The Massachusetts Board of Pharmacy recommends that any prescription pad theft be reported to local pharmacies, local law enforcement agencies, and the State Police Diversion Unit. Theft of controlled substances also should be reported to local law enforcement agencies and the federal Drug Enforcement Agency which has forms specifically designed for this purpose. Internal investigation into the theft or loss should involve the risk manager along with the other hospital departments affected.

Prevention

Prescription slips should never be pre-signed. They should be stored in a locked drawer or safe area and never be left unattended. Pads should be numbered sequentially in order to better identify if any are missing.

Controlled substances should be locked in the medication room at all times and the keys held by authorized individuals only. Department of Public Health regulations require that Schedule II drugs be double locked. Every step in the system, from ordering to dispensing a controlled substance, should be handled by a different individual to minimize opportunities for theft.

Once an employer knows of an existing restraining order, he or she must maintain the level of confidentiality desired by the employee. Ask the victim's input in devising a plan in case the batterer appears at work. Options include circulating a photo or description of the subject of a restraining order with an action plan in case he or she shows up at the office or hospital. Alerting security personnel about the situation would also be helpful. Simpler measures could include having the employee escorted to his or her car, bus stop, etc. One common-sense exercise would be for employers to ask themselves what they would want from their workplace if they were victims of domestic violence.

Case law for determining the extent of liability is scant. Health care facilities and providers might be expected to take "reasonable" measures to protect their workers from unsafe conditions. A facility large enough to have a security staff would be well-advised to provide adequate training in domestic violence response. Having a written plan and adequately disseminating the plan to employees is important. Foreseeability is a component of workplace safety litigation. Batterers are known to commit violent acts against domestic partners at their workplaces. Employers can let all workers know that assistance is available if they are victims of domestic violence, and ensure that their employee assistance plans have a domestic abuse component.

Regulations prohibiting resterilization/reuse of disposables have been softened in recent years. Entities such as the Centers for Disease Control (CDC) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) have removed blanket statements against the practice from their recommendations, but it is not without risk.

If the standard of care for a specific procedure would ordinarily be to use "new" equipment/supplies, the institution should be prepared to justify its rationale that reuse/resterilization presents no additional hazard to patient safety or effectiveness.

A facility reusing or resterilizing certain types of equipment should consider how it will handle the issue of informed consent. Arguably, the patient should be apprised of the facility's policy on reuse, and options discussed. From a realistic viewpoint, the occurrence of such discussion may only become an issue if harm comes to an individual based on the facility's reuse/ resterilization decisions.

In most cases, none.

All individuals have a right to privacy. For this right to be violated there must be some overriding societal necessity or goal to be realized. Thus, a competent adult has a right, in most instances, to control the release of information about their health status to others, including their spouse and parents. This means that information about an adult child's health situation should not be shared with a spouse or parents (even if the child may be financially dependent), unless the adult child authorizes disclosure, or the individual requesting information has been appointed the legal guardian for an incompetent adult child. The only situations where consent would not be needed would be those limited exceptions to the physician-patient privilege, such as "the duty to warn" under certain conditions.

• Abuse of children, elders, or disabled persons
• Births, stillbirths, abortions: all live births, stillbirths of fetuses of 20 weeks gestation or more (or of 350 grams or more), and abortions when the use of an unlawful drug, instrument, or article is suspected
• Burn injuries: affecting more than five percent of body
• Cerebral Palsy (initial diagnosis)
• Childhood vaccine injuries
• Deaths
• Diseases dangerous to the public health
• Dog bites
• Drug addictions
• Gunshot wounds
• Industrial diseases or injuries
• Knife wounds: if criminal action is suspected
• Poisoning caused by lead or by controlled substances
• Sexual assault: omitting the victim's name and address