U.S. Employment

medicineHaving hepatitis B should not impact your ability to obtain employment. However, we realize that people with hepatitis B often face discrimination in the workplace. In the U.S. workplace, this primarily impacts healthcare providers (physicians, nurses, physical therapists, etc) who have hepatitis B. It is important to know your rights so that if you, or someone you know, faces employment discrimination, you can appropriately respond.

 

What we are doing:

In the U.S., people with hepatitis B are protected under the Americans with Disabilities Act (ADA) and Title VI of the Civil Rights Act. The Hepatitis B Foundation is proud to have played a key role in the landmark settlement by the Department of Justice that established protection for people with hepatitis B under the ADA. The settlement was reached based on the strength of  the Centers for Disease Control and Prevention’s (CDC) recommendations for hepatitis B-infected healthcare providers and students, which were updated in 2012 with the support and input of HBF. These recommendations confirm that having hepatitis B is not a reason to deny or dismiss a person from practicing in a healthcare profession. The recommendations offer strategies for the management of hepatitis B–infected healthcare providers, including when and how to put limitations on a person’s clinical practice.

 

What to do if you are facing discrimination:

Unfortunately, places that employ healthcare providers often still have discriminatory policies or practices, often because they are not aware of the current CDC recommendations or ADA protections. These actions are often guided by misperceptions and fear. Lack of knowledge about prevention and treatment of HBV infection has led to discriminatory practices. These practices can include (but are not limited to):

  • Requiring proof of hepatitis B surface antibody as a condition of employment;
  • Requiring hepatitis B testing and denying employment based upon testing hepatitis B surface antigen positive;
  • Putting limitations on clinical experiences that are not aligned with CDC recommendations, for providers who test surface hepatitis B surface antigen positive.

If you are a healthcare provider in the U.S. and have hepatitis B, it is important to know your rights and be familiar with the CDC recommendations. You might want to reach out to potential employers and find out what their policies in advance of applying for a job. Do they require proof of hepatitis B surface antibody status or hepatitis B surface antigen testing as a condition of employment, and do they have a policy for managing healthcare employees who have hepatitis B? You can ask to see the policy in writing - if they don’t have a policy, ask to see, in writing, how they manage employees with hepatitis B. If you are concerned that these questions might impact your chance of employment, you can ask your questions anonymously.

If you feel that an employer might have a discriminatory policy or practice, or if you are experiencing direct discrimination from an employer in the U.S., you can respond in a few ways:

  • Contact the highest-level person you can within the organization, and provide them with the information and documents from the CDC, DOJ and HHS. You can educate them about current recommendations, and ask them to change their policies to reflect the law.
  • You can talk to your hepatitis B doctor to become part of the conversation – doctors often write letters to schools on behalf of patients.
  • You can seek an attorney to assist you.
  • You can contact the Hepatitis B Foundation at info@hepb.org or 215-489-4900 for help.
  • Most powerfully, you can file a complaint with the Department of Justice. Once a complaint is received, the DOJ can investigate into the employer’s policies to assess whether they are discriminatory.

 

For Organizations That Employ Healthcare Providers in the U.S.

All employers in the U.S. must adhere to the antidiscrimination guidelines set by the ADA. If you represent an organization that employs healthcare providers, it is recommended that you create policies and practices based upon three important documents: The 2012 CDC MMWR recommendations, the 2013 DOJ settlement, and the 2013 HHS letter to all health professions schools. These documents will help assess your current hepatitis B-related antidiscrimination policies and bring them up to date and into compliance.

CDC calls upon institutions to develop and implement written policies regarding the management of healthcare workers, students, and applicants who are identified to be HBV-infected. It is important that employers accurately understand their responsibility to healthcare employees who have hepatitis B, and to base policies and practice on sound scientific evidence as well as legal requirements. As a result of the broad adoption of universal (standard) infection control precautions in the medical care setting, and the ever-increasing use of the HBV vaccine, the risk of provider-to-patient transmission of HBV has become negligible. The 2013 CDC recommendations report that “since 1991, no transmission of HBV has been reported in the United States or other developed countries from primary care providers, clinicians, medical or dental students, residents, nurses, other health-care providers, or any others who would not normally perform exposure-prone procedures.”

As stated in the MMWR recommendations, “HBV infection alone should not disqualify infected persons from the practice or study of surgery, dentistry, medicine, or allied health fields.” According to CDC, those who perform non- or minimally-invasive procedures do not require special panel oversight, and their HBV disease should be managed as any other personal health issue would be managed. Your institutional policy should also address identifying and convening a balanced expert review panel familiar with the CDC guidelines to provide oversight and guidance regarding the practice of HBV-infected providers who perform invasive, exposure-prone procedures.

The Hepatitis B Foundation urges all healthcare institutions to incorporate the updated CDC recommendations into their institutional policies. Establishing science-based policies will help to put the risk of hepatitis B transmission into proper perspective, dispel misperceptions about how hepatitis B is spread, and protect healthcare providers who have hepatitis B from disease-based discrimination.

Using evidence and guidance from the CDC, you can develop policies and practices at your organization that offer the highest protection for employees and patients alike. If you need assistance with developing policies, you can contact the Hepatitis B Foundation at info@hepb.org or 215-489-4900 for more information.