20160113 SM5MIAMIBEACH
City Commission Meeting
SUPPLEMENTAL MATERIAL 5
Gity Hall, Commission Chambers,3rd Floor, 1700 Convention Center Drive
January 13,2016
Mayor Philip Levine
Commissioner John Elizabeth Alem6n
Comm issioner Ricky Arriola
Commissioner Kristen Rosen Gonzalez
Commissioner Michael Grieco
Comm issioner Joy Malakoff
Comm issioner Micky Steinberg
City Manager Jimmy L. Morales
City Attorney Raul J. Aguila
City Clerk Rafael E. Granado
VisrT us at www.miamibeachfl.gov for agendas and video "streaming" of City Commission Meetings.
ATTENTION ALL LOBBYISTS
Chapter 2, Article Vll, Division 3 of the City Code of Miami Beach entitled "Lobbyists" requires the
registration of all lobbyists with the City CIerk prior to engaging in any lobbying activity with the City
Commission, any City Board or Committee, or any personnel as defined in the subject Code
sections. Copies of the City Code sections on lobbyists laws are available in the City Clerk's office.
Questions regarding the provisions of the Ordinance should be directed to the Office of the City
Aftorney.
SUPPLEMENTAL AGENDA
R7 - Resolutions
R7D A Resolution Establishing A Policy Not To Hire lndividuals Who Use Tobacco Or Tobacco Products
lncluding, But Not Limited To, Cigarettes, E-Cigarettes, Cigars, Chewing Tobacco, Snuff, And Pipes,
And To Prohibit The Use Of Such Products Throughout The lndividuals' Employment With The City
Of Miami Beach.
(Sponsored by Commissioner Michael Grieco)
(Legislative Tracking: Human Resources)
(Additiona! I nformation)
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2
g MIAMIBEACH
City of Miomi Beoch, ,l700 Convention Center Drive, Miomi Beoch, Florido 33,139, www.miomibeochfl.gov
C
TO: Philip Levine, Mayor and Members
MMIS MEMORANDUM
the City
FROM: Jimmy L. Morales, City Manager
DATE: January 13,2016
SUBJECT: A RESOLUTION OF THE MAYORIAND CITY COMMISSION OF THE Clry
OF MIAMI BEACH, FLORIDA, ESTTABLISHING A POLICY NOT TO HIRE
INDIVIDUALS WHO USE TOBAGCO OR TOBACCO PRODUGTS
INCLUDING, BUT NOT LIMITED TO, CIGARETTES, E.CIGARETTES,
CIGARS, CHEWING TOBACCO, SNUFF, AND PIPES, AND TO PROHIBIT
THE USE OF SUGH PRODUCTS THROUGHOUT THE INDIVIDUALS'
EMPLOYMENT WITH THE CITY OF MIAMI BEACH.
SUPPLEMENTAL I NFORMATION
RELEVANT CURRENT MIAMI BEACH POLICY
The City of Miami Beach currently has a Smoke Free Workplace policy in keeping with
the Clean lndoorAirAct, 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 ltem
Date
R'-] D
l-t2-lL3
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.
ln 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.htt p : //wuaru. f I o ri d a h e a lt h. q ov/p roo ra m s-a n d -
se rvi ces/oreve nti on/tobacco-f ree-f lori da/
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 yeat
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.qov/tobacco/data statisticsifact sheets/health effects/tobacco related
mortalitv/
ln the public sector, the financial consequences are particularly important as insurance
premiums and claims are mostly borne by taxpayer dollars.
Health lnsurance 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 22o/o oE 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:
4
City Commission Memorandum - No Smoking Resolution
January 13,2016
Page 3
AvMed
City of Miami Beach
Respiratory and Lung Cancer
lncurred:2015
Data excludes capitation and expenses related to prescription coverage
Medical Claims Expenditures for Peoole with Tobacco Use
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 lCDg and lCD10 diagnosis codes for COPD, Emphysema,
Lung Cancer as wel/ as other respiratory disorders.
Ihe issue with ICD codes and claims payment is the lack of speciftc 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. lf the patient is seen a few weeks later for another burn on the left arm, the same ICD-9 diagnosis code would be
repofted. Additional documentation would likely be required for a claim for the treatment to explain that the burn treated at
this time is a different bum from the one that was treated previously. ln the ICD-10 diagnosis code set, characters in the
code identify righf versus left, initial encounter versus subsequent encounter, and other clinical information.
CCS means Clinical Classification Software
CCS* Level 1 Descriotion 3CS* Level 2 Descriotion PaidAmount
DISEASES OF TH E RESPI RATORY
NEOPLASMS
RESIDUAL CODES; UNCLASSIFIED;
ASTHMA
CH RO N I C O BSTR U CTIVE P U LM O NARY D I S EAS E AN D B RO N C H I ECTAS IS
OTH ER LOWER RESPIRATORY DISEASE
OTHER UPPER RESPIRATORY DISEASE
PLEURISY; PNEUMOTHORAX; PULMONARY COLLAPSE
R ES P I RATO RY FAI LU R E; I NSU F F I CI E N CY; ARR EST (AD U LT)
RESPIRATORY INFECTIONS
SECONDARY MALIGNANCIES
TOBACCO USE
S r,zsg
S 49i.
S 1o,o2e
S r,sea
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s 68,200
S +,org
5 oq,qta
S ssg
Grand Total S 1s1.418
Medical Claims Expenditures for all Resoiratorv and Luno Cancer
CCS* Level 1 Descriotion CCS* Level 2 Descriotion Paid Amount
DISEASES OF TH E RESPIRATORY
NEOPLASMS
ASTHMA
CHRONICOBSTRUCTIVE PULMONARY DISEASEAND BRONCHI ECTASIS
OTHER LOWER RESPIRATORY DISEASE
OTHER UPPER RESPIRATORY DISEASE
PLEURISY; PNEUMOTHORAX; PULMONARY COLLAPSE
R ES P I RATO RY FAI LU RE ; I NS U FF I Cl E N CY; ARR EST (AD U LT)
RESPIRATORY INFECTIONS
CANCER; OTHER PRIMARY
SECONDARY MALIGNANCIES
S Dt,zqg
S 18,930
s 65,899
5 227,730S sa,on
5 68,2475 zzg,tsoS rss
s 64.478
Grand Tota!s 860.616
5
City Commission Memorandum - No Smoking Resolution
January 13,2016
Page 4
Humana
City of Miami Beach
November 1, 2014 through December 31, 2015
1 Malignant Neoplasms
2 Other/Unclassified
3 Malignant Neoplasms
4 Malignant Neoplasms
5 Malignant Neoplasms
6 Other/Unclassified
7 Malignant Neoplasms
8 Rare Diseases
9 Malignant Neoplasms
10 lnjury and Poisoning
11 Neoplasms (Benign)
12 Rare Diseases
13 GenitourinarySystem
14 Rare Diseases
15 Digestive
16 Signs and Symptoms
17 Signs and Symptoms
18 RetroviralConditions
19 RetroviralConditions
20 Pregnancy and Complications
21 Musculoskeletal and Connective Tissue
22 Other Heart Disease
23 lnjury and Poisoning
24 Musculoskeletal and Connective Tissue
Total
52s8,874
S3,043
s 18s,1s3
s62,02e
s98,445
s2,336
597,74o
Ss,899
s1o,8s7
577,077
s82,986
s4,728
5s9,723
S4,086
s6s,s37
s1s,2eo
s63,841
s1,e46
s6,s37
s43,091
s48,8s8
s46,864
s44,3o2
S13,9s6
s822,729
S4s3
5788,432
Ss86
s100,908
53,tzo
S96,209
So
S83,s80
s73,16s
S6,483
Ssz
576,208
s14,019
S67,014
s79s
Ss1,286
s407
Ss2,8s8
s48,070
s10,248
S3,9s2
ss,401
S6,3so
s36,109
s386.084
Active
Active
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Active
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Active
Termed
Active
Active
Active
Active
Active
Active
Active
Termed
Termed
Termed
Termed
Active
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Completed Program During Period
Former Participant
Declined
Currently Enrolled
Completed Program During Period
Low Opportunity for lmpact
Low Opportunity for lmpact
Former Participant
Former Participant
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Low Opportunity for lmpact
No Response
Declined
Former Participant
Completed Program During Period
Completed Program During Period
No Response
Completed Program During Period
Former Participant
No Response
No Response
Currently Enrolled
Declined
Currently Enrolled
Labor Related Costs:
ln 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.npr.oro/sections/health-shots/2013/06/04/188631885/that-employee-who-
smokes-costs-the-boss-5-800-a-year "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
6
City Commission Memorandum - No Smoking Resolution
January'13,20'16
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. lf this resolution in adopted, the City of Miami Beach will also
join four police forces (Cleanruater 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.
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