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Prescription Opioid Risks to the Workplace Explored at RIMS 2018

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SAN ANTONIO – When the White House declared opioid use a national Public Health Emergency under federal law in 2017, businesses began reviewing their policies and making efforts to curb their employees’ abuse of the drug in its prescribed form. This escalating risk to organizations is why the business impact of prescription opioid use was such a hot topic at RIMS 2018, where a session on April 17 focused on the practical and bottom-line costs of workforce use of prescription opioids. In a session the next day, attendees learned how liability policies are responding to government-led lawsuits against opioid manufacturers, and how to prepare for similar suits brought against other industries.

New Insights into the Impact of Opioid Prescribing to Injured Workers
Data displayed on Tuesday explored opioid-related correlations between worker, industry and employer. Presenters John Ruser, president and CEO of the Workers Compensation Research Institute (WCRI) and Michael Fenlon, senior director of corporate risk management for United Parcel Service (UPS) discussed opioid-related claims and suggested evidence-based information that can encourage a return to work without the prescriptions.

The effectiveness of prescription drug monitoring policies (PDMP) was explored, and Ruser explained that a reactive shift among prescribers has meant that states obligated to adhere to these policies have fewer prescriptions written.

“This shows that the more queries there are, the bigger the drop in opioid prescribing,” he said, using Kentucky as an example of a successful PDMP. He added that Kentucky’s HB1 law mandated the use of the PDMP and has set a standard among states since it was enacted in July 2012. Between 2011 and 2013, WCRI information indicated a 10% decline in prescriptions in the state, whereas prescription levels were flat in others that did not have comprehensive opioid reforms.

Fenlon said that when he learned in recent years that opioid overdoses—almost half of which arise from prescriptions—surpassed car accidents as the number one cause of accidental death, he realized the severity of the issue and its impact on the UPS workforce.

“Once someone gets to that third or fourth script, you can see how it leads to a vicious cycle,” he said. “We need to take ownership of this—in the workers comp space as well as the healthcare side.”

He noted that UPS’ overall pharmacy spend is about 7% of its total medical costs per year for lost-time (LT) patients, with opioids comprising about 22% of that amount. UPS employs more than 454,000 workers, and Fenlon said the company continually pays close attention to the LT patients who are the higher-risk group, with three or more scripts. He added that the collaboration of drug formularies, third-party administrators and UPS case supervisors has contributed to the 44% decrease of the higher-risk group between 2013 and 2017.

Both presenters conceded, however, that injured workers will likely get the medication they need, even if it is not in the form of opioids. “Those who are worried about pain management are noticing the trend in the decline of opioid prescriptions in some areas and ask: ‘What’s the alternative?’” Ruser said. “While there was a drop in that drug, there was an increase in the amount of NSAIDs [nonsteroidal anti-inflammatory drugs]. Clearly, that’s what these prescribers are shifting to, so it’s not that these injured workers are not receiving pain meds.”

Members may access this PowerPoint presentation by logging in at the RIMS 2018 session handout page.

Opioid Lawsuits: A Tsunami of Litigation and Associated Coverage Issues
The topic shifted from boardrooms to courtrooms the next day, as current and pending multidistrict litigations filed by various governments (local, city and state) were examined. Covington & Burling LLP Partner Anna Engh and Marsh Managing Director John Denton (pictured below) discussed insurance policies’ responses to lawsuits and provided insight as to how to prepare should similar suits be brought against other industries.
Manufacturers, distributors, retailers, prescription benefit managers, doctors and clinics are all seemingly in the crosshairs of local municipalities and governmental entities, Engh noted.

“The main focus against the manufacturers is of alleged misrepresentation of the addictive nature of opioids. With respect to the distributors, it is the failure to report and detect suspicious orders, or failing to have controls in place for their diversions,” Engh said. “You’ll see negligence pled in different ways, like common-law negligence, and also pled as violations of states’ controlled substance acts.” She added that public nuisance and RICO claims (Racketeer Influenced and Corrupt Organizations Act) also appear on the dockets.

With nearly 500 claims against pharmaceutical companies, distributors and pharmacies consolidated in Ohio alone, Denton said that the volume of work involved is daunting for insurance, risk and legal professionals.

“That’s thousands of pages of pleadings coming in every month. It’s a very difficult burden,” he said. “I think a lot of companies are tendering them to as many policies as possible. Hopefully, a lot of insurance carriers will be understanding of this. And a lot of this will be sorted out later, either through discussions with the carriers or litigation.”

Denton added that because there is no federal judicial precedent on insurance suits, the progress on such matters will continue to be slow.

“Insurance coverage issues are typically an issue of state law. And with lawsuits in nearly every state, it would be nice to have a [United States] Supreme Court decision on some of these coverage issues, and that would bind everybody,” he said. “But the reality is that’s not going to happen. There will be decisions in multiple states so it may take some time before these issues get sorted out.”

Business and Employee Safety During Crisis Explored at RIMS 2018

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SAN ANTONIO – Emergency preparedness and action plans amid violent crises were explored during educational sessions at RIMS 2018 here. On Monday and Tuesday, experts discussed ways businesses can prepare for active shooter events and kidnapping crises. Experts agreed that in such events, lives, operations, reputation and finances are all at stake.

Some highlights from the sessions:

Kidnapped! A Crisis Simulation Exercise
Bill Laurence, head of crisis management at S-RM offered a kidnap simulation for a well-attended session on Monday. Laurence provided a scenario, asking the audience to assume a collective role as decision-makers of a fictitious, billion-dollar coffee company that has an executive abducted in Mexico. The group’s assignment was to create a crisis management team and decide who the communicator would be, how they would respond to threats and what information to relay to their insurance provider, among other critical actions.

“The first 24 hours are always the most critical during a kidnapping or ransom scenario,” Laurence said.

The simulation included real-life audio and video examples of terrifying ransom-demanding calls. The team learned that the kidnapper has typically planned the abduction in advance and always has control of the situation – beginning with communication. “For that reason alone, you cannot speed up the process,” Laurence said.

And although things may seem dire, he explained ways to glean information – and feel somewhat positive – even after a brief phone call. “We all react differently to pressure,” he said. “But avoid speculation and always prepare for the next call.”

Read more about kidnapping in a Q&A with the session’s co-host, Denise Balan, senior vice president and head of U.S. kidnap & ransom at XL Catlin, on page 9 in Tuesday’s Show Daily.

Active Threat and Workplace Violence on Campus: Preparedness, Response and Recovery
Craig McAllister, Cornell University’s director of risk management and insurance, opened a session on Tuesday with a discussion of duty of care and the obligation to the campus or work environment.

He pointed out that, in early January, the National Fire Protection Association (NFPA) processed its NFPA 3000 Standard as a provisional one to streamline the program elements necessary for organizing, managing, and sustaining an active shooter and/or hostile event response program. The standard gained even more input following the Marjory Stoneman Douglas High School in Parkland, Florida, on Feb. 14 in an effort to reduce or eliminate the risks, effect, and impact on an organization or community affected by these events

Paul Mills, global kidnap prevention manager at AIG, followed with a segment addressing best practices for violent incident preparation and response. He discussed response and resilience training for employees who need enhanced preparedness with the rise of violence against soft targets.

He noted that advances in technology often are putting people in harm’s way by default. “People are distracted to the point where they are unaware of the threats they face. It’s also delaying and inhibiting their response times,” he said. “Without even realizing it, they often portray victim-like behavior.”

Kendell Moore, senior vice president at the Abernathy MacGregor Group, delved into the key crisis management sources of an organization’s response support, both internally and externally. She used a mass shooting that occurred inside a local business in the western United States (that is also part of a major American chain) as an example of an entity that needed to enact its crisis communication plan immediately after the attack.

Moore offered some crisis communication principles:

  • Media is a conduit, not an audience. “The media needs to catch up to the actions of the business.”
  • Speak directly to the impacted. “It is most important to communicate with victims, loved ones, the community and those who are directly affected.”
  • Take action, not credit. “No statement, no matter how eloquent, can substitute for doing the right thing.”
  • Communicate what matters when it matters. ““What is said first must stand the test of time. So announce nothing and predict nothing that isn’t solid and certain.”
  • Build relationships in the community. ““Work alongside local law enforcement, government officials and those who know the community best.”
  • Listen to people’s needs and requests. “Ask what people need, rather than telling them what you think they need.”

Risk Manager of the Year: Q&A with Rebecca Cady

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Rebecca Cady, vice president and chief risk officer of Children’s National Medical Center (CNMC) in Washington, D.C. was named the RIMS 2018 Risk Manager of the Year today. CNMC is the largest freestanding pediatric academic medical center and health system in the greater D.C. area., with annual revenues of nearly $1.2 billion.

She was praised by her peers for her success in elevating CNMC’s culture of safety, addressing risk on an enterprise basis and lowering the system’s total cost of risk. Under her leadership, programs continually seek to benefit the system’s 6,000-plus employees, and ultimately, the services they provide to children and their families. Cady spoke with Risk Management Monitor about her journey to the profession and the combination of challenges she faces as a health care risk manager.

Risk Management Monitor: Your professional career began as a labor and delivery nurse. How did you make your way into risk management?

Rebecca Cady: I was a staff nurse at a small, rural hospital in Kingsville, Texas. During a shift, several co-workers were gathered at the nurse’s station, discussing a lawsuit that many senior nurses were anxious about having to take part in.

They didn’t understand what was going on. I remember thinking: ‘What if lawyers knew what it was like to be a health care provider or practice medicine and nursing?’ It would help them do a better job of guiding the nurses and doctors through the legal process. I thought, ‘I could go to law school.’ And I did. It turned out to be a great idea because it has made for a fulfilling and interesting career.

RMM: After becoming a lawyer—and eventually partner—at a law firm, what drew you to CNMC?

RC: I saw this as an opportunity to get in the practice of avoiding litigation in the first place. I was attracted to the idea of working more closely with providers and in a hospital environment where I felt I could have a greater impact on the organization and manage its risk.

RMM: What is one of CNMC’s top challenges?

RC: Recruitment is up there. Pediatric neurosurgeons are not working at Starbucks while they’re looking for a job.

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In some of the specialties, there are very few qualified people. Being able to recruit and hire the best and the brightest, which we think our kids deserve, is hard because we’re competing with pediatric hospitals that are part of other systems.

RMM: In 2014, you updated the reporting systems to include reporting from mobile phones. What inspired that change?

RC: Being able to report an incident and have it instantly make its way up the chains of command was more of a way to cut past the tediousness of logging a report on paper, or even on a computer. I’m not a techie but I recognize that technology has the ability to make us more efficient and effective. We really do believe that more reports are better, because knowing about the low-level events that don’t reach patients or cause immediate problems can still be useful. You can then identify latent issues that need correcting and prevent something serious. Plus, it was embraced by our employees.

RMM: You are widely regarded by peers and co-workers as a relationship-builder and a strong communicator. What is your management style?

RC: My office is in the hospital and I make it a point to be visible. I go to meetings wherever possible and am present wherever possible, I administer our calls and speak at staff meetings as well and to the new residents and nurses as they come on board. The whole risk team is also out and about among the organization constantly, because having relationships builds trust and makes your job easier.

We’re not the department of ‘No.’ We’re the department of ‘Yes, If…’ Helping folks solve their problems – even if they seem small to you – is huge for them. And once they stop seeing you as the policeman, they see you as a business partner.

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Then they’ll start to call you earlier in the game when they are strategizing. That applies no matter what industry you’re in.

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RIMS Bestows Top Industry Honors and Awards

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SAN ANTONIO—At today’s RIMS 2018 Annual Conference & Exhibition Awards Luncheon, the risk management society kicked off the week by issuing its top marks of distinction for leadership and achievement in the industry.

Ward Ching, managing director of the western region at Aon Global Risk Consulting, received RIMS’ most prestigious honor, the Harry and Dorothy Goodell Award. Named after RIMS’ first president, the award recognizes outstanding service and achievement in furthering the goals of the society and the discipline of risk management. “This year’s winner is an outside of the box thinker, customer focused, and always willing to put others before himself,” said RIMS President Robert Cartwright, Jr. “He created a brand new culture of safety for Safeway, has saved companies billions of dollars and is creating risk management programs for universities across the country.”

This year’s inductee to the Risk Management Hall of Fame is Berry Griffin, former RIMS president from 1979.

“RIMS stands as the premier risk management association in the world and has grown its network to over 10,000 professionals because of individuals like Berry Griffin, Jr.,” said RIMS CEO Mary Roth. “Dedicated, passionate and genuinely invested in demonstrating the value of risk management, Berry’s contributions continue to drive conversation and evolve risk practices. It is an honor to induct this longstanding RIMS leader into the Risk Management Hall of Fame.”

Celebrating the impact of an involved membership both past and future, the RIMS Rising Star Awards went to Lindsey Harris, risk manager at Dollar Tree Stores, and Jaci Mennenga, manager of corporate risk management at COUNTRY Financial. Harris and Mennenga were honored for demonstrating exceptional initiative, volunteerism, professional development, achievement and leadership potential.

Among those recognized for exceptionalism on a chapter level, Randy Jouben, risk manager at Fairfax County Government and active member of RIMS Potomac Chapter, received the Ron Judd “Heart of RIMS” Award. The first ever RIMS EChO Award for enhancing chapter outcomes went to the Oregon Chapter. For their continued service with RIMS and exceptional support of the society’s strategic initiatives, Andrew Bent, risk manager at the Sage Group PLC, and Lori Seidenberg, head of global real assets insurance at BlackRock, Inc., were named to the RIMS Ambassadors Group.

Tomorrow morning, the society will continue to recognize some of the risk management industry’s top talent at the RIMS Risk Manager of the Year Award Breakfast. RIMS Risk Manager of the Year and Risk Management Honor Roll aim to raise the profile of the risk management profession and the outstanding programs practitioners have implemented within their organizations. This year’s Risk Manager of the Year is Rebecca F. Cady, vice president and chief risk officer at the Children’s National Medical Center. Additionally, three risk professionals will will be named to the RIMS Risk Management Honor Roll: Sandy Aspinall, Jr., vice president of global risk management for Comcast Corporation; Jennifer Hills, director of the office of risk management services for King County (Washington); and Joseph Meaney, Jr., vice president of global insurance and risk engineering for The AES Corporation.