Refuse Rx to HIV/HEP patients?

[DwayneEMTP]

According to JEMS: (Though I just glanced through the article and have done no further research to verify)

"Emergency responders are protected by a number of laws and standards of care regarding occupational exposure to communicable diseases. Since 1994, the emergency-responder provisions of the Ryan White Care Act (Public Law 101-381) provided such protection. However, in a recent action that went unnoticed in the emergency-response community, Congress removed these provisions in the latest reauthorization of this law (Public Law 109-415)

This development is bad news for emergency responders-and must be addressed by all of us immediately."

(JEMS; March 2008, vol33 No.3 Page 136)

Does this effect anyone's opinion?

Dwayne

[BVESBC]

I should have been more clear. My intent was that the question should have made it clear that the pt being served by the private sector ambulance, would be known to have a condition which could be communicable. And the situation is non emergent, example a hospital discharge or transfer to non acute facility. As Dustdevil said earlier he excused himself from a procedure with male peds, is this any different? It could only apply to non-emergent Pt's if at all. We regularly refuse jobs based on financial ability to pay and due to equipment and staffing limitations, sometimes based on nothing more than the facilty asking for to service.

[BVESBC]

According to JEMS: (Though I just glanced through the article and have done no further research to verify)

"Emergency responders are protected by a number of laws and standards of care regarding occupational exposure to communicable diseases. Since 1994, the emergency-responder provisions of the Ryan White Care Act (Public Law 101-381) provided such protection. However, in a recent action that went unnoticed in the emergency-response community, Congress removed these provisions in the latest reauthorization of this law (Public Law 109-415)

This development is bad news for emergency responders-and must be addressed by all of us immediately."

(JEMS; March 2008, vol33 No.3 Page 136)

Does this effect anyone's opinion?

Dwayne

This was copied from WashingtonWatch.com

P.L. 109-415, The Ryan White HIV/AIDS Treatment Modernization Act of 2006

This item is from the 109th Congress (2005-2006) and is no longer current. Comments, voting, and wiki editing have been disabled, and the cost/savings estimate has been frozen.

H.R. 6143 would reauthorize the Ryan White program in title XXVI of the Public Health Service Act. The Ryan White program provides grants to fund medical care and other support services for individuals with HIV/AIDS. The bill would modify certain provisions while maintaining the overall structure of the existing program.

I could not find just what provisons would be modified, is this just a reauthorization for funding?? This may need a new thread.

[mperkel]

It seems like that for HCW, people have a lack of knowledge about HIV, I'm not just referring to this thread, but also my class.

You are a HCW, You have an obligation to treat every patient that requires your assistance.

If your a evangelical christian, you may not be obligated to perform abortions, but you cannot refuse a 16 year old birth control, just because you think she should be abstinent.

Trying to make a point there I guess.

Just saying, treat the patient, if your paranoid, wear all the gear you can, but give that patient the same care you would give anyone else.

Most patients with HIV, you won't know, because the likelihood is they won't know.

In class, they tell us to treat everyone as if they have infectious disease.

We work in healthcare, we must maintain constant high alert for infectious diseases. Would be the same for cops and weapons, CIA and bombs, etc.

This is your job, We are here to save lives, Obviously your safety comes first, but if you take the right precautions and know what your doing the likelihood of contracting a virus like AIDS is very slim. A statistic for you is this, from my EMT-B book, "The likelihood of contracting HIV from getting stuck with a needle which has been used on an HIV-positive patient is 0.5%." That is a very low number, and multiple that by how often you will be stuck with a used needle, by the how likely it is the patient is HIV+.

Your risk is relatively low, again, it's up to you for BSI and necessary precautions.

Yes, in closing, I'm not even a Basic yet, but to me this seems like common sense. To comment on another guy's statement above, I also have never heard a discussion of refusing HIV+ patients from any physicians or nurses.

Thank You.

[Dustdevil]

If your a evangelical christian, you may not be obligated to perform abortions, but you cannot refuse a 16 year old birth control, just because you think she should be abstinent.

That's a poor analogy. Yes, you can refuse birth control if it is against your conscience. It is not "treatment" of any condition, and certainly not life threatening. You can punt it. Physicians have the right to refuse service to anyone, just like a bartender. The patient has plenty of options. There are plenty of other physicians around to give her what she wants.

Our patients have no such options, so it is a completely different situation.

[Just Plain Ruff]

I say we should be able to refuse anyone that does not need the ambulance. I hate the you call we haul mentality. I am a healthcare professional not a taxi driver. As far as refusing treatment or transport of someone because of there health condition such as TB, HIV, Hep, as a healthcare professional I say treat them. Perhaps extra precautions are warranted, but you still treat.

Actually Spenac, I agree with you on the refusal of people who do not need it. I really do. But the mentality of the bosses and supervisors which is they call we haul is what you have to go on. IF the boss says, transport every patient even if they are going to get out of the ambulance at the local bar then by all means follow the bosses directives, they sign your paycheck.

[mperkel]

That's a poor analogy. Yes, you can refuse birth control if it is against your conscience. It is not "treatment" of any condition, and certainly not life threatening. You can punt it. Physicians have the right to refuse service to anyone, just like a bartender. The patient has plenty of options. There are plenty of other physicians around to give her what she wants.

Our patients have no such options, so it is a completely different situation.

Agreed, bad analogy. Couldn't think of a better example.

[Dustdevil]

Agreed, bad analogy. Couldn't think of a better example.

Well, to be fair, you were shooting for a good point! The analogy just missed the mark.

[medicstudent1256]

I think everybody is missing Dougs point...if we are going to say that an infected HCW be banned from treating pts due to their disease status than the reverse discrimination could very well be true also. I understand the concept of "do no harm" and agree completely with that train of thought ..but....don't you think that as healthcare professionals we would know and understand slightly better than the "average Joe" on the street what exactly would cause a risk to our pts, were as the infected(and i don't care what the disease is) person seeking our assistance would? If we are going to discriminate against persons with communicable diseases than it should be across the board. On a personal note I DO NOT believe in this line of thought at all. Although I don't personally know any HCW who has this issue I am more than positive there are more than capable individuals out there who are trying to live their lives with this problem and are doing the best job they can. Another note...I am Dougs partner and have been for the last 15 months or so first as a Basic and now as an Intermediate/Medic student...I have NEVER in the thousands of calls we have done together seen him treat a pt with anything less than compassion and resect even if in my mind they didn't always deserve it.

[medicstudent1256]

Shoot I have to learn not to type so fast......compassion and RESPECT is what I meant...on a similar note I am currently working on a project for school on OEMS rules and regulations in the state of MA the CMR 170:940 states and I checked this twice..."Any condition or action that endangers the health or safety of the public is grounds for suspension of EMT certification" the word condition bothers me or am I reading to much into it?