Legal Aspects Of Health Care Administration 11th Edition by George Pozgar

Exercise 7

Facts
The physician, John Doe, was a resident in obstetrics and gynecology (OB/GYN) at the medical center. In 1991, he cut his hand with a scalpel while he was assisting another physician. Because of the uncertainty that blood had been transferred from Doe's hand wound to the patient through an open surgical incision, he agreed to have a blood test for HIV. His blood tested positive for HIV, and he withdrew himself from participation in further surgical procedures. The medical center and Harrisburg Hospital, where Doe also participated in surgery, identified those patients who could be at risk. The medical center identified 279 patients, and Harrisburg identified 168 patients who fell into this category. Because hospital records did not identify those surgeries in which physicians may have accidentally cut themselves, the hospitals filed petitions in the Court of Common Pleas, alleging that there was, under the Confidentiality of HIV-Related Information Act [35 P.S. § 7608(a)(2)], a "compelling need" to disclose information regarding Doe's condition to those patients who conceivably could have been exposed to HIV. Doe argued that there was no compelling need to disclose the information and that he was entitled to confidentiality under the act.
The court issued an order for the selective release of information by: (1) providing the name of Doe to physicians and residents with whom he had participated in a surgical procedure or obstetrical care; (2) providing a letter to the patients at risk describing Doe as a resident in OB/GYN; and (3) setting forth the relevant period of such service. The physicians were prohibited under the HIV act from disclosing Doe's name. The superior court affirmed the decision of the trial court, and Doe appealed.
Issue
Was there a need to release selective information regarding Doe's HIV-positive status as determined by the trial court?
Holding
The Pennsylvania Supreme Court held that a compelling need existed for at least a partial disclosure of the physician's HIV status.
Reason
There was no question that Doe's HIV-positive status fell within the HIV act's definition of confidential information. There were, however, exceptions within the HIV act that allowed for disclosure of the information. In this case, there was a compelling reason to allow disclosure of the information. All the medical experts who testified agreed that there was some risk of exposure and that some form of notice should be given to those patients at risk. Even the expert witness presented by Doe agreed that there was at least some conceivable risk of exposure and that giving a limited form of notice would not be unreasonable. Failure to notify patients at risk could result in the spread of the disease to other noninfected individuals through sexual contact and through exposure to other body fluids. Doe's name was not revealed to the patients, only the fact that a resident physician who participated in their care had tested HIV positive. "No principle is more deeply embedded in the law than that expressed in the maxim Salus populi suprema lex,... (the welfare of the people is the supreme law), and a more compelling and consistent application of that principle than the one presented would be quite difficult to conceive" ( Id. at 163).
Was it necessary to disclose Doe's full name to those physicians with whom he worked? Why?