MLI: Ch. 8 Workplace Law and Ethics

Basic accommodations that can be made for persons with disabilities include: p. 199

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Discrimination in the Workplace p. 188

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Material Safely Data Sheets p. 201

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Professionalism in the Workplace p. 187

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Who Is an Employer Under Title VII? p. 196

A person who employs the services of another and provides payment for those services is considered an employer. The employer has the right to control the physical conduct of the employee in performing the service. The statute does not apply to independent contractors. Parent companies are not liable under Title VII.

Employee Health and Safety p. 200

Both state and federal laws regulate issues affecting an employee's health and safety. State law can be stricter than the federal law, it cannot be more lenient.

National Labor Relations Board (NLRB)

Enforces the National Labor Relations Act

Who is an Employee Under Title VII? p. 196

If an employer witholds employment taxes from a person's income, than that person is considered an employee.

List several questions that may be legally asked during an employment interview

Legal questions a. Age—Only legal to ask if he or she is between 17 and 70; if the person's age falls outside this boundary, then it is legal to ask only the birth date. b. Birthplace—Legal, but inadvisable to ask where the applicants, their parents, spouse, or children were born. It is illegal to ask about their national heritage or nationality or that of their spouse. c. Address—Legal to ask, along with how long applicant has lived there. d. Married/Maiden Name—Legal, but inadvisable. e. Citizenship—Legal to ask, "Are you a citizen of the United States?" f. Organizations person belongs to—Legal to ask if applicant belongs to any organizations. g. Languages—Legal to ask what language a person can speak and write, but can be perceived as discriminatory and a method to determine a person's national origin. h. Military experience—Legal to ask if person was a member of the armed forces and when he or she was discharged. Cannot ask what type of discharge was received. i. If ever convicted of a crime—legal. Illegal questions a. Age—Cannot ask for the applicant's specific age if it falls between 17 and 70. b. National heritage or that of applicant's spouse. c. If applicant rents or owns home. d. If applicant has children. e. Height and weight. f. Race or color. g. Religion or creed. h. If applicant has ever been arrested. i. Any handicaps. j. Memberships in any specific organizations. k. What type of military discharge.

Equal Pay Act of 1963 p. 204

Makes it illegal for an employer to discriminate on the basis of gender in the payment of men and women who are doing the same job.

Discuss the regulations concerning equal employment opportunity and employment discrimination.

Occupational Safety and Health Act (OSHA) of 1970—Under OSHA, an employer is required by law to provide a safe and healthy work environment. The employer must protect the worker against hazards. Clinical Laboratory and Improvement Act (CLIA) of 1988, 1992—The federal government now requires that all clinical laboratories that test human specimens must be controlled. These standards mandate written policies and procedures for a comprehensive quality assurance program to evaluate the overall quality of the laboratory testing process. Health Maintenance Organization (HMO) Act of 1973—This act requires any company with at least 25 employees to provide an HMO alternative to regular group insurance for their employees if an HMO is available in the area. Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985—Under COBRA, a company with 20 or more employees must provide extended healthcare insurance to terminated employees for as long as 18 months—usually, but not always, at the employee's expense. Drug-Free Workplace Act of 1988—Under this act, employers contracting to provide goods or services to the federal government must certify that they maintain a drug-free workplace.

Privacy and the Workplace p. 188-189

Opening a patient's medical file should always be on a "need to know" basis. Any other reason may constitute an illegal action.

Discuss the regulations affecting employee compensation and benefits.

Social Security Act of 1935—This federal law covers all private and most public sector employees. It laid the groundwork for unemployment compensation in the United States. Social Security is paid by the employer and the employee in equal payroll taxes and Medicare participant premiums. Fair Labor Standards Act (FLSA) of 1938—This is the main statute regulating benefits. It establishes the minimum wage, requires payment for overtime work, and sets the maximum hours employees covered by the act may work. Equal Pay Act of 1963—This act makes it illegal for an employer to discriminate on the basis of gender in the payment to men and women who are performing the same job. Unemployment Compensation—The unemployment compensation laws provide for temporary weekly payments for the unemployed worker. Federal Insurance Contribution Act (FICA) of 1935—Under this law, employers are required to contribute to Social Security plans for their employees. Workers' Compensation Act—This statute protects workers and their families from financial problems resulting from employment-related injury, disease, and even death. Employee Retirement Income Security Act (ERISA) of 1974—ERISA regulates employee benefits and pension plans. Family and Medical Leave Act (FMLA) of 1994—This law allows both parents to take a leave of absence of up to 12 weeks in any 12-month period when a baby is born. The employees' jobs, or equivalent ones, must be available when both return to work. The FMLA also requires employers to provide unpaid leave for up to 12 weeks to employees who request leave for their own or a family member's medical or family-related situation, such as birth, death, or adoption.

Equal Employment Opportunity and Employment Discrimination Laws p. 195

Table 8.3

National Employee Health and Safety Laws p. 200

Table 8.4

List of Potentially Infectious Materials p. 201

Table 8.5

List of CLIA Laboratory Requirements p. 201

Table 8.6

Compensation and Benefits Regulations p. 204

Table 8.7 These laws influence the compensation (salary) and benefits provided to employees.

Consumer Protection and Collection Practices p. 206-207

Table 8.8

Guidelines for Collection Efforts p. 209

Table 8.9

Equal Employment Opportunity and Employment Discrimination p. 194

The government regulates the employment relationship, including laws affecting: • recruitment • placement • pay plans • benefits • penalties • termination The basis of the law is that people must be judged primarily by their job performance. Employment-at-Will Concept

The Statue of Limitations p. 210

This statute defines how long a medical practice has to file suit to collect on a past-due account. • The time limit varies from state to state • Consult with an attorney • If an aging account is more than three years old, the creditior should investigate the state's statute of limitations before investing time, effort , and money to collect the debt. • Avoid issues by collecting debts as soon as possible

Quid pro quo p. 196

a Latin term meaning "something for something".

Ethnocentric p. 189

a belief that one's cultural background is better than any other

Employment-at-will p. 195

a common-law doctrine of employment that takes place at either the will of the employer or the employee when a contract is not present. Employment may be terminated at will, without notice, at any time,and without a reason. An employee may quit at any time. The only protection is that employees cannot be fired for an illegal reason (race, religion, etc.) This does not apply if there is a contract between the employer and employee that defines the duration of the employment. This concept is beginning to lose favor as wrongful-discharge lawsuits rise.

Vesting p. 206

a point in time, such as after 10 years of employment, when an employee has the right to receive benefits from a retirement plan.

Occupational Exposure p. 200

a reasonable anticipation that the employee's duties will result in skin, mucous membrane, eye, or parental contact with bloodborne pathogens or other potentially infectious material.

Emergency Medical Treatment and Active Labor Act (EMTALA) p. 207

a section of COBRA dealing with patient dumping. • Patients must be stabilized before transfer or sent to a regional trauma center if they cannot be stabilized • A person reporting patient dumping may not be peanalized • Hospitals can be fined or have their Medicare agreements dropped • The patient can sue the hospital • A physician can be penalized if he/she misrepresents a patient's condition • EMTALA does not apply to HMOs, private clinics, or private phusician's offices.

Patient dumping p. 207

a slang term for transferring patients from one hospital to another if the patient is unable to pay for services.

Recommendations for Good Hiring Practices p. 191-192

a. Develop clear policies and procedures on hiring, discipline, and termination of employees. b. Effectively screen backgrounds. c. State in writing that the employee handbook is not a contract. d. Use a two-tier interview screening process. e. Carefully assess the applicant's skill level. f. Develop an application form that provides accurate information about the applicant's qualifications. g. Provide a job description for every position. h. Develop a progressive disciplinary procedure and make this policy known to all employees and supervisors. i. Provide in-service training to supervisors on how to conduct job interviews and how to motivate and discipline employees. j. Become familiar with the legal and illegal employment interview questions.

Family and Medical Leave Act (FMLA) of 1994 p. 206

allows both the mother and the father to take a leave of absence for up to 12 weeks, in any 12-month period, when a baby is born. • The employees job, or an equivalent position, must be held. • In most cases the leave is without pay. • FMLA also allows an employee to take 12 weeks for a family members medical situation (birth, death, adoption). • The employees heath coverage must be maintained • Accumulated employee benefits cannot be lost

Equal Employment Opportunity Act (EEOA) of 1972 p. 193 & 197

authorizes the EEOC to sue employers in federal court on behalf of people whose rights have been violated under Title VII.

Garnishment p. 209

court order that requires an employer to pay a portion of an employee's paycheck to one of the employee's creditors until the debt is resolved.

Bloodborne pathogens p. 200

disease-producing microorganisms transmitted by means of blood and body fluids containing blood.

Drug Free Workplace Act of 1988 p. 203

employers contracting to provide goods or services federal government must certify that they maintain a drug free workplace. • Drug-using employees are expensive in terms of decreased productivity, workplace, accidents, and increased healthcare costs. • To prevent abuse some organizations require drug testing as a condition of employment.

Pregnancy Discrimination Act of 1978 p. 197

employers must treat pregnant women as they would any other employee, providing they can still do the job. • An employer cannot force a woman to quit her job because she is pregnant • A woman cannot be refused a job because she has had an abortion • The employer's medical plan must cover pregnancy the same way it covers medical conditions. • The woman is entitled to sick leave the same as other employees

Clinical Laboratory Improvement Act (CLIA) p. 202

established minimum quality standards for laboratories. • The federal government requires all clinical laboratories that test human specimens must be controlled. • 1992 - mandate written policies and procedures for a comprehensive quality assurance program • most tests are regulated except simple ones that would not negatively impact a patient if the result were erroneous • The FDA is responsible for categorizing the tests and allowing the waiver of testing • Tests performed at home are general waived but the manufacturer must request the waiver • Tests that use a microscope, calculations, or a judgement call are not waived • A complete list of waived tests is on hcfa.gov/medicaid/clia and www.cola.org

Fair Credit Reporting Act of 1971 p. 207

establishes guidelines for use of an individual's credit information • If a patient is denied credit based on a poor credit rating from a credit agency, the patient must be notified of this fact and given the name and address of the reporting agency. • The agency must disclose the information to the consumer and correct any outdated or erroneous information.

Fair Labor Standards Act (FLSA) p. 205

establishes the minimum wage, requires payment for overtime work, and sets the maximum hours employees covered by the act may work. • This is the main statute regulating employee benefits. • Over time must be provided at time and a half if over 40 hours are worked each week • Hospitals are an exception when they make an agreement with their employed to establish a work period of 14 days. Overtime then starts at 80 hours. • This law affects only full-time, hourly employees. • Salaried, management, part-timers, and time-sharers usually do not benefit from this law.

Social Security Act of 1935 p. 203

federal law that covers all private and most public sector employees. • This act laid the groundwork for unemployment compensation in the United States. • Social Security is paid by the employer and the employee in equal payroll taxes and Medicare participant premiums. • Social Security is composed of different but related programs: - retirement - disability - dependent - survivor's - Medicare health benefits • The amount paid to the beneficiary is calculated based on the worker's average wages earned during his/her working lifetime.

Autonomy p. 190

independence. As long as a person is competent, he or she has the right to make their own decisions. Bioethical and legal issues arise when a person is called upon to make decisions based upon his or her own religious beliefs, for another person such as a child or incompetent adult. Guardianship may have to be established by the courts so the best interested of the patient are observed.

Bankruptcy p. 209

is a legal method for providing some protection to individual debtors who owe money by establishing a fair method of distribution of the debtor's assets to all the creditors. • Once a debtor files for bankruptcy, a creditor (such as a physician who is owed an outstanding debt) may no longer seek payment from the patient, but must instead file a claim in bankruptcy court at a later date. • A creditor who fails to comply with bankruptcy laws, such as harassing the debtor, can be cited for contempt of court.

Right-to-know laws p. 200

laws that give employees access to workplace safety information.

Wrongful discharge p. 195

lawsuit in which the employee believes the employer does not have a just cause, or legal reason, for the firing.

Just cause p. 195

legal reason.

Parenteral p. 200

medication route other than the alimentary canal (oral and rectal), including subcutaneous, intravenous, and intramuscular routes.

Equal Employment Opportunity Commission (EEOC) p. 193

monitors Title VII of the Civil Rights Act. It has strict guidelines on the types of questions that can be asked during a job interview. • EEOC monitors Title VII and the Justice Department enforces the statute.

Stereotyping p. 189

negative generalities concerning specific characteristics about a group are applied to an entire population.

Consolidated Omnibus Budget Reconciliation Act (COBRA) p. 203

offers government financing for health insurance coverage continuation after an employee has been laid off a job. • This is an important act because it has helped decrease the number of uninsured Americans. • A company with 25 or more employees must provide extended healthcare insurance to terminated employees for up to 18 months - usually at the employee's expense. • COBRA also contains an amendment called EMTALA which prohibits "patient dumping"

Preempt p. 194

overrule.

Med Tips

p. 188 - Efficiency is getting the job done; effectiveness is doing the job right! p. Employees should receive a 30 minute lunch break and 2 two 15 minute breaks during each 8-hour work day. The exact policy is established by individual states by the Department of Labor.

Civil Rights Act of 1991 p. 191 & 196

permits the court to award both compensatory damages and punitive damages to mistreated employees. • Prior to this amendment only compensatory damages were awarded • Wrongful discharge suits fall under this law. • Hospitals cannot discriminate against employees and employees cannot discriminate against patients.

Creditor p. 209

person or institution to whom a debt is owed.

Debtor p. 209

person who owes money to another person.

Equal Credit Opportunity Act of 1975 p. 207

prohibits businesses (including hospitals) from granting credit based on race and gender—unfair treatment is referred to as discrimination.

Title VII of the Civil Rights Act p. 195

prohibits discrimination in employment based on five criteria: race, color, religion, gender, or national origin. • This proposal from the Kennedy administration is considered one of the most important pieces of all legislation. • This act applies to all organizations that have 20 or more employees working 20 or more weeks a year. • Some of the most frequent violations in the healthcare employment field are related to Title VII issues. • Title VII also makes sexual harassment a form of unlawful sex discrimination.

National Labor Relations Act of 1935 or The Wagner Act p. 199

prohibits employer actions, such as attempting to force employees to stay out of unions, and labels these actions as "unfair labor practices."

Rehabilitation Act of 1973 p. 198

prohibits employers from discriminating against the handicapped. • This act prohibits discrimination based on disability in any institution that receives federal financial assistance. (e.g., a hospital that receives Medicare or Medicaid reimbursement must comply with this law). • This act had a major influence on the Americans with Disabilities Act of 1990 because it included a broad definition of "handicapped" (people with physical or mental impalement) • This act give legal basis for claims challenging denial for employment because of physical or mental reasons.

Americans with Disabilities Act (ADA) of 1973 p. 198

prohibits employers who have more than 15 employees from discriminating against disabled individuals. • There are 43 million disabled persons in the U.S. • Persons with AIDS are also covered under this act. • Employers must make reasonable accommodations to make the work environment accessible to their disabled employees. • Exceptions occur if making the accommodations would put undue hardship for the employer. • The vagueness of term "undue hardship" has caused problems interpreting this law. • Employers have a 2 years to implement the accommodations. • Patients are also protected under this statute.

Fair Debt Collection Practices Act of 1987 p. 208

prohibits unfair collection practices by creditors. • The FCC issued guidelines for specific times that credit collection phone calls can be made (8 a.m. - 9 p.m.) • It prohibits harassment and threats • Guidelines on page 209 • Billing and collections personnel must have a full understanding of the laws regulating the collection process

Age Discrimination in Employment Act (ADEA) of 1967 p. 197

protects persons 40 years or older against employment discrimination because of age. • Applies to employers who have 20 or more employees. • Does not apply if the older employee does not have the ability to perform the job • The employer must be able to show in writing why the younger job applicant was hired over the older one. • Mandatory retirement is prohibited under this law except for certain exempt executives. • People over 40 are protected by ADEA and Title VII.

Worker's Compensation Act p. 205

protects workers and their families from financial problems resulting from unemployment related injury, disease, and death. • Employers typically pay into a fund to help cover costs when a worker is hurt during the course of employment. • The goal of worker's compensation is to get the worker pack to work as soon as possible. • COBRA may allow for a retraining opportunity if the injury results in permanent inability to work the same job • If the employee has only worked at the job a few months, the former employer may have to pay worker's compensation. • Some medical practices specialize in worker's compensation cases • Worker's Compensation is completely administered at the state level • The employee must submit written notice of the injury to the employer • Worker's Compensation pays a fraction of the normal salary, such as 2/3. • Available even if the employee is at fault for the injury, except employees who violate hospital policy • An employee who is injured by a nonemployee can collect Workman's Compensation and sue the nonemployee for damages.

Unemployment Compensation p. 205

provides for temporary weekly payments for the unemployed worker who lose their job through no fault of their own. • In order to receive unemployment insurance, the employee must have worked for an employer who has paid, or was required to pay, unemployment compensation taxes. • Exemptions apply for religious, educational, or charitable organizations. • Employees who are fired for a good cause cannot collect unemployment benefits.

Employee Retirement Income Security Act (ERISA) p. 194 & 206

regulates employee benefits and pension plans. • ERISA requires employers to earmark money that can only be used to pay future benefits. • Guarantees vesting of pension plans • Under ERISA, employees who stay with a company for 10 years are entitled to 50 percent of the employer's retirement plan even if they leave the company and take another job. • The employee is entitled to 100% of the employer's pension contribution after fifteen years of employment when he or she becomes fully vested. • ERISA protects employees from being laid off just before they become vested.

Truth in Lending Act (Regulation Z) of 1969 or Regulation Z of the Consumer Protection Act p. 207

requires a full written disclosure about interest rates or finance charges concerning the payment of any fee that will be collected in more than four installments. • Installment payments are often used for orthodontia, obstetrical care, and surgical treatment. • It is legal to include a finance charge, however, few physicians and dentists require the charge.

Occupational Safety and Health Act (OSHA) of 1970 p. 200

requires an employer to provide a safe and healthy work environment; the employer must protect the worker against hazards. • OSHA regulations preempt all other state and local regulations regarding employee safety and health, meaning that states may not pass any laws concerning the working environment. • Right-to-know laws • Employers and office managers should become familiar with OSHA regulations as they apply to their specific fields. This protects employees and avoids fines for OSHA violations which can be severe. • Poor publicity from OSHA violations can damage an office or company's reputation. • It is better to err on the side of being to cautious when implementing OSHA regulations.

Health Maintenance Organization Act (HMO) of 1973 p. 202

requires any company with at least 25 employees to provide an HMO alternative to regular group insurance for their employees if an HMO is available in the area

Federal Insurance Contribution Act (FICA) of 1935 p. 205

requires employers to contribute to Social Security for employees. • The oldest act relating to compensation. • Employers are required to contribute to Social Security plans for their employees. • Severe fines ensue if the employer does not pay on time. • Detailed documentation of the employer's payments are necessary

Federal Wage Garnishment Law p. 209

restricts the amount of the paycheck that can be garnished to pay off a debt.

Affirmative action programs p. 196

to remedy discriminating practices in hiring minority group members. Also covered under Title VII. Courts may mandate that affirmative action programs be implemented if there is evidence that an employer has intentionally discriminated against a particular minority group.

Bias p. 189

unfair dislike or preference for something.

Discrimination p. 195

unfair or unequal treatment.

Religious Considerations p. 190

• Advance directives, consent to treatment, and the use of birth control devices are often influenced by a person's religious beliefs. In some cases, it may mean rejecting medical interventions such as blood transfusions or it may mean a patient rejects all medical care. • Bioethical and legal issues arise when a person is called upon to make decisions based upon his or her own religious beliefs, for another person such as a child or incompetent adult. • Guardianship may have to be established by the courts so the best interested of the patient are observed. • It is never appropriate to judge, either with verbal or nonverbal criticism, another person's religious customs and beliefs. A exception occurs when there is evidence of abuse as a result of a religious practice. • There are some beliefs that do not allow a person to receive a blood transfusion. When the patient is a child, a court order is needed for the transfusion to proceed against the objections of the parents. • Employers has a legal obligation under the Civil rights Act to make accommodations so that employees can practice their religious observations.

Hazard Communication Standard (HCS) p. 201

• An OSHA standard meant to reduce injuries and illnesses in the workforce by alerting healthcare employees to potential dangers and risks when using hazardous chemicals and materials. • MSDS must be posted wherever hazardous materials are used. • Employees are instructed to read the sheets and know how to handle the materials.

Tips for Avoiding the Negative Behaviors of Stereotyping, Bias, and Ethnocentrism p. 189

• Be aware of your coworker's and patients' beliefs • Learn as much as you can about other cultures, races, and nationalities. • Be sensitive to the feelings of others • Evaluate all information before accepting it as belief • Always avoid ethnic jokes. Walk away if a co-worker is telling ethnic or disrespectful joke • Be open to differences in other people

Federal Regulations Affecting the Medical Professional p. 194

• Both state and federal laws regulate the employer and employee relationship. • Healthcare facilities must remain current on regulations affecting employment practices such as health, safety, compensations, worker's compensation, unions, and discrimination laws. • In general federal law usually applies to organizations that employ a declared number of employees and who work a minimum number of weeks in the year. • Usually, federal law preempts state laws. An exceptions occur when: - there is no federal law on the topic - the state law does not conflict with the federal law - Congress prohibits states from regulating a certain law by complete preemption

Give examples of regulations affecting consumer protection and collection practices

• Emergency Medical Treatment and Active Labor Act (EMTALA)—A section of the Consolidated Omnibus Budget Reconciliation Act (COBRA) dealing with "patient dumping." • Fair Credit Reporting Act of 1971—This act establishes guidelines for use of an individual's credit information. • Equal Credit Opportunity Act of 1975—This act prohibits businesses, including hospitals and medical offices, from denying credit based on the applicant's race or gender—an unfair treatment referred to as discrimination. • Truth in Lending Act (Regulation Z) of 1969—This act requires a full written disclosure about interest rates or finance charges concerning the payment of any fee that will be collected in more than four installments. • Fair Debt Collection Practices Act of 1978—This act prohibits unfair collection practices by creditors. • Federal Wage Garnishment Law—This law restricts the amount of the employee's paycheck that can be used to pay off a debt (garnishment).

Effective Hiring Practices p. 191

• Employee handbooks should clearly state that they are not contracts and should be carefully examined for any erroneous or misleading statements. • Employees should be allowed to see, comment on, or copy anything affecting them in written review and personnel file memos.

Paid Sick Days p. 204

• Employees "earn" a certain number of paid sick days per year based on the number of hours worked. • These can be saved up and used when the employee has to take time off for an illness or surgery. • Sick days are not part of earned vacation days. They cannot be used except for sickness.

OSHA Occupational Exposure to Bloodborne Pathogens Standards P. 200

• Fines up to $7,000 per violation • All healthcare workers have occupational exposure • OSHA standards mandate that each employee with occupational exposure must be offered the hepatitis B vaccination at the expense of the employer. An employee may decline, in writing, to receive the vaccine. • The OSHA standard refer to urine, stool, sputum, nasal secretions, vomitus, adn sweat only if there is visible evidence of blood. • OSHA compliance checklist for medical facilities includes: - eyewash stations - fire extingishers - first-aid kits - written training programs - labels for chemical and hazardous waste - sharps containers - exit signs - spill kits - accident report forms - chemical inventory lists • OSHA guidelines are available from the U.S. Department of Labor, Washington, D.C.

Cultural Considerations p. 189

• Hygiene Practices Keep one's opinions about he use of deodorants, clean clothing, and frequent bathing to oneself, unless the patient's health is suffering as a result of poor hygiene conditions. • Communication Communication is a challenge for non-English speakers. The nods for "yes" and "no" may be switched.Non-English-speaking-patients need brochures, and handouts in their own language. An interpreter must be available when explaining important information.

Describe accommodations that can be made in the workplace for persons with disabilities.

• Parking spaces, marked for the handicapped, near an accessible doorway • Inclined ramps into buildings and over curbs in parking lots • Elevator floor numbers accessible to wheelchair-bound persons • Handicapped accessible bathrooms with handrails • Hallways with 36 inches of clearance for a wheelchair • Desks and counters that accommodate a wheelchair • Telephone adapters for the hearing impaired

Claims against Estates p. 210

• When a patient dies, a bill should be sent to the estate of the deceased. • Follow up with bill collection to avoid the impression that the physician was at fault in the patient's death • The probate department of the superior court in the county that is handling the estate can provide information on the time limits and also name the administrator of the estate.

Major categories of federal laws regulating the employer-employee relationship

• equal employment opportunity and employment discrimination • employee health and safety • compensation and benefits regulations • consumer protection and collection practices • federal labor acts