Disability Question for Nurses with Hepatitis

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Q: I was diagnosed and treated 5 years ago for hepatitis C. I recently applied

for a job on a med/surg unit at a hospital. When filling out the application, I

was asked if I had any conditions or diseases. How should I handle the situation

- am I required to reveal my condition, even if I am not symptomatic?

A: It is illegal for an employer to ask about your medical history when applying

for a job. The Americans With Disabilities Act (ADA) prohibits general inquiries

about disabilities, health problems and medical conditions.

Section 102 of the ADA states: " A covered entity shall not require a medical

examination and shall not make inquiries of an employee as to whether such

employee is an individual with a disability or as to the nature or severity of

the disability, unless such examination or inquiry is shown to be job-related

and consistent with business necessity. "

According to the CDC, " Currently, no recommendations exist to restrict

professional activities of healthcare workers with HCV infection. As recommended

for all healthcare workers, those who are HCV-positive should follow strict

aseptic technique and standard precautions, including appropriate use of hand

washing, protective barriers, and care in the use and disposal of needles and

other sharp instruments. "

Therefore, your hepatitis C status should have absolutely no bearing on your

employability. As long as you are physically able to perform the duties for your

position, your hepatitis C should not interfere with your ability to provide

safe, adequate patient care.

¾ Paper, RN, CCRN

A: This nurse should not be required to give that information; and if it were

me, I definitely would never answer that question. How many patients do we see

that never fully reveal or disclose their diseases to us? These are sick people,

symptomatic people, who have sought us out for help and treatment; and they

aren't required to tell us, the medical and nursing professionals who are being

placed at risk by caring for them.

This nurse is a healthy individual who is asymptomatic and this should not be an

issue. If this becomes a necessary disclosure then what will they begin to ask

of us next?

¾ Kalaine, BSN, RN, CEN, CFRN

A: This question raises an issue that is answered by the ADA. Under the ADA, an

employer who is covered by the act may not ask disability-related questions and

may not conduct medical examinations until after it makes a conditional job

offer to the applicant. This helps ensure that an applicant's possible hidden

disability (including a prior history of a disability) is not considered before

the employer evaluates an applicant's nonmedical qualifications. An employer may

not ask disability-related questions or require a medical examination pre-offer

even if it intends to look at the answers or results only at the post-offer

stage.

Although employers may not ask disability-related questions or require medical

examinations at the pre-offer stage, they may do a wide variety of things to

evaluate whether an applicant is qualified for the job, including the following:

Ask about an applicant's ability to perform specific job functions. For example,

an employer may state the physical requirements of a job (such as the ability to

lift a certain amount of weight or the ability to climb ladders) and ask if an

applicant can satisfy these requirements.

Ask about an applicant's nonmedical qualifications and skills, such as the

applicant's education, work history and required certifications and licenses.

Ask applicants to describe or demonstrate how they would perform job tasks.

Once a conditional job offer is made, the employer may ask disability-related

questions and require medical examinations as long as this is done for all

entering employees in that job category. If the employer rejects the applicant

after a disability-related question or medical examination, investigators will

closely scrutinize whether the rejection was based on the results of that

question or examination.

If the question or examination screens out an individual because of a

disability, the employer must demonstrate that the reason for the rejection is

" job-related and consistent with business necessity. "

¾ H. , JD, MSN, RN

The Q & A Panel

Paper is executive director of the Hemophilia Foundation of Nevada and was

infected with hepatitis C by a contaminated blood transfusion in 1989. (She

previously wrote an article for ADVANCE, " Oh No, Not Me! " on the risk of

acquiring hepatitis C in the workplace. This article can be accessed by logging

onto www.nursing.advanceweb.com and clicking the " Search Articles " tab.)

Kalaine is a staff nurse at s Hopkins Hospital, Baltimore. (Kalaine

sustained an accidental needlestick in 2001 while caring for a known IV-drug

abuser who had tested positive for hepatitis C; all of her hepatitis C tests

have come back negative.) H. is a healthcare attorney and member of

the health law firm of Tsoules, Sweeney, Kepner & , LLC, Exton, PA.