City's medical marijuana policy for employees remains unchanged, to the chagrin of some

Nearly five months after City Councilor Grant Miller suggested the city change its policies to allow employees to use medical marijuana as they would any other prescription medication, the idea remains a topic of conversation — and of some frustration — among city leaders.

Miller first broached the subject in January when councilors and Mayor G.T. Bynum met to set their priorities for the year. Miller met with Bynum and other city officials in March to discuss the matter further.

In this week's episode, Ginnie Graham and Barry Friedman discuss the legalization of recreational marijuana, which will be voted on March 7. Will State Question 820 pass? Should it pass? What are the pros and cons? Ginne and Barry debate the different sides of a complicated issue.

“It was a short meeting,” Miller said. “For my mind, the purpose of the meeting was to bring all of those folks together who might be affected or impacted by this … and just sit them down and then find out what information it is that they need in order to move forward with some kind of a policy.”

Miller, who is a licensed cannabis grower, said what he took away from the meeting was that “there was very much a willingness to explore what is possible and that we could probably at some point find some middle ground.”

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He stressed that city officials gave no indication that they “are open to actually changing the policy” but did show an openness “to exploring how we could do that if we were willing to.”

Currently, the city can test employees for drug use and can discipline an employee if THC metabolites are detected.

Oklahomans voted in 2018 to approve State Question 788, which legalized the use of medical marijuana for those with a doctor's recommendation.

In making his proposal in January, Miller cited concerns he’d heard from Tulsa firefighters about the potential harmful effects of opioids and their desire to have cannabis available as a safer option for certain medical conditions.

“We have got doctors handing out prescriptions to city staff and to firefighters for the very same thing we are allegedly trying to combat,” Miller said. “It’s a big problem.”

Matt Lay, president of Tulsa Firefighters IAFF Local 176, said post-traumatic stress, sleep disorders, anxiety and chronic pain are common causes of physical and mental health problems among firefighters.

In the last 15 years, Lay said, four active firefighters have died from suicide or overdoses.

“In all of those situations, you had the presence of opioids,” he said, adding, “If you are telling me that there is a safe and effective alternative to an opioid, why wouldn’t we want firefighters to have access to that?”

Bynum said Thursday that he remains open to discussion and consideration of the issue.

“This is a medical policy issue that impacts hundreds of firefighters who are responsible for protecting the lives of 400,000 Tulsans,” he said. “This is not something I will move on casually or without thorough evaluation.”

Lay said the current policy is problematic because it lacks clarity and is applied arbitrarily.

“That is part of what has been problematic — that range from zero discipline and maybe a referral to an employee assistance program all the way through a termination on a first offense,” Lay said.

Little has changed in the firefighters’ drug and alcohol policy since it was adopted in the mid-1990s, Lay said.

“It is very disappointing that a city like Tulsa, that claims to be progressive, should have such archaic views towards something that more than two thirds of Tulsans support and have voted to adopt at the state level,” he said.

Lay pointed to a 2021 survey of 516 likely Tulsa general election voters in which 67% of respondents said they would support a ballot measure allowing firefighters to use medical marijuana if recommended by a doctor and used only while off duty.

Of the 67% of respondents who said they would support such a measure, 46.5% said they would strongly support it and 20.5% said they would somewhat support it.

The survey, commissioned by Local 176 and conducted by Cygnal, had a margin of error of plus or minus 4.31 percentage points.

Lay said the union recently agreed to a tentative agreement with the city on a fiscal year 2024 contract but that the subject of medical marijuana was never on the table.

“We were informed by the city’s negotiator that it was a nonstarter as far as the city was concerned,” he said.

Miller expressed disappointment in the lack of movement on the matter, saying city leaders seem to want things to stay the same.

"They are not interested in giving firefighters an opportunity to use alternative medications and want them to stay on these pain pills and stuff," the councilor said.

Bynum said the medical marijuana issue is an evolving one and that the city did not want to unduly delay firefighters’ getting the raises they deserved while one policy issue was being evaluated.

“So we did not consider it for this contract,” he said. “As I have told Councilor Miller and others, I remain open-minded on the issue. The main challenge right now is that both our city physician and our fire chief do not believe we could safely implement such an option when dosages are not federally monitored and regulated in the same way other medications typically are.

“I do not want to do anything that would put citizens or firefighters at risk, so we have to work through that particular concern.”

The drug policy for firefighters, as spelled out in their collective bargaining agreement and administrative operating procedures, is nuanced. 

It reads, in part: "Normally, a non-probationary employee with a previously satisfactory work record will be given one (and only one) opportunity to continue employment after an initial occurrence of a positive drug or alcohol test where such testing was required by the City."

Generally speaking, a firefighter who violates the policy the first time remains on the job but is subject to discipline. The individual will be subject to random and/or periodic drug testing and must participate in an Employee Assistance Program. 

A firefighter who violates the policy a second time is subject to termination.

Firefighters are tested for alcohol, marijuana metabolites and cannabinoids, opiates, synthetic and semi-synthetic narcotics, cocaine, amphetamines and PCP.

City officials stress that they follow applicable laws for all employees and adhere to collective bargaining processes.

Fire Chief Michael Baker was among the city officials who met with Miller in March to discuss the issue.

“I am really kind of still studying it, to be honest,” Baker said. “The question I have is: How is it going to impact what we can do to help our people? How would you manage it effectively?

“The most important concern for me, whether it is this topic or any topic, is: How does it impact the trust that the public has in us?”

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Delayed packages, bare grocery store shelves, and inflated prices have become the norm for American consumers over the past two years. While the COVID-19 pandemic has been the catalyst, there are other challenges causing supply chain issues, including a lack of truck drivers to transport goods from one place to another. In late 2021, the American Trucking Associations reported that the driver shortage had risen to an all-time high of 80,000, partly due to the aging population and shrinking wages.

In response, the Biden administration vowed in December to get more truck drivers on the road by boosting recruitment efforts and expediting the issuing of commercial licenses. However, that won’t have an effect on another hurdle: disparate marijuana laws across the U.S. that are contributing to an increase in violations. In 2022, a growing number of truckers are being taken off the job, which could soon worsen the already suffering supply chain.

As more states legalize recreational marijuana—four of which did so in the past year and three more are expected to by the end of 2022—more truck drivers have tested positive for the substance. As of April 1, 2022, 10,276 commercial vehicle drivers have tested positive for marijuana use. By the same time in 2021, there had been 7,750 violations. That’s a 32.6% increase year over year.

Truck drivers who travel cross-country face inconsistent state regulations as 19 states have legalized recreational marijuana and 37 states permit it for medicinal purposes. But even if a driver used marijuana or hemp-based products like CBD while off duty in a state where those substances are legal, they could still be faced with a violation due to the Department of Transportation’s (DOT) zero-tolerance policy at the federal level. “While states may allow medical use of marijuana, federal laws and policy do not recognize any legitimate medical use of marijuana,” a DOT handbook for commercial vehicle drivers reads. “Even if a state allows the use of marijuana, DOT regulations treat its use as the same as the use of any other illicit drug.”

Stacker looked at what's causing thousands of truckers to be removed from their jobs, and the looming domino effect of the continued supply chain disruptions.

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Under regulations set forth by the DOT, truck drivers are tested for drug use—including  marijuana—prior to starting a new job. They can also be tested at random, as well as after accidents. In January 2020, the DOT’s Federal Motor Carrier Safety Administration also upped the random drug testing rate from 25% of the average number of driver positions to 50%. Truck drivers are mainly screened for drug use via urinalysis, but there are now new saliva tests being proposed as well.

At worst, if a driver fails just one drug test, that can be grounds for termination under DOT regulations. At best, they are temporarily taken off the road and required to complete an evaluation with a substance misuse professional who determines their rehabilitation process, which can sometimes take months.

As of January 2020, employers are also required to list commercial drivers who fail a drug test in the FMCSA’s Drug & Alcohol Clearinghouse. These violations remain searchable for five years. Potential employers are also required to check the Clearinghouse to see if a commercial driver had any previous violations, which would prevent them from being hired.

In recent years, more states have legalized both recreational and medical marijuana, making it more widely available and used. However, marijuana use is still prohibited for commercial truck drivers, state laws and medical prescriptions aside. According to the FMCSA, “a driver may not use marijuana even if [it] is recommended by a licensed medical practitioner.” The DOT has maintained its zero-tolerance stance for marijuana use even as it’s become legalized, saying, “Legalization of marijuana use by States and other jurisdictions also has not modified the application of U.S. Department of Transportation drug testing regulations.”

A commercial driver could use marijuana while off-duty, not driving, and in a state where marijuana is legal, but still test positive for the substance for up to a month later and be taken off the road. The American Addiction Centers says for infrequent marijuana users—meaning those who use the substance less than two times a week—it can show up in their urine for up to three days. Someone who uses marijuana several times a week can test positive for up to three weeks, and those who use marijuana even more frequently can “test positive for a month or longer.”

Shortages, factory closures, and goods waiting to be unloaded at ports are just some of the current issues affecting the supply chain across America. Trucking transports 72% of products within the U.S., according to a report from the White House, but a growing number of commercial drivers are sidelined for marijuana use.

The return-to-duty process that commercial vehicle drivers must undergo once faced with a marijuana violation can keep them from returning to work at all. According to the FMCSA’s monthly report, 89,650 commercial drivers are currently in prohibited status as of April 1, 2022, but 67,368 of them have not begun the RTD process. 

If violations continue at the current rate, the truck driver shortage will further disrupt the supply chain, which means higher prices not just for commodities but the cost of living at large.

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The Tulsa World compiled the following questions and answers to provide a general overview of the city of Tulsa's drug testing policy.

Q. When was it adopted?

A. In 2018, after Oklahoma voters approved State Question 820, legalizing medical marijuana.

Q. Which employees are tested?

A. All new applicants who have been offered a city position are tested for marijuana metabolites, opiates including semisynthetic, cocaine, amphetamines and PCP. As part of the city's testing process, only commercial driver's license holders are tested for barbiturates and benzodiazepines.

Q. What happens if applicants for safety-sensitive jobs test positive for marijuana metabolites?

A. If an applicant for a safety-sensitive job tests positive for marijuana metabolites, the person cannot continue through the hiring process, even if he or she has a valid medical marijuana card. However, the person could apply for a non-safety-sensitive position.

Q. What happens if an employee tests positive for medical metabolites?

A. If an employee is applying for a non-safety-sensitive job, tests positive for marijuana metabolites as part of the drug screening process, and can produce a medical marijuana card, the city will not take any action.

It’s important to note that the only employees subject to random drug tests are those with safety-sensitive jobs, while all employees are subject to drug tests for reasonable suspicion.

The first time an employee tests positive, the employee could be terminated due to their probationary status and/or work history, or the city could enter into a last-chance agreement with that employee, which comes with substance abuse counseling and random testing. If a last-chance agreement is in play and the employee meets the requirements of the last-chance agreement, he or she can return to work.

If the person tests positive again before the last-chance agreement expires, the employee is scheduled for a pretermination hearing.

Employees who test positive again after successfully completing a last-chance agreement for a first violation would be subject to a disciplinary review that could result in termination.

Q. What about police officers, firefighters and 911 employees?

A. Their drug policies are determined through the collective bargaining process.

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AI Can Help You Ask Better Questions — and Solve Bigger Problems

Just a few years ago, businesses wrestled with artificial intelligence mainly in the abstract — a “future of work” problem they’d have to contend with down the line. Now? More than half the companies around the world are actively adopting AI. Although investments are particularly high in industries such as health care, data management and processing, cloud computing, and fintech, all types of organizations and functions have incorporated AI technology into their operations. And generative AI tools such as ChatGPT are forcing leaders to ask where and how AI can help their businesses.

Even so, most companies still view AI rather narrowly, as a tool that alleviates the costs and inefficiencies of repetitive human labor by automating mundane physical tasks (like moving merchandise in warehouses) and increasing organizations’ capacity to produce, process, and analyze piles and piles of data. But the technology can do much more than that.

Paired with “soft” inquiry-related skills such as critical thinking, innovation, active learning, complex problem solving, creativity, originality, and initiative, this technology can further our understanding of an increasingly complex world, allowing us to engage in more abstract questioning and shifting our focus from identification to ideation. In our research and workshops with executives, we’re finding that companies have much to gain by treating AI as a knowledge-work collaborator in diverse areas such as product design, process efficiency, and prompt engineering. Partnering with the technology in this way can help people ask smarter questions, which in turn makes them better problem solvers and breakthrough innovators. We are also seeing the initial impacts of more context-aware AI systems (like ChatGPT), and as they continue to improve, the skill of asking questions (or creating prompts) will only become more valuable in the discovery process.

Although experts have recognized the need for software engineers to ask smart questions upstream, when developing automated tools (to bake in fewer biases and assumptions), little has been said about the flipside of the relationship between AI and inquiry: the technology’s potential to help people become more inquisitive, creative problem-solvers on the job. We aimed to correct this oversight through design-thinking sessions and extensive follow-up conversations with tech-driven business leaders from a diverse array of countries and industries. We also surveyed roughly 200 leaders, from more than 30 countries who participated in our executive education programs at MIT —to learn how artificial intelligence has affected questioning patterns and innovation behaviors and outcomes in their organizations. (For this research, we’ve defined “artificial intelligence” broadly to include machine learning, deep learning, robotics, and the recent explosion of generative AI.)

We have found two distinct, yet related, paths that leaders follow to strengthen their (and their teams’) inquiry muscles as they tap the power of AI in their question-asking work.

On the first path, they can use the technology to change the cadence and patterns of their questions: AI increases question velocity, question variety, and question novelty. Results from our ongoing research show that AI can significantly increase all three.

On the second path, AI can help transform the conditions and settings where people work so that questions that spark change — what we call “catalytic” questions — can emerge. This pushes leaders out of their comfort zones and into the position of being intellectually wrong, emotionally uncomfortable, and behaviorally quiet and more reflective, all of which, it turns out, promotes innovative thinking and action.

Let’s look at how each path can lead to breakthrough ideas.

Partnering with AI to ramp up the velocity, variety, and novelty of questions requires companies to train algorithms to answer the basic, easy (yes/no) questions independently and to reveal deeply buried patterns in the data. When this foundation is laid, humans can start exploring the power of more context-dependent and nuanced questions that AI technologies are not yet capable of answering alone.

Algorithms can provide immediate answers to questions that leaders pose, in turn allowing them to ask more — and more frequent — questions. In our research, we found that 79% of respondents asked more questions, 18% asked the same amount, and 3% asked fewer.

At the cybersecurity firm Cybereason, researchers rely on AI and machine learning to immediately answer the basic questions about what happened in an apparent breach so the team can more quickly turn its attention to formulating deeper questions about why it happened. In the past, CEO Lior Div said, findings were more black-and-white: “It’s an attack. It’s not an attack. It’s good or it’s bad.” But the speed with which AI filled in those blanks opened up a whole new line of questions around intent — and what hackers are really after in a given situation.

Of course, there are risks to using AI to generate rapid-fire questions. For one, people may keep asking more and more questions without working their way toward an actionable path, making it important to recognize when the process stops being productive. For another, more questions don’t necessarily amount to better questions, which means you’ll still need to exercise human judgment in deciding how to proceed.

AI helps uncover patterns and correlations in large volumes of data — connections that humans can easily miss without the technology. Knowing they have this tool at their disposal frees up leaders to ask farther-ranging questions and explore new ideas that they may not have otherwise considered. In our research, we found that engagement with AI led respondents to ask different questions than they otherwise would have 94% of the time.

Consider this example: Kli Pappas, the director of predictive analytics at Colgate-Palmolive, told us that his team tapped AI to understand how charcoal became a wildly popular ingredient in consumer products so they could “find the next charcoal.” Their algorithm generated and answered thousands of questions based on their initial search for data, sketching out a decades-long trajectory from charcoal scrubs in South Korea 20 years ago to charcoal appearing in face washes in the U.S. and then in all kinds of products around the world. The AI-generated data led the team to ask hundreds of less-obvious questions to spark creative thinking about future trends that may be lurking in unexpected places. “We look backwards across categories and try to see how do trends move between categories from hair care, to skincare, to oral care,” Pappas said. “Just doing that puts you a decade or more ahead of the curve.”

AI also facilitates deeper insights by helping users arrive at novel, “category jumping” questions — the gold standard of innovative inquiry — that apply understanding from one area to a completely different space. Our research shows that AI led respondents to ask unique questions that changed the direction of their team, organization, or industry 75% of the time.

When you know a technology can sift through much more data, and connect more dots, than you could ever do alone, it gives you license to ask wilder questions — things you would never ask if you had to answer them on your own, because they are intractable for the human brain or somehow go against entrenched cognitive biases.

While category-jumping questions will not arise in every encounter with AI systems, being open to the possibilities and allowing for freedom of inquiry can pave the way for more instances. Here’s how Mir Imran, a medical innovator and founder of InCube Labs, described the upside when we spoke: “AI can take really obscure variables and make novel connections. When these hidden connections come together, it causes you to reframe your question and deliver disruptive innovations.” In other words, AI’s novel connections can spark your novel questions, which in turn can lead you to investigate solutions others haven’t dreamed of yet — like the robotic pills that Imran’s team recently created to replace external injections with internal ones.

AI can take leaders out of their usual mode of operation and force them to cede control over where their questions will take them. That’s a good thing. Increased question velocity, variety, and especially novelty give facilitate recognizing where you’re intellectually wrong, and becoming emotionally uncomfortable and behaviorally quiet — the very conditions that, we’ve found, tend to produce game-changing lines of inquiry. Jeff Wilke — former CEO of Amazon Consumer Worldwide, now a cofounder of Re:Build Manufacturing — has embraced these conditions not only in his day-to-day work as a tech executive but also throughout his career, continually revising his mental models while moving from role to role. When we spoke, he had this to say: “If you seek out things that you don’t know, and you have the courage to be wrong, to be ignorant, to have to ask more questions and maybe be embarrassed socially, then I think you build a more complete model, and that model serves you well over the course of your life.”

But there’s a hitch to teaming up with AI: Research suggests that it can be challenging for people to do so congenially because AI’s superhuman capabilities and unpredictable moves may prevent them from fully trusting and engaging with the technology. That tracks with what we’ve observed in organizations and learned from our conversations with leaders.

Distrust of the technology is hardly conducive to creative inquiry. So, look for ways to offset that, and don’t just leave it to AI to produce the conditions for breakthrough thinking and problem-solving. Consider how else you might create them. Where is there room in your problem-solving processes for synthesizing things that don’t seem related? How might you use those opportunities to throw people off balance so they’ll generate questions that reach beyond what they intellectually know to be right, what makes them emotionally comfortable, and what they are accustomed to saying and doing? At the same time, how can you create psychological safety for people in your organization to ask far-ranging questions and to use AI more effectively to learn from them, ultimately leading to asking better questions? When psychological safety is present, people can say, without repercussion, “I am wrong,” “I am uncomfortable,” and “I am still thinking”?

Rather than neatly resolve all those tensions, leaders and teams must learn to sit with the uncertainty that comes from asking questions that take them into new territory. While the process isn’t easy, the results are exciting, which is perhaps the most important benefit of collaborating with an AI system. Excitement provides momentum and motivation to push through a tough process, fueling further creativity.

Artificial intelligence may be superhuman in some ways, but it also has considerable weaknesses. For starters, the technology is fundamentally backward-looking, trained on yesterday’s data — and the future might not look anything like the past. What’s more, inaccurate or otherwise flawed training data (for instance, data skewed by inherent biases) produces poor outcomes.

Leaders and their teams must manage such limitations if they are going to treat AI as a creative-thinking partner. How? By focusing on areas where the human brain and machines complement one another. Whereas AI increases the volume of data we can process and the degree of complexity we can manage, our brains work in a reductive manner; we generate ideas and then explain them to other people. Whereas machines lack imagination and moral judgment, we can tap those critical skills as AI helps us increase the velocity, variety, and novelty of the questions we’re asking to solve problems in our organizations. Such differences are the stuff of fruitful collaboration — and optimizing them can reduce the threat of AI to human labor.

With humans and AI working to their respective strengths, they can transform unknown unknowns into known unknowns, opening the door to breakthrough thinking: logical and conceptual leaps that neither could make without the other. Harnessing this potential will require leaders to look at artificial intelligence in a new light — one that is less about cost savings, efficiency, and automation and more about inspiration, imagination, and innovation. It will also require building a culture that supports, incentivizes, and rewards asking big questions — and not necessarily knowing the answers.

Medical board weighing license of Dr. Roxy who livestreams, takes questions during operations

An Ohio plastic surgeon accused of livestreaming patients' procedures online won't likely learn the fate of her medical license until July.

Dr. Katharine Roxanne Grawe – known to her thousands of social media followers as Dr. Roxy – has not been allowed to practice medicine since last fall and is fighting in hearings this week to keep state regulators from yanking her credentials for good.

The State Medical Board of Ohio voted on Nov. 18 to suspend Grawe's medical license after "clear and convincing" evidence arose that her continued practice presented "a danger of immediate and serious harm to the public." Grawe also is being sued by at least four women who say they faced complications after their surgeries.

In one case cited by the medical board, the doctor was looking and speaking to the camera while performing liposuction on a patient's abdomen during a livestream broadcast. That patient suffered a perforated bowel and ended up in the emergency room with loss of brain function from toxins in the blood.

Dr. Katharine Grawe, better known as Dr. Roxy to her thousands of followers, has had her license temporarily suspended by Ohio's medical board after "clear and convincing" evidence that Grawe's continued practice presented "a danger of immediate and serious harm to the public."

A lawyer for the doctor said this week that patients knew the risks ahead of surgery and the livestream broadcasts were intended to be educational.

Here's everything we know about the case against Dr. Roxy the TikTok doc:

Despite repeatedly warnings from state medical authorities, she continued to livestream patient procedures, and in some cases, answered viewer questions while actively performing surgery.

The secretary of the medical board cautioned Grawe at least twice in the past four years about the need to maintain patient privacy when sharing photos or video on social media, according to the notice of suspension filed online and sent to the doctor.

In September 2021, Grawe was urged by the secretary of the board to undertake remedial education courses related to plastic surgery complications, professionalism and ethics. She was asked to provide certificates of completion of the courses, along with summaries about what she learned and how she would apply it to her future practice.

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After completing the remedial education courses, the board alleged Grawe continued to film and broadcast live the medical procedures of some patients until on or about Oct. 14.

"Aspects of these productions include, but are not limited to, preoperative photos, preoperative interviews with patients about their bodies, livestreams of procedures, postoperative still images of patients taken in the operating room, and the cost of the procedure," the notice addressed to Grawe reads. "During some videos/live-streams you engage in dialogue to respond to viewers' online questions while the surgical procedure remains actively ongoing."

The board cited three patients who reported having complications after Grawe performed surgery on them at her practice, Roxy Plastic Surgery.

In one case, a patient was sent to the emergency room by a nurse practitioner at Roxy Plastic Surgery less than a week after receiving liposuction, a Brazilian butt lift and a skin-tightening procedure from Grawe. Free air was found in her abdomen and medical staff determined she was suffering from hepatic encephalopathy, or loss of brain function when a damaged liver doesn't remove toxins from the blood.

The patient was quickly transferred to another hospital for further evaluation and treatment. There, she underwent exploratory surgery and surgeons found her bowel had been perforated and she had a serious bacterial infection. The patient required a prolonged stay with multiple debridements, or procedures to remove dead tissue, open abdomen and skin grafting, according to Grawe's notice of suspension.

At least part of her procedure at Grawe's office was livestreamed on social media, according to the board, which said Grawe was looking and speaking to the camera while performing liposuction on the patient's abdomen.

"Despite liposuction being a blind surgery that requires awareness of the tip of the cannula (thin tube) to avoid injury, your attention to the camera meant at those moments you were not looking at the patient or palpating the location of the tip of the cannula," the suspension notice reads.

A lawyer representing Grawe during this week's medical board hearing, Sabrina Sellers, said patients underwent the elective procedures aware of the risks, according to local ABC affiliate WSYX. Sellers said the social media broadcasts were meant to be" educational in nature and to allow her patients to feel comfortable with her prior to coming to her office."

"She will tell you that although three patients did experience adverse outcomes, that there were known risks and complications of the procedures and they were not caused by a breach in the standard of care," Sellers said. "The reason she places those videos out into the public, are to relate to her patients. It's to educate, relate and demystify. She has nothing to hide."

Following this week's hearings, an examiner will make a recommendation to the full medical board, said board spokeswoman Jerica Stewart.

At a public meeting, the board will deliberate the recommendation and a decision on Grawe's medical license will likely be made at the board's July 12 meeting, Stewart said.

Contact Filby at mfilby@dispatch.com or on Twitter @MaxFilby.

This article originally appeared on USA TODAY NETWORK: Ohio surgeon Dr Roxy livestreamed operations on TikTok: What we know