Healthcare compliances training and discussion blog

Archive for May, 2011

Compliance Considerations for Accredited Office-Based Surgery Practices When Hiring Employees and Contractors

For New York State accredited office-based surgery practices (“OBS”), the terms of continued accreditation (varying with an OBS’ specific accrediting agency) often come with strict requirements and guidelines concerning the hiring and retention of employees and independent contractors.  Most unexpected (and often overlooked by OBS employers) are the requirements and guidelines that reach far beyond the customary licensure and/or certification requirements and expand into areas that an OBS employer might consider (understandably) to be “private business decisions” or “matters of professional judgment.” It is in these outlying areas that OBS employers must be well versed in order to avoid inadvertent compliance breaches.

When hiring new employees and/or independent contractors, OBS employers must review their accreditation manuals with a specific focus on the following categories of employees and/or contractors:

(a)          Registered Nurses: when hiring Registered Nurses, OBS employers must confirm, among other things, (i) instances of treatment requiring the presence of a Registered Nurse(s) (including pre and post operative care), (ii) licensure, continuing education and liability insurance requirements, (iii) requirements concerning maintenance of medical records and supporting documentation and (iv) reporting requirements concerning adverse events;
(b)          Physicians’ Assistants and/or Specialists’ Assistants: with regard to Physicians’ Assistants and/or Specialists’ Assistants, special attention must be give to rules and regulations concerning (i) the presence and/or supervision of a physician at the OBS facility, (ii) availability of and/or access to a physicians upon request of the patient, (iii) maintenance of medical record, auditing and quality control initiatives, (iv) licensure, continuing education and liability insurance and (v) reporting requirements concerning adverse events;
(c)           Anesthesiologists: in addition to the state and federal laws concerning and/or affecting financial and work relationships among physicians (i.e., Stark Laws, Anti-Kickback Statutes, False Claims Act), OBS employers must review all rules and regulations concerning: (i) the Anesthesiologist’s access and availability to patients, (ii) pre and post operative care directives, (iii) directives concerning maintenance and support of Anesthesia equipment, medication and/or supplies, (iv) maintenance of medical records, auditing and quality control initiatives, (v) board certification, licensure, continuing education, and liability insurance and (vi) reporting requirements concerning adverse events;
It is important to note that most of these “employment requirements” can be outlined as conditions of employment in an employment contract or independent contractor agreement between the OBS employer and the employee/contractor.  Documenting and outlining relevant accreditation-mandated employment requirements, in addition to clarifying the potential employee/contractor’s responsibilities and obligations, demonstrates a good faith effort to comply with all applicable accreditation mandates and delegates applicable accountability.

Education Department Clarifies E-Reader Accessibility Rules

The U.S. Department of Education today released a new guide to laws and rules colleges must follow to ensure e-reading devices and other emerging technologies are accessible to all students. It focuses on students with vision problems, a group whose access issues have triggered official complaints against colleges. The document, in the form of “Frequently Asked Questions,” was published in response to the department’s “Dear Colleague” letter to college presidents on the subject last June.

If colleges use e-readers, or other emerging technologies, blind students “must be afforded the opportunity to acquire the same information, engage in the same interactions, and enjoy the same services as sighted students,” according to the department.

The department doesn’t discourage the use of emerging technologies but indicates that colleges should assess whether a new technology is accessible, or could be modified to be accessible, before using it.

Colleges can offer alternative versions of a text or technology to students with disabilities, as long as the alternative is “equally effective and equally integrated.”

This means that offering an e-text on a tablet device, such as the iPad, that has more options for the visually impaired, could be an effective alternative to an e-reader version.

An audio book might not do the trick, though.

Christopher Danielsen, a spokesman for the National Federation of the Blind, explains that the requirements of equal effectiveness and integration mean that an alternative text needs to offer all the capabilities of a traditional or e-text. This includes the ability to navigate to a particular section or page, an audio explanation or larger-font version of tables and charts, and, for e-textbooks, equivalent alternatives to interactive features, such as quizzes and note-taking tools.

“The blind student needs to be able to do all the other things that students do,” he says.

He says it is important that the department’s document makes clear that the requirements apply to all new technologies, not just e-readers.

His organization filed a federal complaint last year against Penn State University for its “pervasive and ongoing discrimination” against blind students through its use of a course-management system, library catalog, and departmental Web sites that were not accessible.

The Dear Colleague letter last June came in part because of a lawsuit filed in 2009 by the Federation and the American Council of the Blind against Arizona State University, which was planning to offer a pilot program using Amazon’s Kindle e-reader device. Arizona State settled, promising to use only accessible e-reading devices.

This article was originally posted at

Repeat, Fall Hazards Add Up to $125,818 Fine for Aluminum Finishing Firm

OSHAhas issued Aluminum Finishing LLC in Adel, Ga., 18 safety citations for a variety of hazards, including a lack of fall protection and dangers from the corroded components of the facility’s structural integrity. Proposed penalties total $125,818. OSHA opened an inspection in October 2010 as a follow-up to an April 2010 inspection and a complaint alleging the hazards.

Aluminum Finishing, which anodizes aluminum products, was issued one willful citation with a penalty of $53,900 for exposing employees to fall hazards while walking on top of a steel beam without proper fall protection.

The company was issued six repeat citations with $43,120 in penalties for failing to have employees use fall protection while working above dip tanks, ensure emergency lighting is operational, guard live electrical equipment, cover open troughs to prevent tripping, and provide sanitary conditions for workers. The company was cited for similar violations in October 2008 and April 2010.

Eight serious citations with $28,798 in penalties were issued for allowing employees to work near a dip tank without the proper eye or face protection; exposing workers to shock, electrocution and burn injuries; not properly adjusting the work rest on the floor grinder; and having an emergency eye wash unit with inadequate water pressure. The inspection also revealed that workers were exposed to struck-by hazards from corroded ceiling objects, including sprinkler system pipes, metal wall sheathing, and light fixtures.

The company received three other-than-serious citations with no proposed penalties for failing to establish or implement a written respiratory protection program, anchor the floor grinder to the floor, and mount a portable fire extinguisher.

“This company has disregarded the safety of its employees and repeatedly allowed them to be exposed to struck-by hazards from structural failure, electrocution hazards and falls,” said Robert Vazzi, OSHA’s area director in Savannah. “Immediate action needs to be taken to protect employees from these workplace hazards.”

The “Pedagogy of Poverty” in the Learning Age

This impassioned op-ed by Alfie Kohn exposes how school is very different for poor children than it is for their more affluent counterparts. Education for low-income students is rooted in and aims for compliance. Drills and worksheets, tests and recitations make up the “pedagogy of poverty,” a term first used by Martin Haberman of the University of Wisconsin to describe the kind of teaching he saw in inner city public schools.

The “pedagogy of poverty” and everything that goes with it should be no shock to anyone who has read a newspaper in the last decade. It is not shocking that mostly young, inexperienced teachers with little support or meaningful professional development opportunities are more likely to be in the toughest schools. It is not shocking that there is the highest rate of teacher turnover in these same schools. But what is shocking, and what this piece highlights very effectively, is how current “reform” efforts are reinforcing and even extending in new ways these damaging inequities. Kahn states that “[i]t is possible for the accountability movement to simultaneously narrow the test-score gap and widen the learning gap.”

We are in the learning age. Information is everywhere 24/7, and we have to prepare our students to process and recombine it. Yet our education system does not facilitate the openness and fluidity of our current reality and downright prevents it in many our nation’s poorest schools. Khan rightly urges us to think long and hard about the road to reform we’re currently barreling down.

Test results. Student achievement. These are mainstays of the conversation about what education “reform” is trying to achieve. But are they useful proxies for teaching and learning?

Testing cannot be the sole aim of education because test scores don’t tell the whole story of what is going on in classrooms around the nation. Higher test scores do not equate to deeper learning, which goes beyond “competence” to synthesis and analysis across disciplines. And deeper learning is not a luxury in the learning age; it’s a necessity and a right.

Tell us what you think.

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