Policies and Procedures
Policy Title:
Drug and Alcohol Use
Department Responsible:
Human Resources
Policy Code:
ER-HRD-2005-53
Title of Person Responsible:
Vice President, Human
Resources
Approval Council:
Leadership Council
Effective Date:
December 12, 2014
Next
Review/Revision
Date:
December 2017
Date Approved by
Council:
POLICY:
It is the policy of Cone Health to maintain a safe, healthy, and efficient working environment. The
unauthorized or unlawful use, possession, sharing, sale, purchase, manufacture, distribution,
transportation or diversion of controlled substances by employees of Cone Health leads to safety and
health risks, not only for themselves, but for coworkers and patients, and is prohibited. Reporting to
work or being on duty (including break times and scheduled on-call time) while under the influence of
alcohol or illegal drugs is prohibited.
DEFINITIONS:
 Cone Health Property- The term Cone Health property includes work sites; parking lots; Cone
Health vehicles; offices owned, rented, utilized or serviced by Cone Health; employee-owned or
employee-rented vehicles on the property of Cone Health; and locations where the employee
represents Cone Health in any capacity.
 Diversion- The transfer of a controlled substance from a lawful to an unlawful channel of
distribution or use (Controlled Substances Act – 1994).
 Illegal Drugs- Drugs or controlled substances which are (1) not legally obtainable or (2) legally
obtainable but not obtained or used in a lawful manner. Examples include but are not limited to
cocaine and marijuana, as well as prescription drugs which are not lawfully obtained or properly
utilized. The term “illegal drugs” also refers to mind-altering and/or addictive substances which
are not sold as drugs or as medicines for mind- or behavior-altering effect.
 Legal Drugs- Prescribed drugs or over-the-counter drugs which are legally obtained by the
employees and used for the purpose for which they are prescribed and sold.
 Pharmacy Diversion Research- The review of controlled substance administration
times/intervals, charting, Pyxis override dispenses, waste procedures, whole wastes, returns, pain
scores and any other necessary documentation.
 Reasonable Suspicion- This is a belief based on a combination of specific facts, observed
behaviors, and balanced assumptions from those facts that an employee may be under the
influence of alcohol and/or drugs. Examples include but are not limited to breaking safety rules,
careless acts, repeated accidents, erratic behavior, alcohol smelled on the breath, or other job
performance problems. Impairment can be established by professional opinion, supervisory
judgment or a scientifically valid drug and/ or alcohol test with a confirmed positive result.
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PROCEDURE:
Alcohol Use Prohibitions
1. Employees who consume alcohol while at work, on the premises during working time or during
scheduled on-call hours are subject to corrective action, up to and including termination.
Unauthorized or unlawful sale, transfer or distribution of alcohol during working time or on the
premises will result in immediate termination.
2. Cone Health employees are prohibited from reporting to work or working while under the
influence of alcohol. An employee will be considered under the influence of alcohol when, in the
judgment of the employee’s supervisor or other management official, the employee’s ability to
perform their job safely and effectively is compromised by the use of alcohol.
3. An employee who is perceived to be under the influence of alcohol will be removed immediately
from the workplace and required to submit to a breath or blood alcohol test. An employee with
an alcohol concentration of .02 or greater will be considered to be under the influence.
4. Any employee arrested for an alcohol-related incident must notify his or her Department Leader
of the arrest within 24 hours, if the incident occurs during scheduled working hours, while
operating a Cone Health vehicle on Cone Health or personal business or while operating a
personal vehicle on Cone Health business. In the event of an arrest or conviction where an
employee’s license is suspended or revoked and the employee operates a Cone Health vehicle or
is otherwise required to drive a vehicle as part of their job duties, the employee must notify their
immediate supervisor within 24 hours.
Drug Use Prohibitions
1. Unauthorized or unlawful sale, transfer or distribution of illegal drugs during working time or on
the premises will result in immediate termination. Employees who are found to use, divert,
possess without authorization or be under the influence of controlled substances without
appropriate prescription, while at work, on the premises during working time or during
scheduled on-call hours are subject to corrective action, up to and including termination.
2. Cone Health employees are prohibited from reporting to work or working while under the
influence of illegal drugs. An employee will be considered under the influence of illegal drugs
when an employee tests positive for such drug(s) (or their metabolites) at or above the cutoff
levels established by Cone Health.
3. If an employee is arrested for a drug-related crime, they must notify his or her Department
Leader within 24 hours. If an employee is convicted, they have five (5) days to notify their
immediate supervisor (see Reporting of Violations section). Cone Health will investigate the
circumstances, and officials may utilize the drug-testing procedure. The following procedures
will apply:
o During the investigation, an employee may be placed on leave without pay. After the
investigation is completed, the leave may be reclassified to a suspension or the employee
may be reinstated, depending upon the facts and circumstances.
o If convicted of a drug-related crime, the employee will be terminated.
o If an employee has been suspended due to a criminal charge, Cone Health will determine
whether to authorize the employee’s return to work based on Cone Health's own
investigation, as well as other factors related to the individual’s employment.
4. Except as otherwise provided by law, an employee who is taking either over-the-counter
medication or prescribed medication with side effects that may impair the employee’s mental or
physical functioning, may otherwise adversely affect the employee’s performance or may
reasonably create a danger to the employee or others in the workplace should inform his or her
supervisor prior to the start of the employee’s shift.
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o
o
o
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If Cone Health determines such use adversely affects the employee’s ability to safely
perform the functions of his or her job, a temporary accommodation, if reasonable, may
be established.
If Cone Health determines such use does not pose a risk, the employee will be permitted
to work.
Improper use of legal drugs is prohibited and may result in corrective action up to and
including termination. For example, an employee taking a prescription narcotic pain
medication outside of the parameters provided by the prescribing physician.
Prescription medication must be kept in its original container if such medication is taken
during working hours or on Cone Health property.
Post-Offer Screening
Post-offer testing is a requirement for employment. An applicant for employment who refuses to
participate in the post-offer screening tests will be denied employment. In case of inquiry, it will be
indicated only that the applicant “failed to meet the qualifications for employment”.
An applicant for employment failing to pass the post-offer screening tests due to a positive result must
provide a current prescription or refill. The applicant must provide the medication bottle or prescription
bearing the applicant’s name. The current prescription provided must be a medication with metabolic
derivatives, which match the positive result. Applicants who challenge these results may request in
writing a confirmatory retest of the original sample at an accredited/approved laboratory at their own
expense.
An applicant is not allowed to begin work in any capacity prior to obtaining satisfactory drug screen
results. There will be no exceptions.
Reasonable Suspicion
1. When a member of the leadership team or a fellow employee has reason to suspect an employee
is involved in the use, possession, sale, distribution, or diversion of alcohol or other controlled
substances on Cone Health property or appears impaired by alcohol and/or legal or illegal drugs,
the matter will be investigated. The Department Leader and Human Resources should be notified
immediately and provided with specific details related to the concern, observable indicators
and/or incident causing suspicion. The Department Leader and Human Resources Representative
will jointly make the decision regarding the type and scope of the investigation. At times when
the Department Leader is unavailable, the Administrative Coordinator will be contacted. If a
further investigation is necessary, an appropriate individual will be designated at this time.
2. Investigations may vary in scope, extent and duration, depending upon the type and nature of the
suspected violation. They may include, but are not limited to, the search of personal and physical
property, analyses of patient medical records, analysis of Pyxis activity (including drug
administration, charting, and wasting practices), patient interviews, testimony of co-workers,
documentation of observed behaviors exhibited by the employee, and the nature and frequency
of performance problems.
3. If there are grounds for reasonable suspicion, the employee will be required to submit to an
observed drug and/or alcohol screen. Leadership will meet with the employee, and then require
them to report directly to Employer/Employee Health Services or to the Administrative
Coordinator for after hours, for a urine drug and breath or blood alcohol screen. As a condition
of continuous employment, the employee should complete the Employee Drug and Alcohol
Testing Consent Agreement (see Attachments below) prior to testing. After Employer Health
Services hours, the Administrative Coordinator should be contacted to ensure a urine drug and
blood alcohol screen is performed. A written copy of the Notification of Rights under North
Carolina General Statutes (see Attachments below) will be given to the employee. Chain of
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custody procedures will be followed throughout the process to ensure specimen integrity. An
approved outside laboratory will perform the actual drug screen testing and confirmation tests, if
required.
4. The employee will be suspended without pay pending results of the screening and other
necessary investigation. Suspension of access to remote Cone Health systems must be requested
by leadership. Leaders are advised to collect the employee’s badge(s) and keys. While
suspended, the employee must remain off the premises until otherwise notified by leadership,
unless medical treatment is necessary. Failure to do so may result in termination.
5. An employee who refuses to submit to or attempts to tamper with the drug/alcohol screen will be
terminated.
6. The employee will not be permitted to transport themselves. The employee will be asked to
secure safe transportation. If transportation cannot be secured by the employee, leadership will
arrange transportation for the employee. Leadership should witness the employee’s safe
departure from the premises.
7. If the test is positive, the employee must be given a written notification of a positive test result
that advises of the employee’s right to a retest of the same sample at the employee's expense. If
the second test result is negative, Cone Health will reimburse the employee’s expenses for
testing.
8. If the results of the initial and confirmation tests are positive for alcohol and/or illegal drugs, and
it is determined that a violation of this policy has occurred, then the employee will remain
suspended, and be subject to corrective action up to and including termination from employment
decided upon by leadership, in collaboration with Human Resources. Each case will be decided
on an individual basis and will depend upon the type of infraction, the circumstances
surrounding the discovery (whether the employee sought help voluntarily or was compelled to be
screened) and the employee's work history.
9. In no circumstance should a leader involuntarily restrain the employee by either physical means
or via use of the leader’s authority. In those extreme cases when leadership believes restraint is
appropriate, law enforcement should be notified.
10. Where there is reasonable suspicion that an employee has possession of a controlled substance,
Cone Health reserves the right to search corporate property (lockers, desks, cabinets, etc.) at any
time and any employee owned property (purses, bags, clothing, personal vehicles, etc.) brought
on Cone Health's premises. Employees are required to consent to such searches as a condition of
continued employment.
11. There may be situations where the drug screen is negative, but there are other valid objective
indicators that cause concerns for the health, safety, and productivity of the employee and others
in the workplace. Further follow-up may be necessary to ensure the employee is fit for duty.
Participation in this follow-up is required and includes the following:
o A physical review by the Employer/Employee Health Services department Medical
Director.
o A discussion with the employee’s primary care doctor.
o Requirement that the employee meet all Cone Health requests in this process. Not
meeting the requests will result in immediate termination.
12. If the investigation reveals:
o No sale or distribution, no diversion, no impairment or proves inconclusive, the employee
may be returned to work and receive payment at his or her normal base rate for the hours
the employee was scheduled to work while on suspension. The returning employee will
meet with his or her supervisor to discuss the situation and any additional action that may
be taken which could include either counseling and/or corrective action.
o That sale or distribution occurred, the employee will be terminated.
o Controlled substances were diverted with the intention to sell or distribute (including the
use of illegal prescriptions and/or forging prescriptions), the employee will be terminated.
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o
The employee is found to have diverted controlled substances for personal use (including
the use of illegal prescriptions and/or forging prescriptions), or if screens for being under
the influence are positive, the employee will be terminated.
Tampering
Leadership should be contacted immediately if medications have evidence of tampering. An
investigation will commence which may include, but not limited to, drug screens for all employees with
access to the controlled substance, review of pharmacy reports, and staff interviews. Direction on how to
handle the medications is addressed in the Controlled Drug Distribution Policy.
Reporting Violations
Leadership will exercise its statutory duty to report specific policy violations to appropriate law
enforcement and external agencies. In cases of possession and/or sale of controlled substances or illegal
prescriptions, Human Resources will notify the appropriate law enforcement authorities. In cases of
diversion and/or sale of drugs or controlled substances, the Pharmacy Leadership, after collaboration
with Human Resources, will notify the State Bureau of Investigation (SBI), Drug Enforcement Agency
(DEA) and other appropriate law enforcement agencies. Leadership may also report any violations to
licensing boards as appropriate or required.
All employees share the obligation to keep the work environment safe for patients and coworkers. Team
members that have a reasonable suspicion regarding drug/alcohol use or diversion by a coworker must
report directly to their Department Leadership (who will in turn contact Human Resources). Employees
may report anonymously if desired on the safety zone portal under conduct events.
An employee with a professional license that requires structured support will have these activities
coordinated between the appropriate level of leadership and the Employee Assistance Program as
defined in the section Professional Recovery Program (see Attachments below). Leadership will also be
responsible for monitoring an employee’s compliance with all prescribed recovery activities.
The Federal Drug-Free Workplace Act of 1988 requires employees to notify Cone Health within five
days after conviction for a criminal drug offense, and the law requires Cone Health to notify federal
agencies with which it contracts of the conviction. Any employee who is convicted or who fails to report
such a conviction within the five-day time frame will be subject to immediate termination. In these
circumstances, the employee is required to notify their supervisor, who will then inform the Department
Leader and Human Resources.
Employee Assistance Program (EAP)
When the employee voluntarily seeks assistance prior to being compelled to do so through a Reasonable
Suspicion investigation, then the employee will be referred to the Employee Assistance Program (EAP).
Cone Health respects the right of the employee to refuse treatment, but it also recognizes its
responsibility for taking appropriate corrective action, up to and including termination, to address
inadequate job performance and to protect the public’s safety.
Referral to the EAP is the employee's opportunity for substance abuse assistance and treatment.
Employees who are referred to treatment may take advantage of various employee benefits (if eligible)
such as Paid Annual Leave (PAL), approved leave of absence and health insurance to help in the
rehabilitation process. Following the completion of the recommended treatment program and upon
returning to work, the employee will be issued a final written warning that will state that any further
confirmed occurrences of substance abuse or violations of this policy, or any further policy violations,
will be grounds for immediate termination.
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If referred to the EAP, the employee is expected to follow the recommendations made by the EAP. If the
employee does not follow through with the recommendations from EAP, their employment will be
terminated.
For an employee who accesses the EAP, either through referral or on a voluntary basis, care will be
taken to maintain confidentiality of treatment. However, the employee may not continue to work if, in
the opinion of Leadership, after consultation with the EAP, the employee poses a threat to the safety of
the employee or others. The employee will be suspended from work and may be placed on a medical
leave of absence, if approved.
An employee who has been referred for treatment for substance abuse may be required to agree to
specific terms and expectations as a condition of reinstatement. Drug/alcohol screens may be required in
situations before the employee will be allowed to return to work, and periodic screening will be a
condition of employment for reinstatement of an employee following treatment.
Professional Recovery Program
The Professional Recovery Program (PRP) is designed to provide support to those employees whose
jobs requires licensure, certification or registration and who are practicing with or without license
restrictions or who are functioning in another role while waiting for the reinstatement of their licenses
due to substance abuse. Professional facilitators who are employed through the EAP coordinate the
recovery program. Health care professionals outside of Cone Health may be accepted into the program,
if space is available, after screening by the EAP facilitators.
A written agreement will be executed between the health care professional and leadership regarding PRP
participation, attendance, use of controlled substances and testing. Any deviation from this agreement
will be reported to leadership, EAP facilitator and the appropriate Vice President. The employee will be
released from the agreement upon satisfactory completion of the recovery program. The agreement and
written evidence of program completion will be secured in a confidential envelope in the employee’s
medical file.
For nursing professionals, the Board of Nursing will require random drug screenings. The EAP
facilitator will monitor the employee and the procedural process.
An advisory committee will be appointed to advise and consult on the professional recovery program
and to establish and update program rules and regulations. A Vice President will be designated as a
liaison to provide oversight for the program and advisory committee.
ATTACHMENTS:
Employment Drug and Alcohol Testing Consent Agreement
Notification of Rights under North Carolina General Statutes
Confidential Drug/Alcohol Test Notification
RELATED POLICIES:
Uniform Medication Administration Policy
Controlled Drug Distribution Policy
Control of Narcotics and Restricted Drugs Policy
System-Owned Motorized Vehicles, Accident Reporting Policy
PREVIOUS REVISION/REVIEW DATES:
Date
Reviewed
Revised
October 1, 2005
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Notes
Original effective date.
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Date
July 29, 2009
July 31, 2012
October 2012
December 3, 2014
December 12, 2014
June 10, 2015
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Reviewed
Revised
Notes
Updated formatting to match current policy
template; no content changes.
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