Healthcare Workplace Ethics & Laws

• Ethics in the workplace involves creating a just environment for all.

Chapter Objectives

• The chapter aims to educate on employment laws in healthcare.
• Readers can learn how to respond to discrimination, find relevant ethics codes, and understand medical practice acts.
• The chapter will also delve into ethical concerns in healthcare, reporting violations, and progressive discipline.

Key Terms

• Key terms include the Affordable Care Act, Age Discrimination in Employment Act, and Americans with Disabilities Act (ADA).
• The Civil Rights Act, Equal Employment Opportunity Commission (EEOC), and Equal Pay Act are defined.
• Other terms include Fair Labor Standards Act (FLSA), Family and Medical Leave Act, medical practice acts, and Occupational Safety and Health Act.
• Also includes Pregnancy Discrimination Act, progressive discipline model, and Rehabilitation Act

Workplace Laws and Healthcare Professionals

• Employers must comply with several federal laws.
• The Fair Labor Standards Act (FLSA) of 1938 sets minimum wage limits, regulates overtime pay, and establishes youth employment guidelines.
• Compliance with FLSA is mandatory for all employers, excluding small, independently-owned construction, retail, and service businesses
• Some provisions of the FLSA 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 differences can be based on factors such as years on the job or education.
• 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 that includes at least 1,250 hours of work under qualifying circumstances.
• The 12 weeks may include existing sick leave and vacation time.
• Employees can request leave for the birth and care of a child, adoption, foster care, caring for a sick family member, or for the employee's own serious health condition.
• The Affordable Care Act (signed into law in March 2010), mandates reasonable break time for new mothers to pump breast milk for 1 year after the child's birth.
• This act requires a suitable setting (excluding bathrooms) for expressing milk and requires businesses to provide health insurance if they have a certain number of full-time employees.

Civil Rights Act & EEOC

• The Wage and Hour Division of the U.S. Department of Labor oversees and enforces these laws, excluding the Equal Pay Act.
• The Equal Employment Opportunity Commission (EEOC) actually oversees the Equal Pay Act, despite being a provision of the Fair Labor Standards Act (FLSA)
• The EEOC also oversees other laws important to healthcare professionals.
• The Civil Rights Act of 1964 prohibits discrimination based on sex and race in hiring, promoting, and firing practices.
• 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 prohibits discrimination against qualified individuals based on disability, requiring reasonable accommodations if the disabled individual can perform required job duties.
• This act applies only to organizations receiving federal financial assistance, such as Medicaid reimbursement to a hospital.
• The Pregnancy Discrimination Act of 1978 amends Title VII of the Civil Rights Act, making it illegal to refuse to hire a woman because she is pregnant or to force her to take maternity leave.
• The Americans with Disabilities Act (ADA) of 1992 prohibits discrimination against individuals with physical or mental disabilities and extends the Rehabilitation Act of 1973 to employers with at least 15 employees.
• A substantial physical or mental impairment that limits at least one significant life activity (e.g., walking, cognition, breathing, communication, seeing) is considered a disability; this act includes individuals with AIDS and HIV infections.
• The ADA applies to past disabilities and association with someone who is disabled.
• Employers may need to modify the work environment, such as ramps or handicapped-accessible bathrooms.
• Employers can refuse to hire the individual if accommodations cause undue hardship or the person cannot perform specific job functions, but job offers can be contingent on a medical examination that is required of all potential employees.
• During interviews, it is acceptable for future employees to volunteer details on age, marital status, or religion, but employers should not ask those types of questions.
• The EEOC has strict guidelines to ensure questions are not discriminatory.
• Individuals have 180 days to file a complaint for violations of the Civil Rights Act, the Americans with Disabilities Act, or the Age Discrimination Act.
• The EEOC will attempt conciliation by asking the employer to hire, rehire, promote, or award back pay if discrimination has occurred; the employer might face fines and policy changes.
• The EEOC can file a lawsuit on the victim's behalf if conciliation fails.
• Victims of discrimination can also hire a private lawyer and sue the employer at their own expense.
• The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) allows employees to purchase healthcare benefits from their former employer for a certain time.
• Other health insurance coverage options are available through the Affordable Care Act.
• The Affordable Care Act 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).
• OSHA is responsible for regulating the safety and health conditions of most private and public work environments.
• Employers must maintain a safe work environment for employees and patrons.
• OSHA has laws specific to the healthcare industry.
• Risks for injuries include exposure to bloodborne pathogens, biologic hazards, chemicals, and drugs as well as ergonomic hazards from lifting and repetitious tasks.
• Also included are workplace violence incidents

OSHA

• More workers are injured in healthcare and social services industries than in any other industry.
• Potential hazards include laboratory hazards and exposure to radioactive materials, including x-rays.
• The Occupational Safety and Health Administration was founded by President Richard Nixon in 1971.
• OSHA's original focus was on marine cargo handling, roofing and sheet metal work, meat products, and lumber products.
• Healthcare professionals must be aware of potential health and safety risks, and employers must raise awareness of risks, train employees in safe practices (e.g., proper disposal of hazardous waste and proper lifting techniques), and stay updated on OSHA regulations.

The Healthcare Team

• Standards of professionalism include keeping up to date with training and education, addressing the health needs of society and complying with laws and regulations
• Standards of professionalism also include acting in a trustworthy manner toward patients, employers, and fellow employees, and completing job tasks in a prompt and dependable manner.
• Medical practice acts vary by state and govern medical practice and a healthcare professional needs to obtain a license or certificate from the state of employment.

Reporting Misconduct

• Ethical violations should be reported at the place of employment first.
• Approaching the employee might be beneficial, a discussion with a supervisor or submitting information to an anonymous box may also be considered.
• If a supervisor is the one behaving unethically, a complaint should be filed with the state medical society or licensing board.
• While some states allow anonymous complaints to be filed, certain states (e.g., Texas) no longer do.
• Complaints are kept confidential to protect those who file them.
• The licensing board will investigate, seeking evidence and witnesses if necessary.
• If a healthcare professional has committed an ethics violation, there is a risk of civil penalties, job loss, and loss of license.
• No criminal charges can be filed for strictly ethical violations.
• The healthcare professional may be required to pay restitution to the affected parties.
• State licensing boards will determine whether to suspend or revoke the employee’s license.
• Employers can discipline or terminate the employee.
• A progressive discipline model improves job performance rather than to punish, and typically involves providing counseling or a verbal warning.
• The employer would next give a written warning with specific guidelines, suspend or demote the employee, and finally, terminate the employee.

Penalties

• Penalties apply only to healthcare professionals who have committed ethical violations.
• Any criminal action warrants notifying the proper authorities immediately.
• It is important to document actions leading up to termination, discuss specifics with the employee, and provide all reasons for termination.
• Employees need to understand their role and clear expectations need to be provided.
• A systematic plan for evaluation helps keep staff in line with standards and performance measures.
• Thorough interviews can help you get to know a person, but does not guarantee future ethical behavior.
• Knowing and understanding legal and ethical issues is crucial in healthcare, while staying up to date on new or changing laws and understanding that ethical policies remain fairly consistent.
• It might be necessary to review policies with staff.