Need help with Louisiana medical laws...

[BenCarp27]

I know this isn't firearm related, but we do have a sizable number of members involved in the medical field, so I'm hoping one of them will have an answer. I've searched online and have been unable to find any clear answer.
My question is: In the state of Louisiana, is it legal for a medical doctor's staff to perform an employment physical and issue a "clearance" for unrestricted work and/or "respirator use" in an industrial environment, WITHOUT the doctor being present and on site at the time of the examination, or without ever physically meeting with the employee(s) in question?
Any help would be very much appreciated. If needed, you can email me at BenCarp27@yahoo.com.
Thanks.

 

[charlie12]

Too bad they ran our Dr. off the forum, but you would think it would have to have a Dr. present.

 

[BenCarp27]

That's what I'm leaning to believe. Unfortunately, employment physicals and regular medical care visits seem to suffer from a few legal differences. After reading through some of the laws, I found myself wading in water well over my head. I'm hoping someone here may have an answer.
The problem I have is that my company doctor will not release me for work without a written clearance from my private doctor due to the fact I take blood pressure medicine. However, I was informed today that the doctor hired by my company to perform the physical will not accept my doctor's opinion because she is not a cardiologist.
This is fine, because, the way I understand it, it is his prerogative to issue or deny a clearance.
The question I have is whether or not he can deny a clearance, based solely on the history and notation of his M/A's and nurses, without ever performing a physical evaluation or even being present and on site during the exam.
I'm not only out of pocket for half a day today and the remainder of the week, but I'm missing out on 20+ hours of overtime that would have been accumulated, as well as two co-pays(one to my initial doctor and another to the specialist I now have to see).
I'm still coming out of pocket to cover the expenses from damages in Isaac, I definitely didn't need this.
There are also several other guys employed with me going through the same rigamaroo.

 

[charlie12]

Wow sounds screwed up. Maybe someone on here will see it and answer your question.
I hope you get back to work soon.

 

[whitsend]

Not sure I understand the problem here.

Are you saying that the MA did the physical evaluation?
A MA PA or NP can do just about everything a MD can do.

If he is basing his opinion on the evaluation of his MA PA, it would be no different than basing his opinion on the evaluation of another MD in his practice.

EDIT: Sorry, I was confusing a MA with a PA. Thanks for the clarification Brandon.

 

[BrandonLSU]

I assume by MA you mean "medical assistant" if that is the case about all they can do is give shots of non-controlled common medications/vaccines. PAs (physican assistants) and NPs (nurse practitioners) are licensed to practice medicine under the direction of a physician.

If one of these professionals performed the exam definately qualifies as legal. I have always been examined by a MD/DO even though the exams are BS (ie. touch your toes, turn your head, etc.)

At a private physician's office it is unlikely that they will employ a RN (too expensive for the rare times that narcotics would be administered or other areas that a RNs scope of practice would be beneficial in that envoronment) and nurses there are probably LPNs.

 

[BenCarp27]

No NP's or PA's. Just an MA and an RN. In fact, there were no "touch your toes" or "turn your head and cough" examinations. We filled out a question sheet ahead of time, went in, and sat down. They took blood pressure and drew blood. Then we did the horrid, "Blow till you can't possibly curl your toes any further" test, followed by a quick fit test. That was it. I haven't gotten a copy of the "findings" yet, so whether or not the "turn your head and cough" parts were pencil whipped and signed off on, I don't know.
I'm just upset, mainly because if you are going to deny me the right to work, at least have the courtesy to do an actual evaluation on me.

 

[crazy white boy]

I am in the Occupational field and work with numerous Occupational clinics. The form you filled out is the medical questionaire this gives them your past medical history. Your company has an established protocol of what is acceptable and what is not by there standards obviously blood pressure is one of the things that they have established a needed clearance far prior to going to work. Yes a nurse or a PA can legally clear you to wear a respirator.

 

[BenCarp27]

So, if a doctor chooses not to accept the responsibility of issuing a clearance, and chooses to refer you back to your personal doctor to acquire it, wouldn't that mean a clearance from your personal doctor should be all thats needed? I'm not trying to seem difficult, but I'm losing money sitting at home, and I just don't understand the process that is keeping me here. I know general practitioners will usually have a nurse do the initial evaluations, but they must consult the patient.
The reason I'm asking this is because, if the particular doctor's procedure is off base, I'd like to know so I can take steps to prevent this from happening year after year when physicals roll around.

 

[oppsImissed]

Short answer is yes. It is legal for pre employment screenings and drug testing. Only time doctor has to be seen is if it is injury related.

 

[TomTerrific]

Yes a nurse or a PA can legally clear you to wear a respirator.

Could you provide a citation for this?

At one time the OSHA applicable standard specified physician, but it was up to the physician to decide what criteria to apply. That could mean evaluation by a PA or RN, but a physician had to sign off on it. At my plant, each employee had an annual physical, so they had a hearing test and spirometry, the latter for respirator use.

We had one employee who was on sick leave. She refused to be examined by the company doctor prior to return to work and was terminated.

If current regs are similar to the ones when I was working, they would define the health professional, say a physician, and let the professional decide the criteria. I would also think the company physician would have the final say.

 

[CEHollier]

I'm not sure. As a physical therapist only I (a PT) can evaluate, set up a care plan, or discharge a patient. A (physical therapist assistant) PTA follows a PT's care plan making only minor alterations without consulting the PT. They can perform 50% of the patients weekly treatments without direct supervision. Techs are supervised strictly and are very limited under a PT's direct care always. Not sure about Occ Med though.

 

[asianpersuasion]

Too bad they ran our Dr. off the forum, but you would think it would have to have a Dr. present.

I forgot about him. They ran him off you say

 

[Rakkasan]

I assume by MA you mean "medical assistant" if that is the case about all they can do is give shots of non-controlled common medications/vaccines. PAs (physican assistants) and NPs (nurse practitioners) are licensed to practice medicine under the direction of a physician.

If one of these professionals performed the exam definately qualifies as legal. I have always been examined by a MD/DO even though the exams are BS (ie. touch your toes, turn your head, etc.)

At a private physician's office it is unlikely that they will employ a RN (too expensive for the rare times that narcotics would be administered or other areas that a RNs scope of practice would be beneficial in that envoronment) and nurses there are probably LPNs.

Actually, as Nurse Practitioners, we practice under our own license and in collaboration with a physician.

 

[BrandonLSU]

Corrected.

 

[crazy white boy]

So, if a doctor chooses not to accept the responsibility of issuing a clearance, and chooses to refer you back to your personal doctor to acquire it, wouldn't that mean a clearance from your personal doctor should be all thats needed? I'm not trying to seem difficult, but I'm losing money sitting at home, and I just don't understand the process that is keeping me here. I know general practitioners will usually have a nurse do the initial evaluations, but they must consult the patient.
The reason I'm asking this is because, if the particular doctor's procedure is off base, I'd like to know so I can take steps to prevent this from happening year after year when physicals roll around.

Ben a NP or a PA is working for a doctor they are signing for the doctor basically. I know with my company if you are referred for medical clearance for past heart issues or something of that nature they would want a letter from a specialist not a general practioner. The way that the Labor Law reads if a company knowingly accepts your medical condition when they hire you and during your course of employment that condition is aggravated or worsened by your employment it then becomes a work related injury. Or workers compensation claim. What you are going through is the only way a company has of protecting itself during the employment process basically why hire you until they are sure you are fit for duty so that you do not become their liability....Once you have medical clearance from your specialist keep a copy of the letter this should save you some time in the future. Also if you notice on the medical questionaire when you are completing them if you fail to inform them of a medical condition and it is later aggravated at work or discovered you usually can be terminated because you were hired under false pretences.

 

[crazy white boy]

Could you provide a citation for this?

At one time the OSHA applicable standard specified physician, but it was up to the physician to decide what criteria to apply. That could mean evaluation by a PA or RN, but a physician had to sign off on it. At my plant, each employee had an annual physical, so they had a hearing test and spirometry, the latter for respirator use.

We had one employee who was on sick leave. She refused to be examined by the company doctor prior to return to work and was terminated.

If current regs are similar to the ones when I was working, they would define the health professional, say a physician, and let the professional decide the criteria. I would also think the company physician would have the final say.

As you stated if an employee is injured off of the job the employer has the right to have that employee evaluated for fitness to return to duty prior to allowing them to return to work. This keeps the company from having to claim a non work related injury or illness as work related by allowing them to return without medical clearance. Failure to comply usually will result in termination.

 

[crazy white boy]

As you stated if an employee is injured off of the job the employer has the right to have that employee evaluated for fitness to return to duty prior to allowing them to return to work. This keeps the company from having to claim a non work related injury or illness as work related by allowing them to return without medical clearance. Failure to comply usually will result in termination.

Question 1: Does OSHA require the medical questionnaire to be filled out on a yearly basis or may it just be amended as job or health conditions warrant?

Answer: The respiratory protection standard requires an initial medical evaluation to determine the employee's ability to use a respirator before the employee is fit tested or required to use the respirator in the workplace. At a minimum the employer must provide additional evaluations if an employee shows signs or symptoms that are related to their ability to wear a respirator. There is not a specific annual requirement for medical evaluations in the standard. However, the physician or other licensed healthcare provider (PLHCP) may prescribe annual tests to ensure employees' continued ability to wear a respirator.

Question 2: Is it allowable for an employee to go to their own doctor for a medical evaluation of their ability to wear a respirator if the employee is willing to cover the costs?

Answer: The standard requires the employer to select a PLHCP to perform the medical evaluations. Usually the employer has the evaluation performed by a company physician or through an arrangement with a local health care facility. The employer may also choose to use the employee's own physician to evaluate the employee's ability to wear a respirator, in which case, both the physician's fees and the employee's time must be paid by the employer. However, this arrangement is usually difficult to administer since the employer would need to establish a relationship with each physician and provide each physician with the necessary information. If the employer does not select the employee's own doctor or any physician the employee prefers as the PLHCP and the employee goes to a physician of his own choosing, the employer would not be required to accept the evaluation or pay for the evaluation.

Question 3: What information must the company provide to the employee for the physician to make a medical determination as to the employee's ability to wear a respirator?

Answer: The employer must provide the PLHCP with the information in paragraph (e)(5) of the standard. This information includes: the type and weight of the respirator to be used by the employee; the duration and frequency of respirator use; the expected physical work effort; additional protective clothing and equipment to be worn; and the temperature and humidity extremes that may be encountered. The PLHCP must also be provided with a copy of the company's respiratory protection program and a copy of the standard.

Question 4: Can the company dictate to the employee which type of testing must be done by their doctor in order to determine the employee's ability to wear a respirator?

Answer: Most employers use the medical questionnaire to determine an employee's ability to wear a respirator but the standard also allows employers to use a medical examination instead. OSHA requires that the content of the examination include, at least, the items covered in the questionnaire, but this is considered the minimum requirement for the medical evaluation. Any additional testing would be left to the discretion of the company's PLHCP.

Question 5: Does any provision exist to prevent employees from being disqualified or displaced if their ability to use the current type of company-provided respiratory protection is diminished?

Answer: The standard does not provide medical removal protection. However, if the PLHCP determines that an employee has a medical condition that places the employee's health at increased risk if a negative pressure respirator is worn, but the employee could wear a powered air purifying respirator (PAPR), then the employer must provide one. OSHA believes many workers who are medically unable to wear a negative pressure respirator will be able to use a PAPR. However, if it is determined that the employee cannot wear a PAPR either, then the employer cannot assign the employee to a position that would require the employee to wear a respirator.

 

[BenCarp27]

I want to thank all the guys who offered advice in the thread.
I just got a response from the legal aid and advice center in New Orleans, and, according to their attorneys, an employment physical isn't classified as medical treatment, and therefore the doctor can set whatever parameters he feels is sufficient to accomplish the end means. My company, by contract, has accepted his protocol, and there is nothing I can do but follow through with his request.
The national office for human resources with my company, however, has emailed me stating that, if requested, I can challenge the findings of the doctor hired, and provide an authorized clearance from a properly licensed physician of my choice.
At this point, however, it would be quicker to see the cardiologist requested and conduct the clearance process as directed by the original doctor hired by the company.
Hopefully, next year, I can have all my ducks in a row ahead of time, and not be blindsided as I have been this year.

 

[TomTerrific]

Question 3: What information must the company provide to the employee for the physician to make a medical determination as to the employee's ability to wear a respirator?

Answer: The employer must provide the PLHCP with the information in paragraph (e)(5) of the standard. This information includes: the type and weight of the respirator to be used by the employee; the duration and frequency of respirator use; the expected physical work effort; additional protective clothing and equipment to be worn; and the temperature and humidity extremes that may be encountered. The PLHCP must also be provided with a copy of the company's respiratory protection program and a copy of the standard.

I notice this doesn't mention anything about what the respirator is protecting the person from.

I was a CIH in the eighties and they have added stuff to the regulations, but, still, it's up to the certifying physician to decide what is important.

Thanks a lot for this information. I really appreciate your taking the time to do it and it's nice to be able to read what it actually says.

It's a bit strange. I fit tested our entire plant but I get really claustrophobic when I put a negative pressure face mask on, particularly a half-face mask. Those that can't do teach!