Public Health Law Map - Beta 5 - Medical and Public Health Law Site

eing privately owned or managed, federal and state prosecutors have demonstrated
their willingness to treat hospitals like any other business. Health care is a dangerous
business by almost any standard. Nurses have one of the highest rates of back injuries
of any occupation. The risk of death from infectious disease exposures has always been
a part of medical practice, and medical care workers have some of the worst toxic
exposures. Hydrocarbon exposures in manufacturing industries are nothing compared
to the risk to the pharmacist who is handling chemotherapeutics that are themselves
carcinogenic and which may have an LD50 measured in grams. Exposure to X rays,
ultraviolet light, and other forms of radiation is an everyday fact of life in a hospital.
This very familiarity can cause damaging carelessness.
Hospitals are also the natural home of curbside consults. Busy nurses and physicians
find it easier to ask for help or information informally than to make an appointment
and go to the office. It also allows everyone to avoid insurance forms and copays. The
problem is that it also avoids proper recordkeeping. Providing medical care informally
without records is usually a poor idea. If it involves a work- related injury, it is
probably illegal.
As with other businesses, hospitals should have a well-planned system for dealing with
occupational injuries and exposures. There should be one place or person that takes
care of all the occupational medicine for the institution, and it must be available all
hours the business is open. If the work injuries are handled in the emergency room,
there must be proper forms and procedures in place. Staff should not be sent to the ER
when they are hurt because it is the easiest place to find their own bandages. The
employee should be checked in and all care should be documented in the medical
record. Even first aid for an injury that is not severe enough to be OSHA recordable
should be in a medical record. The injury or exposure may also be reportable under
state laws even if it is not OSHA recordable. Doing care off the record to avoid OSHA
recordability or workers’ compensation filings is illegal and carries hefty fines. Once
proper care has been given, all the applicable forms must be completed. A workers’
compensation claim must be filed and, if applicable, an OSHA- entry made. Even if
the hospital does not have to make specific payments to the doctor or the profit center
where care was rendered, most workers’ compensation programs require that the value
of the care be on record.
Control of workplace exposures to communicable disease is a major consideration in
medical care occupational medicine. [Holleman WL, Holleman MC. School and work
release evaluations. JAMA. 1988;260:3629–3640.] Most hospitals are aware of federal
bloodborne pathogen regulations and make an attempt to comply. Far fewer understand
and follow the rules on the control of tuberculosis. These regulations are discussed at
length later in the section. The important thing to remember is that there are extensive
regulations on how these problems are to be handled and they are mandatory
requirements, not guidelines.
Hospitals should also keep in mind that their responsibilities as employers are not
limited to people on their payroll. Volunteers, physicians, professional students, and
employees of contractors such as laundry or food service may be the hospital’s legal
responsibility when it comes to prevention of illness or injury from work in the
631