health care law and legislation week 5

Chapter 16

Acquired Immune Deficiency Syndrome

LEARNING OBJECTIVES

• Describe what AIDS is and how it is spread.

• Discuss confidentiality concerns for AIDS patients.

• Describe how AIDS patients are discriminated against.

• Explain the importance of AIDS related education.

AIDS

• Deadliest epidemic in human history.

• Collection of specific, life-threatening, opportunistic infections & manifestations that are result of underlying immune deficiency.

• Caused by HIV, highly contagious blood-borne virus is most severe form of HIV infection.

• Destroys body's capacity to ward off bacteria & viruses that ordinarily would be fought off by immune system.

Spread of AIDS

• Body Fluids – Breast Milk

• Blood transfusions • Sexual Transmission

– Vaginal secretions – Semen – Partner’s Right to Know

• Healthcare Workers Transmission

Confidentiality • Patients have a right to privacy.

• An individual’s HIV status must be kept confidential.

• Patient information can be shared with other health professionals

– for purposes of patient care on a need to know basis.

Unauthorized Disclosure

• Estate of Behringer v. Med, Ctr, at Princeton

– Hospital & lab director breached duty by allowing a surgeon’s test results to be placed in medical record.

– Hospital should have taken reasonable precautions to prevent disclosure.

Proper Disclosure

• Tarrant Cty. Hospital District v. Hughes

– wrongful death action alleging patient contracted AIDS from blood transfusion administered in hospital.

– societal interest in maintaining an effective blood donor program did not override plaintiff's right to receive such information.

– court order prohibited disclosure of donors' names to 3rd parties.

Duty & Right to Confidentiality

• Right to know when caring for patients with highly contagious diseases.

• Times when duty to disclose out ways rights to confidentiality.

• A prisoner has limited privacy rights.

• Prison authorities have strong interest in preventing the spread of HIV.

Confidentiality Sexual Partners

• Person has right to know when his or her partner has tested positive for HIV.

• Physicians expected: – counsel HIV-positive patient to notify

sexual partners or – to seek help in doing so from public health

officials. • Some states have developed informational

brochures & consent, release, & partner notification forms.

Mandatory Testing

• U.S. District Court found routine testing of firefighters & paramedics for AIDS virus does not violate individual's 4th Amendment or constitutional privacy rights.

– caregivers high-risk group for contracting & transmitting HIV to public.

– city has compelling interest & legal duty to protect public from contracting virus.

• Anonymous Fireman v. Willoughby

Discrimination

• Access to Health Care

– Right to Treatment

• Education

• Employment

• Insurance Benefits

Negligence

• Administration of Wrong Blood

• Failure to Make Timely Diagnosis

• Patient Wrongly Notified She Had AIDS

• Insurance Company Fails to Disclose HIV Status

Reporting Requirements

• AIDS is reportable communicable disease in every state.

• Physicians & hospitals must report with patient's name—to government public health authorities.

AIDS Emergency Act

• Provide emergency assistance to localities that are disproportionately affected by HIV epidemic & make financial assistance available to States & other public or private nonprofit entities to provide for development, organization, coordination & operation of more effective & cost efficient systems for delivery of essential services to individuals & families with HIV.

OSHA & AIDS

• OSHA requires health care organizations to implement strict procedures to protect employees against AIDS virus.

• OSHA requires strict adherence to guidelines developed by CDC.

• Complaints investigated by OSHA can result in issuance of fines for failure to comply with regulatory requirements.

Protecting Caregivers – I

• Personal Protective Devices – Gloves – Masks – Gowns – Goggles

• Engineering Controls – sharps disposal containers – ventilation systems

Protecting Caregivers – II

• Work Practices – hand washing – use of needles – safe collection, transporting & disposal of body

fluids • Practice Universal Precautions

– infection control guidelines – prevent contact with patient blood & body fluids – Assume all patients infected for blood-borne

diseases such as AIDS & hepatitis B

CHAPTER REVIEW – I

1. Describe how AIDS patients are discriminated against.

2. Discuss the privacy and confidentiality issues of HIV- positive patients.

3. Should a hospital be permitted to publish identity of AIDS patients in order to protect other patients and staff?

4. Is AIDS a reportable disease? Why?

5. What steps can be taken to help prevent spread of AIDS