1) Let's say you have a minor patient interest in sterilization ( surgery) ... do you need parental consent or it is not needed because it is contraception method ?

2) Another pt HIV+ don't what to inform the partners of the situation... do you inform the Dept. of Health in detail and that the pt previously mentioned of several partners???
( like other STDs they are reportable illness. How does this report is actually sent? online, fax, etc?? and with # of cases only) ??


3) Finally, your female HIV+ tells you that she'll inform her husband who's in the waiting room that she is positive... On her following appointment, weeks later, she mentions that she did not inform him yet and then he finds out he's HIV+. Does he have grounds to win a lawsuit for not telling him about his wife's viral infection during the prior appointment when he was present at the clinic?

I think you would need parental consent for sterilization because it is invasive. Also, if the patient was married, you would need consent from the spouse.

__________________
Sree

[X]Family Medicine [X]Internal Medicine [X]Ob/Gyn [X] Surgery [X]Psychiatry [X]Pediatrics
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Consent from the spouse is not needed because of autonomy, same true for abortion.

The other 2 cases situations I don't know.

When I was rotating the protocol was to report the patient to the health dept. Usually the patient stayed in the office until a HIV case worker came from the Dept of Health. The case worker interviews the patient about partners and other aspect of their lifestyle. Sfter you make the report you are np longer liable it is in the govenment's hands.

__________________
AEDMD2B
AUA 6th semester/term
All praise to Jehovah
Surgery is done and now onto Emergency Med.

I thought because of confidentiality, you really can't report individuals against their consent to the dep. health ( besides reporting the number of cases)...

there is a list of reportable diseases each state has with timelines. here is illinois: ILLINOIS DEPARTMENT OF PUBLIC HEALTH REPORTABLE DISEASES

also hippa did not change the law pertaining to reporting diseases since each state gives the health dept authority to review medical records, here is massachusets:

"Case investigations frequently require prompt access to confidential medical records for clinical, laboratory, or treatment data. Access by MDPH to hospital, clinic, and laboratory records is specifically authorized under MGL Chapter 111, §§ 5 and 7, and Chapter 111D, §6. These laws are further clarified by 105 CMR 300.000: Reportable Diseases and Isolation and Quarantine Requirements, sections 300.190 (Surveillance and Control of Diseases Dangerous to the Public Health) and 300.191 (Access to Medical Records and Other Information)."

the health dept follows to see if contacts are notified and treatment. some health depts offer anon testing hoping to get people who otherwise would not come in tested. the only difference if i recall is that hiv reporting is done by a unique patient ID number and not identifiable info....

you can also add radiation/lead poisoning to reportable diseases

__________________
AUC M.D. Class of 06'
OBGYN PGY-1.5

I hate Internal Medicine more than fascia

thanks...

So, as for the case scenario # 3, I am assuming that it would be ideal to inform the spouse right away regarding HIV...

Based on my understanding, and I could be wrong: Since the partner is at risk, you have a duty to inform them. Confidentiality doesn't apply.

AIDS is a reportable disease in all 50 states, HIV is not.

Scenario#1 The invasiveness and permanence makes this procedure one that requires parental consent. Additionally most insurance companies would require preauthorization for this procedure and potentially a 30day documented wait period.
When I worked in research none of the OB's I encountered would perform sterilization on women under 21-25 even those infected with HIV.

Scenario#2 and #3 In my state HIV cases are reported with unique identifiers. The health department doesn't do compliance follow up like they do with TB cases. However there has been criminal action taken against spouses who were aware of their disease state refused treatment and failed to inform their spouse of their status, and charges pressed against those who were HIV+ a found guilty of assault and/ or rape. The burden to disclose lies with the infected individual not the health care provider.

(a) The department of health, acting pursuant to § 68-10-109, shall promulgate rules
regarding transmission of human immunodeficiency virus (

39-13-109

. Criminal exposure to HIV - Defenses - Penalty.

(a) A person commits the offense of criminal exposure of another to human
immunodeficiency virus (

HIV) when, knowing that such person is infected with HIV,
such person knowingly:
(1) Engages in intimate contact with another;
(2) Transfers, donates, or provides blood, tissue, semen, organs, or other potentially
infectious body fluids or parts for transfusion, transplantation, insemination, or other
administration to another in any manner that presents a significant risk of HIV

transmission; or
(3) Dispenses, delivers, exchanges, sells, or in any other way transfers to another any
nonsterile intravenous or intramuscular drug paraphernalia.
(b) As used in this section:
(1) "

HIV" means the human immunodeficiency virus or any other identified causative
agent of acquired immunodeficiency syndrome;
(2) "Intimate contact with another" means the exposure of the body of one person to a
bodily fluid of another person in any manner that presents a significant risk of HIV

transmission; and
(3) "Intravenous or intramuscular drug paraphernalia" means any equipment, product, or
material of any kind which is peculiar to and marketed for use in injecting a substance
into the human body.
(c) It is an affirmative defense to prosecution under this section, which must be proven
by a preponderance of the evidence, that the person exposed to

HIV knew that the
infected person was infected with HIV, knew that the action could result in infection
with HIV, and gave advance consent to the action with that knowledge.
(d) Nothing in this section shall be construed to require the actual transmission of HIV

in order for a person to have committed the offense of criminal exposure of another to

HIV

.

(e) Criminal exposure of another to HIV is a Class C felony.