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5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
5530: Chapter 15
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5530: Chapter 15

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  • 1. Chapter 15Acquired Immune Deficiency Syndrome 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. Spread of AIDS – I• Direct contact with – infected blood – body fluids • vaginal secretions • Semen • breast milk 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. 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. Protecting Caregivers - I• Personal Protective Devices – gloves – masks – gowns – goggles• Engineering Controls – sharps disposal containers – ventilation systems 7
  • 7. Protecting Caregivers - II• Work Practices – hand washing – use of needles – safe collection, transporting & disposal of body fluids
  • 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. 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. 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. Confidentiality – III• CASE: Disclosure of Physician’s HIV Status• Delicate Balance 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. 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. 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. Right to Treatment• HIV infected patients have right not to be discriminated against in provision of treatment. 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. 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. Discrimination• Access to Health Care• Education• Employment• Insurance Benefits 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. 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. Reporting Requirements• AIDS is reportable communicable disease in every state.• Physicians & hospitals must report with patients name—to government public health authorities. 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. 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. 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. 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. 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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