BRIGHAM AND WOMEN S HOSPITAL

BRIGHAM AND WOMEN S HOSPITAL HUMAN RESOURCES POLICIES AND PROCEDURES SUBJECT: DRUG AND ALCOHOL ABUSE AND PREVENTION POLICY POLICY #: HR-302 EFFECTIVE DATE: January 1, 2008 POLICY It is the policy of Brigham and Women's Hospital to maintain an environment that is free of impairment related to the abuse of drugs and alcohol by any of its employees and to comply with all applicable state and federal laws, including the Drug-Free Workplace Act of 1988. The hospital and our patients expect employees to arrive for work in a condition free of the influence of alcohol and drugs. The hospital also expects employees to remain free of the influence of alcohol and drugs while they are on the job and to refrain from use or unlawful manufacture, distribution, sale, dispensing, or possession while on hospital property or performing hospital business. I. DEFINITIONS A. Under the influence: For the purposes of this policy, under the influence describes an employee who is affected by a drug and/or alcohol or the combination of a drug and alcohol in any detectable manner wherein such use or influence may affect the safety of the employee, co-workers, patients, or members of the public, the employee's job performance or the safe or efficient operation of the hospital. The symptoms of influence include but are not limited to, changes in behavior, impairment of physical or mental ability, such as slurred speech or difficulty in maintaining balance or perceived smell. B. Legal Drug: Prescribed drugs and over-the-counter drugs that have been legally obtained and are being used for the purpose for which they are prescribed or manufactured. C. Illegal Drug: Any drug (a) which is not legally obtainable; (b) which is legally obtainable but has not been legally obtained; or (c) which has been legally obtained, but is not being used for prescribed purposes. II. PROCEDURES A. Evaluation Interview for Suspicion of Impaired Employee

In an effort to establish if a violation of hospital rules and regulations occurred, managers should conduct their inquiries in the following manner: 1. During normal business hours and prior to initiating questioning relative to the suspected use or possession of alcohol and/or drugs, the manager should consult with their Human Resources Consultant. If consultation is not possible, managers should proceed with their inquiry following the procedures outlined below and then notify HR Consultant as soon as practical. 2. The manager who observes or to whom it is reported that an employee is impaired, must confirm the observations or report by establishing that there is reasonable cause for action which is noticeable in the employee's behavior and/or job performance. The manager should determine, in person, with another manager present as a witness, if an employee "appears" to be under the influence of an alcoholic beverage, drugs, including controlled substances, over-the-counter medication and/or prescriptive medication. The questions should be limited to those that will determine the employee's general condition. The manager should take the appropriate notes that may be necessary for future reference and support documentation. 3. Using the Visual Observation Checklist (Attachment A,) the manager should make visual observations to determine the employee s fitness for duty. With the employee and witness still present, the Consent Form and the Opinion Based on Observation and Questioning (Attachment A, Section II) should be completed and signed by both the manager and management witness. B. Possible Outcomes of Interview 1. Determination that the employee is not under the influence of alcohol and/or drugs. If it is concluded that the employee does not appear to be under the influence of alcohol and/or drugs and is able to perform his/her work assignment, the manager should thank the employee and have him/her return to work. The manager should inform the employee of the confidential and voluntary resources and services available through the EAP. 2. Reasonable cause to suspect the employee is under the influence of alcohol and/or drugs. When there is reasonable cause based on objective facts, i.e., the completed interview, to suspect an employee may be working or on hospital property under the influence of alcohol and/or drugs and the manager believes the employee's faculties are impaired, the employee will be requested to submit

to a medical assessment, blood test, urinalysis or other drug/alcohol screening. An employee who agrees to submit to a medical assessment should be told that they are suspended pending return of the test results and that appropriate corrective action may be taken up to and including termination. Prior to leaving the investigatory interview and before submitting to the medical assessment, the employee should be asked to sign the consent form (Attachment B). 3. If the employee refuses to be tested after the manager has determined the need to be tested, the employee should be relieved of his/her duty and placed on paid administrative leave being informed that corrective action will take place. After further investigation, corrective action may be taken up to and including termination. Prior to leaving the investigatory interview, the employee should be asked to sign the refusal form (Attachment C). 4. Managers are not to attempt to use force in seeking compliance with requests for testing. Both the alcohol and drug screen and the signing of any forms are voluntary on the part of the employee. C. Security 1. Security personnel should be called if the manager determines that the employee should not be allowed to return to the work area and the employee refuses to leave. 2. If the manager suspects that there is theft or other major misconduct related to this incident, the manager, Security and Human Resources will consult to determine appropriate action. D. Medical Assessment/Testing 1. During normal business hours all medical assessment/testing is done in the OHS. When the OHS is closed, these services are provided by the nursing administrator on call. Prior to accompanying an employee to OHS, the manager should call to coordinate the visit. 2. An employee, who agrees to a medical assessment and testing, should be accompanied to the OHS by their manager. The consent form to test should be given to the OHS health care provider. 3. The employee should be informed of confidential services available through the EAP. E. Exiting the Hospital Premises

The manager should make arrangements to have the employee taken home. If the employee refuses assistance, document the employee refused such assistance. F. Determination of Employee Status/Corrective Action 1. The manager should consult with their HR Consultant. 2. While the employee is on administrative leave, Human Resources will work with the manager to determine an appropriate course of action. 3. A first offense may result in corrective action up to and including termination. 4. An employee, who refuses testing, and where an investigation warrants, is subject to corrective action up to and including termination. 5. An employee whose impaired status was discovered under conditions threatening their own safety, patients' or other employees' safety, as well as employees who are involved with selling, stealing or involved in any other major malfeasance will be subject to corrective action up to and including termination. III. REHABILITATION A. Employees who have informed the hospital of such and who agree to go through a drug and/or alcohol rehabilitation program for the first time, will be conditionally reinstated to a job provided they: 1. Take a leave of absence as appropriate. The leave may be in accordance with the Family and Medical Leave Act of 1993 (refer to Leave Policy). 2. Participate in an approved substance abuse rehabilitation program and maintain the preventive course of action prescribed by the program. Submit on-going documentation to the OHS that indicates they are remaining substance free and are adhering to the terms of their contract. This may include random drug testing at the employee s expense. B. EAP is available to assist employees through assessment and appropriate treatment referral, as well as follow up to provide support for their recovery program. C. An employee returning from a leave will be required to sign a conditional reinstatement agreement or other appropriate documents/agreements as determined by Human Resources. The terms of the conditional reinstatement

agreement will be in effect for a minimum of three years following its signing. D. An employee, who does not follow the prescribed preventive treatment plan of their program (as outlined in the conditional reinstatement agreement) and engages in the abuse of drugs or alcohol, will be subject to immediate termination. V. CONFIDENTIALITY Managers and employees should only engage in conversations with persons who are participating in any questioning, evaluation, investigation or corrective action and who have a need to know about the details of the investigation. This restriction includes not mentioning the name of the employee(s) suspected of violating this policy. Managers and investigators are to instruct other employees, except as stated above, not to talk about such details. VI. EMPLOYEE ASSISTANCE PROGRAM Employees may seek assistance from this program in confidence. However, it is the responsibility of each employee to seek assistance from the EAP before alcohol and drug problems lead to corrective action that can include termination for a first offense. Once a violation of this policy occurs, subsequently using the EAP on a voluntary basis will not lessen corrective action and may, in fact, have no bearing on the determination of appropriate corrective action. Accordingly, the purposes and practices of this policy and the EAP are not in conflict and are distinctly separate in their applications. VII. LEGAL/REGULATORY AGENCY COMPLIANCE The use, sale, purchase, transfer, theft or possession of an illegal drug is a violation of the law. The hospital will refer such illegal drug activities to law enforcement, licensing and credentialing agencies when appropriate. All such referrals will be done only after the department/division Vice President and the Vice President of Human Resources is informed. Note: As a condition of employment, an employee must notify the hospital if s/he is convicted of a criminal drug offense, including a plea of nolo contendre (no contest), occurring in the work place within five days after the conviction. The hospital is then required to notify any granting agency of this conviction within ten days after learning of the conviction. VIII. DRUG FREE AWARENESS PROGRAM On a regular basis, the hospital will inform employees about the dangers of drug and alcohol abuse in the workplace, its policy of maintaining a drug-free workplace, available drug counseling, rehabilitation and employee assistance programs, and the

penalties that may be imposed upon employees for drug or alcohol abuse violations. The EAP offers educational seminars and information about substance abuse for employees and managers on request throughout the year. IX. MISCELLANEOUS Hospital Sponsored Events Occasionally the hospital may sponsor an on or off site event where alcohol is served. The moderate consumption of alcohol is permitted during these events. However, it does not relieve an employee from meeting reasonable and acceptable standards of conduct. Under no circumstances should an employee who delivers patient care or provides essential services consume alcoholic beverages prior to going to work. APPROVED BY: Vice President Human Resources Chief Operating Officer This policy is intended as a guideline to assist in the consistent application of Brigham and Women s Hospital policies and programs for employees. The policy does not create a contract implied or expressed, with any hospital employees who are employees at will. The hospital reserves the right to modify this policy in whole or in part, at any time, at its sole discretion.

ATTACHMENT A SECTION I: To be completed by manager observing the interview VISUAL OBSERVATION CHECK LIST DIRECTIONS With another manager present, check pertinent items based on your visual observation of the employee. If the employee admits, at any time during the questioning, to being under the influence of a drug(s) or alcohol, then suspend the employee pending final determination and advise of the hospital policies that were violated. Indicate that appropriate corrective action, up to and including termination may be taken. 1. Walking/Standing staggering falling stumbling Normal swaying unsteady holding on 2. Speech shouting silent whispering Normal slow rambling/incoherent slurred slobbering 3. Demeanor sleepy crying silent Normal talkative excited fighting 4. Actions resisting communications fighting Normal threatening drowsy hostile profanity hyperactive erratic 5. Eyes bloodshot watery glassy Normal droopy closed 6. Face flushed pale sweaty Normal 7. Appearance/Clothing unruly messy dirty Normal partially dressed bodily excrement stain stains on clothing 8. Breath alcoholic odor faint alcoholic odor no alcoholic odor 9. Movements fumbling jerky slow Normal nervous hyperactive 10. Eating/Chewing gum candy mints Other-identify if possible 11. Other Observations:

SECTION II: To be completed by manager interviewing the employee OPINION BASED ON OBSERVATIONS AND QUESTIONING BY MANAGER A. Unfit for work? Yes No Uncertain B. Recommended for drug/alcohol screen and medical assessment? Yes No If yes, ask the employee the following questions: Would you submit to a medical assessment to include a blood and urinalysis by hospital staff? Yes No No response Then, 1. Check with OHS for satisfactory arrangements. For off-shifts, contact the Nurse Administrator. 2. Have employee sign Agreement to Submit to Drug and/or Alcohol Screen (Attachment B). 3. Take, or make appropriate arrangements for employee to be taken to OHS or contact the Nurse Administrator. C. If the employee refuses to sign the Statement for testing, the employee should be told that by refusing s/he may be eligible for further corrective action, up to and including termination. Remarks: Name of Employee Time Manager Signature Witnessed by

CONSENT FORM ATTACHMENT B Agreement To Submit To Drug and/or Alcohol Screen By Blood And Urine Test and Authorization For the Release of Medical Information by the Occupational Health Service I have been informed that Brigham and Women's Hospital, based on my behavior and appearance, is concerned that I may be under the influence of drugs or alcohol, or may otherwise have violated the hospital's rules against drug and alcohol use, and that my ability to perform my job duties, is therefore, in question; and as a result, I have been requested to submit to a drug and/or alcohol screen by blood and/or urine tests and medical assessment. I have been informed and I understand that my agreement to submit to the requested alcohol and/or drug screens by blood and/or urine tests is completely voluntary on my part, and that I have the right to refuse to submit to the test. I am aware and have been told that my refusal to submit to the drug and/or alcohol screen by blood and/or urine tests and/or medical assessment may be grounds for corrective action against me up to and including termination. I have also been informed and am aware and hereby authorize that the results of this drug and/or alcohol screen by blood and/or urine tests and/or medical assessment may be released to the Vice President of Human Resources and such other hospital officials and employees as the Vice President of Human Resources and his/her designee may determine it is necessary to disclose such information. I understand that the information so released to the hospital will be used to determine whether I was fit to perform my job duties, and/or whether I had violated the hospital's work rules concerning drug and alcohol use and that the results of such test(s) may form the basis for corrective action against me, up to and including termination. With full knowledge of the above information, I have decided to voluntarily submit to the requested drug and/or alcohol screen by blood and/or urine tests and/or medical assessment by the Occupational Health Service and in recognition of this agreement, do sign this consent form. Employee Signature NOTE: A witness other than the manager who has requested that the employee submit to a drug and/or alcohol screen by blood and/or urine tests and/or medical assessment should also sign the consent form. Manager Signature Witness Signature

ATTACHMENT C Refusal To Submit to Drug and/or Alcohol Screen by Blood and Urine Tests I hereby refuse to authorize testing of my blood and urine for alcohol or drugs. I understand that my refusal means that I cannot complete a medical exam and such refusal will require a review of the facts by management, which may necessitate corrective action, up to and including termination. Employee Signature Manager Signature Witness Signature