3. 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
properly functioning immune system.
3
4. Spread of AIDS – I
• Direct contact with
– infected blood
– body fluids
• vaginal secretions
• Semen
• breast milk
4
5. 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
6. 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
7. Protecting Caregivers - I
• Personal Protective Devices
– gloves
– masks
– gowns
– goggles
• Engineering Controls
– sharps disposal containers
– ventilation systems
7
8. Protecting Caregivers - II
• Work Practices
– hand washing
– use of needles
– safe collection, transporting & disposal of body
fluids
9. 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
10. 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
11. 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 plaintiff's right to
receive such information.
– court order prohibited disclosure of donors' names
to 3rd parties.
11
13. 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
14. Confidentiality – V
• HIV Status Improperly Disclosed to Employer
– physician's disclosure of patient's 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
15. 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
16. Right to Treatment
• HIV infected patients have right not to be
discriminated against in provision of treatment.
16
17. 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
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18. News Media & Confidentiality
• Protective order limiting public access to
pretrial discovery material did not violate
newspaper's 1st Amendment rights.
• Discovery documents were not judicial records
to which newspaper had common-law right of
access.
18
19. Discrimination
• Access to Health Care
• Education
• Employment
• Insurance Benefits
19
20. 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
21. 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
22. Reporting Requirements
• AIDS is reportable communicable disease in
every state.
• Physicians & hospitals must report with
patient's name—to government public health
authorities.
22
23. 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
24. 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
25. 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
26. Review Questions
1. Should a professional who refuses to treat an
AIDS patient be suspended from an
organization's staff?
2. Describe how AIDS patients are discriminated
against.
3. Discuss the privacy and confidentiality issues
of HIV-positive patients.
26
27. 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.
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