Americans with Disabilities Act: physician-shareholder practice groups and ADA compliance

This article examines the application of Americans with Disabilities Act requirements to professional associations like physician practice groups. In general, employers with 15 or more full-time employees must comply with the Act. However, the definition of an employee is sometimes unclear, especially as applied to business entities commonly used by physician practice groups. A recent case decided by the United States Court of Appeals for the Ninth Circuit held that physician-shareholders of a professional corporation are employees for Americans with Disabilities Act coverage purposes. Analogous cases in other federal circuits have held differently, likening the "owners" of professional corporations to partners in a partnership, who are not considered employees. Similar questions arise for popular business entities, such as Limited Liability Companies and Limited Liability Partnerships. This article discusses the nature of the business forms commonly used by physician practice groups and how their characteristics impact employee status for Americans with Disabilities Act coverage. It then suggests that examination is useful beyond business formation characteristics to the purpose of the Americans with Disabilities Act and other employment antidiscrimination statutes.     

Burn survivors and the Americans with Disabilities Act

In this article the major provisions of the recently revised Americans with Disabilities Act (ADA) and its application to burn survivors are explained. For professionals working with this population, the ADA is a model for dealing with issues of follow-up and long term patient adjustment. An overview of previous laws applying to the rights of the disabled in the USA is followed by a brief history of the ADA's development. Each of the five major provisions of the act is discussed in detail. Case studies of burn survivors are used to demonstrate the way in which knowledge of the ADA can be used to anticipate and deal with potential complications of re-entry after hospitalization.     

Helping persons with traumatic brain injury of minority origin: improve career and employment outcomes

Racial and ethnic minorities have a disproportionately high rate of disability compared to white Americans, with African and Hispanic Americans overrepresented in all disability categories. Subsequently, the demand for quality employment and rehabilitation services for individuals with disabilities from minority racial or ethnic groups is increasing. In order to meet the increasing demands of minorities who are severely impaired, vocational rehabilitation professionals and other team members assisting those with traumatic brain injury (TBI) with employment need to become familiar with effective models of service delivery. This article reviews the literature related to return to work following TBI for minorities. A brief review of the supported employment for TBI and supported education literature is also provided. Afterwards, 2 case studies, illustrating the effectiveness of supported employment and educational services, are offered to show how minority individuals with severe TBI can return to work or college postinjury, when services are individualized to meet personal needs.     

ADA Compliance and Accessibility of Fitness Facilities in Western Wisconsin

Purpose:

The study expands the research on fitness facility accessibility by determining how compliant fitness facilities in rural western Wisconsin were with Title III of the Americans with Disabilities Act (ADA). Comparisons were made with 4 other studies that were conducted in different geographical regions. The study also examined fitness professionals’ disability knowledge and awareness.

Method:

An ADA fitness facility compliance instrument and a fitness professional disability awareness survey were used. Direct observation and physical measurements were taken during on-site visits to 16 of 36 eligible fitness facilities in rural western Wisconsin. Ten fitness professionals from participating facilities completed an online survey. Frequencies were used to analyze the results.

Results:

None of the participating facilities were in 100% compliance with ADA. Customer service desk (84%) and path of travel throughout the facility (72%) were the highest compliance areas. Telephone (6%) and locker rooms (32%) were the lowest compliance areas. No fitness professional was trained in wheelchair transfers and very few had received training in providing services to individuals with disabilities.

Conclusion:

Fitness facility accessibility remains a concern nationally. Continued efforts need to be made to raise the awareness of ADA compliance among fitness professionals across the United States, especially in rural areas where fitness facility availability is limited.     

Flexibility and visibility. An examination of the narratives of Norwegian people with disabilities about working part-time

Among the disabled workforce, many are engaged in part-time work. However, research regarding the relationship between disability and part-time work has only partially elucidated how people with disabilities who are in receipt of partial or graded disability pensions perceive and handle the combination of part-time work with their pension payments. This article addresses the narrated strategies employed by people with disabilities in managing part-time employment, drawing on interview data from 10 Norwegian citizens who worked part-time in addition to receiving a graded disability pension. The findings illustrate that flexibility and visibility are specific strategies that our informants implement when health issues and reduced working hours result in weakened connections to the workplace. The article demonstrates how the discourses around paid employment facilitate these strategies. By providing insight into people's narrated experiences of engaging in part-time work with disabilities, the article offers significant recommendations into the conditions necessary for people with disabilities to remain employed while also in receipt of graded disability pensions.     

Worklife after traumatic spinal cord injury

OBJECTIVE: To develop predictive models to estimate worklife expectancy after spinal cord injury (SCI). DESIGN: Inception cohort study. SETTING: Model SCI Care Systems throughout the United States. PARTICIPANTS: 20,143 persons enrolled in the National Spinal Cord Injury Statistical Center database since 1973. INTERVENTION: Not applicable. MAIN OUTCOME MEASURE: Postinjury employment rates and worklife expectancy. RESULTS: Using logistic regression, we found a greater likelihood of being employed in any given year to be significantly associated with younger age, white race, higher education level, being married, having a nonviolent cause of injury, paraplegia, ASIA D injury, longer time postinjury, being employed at injury and during the previous postinjury year, higher general population employment rate, lower level of Social Security Disability Insurance benefits, and calendar years after the passage of the Americans with Disabilities Act. CONCLUSIONS: The likelihood of postinjury employment varies substantially among persons with SCI. Given favorable patient characteristics, worklife should be considerably higher than previous estimates.     

AIDS, surgery, and the Americans With Disabilities Act

The acquired immunodeficiency syndrome and human immunodeficiency virus have had a major impact on the practice of medicine in the past 2 decades. Medical professionals are once again faced with a lethal contagious disease that has been transmitted in the health care setting to both patients and providers. Because of the stigma and fear associated with the infection, civil rights legislation, such as the Americans With Disabilities Act, has been used to protect infected individuals from inappropriate discrimination based on unwarranted fears and public hysteria. Various courts, with the backing of organized medicine and the public health authorities, have made it clear that it is illegal for a physician to refuse to treat a patient based on the patient's seropositivity. Unfortunately, various courts, with the backing of the American Medical Association and the Centers for Disease Control and Prevention, have made it clear that infected physicians are not necessarily afforded equal protection under the civil rights statutes.     

The employment policy and vocational activity support system for people with intellectual disabilities in Poland

This short report discusses issues related to the employment policy and vocational activity support system for people with intellectual disabilities in Poland. The analyses are based on data from a broader research project entitled Employment and Disability. The reconstruction of the Vocational Experience of Persons with Intellectual Disabilities in Poland. The project sought to explore the work-related situation of persons with intellectual disabilities regarding the employment policy, support practices in workplaces, and vocational experience of employees with intellectual disabilities, their job coaches and the coordinators of employment projects. The methodological framework combined the grounded theory set in social constructivism, as presented in Charmaz's works, with discourse analysis and the sociologically-oriented analysis of practices. The data were collected in 25 workplaces employing persons with disabilities in various parts of Poland, mainly by means of in-depth interviews, observation, and field notes. Although analyses discussing the specificity of Polish employment policy indicate that the vocational activity of persons with intellectual disabilities is promoted in Poland, in reality its implementation is difficult. The difficulties result from the poor quality law regulating vocational activity, lack of adequate legislative solutions, barriers on the part of employers, and the absence of sufficient financial support.     

Work expectations of adults with developmental disabilities

Employment is central to an individual's well-being. Work-related expectations of individuals with developmental disabilities were compared with those of service coordinators. Variables included the type of work expected, expected number of work hours, employment-related concerns, desired workplace supports, and influence that both the severity of a disability and service coordinator's work experience have on work expectations. Data were collected from 46 individuals with developmental disabilities through interviews and from 46 coordinators through an online survey. Results indicated positive work expectations overall. The most common work expected was service and trade work. Competitive employment was expected more frequently than sheltered workshops. While work expectations of service coordinators and those individuals with mild developmental disabilities were closely aligned, a greater distinction in work expectations existed between coordinators and individuals with moderate or severe developmental disabilities. These results have important implications for assisting job placement for adults with developmental disabilities.     

Failure to assist persons in danger in surgery]

From 1949 to 1990, the authors gathered 120 files relating to 181 decisions, most of which are unpublished, and analyzed the teachings provided by case law about physicians faced with failure to assist persons in danger. This long series, extending over 30 years of application of article 63, paragraph 2, of the Penal Code--repressing failure to assist-, describes the most various conditions in which general practitioners or specialists were prosecuted, and most often charged and judged, by various criminal courts. In a number of cases, the appeals that were lodged enabled the Criminal Chamber of the Supreme Court to dram up Law rules taking primarily into account the strict application of the Penal Code article in cause, since its first decision in 1949. This article may involve surgeons as specialists, but also as "medical citizens" who are always regarded as having a particular mission of assistance, because of their vocation to rescue victims of accidents or patients in a pathological condition requiring assistance. The effectiveness of assistance is not considered in this legal requirement, which all representatives of the medical profession regard as a permanent sword of Damocles that must never be ignored whatever the circumstances and the practitioner's specialty.     

Does Coordinated,Multidisciplinary Treatment Limit Medical Disability and Attrition Related to Spine Conditions in the US Navy?

Background

Musculoskeletal conditions account for the largest proportion of cases resulting in early separation from the US Navy. This study evaluates the impact of the Spine Team, a multidisciplinary care group that included physicians, physical therapists, and a clinical psychologist, for the treatment of active-duty service members with work-disabling, nonspecific low back pain at the Naval Medical Center, Portsmouth, VA, USA. We compared the impact of the introduction of the Spine Team in limiting disability and attrition from work-disabling spine conditions with the experience of the Naval Medical Center, San Diego, CA, USA, where there is no comparable spine team.

Questions/purposes

Is a multidisciplinary spine team effective in limiting disability and attrition related to work-disabling spine conditions as compared with the current standard of care for US military active-duty service members?

Methods

This is a retrospective, pre-/post-study with a separate, concurrent control group using administratively collected data from two large military medical centers during the period 2007 to 2009. In this study, disability is expressed as the proportion of active-duty service members seeking treatment for a work-disabling spine condition that results in the assignment of a first-career limited-duty status. Attrition is expressed as the proportion of individuals assigned a first-career limited-duty status for a work-disabling spine condition who were referred to a Physical Evaluation Board. We analyzed 667 individuals assigned a first-career limited-duty for a work-disabling spine condition between 2007 and 2009 who received care at the Naval Medical Center Portsmouth or Naval Medical Center San Diego.

Results

Rates of first-career limited-duty assignments for spine conditions decreased from 2007 to 2009 at both sites, but limited-duty rates decreased to a greater extent at the intervention site (Naval Medical Center Portsmouth; from 8.5 per 100 spine cases in 2007 to 5.1 per 100 cases in 2009, p < 0.001) as compared with the control site (Naval Medical Center San Diego; 16.0 per 100 spine cases in 2007 and 14.1 per 100 cases in 2009, p = 0.38) after the Spine Team was implemented in 2008. The risk of disability was lower at Naval Medical Center Portsmouth as compared with Naval Medical Center San Diego for each of the 3 years studied (in 2007, the relative risk was 0.53 [95% confidence limit {CL}, 0.42–0.68; p < 0.001]) indicating a protective effect of Naval Medical Center Portsmouth in limiting disability (in 2008, it was 0.58 [95% CL, 0.45–0.73; p < 0.001] and in 2009 0.34 [95% CL, 0.27–0.47; p < 0.001]); the relative risk improved in 2009 after the introduction of the Spine Team at Naval Medical Center Portsmouth. There were no differences observed in rates of attrition from the period before the introduction of the Spine Team to after at Naval Medical Center Portsmouth, and no overall differences could be statistically detected between the two sites.

Conclusions

This study provides suggestive evidence that a multi-disciplinary Spine Team may be effective in limiting disability. No conclusion can be drawn about the Spine Team’s effectiveness in limiting attrition. Additional study is warranted to examine the effect of the timing of the introduction of multidisciplinary care for work-disabling spine conditions.

Level of Evidence

Level III, therapeutic study.

Electronic supplementary material

The online version of this article (doi:10.1007/s11999-015-4328-4) contains supplementary material, which is available to authorized users.     

Why kidneys fail: report from an American Society of Nephrology Advances in Research Conference

A recent American Society of Nephrology Conference, entitled "Why Kidneys Fail: Translating Basic Mechanisms of Disease Pathogenesis into Novel Therapies," explored basic mechanisms and their potential translational implications. In this article, the conference organizers summarize the conference presentations.     

Incidence and impact of childhood and adolescent injuries: a population-based study.

BACKGROUND: The study of disabilities, use of health services, and absenteeism of parents among 0- to 17-year-old residents of Jerusalem (n = 432) hospitalized for unintentional injuries. METHODS: Telephone interviews with parents, 6 months after hospitalization. Disabilities among 4 to 17 year olds were measured by a 25-item scale derived from the International Classification of Impairments, Disabilities, and Handicaps and by limitations of activities. RESULTS: Six months after the injury, limitations ranged from 8.3% (daily activities) to 19.4% (sport activities). About one in three presented at least one disability in the 25-item scale. All disabilities were present in higher proportions among adolescents. The more severe injuries whether to the head or other parts of the body presented higher percentages of disabilities. Burns and traffic crashes were associated with higher proportions of disabilities than other causes and with more frequent work absenteeism by their parents. CONCLUSION: A relatively large proportion of children remain with long-term disabilities irrespective of cause and body part injured. Because the sequelae of injuries is multifaceted, rehabilitation should include coordination between health and other services.     

An evidence-based clinical guideline for antibiotic prophylaxis in spine surgery

Background context

The North American Spine Society's (NASS) Evidence-Based Clinical Guideline on Antibiotic Prophylaxis in Spine Surgery provides evidence-based recommendations to address key clinical questions regarding the efficacy and the appropriate antibiotic prophylaxis protocol to prevent surgical site infections in patients undergoing spine surgery. The guideline is intended to address these questions based on the highest quality clinical literature available on this subject as of June 2011.

Purpose

Provide an evidence-based educational tool to assist spine surgeons in preventing surgical site infections.

Study design

Systematic review and evidence-based clinical guideline.

Methods

This guideline is a product of the Antibiotic Prophylaxis in Spine Surgery Work Group of NASS Evidence-Based Guideline Development Committee. The work group consisted of neurosurgeons and orthopedic surgeons who specialize in spine surgery and are trained in the principles of evidence-based analysis. A literature search addressing each question and using a specific search protocol was performed on English language references found in MEDLINE (PubMed), ACP Journal Club, Cochrane Database of Systematic Reviews Database of Abstracts of Reviews of Effectiveness, Cochrane Central Register of Controlled Trials, EMBASE (Drugs and Pharmacology), and Web of Science to identify articles published since the search performed for the original guideline. The relevant literature was then independently rated using the NASS-adopted standardized levels of evidence. An evidentiary table was created for each of the questions. Final recommendations to answer each clinical question were developed via work group discussion, and grades were assigned to the recommendations using standardized grades of recommendation. In the absence of Levels I to IV evidence, work group consensus statements have been developed using a modified nominal group technique, and these statements are clearly identified as such in the guideline.

Results

Sixteen clinical questions were formulated and addressed, and the answers are summarized in this article. The respective recommendations were graded by the strength of the supporting literature, which was stratified by levels of evidence.

Conclusions

The clinical guideline for antibiotic prophylaxis in spine surgery has been created using the techniques of evidence-based medicine and best available evidence to aid practitioners in the care of patients undergoing spine surgery. The entire guideline document, including the evidentiary tables, suggestions for future research, and all the references, is available electronically on the NASS Web site at http://www.spine.org/Pages/PracticePolicy/ClinicalCare/ClinicalGuidlines/Default.aspx and will remain updated on a timely schedule.     

The nose between ethics and aesthetics: Sushruta's legacy.

OBJECTIVES: The aim of this article is to determine the origin of interest in rhinoplasty in ancient India, as well as to discuss the ethical and aesthetic implications of the nose in human history. STUDY DESIGN: Literature review. MATERIALS AND METHODS: Articles on history of medical ethics and rhinoplastic surgery were reviewed. RESULTS: Sushruta is considered "the father of plastic surgery," and ancient India a cradle of rhinoplastic method called "the Indian method." Origin of interest in and need for rhinoplasty is deeply rooted in ancient Indian society due to the practice of nose mutilations as a form of public punishment for immoral conduct. CONCLUSION: The nose, once symbol of morality expressed through physical integrity, today becomes an important factor of human beauty. Rhinoplastic surgery is, both then and now, deeply pervaded with both ethics and aesthetics.     

Professionalism

Medical professionalism has been increasingly discussed over the last decade. Its importance in surgical education is also being recognized, both at undergraduate and postgraduate level, but difficulty in definition has meant it is hard to assess. Supreme Court Justice Potter Stuart said of pornography in 1964 ‘I know what it is when I see it’, and professionalism is defined by many in the same way. It is, however, the central core of our work as doctors, inherent in our interactions with patients, colleagues and paramedical staff. It is the behaviour by which we are judged. This article will set professionalism in context in modern surgical education, and will examine available methods to teach, predict and measure it. The professional duties of both individuals and organizations will be examined and the impact of the digital revolution explored. The impact of bullying and undermining in the workplace will be highlighted.     

Worklife After Traumatic Spinal Cord Injury

Abstract

Objective: To develop predictive models to estimate worklife expectancy after spinal cord injury (SCI).

Design: Inception cohort study.

Setting: Model SCI Care Systems throughout the United States.

Participants: 20,143 persons enrolled in the National Spinal Cord Injury Statistical Centerdatabase since 1973.

Intervention: Not applicable.

Main Outcome Measure: Postinjury employment rates and worklife expectancy.

Results: Using logistic regression, we found a greater likelihood of being employed in any given year to be significantly associated with younger age, white race, higher education level, being married, having a nonviolent cause of injury, paraplegia, ASIA D injury, longer time postinjury, being employed at injury and during the previous postinjury year, higher general population employment rate, lower level of Social Security Disability Insurance benefits, and calendar years after the passage of the Americans with Disabilities Act.

Conclusions: The likelihood of postinjury employment varies substantially among persons with SCI. Given favorable patient characteristics, worklife should be considerably higher than previous estimates.     

Der operative Honorararzt im Krankenhaus vor dem Aus?

The cooperation between surgeons in private practice and hospitals in the discipline of plastic surgery is advantageous for all parties involved. This article is concerned with the legal framework conditions for private physicians and sketches the present discussions on incorporation as a self-employed physician based on the current developments in jurisprudence. The demarcation between a self-employed occupation and a fixed employment can in individual cases be particularly difficult. In addition to the problems in statutory social insurance, due to the latest developments in the establishment of a law for combating corruption in the healthcare system, there are also questions with respect to payments for referral of patients. Finally, in addition to the decision on so-called self-employed physicians by the Federal Supreme Court, the existing possibilities for remuneration of private services and optional benefit payments by self-employed or employed physicians in hospitals are discussed.