[sassafrazzled]

I work in a retirement community that includes all levels of care from Independent living to Long term care/skilled care. Like most healthcare facilities, we require that all new hires be tested for TB using the two step skin test method. If either skin test reacts 10mm or greater, we require a chest Xray to rule out active disease process. We currently require the applicant to be responsible for seeing their own physician and covering the cost of the xray. I am wondering what the standard is in other facilities regarding the cost of chest xrays when needed. We have recently been asked why we don't pay for the test since it is our requirement. What is the policy in other facilities? Thanks for the help.

[elkpark]

I've had a + Mantoux for over 20 years, so I've been through this with a lot of different employers over the years, in three different states. I've never been asked to pay for my own CXR, and would walk away from the potential employment if ever asked to do so.

Your facility doesn't ask new employees to pay for their Mantoux tests, does it? So what's the difference?

Of course, in my case it's a matter of a known + and simply a substitute for the Mantoux. If someone has just turned + and needs to be screened for active disease, I can see an argument that that is a different situation. Since TB is a reportable disease, do you not report this (new positives) to the local public health department? Don't they do screening and prophylaxis?

[sassafrazzled]

Our facility does not ask applicants to pay for the skin tests. I have only run into this situation once in the year that I have worked here. The applicant was not a new conversion to positive (although she did not tell us about past positives before the screening). After having had the skin test, she told HR that she had had a negative chest xray in the past but she was unable to get a copy of the results for some reason. She ended up not being hired for other reasons, so the matter was not further discussed. I want to find out the standard in other facilities for future reference. It may be a matter of having to rewrite the policy.

Thank you for sharing your experiences for comparison.

[elkpark]

Odd that a prospective employee with a hx of a positive Mantoux would not speak up until after the skin test -- not only is there no point to doing further Mantoux tests once you're positive (the results will always be positive), but it's potentially dangerous to the person (I was clearly instructed to not allow anyone to ever give me another skin test). That whole situation sounds fishy -- you're probably better off having not hired her!

I don't know for sure, but it seems to me that you might be opening the agency up to charges of discrimination if you give skin tests to potential employees for no charge, but expect people to pay for CXRs if needed (it's not their fault that they can't just take the skin test ...). As I said, I've never run into that practice anywhere I've worked over the decades, and it would certainly be a "deal breaker" for me in deciding about a new job. But I am a known positive and always tell people that right up front.

On the other hand, though, I can see that a "new dx" situation could be considered different -- just as, for example, if you did a UA for a drug screen and the results came back that the person had an acute UTI, it wouldn't be the facility's responsibility to treat the UTI ... You would just pass on the info and advise the person to seek treatment.

You may also want to check on your legal responsibilities re: TB being a reportable disease -- your policy may need to incorporate something about reporting new positives to the health department, and that may get the facility "off the hook" in terms of further screening.