Max KoonceSenior Director, Risk Management, Walmart Stores, Inc.

Ron ThackerySenior Vice President, Professional Services, Emergency Medical Services Corporation

Darrell BrownChief Performance Officer, Sedgwick

Tuesday, April 23, 2013Session Time: 2:15 to 3:30 p.m.

Introductions

Max KoonceSenior Director, Risk ManagementWalmart

Ron ThackerySenior Vice President, Professional ServicesEmergency Medical Services Corporation

Darrell BrownChief Performance OfficerSedgwick

Under the influence of?

Federal law - marijuana

• Controlled Substances Act (CSA) • Scheduling and approval of drugs, including marijuana, must be

based on both legal and scientific criteria:• High potential for abuse• Drug not currently accepted for medical use in treatment in U.S• Lack of accepted safety for use of the drug under medical supervision

• Department of Health and Human Services (HHS)• Provided scheduling recommendations• Drug Enforcement Administration (DEA) • Reviewed and denied petition to schedule marijuana• Department of Justice Guidelines (DOJ)• Violation of federal law• Subject to federal enforcement action, including prosecution

State laws

• 18 states and the District of Columbia have laws legalizing medical marijuana• Alaska, Arizona, California, Colorado, Connecticut, District of Columbia,

Hawaii, Maine, Maryland, Massachusetts, Michigan, Montana, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, Vermont and Washington

• 2 states legalized marijuana for adults in 2012• Colorado and Washington

Court cases

Raich v. Gonzales (U.S. Supreme Court, 2005)

Emerald Steel Fabricators v. Bureau of Labor and Industries of State of Oregon (2010)

California Ross v. Raging Wire Telecommunications (2008)

Casias v. Walmart (Michigan, 2012)

What about legal prescription drugs?

Max KoonceSenior Director, Risk Management

Walmart Stores, Inc.

Walmart Stores, Inc. is comprised of:Walmart U.S. (approx. 1,400,000 associates)

• 4,005 Walmart Retail Stores• 620 Sam’s Clubs• 142 Distribution Centers

Walmart International (approx. 800,000 associates)• 6,148 Retail Units• 27 Countries

Alcohol and drug free workplace policy

1. Vital interest in maintaining a safe, healthy and efficient environment for Walmart associates, suppliers and customers

2. Committed to maintaining an alcohol and drug free workplace

3. Alcohol and illegal drug use pose a serious threat to workplace safety, health, and productivity

4. Walmart strictly forbids improper use of drugs / alcohol

Alcohol and drug free workplace policy (cont.)

5. Admission prior to testing request:• If an associate self-reports:

Employed a minimum of 180 days with the company Reports to a salaried member of management Provided a leave of absence Signs last chance agreement which provides:

• Enrollment in a substance abuse treatment program

• Certification that program was completed

• Periodic drug screens for following 12 months

Types of testing

Pre-employment Reasonable suspicion

Post-accident

Promotion screening

Transfer to safety sensitive position

Definitions

• Definition of positive alcohol screens• % blood alcohol concentration

• Definition of positive drug screens• Illegal drug: At or above the detection level for that drug

according to the Federal Substance Abuse and Mental Health Services Admin.

• Prescription drug: At a level in excess of the prescribed amount Other than for the condition for which the drug was prescribed Other than the prescribed method for using the drug; or Without a valid prescription

• Conduct of screens / testing

Consequences of positive test

Legal interaction

Wrongful termination

• Pretext

• Medical marijuana

Workers’ compensation claims

• Impact on benefits / compensability

• Opioid use in medical treatment

Americans with Disabilities Act

• Medical marijuana (CA case)

General liability - impaired while in accident

• Deviation from employment

• Insurance coverage

Additional concerns

• Wireless device use while driving company vehicles:– Comply with state laws:

• Texting while driving• Hands free

– Safety first:• Guidelines on call duration• Traffic congestion• Poor road / weather conditions

Additional concerns

• What happens if the associate is involved in an accident?

• Cell phone records could be requested• Elevated level of accountability if the cell phone was in use at

time of accident

• Medical marijuana

Ron ThackerySenior Vice President, Professional Services Emergency Medical Services Corporation

State reactions

Washington / Colorado

Colorado

Colorado - higher education

Emergency medical services corporation

Medical transportation• 3.4 million transports

• 8% share of total ambulance market

• 21% share of private provider ambulance market

Services offered• 911 emergency

• Inter-facility transfers (non-emergency)

• Fixed wing air ambulance

• Managed transportation

• Disaster response (FEMA)

• International

• Site-based

Outsourced facilities based physicians• 8 million patient encounters

• 8% share of ED services market

• 12% share of outsourced ED services market

Services offered• Emergency department

• Hospitalist / inpatient

• Anesthesiology

• Radiology / teleradiology

• Acute surgery centers

Alcohol and drug free workplace policy

• Pre-employment drug testing• Reasonable suspicion drug & alcohol testing• For cause drug & alcohol (collisions, >2 WC claims in 12 months,

missing or altered drugs, open container, presence of controlled substances/paraphernalia)

• Limited random drug & alcohol testing• Last chance - self disclosure, treatment with follow up testing

Alcohol and drug free workplace policy

• Refrain from alcohol consumption at least 8 hours prior to start of duty• Prohibited use, possession, manufacture, distribution and sale of

controlled substances or illicit drug paraphernalia• Report use of a prescribed or over the counter drug that may impair

behavior, alertness, mental ability, driving, patient care• Prescriptions must be in the name of the user• Notify management if arrested or convicted for criminal use/abuse of

drugs or alcohol

Alcohol and drug free workplace policy

• Testing methods• Saliva based screening• Confirmation - DOT lab based drug screening• Confirmation - DOT BAT testing for alcohol

• Positive tests - follow DOT criteria• Outcome - zero tolerance for positive tests• Reapply after 36 months

Practical application

Outcomes

Logistics - testing, transportation,

communication of results

Difficult time or a new beginning

Self disclosure - facing your peers

Left field - every once in a while