Public Risk November/December 2019 by Moire Marketing Partners

PUBLISHED BY THE PUBLIC RISK MANAGEMENT ASSOCIATION NOVEMBER/DECEMBER 2019

WHAT WE DO AND DONâ&#x20AC;&#x2122;T KNOW ABOUT

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ALSO IN THIS ISSUE

PRIMA IN 2019 A YEAR IN REVIEW

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WORKPLACE HAZING EMERGES FROM THE SHADOWS PAGE 16

NOMINATE A COLLE AGUE OR YOURSELF FOR PRIMA’S NEWES T AWARD! PRIMA wants to recognize our long-term members who have made outstanding contributions to PRIMA and the public risk management industry. QUALIFIC ATIONS FOR AWARD: 1. Member of PRIMA for 15 years or more 2. Advancement of PRIMA membership goals 3. Knowledge of public entity risk management skills, industry goals, and trends THE AWARD WINNER WILL RECEIVE: • A framed and personalized Certiﬁcate of Excellence • A one-page spotlight in the Public Risk magazine • Celebratory announcements on PRIMA’s social media, including a photo and quotes

FIND THE NOMINATION FORM AT primacentral.org > Membership > Awards & Recognition

Submit your nominations by

JANUARY 31, 2020

NOV/DEC 2019 | Volume 35, No. 10 | www.primacentral.org

CONTENTS

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

PRESIDENT Scott J. Kramer, MBA, ARM County Administrator Autauga County Commission Prattville, AL PAST PRESIDENT Jani J. Jennings, ARM Risk Manager City of Bellevue Bellevue, NE PRESIDENT-ELECT Sheri D. Swain Director, Enterprise Risk Management Maricopa County Community College Tempe, AZ DIRECTORS Forestine W. Carroll Manager of Risk Management Memphis Housing Authority Memphis, TN

What We Do and Don’t Know About Cannabis

Lori J. Gray, RMPE Risk Manager County of Prince William Woodbridge, VA JamiAnn N. Hannah, RMPE Risk Manager City of Gallatin Gallatin, TN Laurie T. Kemper Sr. Risk Management Consultant City/County Insurance Services Salem, OR Michael S. Payne, ARM, HEM Risk Manager City of Fresno Fresno, CA Melissa R. Steger, MBA, CRM Asst. Dir., WCI & Unemployment Ins. University of Texas System Austin, TX

WORKPLACE HAZING

By Nikki Wilson, PharmD/MBA

NON-VOTING DIRECTOR Jennifer Ackerman, CAE Chief Executive Officer Public Risk Management Association Alexandria, VA EDITOR Teal Griffey, MBA Manager of Marketing and Communications 703.253.1262 • tgriffey@primacentral.org ADVERTISING Teal Griffey, MBA 703.253.1262 • tgriffey@primacentral.org

PRIMA in 2019 A Year in Review By Teal Griffey, MBA

IN EVERY ISSUE

Workplace Hazing Emerges from the Shadows By Claire Wilkinson

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. POSTMASTER: Send address changes to PRIMA, 700 S. Washington St., #218, Alexandria, VA 22314. Copyright 2019 Public Risk Management Association

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MESSAGE FROM PRIMA PRESIDENT SCOTT J. KRAMER, MBA, ARM

n our profession, we experience change. Change in political leadership, change in department head personnel, and change related to transitioning to another entity. As with most employers, when you take care of your personnel—your most valuable resource—they generally are loyal to the entity. However, at times, circumstances change or opportunities arise for a risk manager to make a change in employers. Moving to a different employer creates certain challenges for the risk manager. Such was the case for me after serving 11 years with one entity, the Montgomery County Commission. I was the first ever risk manager employed by Montgomery County, and as such I created a lot of changes in my first few years. Some of these changes include safety and risk management policies, drug testing for new hires, starting an on-site healthcare clinic, and selecting brokers and third-party administrators.

“

As is critical to the success of any position, the transparency

and support I’ve received from City and County management is key. Over time I’ve been able to form relationships around

“

Challenges of Transition for the Risk Manager

Montgomery that make my job more effective. This has the added effect of increasing the awareness and sense of responsibility for finding and reporting risks in those I connect with. for employees after I had created one for the County. It was very popular with the employees and staff, and I capitalized on that success by making decisions that would make our department value-added to other departments. One example was starting a safety committee with input from several departments which gave them ownership of the program.

After over a decade as a risk manager for the County, I was asked to be the Director of Risk Management for the Montgomery County Commission and the City of Montgomery. When I accepted the new position I had to learn a totally different culture for working with the City. In addition, this role involved different risks to manage than the County, including a fire department, large police department, and sanitation department. I had to quickly become an expert on risks associated with these large and vastly different departments.

As part of my new job, I also had to be involved in some difficult personnel issues with both the fire and police department. Some of these issues were related to injuries that prevented an employee from carrying out the essential functions of their job. However, by establishing a personal reputation of being fair and respectful to the employees involved we were able to resolve the issue. Taking this as a growth opportunity, our department strengthened the employee assistance program by working with the police department to develop a peer group that vets possible counselors and therapists. Now, when personal issues arise, officers are more confident that they can get help and the information would remain confidential.

One of my initial goals when I joined the City of Montgomery was earning the respect of the department heads. I had established a positive reputation in my previous position when I helped the City create an on-site clinic

As is critical to the success of any position, the transparency and support I’ve received from City and County management is key. Over time I’ve been able to form relationships around Montgomery that make my job more effective.

This has the added effect of increasing the awareness and sense of responsibility for finding and reporting risks in those I connect with. Personally and professionally, working for both the Montgomery County and City was very fulfilling. As the first risk manager for the County, I enjoyed presenting innovative ideas in a cost-efficient manner that were well received by management and the employees. Now, while working with the City, I fine-tune their already established risk management program to make it better. As such, I feel truly blessed to have worked for both entities. There are always risks in trying a new position or employer, but the rewards can be high. Whether it’s gaining new insights into risk areas, becoming an expert in new areas of risk management, or developing relationships with new colleagues, a change in entity or position can be professionally rewarding. Sincerely,

Scott J. Kramer, MBA, ARM PRIMA President 2019–2020 County Administrator Autauga County Commission Prattville, AL

NOVEMBER /DECEMBER 2019 | PUBLIC RISK

NEWS BRIEFS

NEWS Briefs

THE TWO-WHEEL SAFETY ILLUSION More women are cycling, and more are dying. It reflects an urban failure. Among urban cycling infrastructure experts, conventional wisdom holds that when more women are biking, a city has built a successful cycling network. In too many American cities, though, a gruesome corollary to this rule is becoming apparent: When a city builds infrastructure that creates the illusion but not the reality of cycling safety, more women will die. Urban cycling has long been mostly a male activity. As Evan Friss writes in a new history of cycling in New York City, the bike messengers who helped define the city’s 1980s streets were virtually all men. Today’s food delivery cyclists are predominantly male. And the bicycle commuting population skews heavily toward one gender. Citi Bike, New York’s municipal bike-sharing service, reported in June that of the 36,096 riders that month who listed their gender, 25 percent were women. But as skewed as those Citi Bike numbers may be, they reflect growth of about 3 percentage points for women over four years. In New York and elsewhere, more and more women are taking to two wheels. It may seem counterintuitive, but in large part that increase reflects the reality that women, on average, are more cautious on the road, as is borne out in automobile crash statistics. So when cities build bike lanes and make cycling more hospitable to everyone, it follows that more women will do it; they perceive it as less risky. That’s why an emerging phenomenon should worry urban transportation officials. As of mid-July 2019, a record 15 cyclists had died on New York’s streets, five more than in all of

PUBLIC RISK | NOVEMBER /DECEMBER 2019

2018. Each death is a tragedy, of course, but four of those deaths stand out against historical statistics: Devra Freelander, Robyn Hightman, Aurilla Lawrence and Susan Moses were women. It’s not just a New York phenomenon. In Boston in February, 69-year-old Paula Sharaga was killed; in San Francisco in March, 30-year-old Tess Rothstein died. Both were hit by trucks. These three cities have something in common: They’ve done extensive marketing to get more people to commute by bicycle, despite not having done enough of the more difficult work of building safe cycling networks. It’s likely that that failure was a factor in the recent death of Freelander, a 28-year-old artist who was emerging into an intersection from the sidewalk when she was run over by a truck driver. No bike lane was present for Freelander to bike on and, by city ordinance, trucks and other oversized vehicles were not supposed to be on a residential Brooklyn street.

Even where cycling infrastructure exists, it’s not necessarily adequate to provide genuine safety. Last year, 23-year-old Australian tourist Madison Jane Lyden died on Manhattan’s Upper West Side, hit by a truck after a vehicle parked in a painted bike lane forced her into traffic. Cities have done all cyclists a disservice in encouraging cycling without creating the physical and civil infrastructure cyclists need to be safe. “Women across the city can be an indicator species for the health of the city and the safety of our streets,” says Ellen McDermott, co-deputy director of Transportation Alternatives, a New York street safety advocacy group. “But our infrastructure needs to catch up to the latent demand for biking in this city—fast.” The growing gender parity in the cycling body count points to a persistent urban failure: More people perceive it to be safe when it is nowhere near safe enough.

WHY LOCAL GOVERNMENTS ARE CONSIDERING BALLOON RELEASE BANS

MANAGE RISK WITH AN EFFECTIVE SOCIAL MEDIA POLICY

Several years ago, Jay Falstad’s daughter found a cluster of balloons on a lake near the Eastern Shore of Maryland. One balloon bore a handwritten note with a phone number, imploring whoever retrieved the bunch to call and say where they’d been found.

Many businesses are finding clever and innovative ways to leverage Facebook, LinkedIn, Twitter, Instagram, and other social networking applications to their advantage. These platforms can be effective tools for generating new business, monitoring consumer perceptions of your company, recruiting new employees, and building credibility.

“So we called the number,” said Falstad, executive director of the Queen Anne’s Conservation Association. “They were released four days earlier from Dayton, Ohio—460 miles away.” Falstad was shocked. After that find, he began noticing withered balloons everywhere—draped over tree branches, floating in waterways, abandoned in fields and along roadways. His colleagues in the environmental community were seeing them, too. So were fishermen and farmers. The problem, he thought, needed attention. So he called Queen Anne’s County Commissioner Chris Corchiarino and suggested a legislative solution. The result, a proposed county-wide ban on most balloon releases, debuted before the county commissioners. The bill would make it illegal for people to intentionally release balloons in Queen Anne’s County unless they’re either biodegradable or photodegradable. Violators would be guilty of a civil infraction and subject to a maximum $250 fine. The ban would not apply to balloons released by the government, weather balloons, hot air balloons recovered after launch, or unintentional balloon releases. The ban is meant to mitigate the environmental hazards posed by both latex and mylar balloons that have been intentionally released. Neither product is biodegradable, but the larger threat comes from the ribbons typically tied to the balloons after they’re inflated. “They are almost unbreakable, and you’ll find them tangled up with marine life and other animals. It ends being a slow death, because they can’t get out of it,” Falstad said. “Farmers also experience this, where balloons are out in their fields and their animals can get to it. It’s a choking hazard. It’s not a kite you put up and take back down. You release it for the purpose of putting into the atmosphere until gravity takes hold and it lands somewhere that’s not your property,” he said. “It’s littering. We want to create awareness of that fact.” A handful of municipalities have similar balloon-release bans in place, including San Francisco, Baltimore and Wrightsville Beach, N.C. Statewide bans have been enacted in California, Connecticut, Florida, Tennessee and Virginia, and legislatures in multiple states considered proposals this year (bills are still active in New York, Massachusetts and New Jersey, but stalled out in Maine, Arizona, New Hampshire and Rhode Island.) In Queen Anne’s County, the proposal has garnered mostly positive reactions, officials said. It doesn’t ban the sale of balloons or make it more difficult for businesses to sell them, so community impacts should be minimal.

While social media can be helpful and effective, there are also a variety of risks associated with its use, including a negative impact on employee productivity, potential for workplace harassment, damage to the company’s reputation, legal ramifications, and misuse of the company’s confidential information. In addition, exposure to malware through social media platforms can lead to compromised social media accounts, data loss, identity theft, and damaged devices. Creating an Effective Social Media Policy Although there is no absolute protection from these risks, companies with a well-planned social media policy are in a better position to protect themselves. Here are ideas for creating an effective policy. Involve all departments. When discussing your social media policy, include representatives from HR, legal, compliance, public relations, and marketing. This will bring different viewpoints into the discussion, help customize the policy to the needs of your organization, and ensure legal requirements are met. Be specific. The policy should alert employees that use of all forms of electronic communications in ways that are illegal, contrary to the company’s interests, or in violation of antidiscrimination policies will not be tolerated. This includes social media activities, blogging, texting, and instant messaging. Don’t bury the policy in your employee handbook. While your social media policy should be in writing and included in your employee handbook, it should also be included in ongoing employee training. The repercussions of social media infractions can be costly to your company’s reputation, so be proactive and train employees. Communicate established consequences for policy violations, and follow through when issues arise. Encourage responsible and appropriate use of social media. Provide acceptable language and ideas your employees can use on social media when talking about your company to benefit and promote your company in a positive manner. Keep it up to date. Review your social media policy on a quarterly basis and make any needed changes. Review decisions made by the National Labor Relations Board and Federal Trade Commission regarding social media policies, and update your policy accordingly.

NOVEMBER /DECEMBER 2019 | PUBLIC RISK

WHAT WE DO AND DONâ&#x20AC;&#x2122;T KNOW ABOUT

BY NIKKI WILSON, PHARMD/MBA

PUBLIC RISK | NOVEMBER /DECEMBER 2019

ITH SO MUCH GOING ON IN THE AREA OF MARIJUANA AND CANNABIS, it makes sense to review what we know and what it might mean for injured

workers and workers’ compensation. Nearly a dozen states have approved cannabis for recreational use and more than two-thirds have signed off on

medical marijuana.1 Marijuana’s active chemical components are becoming more widespread, too. Cannabidiol (CBD) has popped up seemingly overnight in products from skin cream to candy to dog treats. Hemp already appears in thousands of commercial products, and the

number is likely to increase thanks to a recent loosening of restrictions on hemp cultivation.2 It’s no secret that the growing popularity of various forms of cannabis increases the likelihood that their use will become a bigger consideration within workers’ comp in the coming years, but before we dive into the implications, let’s define what we’re talking about. In workers’ comp, we often use the terms “marijuana” and “cannabis” interchangeably. That’s understandable given marijuana is perhaps the more commonly used term. While marijuana is more of a slang term encompassing the plant and associated products, the term cannabis originates from the plant genus name and is what we most often find in scientific literature. Cannabis generally refers to a preparation of the cannabis plant. Cannabis is comprised of a variety of chemical components, including cannabinoids. Cannabinoids are the active chemical constituents. It’s this chemical profile—the percentage of cannabinoids in cannabis—that determines a product’s potency and effects. Therefore, the makeup of the cannabis is what matters more than the various strain names or plant species type.3

HOW CANNABIS WORKS

The simple question of how cannabis works gives way to an intriguing answer. The focus

is often on plant-derived cannabinoids. Yet, interestingly, humans have their own cannabinoid systems. Our bodies produce what are called endocannabinoids, or endogenous cannabinoids. Humans possess two cannabinoids receptors: CB1 and CB2. These receptors, found throughout the body, are where various cannabinoids can exert their effects. Depending on where in the body a receptor exists, its task varies. Regardless, in each case, the goal is balance, or homeostasis. As an example, let’s consider the brain. CB1 receptors are located in the brain and nervous system, organs, glands, and connective tissues. These receptors are responsible primarily for regulation of cognition, memory, motor function, pain, appetite, and sedation. CB2 receptors are present on immune cells, bloodforming cells, and organs and they generally play a role in immune function. Plant-derived cannabinoids, sometimes referred to as phytocannabinoids, affect these same systems when they are introduced to the body. It’s for this reason that medical cannabis is often used to treat pain, in addition to attempting to combat muscle spasms, symptoms of multiple sclerosis, fending off nausea, and finding relief

NOVEMBER /DECEMBER 2019 | PUBLIC RISK

WHAT WE DO AND DON’T KNOW ABOUT CANNABIS

While more research is needed, we do have a gathering of evidence that cannabis can bring benefits for some conditions,5 and

research suggests there are areas where cannabis might offer limited evidence

supporting use. These include Tourette

syndrome, HIV/AIDS (appetite/weight

loss), anxiety, post-traumatic stress disorder

(PTSD), and traumatic brain injury. from post-traumatic stress disorder, cancer, seizures and epilepsy, among others. It’s little surprise that patients would identify varying goals when taking cannabis. However, proponents point to numerous potential physiological effects that cannabis can produce. Among the cannabinoids with therapeutic interest, tetrahydrocannabinol (THC) has a number of well-known characteristics such as its psychoactive, analgesic, and anti-nausea properties. Less often known is that THC is also regarded as being neuro-protective and anti-inflammatory. CBD, by comparison, does not possess psychoactive properties because it shows little affinity for interacting with the CB1 or CB2 receptors, the body’s main cannabinoid receptors. Instead, CBD tends to bind to the TRPV1 receptor. This tendency is similar to capsaicin, the chili pepper extract that is sometimes used as a pain reliever. Because CBD alone doesn’t produce a high, it’s the subject of a good deal of research and numerous orphan drug status designation applications. When combined with THC CBD tends to blunt some unwelcome side effects such as anxiety, dysphoria, panic reactions, and paranoia. At the same time, introducing CBD along with THC can improve some of the therapeutic activity of THC.4

MEDICATION VS RECREATION It is important to note there is not a distinct difference between recreational and medical

PUBLIC RISK | NOVEMBER /DECEMBER 2019

marijuana. Most of what is used recreationally contains THC; that’s what causes the high. Cannabis used for medicinal purposes may or may not contain THC. If the product is higher in CBD or purports to be “CBD-only,” the user might not experience euphoric effects. Yet there is much variability to consider. For example, cannabinoid products that are marketed as “CBD” products are intended to have a low psychoactive response and little to no THC. If, however, the patient is obtaining cannabis from a dispensary, which would most often be the case, the amount of THC depends on the blend or the plant strain and the chemical profile. Several dispensaries list the chemical makeup—that is, the amount of THC vs. CBD, for example—on the labeling, but there is no regulation to determine accuracy.

SIDE EFFECTS

Just as the ingredients and methods of taking cannabis vary, so too do the potential adverse side effects. These can include a rapid or irregular heart rate and hypertension. The drug can also interfere with breathing by causing lung irritation, coughing, wheezing, and production of sputum. Gastrointestinal challenges, such as nausea, vomiting, and dry mouth, can also arise. The potential neurological fallout reads like the boilerplate of a pharmaceutical commercial: Side effects can include lethargy, sedation, drowsiness, slowed reaction time, impaired motor coordination, dizziness, loss of balance, and loss of muscle control. Also possible are decreased focus, impaired judgment, disorientation, confusion, impaired

short-term memory and memory formation, recollection, red eyes, and dilated pupils. Perhaps most famously, the psychoactive side effects can include euphoria, hallucinations, anxiety, and even addiction. A rare but particularly concerning effect is referred to as cannabinoid hyperemesis syndrome in which the cannabis user experiences ongoing cyclic vomiting. Cannabis can present further risks when combined with other drugs. It can interact with central nervous system depressants, the blood thinner warfarin, tricyclic antidepressants, antiepileptic drugs, hydrocortisone, and antibiotics, for example. There are other factors to take into account. Does the patient have a history of psychosis? What about cardiovascular disease or respiratory disease? Is she pregnant? Is there a history of a substance-use disorder? There are also safety considerations that aren’t always in play with fully legal medications. Some of these worries are over inconsistency of the product, packaging and labeling, and quality and purity. Beyond that, improper testing can fail to account for undisclosed contents or to identify contaminants. Variations in the percentages of a product’s composition mean one product could be very different from another that contains the same ingredients but at different levels. In fact, every dispensary’s product is different. Manufacturers might have similar dosages of THC and CBD, but the varying inactive ingredients could potentially alter absorption, distribution, and metabolism.

CANNABIS RESEARCH

Despite its widespread availability, we don’t have reams of research about the effects of cannabis. Advocates point to a multitude of medicinal benefits ranging from the relief of chronic pain to reducing stress levels to fighting cancer. Yet few studies have been done to better understand the efficacy, safety concerns such as drug-drug interactions and side effects, proper dosing ranges, or limitations of use related to inhaled or ingested medical cannabis. Many clinicians believe cannabis has a different effect than synthesized cannabinoids. The plant form of cannabis has many distinctive cannabinoid and non-cannabinoid constituents

that might work “synergistically.” This is the so-called entourage effect. Cannabis products might also be less expensive than pharmaceutical cannabinoids. But the more expensive prescription preparations possess excellent quality control, especially if they’re approved by the U.S. Food & Drug Administration (FDA). Plus, pharmaceutical cannabinoids involve precise dosing. Regardless of whether a patient is using cannabis, or its pharmaceutical counterparts, clinicians and consumers should consider the start-low-and-go-slow approach when it comes to dosing.

WHAT WORKS & WHAT DOESN’T While more research is needed, we do have a gathering of evidence that cannabis can bring benefits for some conditions,5 and research suggests there are areas where cannabis might offer limited evidence supporting use. These include Tourette syndrome, HIV/AIDS (appetite/ weight loss), anxiety, post-traumatic stress disorder (PTSD), and traumatic brain injury. There are other conditions where we need more evidence to support the use of cannabis or oral cannabinoids. These include acute pain, multiple sclerosis-related tremors, Huntington’s disease, glaucoma, schizophrenia, dementia, and depression. The FDA has allowed some products derived from cannabis. In June 2018, the agency approved Epidiolex®, a liquid extract form of CBD. It’s administered as an oral solution for the treatment of seizures associated with Lennox-Gastaut syndrome or Dravet syndrome in patients aged two and above. Other formulations have been around longer. In the 1980s, the FDA approved two other pharmaceutical-grade products derived from cannabis. They remain available by prescription. These are dronabinol (or Marinol® or Syndros®) and nabilone (or Cesamet®) and are similar to THC or are synthetic versions of this cannabinoid. Both are indicated for the treatment of chemotherapyinduced nausea/vomiting and appetite enhancement for anorexia due to AIDS or cancer.

HEMP-DERIVED CBD

The Agriculture Improvement Act, also known as the Farm Bill, was signed into law in December 2018. With it came the deregulation of hempderived cannabis products, namely CBD derived

from plants containing no more than 0.3% THC by dry weight. This legislation effectively removed these specific types of products from the definition of cannabis in the Controlled Substances Act. That meant they were no longer classified as illegal at the federal level, thus allowing for less restricted use. However, the Farm Bill explicitly preserved the FDA’s authority to regulate hemp-derived CBD products under the Food, Drug & Cosmetic Act (FDCA) and section 351 of the Public Health Service Act. This means that such goods are still subject to the same laws and requirements as any FDA-regulated product that contains any other substance. Even though it retains oversight, challenges remain as the FDA works to keep pace with the booming CBD industry. In general, in order for a company to market a product as a drug—defined by the FDCA as any product intended to have a therapeutic or medical use—that product must receive pre-market approval through the FDA’s formal drug approval process including human clinical trials or through Over-the Counter (OTC) Drug Review. Unapproved new drugs cannot be distributed or sold, and the FDA has issued more than 90 warning letters over the past 10 years to CBD companies related to fraudulent product and health claims made on websites, social media, and in stores. The FDA also asserts that it has tested the chemical contents of many of these CBD products, and a number of the results have shown inconsistent or inaccurate components. This can be of particular concern for injured workers as several of the “CBD-only” products have been found to contain THC, the component that would show up on a urine drug test. Further, products containing CBD cannot be marketed as a food or dietary supplement because this is the same ingredient found in an FDA-approved drug product (i.e., Epidiolex). Therefore, CBD is considered a drug. The agency has concerns about the number of products claiming to contain CBD that are marketed for therapeutic or medical uses that have not been approved by the FDA. The FDA regards this as a patient-safety issue. Overall, the FDA’s message to the consumer is buyer beware. The FDA continues to gather research data and safety and public health input to develop an applicable regulatory framework, especially when it comes to non-drug uses of cannabis.

CANNABIS AND TREATMENT GUIDELINES

Many widely used treatment protocols discourage use of cannabis. The Official Disability Guidelines (ODG) don’t recommend using cannabinoids to combat pain. Likewise, the American Society of Addiction Medicine (ASAM) states physicians should not recommend that their patients use marijuana for medical purposes. A task force formed by the American College of Occupational and Environmental Medicine (ACOEM) and the American Association of Occupational Health Nurses (AAOHN) recommended that employers develop policies concerning marijuana use in the workplace.

FINAL THOUGHTS

What’s most clear is that the environment around cannabis is changing. This makes it imperative for those involved in the treatment of injured workers to try to keep up with the shifting rules and to consider the questions that arise in the workplace around cannabis. And employers need to consider their role, too. As use of cannabis and related products such as CBD and hemp increase, there will be more questions about what is permissible in the workplace and how to regulate it. This is a topic that will require recurring and sustained attention. Nikki Wilson, PharmD/MBA, has been the director of Pharmacy Product Development at Coventry Workers’ Comp Services since 2015. REFERENCES: 1 https://www.governing.com/gov-data/ safety-justice/state-marijuana-laws-mapmedical-recreational.html 2 https://www.brookings.edu/blog/ fixgov/2018/12/14/the-farm-bill-hemp-andcbd-explainer/ 3 Hazekamp, A. and Fischedick, J. T. (2012), Cannabis – from cultivar to chemovar. Drug Test. Analysis, 4: 660-667. doi:10.1002/ dta.407, https://onlinelibrary.wiley.com/doi/ abs/10.1002/ dta.407 Adapted from CDPHE, 2016; OHA, 2016 4 Russo, Ethan B. “Taming THC: potential cannabis synergy and phytocannabinoidterpenoid entourage effects.” British journal of pharmacology vol. 163,7 (2011): 1344-64. doi:10.1111/ j.1476-5381.2011.01238.x 5 National Academies of Sciences, Engineering, and Medicine. 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. https://doi. org/10.17226/24625.

NOVEMBER /DECEMBER 2019 | PUBLIC RISK

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1 0 9 2 N P R I MA I

A YEAR IN REVIEW 2019

BY TEAL GRIFFEY, MBA

HAS BEEN A BIG YEAR FOR RISK MANAGEMENT and

an even bigger year for PRIMA. While risk management

professionals grappled with ongoing and emerging risks

in their industries, PRIMA has been an educational force, creating webinars, blogs,

toolkits, podcasts, and events to help members like you succeed in your profession. Please enjoy this look back at some of PRIMA’s major accomplishments in 2019.

This year PRIMA increased its

online learning offerings with more podcasts than last year, enabling risk managers to learn in short “bites.”

PRIMA is nothing without members like you.

For four days in June, more than 1,000 risk management professionals from across the country gathered for more than 50 educational sessions and networking events at PRIMA’s 2019 Annual Conference.

NOVEMBER /DECEMBER 2019 | PUBLIC RISK

PRIMA IN 2019 – A YEAR IN REVIEW

CEO MARSHALL DAVIES RETIRES, NEW CEO JENNIFER ACKERMAN STEPS UP

PRIMA’s longtime leader, Marshall Davies, retired in April. Marshall spent almost 20 years helping make PRIMA the great organization it is today and he will be missed. New CEO Jennifer Ackerman has worked for PRIMA for more than a decade in various positions, and is well prepared to serve our PRIMA members. We welcome Jennifer to her new role at PRIMA!

LAUNCHED THE ESSENTIAL ELEMENTS OF PUBLIC ENTITY LOSS CONTROL PROGRAM

Based on the success of our 2018 Value of Risk Management program and a member needs survey, PRIMA saw an opportunity to provide a resource on loss control and launched the successful Essential Elements of Public Entity Loss Control program.

This toolkit was curated by PRIMA members in our Loss Control Task Force and includes a five-part series that guides you through the process of creating an effective loss control program. From the philosophy behind the loss control effort to developing, implementing, and improving your own program, this series is scaled for the beginner to expert. Even if you’re a loss control guru, there’s information in this series that will have you taking a second look at your loss control program.

1,200+ ANNUAL CONFERENCE ATTENDEES

For four days in June, more than 1,000 risk management professionals from across the country gathered for more than 50 educational sessions and networking events at PRIMA’s 2019 Annual Conference. This year introduced the new Sunday afternoon Camp Fire Chats, extended trade show hours, a refreshed Awards Presentation & Reception, and a Wednesday Keynote Lunch and Learn. Don’t miss PRIMA’s 2020 Annual Conference in Nashville, the only yearly conference dedicated to you: public sector risk management professionals.

YEARLY PRIMA INSTITUTE

One of PRIMA’s most popular education offerings is our yearly PRIMA Institute (PI). PI teaches attendees the foundations of risk management in an intimate setting designed to be as much about networking as it is about learning.

In 2019, PRIMA Institute continues to evolve to meet the changing needs of emerging and seasoned public risk management professionals. It took place in sunny San Diego and featured five days filled with topics essential to emergent public risk needs. These include topics like cyber risk, diversity, human resources, and worker’s compensation. If you haven’t been to a PRIMA Institute, you are truly missing out on an educational experience like no other.

AROUND THE COUNTRY ENTERPRISE RISK MANAGEMENT TRAINING

In 2015, we launched PRIMA’s Enterprise Risk Management (ERM) training to increase public risk managers’ understanding of implementing an ERM program following the international ISO 31000 standard. Since then our training has grown into a two-day course offered both in-house and at major cities.

This year, PRIMA hosted trainings in New Orleans and Las Vegas, while we also provided in-house training to entities like the Colorado Special Districts Property and Liability Pool. We look forward to bringing this cost-effective workshop to even more entities across the country and at our spring 2020 hosted event in Washington, DC.

PUBLIC RISK | NOVEMBER /DECEMBER 2019

14 PODCASTS WITH GUEST PRESENTERS ON CRITICAL INCIDENTS, CROSS-GENERATIONAL WORKFORCES, ADA PLANS, AND MORE

While traveling to other cities for educational opportunities can be fun, we all know that our budgets sometimes don’t allow it. This year PRIMA increased its online learning offerings with more podcasts than last year, enabling risk managers to learn in short “bites.”

In 2019, risk management experts covered topics that ranged from “What to Know about V2V and V2I Technologies” to “Sober Living Homes” and “Disaster Recovery in Workers’ Compensation.” These podcasts are available to all on our website, Apple iTunes, and Google Play. Archived podcasts from years past are available only to members. If you haven’t listened to one, I suggest you give it a try the next time you’re stuck in traffic!

16 BLOG POSTS ON RISK MITIGATION, WELLNESS, NEW TECHNOLOGIES, CHANGE MANAGEMENT, AND MORE

PRIMA’s blog posts are authored by risk experts in areas such as loss control, insurance, law, natural disaster response, and more. One of PRIMA’s newest blogs is “Caveats that Affect the Return-to-Work Timeline.” This blog discusses the issues and solutions to comorbidities, incorrect medical equipment, dental issues from opioid use, and social and psychological factors that can impact the recovery timeline of an injured worker. It also provides solutions for how to proactively mitigate these risks before they cause the lifetime of a claim to extend.

MONTHLY PRIMA WEBINARS WITH GUEST PRESENTERS, DOWNLOADABLE PPTS, AND Q&A SESSIONS

In 2019, PRIMA’s one-hour webinars hosted over 12 guest presenters on topics like the fentanyl and opioid crisis, jail operations, avoiding liability, and developing a risk appetite framework. These webinars consist of a live presentation with a specialized risk expert, downloadable PowerPoint presentations, and an open question and answer session at the end.

Missed a webinar? The archived versions are available free to members on the PRIMA website. Members can also tune into our December 11th webinar “What Your Attorney REALLY Wants from Risk Management” for free.

BOARD OF DIRECTOR’S OUTREACH EFFORTS

Reaching decision makers in our entities about the importance and value of risk management can be tough. Members of the board have been representing PRIMA at industry trade shows to get the word out about risk management. PRIMA has been represented at conferences hosted by the National League of Cities, Government Finance Officers Association, and the State and Local Government Benefits Association, just to name a few. Our hope is that speaking to attendees at these events will elevate the profile of risk managers and help us all get a seat at the table.

96% MEMBERSHIP RETENTION RATE

PRIMA is nothing without members like you. We are grateful for another year of providing education, networking, and job opportunities to our risk management members and the risk management community at large.

As we close the chapter on 2019, the PRIMA Board and staff look forward to serving you in 2020.

Thank you for your incredible support of PRIMA! Teal Griffey, MBA, is the manager of marketing and communications at PRIMA.

NOVEMBER /DECEMBER 2019 | PUBLIC RISK

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DECEMBER WEBINAR FREE TO MEMBERS What Your Attorney REALLY Wants from Risk Management DECEMBER 4 | 12:00 – 1:30 PM EST Speaker: J. Michael Billingsley, JD, City Attorney, City of Kingsport, TN The relationship between the risk manager and the organization’s attorney can be a pivotal element in the success of the organization in dealing with legal issues and claims. Resolving issues early and quickly saves the organization money, time and reduces the distraction caused by litigation. Developing a positive professional relationship between the risk manager and the attorney creates value for the organization. Attendee Takeaways: ➊ Recognize the impact of a positive relationship between the risk manager and the attorney ➋ Understand how the risk manager-attorney relationship benefits the organization ➌ Methods and steps to collect and create useful information

2020 PRIMA WEBINARS COMING SOON!

WORKPLACE

PUBLIC RISK | NOVEMBER /DECEMBER 2019

HAZING BY CLAIRE WILKINSON

AZING INCIDENTS OR BULLYING in the workplace can be problematic for both public- and private-sector employers, and amid the #MeToo environment, awareness around the behavior is growing, experts say.

Several insurance coverages may come into play in hazing events, including general liability, employment practices liability and workers’ compensation

policies. Having strong workplace policies, procedures and training in place are critical for employers to manage and mitigate the risks. A recent case in Portland, Oregon, highlights the potential liability public entities can face from such claims. The city reached an $80,000 settlement, effective Aug. 2, ending a lawsuit brought by Adam Rawlins, a former employee who had claimed in U.S. District Court he was subject to battery and intentional infliction of emotional distress due to “extreme hazing” while working for the Portland Bureau of Transportation in 2016. In one incident, Mr. Rawlins alleged he was held against his will and locked in a cage in a city shed while he was bound with zip ties and duct tape, according to court documents. The city of Portland is self-insured for the first $1 million in liability coverage, including employment practices and auto claims, a spokesman in the city’s risk management division confirmed, though he declined to

comment on the specific case. Excess liability coverage, in excess of $1 million, is purchased separately and there is no exclusion for hazing, the spokesman said. Law enforcement claims have a self-insured retention of $2.5 million. While hazing in the college fraternity and sorority setting has been widely publicized, incidents of hazing in municipalities, school districts and townships have not been as prominent. “I haven’t seen a massive rise, but there have been several incidents the last three or four years. There’s a very fine line between hazing and bullying and sexual harassment or assault,” said Dave Marcus, Boca Raton-based area chairman for Florida at Arthur J. Gallagher & Co. “The reason we don’t hear about hazing per se is because it’s bullying, or it could be called sexual assault or molestation.”

NOVEMBER /DECEMBER 2019 | PUBLIC RISK

WORKPL ACE HAZING EMERGES FROM THE SHADOWS

“

It’s not uncommon to see employers that want to

conduct civility or harassment training with their staff,

“

Jack McCalmon, owner of loss prevention consultant The McCalmon Group Inc. in Tulsa, Oklahoma commented on the situation, “We’ve seen slight upticks in the type of behavior that often accompanies hazing, especially if it involves sexual misconduct. Whether hazing has increased or whether public awareness after the #MeToo movement, Harvey Weinstein and issues involving child sexual abuse has made people more aware, it’s hard to say.”

which would deal with these instances of bullying or inappropriate behavior.

Mark Swerdlin, a Baltimore-based partner at Shawe Rosenthal LLP

The McCalmon Group Inc. has seen an uptick in people bringing claims characterized as a hazing ritual. The organizations at greatest risk are those with satellite offices and departments that are outside direct control, because they are not monitored. The manager or person in charge has a lot of autonomy in these situation and can escape scrutiny.

if the (individual) was injured during the hazing, if they had abrasions or, God forbid, broke a bone, in theory it should be covered by workers’ compensation because it was a bodily injury caused or aggravated by the conditions of their employment,” explained Jessica Cullen, New York-based managing director of the casualty practice at Gallagher.

From an insurance standpoint, workplace bullying is covered under a general liability policy, but when the behavior crosses into sexual assault, there may be separate coverage within a general liability policy, or the employer may have a separate policy. “If the hazing turns into some sort of molestation, assault or harassment, it creates a different exposure that may or may not be covered under the GL policy,” Mr. Marcus said, adding that sexual harassment may be excluded from the general liability policy. “Public entities are ruled by the laws and statutes of the states they are in ... Some states have sovereign immunity (laws) or tort caps, and some states don’t. A lot of that (influences) how an entity purchases coverage.”

The challenge for employers in both the private and public sectors in dealing with workplace bullying and hazing is that “up to this point it’s not necessarily something that has been clearly against the law,” said Mark Swerdlin, a Baltimore-based partner at Shawe Rosenthal LLP. Under federal law, Title VII of the Civil Rights Act of 1964 deals with harassment or discrimination in the workplace. “There’s case law and procedures in place to deal with sexual harassment, or harassment based on race or religion or any of the other protected classes. But bullying is not necessarily something that would be covered by those laws,” Mr. Swerdlin said. “Absent a racial or religious or age component to how the alleged bullying happened to the victims, it would be dependent on each city or state or local law that might exist.”

Workplace bullying incidents may trigger employment practices liability policies, subject to policy language, said Natalie Douglass, St. Louis-based chief legal director for the management liability practice at Gallagher. “We would have to be able to trigger the definition of wrongful act, which could include workplace bullying,” she said. “If that’s there, then we can trigger that policy subject to the bodily injury exclusion.” While employment practices liability policies do not cover bodily injury, there is coverage for mental anguish and emotional distress. Workers’ compensation policies could also come into play. “From the workers comp perspective,

PUBLIC RISK | NOVEMBER /DECEMBER 2019

Andrew Smith, senior counsel in the Los Angeles office of Tyson & Mendes LLP added that as an employer, a public entity is generally subject to the same liability any employer is, in that they have to ensure the workplace is one that does not foster an environment of discrimination or harassment or retaliation. If “a rogue supervisor is trying to use the workforce as his personal dating pool, or a group of people are forcing others to do things that they wouldn’t want to do, or people are not being promoted based on their race, gender or disability … and a public entity doesn’t do what they are required to do under the law to prevent

it from happening, there’s potential liability there,” Mr. Smith stated. “It’s not uncommon to see employers that want to conduct civility or harassment training with their staff, which would deal with these instances of bullying or inappropriate behavior,” said Mr. Swerdlin. Bystander intervention training is also growing, he said. “There’s a big push to empower co-workers so that when they witness bullying or harassing behavior the bystander steps up,” he said. Just as important is the active role employers must play in preventing workplace hazing, and any form of workplace abuse or harassment. Employers should mitigate the risks by having appropriate policies and procedures. Employers should also have people on standby with the experience and expertise to conduct a thorough investigation, “to root out any conduct, ritualistic type of harassment or bullying or uncivil-type behavior,” Mr. McCalmon said. “Protecting people and their equal rights is important. Prohibiting certain forms of bullying conduct is important in a written format, but also having a mechanism where people feel they can report their reasonable concerns about violations of the policy without fear or intimidation is vital,” stated Mr. McCalmon. Without a strong culture of employers protecting their employees, even from other employees, workplace hazing, among other forms of harassment will continue. Claire Wilkinson is an author and deputy editor for Business Insurance: News for Insurance Professionals. Article originally appeared September 03, 2019 on BusinessInsurance.com. Click here to go to the original article.

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FIND US ON LINKEDIN!

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.

PRIMA ANNUAL CONFERENCES June 14–17, 2020 PRIMA 2020 Annual Conference Nashville, TN Gaylord Opryland June 13–16, 2021 PRIMA 2021 Annual Conference Milwaukee, WI Wisconsin Center June 5–8, 2022 PRIMA 2022 Annual Conference San Antonio, Texas Henry B. Gonzalez Convention Center

PRIMA INSTITUTE October 26–30, 2020 Washington, DC

ERM TRAINING November 13–14, 2019 New Orleans, LA

PRIMA WEBINARS November 20 Improving Safety in Government by Changing Driving Behavior December 4 What Your Attorney REALLY Wants from Risk Management

Receive daily updates on what’s new at PRIMA and in the public risk management industry! VISIT US AT www.linkedin.com/company/prima-central NOVEMBER /DECEMBER 2019 | PUBLIC RISK

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