ATrain Education

 

Continuing Education for Health Professionals

WA: HIV/AIDS, 4 units

Module 3

Part V: Legal and Ethical Issues

 

Did you know. . .

In the case of HIV or AIDS, reportable means that providers who diagnose a person must submit a confidential case report to the local health jurisdiction within 3 days.

 

HIV and AIDS Are Reportable Conditions

Reporting of HIV and AIDS cases assists local and state officials in tracking the epidemic. It also allows for effective planning and intervention to be provided in the effort to reduce the transmission of HIV to other people.

WA state

AIDS and HIV are reportable conditions in Washington State, by statute WAC 246-101. AIDS (medically diagnosed) and symptomatic HIV infection have been reportable conditions in Washington since 1984 and 1993 respectively. In 1999 asymptomatic HIV infection also became reportable.

Anonymous Tests and Reporting

Positive HIV results obtained through anonymous testing are not reportable. However, once a patient with positive results seeks medical care for conditions related to HIV or AIDS, the provider is required to report the case to the local health department.

 

Answer: A

Test Your Learning

Positive HIV test results obtained through anonymous testing are not reportable to the health department unless that person seeks medical care for conditions related to HIV or AIDS:

  1. True
  2. False

Spousal Notification

Federal Public Law 104–146 (1996) requires that states take action to require that a “good faith effort” be made to notify all spouses of HIV-infected people. A spouse is defined as anyone who is or has been the marriage partner of an HIV-infected individual within 10 years prior to the HIV diagnosis.

Notification means that individuals testing positive will be counseled about the importance of notifying spouses and partners and will be given the choice to notify, to allow the healthcare provider to notify, or to refer to the local health jurisdiction for assistance in notifying the spouse.

Confidentiality

All medical records are confidential and must be maintained in a manner that protects that confidentiality. Confidentiality of medical information means that a person’s medical information (including HIV testing and HIV results) may not be disclosed to anyone unless the individual signs a release-of-information form. However, there are exceptions to this. Medical information can be disclosed under certain circumstances, including:

  • When it is given from one healthcare provider to another healthcare provider for related ongoing medical care of the patient
  • In a life-or-death emergency
  • To a third-party payer (insurance provider)
  • In reporting notifiable conditions to the local health jurisdiction or the DOH

Violation of the above-mentioned laws is a misdemeanor and may result in civil liability actions for reckless or intentional disclosure up to $10,000 or actual damages, whichever is greater. It is the responsibility of the county’s health officer to investigate potential breaches of confidentiality of HIV identifying information and report them to the Department of Health.

WA state

Special requirements regarding HIV and AIDS are found in WAC 246-101 and RCW 70.24.105.

Additional Confidentiality Protections

Some areas of the medical record have additional confidentiality requirements because disclosure of the information to the wrong person or agency could mean additional harm to the patient. It has been determined that there exists a level of prejudice, fear, and discrimination directed at people with these medical conditions. Therefore, there is a balance between civil protection and information access.

WA state

In Washington State, the Washington Law Against Discrimination (WLAD) regulates “disabled” status and explicitly prohibits discrimination on the basis of HIV and hepatitis C infection. The WLAD is enforced by the Washington State Human Rights Commission (see RCW 49.60.174). The WSHRC does not investigate anonymous complaints, and may have to release a complaint under the state’s Public Disclosure Act. In certain circumstances, OCR will not disclose a complainant’s identity.

 

Answer: A

Online Resource

WSHRC Jurisdiction  http://www.hum.wa.gov/

 

Test Your Learning

HIV testing and results may be disclosed:

  1. From one healthcare provider to another for related medical care of the patient.
  2. By a good-faith effort to notify all spouses with or without the consent of the infected person.
  3. Only to the manager of an HIV-infected person in the workplace.
  4. When positive HIV results are obtained through anonymous testing.

Disability and Discrimination

People with AIDS and HIV are also protected by federal law under Title II of the Americans with Disability Act of 1990 (ADA) and Section 504 of the Federal Rehabilitation Act of 1973, as amended. People with HIV infection and/or AIDS who feel discriminated against on the basis of their disease may file a complaint with the Office for Civil Rights (OCR) of the U.S. Department of Health and Human Services.

WA state

In Washington State, the Washington Law Against Discrimination (WLAD) regulates “disabled” status and explicitly prohibits discrimination on the basis of HIV and hepatitis C infection. The WLAD is enforced by the Washington State Human Rights Commission (see RCW 49.60.174).

The WSHRC does not investigate anonymous complaints, and may have to release a complaint under the state’s Public Disclosure Act. In certain circumstances, OCR will not disclose a complainant’s identity.

 

Online Resource

WSHRC jurisdiction information can be found on its website.
http://www.hum.wa.gov

 

Disability
WA state

HIV infection and AIDS are medical conditions that are considered disabilities under the Washington State Law Against Discrimination (RCW 49.60) and the federal Americans with Disability Act of 1990 (ADA) and Section 504 of the Rehabilitation Act of 1973.

These laws mean that it is illegal to discriminate against people who have AIDS or are HIV infected on the basis of their medical condition. It is also illegal to discriminate against someone who is “believed” to have AIDS or HIV infection, even though that person is not, in fact, infected. The areas covered in the law are:

  • Employment
  • Rental, purchase or sale of apartment, house, or real estate
  • Places of public accommodation (restaurants, theaters)
  • Healthcare, legal services, home repairs, and other personal services available to the general public
  • Applying for a loan or credit card, or other credit transaction
  • Certain insurance transactions

 

Did you know . . .

Federal and state jurisdictions differ in approaches to disability.

 

The laws also protect HIV-infected and AIDS-diagnosed people from employment discrimination. Employers may not discriminate against people with HIV infections or AIDS in:

  • Employment
  • Recruitment
  • Hiring
  • Transfers
  • Layoffs
  • Terminations
  • Rate of pay
  • Job assignments
  • Leaves of absence, sick leave, any other leave or fringe benefits available by virtue of employment

 

Did you know . . .

State and federal laws do not cover all employers. For example, state law does not cover employers with fewer than eight employees, religiously controlled non-profits, and Indian tribes.

 

Discrimination-Free Environment

Employers are required to provide and maintain a working environment free of discrimination. They must assure that no harassment, intimidation, or adverse action or personnel distinction is made in terms and conditions of employment based on HIV status.

If a worksite situation develops that poses the threat of discrimination, it is best practice for the employer to provide education and supervision to employees in order to end harassment, the use of slurs, or intimidation. An employer should promptly investigate allegations of discrimination, take appropriate action, and not retaliate against the person who complained.

If someone is in a situation in which they feel they are being discriminated against, they should first document the discrimination, speak with their supervisor, and follow the entity’s internal process to file a discrimination charge. However, it is not necessary to follow an internal grievance process. An aggrieved person can also file directly in state court. A complaint must be filed within 180 days of the alleged discriminatory incident.

WA state

If these remedies do not work, a person should contact the Office for Civil Rights or the Washington State Human Rights Commission.

Reasonable Accommodation

Employers are responsible for providing reasonable worksite accommodations that will enable a qualified disabled employee or job applicant to perform the essential tasks of the particular job.

Reasonable accommodation means modifications to a worksite or job, in the context of the entire employer’s operation, such as:

  • Providing special equipment
  • Altering the work environment
  • Allowing flex-time
  • Providing frequent rest breaks
  • Allowing the person to work at home (telecommute)
  • Restructuring the job

An employee with a disability must self-identify and request a reasonable accommodation. The employer must engage in an interactive process with the requestor. The reasonable accommodation grant may not be exactly the same one as requested by the employee, but one that is equally effective. The employer does not have to change the essential nature of its work, or engage in undue hardship or heavy administrative burdens. The essential functions of the job must be accomplished, with or without reasonable accommodations.

 

Online Resource

Americans with Disabilities Act and People with HIV/AIDS
https://www.ada.gov/hiv/ada_q&a_aids.htm

 

Potentially Prejudicial Information

When a person goes for a job interview or is hired, it is best practice for an employer to refrain from asking questions directed at the perception or presence of HIV infection or AIDS unless the employer has obtained a “bona fide occupational qualification” (BFOQ) from their state.

It is best practice for an employer to refrain from asking “lifestyle” questions, such as inquiring about an applicant’s religion, living arrangements, sexual orientation, or gender identity. Exceptions to the above are applicants for the U.S. military, the Peace Corps, the Job Corps, and people applying for U.S. citizenship under federal law, which supersedes state law.

Behaviors Endangering the Public Health

WA state

Washington State Human Rights Commission (RCW 49.60.172 and WAC 246-100-204). Chapter 49.60 RCW, the Washington Law Against Discrimination, prohibits discrimination based on age, creed, religion, race, color, national origin, sex, sexual orientation and gender identity, HIV and hepatitis C status, whistleblower retaliation, marital status (housing and employment), families with children (housing), or the presence of any sensory, mental, or physical disability or the use of a trained dog guide or service. Washington State law (RCW 70.24) and rules (WAC 246-100 and 246-101) give state and local health officers the authority and responsibility to carry out certain measures to protect the public health from the spread of STDs, including HIV.

Authorities and Responsibilities of Health Officers

The local health officer is the physician hired to direct the operations of the local county’s health department or health district. Included in the broad responsibilities of the health officer is the authority to:

  • Interview people infected with an STD.
  • Notify sexual or needle-sharing partners of exposure to disease.
  • Order people suspected of being infected to receive examination, testing, counseling, or treatment.
  • Issue orders to cease and desist from specific conduct that endangers the public health of others.

Court enforcement of these orders can be sought. State law delineates the standards that must be met before action by the health officer may be taken. After all less-restrictive measures have been exhausted, the law allows for a person to be detained for periods up to 90 days after appropriate hearings and rulings by a court. This detention must include counseling.

WA state

For HIV, Washington state law permits an additional step—the detention of an HIV-infected person who continues to endanger the health of others. Washington State law (RCW 70.24) and rules (WAC 246-100 and 246-101) give state and local health officers the authority and responsibility to carry out certain measures to protect the public health from the spread of STDs, including HIV.

Reporting Non-Compliance

By state law and rule, healthcare providers are required to provide instruction on infection control measures to the patient who is diagnosed with a communicable disease. They are also required to report certain information to the local health officer where there are either impediments to or refusal to comply with prescribed infection control measures.

When a healthcare provider has knowledge that a specific patient is failing to comply with prescribed infection control measures (eg, acquisition of a new STD, sex without disclosure of HIV status to sexual partners, failure to disclose HIV status to needle-sharing partners, donating or selling HIV-infected blood) they should contact the local public health officer to discuss the circumstances of the case and to determine if the name of the person should be reported for investigation and followup.

Case Investigation

The health officer or other authorized representative will investigate the case if credible evidence exists that an HIV-infected person is engaging in conduct endangering the public health. Other laws and regulations concern endangering behaviors as well as occupational exposures. These may be specific to professions and to the jurisdictions of public health officers.

WA state

Washington State Hotline at 800 272 2437, or ask a knowledgeable person to provide the information to your group. HIV infected people can be detained by a health officer if they engage in activities that endanger the health of others.

 

Answer: C

Test Your Learning

According to Washington State law, HIV infected people:

  1. Do not have to be granted “reasonable accommodations” in the workplace unless ordered by a health officer.
  2. Are not covered by the Americans with Disabilities Act.
  3. Can be detained by a health officer if they engage in activities that endanger the health of others.
  4. Must be isolated from their co-workers.
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