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20160113 R7DCA- MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov C MMISSI TO: Philip Levine, Mayor and Members o the City FROM: Jimmy L. Morales, City Manager DATE: January 13, 2016 SUBJECT: A RESOLUTION OF THE MAYO ., 11 AND CITY COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, E TABLISHING A POLICY NOT TO HIRE INDIVIDUALS WHO USE TOBACCO OR TOBACCO PRODUCTS INCLUDING, BUT NOT LIMITED TO, CIGARETTES, E-CIGARETTES, CIGARS, CHEWING TOBACCO, SNUFF, AND PIPES, AND TO PROHIBIT THE USE OF SUCH PRODUCTS THROUGHOUT THE INDIVIDUALS' EMPLOYMENT WITH THE CITY OF MIAMI BEACH. SUPPLEMENTAL INFORMATION RELEVANT CURRENT MIAIVII-REKCH POLICY The City of Miami Beach currently has a Smoke Free Workplace policy in keeping with the Clean Indoor Air Act, Florida Statute 386.201.211. The purpose of this statute is to protect people from the health hazards of secondhand tobacco smoke. SCOPE OF PROPOSED RESOLUTION The scope of this proposed resolution as to the non-smoking requirement applies only to employees hired pursuant to any employment announcement published after adoption of the resolution. Current employees will not be affected. The City is interested in promoting a healthful lifestyle; therefore, current employees who smoke and voluntarily participate in the City's Wellness Program will receive all the support needed to further their success in the smoking cessation programs that will be made available. BACKGROUND 28,600 adults in Florida die from smoking every year. For every person who dies, another 20 suffer from one or more serious illnesses from smoking. Cigarette smoking is the major single cause of cancer death in the United States. Lung cancer is not the only type of cancer that can be caused by smoking. The American Cancer Society estimates that in 2013, about 174,100 cancer deaths were caused by tobacco use. Smoking can cause cancer almost anywhere in your body including the lung, mouth, nose, throat, larynx (voice box), trachea (wind pipe), esophagus, kidney, ureteral, bladder, cervical, bone marrow and blood. Smokeless tobacco products have taken a backseat to smoking for decades, but are recently gaining ground in overall usage and use among young people. Smokeless Agenda Item R-7 b Date I- 14, mmission N MEMORANDUM City Commission Memorandum — No Smoking Resolution January 13, 2016 Page 2 tobacco includes chew, spit, dip, snuff, snus and a host of new dissolvable products. They are simply not a safe alternative to smoking and they can be as addictive as, or more addictive, than cigarettes. Smokeless tobacco causes many significant health problems, including several types of cancer. Smokeless users have an 80 percent higher risk of oral cancer and a 60 percent higher risk of pancreatic and esophageal cancer. Smokeless tobacco products can also increase the risk of a fatal heart attack and stroke. In addition, there is no scientific evidence that using smokeless tobacco products can help a person quit smoking. Using smokeless tobacco can still lead to nicotine addiction and dependence. http://www.floridahealth.gov/programs-and- services/prevention/tobacco-free-florida/ According to the Centers for Disease Control and Prevention, cigarette smoking is responsible for more than 480,000 deaths per year in the United States, including nearly 42,000 deaths resulting from secondhand exposure. The total economic cost of smoking in the United States is more than $300 billion a year in direct medical care, lost productivity due to premature death and exposure to secondhand smoke. On Attachment A, there is information from the Center for Disease Control and Prevention and can be found in a different format at the following link: http://www.cdc.gov/tobacco/data statistics/fact sheets/health effects/tobacco related mortality/ In the public sector, the financial consequences are particularly important as insurance premiums and claims are mostly borne by taxpayer dollars. Health Insurance Costs: The City of Miami Beach is self-insured and has two carriers who provide health insurance administrative services only (ASO). They are Humana, who has been the City's provider for a significant number of years, and AvMed, who started providing services to the City of Miami Beach when Humana and the Baptist Health Care System dissolved their relationship. While Humana does not segregate smokers and non- smoker, AvMed, who came on board on March 1, 2015, does Using an average of 1900 eligible employees, 423 or 22% are covered by AvMed and 1078 or 56% are covered by Humana. The balance of the employee population is not covered by the City's health plans because they are not eligible, they prefer not to be, or have health care coverage otherwise. Set forth below are cost figures from each of our insurers: City Commission Memorandum — No Smoking Resolution January 13, 2016 Page 3 AvMed City of Miami Beach Respiratory and Lung Cancer Incurred: 2015 Data excludes capitation and expenses related to prescription coverage Medical Claims Expenditures for People with Tobacco Use CCS* Level 1 Description CCS* Level 2 Description Paid Amount DISEASES OFTHE RESPIRATORY ASTHMA $ 1,789 CHRONICOBSTRUCTIVE PULMONARYDISEASEAND BRONCHIECTASIS $ 491 OTHER LOWER RESPIRATORY DISEASE $ 10,029 OTHER UPPER RESPIRATORY DISEASE $ 1,884 PLEURISY; PNEUMOTHORAX; PULMONARY COLLAPSE $ 170 RESPIRATORY FAILURE; INSUFFICIENCY;ARREST(ADULT) $ 68,200 RESPIRATORY INFECTIONS $ 4,019 NEOPLASMS SECONDARY MALIGNANCIES $ 64,478 RESIDUAL CODES; UNCLASSIFIED; TOBACCO USE $ 359 Grand Total $ 151,418 Medical Claims Expenditures for all Respiratory and Lung Cancer CCS* Level 1 Description CCS* Level 2 Description Paid Amount DISEASES OF THE RESPIRATORY ASTHMA $ 127,349 CHRONICOBSTRUCTIVEPULMONARYDISEASEAND BRONCHI ECTASIS $ 18,930 OTHER LOWER RESPIRATORY DISEASE $ 65,899 OTHER UPPER RESPIRATORY DISEASE $ 227,730 PLEURISY; PNEUMOTHORAX; PULMONARY COLLAPSE $ 58,077 RESPIRATORYFAILURE; INSUPFICIENCY;ARREST(ADULT) $ 68,241 RESPIRATORY INFECTIONS $ 229,756 NEOPLASMS CANCER; OTH ER PRIMARY $ 155 SECONDARY MALIGNANCIES $ 64,478 Grand Total $ 860,616 Not all medical claims may contain a diagnosis for tobacco use, therefore a table has been added to include all respiratory and lung cancer costs for the employer group. Data includes ICD9 and ICD10 diagnosis codes for COPD, Emphysema, Lung Cancer as well as other respiratory disorders, The issue with ICD codes and claims payment is the lack of specific of information conveyed. For example, if a patient is seen for treatment of a burn on the right arm, the ICD-9 diagnosis code does not distinguish that the burn is on the right arm. If the patient is seen a few weeks later for another burn on the left arm, the same ICD-9 diagnosis code would be reported. Additional documentation would likely be required for a claim for the treatment to explain that the burn treated at this time is a different burn from the one that was treated previously. In the ICD-10 diagnosis code set, characters in the code identify right versus left, Initial encounter versus subsequent encounter, and other clinical information. CCS means Clinical Classification Software City Commission Memorandum - No Smoking Resolution January 13, 2016 Page 4 Humana City of Miami Beach November 1, 2014 through December 31, 2015 Pharmacy Cost Major Clinical Condition Medical Cost Clinical Program 5 atuS Statqs, 1 Malignant Neoplasms $258,874 $453 Completed Program During Period Active 2 Other/Unclassified $3,043 $188,432 Former Participant Active 3 Malignant Neoplasms $185,153 $586 Declined Active J 4 Malignant Neoplasms $62,029 $100,908 Currently Enrolled Active 5 Malignant Neoplasms $98,446 $3,120 Completed Program During Period Active 6 Other/Unclassified $2,336 $96,209 Low Opportunity for Impact Active 7 Malignant Neoplasms $97,740 $0 Low Opportunity for Impact Active 8 Rare Diseases $5,899 $83,580 Former Participant Active 9 Malignant Neoplasms $10,857 $73,165 Former Participant Active 10 Injury and Poisoning $77,077 $6,483 Currently Enrolled Active 11 Neoplasms (Benign) $82,986 $52 Low Opportunity for Impact Termed 12 Rare Diseases $4,728 $76,208 No Response Active 13 Genitourinary System $59,723 $14,019 Declined Active 14 Rare Diseases $4,086 $67,014 Former Participant Active 15 Digestive $65,937 $795 Completed Program During Period Active 16 Signs and Symptoms $15,290 $51,286 Completed Program During Period Active 17 Signs and Symptoms $63,841 $407 No Response Active 18 Retroviral Conditions $1,946 $52,858 Completed Program During Period Active 19 Retroviral Conditions $6,537 $48,070 Former Participant Termed 20 Pregnancy and Complications $43,091 $10,248 No Response Termed 21 Musculoskeletal and Connective Tissue $48,858 $3,952 No Response Termed 22 Other Heart Disease $46,864 $5,401 Currently Enrolled Termed 23 Injury and Poisoning $44,302 $6,350 Declined Active 24 Musculoskeletal and Connective Tissue $13,956 $36,109 Currently Enrolled Active Total $822,729 $386.084 Labor Related Costs: In June 2013, National Public Radio (NPR) reported that smokers cost their employers approximately $5,800 per smoker, per year. And the biggest chunk of that comes not in health care costs, but in work lost during all those smoke breaks. That came in at $3,077, based on an estimate of five smoke breaks during the work day. http://www. org/sections/health-shots/2013/06/04/188631885/that-employee-who- smokes-costs-the-boss-5-800-a-vear "The smoking breaks added up to a lot more than we expected," says Micah Berman, an incoming assistant professor of law and public policy at Ohio State University, who led the study, which was published in Tobacco Control. The researchers tried to be conservative in estimating the number of smoke breaks, figuring on five 15-minute breaks in an eight-hour workday, three of which took place during sanctioned break times. So the cost could well be higher. Furthermore, these figures do not include the sick leave used by smokers due to colds and other respiratory City Commission Memorandum — No Smoking Resolution January 13, 2016 Page 5 diseases caused and/or aggravated by smoking and related impacts. Given that the City of Miami Beach draws applicants primarily from other public sector employers within the county, staff conducted a survey of Miami-Dade County public sector employers which revealed that six municipalities and one large private employer have instituted policies not to hire smokers without detriment to their ability to attract qualified candidates. Attachment B shows the organizations contacted and their respective responses to our questionnaire. RECOMMENDATION Given the actual costs and health related issues associated with the use of tobacco products, it is therefore recommended that the Mayor and City Commission approve the attached resolution to go into effect with the first employment opportunity announced effective upon adoption. If this resolution in adopted, the City of Miami Beach will also join four police forces (Clearwater police, Pinellas, Pasco and Hillsborough counties) and an additional seven other public sector employers across the state: Delray Beach, Sarasota County, Atlantic Beach, Flagler County, City of Hollywood, Hallandale Beach. Finally, Fire fighters, by law, must be non-smokers for a minimum of one year to be eligible for employment. Health Impact from Smoking: Center for Disease Control and Prevention Overview Overall mortality among both male and female smokers in the United States is about three times higher than that among similar people who never smoked. The major causes of excess mortality among smokers are diseases that are related to smoking, including cancer and respiratory and vascular disease. Smokeless tobacco is a known cause of cancer. In addition, the nicotine in smokeless tobacco may increase the risk for sudden death from a condition where the heart does not beat properly (ventricular arrhythmias) Tobacco use is the leading preventable cause of death in the United States. Cigarettes and Death Cigarette smoking causes about one of every five deaths in the United States each year.1,6 Cigarette smoking is estimated to cause the following: More than 480,000 deaths annually (including deaths from secondhand smoke) 278,544 deaths annually among men (including deaths from secondhand smoke) 201,773 deaths annually among women (including deaths from secondhand smoke) Cigarette smoking causes premature death: Life expectancy for smokers is at least 10 years shorter than for nonsmokers. Quitting smoking before the age of 40 reduces the risk of dying from smoking-related disease by about 90%. Secondhand Smoke and Death Exposure to secondhand smoke causes an estimated 41,000 deaths each year among adults in the United States: Secondhand smoke causes 7,333 annual deaths from lung cancer. Secondhand smoke causes 33,951 annual deaths from heart disease. Increased Risk for Death Among Men Men who smoke increase their risk of dying from bronchitis and emphysema by 17 times; from cancer of the trachea, lung, and bronchus by more than 23 times. Smoking increases the risk of dying from coronary heart disease among middle-aged men by almost four times. Increased Risk for Death Among Women Women who smoke increase their risk of dying from bronchitis and emphysema by 12 times; from cancer of the trachea, lung, and bronchus by more than 12 times. Between 1960 and 1990, deaths from lung cancer among women increased by more than 500%. In 1987, lung cancer surpassed breast cancer to become the leading cause of cancer death among U.S. women. In 2000, 67,600 women died from lung cancer. During 2010-2014, almost 282,000 women (56,359 women each year) will die from lung cancer. Smoking increases the risk of dying from coronary heart disease among middle-aged women by almost five times. Death from Specific Diseases The following table lists the estimated number of smokers aged 35 years and older who die each year from smoking-related diseases. Annual Cigarette Smoking-Related Mortality in the United States, 2005-2009 Disease Male Female Total Other cancers include cancers of the lip, pharynx and oral cavity, esophagus, stomach, pancreas, larynx, cervix uteri (women), kidney and renal pelvis, bladder, liver, colon, and rectum; also acute myeloid leukemia Other heart diseases includes rheumatic heart disease, pulmonary heart disease, and other forms of heart disease. Other vascular diseases include atherosclerosis, aortic aneurysm, and other arterial diseases. COPD is chronic obstructive pulmonary disease and includes emphysema, bronchitis, and chronic airways obstruction. Source: 2014 Surgeon General's Report: The Health Consequences of Smoking-50 Years of Progress, Chapter 12, Table 12.4[PDF-2.7 MB) Cancer Lung cancer 74,300 53,400 127,700 V _ LN A U 'i l HO V. Il id Health Impact from Smoking: Center for Disease Control and Prevention Other cancers 26,000 10,000 36,000 Subtotal: Cancer 100,300 63,400 163,700 Cardiovascular Diseases and Metabolic Diseases Coronary heart disease 61,800 37,500 99,300 Other heart diseaseb 13,400 12,100 25,500 Cerebrovascular disease 8,200 7,100 15,300 Other vascular diseasec 6,000 5,500 11,500 Diabetes mellitus 6,200 2,800 9,000 Subtotal: Cardiovascular and Metabolic 95,600 65,000 160,000 Respiratory Diseases Pneumonia, influenza, tuberculosis 7,800 4,700 12,500 COPDd 50,400 50,200 100,600 Subtotal: Respiratory 58,200 54,900 113,100 Total: Cancer, Cardiovascular, Metabolic, Respiratory 254,100 183,300 437,400 Perinatal Conditions Prenatal conditions 346 267 613 Sudden infant death syndrome 236 164 400 Total: Perinatal Conditions 582 431 1,013 Residential Fires 336 284 620 Secondhand Smoke Lung cancer 4,374 2,959 7,333 Coronary heart disease 19,152 14,799 33,951 Total: Secondhand smoke 23,526 17,758 41,284 TOTAL Attributable Deaths 278,544 201,773 480,317 SURVEY, LOCAL PUBLIC SECTOR EMPLOYERS Employer Do you hire smokers do you notify applicants •Do Has the policy. of not hiring smokers affected your competitiveness in the labor market • Does your policy require employees to remain smoke free once hired you require current employees to stop smoking Do you have random nicotine testing foremployees; if so whet happens to employees who test positive Do you test employees for nicotine How do you treat E cigarettes Cutler Bay •. • , Application.' •Yes Y. - Yes • • • No E. cigarette-policy. Done.. . • ..,. • Application-; • No Y Y No • Treated as cigarettes Pnecrest No cat- ':,APellior. No • '..es.. No ' Only if the employee injured on-the job; its- of the'reoular blood: Pa , test ... No Ecigarette policy • nrisf-Iles BeaCti ' ,Application .'( N ... . Not addressed . Mt. Sinai Hospital -.. No Application •N '.Yes' . . •. During the annual : ' wellness biarnetric- ' period, nicotine e,. tobaccothsfing is cone. , . lsf test Positive, :.., : employee is: has to pay a 'S'UiChraelonfiledical. ' Treated aaeigaretteS' South Miaini..: . ,No;started.new policy, . . in.Me.Y 2b15' :• • . Apolcatiern ').velathite : : • • ' - ' , Do not tive'tiata:to determine Y N .N N .Treated as dgai-ettes Aventura Yes N/A N/A N/A N/A N/A N/A No E cigarette policy Bal Harbor Yes N/A N/A N/A N/A N/A N/A No E cigarette policy Bay Harbor Island Yes N/A N/A N/A N/A N/A N/A No E cigarette policy Biscayne Park Yes N/A N/A N/A N/A N/A N No E cigarette policy Coral Gables Yes N/A N/A N/A N/A N/A N/A No E cigarette policy El Portal Yes N/A N/A N/A N/A N/A N/A No E cigarette policy Florida City Yes N/A N/A N/A N/A N/A N/A No E cigarette policy Golden Beach Yes N/A N/A N/A N/A N/A N/A No E cigarette policy Hialeah Yes N/A N/A N/A N/A N/A N/A Treated as cigarettes Hialeah Gardens Yes N/A N/A N/A NM N/A N/A No E cigarette policy Homestead Yes N/A N/A N/A N/A N/A N/A No E cigarette policy Indian Creek Yes N/A. Last person hired was 7 years ago N/A N/A N/A N/A N/A No E cigarette policy Key Biscayne Yes N/A N/A N/A N/A N/A N/A No E cigarette policy Medley Yes N/A N/A N/A N/A N/A N/A No E cigarette policy Miami Gardens Yes N/A N/A NIA N/A N/A N/A Treated as cigarettes Miami Lakes Yes N/A N/A WA N/A N/A N/A Treated as cigarettes Miami Shores Yes N/A N/A N/A N/A N/A N/A No E cigarette policy Miami Springs Yes N/A N/A N/A N/A N/A N/A No E cigarette policy Miami-Dade County Yes N/A N/A N/A N/A N/A N/A Treated as cigarettes 1 [Pages] g I K 1 q U t 11 4 0V I IV SURVEY, LOCAL PUBLIC SECTOR EMPLOYERS Employer Do you hire smokers How do you notify applicants Has the policy of not hiring smokers affected your competitiveness in the labor market Does your policy require employees to remain smoke free once hired Do you require current employees to stop smoking Do you have random nicotine testing for employees; if so what happens to employees who test positive Do you test employees for nicotine How do you treat E cigarettes North Bay Village Yes N/A. Last person hired was 7 years ago N/A N/A N/A N/A N/A Treated as cigarettes North Miami Yes N/A N/A N/A N/A N/A N/A No E cigarette policy North Miami Beach Yes N/A N/A N/A N/A N/A N/A Treated as cigarettes Opa-Locka Yes N/A N/A N/A N/A N/A N/A No E cigarette policy Palmetto Bay Yes N/A N/A N/A N/A N/A N/A No E cigarette policy Surfside Yes N/A N/A N/A N/A N/A N/A No E cigarette policy Sweet Water Yes N/A N/A N/A N/A N/A N/A No E cigarette policy Virginia Gardens Yes N/A N/A N/A N/A N/A N/A No E cigarette policy West Miami Yes N/A N/A N/A N/A N/A N/A No E cigarette policy Dade County Schoot Board Yes N/A N/A N/A N/A No N/A Treated as cigarettes University of Miami Yes N/A N/A N/A N/A N/A N/A No E cigarette policy Florida International University Yes N/A N/A N/A N/A N/A N/A Treated as cigarettes Barry University Yes N/A N/A N/A N/A N/A N/A No E cigarette policy Baptist Hospital Yes N/A N/A N/A N/A N/A N/A Treated as cigarettes Jackson Memorial Hospital Yes N/A N/A N/A N/A N/A N/A Treated as cigarettes Broward County School Board Yes N/A N/A N/A N/A N/A N/A No E cigarette policy Employers 41 Non-smokers 6 2 [Pages]