Sunday, January 26, 2020

The Story Of Josie King Health And Social Care Essay

The Story Of Josie King Health And Social Care Essay The story of Josie King is one that shook the hospital health care system in 2001. Josie King was an 18 month-old that died from complications of treatment at Johns Hopkins Medical Center. Josie was originally admitted to the hospital with second and third degree burns over 60 percent of her body. During care, Josie had received a lethal dose of methadone after which she died as a result of a cardiac arrest. As a result of this sentinel event, the Kings were awarded a settlement which they refused. Josies mother Sorrel wanted everyone to know what happened to her baby. Sorrel King has written an inspiring memoir Josies Story and has created a patient-safety program at Hopkins in addition to a foundation devoted to reducing medical errors. Sorrel King now advocates for patient and families affected by medical errors, and provide lectures to medical professionals countrywide. ( Medical errors have and continue to be an enormous problem in health care. Patients die from the wrong drug or wrong dosage, or perhaps an infection that could have been prevent with better hygiene practices. More attention was placed on the issue of medical errors in 2000 when the Institute of Medicine made available the well-known report titled To Err is Human: Building a Safer Health System. The report documented evidence of an estimated 44,000 people and as many as 98,000 people dying in hospitals from medical errors each year in the United States (IOM, 1999). Of the many medical errors, medication errors happen to be one that can not be overemphasized. Medication use have been found to account for at least 20 percent of adverse events in patients in hospitals. Out of every hundred medication orders, there is an occurrence of five adverse drug events (Tam, 2005). Malpractice claims due to adverse drug events can have negative effects on the hospital and the health care providers. The hospital and health care providers can have their reputation damaged, thousands of dollars are spent for the losses, there is time lost from work, not to mention the emotional stress involved (Rothschild et. al, 2002). The cost of preventable medication errors has been estimated between 17 and 29 billion dollars annually (Strohecker, 2003). As such, due to these alarming statistics, this paper focuses on some of the potential risks of medication errors, and some recommended interventions that can be implemented to help curb the incidence of medication errors. What is a medication error? A medication error is defined as any preventable event that may cause or lead to inappropriate medication or patient harm while the medication is in the control of the health care professional, patient, or consumer (Oren, 2003). The terms adverse drug events and medication errors though used interchangeably do not necessarily mean the same thing. An adverse drug event is an undesirable reaction after a drug administration that is not necessarily caused by the drug. Adverse drug events include adverse drug reactions and medication errors. Medication errors may lead to actual or potential adverse events. The potential adverse events are often termed near misses. For example, if a medication overdose is administered accidentally, it would be a medication error and not described as an adverse drug reaction (Oren, 2003). Potential Risks of Medication Errors Many of the factors leading to medication error are unfortunately human related (Etchells, et. al, 2008). A survey of 983 nurses working in acute care hospitals reported that among the many factors that would contribute to medical errors, illegible hand written prescriptions, distraction from the environment, exhaustion and stress happened to be the most weighted (Mayo Duncan, 2004). A study by Hodgkinson that sought strategies to reduce medication errors cited the most common reason of medication error was due to the lack of drug information by the multidisciplinary team (2006). Inexperience and or lack of knowledge of the drug could lead to the physician ordering the wrong dose, the pharmacist incorrectly mixing the medication with the right concentration, and the nurse administering the medication with the wrong route such as giving an intramuscular injection instead of subcutaneously (Etchells, et. al, 2008). While human error is very important to consider, it is equally important to analyze the context in which errors can occur such as the clinical environment and patient population. The type of clinical setting in a hospital can be more prone to medication errors than others due to the patient population with respect to the severity of their illness, and number and type of medications needed to be administered. Critical care units for example, tend to be at a higher risk for medication errors. Critical care units provide for very sick patients who need to be attended to without delay, may require consults from various providers, and receive twice as many medications as compared to patients on general medical floors. Patients in intensive care experience an average of 1.7 medical errors each day. Medication errors are the most common type or error and account for 78 percent of serious medical errors in critical care (Camire et. al, 2009). In addition to the patients in critical care, pediatrics and the elderly also tend to be at high risk for medication errors since there require many medications when sick. Pediatric patients in particular tend to be very sensitive to most medications hence the need to calculate most of their medication dosages by weight (King, 2003). The least miscalculation could lead to an adverse drug event. Older adult populations, on the other hand, take many prescription medications for their chronic illnesses which need scrutiny to avoid contraindications (ANJ, 2009). However, regardless of whether the patient may be at risk of experiencing a medication error or not, all medication administration must ideally follow the seven rights which include the right patient, right medication, right dose, right time, right route, right reason, and right documentation (Schaeffer, 2009). Another factor which may influence the safety of medication administration involves medication reconciliation. When patients list of home medications and allergies are not collected upon admission, a medication error can occur when a medication being taken regularly at home is not continued during the hospital stay. If the patients medication reconciliation is not complete, the physician would not have full knowledge of the medications that the patients would need to be restarted on after being transferred or discharged from the hospital. At times there may be an oversight on the part of the prescribing physicians where brand and generic medication names are concerned. A physician may also duplicate order a medication that the patient may already be taking at home, and at times order an incorrect dosage (Landro, 2006). In recent times, there have been technological influences in health care, where there has been an effort to get rid of the paper documentation but the transition is not that complete. Many hospitals still document on paper and still creating the risk of medication errors by the use of error prone medication abbreviations. During transcription of written orders, the use of abbreviations can cause errors if not interpreted correctly. American Health Association News mentions a study discussed in the Joint Commission Journal on Quality and Patient Safety, medication errors that were reported to the national database made up 5 percent of all errors that occurred as a result of incorrect interpretation of abbreviations used during prescribing (2007). In this same study, an analysis of 30,000 abbreviations related- medication errors reported to the United States Pharmacopeias database was made. Most of the errors consisting 81 percent were made during the writing of prescriptions. The abbr eviation QD used in place of once daily was found to have caused more errors; 43.1 percent than any other abbreviation. The Joint Commission has a national safety goals report that include a do not use list of abbreviations that hospitals and other healthcare organizations can use as a reference (AHA News, 2007) Medication Error Risk Reduction Strategies In addition to the modified traditional seven rights for medication administration, hospitals are instituting additional evidence-based practices. According to an article in the ACCN monthly publication, the implementation of six best practice procedures for medication administration designed by the California Nursing Outcomes Coalition (CalNOC) significantly improved accuracy (2010). In this study, participating hospitals showed an 80.5 percent improvement in adherence to CalNOC best practices and an 81.4 percent score for combined administration accuracy and best practice improvements. The CalNOC six best practices include: compare medication to medical record, keep medication labeled until administration, check two forms of patient identification, immediately record medication administration in the chart, explain the medication to the patient, and minimize distractions and disruptions during the administration process (ACCN, 2010). Another technological invention to help reduce medication errors are the smart infusion pumps. These smart pumps have built-in danger alerts, clinical calculators, and drug libraries including information on the standardized concentrations of commonly used drugs. Though smart pumps have been designed to prevent mistakes, it only works for high alert intravenous medications. In cases where the smart pumps are not used appropriately, its purpose is not served. In a controlled trial study of smart infusion pumps, nurses were found to routinely ignore danger alerts and drug libraries as much as 25 percent of the time, sometimes administrating medications such as propofol, insulin, and heparin at rates 10 times as high as those ordered (Rothschild, 2005). Smart pumps can work exceptionally and prevent errors if alerts are paid attention to used appropriately. The computerized physician order entry (CPOE) system is another technology that has been found to significantly decrease the danger of illegible handwritten orders and the need for transcription. According to Bates et. al, out of the approximately 28 percent of preventable adverse drug events are associated with medication errors, 56 percent occurred during prescribing (Bates, et. al, 1998).The computerized physician order entry (CPOE), computer based system where all orders are electronically written helps to ensure accuracy of writing orders. Most of these CPOE are accompanied by a Clinical Decision Support System (CDSS) which provides automatic alert to prescriber on drugs or doses that are contraindicated with the patients age, allergies, condition, and or diagnosis. Review of a systematic study by Kaushal et. al on the effects of CPOE with CDSS showed a considerable decline in the rates of medication errors (2003). A study at the Brigham and Womens Hospital in Boston on the effect of CPOE on prevention of serious medication errors showed that the use of the CPOE system caught on to half the possible errors that may have lead to deleterious effects. The study showed a reduction in all the stages of the process; from ordering to dispensing to administration (Bates, 1998). CPOE therefore proven to hold some promise as an intervention to improve patient safety but would require further data of the benefits of costs before implementation. Bar coding is another technological intervention that has been shown to decrease the rate of medication administration errors. Bar coding can alienate the possibility of nurses administrating medications without having a documented order. With bar coding, each time a physician ordered a medication, the order is automatically transmitted to the pharmacy where a unique bar code is generated. After verification of the order by the pharmacist, the labeled medications are sent to the floor/unit. The nurses who have to administer the medication would then have to scan the bar code on the patient identification band against the labels on the medications for comparison. Bar coding has shown to reduce medication errors by more than 50 percent, thus preventing preventable adverse drug events (Wright, 2005). The Veterans Affairs hospital led the way in 1999 instituting a national bar coding program. Within a year of initiation the VA hospital documented a 24 percent decrease in the rate of medication-administration errors (Wright et. al, 2005). Although the ultimate goal is to protect patients, bar coding could also save hospitals lots of money. The average adverse event costs extra hospital days and additional services, not to mention the cost of litigation. Like every other measure there would be disadvantages for using bar coding, but once more research can show that the benefits outweigh the costs, more hospitals can join the increasing number of institutions that have embraced this technology. With medication errors responsible for many lost lives yearly, new national patient-safety standards require hospitals to have a mandatory formal medication reconciliation process for every patient admitted into the hospital. Medication reconciliation would take effect during the patients admission process and involves the recording of a patients allergies and thorough collection of all the patients home medications including over the counter drugs. This routine has been found to reduce medication duplication and avoid the effects of contraindication while the patients are hospitalized. This also aids the physicians on what medications to discharge the patient with. During the medication reconciliation process the need to educate the patients and their families is also import. Patients and families have to understand the rationale behind keeping handy a list of all their medications and being able to provide the list especially in emergent situations (Landro, 2006). Summary This paper has reviewed research on medication errors in hospitals with an emphasis on the prevalence, risk factors, and strategies to prevent errors from occurring. Although the immediate cause of medication errors is often as the result of human error, the majority of errors can be attributed to system failures made worse by the increasing complexity of patient care. A medication error can cause devastating results, threaten patients lives, and affect a providers confidence and job security. Hospitals also tend loose lots of money in malpractice law suits. The wide range of pharmaceutical products and dramatically changing technology adds to the complex situation. Many strategies including the CPOE and CDSS, smart pumps, and bar coding among other strategies have already been implemented by few hospitals. Research shows that these strategies that have been implemented targeting the reduction of medication errors have been found to be promising. However, due to the complexity of pat ient care, both human and technological influence may be able to control but never be able to completely put to death medication errors.

Saturday, January 18, 2020

The Da Vinci Code and the Last Supper

When it comes to world-famous paintings, Leonardo Dad Vine's â€Å"Last Supper† is always on the top of the list. What is it that, even now, 500 years after its creation in 1498, makes â€Å"Last Supper† such a mysterious and conspiracy-laden painting? First, there is a level of mystery surrounding its creator, Leonardo Dad Vinci. Not only was Dad Vinci an influential painter, he was also an engineer, sculptor, designer, and scientist. His ingenious concepts in many subjects and technological inventions were so advanced for the 14th to 1 5th century technology that even some 20th-century inventors, like he Wright brothers, pulled from his work.There have been a lot of theories on Dad Vine's life and on his paintings and it is believed that â€Å"Last Supper† contained hidden messages, which Dad Vinci encoded in the painting himself. This essay will examine what these theories are and how they are counter argued by scholars and art historians. Although there have been many fiction novels about Dad Vine's â€Å"Last Supper†, Dan Brown's novel The Dad Vinci Code, published in 2004, garnered an enormous amount of support from the world wide readers. It brought up a huge scandal on Jesus that, e and Mary Magdalene were lovers and in fact there was a child (or children) between them.In the novel, a secret group, â€Å"Prior of Soon,† protects the descendants of Jesus until today. Dad Vinci, as a member of â€Å"Prior of Soon†, was aware of the truth about Jesus and Mary so he encoded this secret in â€Å"Last Supper† to send out the message . â€Å"The Dad Vinci Code† changed some of its readers' beliefs toward their religion, but scholars say this novel is merely based on fiction. In the words of Renaissance art expert Elizabeth Pillion, â€Å"†¦ It is severely flawed. As a reader of fiction, I think it is a tremendously entertaining view' . The Dad Vinci Code† says that, in Dad Vine's â€Å"Last S upper†, the figure sitting on the right side of Jesus is obviously a female person; the figure does not have a beard like rest of the disciples and the figure's hand is placed closest to Jesus' right hand, suggesting that the two are physically close. Scholars argue that there have been a lot of paintings on the subject of the Last Supper, and it had been common to depict John next to Jesus and beardless. Disco did Boniness's â€Å"Last Supper† from the early 14th century portrayed John in similar ways.In Disco's â€Å"Last Supper,† John is sitting on the left side of Jesus, beardless and leaning on Jesus. Domenici Grandchild's version of â€Å"Last Supper† also has the same description of John, in which he is sitting on the left side of Jesus, leaning on the shoulders. Why do John's illustrations share these similarities, when all these paintings were created over a century apart from each other? The Bible has all the answers. John is known to as Jesus' m ost beloved disciple; in fact, the Bible specifically refers to John as â€Å"the disciple, the one whom Jesus loved†¦ [John 20:2;], and this phrase appears our times throughout the Gospel of John . The Bible describes the scene at the Last Supper with specific details of the position of John and Jesus; â€Å"It is the Beloved Disciple who, while reclining beside Jesus at the Last Supper, asks Jesus, after being requested by Peter to do so, who it is that will betray him† [John 13:23-25]. Both Disco and Garlanding were absolutely correct in terms of the position of Jesus and John according to the Bible and the appearance of John is also similar in both paintings.These three painters' versions of â€Å"Last Supper† are not the only paintings n the same subject; in fact, the earliest depiction of the last supper occurs in the frescos of the Catacomb of Rome from the 6th century . There were some conventions created when many painters drew the â€Å"Last Supperâ₠¬  over the centuries, and Leonardo Dad Vinci was simply following these conventions in accordance with both the Bible and earlier â€Å"Last Supper† depictions created by other painters.Dan Brown's â€Å"the Dad Vinci Code† disregarded the facts about these traditions, yet described Leonardo â€Å"Last Supper† as if everything started from it; therefore, the readers are biased with this faulty concept. Another argument made by Dan Brown has to do with SST. Peter, who is sitting next to the female figure. The novel's interpretation of SST. Peter is that he was against the relationship between Jesus and Mary Magdalene; therefore, he was illustrated showing a sign of execution on the female figure's neck, and he is holding a knife with his right hand as a threat.The author says that Dad Vinci wouldn't have drawn these features unless they meant something, but scholars argue differently. Iconography is one of the characteristics of Renaissance arts, which includes symbolism in the paintings . Pewter's holding a knife at the Last Supper is actually a Christian symbol, foreseeing of the event followed by the Last Supper. In Disco's painting, it is observed that there are a lot of knives present on the table. Although Peter is not holding a knife in this painting, the knives serve as symbolism.It is more obvious in Grandchild's â€Å"Last Supper,† in which Peter is actually holding a knife in his right hand. Contrary to Dan Brown's explanation, it does not look like Peter is threatening someone else. The reference to Pewter's knife appears in the Bible. When Judas showed up with soldiers to arrest Jesus, Peter fought back and cut off the ear of the high priest's servant, named Mulches [John 18:10]. By illustrating Peter with a knife in his hand, it serves as foreshadowing of a future event.It is wrong to say that, because Peter is holding a knife in the painting, it has a meaning of threatening other person, but it serves as a symbolism off future event. What appears to be Pewter's showing an execution gesture on John's neck is, in fact, a misinterpretation made by â€Å"the Dad Vinci Code†. As discussed above, the Bible has some specific details on the ignitions of Peter and John. â€Å"It is the Beloved Disciple who, while reclining beside Jesus at the Last Supper, asks Jesus, after being requested by Peter to do so, who it is that will betray him† [John 13:23-25].Leonardo Dad Vine's â€Å"Last Supper† is describing the scene of Pewter's requesting John to ask Jesus. Dan Brown's explanation of the gesture of Peter is misleading for its readers; therefore, it is only a fictional setting and it should not be taken seriously. Dan Brown was very clever to use Leonardo Dad Vinci as the theme of the book, and he fact that everyone loves to believe a worldwide conspiracy made â€Å"the Dad Vinci Code† very successful fiction novel.It is remarkable how a novel can have so much impact on the wo rldwide reader's views, even on religion, although this particular example shows how dangerous in can be. The readers who do not have much knowledge in art history or religious history can easily be biased with these fictional interpretations mentioned above. When reading these kinds of novels, it is the reader's responsibility to be open-minded and seek the truth themselves instead of being fully influenced by the author.

Friday, January 10, 2020

My research

Fixers are found everywhere wherever rules and regulations governing business or public sector appear overly bureaucratic and complex while proper oversight and control is poor. And wherever Fixers are found, corruption is seldom very far behind. A report from news interviewing a man from Cavity saying that: â€Å"Mamba young pill. Saying Lang young roars OK kayak nag algal an Lang oak† ( it will be a waste of time that's why I was compelled to just give money) Our Government make a law entitled â€Å"the anti Red tape Act of 2007† R.A 9485 to prevent Fixers system but even though we eave a law against in the system of fixers, there are so many people who used fixers for their transaction. Furthermore, maybe it's a Job considered for a person having a financial needs but did they ever think the consequences of being a fixers. Being fixers is a violation against the law. Besides we cannot criticize those fixers because that is their means of living. So here we can deduce that Filipinos really have a shortfall in terms meeting the desired income in order to live in a descent life. That's why some Filipinos engaged on that kind of Job.The question is how we prevent that mind of job, how we can restrain those people who depend on the fixer scheme. Because I believe that if there is no people who depend on the fixers system, there is no fixers. 1. 1 statement of the problem This study Conducted to investigate the causes, effects and solution of the fixers system In the Philippines. Specifically the study attempted to answer the following questions: 1 . How do respondents profile be describe In terms of : 1. 2 Education and position In the office 1. 3 Nature of occupation 1. 4 Family economic status 2. 1 lifestyle 2. Security of family . How effective is the law that create to prevent the fixers system 4. What are the reasons why those people used fixers 5. What are the solutions to prevent fixers 6. What are the ways to prevent those people who used fi xers scheme Chapter 2 Review and Related Literature The review of the literature for this study focuses on what are the fixers' scheme, and other consequences of being fixers. The research is all about of the causes and effects as well as the solution to prevent fixers' scheme and also the relation between the fixers and the bureaucratic system.The underground occupation of corruption is through â€Å"fixing† and discover The motivations, attitudes, worldview, techniques and even Jargon of â€Å"fixers. † The deeper we penetrate through the topsoil of corruption, the better we can arrive at remedies that not only suit our formal and legal structures but also take Into account our culture and social condition, remedies that not only to palliate The symptoms but uproot the malady of corruption. It is a problem from top to bottom of the society is it in the private sector but is most noticeable in the government being the regulatory body of all transactions.Manila ululate post about The Ombudsman (Toadying) of the Philippines, which independently monitors the bureaucracy and three branches of government – Executive, Legislative, and Judiciary – marks its 26th Anniversary on May 12, 2014, with renewed â€Å"passion† in enforcing accountability in public sector; â€Å"inspiration† in instilling integrity in public service; and â€Å"commitment† in promoting transparency in officials and employees accused of crimes, especially graft and corruption.In discharging its functions, the Ombudsman has a three-pronged approach. Its punitive approach covers its investigative and prosecutorial powers. Its promotional initiatives bring the message of good governance to the public. And its preventive measures engage multicultural coordination in efforts to prevent corruption. The Philippine Constitution provides for the Ombudsman. Presidential Decree 1487 on June 1 1, 1978, created the Toadying and vested it with power to investi gate complaints relative to public office and file cases before the courts.The Philippine Constitution ratified in 1987 created a new Ombudsman, whose composition, powers, and functions were defined in Executive Order 243 on July 24, 1987. The Ombudsman became operational on May 12, 1988, the date for its anniversary celebration. The Ombudsman's five major functions under Republic Act 6770, the Ombudsman Act of 1989, are public assistance, graft prevention, investigation, prosecution and administrative adjudication.Ombudsman Contain Carpi Morale has adopted eight priorities for her term (2011-2018) – dispose of high-profile cases, attain zero backlog, improve fact-finding â€Å"survival† rate, enforce monitoring of referred cases, improve responsiveness of public assistance, improve anti-corruption policy and program ordination among sectors, rationalize the functional structure of the office, and enhance transparency and credibility. There was an Ombudsman under the P ermanent Commission during the Philippine Revolutionary Government in 1898.Ombudsman-like agencies were set up by past Philippine Presidents to serve as venue for people to air grievances and seek redress against abuses in government: Integrity Board under President Ellipsoid R. Squiring in 1950, Presidential Complaints and Action Commission under President Ramona R. Massage's in 1957, Presidential Committee on Administration Performance Efficiency under President Carols P. Garcia in 1958, Presidential Anti-Graft Committee of President Doodads P. MacDougal in 1962, and Presidential Agency on Reforms and Government Operations in 1966 and Complaints and Investigation Office in 1970 under President Ferdinand E.Marco's. In that article states that all of the three branches of the government shall follow the transparency act of the Philippines. Research Methodology This study was conducted in order to know the causes and effects as well as the solution of the fixers system. To be able to gather the necessary data, the researcher utilized the descriptive method, using both qualitative and quantitative approaches. Herein, the chosen responded were randomly selected from various people who knows about the system. The survey methods were the research instruments used for the data-gathering.The person who has been chosen in this study accomplished a survey questionnaire to evaluate the causes, effects and the solution facing the fixers system in the Philippine bureaucracy. The credibility of findings and conclusions extensively depend on the quality of the research design, data collection, data management, and data analysis. This chapter will be dedicated to the description of the methods and procedures done in order to obtain the data, how they will be analyses, interpreted, and how the conclusion will be met.This section is to Justify the means in which the study was obtained and will help in giving it purpose and strength as it will then be truthful and analytical. A ll these will help in the processing of the data and the formulation of conclusions. Specifically, this research will cover the following: the research design and method, the respondents or subjects to be studied (which will include the sampling method), he data collection instrument, and the data analysis. These will be presented below. Stratified sampling Use Use it when there are smaller sub-groups that are to be investigated.Use it when you want to achieve greater statistical significance in a smaller sample. Use it to reduce standard error. Method Divide the population up into a set of smaller non-overlapping sub-groups (strata), then do a simple random sample in each sub-group. Strata can be natural groupings, such as age ranges or ethnic origins. Example A high school student who is studying year-ten attitudes in the school uses estimation tuition classes as strata and studies a random selection of students from each of these classes.In a company there are more men than women , but it is required to have each group equally represented. Two strata are thus created, of Stratification aims to reduce standard error by providing some control over variance. If you know that there are groups that must be included, for example men and women, then you can deliberately sample these in a due proportion. Proportionate stratified sampling takes the same proportion (sample fraction) from each stratum. Disproportionate stratified sampling takes a different proportion from different strata.This may be done to ensure minorities are adequately covered. If you do this, and want to make an estimate about the population, you will have to weight within- group estimates using the sampling fraction. If the groups are homogeneous (e. Have the same proportions of each attribute), and hence within-group variation is lower than the population, then stratified random sampling will give a statistically more accurate result than simple random sampling. Stratified sampling is sometimes called quota sampling or stratified random sampling.

Thursday, January 2, 2020

Transgender Rights In The Workplace - Free Essay Example

Sample details Pages: 2 Words: 532 Downloads: 1 Date added: 2019/06/24 Category Society Essay Level High school Tags: Transgender Essay Did you like this example? Language is continually evolving to correctly communicate the speakers intention. A word can have many messages both through literal definition and social contacts. Queer language has become more specific. Don’t waste time! Our writers will create an original "Transgender Rights In The Workplace" essay for you Create order Contributing to this shift in language, some parts of society have becoming more understanding of the LGBT+ community. despite the recent acceptance there is still confusion surrounding transgender people. A transgender person is someone whose gender identity is different than their male/female reproductive system at birth. This term does not have anything to do with sexual orientation, gender expression or physical anatomy. Transgender and transsexual have a different meaning. Transsexual suggests a person who has gone through a sex reassignment surgery. On the federal level the courts have stated that discrimination against gender identity is historically not covered under the 1964 Civil Rights Act prohibiting discrimination against sex. Recently in 2012, the court has extended the definitional of discrimination against sex to include gender identity and in 2014, Eric Holder the US Attorney General stated that he agreed with this decision. As of now there are no comprehensive set of laws that protect transgender people. Selective states (California, Connecticut Hawaii, Massachusetts, New Jersey, New York, Vermont) have altered discrimination law to protect Transgender people. Gender dysphoria is excluded from disability laws except for California. the Transgender Law Center in California, published Know Your Rights: Transgender People at Work that answered 14 commonly asked question. Employees should have safe access to bathrooms that match their gender identity. An alternative is to use a single bathroom if the transgender person feels more comfortable or if another employee does not want to use the same bathroom with a transgender person. California protects transgender citizens from harassment that includes, but is not limited to deliberately and repeatedly calling employee by the incorrect name and pronoun. California recognizes common law name changes but does require a court order to change name on managerial records such as payroll and security clearance. Potential employers may require a background check, and therefore require all previous name used to get a through assurance of character. As a result, employers will likely find out about a prospective employees transgender status. Medical information is protected by t he federal Health Insurance Portability and Accountability Act (HIPAA) and employees are not required to disclose if or where they are transitioning, although it is advisable to coordinate with management to create a transition plan and discuss medical leave. If a person is discriminated against because they are transgender they should first try to use the internal complaints process. The next step is to file a dual complaint with the Department of Fair Employment and Housing (DFEH) and the Equal Employment Commissions (EEOC). In October, the Health and Human Service Department stated they were considering limiting the scope of the Civil Rights act to exclude gender identity from the definition of sexual discrimination. If the new presidential memo goes through, 1.4 million self-identifying transgender American adults will be affected.