Medical Staff Membership and the ADA

The Americans With Disabilities Act, passed in 1990, is designed to protect individuals with disabilities against discriminatory hiring practices. Employers may not ask potential employees questions related to disability unless they pertain to the ability to perform specific job functions.

Most physicians are not hospital employees, so it has been argued that the law does not technically apply to questions asked on an application for medical staff membership. Over the years however, attorneys have advised that the line is a fine one, and it is legally safer to consider the law applicable.

There are a couple of areas that tend to be problematic on medical staff applications, and it would be good to review your application to determine whether any wording changes are advisable. For example, it is permissible to ask about current use of illegal drugs. Is it, however, acceptable to ask about past use of illegal drugs? The answer is…maybe.

The U.S. Department of Justice Civil Rights Division answers the question this way:

May an employer ask applicants about their prior illegal drug use?

Yes, provided that the particular question is not likely to elicit information about a disability. It is important to remember that past addiction to illegal drugs or controlled substances is a covered disability under the ADA (as long as the person is not a current illegal drug user), but past casual use is not a covered disability. Therefore, the question is fine as long as it does not go to past drug addiction.

Example: An employer may ask, “Have you ever used illegal drugs?” “When is the last time you used illegal drugs?” or “Have you used illegal drugs in the last six months?” These questions are not likely to tell the employer anything about whether the applicant was addicted to drugs.

However, questions that ask how much the applicant used drugs in the past are likely to elicit information about whether the applicant was a past drug addict. These questions are therefore impermissible at the pre-offer stage.

Example: At the pre-offer stage, an employer may not ask an applicant questions such as, “How often did you use illegal drugs in the past?” “Have you ever been addicted to drugs?” “Have you ever been treated for drug addiction?” or “Have you ever been treated for drug abuse?”

May an employer ask applicants about their drinking habits?

Yes, unless the particular question is likely to elicit information about alcoholism, which is a disability.

Another point worth noting; be careful what questions you ask of a reference:

May an employer ask third parties questions it could not ask the applicant directly?

No. An employer may not ask a third party (such as a service that provides information about workers’ compensation claims, a state agency, or an applicant’s friends, family, or former employers) any questions that it could not directly ask the applicant.

Source: US Department of Justice Americans with Disabilities Act Q&A

Grand Rounds 3.14 is up at Blogborygmi


Nicholas Genes, MD, PhD, second-year resident in emergency medicine at Mount Sinai Hospital in New York, is best known in the medical blogosphere as the “father” of Grand Rounds.  Nick started the series and hosted the first edition in September, 2004, and hosts edition 3.14 this week.

In the past year he’s taken on the somewhat Herculean task of interviewing each week’s GR host and submitting that information to MedScape for publication.  However, in his usual low-profile way, there’s no interview posted this week.

Dr. Genes closes out 2006 with a wonderful, nostalgic collection of the year’s best posts.  Don’t miss it.

Where Our Money Goes

Do you think you spend the majority of your income on your home?  Your car?  Not according to the 2006 edition of Modern Healthcare’s By the Numbers. MHC reports this about selected components of the US Gross National Product:

(Click image to enlarge)

Conference Planning – NAMSS in New York

I spent most of yesterday on the phone on various conference calls with different groups of NAMSS leaders and executive staff members.  All the calls pertained in some way or another to our 2007 conference in New York City.

These marathon phone conversations resulted in a couple of things, first, a sore ear.  Maybe it’s time to get one of those cool high-tech head sets.  Any excuse for a new toy…

Second, I’m starting to get excited about the program and the location.  The hospitality team, chaired by Sue Walther, is very enthusiastic.  They advised us to stay as long as we could so we’d get a chance to see a few of the sites unique to the largest city in the US.  Having been a guest at the hotel before, I can tell you that it’s in a wonderful spot for walking access to many locations in Manhattan.

The program is coming together, the team leaders (Hospital, Managed Care, CVO/Systems, Special Interest)  are hard at work finalizing topics and speakers. 

We’re cooking up a couple of great pre-conference programs as well, in addition to the Professional Development and Credentialing 101 pre-conference programs that will be offered through the Education Committee.

Stay tuned for more details from NAMSS, and start making plans now for New York in 2007.

NAMSS – Setting the Stage for Excellence in Healthcare – Start Spreading the News!

Healthcare Carnivals on the Sidebar – Welcome Cavalcade of Risk

You’ll note that I’ve added a new health related blog carnival to my sidebar – Cavalacade of Risk.  This week’s edition is hosted by Henry Stern from InsureBlog.  Hank has pulled together a well-rounded collection of posts dealing with various aspects of risk management, including one from this blog questioning the health of the current medical credentialing system. 

Cavalcade of Risk joins Grand Rounds, the Grand Pubah of medical blog carnivals, Health Wonk Review , a healthcare policy carnival, and Change of Shift, a nursing carnival, over on my side-bar. 

A browse through these weekly and bi-weekly collections will keep you (possibly healthy and wealthy) but most definitely wise about all things healthcare.

Joint Commission – No Longer JCAHO

The Joint Commission on Accreditation of Healthcare Organizations is shortening their name and changing their logo as of January 8, 2007 to The Joint Commission.  President Dennis O’Leary said the goal was to make the name easier to remember. 

“So what’s a nice standard like you doing in a Joint like this?”

Okay, moving along… In other Joint Commission news, a newly revised Leadership Standard dealing with disruptive behavior is open for field review until January 24, 2007:

Standard LD.3.15
As a critical component of the culture of safety, leaders set expectations for behavior among those who work in the organization.

Rationale for LD.3.15
Safety and quality thrive in an environment that supports working in teams and respecting other people, regardless of their position in the organization. Undesirable behaviors that intimidate staff, decrease morale, or increase staff turnover can threaten the safety and quality of care. These behaviors may be verbal or non-verbal, and may involve the use of rude language, threatening manners, or even physical abuse. Anyone who works in the organization can display these disruptive behaviors, including management, clinical and administrative staff, volunteers, licensed independent practitioners, and governing body members. Leaders must be prepared to address such disruptive behavior at any level.

Elements of Performance for LD.3.15
1. The leaders develop a code of conduct that applies to everyone who works in the organization.
2. The code of conduct defines desirable and disruptive behavior.
3. All who work in the organization are educated about both desirable and disruptive behaviors.
4. The leaders design processes for managing disruptive behavior.
5. Leaders identify the roles of individual leadership groups in managing disruptive behavior.
6. The organized medical staff manages disruptive behavior exhibited by physicians or individuals. who are granted clinical privileges.
7. Leaders establish a fair hearing process for those who exhibit disruptive behavior.

Medgadget Medical Blog Awards – Nominations are Open

Med_blog_award_1Medgadget has announced open nominations until December 31st for the 2006 Best Medical Weblogs Award.

This is the third year for the Medgadget "Bloscars," and the first ever nomination for the MSSPNexus Blog, which was nominated under the category of Best Health Policies/Ethics Weblog.  (Thanks Kim!)

You can view of a list of the current nominees here.  Stop over at Medgadget  to vote for your favorites anytime from Wednesday, January 3, 2007 until midnight on Sunday, January 14, 2007 (PST).  One vote per customer please.

Judges: Medgadget’s editorial staff will be joined by Sumer from Sumer’s Radiology Site, Josh from Kidney Notes, Enoch from Tech Medicine, Maria from Intueri, Orac from Respectful Insolence, Steven from docinthemachine, Bard from A Chance to Cut is a Chance to Cure, Amy from Diabetes Mine and Allen from GruntDoc.

Public votes and judges’ votes are counted as 50%  50%.

Health Wonk Review #22

It is our policy to follow our policy. In the absence of a policy, it is our policy to develop a policy. - Hugh Greeley, Founder, The Greeley Company

Welcome to the December 14, 2006 edition of Health Wonk Review, a blog carnival created by Joe Paduda and friends to “highlight the best-of-the-best, to showcase studies, perspectives, and insights not available anywhere else, and to provide the broader community with a fast and simple way to stay on top of all things health policy related.”

As health policy wonks (by the way, one of the definitions of wonk is “a student who spends much time studying and has little or no social life…” However, I’m sure that’s not an accurate definition of any of this week’s contributors.) it is our job to help efficiently guide and direct the myriad of processes that come to bear in today’s complex healthcare environment.

Anyone who works in healthcare knows that everywhere you look, in every setting, there are big fat policy manuals tucked away, and long, complex documents stored electronically on web and intranet sites. Therefore, I believe that the content of Health Wonk Review has a great deal of room for future expansion.

Do your workmates come to you for opinions on policy, standards, bylaws, or interpretive guidelines? If so, consider submitting a post to a future edition of HWR! Fame and fortune, well okay, fame, awaits you!

A fine collection of posts awaits readers this week:

Learn more about the emerging healthcare blogosphere. Envision Solutions and The Medical Blog Network have released the results of the first global survey of healthcare bloggers: Taking The Pulse Of The Healthcare Blogosphere.

Joe Paduda at Managed Care Matters weighs in on the cost/quality/patient responsibility discussion, noting that some payers and states are beginning to publish outcomes and cost data. There’s a long way to go, but the trip has begun.

Marcus Newberry of Fixin Healthcare writes in Lifestyle Chronicles about the need for balance in the health care system. Problem oriented medical care long ago entered into the realm of diminishing returns. Risk oriented health care has developed enough substance to take the lead.

David Williams from the Health Business Blog notes that being rich doesn’t necessarily mean that you get better healthcare. That’s one reason that corporate executives are interested in improving the quality and service levels of the US health care system.

David Hogberg, Senior Policy Analyst, National Center for Public Policy Research offers a link to an article on Market Driven Insurance and Health Savings Accounts and one to Bitter Medicine a discussion about Medicare and prescription drugs.

David Harlow of HealthBlawg asks “Why haven’t consumer-directed health plans taken off?”

Interested in health data on all 50 states? Losrivas share a review of a website by the Henry J. Kaiser Family Foundation. Carlos Rivas goes on to draw some conclusions from highlighted data points, especially as they concern Latino Health and Universal Health Care in California. Links to further reading on Universal Health Care are provided.

InsureBlog‘s Bill Halper reports on a California county’s new initiative to cover the uninsured.Will it create more problems than it solves?

Colorado Health Insurance Insider has an opinion on What Needs to Be Done about the health care conundrum.

Health Affairs Blog highlights Rep. Bill Thomas’ last hearing as Chairman of the Ways & Means Committee. Deputy Editor Rob Cunningham reports from the hearing which examined the hot issue of Medicare’s overpayment for the medication Epogen to treat anemia in patients with end stage renal disease. Health Affairs Blog also shares disheartening data revealing that more than half of the nation’s uninsured residents are ineligible for public programs but do not have enough resources to purchase coverage.

John Coppelman of Worker’s Comp Insider discusses the case of a worker fired by The Scotts Company after a urine test revealed the presence of nicotine in violation of the company’s policy against smoking on or off the job in Where There’s Smoke, You’re Fired. Is this a violation of the worker’s privacy and civil rights?

Dr Kavokin of RDoctor interviews Hank Stern of InsureBlog, who thinks we live in fascinating times. I agree.

Matthew Holt at The Health Care Blog opines about a reporter stirring up trouble for a surgeon at the Cleveland Clinic, thinking that he might possibly do something in his own financial interests and hide that fact from patients and the Congress. Obviously those reporters don’t understand medical ethics.
Editor’s Note: The Cleveland Clinic issued a statement this week supporting Dr. Lieberman, and indicating that after review they found nothing in his intent or behavior that breached Cleveland Clinic standards.

Trusted Advisor Associates doesn’t think Pfizer slashed 20% of its sales force because of cost, but rather because they’ve become remarkably unproductive since doctors no longer trust them.

Healthcare Renwal weighs in on the NIH Leader Indicted for “Criminal Conflict of Interest” for his Relationship with Pfizer Inc.



From the UK’s Informaticopia The influential Royal Society has published it’s long awaited report into The impact of information and communication technologies on healthcare. Find out more in Digital healthcare.

John Sharp of eHealth comments on issues raised by a New EHR Business Model. Practice Fusion is offering to discount a hosted electronic health record (EHR) and then sell “de-identified data to insurance groups, clinical researchers and pharmaceutical companies.

The Healthcare Economist analyzes why large firms such as Wal-Mart and Intel are pushing for electronic medical records. Also discussed is whether or not government-controlled medical records are a viable option.

Aggravated DocSurg goes “undercover” as a policy wonk with three posts 1 / 2 / 3 that share his insights into the current state of medical staff credentialing.

Dmitriy Kruglyak of The Medical Blog Network discusses a recent brouhaha about online physician review sites. Can you trust anonymous consumer ratings? What does the future hold?

Yours truly closes with a reminder for hospital medical and administrative types to follow their bylaws, and what can potentially happen in court if they don’t.

Thanks for stopping by this edition of Health Wonk Review.  I did receive a few submissions that were well written but not at all related to healthcare policy, so they were not included. The next edition, January 11, 2007, will be hosted by Health Care Renewal.