ADDITIONAL READING RESOURCE>> All of the states in the United States have passed public health statutes that protect their citizens from a variety of dangers, including communicable diseases, medical waste products, drug abuse, child abuse, and elder abuse. In order to enforce these statutes, healthcare providers such as physicians and nurse practitioners, with the help of their assistants, are required to report certain information to public officials. Reportable diseases to the Centers for Disease Control (CDC), dependent upon state, can include the following: anthrax, botulism, chickenpox, cholera, diphtheria, gonorrhea, hepatitis A, hepatitis B, hepatitis C, influenza, malaria, mumps, pertussis, rabies, syphilis, tuberculosis, and typhoid (NIH, 2015). Public health records and vital statistics include births, deaths, communicable diseases, and a variety of abuses including child and elder abuse along with substance abuse. Providers are also charged with reporting both actual and suspected cases of abuse, such as spousal abuse. These cases are evidenced by repeated injuries, bruises, unexplained fractures, bite marks, swelling, bruising, and pain in the genital area, signs of inadequate nutrition, and venereal disease. In cases of abuse, or suspected abuse, providers gather evidence such as photos of bruises, female urine (containing sperm), soiled clothing, and bodily fluids following the chain of custody of evidence. In addition, foreign objects such as bullets, hair, and nail clippings are collected. These serve as valuable pieces of evidence when trying to document and prove cases of abuse. Controlled Substances Act and Regulations exist to protect both providers and patients. Legislation experiences changes allowing health care providers to prescribe different schedules of medications safely. Acts and regulations include the following. Food and Drug Administration (FDA) Drug Enforcement Administration (DEA) Controlled Substances Act of 1970 The Bureau of Narcotics and Dangerous Drugs (BNDD) Controlled Substances (Schedules I-V) For example, the Controlled Substances Act of 1970 is a federal statute that regulates the manufacture and distribution of the drugs that are capable of causing dependency. The DEA is a division of the Department of Justice (DOJ) that enforces the Controlled Substances Act of 1970. In Illinois, for example, practitioners must apply for both their controlled substances license (after their initial licensure has been granted) and their DEA number, which must accompany prescriptions of narcotics. States differ on their procedures and requirements for providers and must be considered separately. However, the DEA number is obtained from the federal government. Both the employer (healthcare provider) and the employee (staff) work under federal and state regulations. Therefore, it is important that everyone working in the healthcare field be knowledgeable about regulations affecting employment practices, such as health, safety, workers’ compensation, unions, and discrimination in the workplace. The Federal government has been involved with the regulation and interpretation of the Pure Food and Drug Act (1906) and its legislation for over 100 years. At times, Congress has had limits placed on its authority of controlled substances related to the actions and decisions of the Supreme Court. Together the Harrison Narcotic Act and the “Marihuana Tax Act” exposed the limitations of the federal government of the regulation of drugs. Griffin (2014) stated the first obstacle of the Harrison Narcotic Act ended with the limiting of this Act by the Court. A brief time later, the Court extended the power of the Act and the Court ruled in favor of forbidding of addiction maintenance, which may have well been the initial step towards declaring the war on drugs. According to Griffin (2014), “the Supreme Court has had a profound effect on drug policy through the institution’s interpretation of federal drug legislation, which ostensibly will continue into the future.” As policies and legislation evolve along with the medical profession and their prescriptive powers, the Supreme Court will aid in shaping the outcomes. States continue to be involved, for example, in the case of changes to prescriptive authority by many mid-level providers such as nurse practitioners and physician assistants. Professionalism in the workplace involves eliminating discrimination, maintaining privacy, and supporting cultural and religious considerations. It further extends to effective hiring practices and differentiates between legal and illegal interview questions such as asking about a man’s marital status and whether or not he has children or a woman’s age or year she graduated college. It extends to actual protection of employers and employees. Federal regulations affecting the medical professional include equal employment opportunity and employment discrimination, employee health and safety, compensation and benefits regulations, and consumer protection and collection practices. These regulations standardize employment practices across medical practices and help ensure fair and equitable treatment of all employees. Additionally, regulations make the job environment comfortable for employees and they know what to expect. Examples of establishing equal employment opportunity and employment discrimination include Title VII of the Civil Rights Act of 1964 and the Pregnancy Discrimination Act of 1978. Title VII of the Civil Rights Act prohibits discrimination, or unfair treatment, in employment based on race, color, religion, gender, or national origin. The Pregnancy Discrimination Act of 1978 states that, by law, employers must treat pregnant women as they would any other employee, providing they can still do the job. Woodward (2015) writes about how the National Organization for Women (NOW) began as a response to the Equal Employment Opportunity Commission (EEOC) repeatedly “denied Title VII employment rights on the basis of sex.” NOW sought to secure that people were not discriminated against on the basis of the sex provision of the law. The author believes that change has emanated from the efforts of NOW through the propulsion of new rights, claims, and reforms of policies advancing the feminist movement, which seeks to equalize men and women in all areas, such as pay-for-performance regardless of gender. While initially the intent of NOW was to provide short-term reform to ensure the sex provision of Title VII and its enforcement, new groups sprung form its emergence adding to the securement and prolific nature of the feminist movement. OSHA, Occupational Safety and Health Act of 1970, states that many jobs are dangerous by their very nature. OSHA regulations seek to protect workers in these jobs. These standards apply to employees who have occupational exposure, which is defined as reasonable anticipation that employees’ duties will result in skin, mucous membrane, eye, or parenteral contact with bloodborne pathogens or other potential infectious material. CLIA, the Clinical Laboratory Improvement Act of 1988, is a law that requires that all clinical laboratories that test human specimens must be controlled. CLIA divides laboratories into three categories: simple testing, intermediate-level testing, and complex testing. Compensation and Benefits Regulations are laws that influence the compensation (salary) and benefits provided to employees. The Social Security Act of 1935 falls under this category, which is paid by the employer and the employee in equal payroll taxes and Medicare premiums. It is composed of several different related programs such as retirement, disability, dependent, and survivor’s benefits as well as health benefits under Medicare. This is the amount paid to the retiree or disabled or dependent widow and is based on the worker’s average wages during his or her working life. While experts differ on the best age to retire in the United States, the Social Security Act of 1935 previously set the age to collect benefits at age 65, which was then the average life expectancy. Often quoted sources today have arrived at an average life expectancy of 78 for men and women, with women often outliving their male partners. The disparity in the collection draws much debate. Experts discuss the options available to take retirement benefits often emphasizing that a delay in payment results in a substantial seven to eight percent increase in payments and is more beneficial, circumstances dependent. Steinreich (2014) remarks on welfare in Europe and the United States and their increases in the welfare state. Also in the United States, the use of “food stamps, Medicaid, and Medicare did not arrive until a very late 1964-1965.” With these social programs in place, it is often thought that protection of the aging population has a plan to match the imminent need of its citizens. Programs such as these impact reimbursement rates to healthcare providers as well. One of the more modern programs in place is the advent of the Employee Assistance Programs (EAPs) that employers offer their employees as part of their benefit packages. These programs may have certain core programs such as information, education, and assistance regarding topics such as stress, and “hotlines” in which employees may discuss certain confidential work or personal occurrences. In turn, these EAPs help employees with resources for managing issues including financial planning, legal advice, and work difficulties. Employers and employees benefit largely when both understand the rewards that these programs offer. Roberts (2015) states the importance of employees becoming literate about their own particular EAPs. Companies are increasingly adopting these programs as an incentive to employees and are required to show a return on their investment of these programs. “The critical issue here is for parts of organisations – specifically HR [Human Resources] and OH [Occupational Health] teams, as well as those involved in procurement – to understand the measures and evaluation used by your provider. When you review your EAP usage reports, be clear about what it is telling you, what each measure counts for and what this means in the context of your own organisation” (Roberts, 2015). Lecture and Research Update Bibliography Fremgen, B. F. (2016). Medical Law and Ethics (5th ed.). United States: Prentice Hall. Griffin, O. H. (2014). The Role of the United States Supreme Court in Shaping Federal Drug Policy. American Journal of Criminal Justice : AJCJ, 39(3), 660-679. National Institute of Health. Medline Plus (2015). Reportable Diseases. Retrieved from Roberts, P. (2015). Getting More From Your EAP. Occupational Health, 67(7), 24-25.  Steinreich, D. (2014). Welfare and Old Age in Europe and North America. Quarterly Journal of Austrian Economics, 17(2), 249-259.  Woodward, J. (2015). Making Rights Work: Legal Mobilization at the Agency Level. Law & Society Review, 49(3), 691-723.

Discussion 3-1 Ethics