Chapter 15Acquired Immune Deficiency         Syndrome                             2
AIDS• Deadliest epidemic in human history.• Collection of specific, life-threatening, opportunistic  infections & manifest...
Spread of AIDS – I• Direct contact with  – infected blood  – body fluids     • vaginal secretions     • Semen     • breast...
Spread of AIDS – II• Blood Transfusions   –Historically: Transfusion Before Testing   –transfusion of mismatched blood   –...
AIDS & Health Care Workers• Practice Universal Precautions  – infection control guidelines  – prevent contact with patient...
Protecting Caregivers - I• Personal Protective Devices   – gloves   – masks   – gowns   – goggles• Engineering Controls   ...
Protecting Caregivers - II• Work Practices  – hand washing  – use of needles  – safe collection, transporting & disposal o...
Refusal to Treat HIV Patient• The hospital’s on-call surgeon in Fiske v. U.S.  Health Corp. of Southern Ohio14 had a duty ...
Confidentiality – I• Guidelines drafted by CDC  – health care workers who perform exposure-prone    procedures to undergo ...
Confidentiality – II• Tarrant County Hospital District v. Hughes• Wrongful death action alleging patient contracted  AIDS ...
Confidentiality – III• CASE: Disclosure of Physician’s HIV Status• Delicate Balance                                       ...
Confidentiality – IV• Partner’s Right to Know   – person has right to know when his or her partner has     tested positive...
Confidentiality – V• HIV Status Improperly Disclosed to Employer  – physicians disclosure of patients HIV status    withou...
Confidentiality – VI• HIV Status Properly Disclosed to Employer  – trial court properly dismissed claim for breach of    p...
Right to Treatment• HIV infected patients have right not to be  discriminated against in provision of treatment.          ...
Mandatory Testing• U.S. District Court found routine testing of  firefighters & paramedics for AIDS virus does not  violat...
News Media & Confidentiality• Protective order limiting public access to  pretrial discovery material did not violate  new...
Discrimination•   Access to Health Care•   Education•   Employment•   Insurance Benefits                                19
Negligence• Administration of Wrong Blood• CASE: Failure to Make Timely Diagnosis• Patient Wrongly Notified She Had AIDS• ...
Criminal Actions• Inmate at Federal Medical Center   – convicted by jury of assault & battery with a     deadly or dangero...
Reporting Requirements• AIDS is reportable communicable disease in  every state.• Physicians & hospitals must report with ...
AIDS Emergency Act• Provide emergency assistance to localities that are  disproportionately affected by HIV epidemic & mak...
OSHA & AIDS• Health care organizations required to  implement strict procedures to protect  employees• OSHA requires stric...
AIDS Education• Ever-increasing likelihood healthcare workers  will come into contact with persons carrying  HIV  – Need f...
Review Questions1. Should a professional who refuses to treat an  AIDS patient be suspended from an  organizations staff?2...
Review Questions cont.4. Should a hospital be permitted to publish  identity of AIDS patients in order to protect  other p...
5530: Chapter 15
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5530: Chapter 15

  1. 1. Chapter 15Acquired Immune Deficiency Syndrome 2
  2. 2. 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 bodys capacity to ward off bacteria & viruses that ordinarily would be fought off by properly functioning immune system. 3
  3. 3. Spread of AIDS – I• Direct contact with – infected blood – body fluids • vaginal secretions • Semen • breast milk 4
  4. 4. Spread of AIDS – II• Blood Transfusions –Historically: Transfusion Before Testing –transfusion of mismatched blood –improper screening & transfusion of contaminated blood –unnecessary administration of blood –improper handling procedures (e.g., inadequate refrigeration)• CASE: Negligence and the Collection of Blood• Sexual Transmission 5
  5. 5. AIDS & Health Care Workers• 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 6
  6. 6. Protecting Caregivers - I• Personal Protective Devices – gloves – masks – gowns – goggles• Engineering Controls – sharps disposal containers – ventilation systems 7
  7. 7. Protecting Caregivers - II• Work Practices – hand washing – use of needles – safe collection, transporting & disposal of body fluids
  8. 8. Refusal to Treat HIV Patient• The hospital’s on-call surgeon in Fiske v. U.S. Health Corp. of Southern Ohio14 had a duty to treat patients who came to the emergency room and required his services. The surgeon’s alleged refusal to treat a patient allegedly because of his HIV-positive status constituted an act of omission that could provide the basis for an action in negligence. 9
  9. 9. Confidentiality – I• Guidelines drafted by CDC – health care workers who perform exposure-prone procedures to undergo tests voluntarily to determine whether they are infected. – guidelines recommend patients be informed. – health care workers & patients claim mandatory HIV testing violates their 4th Amendment right to privacy. – dilemma is how to balance these rights against rights of public in general to be protected from a deadly disease. 10
  10. 10. Confidentiality – II• Tarrant County 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 plaintiffs right to receive such information. – court order prohibited disclosure of donors names to 3rd parties. 11
  11. 11. Confidentiality – III• CASE: Disclosure of Physician’s HIV Status• Delicate Balance 12
  12. 12. Confidentiality – IV• Partner’s Right to Know – person has right to know when his or her partner has tested positive for HIV – physicians expected counsel HIV-positive patient to notify his or her sexual or needle-sharing partners or to seek help in doing so from public health officials – if patient refuses, physician may, without consent, notify a sexual partner known to be at risk of HIV infection – Some states have developed informational brochures & consent, release, & partner notification forms 13
  13. 13. Confidentiality – V• HIV Status Improperly Disclosed to Employer – physicians disclosure of patients HIV status without his consent. – plaintiff-employee had a constitutionally protected interest in privacy of his medical records, & his right to privacy. • Francies v. Kapla• HIV Status Properly Disclosed to Employer 14
  14. 14. Confidentiality – VI• HIV Status Properly Disclosed to Employer – trial court properly dismissed claim for breach of privacy by HIV patient seeking damages from physician for disclosing his HIV status in a medical record that was forwarded to his employer. – patient, a veterinary assistant had developed an infection after being bitten by a cat, sought treatment for work- related injury. – since employer was required by law to pay work-related medical bills, very same law gave employer right to know pertinent medical information. (Meld v. Barnett) 15
  15. 15. Right to Treatment• HIV infected patients have right not to be discriminated against in provision of treatment. 16
  16. 16. Mandatory Testing• U.S. District Court found routine testing of firefighters & paramedics for AIDS virus does not violate individuals 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 17
  17. 17. News Media & Confidentiality• Protective order limiting public access to pretrial discovery material did not violate newspapers 1st Amendment rights.• Discovery documents were not judicial records to which newspaper had common-law right of access. 18
  18. 18. Discrimination• Access to Health Care• Education• Employment• Insurance Benefits 19
  19. 19. Negligence• Administration of Wrong Blood• CASE: Failure to Make Timely Diagnosis• Patient Wrongly Notified She Had AIDS• Serviceman Unknowingly Spreads AIDS to Family• Insurance Company Fails to Disclose HIV Status 20
  20. 20. Criminal Actions• Inmate at Federal Medical Center – convicted by jury of assault & battery with a deadly or dangerous weapon. – Indictment indicated he had tested positive for HIV antibody and later assaulted 2 federal correctional officers with his teeth. • United States v. Moore 21
  21. 21. Reporting Requirements• AIDS is reportable communicable disease in every state.• Physicians & hospitals must report with patients name—to government public health authorities. 22
  22. 22. 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. 23
  23. 23. OSHA & AIDS• Health care organizations required to implement strict procedures to protect employees• 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. 24
  24. 24. AIDS Education• Ever-increasing likelihood healthcare workers will come into contact with persons carrying HIV – Need for development of & compliance with approved safety procedures• Educational materials – CDC – OSHA 25
  25. 25. Review Questions1. Should a professional who refuses to treat an AIDS patient be suspended from an organizations staff?2. Describe how AIDS patients are discriminated against.3. Discuss the privacy and confidentiality issues of HIV-positive patients. 26
  26. 26. Review Questions cont.4. Should a hospital be permitted to publish identity of AIDS patients in order to protect other patients and staff?5. Is AIDS a reportable disease? Why?6. Discuss what steps can be taken in health care setting to help prevent spread of AIDS. 27

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