Healthcare Ethics and Workplace Laws

Ethics and the Workplace

• Health care is a business, but most people choose it to help others
• Most healthcare professions balance running a successful business with helping society via a code of ethics
• Understanding laws and ethical principles in healthcare is vital

Workplace Laws and Healthcare Professionals

• The Fair Labor Standards Act (FLSA) of 1938 sets minimum wage limits, regulates overtime pay, and establishes youth employment guidelines
• All employers must comply with the FLSA, except small, independently owned construction, retail, and service businesses
• Certain provisions apply specifically to healthcare professionals
• The Equal Pay Act prohibits sex-based wage differences in the same establishment for jobs requiring equal skill, effort, and responsibility under similar working conditions
• Pay rates can vary due to factors like years on the job, education, etc
• The Family and Medical Leave Act requires employers to allow up to 12 weeks of unpaid, job-protected leave each year after 1 year of employment with at least 1,250 hours worked, given qualifying circumstances
• Leave can be requested for the birth of a child, adoption, foster care, care of a sick child/spouse/parent, or the employee's serious health condition
• The Affordable Care Act requires employers to provide reasonable break time for new mothers to pump breast milk for 1 year after the child's birth, and an appropriate setting excluding bathrooms
• This act also requires businesses to provide some form of healthcare insurance if they have more than a certain number of full-time employees
• The Wage and Hour Division of the U.S. Department of Labor oversees and enforces these laws, except for the Equal Pay Act
• The Equal Employment Opportunity Commission (EEOC) oversees the Equal Pay Act and other important laws for healthcare professionals
• The Civil Rights Act of 1964 prohibits discrimination based on sex and race during hiring, promoting, and firing
• Title VII of this act prohibits employment discrimination based on race, color, religion, sex, or national origin
• The Age Discrimination in Employment Act of 1967 prohibits employment discrimination against individuals 40 years of age or older
• The Rehabilitation Act of 1973 requires nondiscrimination against qualified individuals based on disability by employers, if they are able to perform job duties with minimal accommodations
• This act applies to organizations receiving federal financial assistance (ex: Medicaid reimbursement to a hospital)
• The Pregnancy Discrimination Act of 1978 amends Title VII of the Civil Rights Act and makes it illegal for an employer to refuse to hire a woman because she is pregnant, fire her for being pregnant, or force her to take maternity leave
• The Americans with Disabilities Act (ADA) of 1992 prohibits discrimination against individuals with physical or mental disabilities, extending the Rehabilitation Act of 1973 to all employers with at least 15 employees
• Disability is defined as any substantial physical or mental impairment that limits at least one significant life activity (ex: walking, cognition, breathing, communication, seeing)
• The ADA includes individuals with AIDS and HIV infections, past disabilities, and association with someone who is disabled
• Employers might be required to make minor modifications to the work environment for employees with disability
• Job offers can be contingent on a medical examination, but only if the examination is required of all potential employees
• During the interview process, the EEOC has strict guidelines to prevent discrimination
• Any suspected cases of discrimination may be filed in person, by mail, or by phone at the nearest EEOC office
• An individual generally has 180 days to file a complaint for violations of the Civil Rights Act, the Americans with Disabilities Act, or the Age Discrimination Act
• If the EEOC determines that discrimination has occurred, it will first contact the employer and attempt to conciliate
• Conciliation might involve asking the company to hire/rehire, promote, or award back pay to the victim of discrimination
• The employer might also be fined and forced to make policy changes
• If conciliation fails, the EEOC will file a lawsuit on the victim's behalf
• The victim can hire a private lawyer and sue the employer at his or her own expense
• The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) refers to an employee's right to purchase healthcare benefits available from his or her employer for a certain length of time
• Other health insurance options are under the Affordable Care Act, which prevents refusal of coverage due to pre-existing conditions or a brief lapse in coverage
• The Occupational Safety and Health Act is administered by the Occupational Safety and Health Administration (OSHA), regulating the safety and health conditions of most private and public work environments
• Employers must maintain a safe work environment for employees and patrons, and OSHA has laws specific to the healthcare industry
• More workers are injured in healthcare and social services industries than in any other industry
• Risks for injuries include exposure to bloodborne pathogens/biologic hazards/chemicals/drugs, ergonomic hazards from lifting and repetitious tasks, workplace violence, laboratory hazards, and exposure to radioactive materials

The Healthcare Team—What is Your Role?

• Starting a job in healthcare can be overwhelming because there are many different types of professionals that interact
• Professionals have different roles and responsibilities known as scope of practice
• It is necessary to understand the general scope of practice of each profession to work as a team
• Knowing the various roles of healthcare professionals can help overall relations in the workplace
• Standards of professionalism that must be observed to provide a safe environment for patients include: keeping up to date with training and education, addressing the health needs of society, complying with laws and regulations, acting in a trustworthy manner, and completing job tasks in a prompt and dependable manner
• Healthcare professionals must follow the code of ethics related to their profession, and it is simple to find the code of ethics for a professional organization online
• Most states have laws related to licensure and certification called medical practice acts that vary from state to state and serve to govern the practice of medicine
• After obtaining a degree, a healthcare professional needs to obtain a license or certificate from the state in which he or she wishes to obtain a job
• Information on licensure and certification can be found through the websites of professional organizations
• In general, ethical violations should be reported at the place of employment first, but if a supervisor is the one behaving unethically, it might be necessary to file a complaint at the state medical society or licensing board
• Once a complaint is filed, the licensing board completes an investigation, seeking evidence and witnesses
• If a healthcare professional is found to have committed an ethics violation, there is a risk of civil penalties, job loss, and loss of license
• If an employer decides to discipline the healthcare professional rather than terminate him or her, they might use a progressive discipline model to encourage the employee to improve job performance
• Progressive discipline models involve providing counseling or a verbal warning, giving a written warning with specific guidelines, suspending or demoting the employee, and terminating the employee

Putting It All Together

• Types of penalties only apply to healthcare professionals who have committed an ethical violation
• Any criminal action would be treated differently, and the proper authorities should be notified immediately
• If termination is needed, it must be done fairly and through proper channels with any actions leading up to the termination must be well documented
• Always be sure that an employee understands his or her role in the workplace and that clear expectations are given
• Laws do not always stay the same, so it is necessary to stay up to date on new laws or any changes to existing laws
• Ethical policies, on the other hand, stay fairly consistent, but might need reviewed with staff