move from seeking explicit direction from superiors to practicing self-management. As the great management consultant (and friend) Zemira Jones shared with me, the more people can self-manage— evaluate and make corrections—the more motivated and inspired they will be. Being free from the need to wait for

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constant approval allows quick and timely adjustments to be made, resulting in a tremendous time savings.

To effectively self-manage, it is critical to verify your roles, responsibilities and goals. If they have not been communicated to you, be proactive in creating them yourself. Look around for information and data; then create your roles, responsibilities and goals. Confirm all of it with those to whom you report and then move forward on them.

Do not wait for goals and direction while opportunities pass you by. Instead, create, verify and take action.

We cannot necessarily control our environment, but we can control how we respond to that environment.

Choose to see the opportunities uncertainty creates rather than getting tied up in the challenges. Often by responding in an effective way, we can shape and affect the environment. ➌ Use Influence, Not Authority. As we discussed, we often end up operating in a matrix environment, which means we need to do things more by persuasion than by directing and ordering. Even if we do have the authority, we want to stay away from exercising that authority in a heavy-handed way. Doing so may cause others to give us lip service and then slow roll the initiative, or resist us in other passive-aggressive ways.

The ability to influence others in an honest, non-manipulative and effective manner is a crucial skill set in today’s complex world. One skill for improving your influence is building and maintaining rapport with others. Another important skill is addressing and resolving objections and hidden issues. If you can work on improving those two skills, then your ability to influence will continue to grow.

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Consider this: when was the last time you saw a plan that was executed the way it was designed? The truth is that no matter how well thought out our plans are, we will most likely need to make adjustments. Encourage everyone to expect change and embrace it.

➍ Get Clarity on the Non-Negotiables. Even in the most ambiguous, unclear environment, there are certain things that are non-negotiable—off the table. Our ability to gain clarity on those things can save tremendous time and resources. Nothing destroys motivation like spending time working on something that was actually non-negotiable from the start. Leaders who bring clarity about negotiable vs. non-negotiable can get extremely high returns from a workforce that focuses their ideas and actions on the negotiables. ➎ Beware of Idea Killers. Watch out for statements like these: “We already know what they want”; “We know better”; “We tried that before”; and “That will never work.” Attitudes like these are idea killers and they can leave your organization stagnant, allowing others to pass you by. The antidote to idea killers is to ask questions and dig for information. Do not assume your customers want what they have wanted in the past. Choose to probe and uncover hidden needs. This is a key to capitalizing on the opportunities in an ambiguous environment. ➏ Reset Expectations. I am struck by how many people are waiting for change to stop and responsibilities to become clear. If this is happening, hit the reboot button and reset people’s expectations. Remind them that things will always be changing and that much will be unclear. For that reason, it makes sense to always be improving (and therefore tinkering with things). If we are not progressing, we are regressing.

The pace of change in today’s business environment demands constant improvement on an individual and organizational level. That means it is crucial to have the mindset that there is no such thing as the perfect solution. Often it is taking action that allows us to see

how to make things better. Consider this: when was the last time you saw a plan that was executed the way it was designed? The truth is that no matter how well thought out our plans are, we will most likely need to make adjustments. Encourage everyone to expect change and embrace it. ➐ Keep the Floodgates Open. One leader told me he actually likes uncertainty because it forces people to think and communicate. In the absence of being certain, people have to seek out others and talk with them. For that reason, an environment that encourages open, honest communication is a must in order for the other strategies to work. It is the foundation for capitalizing on uncertainty’s opportunities.

If staff is not willing to share issues and challenges or is not empowered to freely share ideas, then uncertainty’s opportunities cannot be seized. Open those floodgates by rewarding honest communication and encouraging staff to share problems and solutions. This will enhance creativity, make room for outside-the-box thinking and improve teamwork—exactly what is needed in an ambiguous environment. The end result will be a boost to the bottom line.

The factors that contribute to uncertainty are here to stay. Uncertainty offers great opportunity to flourish—to lead the way in the ever-changing marketplace. Take the initiative and use the seven strategies to operate, excel and lead in an ambiguous workplace.

Steven Gaffney, founder and CEO of the Steven Gaffney Company. Gaffney was a general session speaker at PRIMA’s 2014 Annual Conference in Long Beach.

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PRIMA 2014

WEBINAR SERIES FREE FOR PRIMA MEMBERS! Looking for a cost-effective way to train your staff while avoiding the frustration of budget cuts and travel expenses? The Public Risk Management Association’s Webinar series is designed to help risk management professionals like you excel in the field without leaving your office.

WEDNESDAY, NOVEMBER 12 | 12 PM – 1:30 PM EST

CONTRACTUAL RISK TRANSFER AND FLYING TOMAHAWKS PRESENTERS: Michael Fann, Loss Control Director, TML Risk Management Pool Amy Larson, Esq, Risk and Litigation Manager, City of Bloomington, MN All day, every day, we transfer risk, even if we don’t recognize it. This Webinar will discuss traditional risk transfer methods such as contracts, insurance, bonds and indemnification agreements; as well as nontraditional methods such as waivers and personal guarantees. The presenters will also discuss how to evaluate what types of risk transfer will work in different situations, as well as when an entity needs to respond with traditional risk transfer methods.

Attendee Takeaways • Understand when your entity must use traditional methods of risk transfer • Identify and understand when non-traditional methods are a more practical way of transferring risk • Know how much insurance is enough • Identify what has to be on your certificate of insurance to ensure accurate coverage Who Should Attend • City attorneys and legal assistants • Contract administrators and department heads • Insurance agents and brokers • Purchasing directors and buyers • Risk management professionals

REGISTER TODAY!

PRIMA members receive complimentary registration and access to the Webinars!

For more information, or to register, visit www.primacentral.org.

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PUBLIC RISK | NOVEMBER/DECEMBER 2014

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SPECIAL EVENTS:

ENTERTAINMENT CONTRACT CONCERNS

By Kenny Smith

C

ommunity events have always been a well-loved tradition in towns and counties nationwide. From farmers markets to holiday celebrations, communities find many ways to come together. As the popularity of these events have grown over the past several years, towns have begun to utilize entertainers on a larger scale to bring in crowds, offering entertainment such as live events and shows ranging from bands and comics to Shakespeare in the Park.

But while these live performers bring joy and entertainment to communities, they sometimes also bring headaches to public entity management, who must navigate entertainment contracts. While public entities very often contract out work around their towns and municipalities and have set policies and procedures around those contracts, they may not routinely contract entertainers. However, as the demand for frequent and complex community events grows, public risk managers should become knowledgeable about these contracts and the various pitfalls and concerns they present.

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Generally, when you hire an entertainer or group, they will have a contract on-hand to offer. Although most likely an effort on the entertainment’s side to save time for everyone, these contracts may be weighted in their favor. While managers may feel like they are expected to sign with no questions asked—don’t! Such contracts come with many pitfalls and hard to notice addendums which may require an entity to pick up unplanned costs, such as travel insurance for band instruments during transport.

EXPECT VARIETY The variety of entertainers that can be utilized and invited by public entities is endless—from one man bands to full performing troupes—the list can be as small or as large as desired. Unfortunately, the variety in entertainment contract complexity and the factors to be considered can also feel endless. The one man band may not require the same considerations as booking a controversial multi-piece group.

While many managers already know the basics of contractual liability, which serve as the basis with entertainment contracts, these contracts contain a few unique factors to watch out for. More typical provisions such as hold harmless agreements, additional insured status and types of insurance (with values) may be sufficient for the small or low-key entertainer groups, larger performers or troupes contracts tend to be more complex.

HAVE IT YOUR WAY Generally, when you hire an entertainer or group, they will have a contract on-hand to offer. Although most likely an effort on the entertainment’s side to save time for everyone, these contracts may be weighted in their favor. While managers may feel like they are expected to sign with no questions asked—don’t! Such contracts come with many pitfalls and hard to notice addendums which may require an entity to pick up unplanned costs, such as travel insurance for band instruments during transport.

At the very least, an entity’s legal team should review any and all contracts and provide feedback or revisions. This is particularly true for entertainment contracts, no matter how big or small the group. An even better approach for limiting an entity’s liability is to create its own standard entertainment contract that includes a preferred hold harmless provision, insurance requirements, and any specific information on local regulations (pyrotechnics) or restrictions.

It is also helpful to provide specific deadlines for submitting revisions and signing. This will help eliminate situations where entertainers wait until the last moment to send their revisions and expectations which deprive entities of the opportunity to negotiate favorable terms.

A FEW EXAMPLES: To illustrate potential pitfalls of signing a ready-made contract provided by an entertainer, below are a few examples of addendums found in real-life contracts: “Please Note: [EntertainerXYZ] will be using Pyrotechnic, Laser & Fog special effects in the stage show. Event Sponsor (County) will be responsible for all permits, licenses, certificates and insurance as outlined in Section II. In most cases our suppliers will secure all permits and make all payments, which will be billed back at settlement. Please contact the Pyrotechnic and Laser suppliers directly to discuss these responsibilities.”

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Special Events: Entertainment Contract Concerns This particular addendum went unnoticed by the town until the entertainer arrived and began setting up. It caused a lot of last-minute pressure on the sponsor to try and fulfill an obligation it was not previously aware of.

“Venue will provide meals and drinks for the entertainers and crew as described in addendum. (Venue will provide four fifths of Jack Daniels and three cases of beer to the dressing rooms five hours prior to the performance).”

If an entity agrees to provide alcohol to the entertainers as a part of the backstage agreements in the contract, the entity’s insurance agent or broker should be contacted to determine the entity’s liquor liability and excess liability needs. Providing alcohol may lead to some very difficult situations. For example, if the entity agrees to provide alcohol to entertainers or their backstage guests who are later involved in an auto accident, the entity may be held liable.

These two real-life scenarios highlight only a few ways an entertainer’s contract may expose an entity to liability and also illustrates why it is so important for an entity to create

its own standard entertainment contract. In addition to providing alcohol and permits for special effects or pyrotechnics, here is a list of some primary areas public managers should consider when creating a contract, or reviewing an entertainer’s contract: • Date, time, location, compensation agreements and signature of both parties • Description of performance (length, set breaks, anything unique to performance) • Rights established for photography, reproduction, and recordings and merchandise sales • Sound, lighting, stage and who provides, set up • Permits, licenses—responsibility for securing & purchase; specifically, pyrotechnics • Cancellation terms • Outdoor venue weather interruption procedures • Hold harmless agreement • Insurance requirements • Security for event and entertainer • Entertainer expectations (attire, language, music selection) • Performer expectations (guest list, passes, dressing rooms, backstage refreshments, other) Be sure to carefully review all contract provisions and addendums and watch for any unusual demands. If there are any uncommon insurance requirements in the contract, be sure to have your insurance agent or broker review the contract. Finally, never sign a contract until it has been reviewed and approved by your entity’s legal counsel.

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While a town or county stands to benefit greatly from sponsoring festivals and entertainment for its community to enjoy, public managers should be very aware of the pitfalls as well. Navigating the waters of entertainment contracts may seem difficult, and it may seem easier to simply sign a ready-made contract provided by the entertainer. However, it is vital that public entities remain dedicated to the policies in place for other contractors and not deviate from these practices when reviewing contracts not created in-house. This means a strict review by managers and legal counsel, or better yet, the creation of an original contract to be used specifically for entertainment. By doing this, and by simply being aware of the primary concerns when it comes to entertainment contracts, public entities can help ensure that their communities can enjoy a worry-free and liability-free event!

Kenny Smith is a risk control manager at OneBeacon Government Risks.

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How Risk Managers Can Guide Injured Workers Along the

RIGHT PATH

By Robert Hall, MD

Many patients enter the workers’ compensation system due to physical injury requiring treatment for pain. In an effort to control this pain, physicians often prescribe opioid analgesics, which can be successful in managing acute pain. However, the long-term use of opioids has been associated with potentially serious side effects and can lead to tolerance, dependence and addiction in some cases. A recent report by the Centers for Disease Control and Prevention (CDC) illustrates this point: 46 people die every day from an overdose of prescription painkillers in the U.S. and in 2012, 259 million prescriptions for painkillers were written—enough for every American adult to have a bottle of pills. The CDC’s report, CDC Grand Rounds: Prescription Drug Overdoses—a U.S. Epidemic (2012), states that for every opioid-related death, there are more than 150 people who abuse or are dependent on opioids.

OPIOID ANALGESICS BEST WHEN GLOBALLY MANAGED The National Institute on Drug Abuse explains that opioid analgesics reduce the intensity of pain signals reaching the brain. They also dull other areas that control emotion, further reducing the pain stimulus by attaching to specific proteins called opioid receptors, found mostly in the brain, but are also in the spinal cord, gastrointestinal tract and other organs in the body.

Additionally, opioid analgesics have a euphoric effect that over time may cause some individuals to desire more of the medication—a behavior that can lead to misuse and abuse. Side effects of the medication include drowsiness, mental confusion, nausea, constipation and sometimes difficulty breathing. Commonly prescribed opioid analgesics include hydrocodone (one of the ingredients in Vicodin®), oxycodone (in medications like Percocet® and OxyContin®) and morphine.

Several studies show that use of opioid analgesics for chronic non-cancer pain has increased substantially over the last two decades. A May 2014 study by the Workers’ Compensation Research Institute (WCRI) indicated that 3-out-of-4 injured workers receive opioid analgesics for pain relief in most states (Interstate variations in use of narcotics, 2014). Similarly, research by the National Council on Compensation Insurance (NCCI) showed

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Risk Managers Can Guide Injured Workers Along the Right Path

With the potential for misuse, which may lead to harm to the individual, it can be easy to forget that opioid analgesics do have a clinical application in treatment… The key is appropriate, monitored use, with the ultimate goal of pain control for injured workers while effectively addressing their daily living needs, including physical, psychological, social and return-to-work factors.

continued growth in the number of prescriptions per claim for opioid analgesics, growing 18 percent from 2008 to 2011 (Prescription Drug Study, 2013). NCCI also reports that opioids make up 25 percent of workers’ compensation pharmacy costs.

Guidelines by the American College of Occupational and Environmental Medicine (ACOEM) and the Official Disability Guidelines (ODG) generally discourage the use of initial opioid medications except for traumatic cases or those with severe pain. They also recommend the use of monitoring and management services such as urine drug testing, especially for those on chronic or long-term use of opioid therapy.

With the potential for misuse, which may lead to harm to the individual, it can be easy to forget that opioid analgesics do have a clinical application in treatment.

Studies show that effective pain control with opioid analgesics, especially in acute pain management, provide a means for returning to normal life activities. The key is appropriate, monitored use, with the ultimate goal of pain control for injured workers while effectively addressing their daily living needs, including physical, psychological, social and return-to-work factors.

THE RIGHT PATH It’s important that safeguards be incorporated into prescribing practices along with a watchful eye for signs of aberrant behaviors. Equally as important, the injured worker must take a proactive and involved approach to their recovery. As a risk manager, you can help injured workers better understand their condition by educating yourself and your team on what to look for as a claim progresses.

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• Initial visit. At the prescriber’s office, an initial medical history, prescription history and physical examination is completed. Generally, the following information is documented into the medical record: diagnosis, nature and intensity of pain, current and past treatments for pain, underlying or co-existing diseases and conditions, the effect of the pain on physical and psychological function and history of substance abuse.

When documenting the first report of injury, if circumstances allow, let the injured worker know they should be ready to tell the physician about all prescription or non-prescription medications, vitamins, or supplements being taken. It may be helpful for the injured worker to take the actual medication bottles to their appointment.

• Treatment plan. The treatment plan states the goals for recovery and outlines the objective measurements.

Prescribers use them to determine treatment success, such as pain relief and improved physical and functional status. It should also indicate plans for any further diagnostic evaluations or other treatments. After treatment begins, the medication therapy should be tailored to meet the individual needs of each injured worker. Other treatment options or a rehabilitation program may be necessary depending on the cause of the pain and the extent to which the pain is associated with physical and psychosocial impairment.

Throughout the course of treatment, reinforce the importance of the injured worker being an active participant in their recovery. Suggest that they take notes to help remember prescriber instructions, as well as to track any effects (positive or negative) from the medication.

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• Know the risks and the benefits. By knowing the risks and benefits associated with opioid analgesics, you can better manage risk and your entity. Return-towork programs can be built with medication effects in mind. You can level set expectations when it comes to reporting suspected misuse and abuse and in doing so, establish a culture wherein coworkers not only watch out for one another, but also are comfortable escalating potential concerns.

• One prescriber and one pharmacy is best practice. Effective pain management may be best achieved by having one prescriber and one pharmacy for all medications, which decreases the potential for therapy duplications and drug-to-drug interactions.

By using one pharmacy, a pharmacist is more readily alerted to early refills of pain medications. This may indicate that the injured worker is using a higher dose or frequency than prescribed. This is not always a sign of dependence, misuse, abuse, diversion, or addiction to the medication; it could be that his or her pain is being undertreated.

• Talk with the prescriber and pharmacist.

Encourage injured workers to communicate with his or her prescriber and pharmacists. This may be done through follow-up visits or when refilling the prescription. Advise them to share information about how the recovery is going, any new information about the pain, side effects and overall condition. During these visits, the prescriber will determine whether continuation or modification of opioids for pain management is appropriate. Adequate response to treatment may be indicated by decreased pain, increased level of function, or improved quality of life. Whereas inadequate progress will require reassessment of the current treatment plan and consideration for the use of other therapeutic modalities.

• Random urine drug monitoring. Urine drug monitoring can be a useful tool in monitoring an injured worker’s treatment plan and managing their chronic pain while helping them achieve better outcomes.

Information from these tests helps prescribers determine if the prescribed medication is being taken and may help determine if the treatment plan is progressing as planned or needs to be altered. They may help identify harmful drug-to-drug interactions and ways to refine the treatment plan, if necessary. It’s important to keep in mind that urine drug monitoring is not an indication that there is suspicious behavior occurring, but rather a standard protocol many national and state guidelines recommend today.

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Risk Managers Can Guide Injured Workers Along the Right Path

CALENDAR OF EVENTS PRIMA’s calendar of events is current at time of publication. For the most up-to-date schedule, visit www.primacentral.org.

WEBINARS 2014 • November 12: Contractual Risk Transfer and Flying Tomahawks

PRIMA ANNUAL CONFERENCES June 7–10, 2015 PRIMA 2015 Annual Conference Houston, TX George R. Brown Convention Center June 5–8, 2016 PRIMA 2016 Annual Conference Atlanta, GA Hyatt Regency Atlanta June 4–7, 2017 PRIMA 2017 Annual Conference Phoenix, AZ Phoenix Convention Center June 3–8, 2018 PRIMA 2018 Annual Conference Indianapolis, IN Indiana Convention Center

• Be versed in public policy. There is ongoing activity throughout the country at the state and Federal levels to curb the misuse and abuse of opioid analgesics. Closed formularies, opioid guidelines, prescription drug monitoring programs (PDMPs), bills addressing pill mills, the requirement of abuse-deterrent formulations and the reclassification of hydrocodone containing products (HCPs) from Schedule III to Schedule II are just some of these activities. Not only is it advisable to monitor the changing legislative and regulatory landscape, but to also be engaged with a voice in the process. It is critical for policy makers to hear from experts in their communities and they will welcome the advice.

GUIDING THE WAY FORWARD Proactively setting clear expectations, encouraging collaboration and communication and sharing information with your workforce are among the better ways a risk manager can guide injured workers along the right path; a path wherein opioid analgesics are globally managed so that misuse and abuse situations are lessened.

Robert Hall, MD, is the medical director for Helios.

OTHER MEETINGS November 3-7 PRIMA Institute 2014 Louisville, KY

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Each month, Public Risk features articles from practitioners like you. Share your successes with your colleagues by writing for Public Risk magazine!

For more information, or to submit an article, contact Jennifer Ackerman at jackerman@primacentral.org or 703.253.1267.

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Member Spotlight

HILLSBORO U BRINGS CITY STAFF TOGETHER features a member who has gone above and beyond

F

in a feature column titled “Member Spotlight.” Do you know someone who deserves recognition, has made a contribution or excelled in their profession?

If so, we’d like to hear from you for this exciting column, as PRIMA shines the spotlight on its members.

To be considered for the Member Spotlight column, contact Jennifer Ackerman at jackerman@primacentral.org or 703.253.1267.

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“It brings together all city employees to help build relationships and collaboration between departments,” said Tanya Woodson, risk management analyst for the City of Hillsboro. “The city offers few events that bring everyone together for a unified purpose.”

The 2013 event featured breakout sessions on CPR, fire extinguisher safety, traffic control, equipment tie down, confined space entry and earthquake preparedness.

Attendees also received a matrix of sessions and speaker, including a notation about the session’s target audience.

The budget for the event is $8,500, which includes the cost of speakers, food, printing and facilities. Hillsboro does not rely solely on paid speakers, but also taps in to trainers and speakers from local agencies that are willing to participate at no cost. In 2015, the city will have several internal speakers offering topics such as communications and media training, self defense, open carry laws, AED/CPR, contracting and insurance law, identity theft act, personnel policies, fire extinguisher, working with youth, threat assessment and domestic violence and a full supervisory development series. “We have also offered continuing education credits for our water department operators to assist them with maintaining their licenses,” Woodson said.

Woodson said that it takes approximately five months to plan the event and plans to put together a Hillsboro U committee to plan next year’s event.

“We begin with risk staff brainstorming ideas for session and then determining the required training that need to be included,” said Woodson.

With a risk staff of three to serve 900 employees, Woodson said that it’s important for the team to start the planning early. Once the sessions are outlined, it’s just a matter of scheduling and promoting the event.

“Our Hillsboro U concept has been very well received by employee and managers,” said Woodson. “Other entities in our areas are working to put together similar events for their employees. It is a great way to make learning fun for our employees, promotes cross departmental communications and is cost-effective for our organization.”

The event puts risk management and safety in front of all employees and helps create a culture of safety and awareness, she said.

Hillsboro U won the PRIMA Product Achievement Award at the 2014 Annual Conference in Long Beach, Calif.

For more information, contact Tanya Woodson at tanya. woodson@hillsboro-oregon.gov.

Other entities in our areas are working to put together similar events for their employees. It is a great way to make learning fun for our employees, promotes cross departmental communications and is cost-effective for our organization.

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Each month, Public Risk

or the last seven years, the City of Hillsboro, Ore., has brought together staff from all city departments for three days of safety training called Hillsboro U. The event is a forum to provide OSHA-required training as well as leadership and professional development classes.

Tanya Woodson, risk management specialist for the City of Hillsboro

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