Chapter 05 - LBJ American Samoa Medical Center Drug and Alcohol Abuse Policy

11.0501 Purpose.


A. LBJ promulgates this Program in order to protect the environment, to protect its Employees, and to maintain public health and safety. This Program establishes policies, criteria, and procedures that help to maintain a workplace free from the improper use of alcohol and illegal drugs. It applies to all LBJ Employees performing work for LBJ. The procedures include detection of the use of alcohol and illegal drugs by current or prospective Employees.

B. LBJ encourages Employees who have drug or alcohol use difficulties to seek assistance or rehabilitation services through the American Samoa Government’s Department of Human Resources Employee assistance programs, through LBJ’s Employee assistance programs, or through the Employee’s health plan, as appropriate. Obtaining assistance, however, does not absolve an Employee from further testing, such as random or reasonable suspicion testing. Once an Employee is identified for testing, the Employee is compelled to take the test or be considered as refusing to test. Therefore, Employees are encouraged to seek help before it is too late. Employees participating in a rehabilitation program may use their accumulated vacation or sick leave for in or out-patient treatment.

C. LBJ will also provide adequate safeguards to ensure that testing is performed in a manner which protects the individual’s rights or privacy, to the extent possible, and conform to the requirements of the Drug-Free Workplace Act of 1988.

11.0502 Scope.


This policy applies to all Employees of LBJ, and applicants for employment with LBJ.

11.0503 Definitions.


For the purposes of this Program, the following definitions apply:

A. Act means the provisions of the Drug-Free Workplace Act of 1988 (41 U.S.C. 701 et. seq.)

B. Alcohol means the intoxicating agent in beverage alcohol, ethyl alcohol or other low molecular, weight alcohol’s including methyl or isopropyl alcohol, and including any medication containing alcohol.

C. Alcohol Concentration (AC) or Breath Alcohol Concentration (BAC) means the alcohol in a volume of breath expressed in terms of grams of alcohol per 0210 liters of breath as indicated by an evidential breath test.

D. Alcohol Use means the consumption of any beverage, mixture or preparation, including any medication, containing alcohol.

E. LBJ Medical Center means Lyndon Bird Johnson Medical Center, a quasi-governmental entity created pursuant to Title 13, A.S.C.A.

F. Breath Alcohol Technician (BAT) means an Employee who is certified in the operation of an evidential breath testing (EBT) device. The BAT obtains both initial and confirmation alcohol tests with or without trained assistance.

G. Collection Site means a place used for conducting drug and/or alcohol tests.

H. Collection Site Person means a technician or other person trained and qualified to take urine samples and to secure urine samples for later laboratory analysis.

I. Confirmation Test means, for drug testing, a second analytical procedure, gas chromatography/mass spectrometry, to identify the presence of a specific drug. For alcohol testing, a second test, following a screening test with a result of 0.02 or greater, that provides quantitative data of alcohol concentration.

J. Confirmed Positive Test means, for drugs, a finding based on a positive initial or screening test result, confirmed by another positive test on the same sample. The confirmatory test must be by the gas chromatography/mass spectrometry method.

K. Counseling means assistance provided by qualified professionals to Employees, especially, but not limited to those Employees whose job performance is, or might be, impaired as a result of alcohol and/or illegal drug use or a medical-behavioral problem; such assistance may include short-term counseling and assessment, crisis intervention, referral to outside treatment facilities, and follow-up services to the Employee after completion of treatment and return to work.

L. Drug Certification means a written assurance signed by an Employee with known past illegal drug involvement, as a condition for obtaining or retaining employment, stating that the Employee will refrain from using or being involved with illegal drugs while employed in a position with LBJ.

M. Employee means any Employee of LBJ. For the purpose of pre-employment/pre-duty testing the term Employee includes a person applying for employment with LBJ.

N. Employee Assistance means a program of counseling, referral, and educational services concerning illegal drug use and other medical, mental, emotional, or personal problems of Employees, particularly those which adversely affect behavior and job performance.

O. Evidential Breath Testing Device (EBT) means a device that has been approved by the National Highway Traffic Safety Administration to ensure alcohol concentration.

P. Illegal Drug, subject to the further provisions herein, means a controlled substance, as specified in A.S.C.A. §13.10 et. seq.

Q. Medical Review Officer (MRO) means a licensed doctor of medicine or osteopathy with knowledge of drug abuse disorders, who is employed or used by LBJ to review laboratory drug testing results and verify positive test results for drug testing. A MRO reviews testing procedures, and evaluates and counsels Employees with positive alcohol and drug test results.

R. Occurrence means any event or incident that is a deviation from the planned or expected behavior or course of events in connection with any LBJ or LBJ-controlled operation, if the deviation has environmental, or public health and safety significance. Incidents having such significance include the following, or incidents of a similar nature, involving LBJ Employees:

1. Injury or fatality to any person involving actions of a LBJ Employee.

2. Involvement in an incident which results in an explosion, fire, personal injury or death, or significant damage to property.

3. Accidental release of pollutants which results or could result in a significant effect on the public or environment.

4. LBJ Employee receiving a citation for a moving traffic violation within the scope of employment, or at any time when involving alcohol or illegal drugs.

S. Random Testing means the unscheduled, unannounced urine drug testing of randomly selected individuals in Testing-Designated Positions, by a process designed to ensure that selections are made in a non-discriminatory manner.

T. Reasonable Suspicion means a suspicion based on an articulable belief that an Employee improperly uses alcohol or illegal drugs, drawn from particularized facts and reasonable inferences from those facts, as detailed further in §4.2716 (b)(2.2.3.).

U. Referral means the direction of an Employee toward an Employee Assistance Program or to an outside treatment facility by the Employee Assistance Program professional, for assistance with prevention of illegal drug use, treatment, or rehabilitation from alcohol or illegal drug use or other problems. Referrals to an Employee Assistance Program can be made by the Employee (self-referral), LBJ supervisors or managers.

V. Rehabilitation means a formal treatment process aimed at the resolution of behavioral-medical problems, including alcohol or illegal drug use, and resulting in such resolution.

W. Substance Abuse Professional (SAP) means a licensed physician, or a licensed or certified psychologist, social worker, Employee assistance professional, or addiction counselor (certified by the National Association of Alcoholism and Drug Abuse Counselors Certification Commission) with knowledge of and clinical experience in the diagnosis and treatment of alcohol and drug-related disorders. The role of the SAP in the program is to evaluate the need for a rehabilitation plan for Employees referred to the SAP, develop a rehabilitation program as required, monitor and assist the Employee in their progress to return to full duties and schedule return-to-duty and follow-up tests.

X. Testing-Designated Position names a position whose incumbents are subject to drug testing under this part.

11.0504 Prohibitions.


The following are prohibited actions for Employees and shall be grounds for termination:

A. Alcohol:

1. To report for or remain on duty with a breath alcohol concentration (BAC) of 0.02 or greater; BAC of 0.04 or greater requires “return to duty test” pursuant to §2.2.6 herein and clearance of Substance Abuse Professional (SAP).

2. To possess alcohol (including possession of prescription or over the counter medicines containing alcohol).

3. To use alcohol while performing a safety sensitive function.

1. To use alcohol 4 hours prior to performing safety-sensitive functions

2. To use alcohol 8 hours following an accident, or before a post-accident alcohol test is completed.

6. To refuse to take a required alcohol test.

11.0505 Types of Testing.


A. To use any of the following illegal drugs or classes of drugs: marijuana; cocaine; opiates; phencyclidine; amphetamines and/or controlled substances listed in A.S.C.A. §13.10 et. seq., except as prescribed by a physician, and then only if the physician has advised the Employee that the drug will not adversely affect the Employee’s ability to safely perform his job responsibilities.

B. To report or remain on duty while on drugs.

C. To refuse to take a required drug test.

11.0506 Applicant Drug Testing.


An applicant for a Testing-Designated Position will be tested for the use of alcohol and illegal drugs before final selection for employment or assignment to such a position. Applicants with a history of illegal drug use, or who refuse to submit to a drug test, or tests positive, shall not be selected. LBJ shall schedule the test date and time. Applicants will not be permitted to reschedule a drug test, except for an emergency. Applicants are required to provide a release for LBJ to verify the last two (2) years of employment history, including obtaining the results of prior alcohol and drug tests.

11.0507 Occurrence Drug Testing.


Drug and alcohol tests are required as soon as possible following an Occurrence. The alcohol test must be conducted within 8 hours of the Occurrence. The drug test must be conducted within 24 hours of the Occurrence. NOTE: Nothing in this Program shall be construed to delay necessary medical treatment for Employees involved in an Occurrence.

11.0508 Random Drug Testing Requirements and Identification of Testing Designated Position.


A. Each year at least 25 percent (25%) of the Testing-Designated Positions will tested for alcohol misuse and 50 percent (50%) for drug use. Selection of Employees for these tests will be through a scientifically valid random-position number selection method. These unannounced tests will be conducted throughout each 12 month period. Each Testing-Designated Positions Employee will have an equal chance of selection each time a test is administered.

B. The Testing-Designated Positions subject to random drug testing are: Positions identified by LBJ which entail duties where failure of an Employee adequately to discharge his or her position could significantly harm the environment, fellow Employees, or public health or safety.

11.0509 Reasonable Suspicion Testing.


A. An Employee may be tested for the improper use of alcohol or illegal drugs, if the behavior of such an Employee creates the basis for reasonable suspicion of the improper use of alcohol or illegal drugs. Two or more LBJ supervisory or management officials, at least one of whom is in the direct chain of supervision of the Employee, must agree that such testing is appropriate. Reasonable suspicion must be based on an articulable belief that an Employee has improperly used alcohol or illegal drugs, drawn from particularized facts ad reasonable inferences from those facts.

B. Such a belief may be based upon, among other things, observable phenomena, such as direct observation of:

1. The use or possession of alcohol or illegal drugs;

2. The physical symptoms of being under the influence of alcohol or illegal drugs;

3. A pattern of abnormal conduct or erratic behavior;

4. Arrest for a conviction of an alcohol or drug related offense, or the identification of the Employee as the focus of a criminal investigation into illegal drug possession, use, or trafficking;

5. Information that is either provided by a reliable and credible source or is independently corroborated; or

6. Evidence that an Employee has tampered with a drug test; or

7. Temperature of the urine specimen is outside the range of 32.5-37.7 degrees centigrade or 90.5-99.8 degrees Fahrenheit.

C. The fact that an Employee had a confirmed positive test for the use of illegal drugs at some prior time, or has undergone a period of rehabilitation or treatment, will not, in and of itself, be grounds for testing on the basis of reasonable suspicion.

11.0510 Call Back Duty.


Employees who are called in to work outside of their regularly-scheduled hours shall inform their LBJ supervisor if they consumed alcohol within the previous four hours, have reason to believe that their alcohol concentration level would be 0.02 BAC or greater, or would otherwise be ineligible for duty due to other prohibitions of this Program. The disclosure shall not subject the Employee to disciplinary action; however, LBJ is not required to offer work to the Employee.

11.0511 Return to Duty Testing.


Whenever an Employee is referred to a Substance Abuse Professional (SAP) to determine the need for assistance in resolving difficulties associated with drugs or alcohol prohibitions, a return to duty test is required. Only the SAP may require the Employee to take both alcohol and drug tests. Test results must be less than 0.02 BAC and negative for controlled substance use before an Employee can return to a Testing-Designated Position.

11.0512 Follow-Up Testing.


Any Employee who the SAP determines as needing additional assistance in maintaining their resolve after an Employee obtains a negative return to duty test result and is performing a Testing-Designated Position is subject to unannounced follow-up tests. The SAP may require both drug and alcohol tests be administered, prescribed the length of the follow-up tests (up to 60 months), and prescribe the frequency of unannounced follow-up tests (at least 6 in the first 12 months). Follow-up tests are in addition to other tests to which the Employee may be subjected.

11.0513 Alcohol and Drug Testing Procedures.


A. All drugs and alcohol tests and procedures will be conducted in compliance with regulation 49 CFR §40 et. seq.

B. Leave shall not be granted after an Employee has been informed that he/she is required to submit to testing.

11.0514 Drug Testing – Confirmation Test.


Employees with negative test results will not be contacted. A Medical Review Officer (MRO) will contact Employees who test positive from improper alcohol or drug use. The Employees will have an opportunity to explain to the MRO that the results where not due to the improper use of alcohol or illegal drugs. Employees, at their own cost, may select a third-party certified laboratory to analyze the split sample. The selection of a certified third party laboratory shall be made through the MRO. The Employee has 72 hours from the MRO notification (or from their supervisor if the MRO is unable to contact the Employee) to exercise this option, otherwise the confirmation test will be accomplished by the test vendor’s laboratory.

11.0515 Alcohol Testing – Initial Screening Test.


LBJ may use alcohol saliva swab test methodology or an evidential breath testing device to screen for alcohol misuse. The employer shall not employ blood alcohol testing methodology to screen or confirm Employee BAC; however, blood alcohol test results obtained from law enforcement officials in their investigations may be used to meet DOT post accident confirmation test requirements.

11.0516 Alcohol Testing – Confirmation Test.


An evidential breath testing (EBT) device approved by the National Highway Traffic Safety Administration will be used to confirm BAC. The testing will be conducted by a Breath Alcohol Technician (BAT) who is certified to operate the EBT device. The BAT will immediately inform the LBJ HR manager of any confirmed tes result of 0.02 or higher BAC. The Employee with a 0.02 or higher will be released from duty for 24 hours. In addition, Employees with test results of 0.04 or higher BAC will be restricted from performing a Testing-Designated Position until released by the SAP and only after having a negative test result(s).

11.0517 Collection of Samples – Privacy.


Procedures for providing urine specimens must allow Employee privacy, unless there is reason to believe that a particular Employee may alter or substitute the specimen to be provided. LBJ shall utilize a chain of custody procedure for maintaining control and accountability from point of collection to final disposition of specimens, and testing laboratories shall use appropriate cutoff levels in screening specimens to determine whether they are negative or positive for a specific drug, consistent with 49 CFR §40 et. seq. If there is not a sufficient amount of urine, additional urine will be collected in a separate container. The Employee may be given reasonable amounts of liquid and a reasonable amount of time in which to provide the specimen required. The Employee and the Collection Site Person must keep the specimen in view at all times. When collection is complete, the partial specimens will be combined in a single container. In the event that the Employee fails to provide a sufficient amount of urine, the amount collected will be noted and documented. In this case, the Collection Site Person will consult with the employee’s supervisor to determine the next appropriate action. This may include deciding to reschedule the Employee for testing, to return the Employee to his or her work site and initiate disciplinary action, or both.

C. The following constitute a refusal to test:

1. Refusal to take a test either by statement or action;

2. Refusal to sign appropriate forms as required;

3. Failure to provide adequate breath for alcohol testing without a valid medical explanation;

4. Behavior or conduct that clearly obstructs the testing process, and,

5. Leaving the scene of an accident without a valid reason before the tests have been conducted.

11.0519 Result, Medical Review.


All test results shall be submitted for medical review by the MRO. The Medical Review Officer will consider the medical history of the Employee or Applicant, as well as any other relevant biomedical information. When there is a confirmed positive test result, the Employee or Applicant will be given an opportunity to report to the MRO the use of any prescription or over-the-counter medication. If the MRO determines that there is a legitimate medical explanation for a confirmed positive test result, consistent with legal and non-abusive drug use, the MRO will certify that the test results do not meet the conditions for a determination of improper use of alcohol or illegal drugs. If no such certification can be made, the MRO will make a determination of improper use of alcohol or illegal drugs.

11.0520 Action – Positive Test.


A. When an Applicant for employment has been tested and determined to have improperly used alcohol or an illegal drug, processing for employment will be terminated and the Applicant will be so notified.

B. When an Employee is tested and determined to have improperly used alcohol or illegal drugs, if this is the first determination of use of illegal drugs by that Employee, the Employee may be offered a reasonable opportunity for rehabilitation, consistent with LBJ’s policies. When an Employee who is in a Testing-Designated Position has been tested and determined to have used an illegal drug, LBJ shall immediately remove that Employee from the Testing-Designated Position. If rehabilitation is offered, any Employee will be placed in a non-Testing Designated Position, provided there is such an acceptable position in which the Employee can be placed during rehabilitation. If there is no acceptable non-Testing Designated Position, the Employee will be placed on sick, annual, or other leave status, for a reasonable period sufficient to permit rehabilitation. However, the Employee will not be protected from disciplinary action which may result from violations of work rules other than a positive test result for alcohol or illegal drugs.

C. Following a determination, after counseling or rehabilitation, that the Employee can safely return to duty, LBJ may offer the Employee reinstatement, in the same or a comparable position to the one held prior to the removal. Failure to take the opportunity for rehabilitation, if it has been made available, for the improper use of alcohol or illegal drugs, will result in disciplinary action up to and including removal from employment with LBJ.

D. Any Employee who is twice determined to have improperly used alcohol or illegal drugs shall in all cases be removed from employment with LBJ.

E. An Employee who has been removed from a Testing-Designated Position because of the use of alcohol or illegal drugs may not be returned to such position until that Employee has:

?. Successfully completed counseling or a program of rehabilitation;

?. Undergone a urine drug test with a negative result; and

?. 3. Been evaluated by a SAP, who has determined that the Employee is capable of safely returning to duty.

F. After an Employee determined to have improperly used alcohol or illegal drugs has been returned to duty, the Employee shall be subject to unannounced drug testing, at intervals, for a period of 12 months.

11.0521 Release of Information.


Except as provided by law or regulation, neither the Director nor a department shall release information on tests required under this policy.

Written test results will be provided to Employees who tests positive for either or both drugs or alcohol tests.