Nurses Regulations 1994: Fill & Download for Free

Since areas like Hospital operations and functionality management are already explained in previous answers I would here explain you about the laws and legal requirements to start up a new hospital in India.Hospitals can primarily be of two types- government or private. Further, they can be general, speciality or multispeciality hospitals. Following are the rules and regulations need to comply for setting up a private hospital in Delhi:Registration/Requirement of LicensesClinical Establishments (Registration and Regulation) Bill, 2007 is passed by the parliament and implemented by the states, registration of all clinics (Private/Public) of all systems of medicine will become mandatoryRegistration with the municipal authorities (Delhi Shops and Establishments Act, 1954)Recognition for usage of narcotic drugs (Delhi Narcotic Drugs (Amendment) Rules, 2002Authorisation for generation of Bio-Medical Waste, if treating 1,000 or more patients per monthPermit for procurement/usage of spirit2. Land and ConstructionLand allotted for agriculture cannot be used. To start building the hospital wing, several permissions from local authorities need to be taken. Numerous documents need to be approved, like land deed, architect’s plan, etc.An occupation certificate is obtained after clearing all formalities.Electricity and waterAs per the requirements of the hospital, permission has to be taken from the local governing body to obtain electric meters and water supply.SewageProper disposal of waste requires a well planned sewage and drainage system, which is done after permission is required from the local board.Fire and Health LicenceA Fire licence is necessary to prove that the hospital will not cause any damage or loss of life and needs to be procured from the local municipal council.  Procuring a health licence is vital to provide health care to the patients.Biomedical wasteThis is very vital aspect and permission of Municipal Corporation is required for installing incinerators required to dispose of medical waste and body parts.By ministry of environment and forestControlled by state pollution control boardRegulations Related to Employment of StaffEmployment of staff (Doctors, Nurses, Pharmacists) only after proper credentialingPrevention of sexual harassment of women at work placeResponsibility of employer for safety of employeesRules governing the employment of staff (Delhi Shops and Establishments Act, 1954)Immunisation / other measures for protection of staff from Occupational Health hazards.Sign BoardsRules for the size, contents and correct place for sign boards (IMC Regulations 2002)Information to be displayed at the HospitalCertificate of registration of clinic with the municipal authoritiesIMC/SMC registration certificate (IMC Regulations, 2002)Charges for consultation and other procedures/services (IMC Regulations 2002)Clinic timings, closed days (Delhi Shops and Establishments Act, 1954)Documents to be maintained by the ClinicRegistration of the clinic with the municipal authorities (Delhi Shops and Establishments Act, 1954)Record of employment of adults, letters of employment issued and hours of workMaintenance of record of patients treated (IMC Regulations 2002) and a register of medico-legal cases (MLCs)Maintenance of a register of medical certificates issuedCopies of medical certificates issuedRegistration certificates of doctors/nurses/pharmacists with the State Medical Councils (SMCs)Professional qualifications (degrees/diplomas) of the staffRecord of consumption of Morphine (if applicable) (Delhi Narcotic Drugs Rules, 2002)Account of money receipts and expenses (Income Tax Act, 1961)Authorization for generation of Bio-Medical Waste and record of category wise waste generated (BMW Management Rules, 1998)Issue of any medical certificate, notification, document or report, which is untrue, misleading or improper is a misconduct and punishable offence (IMC Regulations 2002, Section 197 of Indian Penal Code)Regulations Related to Treatment of PatientsValid consent for examination/investigation/treatment/research procedure (or informed refusal of consent), as applicable (IMC Regulations, 2002)Confidentiality of privileged communication, as far as permitted under the lawLife saving treatment of emergency casesRegistration under the Medical Termination of Pregnancy (MTP) Act 1971, the Pre-Natal Diagnostic Techniques (PNDT) Act, 1994, as applicableRules for issue of prescriptions (IMC Regulations, 2002)Maintenance of Medical Records of the patients treated for a period of three years and as per the format vide Appendix 3 to the IMC Regulations, 2002Reporting of Medico-Legal cases to the policeReporting of occurrence of occupational diseasesResponsibility for ensuring safety of patientsRights of patientsPrivacy of patients during consultation, examination and treatmentProfessional indemnity insurance cover of an appropriate amount (Insurance Regulatory and Development Authority Act, 1999)Laws applicable to medical negligence - Vicarious Liability, Respondeat Superior, Indian Contract Law, Tort law, Consumer Protection Act, 1986, Indian Penal Code sections (52, 80, 88, 89, 92, 93, 274-276, 284, 304-A, 336, 337, 338 and 376-D).Drug and Cosmetics Act 1940, Drugs (Control) Act 1950, Narcotic Drugs and Psychotropic Substances Act 1985, Drugs and Magic remedies (Objectionable Advertisements) Act, 1954, Pharmacy Act, 1948.2.  Submission of Reports/Returns to Health AuthoritiesCases of notifiable diseases as applicable in the state (Section 371, Delhi Municipal Corporation Act)Report of cases of food poisoning, if required by Municipal Health Authorities (Prevention of Food Adulteration Act, 1954)Incidence of needle stick injuriesAnnual report under BM Waste Management Rules, 1998 (if applicable)Reports on the MTPs carried outReports on the USG abdomen (abdominal ultrasonography) done on the pregnant women.Safe disposal of infectious/hazardous waste generated at the clinic (BMW Management Rules, Environment Protection Act 1986, IPC Section 269, 270).Prohibition of unethical activities, such as soliciting patients directly or indirectly, by a physician, a group of physicians, or by institutions or organisations by advertising, self-promotion or self-aggrandizement use of touts for procuring patients giving/offering or receiving rebates, gifts, commissions, cutbacks or kickbacks in return for referral or procurement of patients etc (IMC Regulations, 2002).Prohibition of Smoking in Public Places Rules, 2008, Fire Safety Regulations, Financial Regulations: Income Tax Act, Value Added Tax (VAT) Act, Central Sales Tax Act, etc.State laws for prevention of vandalism/violence against medical service staff and institutions.Presently, the operation of private clinics is being governed by the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations 2002 and certain other legislations as outlined below.Cases of notifiable diseases as applicable in the state (Section 371, Delhi Municipal Corporation Act)Report of cases of food poisoning, if required by Municipal Health Authorities (Prevention of Food Adulteration Act, 1954)Incidence of needle stick injuriesAnnual report under BM Waste Management Rules, 1998 (if applicable)Reports on the MTPs carried outReports on the USG abdomen (abdominal ultrasonography) done on the pregnant women.Safe disposal of infectious/hazardous waste generated at the clinic (BMW Management Rules, Environment Protection Act 1986, IPC Section 269, 270).Prohibition of unethical activities, such as soliciting patients directly or indirectly, by a physician, a group of physicians, or by institutions or organisations by advertising, self-promotion or self-aggrandizement use of touts for procuring patients giving/offering or receiving rebates, gifts, commissions, cutbacks or kickbacks in return for referral or procurement of patients etc (IMC Regulations, 2002).Prohibition of Smoking in Public Places Rules, 2008, Fire Safety Regulations, Financial Regulations: Income Tax Act, Value Added Tax (VAT) Act, Central Sales Tax Act, etc.State laws for prevention of vandalism/violence against medical service staff and institutions.Note:1. All of these regulations may not be applicable to every Hospital.2. Delhi Laws quoted above may be substituted by the relevant state laws

Q. Why are surgeons more aggressive and short tempered than doctors of other streams?A. TL;DR There are potential risks and consequences of operating room nurse/colleagues abuse and these include violation of institutional and medical staff bylaws and violations of Title VII of the Civil Rights Act of 1964 with potential monetary awards which are not covered by most malpractice carriers. If the awards include punitive damages, they are designed to punish and are not recoverable from any insurance held by the defendant.The JCAHO recommends that disruptive physicians be educated and that the focus of handling disruptive behavior should be based on rehabilitation rather than punishment. JCAHO regulations do recognize that at times, after attempts at rehabilitation have failed, suspension, abridgement, or revocation of hospital privileges are the only options remaining to the institution. At that time, reporting of the decisions to the State Licensing Board and the National Practitioner Data Bank is mandatory.Consequences and potential problems of operating room outbursts and temper tantrums by surgeonsGeorge B. Jacobs and Rosanne L. WilleAbstractBackground:Anecdotal tales of colorful temper tantrums and outbursts by surgeons directed at operating room nurses and at times other health care providers, like residents and fellows, are part of the history of surgery and include not only verbal abuse but also instrument throwing and real harassment. Our Editor-in-Chief, Dr. Nancy Epstein, has made the literature review of “Are there truly any risks and consequences when spine surgeons mistreat their predominantly female OR nursing staff/colleagues, and what can we do about it?,” an assigned topic for members of the editorial board as part of a new category entitled Ethical Note for our journal. This is a topic long overdue and I chose to research it.Methods:There is no medical literature to review dealing with nurse abuse. To research this topic, one has to involve business, industry, educational institutions, compliance standards and practices, and existing state and federal laws. I asked Dr. Rosanne Wille to co-author this paper since, as the former Dean of Nursing and then Provost and Senior Vice President for Academic Affairs at a major higher educational institution, she had personal experience with compliance regulations and both sexual harassment and employment discrimination complaints, to make this review meaningful.Results:A review of the existing business practices and both state and federal laws strongly suggests that although there has not been any specific legal complaint that is part of the public record, any surgeon who chooses to act out his or her frustration and nervous energy demands by abusing co-workers on the health care team, and in this case specifically operating room personnel, is taking a chance of making legal history with financial outcomes which only an actual trial can predict or determine. Even more serious outcomes of an out-of-control temper tantrum and disruptive behavior can terminate, after multiple hearings and appeals, in adverse decisions affecting hospital privileges.Conclusions:Surgeons who abuse other health care workers are in violation of institutional bylaws and compliance regulations and create a hostile environment at work which adversely affects efficient productivity and violates specific State and Federal laws which prohibit discrimination based on race, color, sex, religion, or national origin.Keywords: Compliance, discrimination, employment, federal laws, harassment, hospital privileges, hostile, sexual, state lawsINTRODUCTIONThe history of surgery abounds with tales of angry and difficult senior surgeons who abused any person who, because of physical proximity, became the object of their fury. Many of us find amusement in retelling these anecdotes after we have escaped to the relative safety of rank or distance but remember that we passed the ring of fire and escaped injury. In the operating room, the abusive outbursts were commonly directed at the scrub nurse who was expected to stand mute and take it. I specifically do not want to name the offending surgeons who not only used words but also threw instruments to the floor and occasionally at the nurses. Their aim happily was often spoiled by their rage but occasionally hit its intended victim. Most of us in academic medicine know about a famous chair of neurosurgery in the Midwest and another famous chief of surgery in New York whose statue adorns the lobby of a major medical center as chronic offenders. Younger surgeons often took on the traits of their teacher and I vividly remember a chief resident who was described by our “CHIEF” with some admiration as someone who could slam a curtain. I myself had less luck with attempts at dominant behavior in the operating room. As a young surgeon, I once irritably instructed a very young scrub nurse that I wanted only blind obedience in my operating room. For the next 35 or so years, when she was an operating room director and I was a surgical chair and we were friends, she never once let me forget the stupidity of my outburst which was told and retold accompanied by gales of laughter at my expense over and over again. I am a quick learner, so I never repeated anything like that again.Tolerating this abysmal behavior is thankfully no longer accepted. Public abuse of operating room personnel can, and should, be stopped instantly by surgical chiefs, medical staff officers, and administrators. It is more difficult to stop private discussions which border on abuse and insults, but education through mandatory conferences dealing with sexual abuse and a hostile work environment should and will help. Both industry and colleges and universities have required, compliance mandated, sessions to prevent violations of real and at times oversensitive and perceived, rather then intended, offenses.This paper will examine the industry and institutional standards and existing state and federal laws which may potentially apply and represent a risk for the offenders.INSTITUTIONAL BYLAWS AND PRACTICESEvery institution providing health care, be it a major medical center or a local community hospital must, as part of its incorporation and accreditation documentation, provide a set of bylaws of the governing body and the medical staff. All of the bylaws have a section dealing with ensuring and supporting a productive work environment. The specific wording may differ from institution to institution, but the meaning of the bylaws is uniformly clear, and that is to promote a healthy, cooperative, and safe environment for patients and staff alike.Regulatory agencies, i.e. the Joint Commission for Accreditation of Health Care Organizations (JCAHO), also known as The Joint Commission (TJC), State Medical Boards, and the federally mandated National Practitioner Data Bank have established requirements for handling and reporting of disruptive behavior by physicians. The JCAHO recommends that disruptive physicians be educated and that the focus of handling disruptive behavior should be based on rehabilitation rather than punishment. JCAHO regulations do recognize that at times, after attempts at rehabilitation have failed, suspension, abridgement, or revocation of hospital privileges are the only options remaining to the institution. At that time, reporting of the decisions to the State Licensing Board and the National Practitioner Data Bank is mandatory.[5,7]Specific forms of disruptive behavior listed are:[5,7] (1) degrading comments or insults, (2) inappropriate joking, (3) profanity, (4) physical assault, and (5) spreading malicious rumors.The JCAHO, in other words, recognizes and condemns abusive behavior in the operating room and elsewhere in the hospital environment. Insulting language or descriptions involving a member of the health care team or the spreading of malicious rumors about colleagues, out of the immediate institutional environment, would qualify as being disruptive behavior.Large businesses, industry, and educational institutions have a long history of needing to deal with complaints about discriminatory practices. In industries where the majority of workers are women and many supervisors are men, an allegation of sexual harassment is not unusual. To be defined as sexual harassment, the behavior does not have to be a request for sexual favors. Offensive comments about, or interpreted to be about, women are sufficient to be labeled sexual harassment. In an environment where the majority of nurses are women and the majority of surgeons are men, it is not difficult to imagine that the person at the receiving end of a barrage of insults decides that she was a victim of sexual discrimination.[6,14]In order to meet corporate compliance regulations of the Equal Employment Opportunity Commission (EEOC) and reduce liability of harassment claims, a company (educational or health care institution) must train employees and supervisors, require employees to report harassment, thoroughly investigate all reports, and take corrective actions.[5,6] Many institutions, including colleges and universities and major medical centers, have instituted mandatory training and education which is conducted on an yearly basis. There are multiple providers of compliancy training to assist organizations to meet the requirements and be proactive in preventing or ending a hostile work environment. Inactivity represents a real liability financially and a potentially devastating public image risks affecting the success of the institution, be it a business, hospital, or university.FEDERAL ANTI-DISCRIMINATION LAWSThe Federal EEOC is charged with enforcing all the federal laws prohibiting job discrimination.For the purpose of this paper, the most significant federal law is Title VII of the Civil Rights Act of 1964, which prohibits discrimination based on race, color, religion, sex, or national origin. As a corollary to the 1964 Civil Rights Act is the Civil Rights Act of 1991, which among other provisions provides monetary damages in cases of intentional employment discrimination.[4]It does not take much imagination to see how this can be applied to nurse abuse in the operating room by surgeons.STATE ANTI-DISCRIMINATION LAWSMany states have adopted anti-discrimination legislation which, to some extent, is similar and even mirrors the federal laws. The most specific is California AB 1825 which requires employers of 50 or more employees to provide all supervisory employees with formal education consisting of 2 hours of sexual harassment prevention[13] every 2 years. The final regulations were issued by the California Fair Employment and Housing Commission (FEHC) which published the finding that failure to comply with AB 1825 will open the door to sexual harassment lawsuits and make it harder to prove in court that the (your) organization took reasonable steps to correct sexual harassment.A similar law in Connecticut requires that all supervisory personnel be given 2 hours of harassment prevention instruction within 6 months after becoming a supervisor. Additional training within 3 years is encouraged.Maine Title 26, Section 808 requires that employers of 15 or more employees train all their employees about workplace harassment and discrimination within 1 year. The specifics of the training are not defined.Other states have approved anti-discrimination laws, but training is not required for compliance. Federal anti-discrimination rules and training requirements apply in all states.ATTORNEY ADVERTISINGIt is only necessary to open a yellow page phone book or access Google or any other search engine to find advertising from multiple law firms seeking clients. The law firms promise to address potential discrimination claims using state and federal courts. Nearly all of the firms offer a contingency fee arrangement, or a no risk to the client lawsuit alleging, among other complaints, sexual harassment, the creation of a hostile work environment, and employment discrimination. In view of the media-publicised hostile work environment, sexual harassment, and employment discrimination awards, it is a surprise, not an expectation, that some operating room nurse has not thought about how to respond to an aggressive surgical attack instead of ignoring the torment. Sooner or later, however, this is bound to happen.DEFENDING HOSTILE WORK ENVIRONMENT CLAIMSThere are two separate areas of potential problems for the abusive surgeon which may call for a legal defense. The first one is the institution and the second, a court of law. Only two theories are available to the defense.What Dr. X said does not meet the “severe or pervasive” definition of harassment laws. He didn’t mean it. He is sorry. She is oversensitive and he was just talking and making a joke.[9] This defense theory can be best described as the “I didn’t know the gun was loaded” defense.This claim represents a violation of my First Amendment rights of free speech.This line of defense has a more substantial chance of success. Professor of Law at UCLA, Eugene Volokh, has written extensively about Freedom of Speech and Workplace Harassment Laws.[9] He reported a big free speech win in the Ninth Circuit Court of Appeals in the Huffington Post.[19] The court opined that in an academic community, a professor's expression on a matter of public concern (even if offensive to some) does not constitute harassment.DISCUSSIONThis paper aims to address the questions: “Are there risks and consequences when spine surgeons mistreat their predominately female operating room nursing staff/colleagues and what can we do about it?” It became quickly obvious to us that this could not be handled in the same manner as our usual literature search. Medical literature does not address abusive behavior problems except obliquely. Even nursing literature tends to shy away from this topic. We had to turn to industry and the law to answer these questions.Gender discrimination at work has been described in Psych Central News, an internet psychology journal.[10] In Forbes Magazine, an excellent article by Michael Morris and Susan Fiske quoted Susan Fiske's keynote address at the Columbia Business School Conference in 2012. Dr. Fiske is a Princeton University psychologist. The theme of the conference was that despite decades of activism, legislation, and human resources programs, discrimination at work continues unabated but manages to hide itself better.[8]Many of us are products of training programs which profess to practice the Socratic Method of Education.[1,3] This educational theory is based on teaching by dialogue rather then lectures and is very appealing until it becomes a method of practicing resident abuse at Grand Rounds. The fellows, who are at times leading the conferences, are expected to follow the example of the Chief and actively participate in resident hazing in order to "make men of them." Small wonder that after this education, some of us turn to nurse and colleague abuse, particularly if they are women and appear to be defenseless.The term “sexual harassment” was used for the first time in 1973 in a report to the President and Chancellor of MIT about various forms of gender issues. It may have been used by various women's groups as early as 1970.[11,12] It is essential to understand that sexual harassment does not have to include demands for sexual favors. It is sufficient that it can be interpreted as being gender specific and severe and pervasive. Employment discrimination law recognizes several protected categories. Among the 16 categories listed, Sex or Gender and Gender Orientation are pertinent to this paper.[9]Professor Volokh, in his excellent paper in the Georgetown Law Journal,[20] describes the fact that the law's vagueness increases its breath and makes it open to interpretation. He advises to stay wide of the unlawful zone and eliminate any possible offensive behavior and severe and pervasive practices to create a hostile or abusive environment at work. If an employer continues to question his attorney to describe specific potential consequences of violations of the law, Professor Volokh advises counsel to answer: “We won’t know until it gets to court.” That is exactly the potential fate of the surgeon who insists on abusing co-workers.A complaint to the governing body of the institution (hospital, medical center) leads to a hearing by a medical staff committee. Depending on the seriousness of the complaint, the resolution may be dismissal of the complaint or may include a number of remedial actions up to and including revocation of privileges. When that happens or when a suspension or abridgement of privileges is recommended, the case invariably will end up in court. It would be unusual to have operating room nurse abuse alone result in a penalty so severe that a report to the National Practitioner Data Bank and the State Board of Medical Examiners becomes mandatory. Any adverse decision about clinical privileges meets the mandatory reporting criteria in every state.[5,7] To result in privilege abridgment, or more, the physician would have to be considered a disruptive physician whose continued presence on the medical staff would interfere in quality health care delivery. Very few judges are likely to reverse that kind of decision.During my tenure as a Department Chair, President of the Medical Staff, and Chair of the Medical Board (Medical Executive Committee), and my many years of membership on the Executive Committee of the Board of Governors of the University Hospital, we had several instances dealing with impaired physicians and only one instance when a revocation of privileges was recommended because of disruptive behavior. The physician who came under review did not just abuse operating room nurses, but also engaged in hostile and threatening behavior in other areas of the institution.Most industries recognized some time ago that it is not a good business practice to use gender-specific names and terms which part of the workforce might find demeaning or offensive. Both I and Dr. Wille, as professional pilots, experienced this alternate terminology when we were directed to change the name of “cockpit” to “flight deck” and “stewardess” to “flight attendant”. It was only after the change in name was official that most of us recognized the potential problem which could be interpreted as contributing to the creation or maintenance of a hostile work environment.The First Amendment to the Constitution, adopted on December 15, 1789, simply states: Congress shall make no laws respecting the establishment of religion, or prohibiting the free exercise thereof, or abridging the freedom of speech, or of the press, or the right of the people peacefully to assemble, and to petition the government for regress of grievances. In the beginning, the First Amendment applied only to the federal governments, but in the 20th century the Supreme Court incorporated the Establishment Clause which made the amendment apply to the states as well.[15–18]It is the First Amendment freedom of speech clause which is used to defend most of the verbal harassment complaints which are the discussed in this paper.CONCLUSIONSThere are indeed potential risks and consequences of operating room nurse/colleagues abuse and these include violation of institutional and medical staff bylaws and violations of Title VII of the Civil Rights Act of 1964 with potential monetary awards which are not covered by most malpractice carriers. If the awards include punitive damages, they are designed to punish and are not recoverable from any insurance held by the defendant.Finally, for those surgeons who have a self-value far in excess of what any nurse has, it is worth to consider the following as a valuable lesson of what the world thinks of nurses: On the retirement of Lieutenant General Eric B. Schoomaker, MD, PhD, as the US Army Surgeon General, President Obama nominated and the US Senate confirmed the appointment of Major General Patricia D. Horoho as the US Army Surgeon General. General Horoho served as the Commanding Officer of the Army Nurse Corps and Assistant Surgeon General prior to be given the Army Medical Command. On December 5, 2011, General Raymond T. Ordierno, the Army Chief of Staff, promoted Major General Horoho to Lieutenant General and administered the oath to swear her in as the Army's Chief Medical Officer. General Horoho is the first woman and the first nurse to serve as the Commanding Officer of the Medical Corps. Think about that the next time you decide to abuse a nurse or a woman colleague.[2]FootnotesDisclaimer: The authors of this paper have received no outside funding and have nothing to disclose.Available FREE in open access from: http://www.surgicalneurologyint.com/text.asp?2012/3/4/167/98577REFERENCES1. Areeda PE. The Socratic Method. Harv Law Rev. 1996;109:911–22.2. Army News Service. 1996;109:911–922.3. Benson HH. Socratic Wisdom: The Model of Knowledge in Plato's Early Dialogues. New York: Oxford University Press; 2000. pp. ix–292.4. Federal Laws Prohibiting Job Discrimination: EEOP/Civil Service Reform Act of 1978 (CSRA) Office of Personnel Management (OPM) Office of Special Councel (OSC) Merit System Protection Board (MSPB)5. Gross JC. Article Regarding Disruptive Physicians. [Last accessed on 2012 Feb 15]. Available from: http://www.medical-peer-review.com/Articles/Article-Regarding-Disruptive-Physicians.sh,2012 .6. Huhman H. How to Recognize Sexual Harassment in the Workplace. [Last accessed on 2012 Feb 15]. Available from:http://money.usnews.com/money/blogs/outside-voicescareers/2011/11/11 .7. McDonald O, Silbaugh B. Disruptive Physician Behavior. Quantia MD. 20118. Morris M, Fiske S. The New Face of Workplace Discrimination. [Last accessed on 2012 Feb 15]. Available from:http://www.forbes.com/2009/11/12/discriminination-workplace-prejudiceleadership-managers .9. OPM web site. [Last accessed on 2012 Feb 15]. Available from:http://www.opm.gov/er/address2/guide01.htm , http://www.osc.gov/ , http://www.mspb.gov/10. Psych Central News Editor. Gender Discrimination in the Workplace. [Last accessed on 2012 Feb 15]. Available from:http://psychcentral.com/news/2009/10/09/gender-discrimination-in-theworkplace/8868.html .11. Rowe M. Saturn's Rings: Graduate and Professional Education of Women, American Association of University Women. 197412. Rowe M, Bendersky C. Workplace to Society. New York: Cornell University Press; 2001. Workplace Justice, Zero Tolerance and Zero Barriers.13. State of California: AB 1825, June 27, 2003.14. US Equal Employment Opportunity Commission: Sexual Harassment. 2003 Jun 27;15. United States Supreme Court: Burlington Industries v. Ellerth, 524 U.S. 199816. US Supreme Court: Board of Education of Kiryas Joel Village School District v. Grumet, 512 U.S. 687. 199417. US Supreme Court: Everson v. Board of Education. 194718. US Supreme Court: Faragher v. City of Boca Raton, U.S. 755. 199819. Volokh E. Freedom of Speech vs. Workplace Harassment Law–A Big Free Speech Win in the Ninth Circuit. [Last accessed on 2012 Feb 15]. Available from: http://www.huffingtonpost.com/eugene-volokh/freedom-of-speech-vs-work_b_584017.html .20. Volokh E. What Speech Does “Hostile Work Environment” Harassment Law Restrict? Georgetown Law J. 1997;85:627.

Here you go, here’s why I’m excited about Trump:1. Trump is the Opposite of Racist, a Nationalist. Nationalism was conceived as a means of overcoming tribal racism, of uniting diverse peoples with a mutually supportive, overarching national identity. Does dividing us by races, ethnicities, and identities and prevent us from being united as Americans? E Pluribus Unum – from the many, one people.And yes, he has denounced white supremacists: Trump condemns 'racism, bigotry and white supremacy' in speech after mass shootings kill 31 and 'Racism Is Evil': Trump Denounces The KKK, Neo-Nazis And White Supremacists and Frank Macera's answer to Has Trump denounced white supremacy? and President Trump Releases The Platinum Plan for Black Americans: Opportunity, Security, Prosperity, and Fairness)The Chairman of the Proud Boys, Enrique Tarrio, is both black and Hispanic.Trump receiving the Ellis Island Award along with Rosa Parks:Lowest black and Hispanic unemployment in our history.Support for historically black colleges. “Provided long-term funding for historically black colleges and universities in his three years in office, and has helped redirect resources to opportunity zones, or low-income areas where new investments may be eligible for tax breaks.Criminal Justice Reform with the First Step Act has released 1,000’s of non-violent offenders.First Step Act, landmark criminal justice reform legislation enacted by an 87-12 vote in the Senate on December 18 and a 356-36 vote in the House on December 20. President Donald Trump signed the bill into law on December 21.”First Step Act Was This Past Year's Second Example Of Federalism At Its FinestEven Obama adviser Van Jones says Trump doesn't get credit for the good things he has done for the black community.Lowest black and Hispanic unemployment in our history.Support for historically black colleges. “Provided long-term funding for historically black colleges and universities in his three years in office, and has helped redirect resources to opportunity zones, or low-income areas where new investments may be eligible for tax breaks.Criminal Justice Reform with the First Step Act has released 1,000’s of non-violent offenders.First Step Act, landmark criminal justice reform legislation enacted by an 87-12 vote in the Senate on December 18 and a 356-36 vote in the House on December 20. President Donald Trump signed the bill into law on December 21.”First Step Act Was This Past Year's Second Example Of Federalism At Its FinestEven Obama adviser Van Jones says Trump doesn't get credit for the good things he has done for the black community.Van Jones says Trump 'doesn't get credit' for helping black people2. Covid-19:Jan. 31. Trump restricts travel by anyone who had been to China within 2 weeks to returning citizens and authorizes screening and quarantine as needed:“The entry into the United States, as immigrants or nonimmigrants, of all aliens who were physically present within the People’s Republic of China, excluding the Special Administrative Regions of Hong Kong and Macau, during the 14-day period preceding their entry or attempted entry into the United States is hereby suspended and limited subject to section 2 of this proclamation. I have also determined that the United States should take all necessary and appropriate measures to facilitate orderly medical screening and, where appropriate, quarantine of persons allowed to enter the United States who may have been exposed to this virus.”Feb. 1 Biden calls Trump a xenophobe and fear-monger and offers no plan of his own. Apparently, it would have been a lot worse if Biden were president. “We are in the midst of a crisis with the coronavirus. We need to lead the way with science — not Donald Trump’s record of hysteria, xenophobia, and fear-mongering. He is the worst possible person to lead our country through a global health emergency.” – Joe Biden @JoeBiden 4:01 PM · Feb 1, 2020·TweetDeck?Biden was a United States Senator with 47 years in politics and a national platform. What new anti-virus policies is he endorsing? Is criticizing Trump enough to end the virus?De Blasio’s actions in New York were responsible for the majority of the spread in the United States:Feb. 9 De Blasio urged the 500,000 person Chinese New Year celebration to go forward with tourists from all over the country and the world, especially Europe. This resulted in nearly half of all the early cases, and all those tourists going home and initiating the spread in a number of places around the country.New York Chinese New Year Feb. 20203. Apprenticeship training - Apprenticeship.gov4. School Choice. Why shouldn’t hard working poor kids be able to join others of like mind and get a good education? Public school isn’t always the best choice: Ted Kord's answer to Shouldn’t well-behaved students have a right to a peaceful and safe environment in which to learn? Restorative justice in my kids’ schools is making my kids miserable and inhibiting their learning.5. Block education grants allow local districts to spend money the way it makes sense in their district instead of the current “knowledge isn’t important” and “no discipline” philosophy coming out of Washington. Our spending has risen dramatically in the last decades, yet test scores haven’t gone up and teachers complain about their salaries. Shouldn’t we try another way?6. Lowest black and Hispanic unemployment in our history.7. Lower foreign student enrollment to make room for our own children.8. Tax code that stopped subsidizing the rich with $10,000 maximum local tax deduction. I paid more myself, but I think it’s fair. Individual tax receipts were higher in 2018 than 2017. Middle and lower incomes paid less, with childcare credit doubled to $2,000, standard deduction raised to $12,000, and tax brackets lowered, so where did the money come from to pay for these cuts? People with expensive houses paid for it.9. Big companies like Apple and Goldman no longer allowed to transfer income overseas to avoid taxes. This cost Goldman $5 billion in 2018.Goldman Sachs Is Taking a $5 Billion Hit From the Republican Tax Bill10. Equalized corporate taxes between the US and the developed world. Britain is 19%, China 20%, Sweden 21%, and now the US is 21%. How can we keep our jobs if we don’t at least avoid adding higher taxes to the incentives to leave? Apple announced building their first computer plant in America Jan. 1, 2018, the same day Trump allowed them to bring their billions home from China at 15% tax instead of 40%. They had been planning since 2013, and were just waiting for the tax to be lowered. Apple expands in Austin11. Fighting to prevent Chinese technology theft. Tariffs have already caused movement away from China to countries without state-sponsored technology theft. Blocking Huawei will spur more US component manufacture and send other business to Nokia and Ericsson who respect our laws.12. Net neutrality. Remember when charging based on data usage was going to censor the internet? Now everything is running better than ever, as promised.13. Ended Obamacare tax on poor who cannot afford health insurance even with subsidies.14. Drug pricing – Companies like GoodRx have shown us disclosing and comparing pricing caused drug prices to drop so much I’ve been able to drop my drug insurance. The pharmacy benefit manager middle men and drug stores had large markups, and now we’re reaping the benefits of competitive capitalism with lower prices. Epi pens were up to $600 under the previous administration, now the price is down to $110 at CVS and Target. Unlike single payer or insurance, you can get any drug cash pay with no hassles. Adrenaclick Prices, Coupons & Savings Tips - GoodRx15. Competitive, efficient hospital pricing. Actual hospital pricing will be disclosed starting Jan 1, 2020. This will rationalize and lower healthcare cost in the US. All the paid hours that go into our labyrinth of hidden pricing and negotiation, and multitudinous paperwork is expensive, and it prevents people from making informed decisions. Administration is about 1/4 of every healthcare dollar. All that paperwork and process costs a lot, there are separate contracts for every insurance company and fees are individually negotiated for each patient, all hidden and protected from competition. Straight forward healthcare pricing will save a bundle on administrative cost.My recent X-rays were billed at $1736. The insurance discount $1528, insurance payment $168, my payment $42. Obviously, I have to have insurance for the discount. But what if the X-rays were just billed at $210 cash pay? I wouldn’t need $1500/month insurance for ordinary care, I could have low cost catastrophic insurance, and pay cash for everything else. This would save a lot of administrative expense, and the more healthcare delivered per dollar, the more we’ll all have. The only way we can afford to provide healthcare for everyone is get that cost down. Total healthcare spending in 2018 was $3.65 trillion.Hospitals Sued to Keep Prices Secret. They Lost.Trump scores court win on hospital price transparencyU.S. Health Care Costs Skyrocketed to $3.65 Trillion in 2018 - A new analysis from U.S. federal government actuaries, the U.K., Mexico, Spain, and Canada.16. Defeated the ISIS Caliphate in short order by empowering military leaders to “seize the initiative and win,” reducing the need for a White House sign off on every mission. Trump has refused to get involved in any new wars, which is lovely.17. Criminal Justice Reform bill, “First Step Act” eliminated required minimum sentences. “More than 3,000 inmates have been released and another roughly 1,700 people convicted of crack cocaine offenses have seen their sentences reduced thanks to the First Step Act, according to data from the Federal Bureau of Prisons and the U.S. Sentencing Commission.” The First Step Act promised widespread reform. What has the criminal justice overhaul achieved so far?18. Recognized Jerusalem. Israel wasn’t going to give up their ancestral home, so it was a necessary condition for peace in the Middle East. Trump was right, the fears of violence were unfounded, and putting the recognition behind us paved the way for the UAE, Bahrain, and Sudan to recognize Israel for the first recognitions since Jordan in 1994. Egypt was first in the region in 1979.19. Improved the quality of VA care with the Veterans Accountability and Whistleblower Protection Act to allow senior officials in the Department of Veterans Affairs to fire failing employees and established safeguards for whistleblowers.Trump’s VA MISSION Act:• Strengthens VA’s ability to recruit and retain clinicians.• Authorizes “Anywhere to Anywhere” telehealth across state lines.• Empowers Veterans with increased access to community care.20. Did something about the 185,000 pages of conflicting overregulation. It isn’t even possible to meet all the regulations because different regulations call for different things. Here’s How Much Red Tape Trump Has Cut21. Rational EPA regulations. It doesn’t help the environment to let stock ponds turn black and stink and make the cattle drink it. You really do need to treat for invasive weeds and bacteria. I couldn’t treat the water in my tank to drinking water standard so the bacteria broke my skin out every time I ran my pump. Then, to add insult to injury, they said that water’s nasty so you have to spend $10,000 to have it disposed as hazardous material. Drinking water is hazardous to the environment?He plowed his field; now he faces a $2.8 million fine22. Great American Outdoors Act. “The fund must be used for priority deferred maintenance projects in specified systems that are administered by• the National Park Service,• the Forest Service,• the U.S. Fish and Wildlife Service,• the Bureau of Land Management, and• the Bureau of Indian Education.22. Brought stranded citizens back home:Here Are The 17 Prisoners Trump Has Freed Since He Took Office23. Expensive illegal immigration and the associated crime is being reduced. The cost of additional schools, healthcare, housing, and food benefits is substantial, especially when we’re spending over a $trillion/yr we don’t have. And there’s the gangs with their associated theft, murder, drugs, and sex slaves. Trump’s border wall construction:Trump Wall Construction - Track the Status of Trump's Border Wall!400th mile of border wall celebratedhttps://www.wfmz.com/news/livestream/watch-live-400th-mile-of-border-wall-celebrated/video_3c242b8a-19f7-11eb-91d9-1bdc61296a5c.htmlThen it turns out the major objections to Trump just aren’t true:1. Covid Mismanagement was Trump’s fault?List: 74 actions taken by Trump to fight virus and bolster economy.List: 74 actions taken by Trump to fight virus and bolster economy (List: 74 actions taken by Trump to fight virus and bolster economy)Jan. 31 Trump restricts travel to and from China, and those who had been to China:“The entry into the United States, as immigrants or nonimmigrants, of all aliens who were physically present within the People’s Republic of China, excluding the Special Administrative Regions of Hong Kong and Macau, during the 14-day period preceding their entry or attempted entry into the United States is hereby suspended and limited subject to section 2 of this proclamation. I have also determined that the United States should take all necessary and appropriate measures to facilitate orderly medical screening and, where appropriate, quarantine of persons allowed to enter the United States who may have been exposed to this virus.”https://www.whitehouse.gov/presidential-actions/proclamation-suspension-entry-immigrants-nonimmigrants-persons-pose-risk-transmitting-2019-novel-coronavirus/Feb. 1 Biden calls Trump a xenophobe and fear-monger and offers no plan of his own. Apparently, it would have been a lot worse if Biden were president. “We are in the midst of a crisis with the coronavirus. We need to lead the way with science — not Donald Trump’s record of hysteria, xenophobia, and fear-mongering. He is the worst possible person to lead our country through a global health emergency.” – Joe Biden @JoeBiden 4:01 PM · Feb 1, 2020·TweetDeckDe Blasio’s actions in New York spread Covid in the United States:Feb. 9 De Blasio urged the 500,000 person Chinese New Year celebration to go forward with tourists from all over the country and the world, especially Europe. This resulted in nearly half of all the early cases, and all those tourists going home and initiating the spread in a number of places around the country.New York Chinese New Year Feb. 2020“NYC health officials were on high alert, on Jan. 23, as deadly Coronavirus spreads around globe. Yet they did not stop Chinese’s New Year parades, Feb. 9, in all 5 boroughs, that typically draw 500,000 people. “https://brooklyneagle.com/articles/2020/01/23/nyc-health-officials-on-high-alert-as-deadly-coronavirus-spreads-around-globe/Feb. 13: "There are ZERO confirmed cases of coronavirus in New York City, and hundreds of Chinese restaurants that need your business!" the New York City mayor's office tweets. "There is nothing to fear. Stop by any Chinatown for lunch or dinner!"Feb. 24 Pelosi does her own spreading: “Speaker of the House Nancy Pelosi toured San Francisco's Chinatown Monday to send a message. She said there's no reason tourists or locals should be staying away from the area because of coronavirus concerns.https://www.nbcbayarea.com/news/local/nancy-pelosi-visits-san-franciscos-chinatown/2240247/‘That’s what we’re trying to do today is to say everything is fine here,’ Pelosi said. "Come because precautions have been taken. The city is on top of the situation."March 13, 2020And then, even worse, they refuse to shut the schools until mid-MARCH. 1.2 Million kids spreading the virus and infecting parents and grandparents.“Cuomo, De Blasio Resist Calls to Close New York Schools”“New York Governor Andrew Cuomo said he does not see a need to close schools statewide and would leave such decisions to the localities.His statement comes as New York Mayor Bill de Blasio faces pressure from the leaders of the teacher’s union and the City Council to close schools as cases of the new coronavirus surge.”https://www.bloomberg.com/news/articles/2020-03-13/de-blasio-says-nyc-schools-mass-transit-will-stay-openThis took place in 20 places across NYC in February.https://images.rove.me/w_1920,q_85/naujawgeoqdga3iored6/new-york-chinese-new-year.jpgAnd then, after we know that rest homes are vulnerable, Cuomo allows this:“Coronavirus spreads in a New York nursing home forced to take recovering patients” “It’s reckless and careless,” said the granddaughter of a 96-year-old man whose family withdrew him from a Long Island nursing home. “Over 1,700 more coronavirus deaths reported in New York nursing homes”https://nypost.com/2020/05/05/over-1700-more-deaths-reported-in-new-york-nursing-homes/https://www.nbcnews.com/news/us-news/coronavirus-spreads-new-york-nursing-home-forced-take-recovering-patients-n1191811“New York refused to send nursing home’s COVID-19 patients to nearly empty USNS Comfort”https://nypost.com/2020/04/24/new-york-nursing-home-denied-requests-to-send-covid-19-patients-to-usns-comfort/“An NYC nursing home forced to take coronavirus patients was also sent a supply of body bags for when they died”https://www.businessinsider.com/nursing-home-given-body-bags-when-they-accepted-coronavirus-patients-2020-4And of course, Nancy Pelosi wants to investigate how the response was handled after she did the same thing as NYC in February.- Ted A. Brewster and Cal Stowe2. Trump was not responsible for “ripping babies from their mother’s arms”, in fact it was a Democrat policy ended by Trump. It was the propaganda coup of the century to turn a noble fight to get illegal children treated the same way as citizens into something evil and hang it on Trump.In September 2018, the Trump Administration proposed regulations that sought to end the practice of forcing children to be “ripped from their mother’s arms” by the Flores Agreement won by liberal lawsuits. Democrats voted it down, saying “ripping children from their mother’s arms” is actually “legal safeguards for children”, in order to keep the practice and blame it on Trump. Trump officially ended the practice with an executive order in June 2018 - https://www.politico.com/story/2018/06/20/full-text-trump-executive-order-family-separations-transcript-658639 .Citizen children are always separated from parents in childcare centers, jail not being considered a suitable environment for children, but historically illegals were considered a special case, and children stayed with their parents. There was a problem with unaccompanied minors, and a suit was filed on the behalf of JENNY LISETTE FLORES. Negotiations and court proceedings dragged on for nine years, spanning three presidencies. This resulted in the Flores Settlement in 1997. In short, unaccompanied illegal children were to be detained in the same facilities and subject to the same rules as citizen children.In 2016, liberal activists got the 9th U.S. Circus of Appeals to extend the 1997 Flores Settlement from unaccompanied illegal minors to children detained with their parents. Children were ordered to be separated from the parents detained under immigration law. Trump put the children in childcare centers as the law requires, and Democrats claimed he was “ripping them from their mother’s arms” and “throwing children in cages”. This was widely believed, a testament to the propaganda power of the media. Pelosi, to her credit, backed a bipartisan bill to avoid all this, but the other Democrats would not have it.2016 Ruling, see page 13 I. The Settlement Applies to Accompanied Minors. “We agree with the district court that “[t]he plain language of the Agreement clearly encompasses accompanied minors.”https://cdn.ca9.uscourts.gov/datastore/opinions/2016/07/06/15-56434.pdfFlores Agreement – Janet Reno under Clinton 1997https://cliniclegal.org/sites/default/files/attachments/flores_v._reno_settlement_agreement_1.pdfThe Flores settlement, the court order Trump blames for family separation, explainedU.S. must release child migrants held in family detention, court says - :~:text=S. must release child migrants held in family,the Rio Grande into Texas. %28John MooreCourt: Illegal immigrant parents can be detained, children must be released - :~:text=Court%3A Illegal immigrant parents can be detained, children,on June 25, 2014. %28Associated Press%29 more >3. Tax Cuts for the Rich? No, the new tax code stopped subsidizing the rich with $10,000 maximum local tax deduction. I paid more myself, but I think it’s fair. Let’s and look at the results:a) Individual tax receipts were higher in 2018 than 2017. Middle and lower incomes paid less, with childcare credit doubled to $2,000, standard deduction raised to $12,000, and tax brackets lowered, so where did the money come from to pay for these cuts? People with expensive houses paid for it.b) State and local tax deductions permanently limited to $10,000. Ordinary tax payers have been subsidizing the wealthy for a long time, by letting them deduct their local tax from income for federal tax. This accounted for the majority of the tax increase on the wealthy, and spurred migration out of New York and California. Not to mention the slump in high end real estate prices.“The SALT-tax [cap] was incredibly damaging to the market, and the additional mansion and transfer taxes have also caused people to pause,” said Pam Liebman, president and CEO of the Corcoran Group brokerage.”Manhattan home prices in ‘near free fall’ as median dips below $1M“changes to the tax law that have hit high-tax states hardest and sellers who are still clinging to 2014 prices.”Real estate in the Hamptons had its worst spring quarter in 8 yearsc) On average, the top 6% paid more tax in most states, and the top 9% paid more in California, New York, and New Jersey.d) Maximum deductible mortgage size was lowered from $1 million to $750,000.e) Truly wealthy hedge fund managers like Goldman and international companies like, Apple, Big Pharma, etc. avoid tax by shifting income overseas to low tax countries. Now they have to pay 15% even on overseas income from foreign subsidiaries. This cost Goldman $5 billion in 2018.Tax overhaul costs Goldman Sachs $5 billion