In Reply Ms Schwartz emphasizes the importance of disclosure as it relates to providing opportunities to medical students with disabilities. Although disclosure is important, if not necessary, for receiving accommodations from an institution, disclosure alone is unlikely to change the broader attitudes and cultural norms that limit access to medical education for students with disabilities. First, the direction of causality is unclear. The fear of disclosure and the culture that precipitates that fear are likely jointly determined: lack of disclosure may contribute to a less-inclusive culture for students with disabilities, but that culture may also breed a fear of disclosure. Second, full disclosure would be difficult to enforce. The decision to disclose may be weighed differently by the applicant, who desires admission, compared with the matriculant, who has already been admitted and desires accommodations. Third, not all disabilities are readily apparent. Although Schwartz emphasizes physical disabilities, research suggests that nonphysical disabilities such as attention-deficit/hyperactivity disorder, learning disabilities, and psychological disabilities are more prevalent among US medical students.1 Those with nonapparent disabilities may face considerable bias that disclosure alone does little to resolve.
Date Written: 2017
While big data offers society many potential benefits, it also comes with serious risks. This Essay focuses on the concern that big data will lead to increased employment discrimination. It develops the novel argument that the Americans with Disabilities Act (ADA) should be amended in response to the big data phenomenon in order to protect individuals who are perceived as likely to develop physical or mental impairments in the future. Employers can obtain medical data about employees not only through the traditional means of medical examinations and inquiries, but also through the non-traditional mechanisms of social media, wellness programs, and data brokers. Information about workers’ habits, behaviors, or attributes that is derived from big data can be used to create profiles of undesirable employees. It can also be used to exclude healthy and qualified individuals whom employers regard as vulnerable to future medical problems. The ADA, which now protects only individuals with current or past disabilities and those who are perceived as having existing impairments, can no longer ignore the discrimination threats posed by predictive health data. The Essay analyzes these risks and propose a detailed statutory response to them.
Hoffman, Sharona, Big Data and the Americans with Disabilities Act (2017). 68 Hastings Law Journal 777 (2017); Case Legal Studies Research Paper No. 2016-33. Available at SSRN: https://ssrn.com/abstract=2841431
S@W/R2W Research & State Demonstration Projects
Millions of American workers leave the workforce each year after experiencing an injury or illness.1 Hundreds of thousands of these workers go on to receive State or Federal disability benefits.2 Keeping even some of these workers in the workforce would help them stay productive while also reducing their dependence on disability programs.
- Four million nonfatal work-related injuries and illnesses occur annually.3
- Productivity losses linked to absenteeism cost employers $225.8 billion, or $1,685 per employee.4
- Lost productivity from workplace injuries and illnesses costs companies $60 billion each year.5
- Businesses spend $170 billion a year on costs associated with occupational illnesses and injuries.6
- In 2013, off-the-job injuries resulted in about 240 million days of lost production time — a number that will grow to 525 million days of future lost production time.7
Many injured workers could remain in their jobs or the workforce if they received timely, effective help. Early return to work (RTW) programs succeed by returning injured workers to productivity as soon as medically possible during their recovery process. While disability cash and health benefits are an essential protection for workers with incapacitating long-term and permanent disabilities, they should not be the default path for those with disabilities if viable options for full and partial RTW exist. By keeping these workers engaged in gainful employment as tax-paying members of the community, fewer individuals will need to apply for or receive disability benefits.
Recognizing the importance of giving workers with disabilities economically sustainable alternatives to Federal disability benefits, the President’s 2018 proposed budget supports early intervention demonstrations to test promising Stay at Work/Return at Work (SAW/RTW) strategies. ODEP and the Social Security Administration, in partnership with other federal agencies, are currently developing the model and structure for the grant program and related evaluation and hope to launch the grant competition shortly after Fiscal Year 2018 funding is available.
1 Bardos, Maura, Hannah Burak, and Yonatan Ben-Shalom. “Assessing the Costs and Benefits of Return-to-Work Programs.” Final report submitted to the U.S. Department of Labor, Office of Disability Employment Policy. Washington, DC: Mathematica Policy Research, March 2015.
2 Social Security Administration, “Annual Statistical Report on the Social Security Disability Insurance Program, 2015.” SSA Publication No. 13-11826. Washington, DC: Social Security Administration, October 2016.
3 U.S. Department of Labor, Occupational Safety and Health Administration, 2012, “Injury and Illness Prevention Programs White Paper.” Available online athttps://www.osha.gov/dsg/InjuryIllnessPreventionProgramsWhitePaper.html.
4 Stewart, W.F., Ricci, J.A., Chee, E., and Morganstein, D. 2003. “Lost Productive Work Time Costs from Health Conditions in the United States: Results from the American Productivity Audit.” Journal of Occupational and Environmental Medicine. 45(12): 1234-1246.
5 U.S. Department of Labor, Occupational Safety and Health Administration. Office of Safety and Health Administration. Available online athttps://www.osha.gov/Publications/safety-health-addvalue.html.
7 National Safety Council. 2015, “National Safety Council Injury Facts 2015 Edition.” Available online athttp://www.nsc.org/Membership%20Site%20Document%20Library/2015%20Injury%20Facts/NSC_InjuryFacts2015Ed.pdf.
Baltimore hospital settles allegations of disability discrimination with $180,000 payment | Legal Newsline
BALTIMORE (Legal Newsline) — The U.S. Equal Employment Opportunity Commission (EEOC) announced April 27 that Harbor Hospital Inc., trading as MedStar Hospital, will pay $179,576 after allegations of federal disability discrimination.
“Health care providers, like all employers, must be mindful of the obligation to provide a reasonable accommodation that allows an employee with a disability to remain employed,” said EEOC Philadelphia district office director Spencer H. Lewis Jr. “It’s not only a good employment practice to retain loyal and productive workers; it’s required by federal law.”
According to EEOC, MedStar Harbor Hospital violated the Americans with Disabilities Act (ADA) when it fired Jerome Alston, a respiratory therapist, because of his disability. Alston had had a kidney transplant and needs to take medications. These medications weaken his immune system. Alston asked for a “work-around” accommodation, so that he would not have to work in isolation rooms with a mechanical ventilation system designed to trap infectious airborne materials. MedStar did not grant him the accommodation and fired him instead, EEOC said.
“An employer must provide a reasonable accommodation to an employee with a disability such as renal failure, whether it is needed because of limitations caused by the disability itself or by the side effects of medication or treatment for the disability,” said EEOC regional attorney Debra M. Lawrence. “We are pleased that MedStar Harbor Hospital took these claims seriously, cooperated in resolving this matter, and agreed to make meaningful policy changes to ensure that its employees and applicants are protected from disability discrimination and receive the accommodations to which they are entitled under the ADA.”
N Engl J Med 2017; 376:1103-1105
March 23, 2017 DOI: 10.1056/NEJMp1615974
My name is Adam. I am a human being, a husband, a father, a pediatric palliative care physician, and an associate residency director. I have a history of depression and suicidal ideation and am a recovering alcoholic. Several years ago, I found myself sitting in a state park 45 minutes from my home, on a beautiful fall night under a canopy of ash trees, with a plan to never come home. For several months, I had been feeling abused, overworked, neglected, and under-appreciated. I felt I had lost my identity. I had slipped into a deep depression and relied on going home at night and having a handful of drinks just to fall asleep. Yet mine is a story of recovery: I am a survivor of an ongoing national epidemic of neglect of physicians’ mental health.
Interview with Dr. Stuart Slavin on depression and suicide among physicians and trainees and how to address stigma associated with mental illness. (6:24)
- In the past year, two of my colleagues have died from suicide after struggling with mental health conditions. On my own recovery journey, I have often felt branded, tarnished, and broken in a system that still embroiders a scarlet letter on the chest of anyone with a mental health condition. A system of hoops and barriers detours suffering people away from the help they desperately need — costing some of them their lives.
Last year, I decided I could no longer sit by and watch friends and colleagues suffer in silence. I wanted to let my suffering colleagues know they are not alone. I delivered a grand-rounds lecture to 200 people at my hospital, telling my own story of addiction, depression, and recovery. The audience was quiet, respectful, and compassionate and gave me a standing ovation. Afterward, hundreds of e-mails poured in from people sharing their own stories, struggles, and triumphs. A floodgate of human connection opened up. I had been living in fear, ashamed of my own mental health history. When I embraced my own vulnerability, I found that many others also want to be heard — enough of us to start a cultural revolution.
My years of recovery taught me several important lessons. The first is about self-care and creating a plan to enable us to cope with our rigorous and stressful work. Personally, I use counseling, meditation and mindfulness activities, exercise, deep breathing, support groups, and hot showers. I’ve worked hard to develop self-awareness — to know and acknowledge my own emotions and triggers — and I’ve set my own boundaries in both medicine and my personal life. I rearranged the hierarchy of my needs to reflect the fact that I’m a human being, a husband, a father, and then a physician. I learned that I must take care of myself before I can care for anyone else.
The second lesson is about stereotyping. Alcoholics are stereotyped as deadbeats or bums, but being humbled in your own life changes the way you treat other people. An alcoholic isn’t a bum under a bridge or an abusive spouse: I am the face of alcoholism. I have been in recovery meetings with people of every color, race, and creed, from homeless people to executives. Mental health and substance-abuse conditions have no prejudice, and recovery shouldn’t either. When you live with such a condition, you’re made to feel afraid, ashamed, different, and guilty. Those feelings remove us further from human connection and empathy. I’ve learned to be intolerant of stereotypes, to recognize that every person has a unique story. When we are privileged as professionals to hear another person’s story, we shouldn’t take it for granted.
The third lesson is about stigma. It’s ironic that mental health conditions are so stigmatized in the medical profession, given that physicians long fought to categorize them as medical diagnoses. Why do medical institutions tolerate the fact that more than half their personnel have signs or symptoms of burnout? When mental health conditions come too close to us, we tend to look away — or to look with pity, exclusion, or shame.
We may brand physicians who’ve had mental health conditions, while fostering environments that impede their ability to become and remain well. When, recently, I moved to a new state and disclosed my history of mental health treatment, the licensing board asked me to write a public letter discussing my treatment — an archaic practice of public shaming. Indeed, we are to be ashamed not only of the condition, but of seeking treatment for it, which our culture views as a sign of weakness. This attitude is pervasive and detrimental — it is killing our friends and colleagues. I’ve never heard a colleague say, “Dr. X wasn’t tough enough to fight off her cancer,” yet recently when a medical student died from suicide, I overheard someone say, “We were all worried she wasn’t strong enough to be a doctor.” We are all responsible for this shaming, and it’s up to us to stop it.
The fourth lesson is about vulnerability. Seeing other people’s Facebook-perfect lives, we react by hiding away our truest selves. We forget that setbacks can breed creativity, innovation, discovery, and resilience and that vulnerability opens us up to personal growth. Being honest with myself about my own vulnerability has helped me develop self-compassion and understanding. And revealing my vulnerability to trusted colleagues, friends, and family members has unlocked their compassion, understanding, and human connection.
Many physicians fear that showing vulnerability will lead to professional repercussions, judgment, or reduced opportunities. My experience has been that the benefits of living authentically far outweigh the risks. When I introduced myself in an interview for a promotion by saying, “My name is Adam, I’m a recovering alcoholic with a history of depression, and let me tell you why that makes me an exceptional candidate,” I got the job. My openly discussing recovery also revealed the true identity of others. I quickly discovered the supportive people in my life. I can now seek work opportunities only in environments that support my personal and professional growth.
The fifth lesson is about professionalism and patient safety. We work in a profession in which lives are at risk, and patient safety is critically important. But if we assume that the incidence of mental health conditions, substance abuse, and suicidal ideation among physicians is similar to (or actually higher than) that in the general population, there are, nevertheless, many of us out there working successfully. The professionals who pose a risk to patient safety are those with active, untreated medical conditions who don’t seek help out of fear and shame. Physicians who are successfully engaged in a treatment program are actually the safest, thanks to their own self-care plans and support and accountability programs.
Instead of stigmatizing physicians who have sought treatment, we need to break down the barriers we’ve erected between our colleagues who are standing on the edge of the cliff and treatment and recovery. Empathy, unity, and understanding can help us shift the cultural framework toward acceptance and support. Mentally healthy physicians are safe, productive, effective physicians.
The last lesson is about building a support network. My network has been the bedrock of my recovery. You can start small and gradually add trusted people, from your spouse and family to friends, counselors, support groups, and eventually colleagues. Then when you fall flat on your face, there will be someone to pick you up, dust you off, and say, “Get back out there and try it again.” A support network can also hold you accountable, ensuring that you remain true to your own personal and professional standards.
Without question, my own successful recovery journey has made me a better physician. My newfound perspective, passion, and perseverance have opened up levels of compassion and empathy that were not previously possible. I still wear a scarlet A on my chest, but it doesn’t stand for “alcoholic,” “addict,” or “ashamed” — it stands for Adam. I wear it proudly and unapologetically.
When a colleague dies from suicide, we become angry, we mourn, we search for understanding and try to process the death . . . and then we go on doing things the same way we always have, somehow expecting different results — one definition of insanity. It’s way past time for a change.
- Disclosure forms provided by the author are available at NEJM.org.
From the Indiana University School of Medicine and the Riley Hospital for Children, Indianapolis.
Worldwide, more than 350,000 women die every year from complications related to pregnancy and childbirth—that’s nearly one every minute. For women affected by conflict or disaster, who are displaced from their homes and communities, the risk of maternal death or injury is especially high. In fact, over 60 percent of the world’s maternal deaths occur in 10 countries, nine of which are currently experiencing or emerging from conflict. With the breakdown of traditional social structures during times of war or conflict, women face an increased threat of sexual abuse, exploitation and violence. And sexual violence puts them at high risk of unwanted pregnancies and unsafe abortions, especially since they often lack access to emergency contraception and emergency care for pregnancy and childbirth complications.
Access to quality health services can mean the difference between life and death. In crisis settings, this access is particularly limited, increasing the risk of maternal death, the main causes of which are: hemorrhage, unsafe abortions, high blood pressure or prolonged and obstructed labor without access to cesarean section. The lack of access to health care also raises the risk of newborn death, usually caused by preterm birth, infection or asphyxia (lack of oxygen) during childbirth. However, there are several steps that can be taken to prevent maternal and newborn death. Training attendants to assist mothers during childbirth and making cesarean section readily available can prevent mothers and their infants from dying needlessly.
Parental Rights Toolkit
- Parental Rights Report Spanish
- Parental Rights Report-Final
- Parental Rights-Make-A-Plan-June-2014-Spanish
– See more at: http://outsolve.com/blog/ofccp-director-blogs-about-updated-veteran-people-with-a-disability-regulations#sthash.tvtBwib0.dpuf
Karla wrote for her daughter, a high school student with cerebral palsy who, her mom points out, “will be as qualified as anyone else” when she enters the workforce. Gerald wrote to make sure we didn’t forget the continuing barriers Vietnam veterans like him still face when trying to enter or re-enter the workforce. And Mike wrote just to say thank you – for helping people “to live improved lives by having a job.”
For millions of workers around the nation, March 24 was just another Monday, the first day of another week of work. But at the Office of Federal Contract Compliance Programs, March 24 was a special day: the day our rules expanding employment opportunities for qualified workers with disabilities and protected groups of veterans went into effect.
For my staff; for Karla, Gerald and Mike; for the hundreds of people who wrote to us supporting our proposals during the rulemaking process; and for thousands of people like them, March 24 was a day of new opportunities. In fact, leaders from the National Organization on Disability and the Easter Seals have suggested that March 24, 2014, will join the anniversary of the Americans with Disabilities Act and even Veteran’s Day as another major milestone in our nation’s journey of expanding rights for veterans and people with disabilities.
These two rules are game-changers. But change is a process, not a switch. That’s true for the contractor community, and it’s true for all of us. Thousands of people have already participated in OFCCP webinars on the new rules, and more training will be coming over the next three months.
At OFCCP, we are committed to getting this right. We know it’s important to be flexible, open and inclusive; to be good enforcers as well as good listeners. We also know that diverse workplaces are better workplaces. They are safer and fairer; they are more productive and, yes, more profitable.
Our job is to protect workers, promote diversity and enforce the law. In doing so, we facilitate the success of businesses, workers and the federal agencies that rely on contracted work. That’s good government and good business sense working together for the good of the country we serve.
Patricia A. Shiu is the director of the Office of Federal Contract Compliance Programs.
Accommodations can stop being effective for various reasons, such as: the employee’s limitations change, workplace equipment changes, the job changes, the workplace itself changes, or the accommodation becomes an undue hardship for the employer to continue to provide.
Medical and Allied Health Careers: Technical Standards and Individuals who are Deaf or Hard of Hearing
October 2015 PepNet 2 put out a “fast facts” document about technical standards and deaf and hard of hearing students studying medical and allied health professions.