HI 103

1. © 2017 American Health Information Management Association© 2017 American Health Information Management Association
Chapter 20: Workplace Law
Fundamentals of Law for Health
Informatics and Information
Management, Third Edition

2. © 2017 American Health Information Management Association
Goal of Workplace Law
• To strike a balance between employee and
employer that protects the employee from
personal injury, prejudice, duress, and
unwanted sexual advances while allowing
the employer to pursue desired business
outcomes

3. © 2017 American Health Information Management Association
Workplace Laws
• Federal employment laws
– Deal with employee-employer issues
• Federal labor laws
– Refer to employer-union issues or other labor
practices

4. © 2017 American Health Information Management Association
Discrimination and Related
Laws
• Equal Employment Opportunity Commission
(EEOC)
– Enforces federal laws that discriminate against
employee or job applicant on basis of:
• Age
• Disability
• Equal
Pay/Compensa
tion
• Genetic
information
• Harrassment
• National origin
• Pregnancy
• Race/color
• Religion
• Retaliation
• Sex
• Sexual
harassment

5. © 2017 American Health Information Management Association
Equal Employment Opportunity
Act of 1972
• Gives authority to the EEOC to sue in
federal court if there is reasonable cause
to believe discrimination
• Uniform Guidelines on employee selection
procedures
– EEOC publication that supports “employee
selection must be made on qualifications
related to job performance”

6. © 2017 American Health Information Management Association
Title VII of the Civil Rights Act of
1964
• Prohibits discrimination based on age, race,
color, national origin, sex, religion, age,
disability, political beliefs, and marital or
familial status
• EEOC was created as part of this act
• Prohibits intentional discrimination and
practices that discriminate against someone
• 1991 act expanded to authorize
compensatory and punitive damages in
cases of intentional discrimination

7. © 2017 American Health Information Management Association
Diversity Awareness Programs
• Diversity awareness and cultural
competency are important to effectively
care for patients.
• The Joint Commission has standards for
cultural competency and patient
communication.

8. © 2017 American Health Information Management Association
Age Discrimination in
Employment Act of 1967
• Protects individuals 40 years or older;
however, some states have laws that protect
younger workers
• Applies to any aspect or terms of
employment (hiring, promotion, discharge,
pay, fringe benefits, job training, and
classification referral)
• Includes harassing someone because of their
age verbally or in writing or condoning a
hostile or offensive work environment

9. © 2017 American Health Information Management Association
American with Disabilities Act of
1990
• Protects individuals with disabilities,
broadly defined to include physical
conditions, psychological conditions,
contagious diseases, substance abuse,
and other conditions
• Employers must provide “reasonable
accommodations”
• Table 20.1 contains examples

10. © 2017 American Health Information Management Association
Equal Pay Act of 1963
• Regulates the concept of equal pay for
men and women who perform similar work
requiring similar skills, effort, and
responsibility under similar working
conditions

11. © 2017 American Health Information Management Association
Genetic Information
Nondiscrimination Act (GINA) of
2008
• Prohibits health insurers and employers from
discriminating against an individual or employee
based on genetic information
• Restricts information about an individual’s genetic
tests; family members’ genetic tests; manifestation
of diseases or disorders in family members (family
medical history); requests for or receipt of genetic
services; or participation in research that includes
genetic services by an applicant, employee, or
family member

12. © 2017 American Health Information Management Association
National Origin
• Illegal to discriminate against an individual
because of birthplace, ancestry, culture, or
linguistic characteristics common to a specific
ethnic group
• Immigration Reform and Control Act of 1986
requires employers to assure that employees
hired are legally authorized to work in the US;
however, can’t single out individuals of a
particular origin who appear foreign. Must
treat everyone similarly

13. © 2017 American Health Information Management Association
Immigration Reform and Control
Act of 1986
• Requires verification by employers that
employee is legally authorized to work.
• This verification should be done with the
Form I-9
• Form I-9 should be required for all workers

14. © 2017 American Health Information Management Association
Title VI of the Civil Rights Act
• Focus of Title VI is on patients with limited
English proficiency (LEP) and employees
as well. Title VI applies to any healthcare
organization or entity that receives federal
funding
– Obligation to translate vital materials such as
informed consents LEP persons and provide
interpreters

15. © 2017 American Health Information Management Association
Sex and Sexual Harassment
• Civil Rights Act was expanded by the
Pregnancy Discrimination Act of 1973, which
prohibits discrimination against pregnancy,
childbirth, or related medical conditions
• Sexual harassment: Unwelcome sexual
advances, requests for sexual favors, and
other verbal or physical harassment of a
sexual nature

16. © 2017 American Health Information Management Association
Labor Laws
• Fair Labor Standards Act of 1938 (and
amendments)
– Establishes federal minimum wage and rules for
overtime pay
– Age limitations on hiring children
– Sets minimum wage standard
• Exempt employees (professionals, administrators,
salespeople)
• Nonexempt employees: Paid minimum wage and time-
and-a-half for overtime

17. © 2017 American Health Information Management Association
FLSA Recordkeeping
Requirements
• Minimum elements for time-keeping for all
employees
• Also requires retention for payroll and
employment-related wage records
• Guidelines for meal and sleep breaks
• DOL has fact sheets specific for
healthcare facilities

18. © 2017 American Health Information Management Association
Compensation and Benefits
• Compensation includes direct and indirect
pay
• Benefits
– Medical, dental, life, accident insurance
– Child and elder care
– Retirement plans
– Longevity pay
– Paid time off
– Paid sick time

19. © 2017 American Health Information Management Association
Benefits
• Employment Retirement Income Security Act of
1974 (ERISA)
– Sets minimum standards for most voluntarily
established pension and health plans in private
industry to provide protection for individuals in these
plans
• Consolidated Omnibus Budget Reconciliation Act
(COBRA) of 1986
– Provides continued health insurance for a certain
period of time for those who have lost coverage
because of termination or in some other
circumstances

20. © 2017 American Health Information Management Association
Benefits and HIPAA
• Includes protections for coverage under group
health plans that limit exclusions for preexisting
conditions
• Prohibits discrimination against employees and
dependents based on their health status
• Allows a special opportunity to enroll in a new plan
to individuals in certain circumstances
• Allows the purchase of individual coverage if no
group health plan coverage is available, and have
exhausted COBRA or other continuation coverage

21. © 2017 American Health Information Management Association
Unions
• Total number of unionized workers in 2015
= 14.8 million, 13% of these union
members are in healthcare support
occupations
• Issues that support union activity
– Minimum staffing, overtime pay issues, and
recruitment; workers want protection of their
jobs and formal method of communicating
with management

22. © 2017 American Health Information Management Association
National Labor Relations Act
(NLRA) of 1935 (a.k.a. Wagner
Act)
• Regulates union and employer relations in
the private sector
• Gives employees the right to self-organize,
to form, join, or assist labor organizations
• Allows employees to bargain collectively
through whomever they chose as their
representative and to engage in other
activities for mutual and protection

23. © 2017 American Health Information Management Association
Labor-Management Relations
Act of 1947
• Amended Wagner Act to prohibit unfair
labor practices on part of unions and
allows president of the United States to
stop strikes in cases that might impact
national health and safety
• Identified behavior considered to be unfair
labor practices on part of employers

24. © 2017 American Health Information Management Association
National Labor Relations Board
(NLRB)
• Independent federal agency that safeguards
employees’ rights to engage in union activity
• Oversees union elections and handles unfair labor
practice committed by private sector employers
and unions
• Assumed jurisdiction over hospitals in 1974
• Person most responsible for operation of union
contract on a day-to-day basis is supervisor
– Training of supervisors and departmental
management is important to ensure good
relationships

25. © 2017 American Health Information Management Association
NLRB
• When union organizing begins, an election following
NLRB regulations is conducted to determine if a union
will be authorized to bargain and negotiate a labor
contract with management, as well as which
employees will be part of the bargaining unit that will
be covered.
• Contracts deal with union recognition, management
rights, union security, wages, pensions, benefits,
conditions, and hours of work, vacations, holidays,
leaves of absence, seniority, promotions, and similar
terms and conditions of employment.

26. © 2017 American Health Information Management Association
Collective Bargaining
• Process whereby contract is negotiated
that sets forth the relationship between the
employees and the healthcare
organization
• Must abide by the contract in matters of
discipline when employees do not follow
organization’s rules and in handling
employee grievances or complaints

27. © 2017 American Health Information Management Association
Union process
• Grievance procedure: Handles situations
such as violation of a work rule or other
condition of employment, begins with the
employee and the supervisor
• Union steward: Represents the employee
• Employee has right to due process
• Arbitration: Issues that are not settled go to
hearings by a third party to settle an
agreement

28. © 2017 American Health Information Management Association
State Laws on Unions
• State labor laws may be fashioned after federal
labor laws or a state law may establish its own
version of the law.
• Many states have enacted “right to work” laws,
which means that a worker does not have to join a
labor union to keep or land a job.
• Federal labor law is considered minimum law.
• A state may enact stricter labor laws or labor laws
that go beyond the federal laws. If the state law is
considered stricter than the federal law, then the
state law will preempt the federal law.

29. © 2017 American Health Information Management Association
The Occupational Safety and
Health Administration (OSHA)
• Occupational Safety and Health Act of
1970
– To help employers reduce injuries, illnesses
and deaths on the job
– Established Occupational Safety and Health
Administration (OSHA)
• Responsible for setting and enforcing workplace
safety standards, and providing information,
training, and assistance to employers and workers

30. © 2017 American Health Information Management Association
OSHA
• Works closely with Center for Disease
Control (CDC) in identifying best practices for
management of diseases and injuries that
may affect employees in workplace
• Provides guidelines for handling hazardous
chemicals, equipment, and waste products
such as chemicals or equipment used in
laboratories and radiology, and blood fluids,
tissues, vaccines, etc., related to patient
treatment

31. © 2017 American Health Information Management Association
Additional Safety Legislation
• Occupational Exposure to Bloodborne Pathogens
of 1991
– Established to set safety standards for exposure to
viruses and other microorganisms such as human
immunodeficiency virus (HIV) and hepatitis viruses B
and C and other bloodborne pathogens
• Needlestick Safety and Prevention Act of 2001
– Directed OSHA to revise bloodborne pathogen
standard to require employers to establish an
exposure control plan including controls to eliminate
or minimize employee risk as a result of needlestick
and other sharps-related injury

32. © 2017 American Health Information Management Association
Employer Responsibility
• Duty under OSHA standards to provide
employees with a safe working environment,
especially in a healthcare setting
• Must keep detailed records on all safety
issues. Recordkeeping requirements are
defined in the 2001 rule on Occupational
Injury and Illness Recording and Reporting
Requirements (“the recordkeeping rule”)
• This rule was revised in 2014

33. © 2017 American Health Information Management Association
Employer Responsibility
(continued)
• Follow all relevant OSHA safety and health standards
• Find and correct safety and health hazards
• Inform employees about hazards
• Notify OSHA within 8 hours of a workplace fatality or
when three or more workers are hospitalized
• Provide required personal protective equipment
• Post OSHA citations, injury and illness summary data
• Not discriminate or retaliate against any worker for
using their rights under the law

34. © 2017 American Health Information Management Association
Employee Responsibility
• Employees also have a duty to comply with OSHA
standards and report problems, follow safety rules,
and wear protective equipment if required to do so.
• Employees have the right to
– Working conditions that do not pose a risk of serious harm
– Receive information and training
– Review records of work-related injuries and illnesses
– Get copies of test results
– File a complaint asking OSHA to inspect their workplace
– Use their rights under the law without retaliation or
discrimination

35. © 2017 American Health Information Management Association
OSHA Inspections
• Usually unannounced. However, under special circumstances, an
employer may be given 24-hour notice of a pending inspection for
the following:
– Imminent danger situations that require correction as soon as possible
– Accident investigations
– Inspections that must take place after regular business hours or that
require special preparation
– Cases where notice is required to ensure that the employer and
employee representative or other personnel will be present
– Cases where an inspection must be delayed for more than five working
days
– Situations in which the OSHA area director determines that advance
notice would produce a more thorough or effective inspection