Question about HIV patient

Posted
by SNLou84 SNLou84 Member

Has 2 years experience.

Hi everyone. So I am a nursing student taking patient education and we were given the following scenario - Basically there is an 18 year old male who has HIV, he admits to the nurse that he is intimate with his girlfriend but that she does not know he has HIV. He states that she would leave him if he told her. I have heard many news stories about people being arrested for not disclosing their HIV status. I put this as my response - that I would educate him about the risks and the risk he is putting his partner in. I would also talk to someone who is above me who also knows the patients situation and find out if the police should be involved. Before I put my response, I even looked online and found many different cases in which this occurred in the newspaper. The only thing I am unsure about is if this would be violating HIPPA to involve the police. Yet, if the police weren't involved, and he continued to have sex with more and more people, wouldn't he be spreading HIV and putting more and more people at risk? That to me seems completely immoral. But my instructor said going to the police would make for an awkward situation, so then I started feeling like my response was not correct. Any insight would be greatly appreciated! Thanks!

imrn2b

imrn2b

4 Posts

I feel that as a medical profrssional we could not divulge this information to the police no matter how good our intentions were. That is a major violation of privacy. That being said, I of course do not agree with the "patient" in the scenario, he would be completely immoral for putting people at risk, but if you think about it, there are many people out there with Hep B and H.I.V that may be putting people at risk daily, but that is still information that we cannot give out. But I do understand where your coming fromsmile.png.

baylor06

baylor06

Specializes in ER. Has 4 years experience. 29 Posts

I think your charge nurse or your director would be best suited to ask about this situation. I am not sure how it works exactly, but as a healthcare professional you have a duty nnot only to your patient but to promote health overall. Maybe the CDC would get involved? I know in STD clinics partners are notified, but am not sure of the process...

PaperPencil

PaperPencil

44 Posts

Google "notifiable diseases"... that might help.

Mexarican

Mexarican

Specializes in Pediatric Intensive Care, Urgent Care. Has 4 years experience. 431 Posts

This is a classic scenario used in medical ethics discussions. As it stands, as a healthcare you are bound by HIPPA first and foremost! I would definately get the charge involved but thats as far you are allowed to take it.

Mex

mamamerlee

mamamerlee, LPN

Specializes in home health, dialysis, others. Has 35 years experience. 949 Posts

Get the social worker involved. And HIPAA be damned if a deadly disease is being purposely spread. Your manager needs to be involved. There is a need for the 'greater good' here.

Whispera, MSN, RN

Specializes in psych, addictions, hospice, education. 3,458 Posts

I've been out of the loop awhile. What's going on with "reportable diseases?" Just a few years ago, such things had to be reported to the local health department. Has this changed?

Higgs

Higgs

Specializes in Med/surg. ED. Palliative. Geront. Has 20 years experience. 109 Posts

I ask purely as devil's advocate...would your responses be different if it was your sister's boyfriend...?

caroladybelle, BSN, RN

Specializes in Oncology/Haemetology/HIV. 5,486 Posts

As far as I was aware, HIV/AIDs are reportable diseases to the Health department, whereupon, the infected person is "required" to inform all known sex partners through disclosure to the health department, who notifies them.

And we all know how honest everyone is on those lists.

Involving the police, violating HiPAA on your own is inadvisable. However, making the pts MD aware of the issue, or involving risk management in making the health department aware of incomplete disclosure has potential, depending on the risk management department/MD. Many still choose silence over disclosure. I have known MDs that have covered up the fact that a dying pt had an STD, found during exam, and treated them, without testing( which would be reportable, so that their spouse would not be upset with them during their final days, though that put the surviving wife at risk for infection, PID and/or cervical cancer.

As such, with current law, you stand a chance of losing in any event.

Mexarican

Mexarican

Specializes in Pediatric Intensive Care, Urgent Care. Has 4 years experience. 431 Posts

Having a background in HIV education, testing and counseling i notice many of you are confusing what "reportable disease" means and how it relates to the health department and the criminality of this person's actions. When a person tests positive for HIV, the provider who tested them and provided them with those results is required to "report" to the health dept that "a positive" test has occurred. this is done to maintain an accurate count of HIV cases in the nation and it's what "reportable disease" means. "reportable disease" only refers to the responsibility of the provider who tested this person and only means that the provider MUST report that "a positive" has occured to their local health department. That is the extent of what "reportable disease" is and means. Now, if the person cooperates (yes they actually have the choice) it can facilitate notifying sex partners that may have been exposed. This depends on whether the person consents to have their name attached to those results in the first place which determines whether the health department is able to get in contact with the person and work with them in notifying sex partners that they may have exposed to HIV. At no time is the persons name divulged to any potential partners although im sure the persons partner can find out through process of elimination especially if that person only had the infected person as a sex partner. That's the extent of "reportable" and it ONLY happens when the person initially test positive.

Now, if this infected person later meets someone and becomes intimate with that person without divulging their HIV status then in many states that is considered a crime which means there are laws that require them to divulge their status prior to becoming intimate with someone, but those laws DO NOT protect you as a healthcare provider in "facilitating" the divulging of this persons status. Which means you can't think, "well since this person is "committing" a crime, i can tell on him/her." Unfortunately these laws are only in place to prosecute after the fact. You can and you will lose your license for violating a persons HIV status confidentiality and it is considered one of the severest violations of HIPPA! In fact their is no more severe violation of HIPPA than divulging a person's HIV status! Their may be some HIPPA violations that are comparable but no other violation surpasses it! So much so that many medical information release forms have a special box where the person has to specifically consent to an HIV status/HIV medical record so that those too can be included in the passing on of medical information. In other words, when you sign a medical release form it does not automatically include any and all HIV medical information including status, you have to sign an additional release specifically for HIV medical information or check the appropriate box. So even making the private MD aware of the persons status without the consent of the patient is a violation of HIPPA. Although one would think that a persons private MD would already know this but don't be surprised as many people will go get tested at the health department in order to purposely avoid involving their MD.

As for if this girl was my sister...I would hope that my sister had enough sense to have herself and her partner tested for HIV before becoming intimate with this person and to use protection until then. We all make choices here and even with paying due diligence to our matters (ex:getting tested, using condoms) we can never be 100 percent sure the other person is being true to us...life's a gamble.

Mex

Edited by Mexarican

morte

morte, LPN, LVN

7,015 Posts

Having a background in HIV education, testing and counseling i notice many of you are confusing what "reportable disease" means and how it relates to the health department and the criminality of this person's actions. When a person tests positive for HIV, the provider who tested them and provided them with those results is required to "report" to the health dept that "a positive" test has occurred. this is done to maintain an accurate count of HIV cases in the nation and it's what "reportable disease" means. "reportable disease" only refers to the responsibility of the provider who tested this person and only means that the provider MUST report that "a positive" has occured to their local health department. That is the extent of what "reportable disease" is and means. Now, if the person cooperates (yes they actually have the choice) it can facilitate notifying sex partners that may have been exposed. This depends on whether the person consents to have their name attached to those results in the first place which determines whether the health department is able to get in contact with the person and work with them in notifying sex partners that they may have exposed to HIV. At no time is the persons name divulged to any potential partners although im sure the persons partner can find out through process of elimination especially if that person only had the infected person as a sex partner. That's the extent of "reportable" and it ONLY happens when the person initially test positive.

Now, if this infected person later meets someone and becomes intimate with that person without divulging their HIV status then in many states that is considered a crime which means there are laws that require them to divulge their status prior to becoming intimate with someone, but those laws DO NOT protect you as a healthcare provider in "facilitating" the divulging of this persons status. Which means you can't think, "well since this person is "committing" a crime, i can tell on him/her." Unfortunately these laws are only in place to prosecute after the fact. You can and you will lose your license for violating a persons HIV status confidentiality and it is considered one of the severest violations of HIPPA! In fact their is no more severe violation of HIPPA than divulging a person's HIV status! Their may be some HIPPA violations that are comparable but no other violation surpasses it! So much so that many medical information release forms have a special box where the person has to specifically consent to an HIV status/HIV medical record so that those too can be included in the passing on of medical information. In other words, when you sign a medical release form it does not automatically include any and all HIV medical information including status, you have to sign an additional release specifically for HIV medical information or check the appropriate box. So even making the private MD aware of the persons status without the consent of the patient is a violation of HIPPA. Although one would think that a persons private MD would already know this but don't be surprised as many people will go get tested at the health department in order to purposely avoid involving their MD.

As for if this girl was my sister...I would hope that my sister had enough sense to have herself and her partner tested for HIV before becoming intimate with this person and to use protection until then. We all make choices here and even with paying due diligence to our matters (ex:getting tested, using condoms) we can never be 100 percent sure the other person is being true to us...life's a gamble.

Mex

so, if we know that someone is HIV positive, we can not be charged with aiding and abetting murder if we dont tell their unsuspecting partner?

shoegalRN

shoegalRN, RN

1,338 Posts

so, if we know that someone is HIV positive, we can not be charged with aiding and abetting murder if we dont tell their unsuspecting partner?

I had a pt that was HIV positive. I seen this pt out in a social setting with a woman. I wondered if the woman knew he was HIV positive. However, it's not my place to disclose that info to this unsuspecting woman. HIPAA.

Personally, I struggled with the pt that was out in a social setting with a woman, possibly spreading HIV, however, it's not my place to disclose his HIV status. In fact, it's not my place to even acknowledge I was his nurse. This is one reason why I MAKE someone get an HIV test prior to having sex with them (I am single), because of situations like this. You never know and I'm responsible for my own health. Not everyone is gonna be truthful and I trust nobody with my health. That's just my two sense.

Edited by shoegalRN