| |
Physician's Guide to Medicine - HIV
Who is authorized in the State of Missouri to
perform HIV testing?
Consultation with test subject
Privileged communications
Anonymous testing
Who must be reported to the Department of Health?
Is there a law prohibiting an HIV-infected person from
knowingly exposing another person to the virus?
Is a physician liable for reporting an HIV-infected
person to the Department of Health, or for cooperating or participating in
certain health department investigations or related judicial proceedings?
What infection control procedures and related
training requirements are specified in Missouri law?
To whom may a physician disclose the results of an HIV test?
Can the results of HIV testing of an applicant for insurance
coverage be disclosed to his or her physician?
Are there other reporting requirements?
Can a "first responder" or good Samaritan be notified
if exposed to HIV or other communicable diseases?
Under what circumstances may HIV testing be performed
without right of refusal?
Can a physician refuse to treat an HIV positive
patient?
Is it permissible to condition medical treatment on HIV
testing or on knowledge of a patient´s HIV status?
Are physicians required to be tested for HIV?
Who is authorized in the State of Missouri to perform HIV testing?
Only physicians, licensed hospitals, and those
authorized by the Department of Health may perform or conduct HIV testing. "HIV
testing" is the performing of a serological test or other tests upon a
biological specimen to determine the presence of Human Immunodeficiency Virus or
its antibodies.
To be authorized to perform HIV testing, a person must provide suitable
verification to the Department of Health that such testing will be performed in
accordance with Department regulations. The Department of Health may monitor
continuing compliance with such regulations.
Consultation with test subject
All physicians, hospitals, and other authorized
persons who perform or conduct HIV sampling must provide consultation to the
patient prior to taking the sample and during the reporting of the test results
to the patient.
Privileged communications
All communications between the subject of an HIV test
and a physician, hospital, or other person authorized by the Department of
Health to perform or conduct HIV sampling are privileged communications.
Anonymous testing
The Department of Health has, in accordance with
Missouri law, designated one HIV testing site in St. Louis, Kansas City, and
Springfield where persons can voluntarily be tested anonymously.
Physicians may refuse to anonymously test an individual and may refer the person
to the designated anonymous HIV testing sites.
The result of an anonymous test performed at one of the designated anonymous
testing sites will be reported to the Department of Health by a code that does
not link the individual´s identity with the request or the test result.
If an anonymous test is positive, the HIV testing site must initiate contact
notification when submitting the result to the patient.
Who must be reported to the Department of Health?
Physicians are required by Missouri law to report,
by name, patients with any of the following HIV-associated diseases or
conditions:
(1) Acquired Immunodeficiency Syndrome (AIDS);
(2) HIV infection, confirmed; or
(3) CD4+ lymphocyte counts on any person with HIV infection.
Physicians in St. Louis City and St. Louis County should direct their reports to
the St. Louis City Department of Health and Hospitals at (314) 658-1159.
Physicians in the five-county Kansas City metropolitan area should report to the
Kansas City Health Department at (816) 983-4200. All other Missouri physicians
should report to the Department of Health´s Bureau of STD/HIV Prevention at
(573) 751-6463. Epidemiology Services personnel at these numbers can answer any
questions a physician has about reporting, and can provide forms on which
reports are to be made.
Exceptions to the requirement for named reporting are persons tested at one of
the three Department of Health designated anonymous HIV testing sites, and
persons participating in a research project approved by an institutional review
board.
Is there a law prohibiting an HIV-infected person from knowingly exposing
another person to the virus?
According to Missouri statute, it is unlawful for
any individual knowingly infected with HIV to donate blood, blood products, an
organ, sperm or tissue. It is likewise unlawful for a person knowingly infected
with HIV to act in a reckless manner by exposing another individual to HIV
without the knowledge and consent of that individual through oral, anal or
vaginal sexual intercourse, or by sharing of needles. Violation of these
provisions constitutes a felony.
If a person is believed to have knowingly exposed someone to HIV by any of these
means, the Department of Health, a local law enforcement agency, the victim, or
others may file a complaint with the appropriate prosecuting attorney.
Is a physician liable for reporting an HIV-infected person to the Department
of Health, or for cooperating or participating in certain health department
investigations or related judicial proceedings?
No civil liability shall accrue to a physician as
a result of making a good faith report to the Department of Health about a
person reasonably believed to be infected with HIV, or cooperating in good faith
with the Department in an investigation determining whether a court order
directing an individual to undergo HIV testing will be sought, or in
participating in good faith in any judicial proceeding resulting from such a
report or investigation.
What infection control procedures and related training requirements are
specified in Missouri law?
All physicians (and other health care
professionals) are required to adhere to universal precautions, including the
appropriate use of hand washing, protective barriers, and care in the use and
disposal of needles and other sharp instruments. Also required is compliance
with current guidelines, established by the Centers for Disease Control and
Prevention, for disinfecting and sterilizing reusable devices used in invasive
procedures.
Any health care professional who has exudative lesions or weeping dermatitis of
the hands, forearms, or other locations that may contact patients must refrain
from performing all invasive procedures, and from handling patient-care
equipment and devices used in performing invasive procedures until the condition
resolves.
All health care facilities must provide periodic training in infection control
procedures, including universal precautions, to all personnel who perform
patient care services at or from such facilities.
All health care professionals who perform invasive procedures must receive
training on infection control procedures relevant to HIV and related diseases,
including universal precautions and prevention of percutaneous injuries,
appropriate for their specialty. If such training is not received in a health
care facility, it must be obtained elsewhere on an annual basis. Documents that
validate the completion of this training must be maintained by the health care
professional for a period of three years and shall be made available to the
Department of Health upon request.
To whom may a physician disclose the results of an HIV test?
Unless the physician acts in bad faith or with conscious
disregard, he or she will not be liable for violating any duty or right of
confidentiality established by law for disclosing the results of an individual's
HIV test to the following:
(1) The Department of Health;
(2) Health care personnel working directly with the infected person who have a
reasonable need to know in order to provide direct patient health care;
(3) Anyone authorized in writing by the person who is the subject of the test
results;
(4) The subject of the test results;
(5) The spouse of the person who is the subject of the test results;
(6) The parents, legal guardian or custodian of the subject of the testing if he
or she is an unemancipated minor;
(7) Employees of a state licensing board in the execution of their duties,
pursuant to discipline taken by such a board; and
(8) The victim of any sexual offense which includes sexual inter-course as an
element of the crime.
A physician is not under any affirmative legal duty to disclose the results of
an individual's HIV test to a spouse, health care professional or other
potentially exposed person, parent or guardian.
Can the results of HIV testing of an applicant for insurance coverage be
disclosed to his or her physician?
Such test results must be disclosed by the insurer, health
services corporation, or health maintenance corporation to a physician
designated by the test subject. If no physician is designated, the identity of
persons living in Missouri having a confirmed positive HIV test result must be
disclosed to the Department of Health, in a manner that assures confidentiality.
Are there other reporting requirements?
A health care facility that treats a patient with
HIV or any other reportable infectious disease must notify the funeral
establishment, coroner or medical examiner prior to removal of the deceased
patient from the facility. Notification must be conducted in such a way as to
protect the confidentiality of the deceased patient.
Can a "first responder" or good Samaritan be notified if exposed to HIV or
other communicable diseases?
The Department of Health is responsible under
Missouri law for ensuring that first responders or good Samaritans are notified
if there is reason to believe an exposure has occurred which may present a
significant risk of a communicable disease as a result of attending or
transporting a patient to a licensed facility. At the request of any first
responder, the licensed facility shall notify any such first responder, and at
the request of any good Samaritan, a "designated officer" shall notify such good
Samaritan.
However, the Department of Health has yet to appoint "designated officers" and
"sub-officers." Consequently, no one is currently duty-bound to carry out this
notification. It is hoped that a facility will go ahead and carry out the intent
of the law to the extent possible.
Written notification is to be made as soon as is practicable, but not later than
forty-eight hours. The report to the first responder or good Samaritan shall
provide the name of the communicable disease involved, the date on which the
possible patient was assisted or transported, and possible advice or information
about the communicable disease. In addition, the first responder or the good
Samaritan will be informed of the provisions of Missouri law regarding the
confidentiality and to the consequences of violation of confidentiality
provisions.
This rule shall not be construed to authorize or require a licensed facility to
test any patient for any communicable disease.
(A "first responder" is any person trained and authorized by law or rule to
render emergency medical assistance or treatment. Such persons include emergency
first responders, police officers, sheriffs, deputy sheriffs, fire fighters,
ambulance attendants and drivers, emergency medical technicians, mobile
emergency medical technicians, emergency medical technician-paramedics,
registered nurses, and physicians.)
Under what circumstances may HIV testing be performed without right of
refusal?
(1) By the Department of Corrections on all
individuals who are delivered to, released or discharged from any state
correctional facility;
(2) By the Department of Mental Health on any individual participating in a
methadone treatment program for the treatment of intravenous drug abuse who has
refused to undergo HIV testing whenever there are reasonable ground to believe
the individual is infected with HIV and is a reasonable health threat to others.
The identities of persons testing positive for HIV in these situations are not
to be reported to the Department of Health if prohibited by federal law;
(3) On any person who is convicted or who pleads guilty or nolo contendere to a
defined sexual offense. Results may be disclosed only to the victim, the
defendant, and the administrator of the correction facility in which the
defendant is confined; or
(4) When an HIV test is mandated by court order which may be sought by the
Department of Health after reasonable grounds to believe that the individual is
infected with HIV and, if infected, poses a threat to others.
Can a physician refuse to treat an HIV positive patient?
No. Discrimination against an HIV patient not only
violates medical ethics, but is a violation of state and federal laws.
Is it permissible to condition medical treatment on HIV testing or on
knowledge of a patient´s HIV status?
No. An HIV-infected individual is required to disclose
his or her infection status to the physician prior to treatment, but the
physician shall be subject to disciplinary action for violating a professional
trust or unprofessional conduct if the physician discriminates against a patient
who has disclosed the existence of HIV infection. Absent disclosure, a physician
may not make HIV testing a condition of treatment.
Are physicians required to be tested for HIV?
No. However, all physicians who perform invasive
procedures are advised to know their HIV (and hepatitis B) status. If a
physician performs invasive procedures and tests positive for HIV (or hepatitis
B), the physician may access a voluntary, confidential evaluation process. An
individualized evaluation is conducted either by an expert review panel
appointed by the Department of Health, or by a health care facility peer review
panel. The purpose of the evaluation is to determine whether, and under what
circumstances, restrictions or limitations should be placed on the physician´s
medical practice.
If restrictions or limitations are placed on the physician´s practice, their
violation constitutes either an act violative of professional trust and
confidence, or failure or refusal to properly guard against contagious
infections or communicable diseases or the spread thereof, or both.
|
|
