Risk Insider: Zachary Gifford

The Role We Must Own

By: | November 24, 2015 • 2 min read
Zachary Gifford is Director, Systemwide Risk Management with the California State University – Office of the Chancellor. He also is active in risk management organizations such as PARMA, PRIMA and RIMS. He can be reached at [email protected]

Unfortunately, campus shootings are not a new issue and the recent (or seemingly continual) spate of incidents reinforces the need to take a holistic approach to the risk, i.e., it is not a law enforcement issue alone.

I’m not talking about the need to include a variety of campus personnel and stakeholders in the planning, response and recovery processes, this is self-evident and well-established.

Rather, in this case the term “holistic” is best applied to considering the place of mental health professionals, such as Behavior Intervention Teams (BITS) or campus counseling teams (mental first aid) in collaborating on emergency management (prep, response & recovery) and with stakeholders/administration and academics.  Everybody has a stake in trying to mitigate the risk.

Most people wouldn’t argue with the point that the root cause of the vast majority of campus violence incidents is one of acute mental illness and the aforementioned feelings of desperation.

Here are two definitions of “holistic”:

Philosophy – characterized by comprehension of the parts of something as intimately interconnected and explicable only by reference to the whole.

Medicine – characterized by the treatment of the whole person, taking into account mental and social factors, rather than just the physical symptoms of a disease.

Recently when speaking with mental health professionals about emergency preparation and response, I had an epiphany … this being that the mental health component of preparation, response and recovery had not been a focus or even present in the emergency planning conversation.

As such, I made a commitment that one of my big pushes going forward was to make sure I would be an advocate for having campus mental health professionals at the table when discussing campus risk mitigation and crisis response.

In the words of  Patrick Prince of Prince & Phelps Consultants“No one wakes up one morning and decides, ‘I think I’ll go shoot up a campus today’.”

Rather, it is generally a lengthy mental process as one devolves from feeling that they have a gripe to feeling totally disenfranchised, disrespected, desperate, lonely and angry.

There are points along the way wherein there is a chance for intervention to address the risk and perhaps even assist the person of interest.

Most people wouldn’t argue with the point that the root cause of the vast majority of campus violence incidents is one of acute mental illness and the aforementioned feelings of desperation. We must remember that the perpetrator was once someone’s baby, friend, schoolmate, etc. and likely was not born with homicidal ideations.

Herein lies the opportunity for mental health professionals to mitigate the risk by assisting in the identification of people at risk, collaborating on intervention techniques and perhaps even treatment.

Further, it is incumbent upon an organization to stress the values of empathy, respect, dignity and looking through a holistic and not personally prejudiced paradigm.

We all have a chance to mitigate the risk by being decent human beings and not being afraid to reach out to appropriate persons to address a concern when observing disturbing behavior. “It is not my problem,” or “ I do not want to get involved,” are not responsible alternatives.

Ask yourself this.

“Are you a potential solution or a potential victim?”

Share this article:

Risk Scenario


A company’s failure to communicate important information to survivors in the wake of a deadly shooting exacerbates a tragedy.
By: | October 6, 2015 • 12 min read
Risk Scenarios are created by Risk & Insurance editors along with leading industry partners. The hypothetical, yet realistic stories, showcase emerging risks that can result in significant losses if not properly addressed.

Disclaimer: The events depicted in this scenario are fictitious. Any similarity to any corporation or person, living or dead, is merely coincidental.

No One Here Gets Out Alive

All is not well in the home of Gretchen and Peter Mansfield. Gretchen, 41 is a sales manager for Durham, N.C.-based pharmaceutical manufacturer BioRealm. Her husband Peter, 44, lost his sales job in mid-2015 and insecurity has been eating away at him.


A big part of Gretchen’s job is working with BioRealm’s SVP for sales, Brian Hatch, 35. Fit, good looking and very well compensated, Brian is Peter’s current nightmare.

Brian and Gretchen spend a lot of time traveling together, sometimes staying in the same hotel for days at a time. Peter, always the jealous sort, stole Gretchen’s work email password long ago and has been following her every move.

He’s read emails between Gretchen and Brian that left no doubt in Peter’s mind they were having an affair.

The last straw was when he picked up a voicemail from Brian that went direct to Gretchen’s email. Hearing Brian describe what he’d like to do with Gretchen the next time he saw her sent Peter over the edge.

At 11:10 am on September 15, 2015, Peter parked his family’s SUV in the parking lot of the Durham location of BioRealm.

From the open windows of the car, Metallica’s “For Whom the Bell Tolls” was blaring.

Peter wore a two-day beard, but there was nothing else in his appearance to warrant alarm.



As he walked to the front door, carrying a large black gym bag and a vinyl grocery bag, he caught the eye of Sandy Brick, Gretchen’s friend and coworker, whom he’d known for years.

Sandy always liked Peter.

“Hey Sandy,” said Peter with a smile.

He was in sales for years. He can do this.

“Hey Peter, what brings you here?” said Sandy.

“Gretchen forgot her lunch bag and her gym bag,” said Peter affably, smiling and holding up the gym bag as he did so.

He did this just as Sandy reached the front door. Not giving her action a second thought, Sandy swiped her security card to open the front door and allowed Peter in ahead of her.

“You know where Gretchen’s office is, right?” Sandy said.

“Sure I do,” said Peter with a smile that faded a little too quickly.

But instead of heading toward Gretchen’s office, Peter made a beeline for Brian’s office, in the opposite direction.

Peter half-jogged to Brian’s office pulling a Glock 9 mm handgun with a 12-round magazine from the grocery bag and an AK-101 with a 30-round clip from the gym bag.

Approaching Brian’s office, he heard his voice, that same confident baritone that Peter last heard on Gretchen’s voicemail. Peter’s rage went from burning red to white hot.

Now running, Peter burst into Brian’s office and shot him three times in the head with the Glock. Peter bit completely through his lower lip as he shot Brian, so intense was his anger.

Not knowing exactly what they heard, BioRealm employees turned their heads to see Peter, with blood running from his mouth, leaving Brian’s office holding the handgun and the assault rifle and heading toward Gretchen’s office.

Now it’s clear what’s happening. Screams begin to rise from the cubicles.

“He’s going for Gretchen!” a woman shouted.

Two men rushed Peter and he shot them down with a burst from the AK-101.

Gretchen poked her head out of her office at the sound of the second round of shots. She saw Peter coming at her. But it wasn’t like it was him at all.

His face was a grey mask and his pupils were pinpoints.

Gretchen’s right hand went up reflexively as Peter fired a 9 mm bullet through her hand and into her temple. Peter fired again and again, some of the bullets hitting Gretchen’s falling body and some of them ricocheting off of office fixtures.

In a half-jog, wiping spasmodically at his bleeding mouth, Peter moved back to the front door.

People attempting to flee the building scattered as he approached. Peter fired with the AK-101 as he neared the front door, striking at least half a dozen people as those more fortunate fled in a different direction.

The exit door was streaked with blood. A woman with sandy hair was propped against the door, dead.

Peter grabbed her by the hair and tossed her aside to clear his exit. The door wouldn’t budge. So he shot the latch to pieces with the AK-101.

Peter walked out to the parking lot, placed the muzzle of the Glock in his mouth and pulled the trigger. Blood splattered on the BioRealm sign adjacent to the front door.

Peter Mansfield’s final visit to BioRealm lasted all of three minutes and 25 seconds.

Does your company have a crisis response plan for an active shooter scenario?

View Results

Loading ... Loading ...

Falling Short of Competence

BioRealm prided itself on having a state-of-the art emergency response and security system. In the wake of numerous office shootings throughout the country, the company installed swipe card security six months before Peter Mansfield’s shooting rampage.


Within 10 minutes of the attack, a text alert was sent to all BioRealm employees and their preferred emergency contacts informing them of the incident.

The text informed BioRealm employees to punch in a code number to let the system know they were safe and sound.

The text lacked specific detail, however, only informing employees and next of kin that an incident had occurred at the Durham campus and that BioRealm was working with local authorities to resolve any issues.

The texting system also failed to take into account any employees that might have gone into hiding when Peter Mansfield first opened fire.

Peter shot Brian Hatch down at 11:12 am.

At 1:10 pm, Angela Brighton, an event planner who assisted the BioRealm sales team, was still hunkered down in a utility closet on the first floor of the Durham offices. When the shooting started, Angela fled for cover, not having time to take her cell phone with her.

In her haste to pull the closet door shut, Angela lacerated her shin against the edge of a mop bucket. Traumatized and now dehydrated, Angela finally burst out of the closet at 1:15 p.m., overcome by claustrophobia and pain and crying hysterically. The building by then had been evacuated.

Angela suffered the surreal experience of walking through the BioRealm offices, seemingly by herself. In her shock, she saw a smear of blood on a corridor wall, and traced it with her finger, as if to confirm for herself that it was real.

The first person she encountered was a County Police Lieutenant, who looked at her in shock when he saw her.

“Ma’am, have you been in here the whole time?” the Police Lieutenant asked her.


“Nobody….nobody said anything,” Angela said, visibly distraught. “Nobody came looking for me. It’s like I don’t exist,” she said, clearly off-center.

Quickly, the Lieutenant got her a seat and ordered medical attention for her via walkie-talkie. No sooner did he have her seated when Gabe Crooks, an intern from Duke, walked up.

“I was in a second floor bathroom,” Crooks told the Lieutenant. Crooks was less visibly shaken than Brighton, but he was clearly upset.

“I’d like to go home now,” he told the Lieutenant.

In a nearby hotel conference room, BioRealm risk manager Nathalie Galbreath, company CEO Keith Ryerson and chief communications officer Roger Blinton were huddled over scratch pads, cell phones and laptops.

“How many are still unaccounted for?” Ryerson asked Galbreath.

“My latest information is five,” Galbreath said.

“That’s five employees that aren’t in the time and attendance system as being on business travel or vacation and who haven’t responded to the emergency text.”

“Dead and injured, again?” Ryerson asked Galbreath.

“Seven dead, four injured, one critically.”

“Text the families of the missing again,” Ryerson told Blinton. “Let them know that we’re still working with authorities to find their relatives.”

“Text them?” Blinton asked.

“Yep. Do it. It’s the fastest way to get to them,” Ryerson said.

Blinton gave Galbreath a look and then turned away to start texting.

The swirl of events continued.

Social media was alive with cell-phone footage of Peter Mansfield’s exit from the BioRealm offices, when he heartlessly yanked a dead woman’s body from the door and shot his way out.

A gutsy BioRealm intern somehow managed to follow him to the door, shooting video with her phone. She posted the video to Facebook within ten minutes of Peter’s death.

BioRealm’s attempts to comfort bereaved families and provide information to others continued to fall short.

Four hours after the incident, no BioRealm employee had reached out to families in person to tell them what was going on. Contrasting this failure was the excellent effort put out by local emergency responders, who placed personal calls to the homes of every dead or injured employee.

With frustration against BioRealm building to a peak, the grieving sister of a slain employee became outraged when BioRealm couldn’t give her a solid answer as to when she’d be able to enter the building to collect his belongings.

“What do you mean you can’t answer that?” she screamed at a BioRealm employee outside the Durham offices as television cameras recorded the moment.

“My brother is dead! Answer me!” she screamed as the employee, rattled, turned his back on her and headed back into the building, all the while on camera.

Television news producers edit the blood-spattered BioRealm sign into their coverage.

It took BioRealm executives until noon the following day to determine that their time and attendance system malfunctioned and that the five “missing” employees were actually in the building at the time the shooting occurred and had fled to their homes.

None of the five ever came back to work for BioRealm.

In the event of an emergency incident at your company, do your protocols include voice to voice contact with employees and their preferred emergency contacts?

View Results

Loading ... Loading ...

No Quarter Asked or Given

Executives at BioRealm were prepared for an active shooter scenario, or so they thought. There was the aforementioned addition of swipe card security. The company was also banking on its text messaging system to get crucial information out to friends and family in a timely manner.


The company had created an evacuation plan and an emergency communications plan in case of an extreme weather event or some other catastrophe. The actual event, someone’s spouse entering the building and killing people, simply overwhelmed all preparations.

BioRealm’s risk management and emergency response management failures would prove costly in human and financial terms.

Keith Ryerson’s inability to realize the importance of speaking directly to employees and their families on the most notorious day in his company’s existence did not play well.

Coupled with the results of investigations that reported that BioRealm failed to adhere to its own crisis response policies, families that felt their loved ones were killed or injured due to corporate security laxity filed suit.

Also filing suit were 25 BioRealm employees who left the company after the shooting. They alleged that the company’s emergency management training and security measures were inadequate.

Included in that class of litigants were Angela Brighton and Gabe Brooks, the two employees who were left behind the day of the shooting.

“Let me get this straight. Nobody made any attempt other than a text message to reach you and no one came looking for you,” one of the attorneys handling the lawsuit asked Brighton and Brooks.

“No one,” Brighton said.

“No one, means no one,” said Brooks, whose usually sunny disposition was under a very dark cloud.

“Who allows a non-employee to enter a supposedly secure building carrying a heavy black bag?” another attorney representing the employees in the lawsuit said to one of his colleagues as they prepared their brief.

The reputational harm caused by social media sharing of the Peter Mansfield shooting video, plus the images of a BioRealm employee turning his back on a grieving family member also wouldn’t go away.

“We’re going to have to up investments in security,” Nathalie Galbreath told Keith Ryerson in a meeting two months after the shooting.

“I’m talking metal detectors on every door and armed security guards. I think it’s the only way we’re going to get any sense of stability in our workplace,” she added.

“Do you know what our legal bill is already from this?” Keith Ryerson said to her.

“Um, no, I don’t know what it is,” Nathalie said, not feeling very patient.

“How about $650,000 and we’re not even at trial with any one of five lawsuits?” Keith said.

Keith Ryerson put his head in his hands.

“Go ahead,” he said.

“Go ahead what?” Nathalie said, sharing his exhaustion and depression.

“Go ahead and order the metal detectors, order the guards,” Keith said weakly.

How integrated is your employee time and attendance system with your emergency response planning?

View Results

Loading ... Loading ...

Risk & Insurance® partnered with Black Swan Solutions to produce this scenario. Below are Black Swan Solutions’ recommendations on how to prevent the losses presented in the scenario. This perspective is not an editorial opinion of Risk & Insurance®.

1. Crisis Response and Business Continuity plans must coordinate with community police, fire and emergency medical agencies. In addition, pre-establish coordination with a local chapter of the Red Cross.  All organizations rely on community responders to assist in a crisis.  Yet most never proactively involve these same agencies in plan development and testing. If a crisis occurs, this can result in significant challenges related to cooperation and coordination.

2. Have a plan for testing, shelter in place and evacuation processes including a reliable means to account for every employee on premise at the time of the event. This information will also be invaluable for first responders involved in the search and rescue effort.

3. Have a secure centralized database for up to date information. This will allow for timely and accurate notifications to stakeholders.

4. Consider contracting with a specialized crisis call center to ensure you have a plan in place to accommodate mass inquires while providing a professional and compassionate response. Families will expect your organization to provide timely information and account for their loved ones who may have been affected by the crisis. The volume of inquiries and requests for information will often overwhelm your expectations and capabilities to respond.

5. Difficult news must be delivered personally. If the news is not good, make the effort to say it either in person or on the telephone – don’t text it.  Realizing you have to use the tools and contact information you have, do your best to connect on a personal level, no matter how challenging, when you must deliver bad news.

6. Prior to a crisis, identify and train organizational personnel who will interface with victims and families in a critical event. Understand the importance of self-care for those involved in responding to the incident and debrief them at the end of every shift.  Consider contracting with an organization to provide specialized training, as well as to provide guidance and support to those employees during the crisis.

7. Pre-consider strategies for establishing a family assistance center, typically at a hotel, where victim families can gather to obtain information and receive emotional support and psychological first aid. Families also have an opportunity to obtain information from responding authorities.

Dan Reynolds is editor-in-chief of Risk & Insurance. He can be reached at [email protected]
Share this article:

Sponsored Content by CorVel

Telehealth: The Wait is Over

Telehealth delivers access to the work comp industry.
By: | November 2, 2015 • 5 min read


From Early Intervention To Immediate Intervention

Reducing medical lag times and initiating early intervention are some of the cornerstones to a successful claims management program. A key element in refining those metrics is improving access to appropriate care.

Telehealth is the use of electronic communications to facilitate interaction between a patient and a physician. With today’s technology and mass presence of mobile devices, injured workers can be connected to providers instantaneously via virtual visits. Early intervention offers time and cost saving benefits, and emerging technology presents the capability for immediate intervention.

Telehealth creates an opportunity to reduce overall claim duration by putting an injured worker in touch with a doctor including a prescription or referral to physical therapy when needed. On demand, secure and cost efficient, telehealth offers significant benefits to both payors and patients.

The Doctor Will See You Now

Major healthcare players like Aetna and Blue Cross Blue Shield are adding telehealth as part of their program standards. This comes as no surprise as multiple studies have found a correlation between improved outcomes and patients taking responsibility for their treatment with communications outside of the doctor’s office. CorVel has launched the new technology within the workers’ compensation industry as part of their service offering.

“Telehealth is an exciting enhancement for the Workers’ Compensation industry and our program. By piloting this new technology with CorVel, we hope to impact our program by streamlining communication and facilitating injured worker care more efficiently,” said one of CorVel’s clients.

SponsoredContent_Corvel“We expect to add convenience for the injured worker while significantly reducing lag times from the injury to initiating treatment. The goal is to continue to merge the ecosystems of providers, injured workers and payors.”

— David Lupinsky, Vice President, Medical Review Services, CorVel Corporation

As with all new solutions, there are some questions about telehealth. Regarding privacy concerns, telehealth is held to the same standards of HIPAA and all similar rules and regulations regarding health information technology and patients’ personal information. Telehealth offers secure, one on one interactions between the doctor and the injured worker, maintaining patient confidentiality.

The integrity of the patient-physician relationship often fuels debates against technology in healthcare. Conversely, telehealth may facilitate the undivided attention patients seek. In office physicians’ actual facetime with patients is continually decreasing, citing an average of eight minutes per patient, according to a 2013 New York Times article. Telehealth may offer an alternative.

Virtual visits last about 10 to 15 minutes, offering more one on one time with physicians than a standard visit. Patients also can physically participate in the physician examination. When consulting with a telehealth physician, the patient can enter their vital signs like heart rate, blood pressure, and temperature and follow physical cues from the doctor to help determine the diagnosis. This gives patients an active role in their treatment.

Additionally, a 2010 BioMed Central Health Services Research Report is helping to dispel any questions regarding telehealth quality of care, stating “91% of health outcomes were as good or better via telehealth.”

Care: On Demand

By leveraging technology, claims professionals can enhance an already proactive claims model. Mobile phones and tablets provide access anywhere an injured worker may be and break previous barriers set by after hours injuries, incidents occurring in rural areas, or being out of a familiar place (i.e. employees in the transportation industry).

With telehealth, CorVel eliminates travel and wait times. The injured worker meets virtually with an in-network physician via his or her computer, smart phone or tablet device.

As most injuries reported in workers’ compensation are musculoskeletal injuries – soft tissue injuries that may not need escalation – the industry can benefit from telehealth since many times the initial physician visit ends with either a pharmacy or physical therapy script.

In CorVel’s model, because all communication is conducted electronically, the physician receives the patient’s information transmitted from the triage nurse via email and/or electronic data feeds. This saves time and eliminates the patient having to sit in a crowded waiting room trying to fill out a form with information they may not know.

Through electronic correspondence, the physician will also be alerted that the injured worker is a workers’ compensation patient with the goal of returning to work, helping to dictate treatment just as it would for an in office doctor.

In the scope of workers’ compensation, active participation in telehealth examinations, accompanied by convenience, is beneficial for payors. As the physician understands return to work goals, they can ensure follow up care like physical therapy is channeled within the network and can also help determine modified duty and other means to assist the patient to return to work quickly.


Convenience Costs Less

Today, convenience can often be synonymous with costly. While it may be believed that an on demand, physician’s visit would cost more than seeing your regular physician; perceptions can be deceiving. One of the goals of telehealth is to provide quality care with convenience and a fair cost.

Telehealth virtual visits cost on average 30% less than brick and mortar doctor’s office visits, according to California state fee schedule. In addition, “health plans and employers see telehealth as a significant cost savings since as many as 10% of virtual visits replace emergency room visits which cost hundreds, if not thousands, of dollars for relatively minor complaints” according to a study by American Well.

“Telehealth is an exciting enhancement for the Workers’ Compensation industry and our program. By piloting this new technology with CorVel, we hope to impact our program by streamlining communication and facilitating injured worker care more efficiently,” said one of CorVel’s clients.

Benefits For All

Substantial evidence supports that better outcomes are produced the sooner an injured worker seeks care. Layered into CorVel’s proactive claims and medical management model, telehealth can upgrade early intervention to immediate intervention and is crucial for program success.

“We expect to add convenience for the injured worker while significantly reducing lag times from the injury to initiating treatment,” said David Lupinsky, Vice President, Medical Review Services.

“The goal is to continue to merge the ecosystems of providers, injured workers and payors.”

With a people first philosophy and an emphasis on immediacy, CorVel’s telehealth services reduce lag time and connect patients to convenient, quality care. It’s a win-win.

This article was produced by CorVel Corporation and not the Risk & Insurance® editorial team.

CorVel is a national provider of risk management solutions for employers, third party administrators, insurance companies and government agencies seeking to control costs and promote positive outcomes.
Share this article: