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Apply civil and criminal liability concepts to healthcare providers and consumers
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Examine the concept of ethics and its application to healthcare organizations
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DID YOU KNOW THAT?
• The healthcare industry is one of the most regulated industries in the United States
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• Voluntary hospitals are no longer exempt from lawsuits
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• Providers may order more tests and provide more services to protect themselves
from medical malpractice lawsuits
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Ethical
behavior, which is considered actions that are the right thing to do, not simply what is
required by law, must also be described because the healthcare industry is fraught with
difficult situations that involve ethical dilemmas
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resources (HR) department to make employees knowledgeable in the information presented in this chapter
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■ Basic Concepts of Law in the Healthcare Workplace
The healthcare industry is one of the most heavily regulated industries in the United
States
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Law is a body of rules for the conduct of individuals and organizations
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There exist laws created by federal, state,
and local governments
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The
minimal standard for action is federal law, although state law may be more stringent
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Both common law and statutes are
then interpreted by administrative agencies by developing rules and regulations that
interpret the law
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Civil law
focuses on the wrongful acts against individuals and organizations based on contractual violations
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To prove a civil infraction, you do not need as much evidence as in a
criminal case
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To convict someone of a criminal activity, it has to be proved without a
reasonable doubt of guilt
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As stated earlier, torts are wrongdoings that occur to individuals or organizations
regardless of whether a contract is in place
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There are several different types of violations that can apply to health care
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An example of negligence is if a provider does not give appropriate care or withholds care that results in damages to the patient’s health
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An example of invasion of
privacy would be the violation of patients’ health records
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As more information that is
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These examples are categorized under the term medical malpractice
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According to the Institute of
Medicine’s landmark report To Err Is Human, medical malpractice results in approximately 80,000 to 100,000 deaths per year
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Harvard School of Medicine researchers indicate that in 2005 nearly 20% of
hospital patients are injured during their care (Medical Negligence, 2011)
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Patients have
sued physicians because of the belief that the physician has not given the patient a level
of care comparable with the standard of care established in the industry
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In addition, some states are no longer offering malpractice insurance, which means
there are fewer physicians in needed areas resulting in geographic maldistribution
of physicians
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The issues in the 1970s led to joint underwriting measures that
required insurance companies to offer medical malpractice if the physician purchased
other insurance
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The number of malpractice suits decreased, but the amounts of
awards were still huge
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A third malpractice insurance crisis occurred in the first
decade of the 21st century
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As a result of the recent malpractice insurance crisis, more states have adopted
statutory caps on monetary damages that a plaintiff can recover in malpractice claims
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The less an insurance company has paid out in malpractice insurance claims, the less the insurance company would have to raise insurance rates
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For example, Nevada adopted a cap
of $350,000 on noneconomic damages in medical malpractice cases
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state appellate courts have declared caps to be unconstitutional (Nelson, Morrisey &
Kilgore, 2007)
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States have also developed several other tort reform measures that relate to filing claims such as limiting
attorney’s fees, setting a statute of limitations on claims, and adhering to alternative
dispute resolution methods, which are typically less costly than court disputes
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Voluntary
hospitals, which are private and not for profit, are no longer exempt from malpractice
suits
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The
concept of informed consent parameters, which means the patient is provided accurate
information prior to any medical treatment, has expanded and therefore increased
claims have occurred
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Expert witness qualifications are also specified to ensure that the witness is an
expert in his or her field
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The informed consent of
a patient to receive care was also expanded in the 1970s to become a patient-friendly
standard that specifies what information must be given to the patient to ensure he or
she is making an informed decision regarding his or her care (Office of Technology
Assessment, 1993)
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The malpractice insurance issues
have forced many states to review their malpractice guidelines
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However, recent federal studies have indicated that imposing caps on awards may be
an effective method to reduce malpractice costs and to discourage frivolous lawsuits
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It is the responsibility of the HR department to ensure that healthcare employees are
aware of these litigious issues and are trained to deal with patients in accordance with
these legal issues
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The following section outlines major human
resources-related legislation that influences the healthcare industry (Table 2
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■ Human Resource-Related Legislation
Equal Pay Act of 1963 (Amended FLSA)
This act, which amended the Fair Labor Standards Act and is enforced by the U
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Department of Labor, mandates that all employers award pay fairly to both genders
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1 Major Human Resource-Related Legislation
Equal Pay Act of 1963: All employers must provide equal pay to both genders that
have the same position with equal responsibilities and skills
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Civil Rights Act of 1964, Title VII: Landmark legislation
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Enforced by the EEOC
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Age Discrimination in Employment Act of 1967 (ADEA): Protects employees and
job applicants 40 years or older from discrimination in hiring, firing, promotion,
layoffs, training, benefits, and assignments
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Applies to
employers with 20 or more employees
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Guidelines for working with
hazardous chemicals and for working ergonomically
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Rehabilitation Act of 1973: Employers with 50 or more employees and with
federal funding of $50,000 must submit an affirmative action plan
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Enforced by the
Office of Federal Contract Compliance Programs
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Forbids employers from firing employees so the employers
do not have to pay the employee’s medical coverage
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Enforced by the U
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Department of Labor
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Applied to employers with 15 or more employees
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Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA): Passed
to ensure that if an individual changes jobs, he or she can still obtain health
insurance
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S
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Worker Adjustment and Retraining Notification Act of 1989: Employers with 100
employees or more must give their employees 60 days notice of layoffs and closings
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S
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Americans with Disabilities Act of 1990 (ADA): Protects the disabled from
employment discrimination
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Applies to employers with 15 or more employees
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Its 2008 amendments expanded the concept of disabilities
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Table 2
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Benefits must be provided to both younger and older workers
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Enforced by the EEOC
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Enables individuals to receive
monetary damages up to $300,000 because of intentional discrimination
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Applies to employers with 15 or more employees
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Family Medical Leave Act of 1993 (FMLA): Requires employers with 50 or more
employees within a 75-mile radius who work more than 25 hours per week and
who have been employed more than 1 year to provide up to 12 work weeks of
unpaid leave to an employee during any 12-month period so the employee may
provide care for a family member or obtain care for himself or herself
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Uniformed Services Employment and Reemployment Rights Act of 1994
(USERRA): Workers are entitled to return to their job after military service
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The U
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Department of Labor’s (DOL) Veterans’ Employment
and Training Service (VETS) enforces USERRA
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Enforced by U
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Health and Human Services
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Landmark legislation that strengthens employer funding requirements for employee
pension plans and creates a stronger pension insurance system
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National Defense Authorization Act of 2008: Expanded the FMLA to include
families of military service members, which means that an employee may take up
to 12 weeks of leave if a child, spouse, or parent has been called to active duty in
the armed forces
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S
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Genetic Information Nondiscrimination Act of 2008: Prohibits U
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insurance
companies and employers from discriminating based on genetic test results
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1 (Continued)
Lilly Ledbetter Fair Pay Act of 2009: An amendment to Title VII of the Civil
Rights Act of 1964 that also applies to claims under the Age Discrimination
in Employment Act of 1967 and ADA and provides protection for unlawful
employment practices related to compensation discrimination
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Patient Protection and Affordable Care Act of 2010 (PPACA): Controversial
legislation that requires individuals to purchase health insurance by 2014
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if it is determined their jobs have equal responsibilities and require the same skills
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One employee may have additional duties, which would affect his or her pay
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However, research consistently states that women earn less
than men do
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Civil Rights Act of 1964, Title VII
This landmark act prohibits discrimination based on race, sex, color, religion, and
national origin
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This legislation is the key legal piece to equal opportunity employment
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This legislation applies to employers with 15 or more employees
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The Civil Rights Act of 1964, Title VII, created a concept of protected classes to
protect these groups from employment discrimination of compensation, conditions,
or privileges of employment
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A major current issue under the purview of discrimination legislation is sexual harassment
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There are
two major distinctions in sexual harassment: (1) quid pro quo sexual harassment,
which occurs when sexual activities occur in return for an employment benefit, and
(2) when the behavior of coworkers is sexual in nature and creates an uncomfortable
work environment
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Several court case judgments indicate that repeated suggestive joke telling or lewd photos on display can be legally constituted as a hostile
work environment
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Human Resource-Related Legislation

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Older employees file lawsuits for age discrimination in job termination
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During difficult economic times, older employees’ complaints of termination increase
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This Act also limits the weekly garnishment amount from the individual’s pay
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Occupational Safety and Health Act of 1970
The OSHA Act of 1970 requires employers to provide a safe and healthy place of
employment
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Rehabilitation Act of 1973
This law applies to organizations that receive financial assistance from federal organizations, including the U
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Department of Health and Human Services, to prevent
discrimination against individuals with disabilities with respect to receipt of employee
benefits and job opportunities
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Employers
with 50 or more employees and federal contracts of $50,000 or more must submit
written affirmative action plans
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Employee Retirement Income Security Act of 1974
The Employee Retirement Income Security Act of 1974 (ERISA) regulates pension
and benefit plans for employees, including medical and disability benefits
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An employee may change the benefits
provided under his or her plan, but employers cannot force an employee to leave so
that the employer does not have to pay the employee’s medical coverage
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This act protects
female employees that are discriminated against based on pregnancy-related conditions,
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A pregnant woman must be treated like
anyone with a medical condition
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, 2012)
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Consolidated Omnibus Budget Reconciliation Act of 1986
The Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA), an amendment to ERISA, was passed to protect employees who lost or changed employers so
that they could keep their health insurance if they paid 102% of the full premium
(Anderson, Rice & Kominski, 2007b)
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COBRA also includes provisions that require hospitals to provide care to everyone
who presented at an emergency department, regardless of their ability to pay
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This component was very important because many individuals were
refused treatment because they could not pay for the services or were uninsured
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Most employees are only aware of this legislation because
of the I-9 form all new employees must complete
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Category A establishes identity and eligibility to work such as
by a passport, Permanent Resident Card, or Permanent Alien Registration Receipt
Card
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Acceptable proof of identify
includes a driver’s license and different types of identification cards with photographs
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Documentation includes a
Social Security card or birth certificate
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This
prohibits any company from hiring illegal aliens and penalizes employers who hire
illegal aliens
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This act is enforced by the U
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Department of Labor
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They
must provide education to their employees about drug abuse
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This act is enforced by the U
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Department of Labor
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Worker Adjustment and Retraining Notification Act of 1989
Employers who have 100 employees or more must give their employees 60 days notice
of layoffs and business closings
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Americans with Disabilities Act of 1990
The Americans with Disabilities Act of 1990 (ADA) focuses on individuals who are
considered disabled in the workplace
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This legislation applies to employers
who have 15 employees or more and is enforced by the EEOC
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The act was passed to ensure that those individuals who had a disability but who could perform primary job functions were not
discriminated against
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A nursing home cannot refuse to admit a person with AIDS that
requires a nursing service if the hospital has that type of service available (Americans
with Disabilities Act of 1990, 2011)
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Individuals who are morbidly obese can be considered disabled if the
obesity was related to a physical cause
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Essential functions are job duties that must be performed for an
individual to be a satisfactory employee
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The
reasonable accommodation should not cause undue financial hardship to the employer
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Intellectual disabilities refer to an IQ
less than 70–75, the disability occurred before 18 years of age, and the individual has
issues with social skills
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The ADA amendments of 2008 expanded living activities to include bodily
functions such as bladder, circulatory, neurologic, and digestive functions
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Its goal was to ensure
that older workers’ employee benefits were protected and that an organization provided
the same benefits to both younger and older workers
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to change their mind if they have signed a waiver for their right to sue
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Civil Rights Act of 1991 (Amendment to CRA of 1964)
Title VII only allowed damages for back pay
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This legislation applies to employers
with 15 or more employees
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This act is enforced by
the EEOC
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Organizations had developed a
policy of adjusting scores on employment tests so that a certain percentage of a protected class would be hired
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The amendment also created the Glass Ceiling
Commission, which examined the lack of protected classes in senior management
positions (1991–1996)
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This benefit can also include
post-childbirth or adoption
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This benefit does not cover the organization’s 10%
highest paid employees
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Health Insurance Portability and Affordability Act of 1996
The Health Insurance Portability and Affordability Act of 1996 (HIPAA) was passed
to promote patient information and confidentiality in a secure environment
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This is the first federal legislation that provides in-depth protection of consumers’ health information
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were included in this act
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Criminal penalties ranged from $50,000 to $250,000 with 1–10 years of
incarceration (Stanwyck & Stanwyck, 2009)
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HIPAA made it illegal to
obtain personal medical information for reasons other than healthcare activities, which
also includes genetic information
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Other provisions include (1) small businesses
with 2–50 employees cannot be refused insurance, (2) self-employed individuals are
allowed an increased tax deduction (30% to 80% by 2006) for health insurance premiums, and (3) employers or insurance companies cannot drop individuals for high usage of
their medical plans (Shi & Singh, 2008b)
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S
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S
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Mental Health Parity Act of 1996
This act defines the equality or parity between lifetime and annual limits of health
insurance reimbursements on both mental health and medical care
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This
federal legislation spurred several states to implement their own parity legislation
(Anderson, Rice & Kominski, 2007b)
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It gives patients new rights to access of their records,
restricts the amount of patient information released, and establishes new restrictions
to researchers’ access (The Privacy Rule, 2011)
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National Defense Authorization Act of 2008
This act expanded FMLA to include families of military service members, which means
that an employee may take up to 12 weeks of leave if a child, spouse, or parent has
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Additionally, if a service member is
injured or ill as a result of active duty, the employee may take up to 26 weeks of leave
in a single 12-month leave year (Hickman, Gilligan & Patton, 2008)
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S
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Specifically, it forbids insurance companies
from discriminating through reduced coverage or price increases
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Employers or insurance companies cannot demand a genetic test (National
Human Genome Research Institute, 2009)
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These new rules apply to any
associates of the health plans
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Civil penalties
were increased to $1,500,000 per calendar year, which was a huge increase in the
original penalty cap of $25,000
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Lilly Ledbetter Fair Pay Act of 2009
This act, an amendment to Title VII of the Civil Rights Act of 1964 that also applies to
claims under the Age Discrimination in Employment Act of 1967 and the Americans
with Disabilities Act of 1990, provides protection for unlawful employment practices
related to compensation discrimination
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The U
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Supreme Court ruled
that she should have filed a suit within 180 days of the date that Goodyear paid her
less than her peers
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To avoid litigation, Sedhom (2009) suggests the implementation of a program coordinated by senior management and HR to help protect employers from being accused
of unfair employment practices
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Establish compensation criteria
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Develop pay audits and document these audits for several years
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Document retention processes related to pay
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4
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5
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Patient Protection and Affordability Care Act of 2010
This healthcare legislation has been controversial
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People, in general, agreed that the U
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healthcare system needed some type of
reform, but it was difficult to develop common recommendations that had majority
support
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The one implementation that has been generally supported is the expansion of the
dependent coverage provided by parental health insurance from age 25 until age 26,
even if the child is not living with his or her parents, is not declared a dependent on
the parents’ tax return, is a student, or is no longer a student
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Another positive mandate, implemented in July 2010, was the establishment of a web portal, www
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gov, to increase consumer awareness about eligibility for specific healthcare insurance
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• Provision of assistance for the uninsured with preexisting conditions
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In the past, health insurance companies would establish an annual or lifetime cap
of reimbursement for the use of healthcare insurance
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Unlike the past, health insurance companies would also be prohibited from dropping
individuals and children with certain conditions or not providing insurance to those
individuals with preexisting conditions
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The following are selected major reforms that will be implemented by 2014:
• Insurance companies will be prohibited from setting insurance rates based on
health status, medical condition, genetic information, or other related factors
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• Most individuals must maintain minimum essential healthcare coverage or pay a
fine of $95, $350 in 2015, $750 in 2016, and indexed after that year
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Employers will also receive tax credits
depending on their size
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In the past, there were issues with health insurance companies denying coverage based
on health status or other conditions
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In addition, each state will establish an American
Health Benefit Exchange to assist consumers with obtaining health insurance
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There will be Public Plan Options and Consumer Operated
and Oriented Plans
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The Consumer Operated and Oriented Plans are memberrun health organizations in all 50 states and must be consumer focused with profits
targeted to lowering premiums and improving benefits
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The information will be provided to consumers in a standardized
format so they can compare the plans
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There are exceptions based on circumstances
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The purpose of these
programs is to increase the number of consumers who have access to affordable health
care
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The PPACA has affected how health insurance companies provide coverage (Niles, 2010)
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It is responsible for
processing complaints, issuing regulations, and collecting information from employers
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S
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Processing Complaints
If an individual feels discriminated against, he or she files a complaint with the EEOC,
which, in turn, notifies the employer
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The EEOC then investigates the
complaint to determine if the employer did violate any laws
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If conciliation is not successful, litigation or going to trial is the next step
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Most cases are resolved by conciliation
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They have written regulations and amendments for the ADA, ADEA,

Human Resource-Related Legislation

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They also issue guidelines for different issues such as sexual harassment and affirmative action
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These
potential employees must be qualified for the job
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They can develop strategies to encourage applications by diverse candidates
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The employer must also calculate the percentage of the protected class
among the qualified applicants
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If it is determined
that the current workforce is not diverse, then an employer develops a timetable to
hire diverse employees, which also includes a recruitment plan
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Employers
with 100 or more employees must file an EEO-1 report, which reflects the number of
women and minorities who hold positions
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The EEOC also provides written and electronic media education
about discrimination to employers
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These pieces of legislation focus on equal employment opportunity in the workplace
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In addition to this landmark legislation, the Age in Discrimination Act, Older Workers
Benefit Protection Act, and the ADA establish standards for treating individuals who
are older than 40 years, and those individuals who have a disability are also treated
fairly in their terms of employment
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In addition, the Pregnancy Discrimination Act and the Equal Pay
Act target discrimination against women
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The release of patient information is more complex because of the introduction of
information technology to the healthcare industry
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Physicians may also communicate via e-mail as long as safeguards are
implemented
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S
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It enforces
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There is a high risk of exposure to workplace
hazards such as airborne and blood-borne infectious diseases, physical injuries from
the lifting of patients, and needle-stick injuries
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Employers are also required
to inform employees of potential hazardous conditions and Occupational Safety and
Health Administration (OSHA) standards
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OSHA is responsible for enforcing these provisions
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OSHA enforces the
Hazard Communication standard, which requires companies to label hazardous materials
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OSHA has also issued a standard for
exposure to human immunodeficiency virus, hepatitis B virus, and other blood-borne
pathogens
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OSHA has also developed standards for personal protective equipment, which
mandate equipment to be used in situations of personal exposure to hazardous
materials or working conditions
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OSHA provides workers with the rights to receive training, to keep a copy
of their medical records, and to request OSHA inspections of their workplace
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Studies indicate that
repetitive motion can create employee injuries
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Employers can provide
ergonomic-friendly equipment and guidelines for ergonomic actions to eliminate these
types of injuries
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■ Basic Concepts of Ethics in the Healthcare Workplace
Ethical standards are considered one level above legal standards because individuals
make a choice based on what is the “right thing to do,” or what one ought to do, not
what are the minimal actions required by law
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Ethics has been interpreted as the moral foundation for standards
of conduct (Taylor, 1975)
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There are many definitions of ethics but,
basically, ethics is concerned with what are right and wrong choices as perceived by
Basic Concepts of Ethics in the Healthcare Workplace

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Ethical dilemmas are often a conflict between personal and
professional ethics
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The dilemma occurs when the ethical reasoning of the decision maker may conflict with the ethical reasoning of the patient and
the institution
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According to Beauchamp and Childress (2001) and Gillon (1994), the role of ethics in the healthcare industry is based on five basic values that all healthcare providers
should observe:
• Respect for autonomy: Decision making may be different, and healthcare providers
must respect their patients’ decisions
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• No malfeasance: The healthcare provider will not cause any harm when taking
action
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• Dignity: Patients should be treated with respect and dignity
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Informed consent is a legal requirement for medical intervention
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A friend who has been diagnosed with a very advanced stage of cancer was told
by her provider that she could enroll her in an experimental program that would give
her 2 to 3 months to live
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My
friend decided to try a homeopathic medicine to attack her disease
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She told her
that if she needed pain medication, she could come and see her, and she would help
her
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Beneficence means that the best interest of the patient should always be the first
priority of the healthcare provider, and no malfeasance states that healthcare providers must not take any actions to harm the patient
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For example, Jehovah’s Witnesses,
a religious sect, do not believe in blood transfusions and will not give consent during
an operation for a transfusion to occur, despite the procedure’s ability to possibly save
a life (Miller, 2006f)
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malfeasance
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Justice or fairness in health care emphasizes that patients should be treated equally
and that health care should be accessible to all
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Unfortunately, in the United States, the healthcare system does not
provide accessibility to all of its citizens
...
In countries with universal healthcare coverage, justice in the healthcare
industry is more prevalent
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Ethics
has several individual interpretations, so establishing a code of ethics, developing
ethics roundtables, creating a decision model for healthcare dilemmas, and providing
ongoing ethical training are tools that both HR and management can use to create
an ethical culture
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Codes
of ethics and HR training can assist with a solution
...
The following is an adapted version of the steps of the PLUS ethical
decision-making model:
1
...

3
...

5
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Identification of the dilemma
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Identification of alternatives to a solution
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Selection of the solution
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Application of PLUS Decision-Making Model
Healthcare Dilemma (discussed earlier): An oncologist has a patient who has an
advanced stage of melanoma (skin cancer)
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The oncologist has developed an experimental treatment program that has severe side effects but
may give the patient an additional 6 months
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Step 1: Define the problem
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This
step should define the problem and the ultimate outcome of the decision-making
process
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Application: The problem is the differing views of treatment by both the physician and the patient
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The ultimate outcome of the decision-making process is to prolong the life of the
patient if possible
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List the possible alternatives to
the desired outcome
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Alternative 1: Patient accepts experimental treatment program
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Alternative 3: Physician researches homeopathic remedies for patient
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Alternative 5: Patient seeks other medical advice from different physician
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Step 3: Evaluate the identified alternatives
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Alternative 1: Patient accepts experimental treatment program
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Negative: Treatment has no impact on cancer
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Alternative 2: Patient rejects experimental treatment program
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Negative: Patient dies shortly
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Positive: Physician finds a homeopathic remedy that can be used in conjunction
with experimental program
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Cancer is eradicated
or goes into remission
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Patient refuses treatment
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Alternative 4: Physician refuses to research homeopathic remedies for patient
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Program is successful
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Receives no treatment and dies
shortly
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Positive: Patient finds a physician that agrees with homeopathic remedies
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Alternative 6: Physician refers patient to a physician who is an expert in homeopathic medicine
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Negative: Patient is treated with a homeopathic solution that does not prolong
her life
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In the healthcare industry, the decision must include
the patient’s best interest and his or her values, which can be conflicting at times
...

In this instance, alternative 6 is chosen, because the patient believes in homeopathic
medicine
...

The physician wanted to be involved in the patient care by supporting the beliefs
of her patient
...
Once the decision is made, the physician actually
finds a physician referral that would help her patient
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Step 6: Evaluate the decision
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An evaluation process for this model would be to assess the success of the chosen
treatment
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This was an actual case
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The patient lived 3 more years with a
high quality of life
...
This model can be used in HR training
on ethical issues in the healthcare workplace
...
As
a result of many public ethical crises that have occurred, particularly in the business
world, many organizations have developed codes of ethics
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The healthcare industry is no different
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The American Medical
Codes of Ethics and the Doctor–Patient Relationship

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In
2001, the Code of Medical Ethics was amended to include the following: provide competent medical care, uphold professional standards, respect the law, respect the rights
of patients and colleagues, maintain a commitment to medical education, support
public health activities, regard patient care as the primary goal, and support medical
care access for all individuals (Medical Ethics, 2011)
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The following is a summary of the statements:
• Clinicians, healthcare plans, insurance companies, and patients should be honest
in their relationship with each other
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• Clinicians should maintain accurate patient records
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• The clinician’s primary duty is the care of the patient
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• Clinicians should recognize that all individuals, regardless of their position, should
have health care
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• Patients have a responsibility to understand their health insurance
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• Clinicians should enter agreements with healthcare plans that support ethical
standards
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• Clinicians should disclose conflicts of interest to their patients
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, 2004)
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It provided guidelines to healthcare practitioners, to healthcare organizations, and to the healthcare insurance industry about ethical actions in
the changing healthcare environment
...
The American
Nurses Association established a code for nurses in 1985, which was revised in 1995
and most recently in 2001 (American Nurses Association, 2011)
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have a code of ethics that was established in 1941 that describes the relationship with
their stakeholders and that was most recently updated in 2007
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They established a code of ethics in 1941, which was
most recently updated in 2007
...
They also offer an ethics selfassessment tool that enables employees to target potential areas of ethical weakness
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■ How to Develop a Code of Ethics
A code of ethics must be written clearly because employees at all organizational levels
will use it
...
The code must be current in
laws and regulations
...

2
...

4
...

6
...


Memorable title
Leadership letter
Table of contents
Introduction
Core values of the organization
Code provisions
Information and resources

The code of ethics must be a user-friendly resource for the organization
...
The language should be specific as
to what the organization should expect from its employees
...


■ Ethics and Research
The conduct of research involving human subjects requires assessment of the risks
and benefits to the human subjects, which must be explained clearly to them before
the consent to participate in the research is given
...
An IRB is a group that has been
formally designated to review and monitor medical research involving human subjects
...
This group review serves an important role in the protection
Ethics and Research

55

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Any organization that performs research should develop an IRB for their
organization
...
IRBs require researchers to minimize the risks and maximize the benefits to the
participant and to explain these assessments clearly
...

Assuming the study clears the IRB’s assessment of risks and benefits, it is important that the subject understands the study and its impact on him or her
...

Informed consent protects human subjects because it allows the individual to consider
personal issues before participating in medical research
...

Both the U
...
Department of Health and Human Services and the Food and Drug
Administration have outlined common rule regulations that comprise the elements
of informed consent
...
Additional requirements
are needed for children, pregnant women, people with disabilities, mentally disabled
people, prisoners, and so forth
...
It is
important that all researchers be trained in IRB protocols to protect themselves, the
participants, and the organization
...
Workplace bullying is receiving increased attention worldwide as a negative organizational issue
...
Although the definitions are
similar worldwide, there are different labels of bullying that are used—mobbing is used
in France and Germany, harassment in Finland, and in the United States and Australia,
aggression, emotional abuse, or workplace bullying (Sheehan, 1999; Keashly, 2001)
...
NOT FOR SALE OR DISTRIBUTION

from 3
...

This negative behavior is considered bullying if it is repeated over an extended
period of time
...
Definitions also include negative verbal or nonverbal
behavior such as snide comments, verbal or physical threats, or items being thrown
...
The literature has reported
an increased incidence of bullying reported in healthcare organizations and in academe (Vartia, 2001; Ayoko, Callan & Hartel, 2003; Djurkovic, McCormack &
Casimir, 2008)
...
Specifically, there are bullying issues
between physicians and nurses
...
The Center for American Nurses,
American Association of Critical-Care Nurses, International Council of Nurses, and
National Student Nurses Association have all issued statements regarding the need
for healthcare organizations to stop bullying in the healthcare workplace
...

Lateral violence also occurs in health care, which is defined as “nurse to nurse”
aggression, demonstrated by both verbal and nonverbal behavior (Lateral Violence
and Bullying in the Workplace, 2011)
...
Gary and Ruth Nanie as a result of Ruth being bullied in her workplace by
a female supervisor
...
workplacebullying

...

In August 2007, they conducted the first study of all adult Americans on workplace
bullying—the results indicating that workplace bullying was a major organizational
issue
...
S
...
Approximately 70% of the bullying
was from supervisors with 60% of those bullies being women
...
According to the survey, more than 60% of the
employers ignored the problem
...
NOT FOR SALE OR DISTRIBUTION

panic attacks (Workplace Bullying, 2011)
...


Impact of Workplace Bullying
As indicated earlier, workplace bully targets can experience a range of physical and psychological symptoms such as work stress anxiety, lowered job satisfaction and loyalty
to the organization, increase in absenteeism, lowered work productivity, and depression (Ayoko et al
...
A sense of powerlessness is often reported by the target
...

In two Australian studies, more than 40% of the employees were bullied by their
supervisors, more than 10% were bullied by their peers, and 2% were bullied by their
subordinates (Ayoko et al
...

Workplace bullying also affects other employees because if the bullying continues
and is not addressed by management, it affects the overall morale of the workforce
...
It also can disrupt the professional career of the target as well
as the personal life of the target
...


Legal Implications of Workplace Bullying
Unfortunately, 80% of workplace bullying incidents is not illegal
...
Thirteen states have
introduced bills
...
There are two federal laws that can be applied
in workplace bullying: the Occupational Safety and Health Act of 1970 and Title VII of
the Civil Rights Act of 1964
...

Under Title VII of the Civil Rights Act, if a protected class employee (gender, religion,
ethnicity, etc
...


Recommendations to Eliminate Workplace Bullying
To date, there is no federal legislation that specifically addresses workplace bullying
...
The following are recommendations
for organizations including healthcare organizations:
1
...

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Create an organizational culture that focuses on a positive work environment
enabling all individuals to pursue their careers
...
Reward behaviors that encourage teamwork and collaboration among employees and their supervisors
...
Develop an educational program for all employees on what constitutes workplace bullying (LaVan & Martin, 2007)
...
In
the United States, the Workplace Bullying Institute has developed a Healthy Workplace
Bill that precisely defines workplace bullying and extends protection to employees
against this type of behavior
...

There is no specific federal legislation against bullying, so bullying will unfortunately
continue to be legal
...
The results can be devastating from both an
organizational and individual level
...
They issued the following statement:
Intimidating and disruptive behaviors can foster medical errors, contribute
to poor patient satisfaction and to preventable adverse outcomes, increase
the cost of care, and cause qualified clinicians, administrators, and managers to seek new positions in more professional environments
...
To assure quality and to promote a culture
of safety, health care organizations must address the problem of behaviors
that threaten the performance of the health care team
...
” The second requires an institution
“to create and implement a process for managing disruptive and inappropriate behaviors” (Yamada, 2011)
...
Their
standard focused on the impact of these types of behavior on patient care quality
...
In addition to the stance of the Joint Commission,
the Center for Professional Health at the Vanderbilt University Medical Center has
developed a program for treating and remediating disruptive behaviors by physicians
...

Workplace Bullying—An International Issue

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...
Both
federal and state laws have been enacted and policy has been implemented to protect
both the healthcare provider and the healthcare consumer
...

In the healthcare industry, there are several areas of operation that are affected
by ethics
...
If research is performed by an
organization and its employees, IRB training must be implemented to ensure that
ethical guidelines are followed when performing research on humans
...
At this time,
there is no federal mandate that targets this type of behavior
...
HR training must target this
type of unethical behavior
...


■ Vocabulary
Affirmative action plan
Age Discrimination in Employment
Act of 1967
American College of Physicians and
Harvard Pilgrim Health Care
Ethics Program
Americans with Disabilities Act
Assault
Autonomy
Battery
Beneficence
Carpal tunnel syndrome
Civil law
Civil Rights Act of 1964
Civil Rights Act of 1991
Codes of ethics
Common law

60

Common rule
Compensatory damages
Consolidated Omnibus Budget
Reconciliation Act
Criminal law
Defensive medicine
Employee Retirement Income
Security Act
Equal Pay Act
Ergonomics
Essential functions
Ethical standards
Ethics
Family Medical Leave Act
General duty
Genetic Information
Nondiscrimination Act

CHAPTER 2 Legal, Ethical, and Safety Issues in the Healthcare Workplace

© Jones & Bartlett Learning, LLC
...
(1992)
...
London, UK: Vrago Press, pp
...

American College of Healthcare Executives Code of Ethics (2011)
...
advamed

...
Accessed February 2, 2011
...
Boston, MA: Houghton Mifflin, p
...

American Medical Association (2010)
...
Available at: http://www
...
org/
ama/pub/physician-resources/medical-ethics/code-medical-ethics/
...

American Nurses Association (2011)
...
Available at: http://www
...
org/
MainMenuCategories/EthicsStandards
...
Accessed January 5, 2011
...
Available at: http://www
...
gov/pubs/ada
...
Accessed
December 3, 2011
...
, Rice, T
...
(2007)
...
S
...
San Francisco,
CA: Jossey-Boss
...
, Callan, V
...
(2003)
...

International Journal of Organizational Analysis, 11:283–301
...
NOT FOR SALE OR DISTRIBUTION

Beauchamp, T
...
(2001)
...
Oxford, UK: Oxford
University Press
...
& Shanks, N
...
Introduction to Health Care Management
...
347–48
...
(1995)
...
Cambridge, MA: Harvard
University Press
...
(2011)
...
dol
...
htm
...

Djurkovic, N
...
& Casimir, G
...
Workplace bullying and intention to leave: The
modernizing effect of perceived organizational support
...

Drachsler, D
...
Notes on: Year one of the Lilly Ledbetter Fair Pay Act
...

Driscoll, D
...
(2000)
...

Waltham, MA: Center for Business Ethics at Bentley College, pp
...

Einarsen, S
...
, Zapf, D
...
L
...
The concept of bullying at work: the European
tradition
...
1st ed
...

Emanuel, E
...
Health Care Guaranteed
...

Food and Drug Administration (2009)
...
Available at: http://www
...
gov/oc/ohrt/irbs/facts

...
Accessed November 4, 2010
...
(1994) Principles of medical ethics
...

Gomez-Mejia, L
...
& Cardy, R
...
Managing Human Resources
...
100–125
...
, Gilligan, M
...
(2008)
...
Benefits Law Journal, 21(3):5–16
...
(2001)
...
Violence and Victims, 16:233–268
...
& Merchant, T
...
Workplace bullying in Australia: A review of current conceptualizations and research
...

Kolpack, D
...
PPACA’s adult child coverage requirement clarified
...
bcbsnd
...
Accessed December 3, 2011
...
G
...
Teaching the responsible conduct of research in humans
...
hhs
...
htm
...

Lateral Violence and Bullying in the Workplace (2011)
...
tnaonline
...
pdf
...

LaVan, H
...
(2007)
...
S
...
Journal of Business Ethics, 83:147–165
...
Available at: http://www
...
org/ama/pub/physician-resources/medicalethics/code-medical-ethics
...
Accessed July 7, 2011
...
American
Association for Justice
...
kff
...
pdf
...


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...
& Berg, J
...
Human subjects’ protections in biomedical enhancement research:
Assessing risk and benefit and obtaining informed consent
...

Miller, R
...
Problems in Health Care Law (9th ed
...
1
...
(2006b)
...
Sudbury, MA: Jones and Bartlett Publishers,
p
...

Miller, R
...
Problems in Health Care Law (9th ed
...
605
...
(2006d)
...
Sudbury, MA: Jones and Bartlett Publishers,
p
...

Miller, R
...
Problems in Health Care Law (9th ed
...
587
...
(2006f)
...
Sudbury, MA: Jones and Bartlett Publishers,
p
...

Minding the Workplace (2011)
...
wordpress
...
Accessed June 10, 2011
...
& Namie, R (2009)
...
S
...
Consulting Psychology Journal, 61 (3), 202–219
...
Available at: http://www
...
gov/About/
...

Nelson III, L
...
& Kilgore, M
...
Damages caps in malpractice cases
...

Niles, N
...
Basics of the U
...
Health Care System
...
247–259
...
, Hollenbeck, J
...
& Wright, P
...
Fundamentals of Human Resource Management
(3rd ed
...

Occupational Safety & Health Administration (2010)
...
Retrieved from http://www
...
gov/SLTC/ergonomics/
...

Office of Technology Assessment (1993)
...
Washington, DC: U
...
Government Printing Office
...
Available at: http://www
...
org/resource/plus-decision-makingmodel
...

Povar, C
...
, Daniel, J
...
, Evans, L
...
, et al
...
Ethics in practice: Obama,
Task Force call on Senate to pass Paycheck Fairness Act
...

Privitera, C
...
& Campbell, M
...
Cyberbullying: The new face of workplace bullying?
Cyber Psychology & Behavior, 12(4):395–400
...
& Stone, A
...
Malpractice insurance costs and physician practice—1981–1986
...

Sedhom, S
...
Reacting to the Lilly Ledbetter Fair Pay Act: What every employer needs to know
...

Sheehan, M
...
Workplace bullying: Responding with some emotional intelligence
...

Shi, L
...
(2008a)
...
S
...
Sudbury, MA: Jones
and Bartlett Publishers, p
...


References

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...
& Singh, D
...
Essentials of the U
...
Health Care Delivery System
...
227
...
& Stanwyck, S
...
Understanding Business Ethics
...
110–112
...
& Young, K
...
Healthcare USA: Understanding its organization and delivery
...

Taylor, P
...
Principles of Ethics: An Introduction to Ethics (2nd ed
...

The Privacy Rule (2011)
...
hhs
...
html
...

Vartia, M
...
Consequences of workplace bullying with respect to the well-being of its targets and
the observers of bullying
...

Waters, T
...
, Claxton, G
...
(2007)
...
Health Affairs, 26(2):500–509
...
Available at: http://www
...
org
...

Wynia, M
...
Ethics and public health emergencies: Encouraging responsibility
...

Yamada, D
...
Workplace Bullying in Healthcare: The Joint Commission Standards
...
wordpress
...
Accessed September 23, 2011
...
NOT FOR SALE OR DISTRIBUTION

STUDENT WORKBOOK ACTIVITY 2
...
Your answer must be in your own words
...
There is one female, one disabled, one African
American, and one Muslim individual
...

Activity
Select the laws you believe are the most important to the new employees
...

Responses

Student Workbook Activity

65

© Jones & Bartlett Learning, LLC
...
He has requested that you develop mandatory ethics training for all employees
...

Activity
Devise an ethics training that includes healthcare codes of ethics for managed care
...

Responses

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CHAPTER 2 Legal, Ethical, and Safety Issues in the Healthcare Workplace

© Jones & Bartlett Learning, LLC
...

Activity
Design a program that focuses on ethics in the public health workplace
...
NOT FOR SALE OR DISTRIBUTION

Real-Life Applications: Case Scenario 4
You have been experiencing some negative behavior from a physician you are working
with and your nursing supervisor
...
You decide to go to
HR to find out what can be done to rectify these problems
...
Please provide
the information you found from HR
...
NOT FOR SALE OR DISTRIBUTION

Responses

Student Workbook Activity

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© Jones & Bartlett Learning, LLC
...
2
In Your Own Words
Based on this chapter, please provide an explanation of the following concepts in your
own words as they apply to human resource management
...

Criminal law:

Civil law:

Healthcare ethical dilemma:

Autonomy:

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CHAPTER 2 Legal, Ethical, and Safety Issues in the Healthcare Workplace

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...
NOT FOR SALE OR DISTRIBUTION

STUDENT WORKBOOK ACTIVITY 2
...

•
•
•
•
•

Visit each of the websites listed in the text that follows
...

Locate its mission statement on its website
...

Apply this organization to the chapter information
...
justice
...
NOT FOR SALE OR DISTRIBUTION

http://www
...
gov

Organization name:

Mission statement:

Overview of activities:

Application to chapter information:

http://www
...
org

Organization name:

Mission statement:

Student Workbook Activity

73

© Jones & Bartlett Learning, LLC
...
eeoc
...
NOT FOR SALE OR DISTRIBUTION

Application to chapter information:

http://www
...
org

Organization name:

Mission statement:

Overview of activities:

Application to chapter information:

http://www
...
org

Organization name:

Student Workbook Activity

75

© Jones & Bartlett Learning, LLC
...
4: DISCUSSION BOARDS FOR
ONLINE, HYBRID, AND TRADITIONAL ONGROUND
CLASSES
Discussion Board Guidelines
The discussion board is used in online and web-enhanced courses in place of classroom
lectures and discussion
...
The discussion board is the way in which the students “link together” as a
class
...
The educator will be the discussion moderator for this course
...
The educator will post the discussion topic and directions for the upcoming
week
...
When people respond to what someone else has
posted, they should start the posting with the person’s name so it is clear which
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CHAPTER 2 Legal, Ethical, and Safety Issues in the Healthcare Workplace

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...
A response such as “Yes” or “I agree” does
not count for credit
...
You cannot
copy and paste from the text
...
Postings (especially responses) should include enough information so the message is clear but should not be so long that it becomes difficult to follow
...
The postings should reflect the content of the text or other assignments
...

3
...

Good discussion will often include different points of view
...
All discussions
must be handled in a respectful manner
...

Discussion Boards
1
...

2
...
Discuss three employment-related pieces of legislation that you believe are very
important and why
...
What is your definition of ethics? What do you think are some unethical situations in the healthcare industry?

Student Workbook Activity

77

© Jones & Bartlett Learning, LLC

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