Category: Genetic Information and Nondiscrimination Act (GINA)
I recently spoke at the American College of Occupational and Environmental Medicine (ACOEM) which is a think tank for occupational medicine. Here are some random notes I gathered from that conference:
- State workers’ compensation typically pays the physician for their billed services at a higher rate than Blue Cross or Medicaid.
- The number of occupational medicine practice physician jobs coming open each year far exceeds the supply of occupational medicine physicians to fill them.
- When any of your employees are traveling to a foreign country it is important to understand all the necessary preventative healthcare measures that should be taken.
- The best marketing tool for an independent medical exam practice is the physician’s written report.
- Single site chronic pain is uncommon – only 13% of those with chronic low back pain have isolated pain.
- Workplace injuries have increased incidence and severity due to obesity, sleep deprivation, smoking, drug and alcohol abuse, impairment from certain medicines, diabetes, depression, and workplace conflict.
- An employee’s health behaviors are influenced by their work environment.
- The most common reasons for medical examination disqualification in a study of New Hampshire drivers presenting for a DOT medical exam was neurological conditions and substance abuse.
- Occupational medicine practice can include pre-hire medical examinations, risk analysis, return to work, and job accommodation.
- A driver with sleep apnea cannot be qualified to operate a commercial vehicle.
- Pesticide exposures can include complaints such as skin rashes, headaches, respiratory problems, itchiness, eye irritation and dizziness. There are also serious concerns over the potential threat of long-term health impacts. Farm workers have the highest rate of chemically-related illnesses of any occupational group.
- Deficiencies seen in occupational health nursing include an increase in the average age of nurses, the fact new nurses often do not receive orientation and there is no formal process of validating their competence in the role.
- 30% of the US population sleeps less and six hours per night.
- On-site support and employer size can include the following:
- In-person patient care for acute care and primary care
- Minor acute care via telemedicine tools such as kiosks, web videos, and telephone
- Health coaching with and on-site nurse or coach
- Biometric screening to identify and motivate people with health risks.
- The key elements of a well-designed wellness program include
- Strategic planning
- Cultural support
- Programs for assessment and screening
- Behavior change interventions
- Measurement and evaluation
- Four modifiable risk factors: weight, smoking, exercise, and nutrition/healthy eating drive most chronic conditions in the U.S.
- Some 60 to 90% of low back pain has an unclear etiology.
- An integrated view of health-related costs for a company include medical, pharmacy, wage replacement costs, and lost productivity due to absence and presenteeism.
- The time-frame of the impact of marijuana on driving appears to be 90 minutes.
- Urine drug testing in most settings fails to detect the drugs that factor into accidents at work.
- The prolonged absence from one’s normal role is detrimental to physical, mental, and social well-being. Long-term unemployment post-injury is itself a health problem.
- It is estimated that there are approximately 20,000 cancer deaths per year that can be attributed to the workplace. Historical carcinogens include asbestos, benzene, and chromium.
- In conducting an IME, the physician may not ask a patient for their family medical history, tell the company if a patient has cancer, or asked the patient undergo genetic testing for specific diseases. All of these activities are prevented by GINA.
- Under HIPAA you may not look up laboratory results on a family member, let a mother know her 21-year-old daughter is pregnant, or that her 20-year-old son is in the ER. You can however ask a patient if he wants family to be present during the evaluation.
To learn more about the ACOEM please go to www.ACOEM.org.
As stated in the preamble “The State of California has a compelling public interest in realizing the medical promise of genomics. It also has a compelling public interest in relieving the fear of discrimination and in prohibiting its actual practice….Although Congress enacted the federal Genetic Information and Nondiscrimination Act of 2008 (P.L. 110-233), its range of protections is incomplete for Californians”
While the law deals with insurance, housing and employment, we will focus on the employment law aspects.
- A violation of the right of any individual under the federal Americans with Disabilities Act of 1990 (P.L. 101-336) shall also constitute a violation of this section.
- The new law defines genetic information as being about an individual’s genetic tests, tests of family members, or the manifestation of a disease or disorder among an individual’s family members, and it covers information from genetics services and participation in clinical research.
- Federal GINA’s range of genetic information and nondiscrimination protections is limited to employment and health insurance coverage. SB 559 ensures that the range of protections for Californians applies to all California civil rights laws and would include genetic information as a prohibited basis for discrimination.
You can read the Act by going to http://leginfo.ca.gov/pub/11-12/bill/sen/sb_0551-0600/sb_559_bill_20110906_chaptered.pdf
Information on the bill posted by its author can be found by clicking here.