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Baseline PPD skin testing and medical history must be obtained on all employees who are identified as having occupational exposure. Medical management and follow-up must be provided after exposure incidents. Infectious employees must be removed from the workplace until noninfectious. There must be acceptable employee training and recordkeeping. The OSHA regulations require PPD retesting every three to twelve months depending on the level of risk and exposure history of a given employee. Employees with a low risk of exposure may be retested yearly. Those with higher risk must be retested every six months. The latter include those who (1) enter AFB isolation rooms, (2) perform high- hazard procedures, (3) transport TB patients in an enclosed vehicle, or (4) work in intake areas in an institution with a high number of TB patients (6 in 12 months). If there has been a direct exposure, the employee must be retested immediately and again in three months. The OSHA regulations do allow for the limitations of the PPD skin test as a screening test. Anyone who has not had a TB skin test in the last 12 months, must have a two- step baseline test. This involves doing the test and then repeating it in two weeks if it is negative or equivocal. This allows them to distinguish true conversions from the booster effect. A true conversion occurs when the patient becomes infected with TB between two tests. The booster effect occurs when a patient has been infected in the past but does not have high levels of antibody. The first test boosts the antibody levels so that the repeat in two weeks will give a true reading. Contrary to popular myth, you cannot develop a positive PPD skin test by having too many tests. If the employee already has a documented positive PPD skin test, then it does not have to be repeated. The employer may rely on careful history and chest X ray when indicated to follow these employees. Routine chest X rays are not required or recommended. In addition to regular screening of individual employees, regulated establishments must watch for clusters of disease or skin test conversion. These may indicate areas where active TB has gone unnoticed or where administrative or engineering controls have broken down. When an employee has become infected with TB, whether they have active disease or silent infection detected on skin testing, the employer must provide medical care and follow-up. Some states recognize such infection as a compensable injury under workers’ compensation. Other do not. However, under OSHA regulation, proper care and treatment must be provided. An employee who is found to have infectious TB must be put on medical exclusion from work until they are no longer infectious and do not pose a risk to others. This means that a medical care professional cannot practice until they are noncontagious. The nurse who is on medical exclusion from the hospital may not do immunization 665
clinics or home health visits. An important consideration about TB control in the work environment is that it must fit with the control of this disease in the larger community. The OSHA regulations and recordkeeping do not negate the state public health laws. TB is a reportable disease in every state and territory of the United States. There is a large federal TB control program administered at the local health department level. In addition, charity hospitals, homeless shelters, and jails have a large number of clients in common. Patients receive better care and workers have a safer work environment when there is coordination of TB control efforts by local public health officials. O. References - Occupational Medicine 1. Health Care Organizations Agerton TB, Mahoney FJ, Polish LB, Shapiro CN. Impact of the bloodborne pathogens standard on vaccination of healthcare workers with hepatitis B vaccine. Infect Control Hosp Epidemiol. 1995;16:287–291. Alty CT. A historical look at infection control. RDH. 1994;14:32–33, 34. Alty CT. Select protective gear carefully. RDH. 1994;14:25– 27. Breathnach AS, de Ruiter A, Holdsworth GM, et al. An outbreak of multi-drug- resistant tuberculosis in a London teaching hospital. J Hosp Infect. 1998;39:111–117. Bryan CS, Brenner ER. Utility of the hospital tuberculosis registry. Infect Control Hosp Epidemiol. 1994;15:536–539. Centers for Disease Control. Immunization of health-care workers: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR Morb Mortal Wkly Rep. 1997;46:1–42. DeJoy DM, Gershon RR, Murphy LR, Wilson MG. A work- systems analysis of compliance with universal precautions among medical care workers. Health Educ Q. 1996;23:159– 174. Feldman M, Bramson J. What is the cost of office compliance? An ADA survey on OSHA regulations, dentistry. Dent Teamwork. 1994;7:26–29. French AL, Welbel SF, Dietrich SE, et al. Use of DNA fingerprinting to assess tuberculosis infection control. Ann Intern Med. 1998;129:856–861. Garner JS. Guideline for isolation precautions in hospitals, I. evolution of isolation practices, Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1996;24:24–31. Gittelman EL. An office OSHA inspection—up close and personal. J NJ Dent Assoc. 666
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Public Health Law Map - Beta 5.7 I.
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1942.] The English statutory and co
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health or individual health officer
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actions through the district attorn
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3. The Judicial Branch The federal
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consumer protection, such as requir
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With these exceptions, most litigat
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the court in Los Angeles might allo
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subject matter and may also have in
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2. Implementing ADR The major benef
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III. Tort Claims against Private Pa
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cannot be proved, but it is clear t
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uterus, triggering a miscarriage. T
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first were passed immediately after
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years. If the practitioner violates
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defendant’s conduct or (for the d
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proving a case against a physician
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e important for their adult medical
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emoving the plantar wart. This emph
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Blake BL. Sgt. Friday, Dr. Welby, a
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Walter C, Richards EP. Keeping junk
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earning capacity. b) Medical Expens
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simple as installing wheelchair ram
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cases do not give rise to injury-re
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medical costs from the lawsuit. Som
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compilation of legal principles. It
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traditional sense. Fetal heart moni
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oxygen saturation. When saturation
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1993;56:12-14. King JY. Practice gu
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are handled through an administrati
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U.S.C. § 1491. As such, the Court
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waiving immunity provide the only m
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against the United States in federa
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A discretionary function is an act
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deviant sexual conduct by an Air Fo
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The government can be liable under
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decision of the hospital officials
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constitutional rights have been vio
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case basis. The critical element in
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allegedly defective product was a m
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that state law is displaced if it i
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adopted. Therefore, Congress may au
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alleged. The “color of state law
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Importantly, the DeShaney analysis
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In the context of public health, on
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Also, immunity from suit is preserv
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The mere fact a private corporation
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1. Absolute Immunity Absolute immun
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prisoners were infected with HIV an
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against physicians who sold prescri
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The key distinction between crimina
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it almost impossible for practition
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forced to give hair samples, blood
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medical care practitioner does not
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assume that a hospital has an incen
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fined not more than $25,000 or impr
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charitable, religious, or philanthr
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(2) The Everyone-Does-It Defense De
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automatically invoke attorney-clien
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The Federal government, and several
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e of no benefit to the community, t
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activities of the large professiona
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Some of these provisions, such as t
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not support the scheme to reduce ho
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(1) Sentencing Guideline Standards
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did not provide full information ab
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5. If an employee chooses not to re
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documents until the court had made
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Frech HE III, Danger KL. Exclusive
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1998;29:16-18. Stahl DA. Consolidat
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tampering. b) Search Warrants If th
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defense lawyers to fight claims tha
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a) Service of Process One distressi
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provide as little speculation from
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place for the deposition. Each part
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should include a signed release by
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juries will disregard scientific ev
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the jury may be out of the room for
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entered the patient’s description
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the information being presented is
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are situations where what is genera
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test so generously that it also gav
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defendant’s failure to render the
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fees may be construed as attempting
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Fish R, Rosen P. Physicians should
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$150,000 to fight a case that could
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case; rather, it encourages the att
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were below the acceptable standard
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A. Establishing Agencies For its fi
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local level because the employees a
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dispute before the court. The lawye
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c) The Goldberg Rights Persons whos
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the cost of butter. A public intere
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standards and who agree to complian
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a) Agency Interpretation of Law All
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Johnson JA. Court limits board of m
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persons—business law, constitutio
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5. Corporate Employers and Institut
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prohibited the attorney from asking
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supervising the work. A more fundam
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medical problems. Whether it is can
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for buying insurance is that it pay
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Lawyers working on a contingency do
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Review deposition summary: 30 Novem
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of an effective preventive law plan
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ibes were in the form of consulting
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detailed summaries of important doc
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A very important part of the invest
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cases. Houston Bar Assoc. 1996;34:2
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state civil rights laws and health
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must carry out these actions correc
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c) Informal Consultations One of th
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on relinquishing care and follow-up
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The manufacturers of emergency kits
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equire a consultation before certai
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any differences of opinion between
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to refer a patient to such an insti
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help the patient deal with the insu
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diagnostic interest to the physicia
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attendant duties. When they exercis
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physician must be notified at once.
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to find a specialist willing to see
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physicians, a recent U.S. Supreme C
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The law requires a physician to pro
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proper diagnosis. The physician los
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possible, the letter should be sent
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states than in others.) The best ra
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Medical licensing agencies and medi
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If there is a physician-patient rel
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(1) In general If any individual (w
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subject to a civil money penalty of
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condition described in paragraph (1
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(A) Placing the health of the indiv
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may not transfer the individual unl
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sent by certified mail, return rece
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Berlin L. Communication of the sign
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evaluation of distance medicine tec
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consent: reducing conflicts with pa
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) Children in the Emergency Room A
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such as cancer should be withheld f
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eing challenged over their good- fa
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would not require that the risk be
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usual in the community, and in othe
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consent to risks of the treatment b
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) Reasonable-Patient Standard This
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candidates for treatment if their u
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prospective reimbursement systems r
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The child’s legal status should b
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litigation. Most states allow a phy
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should be reported to the child pro
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mental suffering and injury. 5. No
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ensure that all other participants
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(1) The research involves no more t
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different dialects but with differe
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to consent to medical care. Convers
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person. The power of attorney may b
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eligious reasons. Parents may refus
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life-support technologies, patients
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use every possible avenue to prolon
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decision? The court found that Miss
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Cruzan really dead? Justice Rehnqui
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discussed in terms of the patient
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) Following the Patient’s Wishes
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Few termination of life-support cas
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than any element of human behaviora
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Law Policy. 1997;361. Brody, H. Com
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Furthermore, a physician who withdr
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Cunningham N. Fear and informed con
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Invest Radiol. 1996;31:109-113. Nic
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interests test. J Leg Med. 1991;12:
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esearch subjects: proposed guidelin
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1994;8:19-27. Silverman HJ. Ethical
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Insurance Portability and Accountab
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physician, just as the records of c
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and if the patient is the victim of
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Disabilities Act (ADA) limits an em
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that is part of routine medical car
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A description of each purpose of th
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services to the medical care provid
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Access to the records is subject to
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Use appropriate safeguards to preve
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when they were designing research s
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such as an antitrust or false claim
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contain, the potential for harm in
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identification of abnormal findings
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Anything that indicates special tre
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put in the chart to document that t
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keep personal notes, and often the
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night unless she has a serious conc
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difficult to authenticate, unless t
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225. Smith J. Good medical records
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The legal consequences of the corpo
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to set up their own practices or wo
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California. Independent Contractor:
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physician fail to obtain a proper i
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When a physician recommends unneces
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Because employers attempt to limit
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utilization review organization den
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to influence a treating doctor’s
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important if the employee injures a
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these rules vary greatly from state
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If, as frequently happens, the pati
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eviewed completely by the supervisi
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protocols become generic documentat
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the physician is directly supervisi
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a. Penicillin V potassium 250 mg q.
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they hospitalize or refer a patient
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patient’s right of privacy should
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Medical students are often enthusia
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unauthorized practice of medicine.
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staff knows that the orders are onl
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is injured by a fellow workers’ n
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limited due process restrictions on
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agreeing to reimburse the MCO for a
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collective action, a close reading
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Med Soc. 1996;148:341-343. Maurer W
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Fiesta J. Delegation, downsizing an
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XIV. Peer Review and Deselection HI
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the development of new legal theori
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juror’s perspective, peer review
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to deal fairly with citizens, these
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5. There is an overriding national
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a) Notice of a Right to a Hearing T
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equest, to the physician or practit
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subchapter. Information about malpr
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the standards set forth in the Act,
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2. The Problem of Bias Until recent
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from general disclosure, but it sho
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do cost-cutting that the physicians
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Med. 1997;18:521-538. Maguire D. Te
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Introduction All medical care pract
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we are due for another worldwide ep
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include nurses, dentists, veterinar
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marital disharmony. In the classic
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criticisms of the cost of contact t
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diseases such as the Marburg or Ebo
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organized, powerful political lobby
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homosexual activists and the religi
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eligion or conscience. Thus, he can
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high, amounting to several dollars
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1. Birth Certificates Normally the
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caused or contributed to by infecti
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D. Law Enforcement Reporting Every
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campus police. The campus police de
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the law enforcement authorities are
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when they are acting as officers of
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eporting practices. J Emerg Med. 19
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Starr P, Starr S. Reinventing vital
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October;51:132]. J Am Med Womens As
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laws governing air and water pollut
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the widespread occurrence of tooth
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within the power of the judiciary t
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[specify fluoridation measure at is
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Still other arguments center on all
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(Wash. 1955); Rogowski v. City of D
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adverse effects would occur was arb
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Kaul v. City of Chehalis, 277 P.2d
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Introduction There are special cons
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Under no circumstances should medic
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patients about high-risk behavior a
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arrier method that is only 70% effe
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injectable contraceptive that lasts
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that HIV is less of a threat than a
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for procedures affecting reproducti
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funded services to coerce a person
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The person who obtains the consent;
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The recognition of personal privacy
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medically necessary: On their face,
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Although abortion is still a surgic
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The presumption of legitimacy was a
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Unfitness is also narrowly defined
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consistent with public health and s
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constitutional protections or feder
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information in violation of confide
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Mary Sue’s ova were successfully
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But the rule does not contemplate t
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as not to violate this prohibition.
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committed before she knows the stre
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1. Adoption 2. Family Planning and
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Soderberg H, Andersson C, Janzon L,
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Hum Reprod. 1992;7:1029-1033. Snowd
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condition. This conflict can take t
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eaching a level of 1 per 11 births
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who has finally conceived after thr
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should be sure that she understands
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The treatment of infertility poses
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disorder should not be helped to co
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Choosing a sperm donor can be legal
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prevent the spread of disease, and
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problems before they cause accident
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Beyond a structured prenatal care s
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patient’s decisions. The patient
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covered in signs that ask women if
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decisions not to use medical interv
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lifesaving care. Many physicians ig
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profound differences in the underly
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midwife’s skills and judgment, as
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who might sue on her behalf or on t
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contraception, but contraception ha
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One example has been the developmen
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Marshall BM. Ethical issues in assi
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1995;115:39-43. Greely HT. Genetic
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3. General Obstetrics Abrams FR. Co
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King NM. Informed consent and the p
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XIX. Occupational Medicine and Disa
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and balances inherent in having gen
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putative illness, requesting an exc
Page 615 and 616: compensation system. The company ma
Page 617 and 618: In some circumstances, the union ma
Page 619 and 620: ethical obligations concerning the
Page 621 and 622: Records concerning voluntary employ
Page 623 and 624: employee’s health status.” In t
Page 625 and 626: films shall be preserved in their o
Page 627 and 628: Employees may also have a financial
Page 629 and 630: available information on the proper
Page 631 and 632: lood tests that are medically neces
Page 633 and 634: hospital. Both the medical care pro
Page 635 and 636: Section 504 was a remedial statute
Page 637 and 638: or recurrent, that the key word was
Page 639 and 640: government officials investigating
Page 641 and 642: incorrect, so this area of the law
Page 643 and 644: is to ensure that patients have eno
Page 645 and 646: problems. The Court also reiterated
Page 647 and 648: the medical problems have affected
Page 649 and 650: normal eyes and kidneys and no peri
Page 651 and 652: not constitute a disability. The pa
Page 653 and 654: workplace, their legal status is no
Page 655 and 656: hepatitis A, the onset of the disea
Page 657 and 658: (2) The nature and severity of the
Page 659 and 660: Many diseases are spread by insects
Page 661 and 662: eporting duties that apply to the c
Page 663 and 664: 9. Bloodborne Pathogens All workpla
Page 665: this includes all types of medical
Page 669 and 670: Purtilo RB. Ethical issues in the h
Page 671 and 672: Disabilities Act: a decision analys
Page 673 and 674: occupational accidents and diseases
Page 675 and 676: 1998;13:241-272. Pollack R. Update
Page 677 and 678: legislation, set minimum standards
Page 679 and 680: hearing seems to be rooted in the l
Page 681 and 682: ates among drug addicts. Beyond the
Page 683 and 684: Team physicians’ duties are to th
Page 685 and 686: first aid and training programs are
Page 687 and 688: equired by the school is not accept
Page 689 and 690: interfere with getting the child pr
Page 691 and 692: 4. Handicapped Children Handicapped
Page 693 and 694: 1996;35:237-242. Cheng TL, Savageau
Page 695 and 696: Med Sci Law. 1995;35:45-47. Mitten
Page 697 and 698: handling prisoners in a burns unit.
Page 699 and 700: legislation. The FDA, DHHS, HCFA, a
Page 701 and 702: of a lower court to a higher, appel
Page 703 and 704: assaulted will bring a legal action
Page 705 and 706: anesthesiologists and nurses with i
Page 707 and 708: Negligence to consider the plaintif
Page 709 and 710: declaratory judgments about the con
Page 711 and 712: Durable Power of Attorney ensurance
Page 713 and 714: fiduciary relationship, as is the r
Page 715 and 716: Hearsay Rule Testimony of what anot
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In Loco Parentis Literally, in the
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to dangerous products such as drugs
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filing of all official documents. I
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Perjury The willful act of giving f
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had that reasonable person been in
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RICO The common abbreviation for st
Page 729 and 730:
person seeks damages or other legal
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appropriateness. Vacate When a cour
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