Ryan White Law: NY State DoH Update

[Richard B the EMT]

«

STATE OF NEW YORK

DEPARTMENT OF HEALTH

433 River Street, Suite 303

Troy, New York 12180-2299

Richard F. Daines. M.D.

Wendy E. Sawnders

Commissioner

Chief of Staff

August 1, 2008

Dear Colleague:

The purpose of this letter is to clarify c,urrent New-York State (NYS) provisions for sharing of confidential information in cases of occupational potential exposure to H1V; to ask that you review and update applicable policies and procedures and to request your help in making sure that emergency responders know the steps to be taken in such situations.

Although preventing exposures to blood and body fluids is the primary means of preventing occupationally acquired Human Immunodeficiency Virus (HIV) infection, appropriate post exposure management is an important element of workplace safety. Each emergency response agency is required 10 have plans in place for post exposure management. ill cases of significant exposure, seeking medical treatment immediately is crucial. NYS Department of Health (NYSDOH) guidelines recommend that post exposure prophylaxis (PEP) should be initiated as soon as possible, ideally within 2 hours and generally no later than 36 hours post-exposure. Emergenc>; responders should go to the nearest emergency room for evaluation of exposure.

We are Vriting at this time due to changes to the federal law that previously governed. the manner in which response agencies could seek information. As background, the original Ryan Vhite law sections 2681·2690, passed in 1990 (public law 101-381, section 411) containing emergency response provisions for notification ofpossible exposure to infectious diseases, ,"vere not included in the 2006 Reauthorization. These provisions required emergency response employers (i.e., fire departments, police departments, emergency medical services} to have a "designated officer" to field calls from employees regarding possible exposures to communicable diseases and obtain the disease status of the patients in those exposures from the medical facility providing treatment to that patient. This language was included in subsequent reauthorizations ofthe Ryan Willte law until 2006, when public law I09~415 eliminated them.

Despite these changes to the federal law, emergency response agencies can still access HIV test results on patients when there has been a bona fide risk exposure. KYS regulations now govern the manner in which disclosure of the HIV status of a patient may be made to emergency responders. Section 63.8(m)ofTitle10 oftheNewYorkCodes, RulesandRegulations (enclosed) provides for disclosure in such instances. Section 63,8(m) differs from the previous federal tawas [0110>"8:

•

(1)

The federal law required disclosure to a "designated officer" ofthe emergency response employer. Under Part 63.8(m), sLlch disclosure may be made to the physicians or other medical providers ofthe emergency responders.

(2)

The federal law did not require knowledge of the HIV status of the emergency responder for disclosure of the patient's HIV status. NYS regulations for disclosure require that the emergency responder's status is HIV-negative. Ifthe emergency responder's mv status is unknO'IlTI, an HIV test must be offered and administered 1th consent ofthe emergency responder.

Therefore, the following steps are now required when a significant ri1'k exposure occurs:

L .-n incident report documenting the details ofthe exposure, including witnesses to th~ incident, ifany, is on record v,ith supenisory staff.

2.

A request for disclosure ofthe patient's HIV status is made to the patient's physician or to the medical provider designated by the hospital or clinic to which the patient is brought. This request may be made by the exposed person (EMS provider) or by his or her physician as soon as . possible after the alleged exposure if a decision relating to the initiation or continuation of postexposure

proph.ylactic treatment is being considered.

3.

The medical provider ofthe EMS provider or the medical provider designated by the hospital or clinic must review, investigate and evaluate the incident and certify that:

(a)

the information is necessary for immediate decisions regarding initiation or continuation ofpost-exposure prophylactLc treatment for the EMS provider; and

(

the EMS provider's status is either HIV negative or unknown and that ifthe patient's status is unknown, the EMS provider has consented to an HIV test; and

©

ifthe EMS provider'''l test result becomes knovm as positive prior to the receipt ofthe patient's HIV stanIS, no disclosure of the patient's H1V status v,ill be made to the EMS provider.

4.

Documentation of the request is placed in the medical record ofthe EMS provider.

5.

If the patient's physician or the medical provider designated by the hospital or clinic detennines that a risk oftransmission has occurred or is likely to have occurred in the reasonable exercise afms/her professional judgment, the patient's physician or medical provider designated by the hospital or clinic may release the HIV status ofthe patient, ifknovm. The patient's physician or medical provider in the hospital or clinic may consult v,ith the local director or commissioner ofpublic health to detennine whether a risk oftransmission exists, Ifconsultation occurs, both the medical provider ofthe hospital or clinic and the local director or commissioner ofpublic health must be in agreement ifthe Iffi' information is to be dlsclosed. in the disclosure process the name ofthe patient shall not be provided to the EMS provider. Redisclosure ofthe HIV status ofthe source is prohibited except when made in conformance with Public Health Law

,Article 21, Title III.

In addition to the above, the NYSDOH recommends that, if the patient's HIV status is not known, consent of the patient be obtained for a rapid HIV test. Rapid test results are usually available within 30 minutes ortesting. Rules regarding confidentiality and consent for testing are identical to those for other HIV tests. A fonn, titled "Informed Consent to Perform a Coniidential HIV Test and Authorization for Release of HIV-related Information for Purposes of Providing PosI-exposure Care to a Health Care Worker Exposed to a Patient's Blood or Body Fluids" (DOH· 4054, Rev 8/05) is enclosed. This form is available at the NYSDOH web site at: http://m..-v.'.nyhealth.goviforms/doh-4054.pdf. The EMS providers' medical provider could request that the hospital try to secure a rapid HIV test of the patent.

An informational slide s.et has been developed by the Department to aid emergency response agencies in implementing the above provisions. It is available on-line at: http://wHV.health.state.ny.us/nvsdohfems/bemsuodates.htm.

At this time, your organization should review and update its policies and procedures to ensure that they are in compliance -lth section 63.8(m) and notify individual emergency responders ofthe procedures to be followed in cases ofpossible exposure. Specific questions should be directed as follm.'s:

1.

Emergency medical response organizations should contact the NYSDOH Bureau of Emergenc)' J·...1edical Services at: (518) 402-0996, Ext. 2.

2.

Police agencies should contact the NYS Police, Bureau ofMunicipal Police, at

(518) 457-2667.

3.

Fire Departments should contact the NYS Department of State. Office ofFire Prevention and Control at (518) 474-6746.

NYSDOH AIDS Institute recommendations for PEP follo;ng occupational exposure are based on careful re'lew of available studies and constitute the considered opinion ofexpert HIV clinicians. They are available for review on the NYSDOH HrV Guidelines Website at -vwvli.hivguidelines.org. In addition, clinical assistance is available through the NYSDOH HIV Clinical Education Initiative's PEP, Te~iing & Diagnosis Center of Excellence (212~604~2980), This Center provides education and te-chnical ass.istance to providers regarding PEP. This Center operates the PEP Line (1-888-448-4911), a 24-hour provider consultation line for the management of PEP.

Enclosed for your reference are copies of Part 63.8(m) and a letter from the Department to hospitals in NYS that notifies them ofthe status of the fed.crallaw and applicable NYS regulations. Your attention to this matter is appreciated.

Sincerely,

;;u~Jvr1~1

Edward G. Vronski Director Bureau of Emergency Medical Services

Enclosures (4)

-Part 63.S(m) of Title 10 NYCRR -DOH·4054

. Letter sent to hospitals -Letter sent to health departments

T;,I.l0 NYCRR: Part 63.8(m) as of April 2008

(m) Vhen the requirements of this section have been met, physicians and other diagnostic providers may disclose HIV-related information to physicians or other diagnostic prov.iders of persons whom the protected individual may have exposed to HIV under the circumstances noted below that present a risk of transmission ofHIV, except that disclosures related to exposure:; of emergency response employees governed by federal law shall continue to be governed by such law:

(1)

the incident must involve exposure to blood, semen, vaginal secretions, tissue or the follov.ing body fluids: cerebrospinal, amniotic, peritoneal, synovial, pericardia! and pleuraL and

(2)

a person has contact with the body substances, as noted in paragraph (1) above, of another to mucus membranes (e.g.. eyes, nose, mouth), ml1l-iiltact skin (e:g., open wound, skin Vyith a dermatitis condition, abraded areas) or to the vascular system. Examples of such contact may include ncc:dlesticks; puncture wound injuries and direct saturation or permeation of oonintact

skin by potentially infectious substances. These circumstances shall not include those delineated in subdivision (d) of section 63.10; and

(3)

the exposure incident occurred to staff, employees or volunteers in the performance of emplo)'lnent or professional duties:

(i)

in a medical or dental oftlce; or

(ii)

in a facility regulated, authorized or supervised by the Department of Health, Office of'Nlental Health, Office of Mental Retardation and Developmental Disabilities, Office of Children and Family Services, Office ofAlcoholism and Substance Abuse Services, Department of Correctional Services; or

(iii) involved an emergency response employee, paid or volunteer, including an emergency medical technician, a firefighter, a law enforcement officer (e.g., police, probation, parole oftleer) or local correctional officer or medical staff; and

(4)

an incident report documenting the details of the exposure, including v.itnesses to the incident, if any, is on record with supervisory staff; and

(5)arequestfor disclosure ofHIV statusismade to the providerofthesourceortothe medical officer designated by the facility by the exposed person or by the provider ofthe exposed person as soon as possible after the alleged exposure if a decision relating to the initiation or continll3tion afpost-exposure prophylactic treatment is being considered; and

(6) the medical provider of the exposed person or the mediC21 officer designated by the facility revit:ws, investigates and evaluates the incident and certifies that:

. (i) the infomlation is necessary for immediate decisions regarding initiation or continuation of post-exposure prophylactic treannent for the exposed person; and

(ii) the exposed person's status is either mv negative or unknovm. and that if the person's status is unknOin, the person has consented to an Hrv test; and

(iii) ifsuch test result becomes knoVvu as positive prior to the receipt of the source's HIV status, no disclosure of the souTce's HI' status ill be made to the person; and

(7) documentation of the request is placed in the medical record of me exposed person; and

(8) if the provider of the source or the medical officer designated by the facility detennines that a risk of t:ransmission has occurred or is likely to have occurred in the reasonable exercise of hisfher professional judgment, the provider or medical officer may release the HIV status ofthe source, ifkno.V1l. The provider or medical officer may consult v,,;"'.h the municipal health

commissioner or district health officer to determine whether a risk of transmission exists, If consultation occurs, both the provider and the local health officer must be in agreement if the HIV information is to be disclosed. In the disclosure process the name of the source shall not be provided to the exposed persall. Redisc10surc of the HIV status of the source is prohibited except 'vhen made in conformance '''lith Public Hc.alth Law Article 21, Title III.

NEW YORK STATE DEPARTMENT OF HEALTH

Informed Consent to Perform HIV Testing

AIDS Institute

and Authorization for Release of HIV-related Information for Purposes of Providing Post-exposure Care to a Health (are Worker Exposed to a Patient's Blood or Body Fluids,

An employee has been exposed to your blood or 11 body fluid in a manner which may pose a risk fortrllnsmission of a blood-borne infection. Many individuals may not know whether they have a btoodborne infection because people can carry these viruses without having any symptoms. We therefore are asking for consent to test you for tile presence of human immunodeficiency virus (HNl, the virus that causes AIDS. You willalso be tested for hepatitis Bvirus (HBVl and hepatitis (virus jHCV).

Under New York State law, HIV testing is lIoluntary and requires COnsent in writing lconsent can be withdrawn for testing at any time.] There afe a number of tests that can be done to show if you are infected with HIV. Your provider or counselor can provide specific information on these tests. Anonymous testing is available at selected sites. These tests involve collecting and testing

blood, urine or oral fluid. Additional testing also wilt tell whether you are carrying HBV or HCV.

HlV Testing is lrnportant for Your Health If your test result is negative. you can [earn how to protect yourself from being infected in the future If your test result is positive:

You can take steps to prevent passing the virus to others ~ You can receive treatment for HIV and learn about other ways to stay healthy. As part of treatment, additional tests will be done to determine the best treatment for you. These tests may include viral load and viral resirtilnce tests. An infected mother (an pass HIVto her child during pregnancy or birth ortnrough bre1lstfeeding.

• If you are pregnant and have HIV, treatment is available for your own health and to prevent passing HIV 10 your baby. If you have HIV ,md do not get treatment, the chance of passing HIV to your baby is one in four. If you get treatment, your chance of passing HIVto your baby is mllch tower,

If You Test Positive:

State law protects the mnfidentiality of your test results and also protedsyou from discrimination based on your HIV status. In almost all cases, you will be asked to give written approva,l before your HIV lest can be shared. Your HIV information can be released to health providers caring for your oryour exposed child; to hea1h officials when required

by law; to insurers to permit payment; to persons involved in foster care or adoption; to officiat correctionaL probation and parole

staff: to emergency or health care staff who are accidentally exposed to your blood; or by special court order.

The names of persons with HIV are reported to the State Health Department for tracking the epidemic <lndfor planning services.

The HIV Confidentiality Hotline at 1-800·962-5065 can answer your .questions and help with c.onlldentiatity problems.

The New York State Division of Human Rights at 1·800·523·2437 can help if you think you've been discriminated against based

on your HIV status.

If you are positive, your counselor/doctor will talk with you about notifying your sex or needle-sharing partners of fXl~sible exposure to HIV.

•

Your partners need to know that they may have been exposed to HIV so they can be tested and get treated if they have HIV.

If your health care provider knows the name of yourspouse Of other partner, he or she must report the name to the health

department unless itwould result in harm to you.

•

Health department counselors can help notify your partnens) without ever telling them your name.

•

To ensure your safety, your counselor or doctor will ask you questions about the risk of domestic. violence for each partner to be notified.

If there is any risk. the Health Department willno1 notify partners right away arld wilt assist you in getting help. DOH-4054 (Rev. 8/051. compliant with 45 tF.R. of 164.5D8((4)1iii) [HlPAA]

You are atso being asked to authorize the release of confidential HIV-related information related to this consent for testing to the health professional, named below, who is treating the healtn care worker that has been exposed to VOlJr blood or body fluid. This is necessary to provide appropriate care ~nd to counsel the worker about his or her risk of becoming infected and possibly infecting other$. Under New York State law Hrv-reLated information can only be given to people vou aLLow to have it by signing a written release, except in the instances outlined above. These individuals are prohibited by law from re-disclosing testing results in a way that could reveal your identity.

Name and address of facility/provider disdosing HN-reLated information:

Name and address of facilityjproviderto be given HIV-related information:

DescrilH! information 10 be released: t1IVTest Results

Time period during which release of information is authorized From: _ Too _

You may revoke this release, but disclosures caortot be revoked, once made, Additional exceptions to the right to revoke this release. ifany: _

Describe consequences, if any, of failing to tonsel1t to disdosure upon treatment, payment, enrollment or eligibility for benefits. (Note: Federal privacy regulation may restrici some consequences): _

Iunderstandthat Iambeingaskedtosubmitaspecimenfor HIVtestingfor oc.cupationalexposure,Iagreetotestingforthe determination of HIV infection. If] am found to have HIV,1 agree to additional testing that may occur on the sample I provide today to determine the best treatment for me and to help guide HIV prevention programs.lalso agree to future tests to guide my treatment I understand that I can withdraw my consent for future tests at any time.

Jalso authorize release of this information to the health care professional, named above, who is treating the health care worker that has been exposed to my blood or body fluid.

Signature:

(Test subject or legally authorized representative) Printed Name: _

Date:

Patient 10#:

DOB:

Address:

If legal representative, indica'te relationship to subject:

DOH-4054 (Rev. 81051, wmp!;~nt with 45 c.F.R, of 16450S(bl(4-l(fiij [HIPAAj

STATE OF NEW YORK DEPARTMEIlT OF HEALTH

433 RWer Street. SUite 303

Troy, New York 12160·2299

Richard E Daines, M.D. Comrr[iSSiOOO(

Wel1c'y E Saunders ClJJef of Staff

August 1, 2008 DPACS, 08 -06

Dear Chief Executive Officer:

The purpose of this letter is to clarify New York State ~"'lS) provIsions for sharing ofconfidential information in cases ofpotcntial occupational exposure of emergency responders to HIV, to ask that you review and update appllcable policies and procedures and to request your llelp in making sure that hospital staffknow the steps to be taken in such situations.

. The original Ryan ;bite law, enacted in 1990, contained provisions by which emergency response agencies (I.e., fire departments, police departments, emergency medical senices) were required to have a "designated officer" to field calls from employees regarding possible exposures to communicable diseases and obtain the disease status of the patients in those exposures from the medical facility providing tream1ent to that patient. This language was included in subsequent reauthorizations of the Ryan White law until 2006, when Public Law 109-415 eliminated them.

Despite these changes to the federal law, emergency responders can access EIV test results on patients when there has been a bona fide risk exposure. NYS regulations now govern the manner in which disclosure ofthe HIV status ofa patient may be made to emergency responders. Section 63.S(rn) ofTitle 10 of the New York Codes. Rules and Regulations provides for disclosure in such instances. Section 63.8(m) differs from the previous federalla" as follows:

(1)

The federat law required disclosure to a "desigriated officer" oftne emergency response employer. Under Part 63.8(m), such disclosuc(': may be made to the physicians or other medical providers ofthe emergency responders,

(2)

The federal lawdidnotrequireknowledgeoftheHIVstatusofthe emergency responder for disclosure of the patient's HIV status. NYS regulations for disclosure require that the emergency responder's status 15 HIV·negative. If the emergency responder's HIV status is unknown, an mv test must be offered and administered with consent ofthe emergency responder.

Therefore, the fcllowing steps are nov.' required when a significant risk exposure occurs:

1.

An incident report dOc:umC'llting the details of the exposure, including witnesses to the incident, ifany, is on record ,vith supervisory s.taff at the emergency response agency.

2.

A request for disclosure ofthe patient's HlV status is made to the patient's physician or to the medical provider designated by the hospital or clintc to which the patient is brought. This request may be made by the exposed person (emergency responder) or by his 0]' her physician as soon as possible after the alleged exposure ifa decision relating to the initiation or continuation afpasl-exposure prophylactic treatment is being considered.

3.

The medical provider ofthe emergency responder or the medical provider dcsignat~d by the hospital or clinic must review, investigate and evaluate the incidem and certify that:

(u)

the information is necessary for immediate decisions regarding initiation or contilluation ofpm:t-exposure prophylactic treatment for the emergency responder; and

(

the emergency responder's status is either HIV negative or unknown and that if the patient's status is unknown, the emergency responder has consented to an HN test; and

(c.) ifthe emergency responder's test result becomes known as positive prior to the receipt ofthe patient's HIV status, no disclosure of the patient's HIV status will be nude to the emergency responder,

4. Documentation ofthe request is placed in the medical record Qftbe emergency responder.

5, Ifthe patient's physician or the medical provider designated by the hospit..1.1 or ..::linic determines that a risk oftransmission bas occurred or is likely to have occurred in the reasonable exercise ofhis/her professional judgment, the patient's physician or medical provider designated by the hospital or clinic may release the HIV status of me patient, if known. The Patient's physician or medical provider in the hospital or clinic may consult with the local director or commissioner ofpublic health to deter:mh1e whether a risk of transmission exists. Ifconsultation occurs, both the medical provider of the hospital or clinic and the local director or commissioner ofpublic health must be in agreement ifthe HIV iniormation is to be disclosed, In the disclosure process the name of tho patient shall notbeprovidedtotheemergencyresponder. Redisclosure oftheHIVstatusofthesource is prohibited except when made in confonnance with Public Health Law Article 21, Title IlL

Although preventing exposures to blood and body fluids is the primary means of preventing occupationally acquired HIV infection, each emergency response agency is required to have plans in place for post exposure management. In cases ofsignificant exposure, seeking medical treatment immediately is crucial. NYS Department ofHealth (N"YSDOH) guidelines recommend that post exposure prophylaxsis (PEP) should be initiated as soon as possible, ideally within two (2) hours and generally no later than 36

hours post-exposure. Emergency responders usually rely on hospital emergency rooms for evaluation ofexposure and emergency re~ponse agencies have established relationships 'I,1,ith hospitals for purposes of accessing confidential infomlation about the HIV infection status ofpatients.

In addition to the above, the NYSDOH recommends that if the patient's HIV status is not known, consent of the patient be obtained for a rapid HIV test. Rapid test results arc usually available within 30 minutes oftesting. Rules regarding confidentiality and consent for testing are identical to those for other HIV tests. A fom), titled "Informed Consent to Petform a Confidential HIV Test and Authorization for Release of illV-relatetllnfonnation [or Purpose~ of Providing Post-exposure Care to a Health Care Worker Exposed to a Patient's Blood or Body Fluids" (DOH· 4054, Rev 8/05) is attached. This fonn is available at the NYSDOH web site at: http:/.rv."'v.n}11 ea.1tll .goviforms/doh-4054,pdf.

At this time. your hospital sboultl review and update its policies and procedures to ensure that they are in compliance with section 6J.8(m) and notify individual staff ofihe proc.edures to be followed in cases ofpossible ex.posure. :r-.:Y"SDOH AIDS Institute recommendations for PEP following occupational exposure arc bascd on careful review ofavailable studies and constitute the considered opinion of expert HIV clinicians. They are available for review on the NYSDOH HIV Guidelines V....ehsite at V'.'.hiv!.!uidelines.org. Ifyou need clinical assistance please contact the NYSDOH HIV Clinical Education Initiative's PEP, Testing & Diagnosis Center ofExcellence (212-6042980).

Tbis Center provides education and technical assistance to providers regarding post-exposure prophylaxis. This Center operates the PEP Line (1-888-448-4911), a 24hour

provider consultation line for the management of post-exposure propbylaxis.

Artached for your reference is a copy ofPart 63.8(m) and letters from the Department to emergency response agencies and local health departments in NYS notifying them of the status ofthe federal law and applicable NYS regulations. Your attcIltion to this matter is appreciated.

Sincerely,

1viartin 1. Conroy Director, Division ofPrimary & Acute Care Services

Attachments:

-Part 63.8(m) ofTitle 10 NYCRR

-"Informed Consent to PerfonTI a Confidential HJV Test and Authorization for Release

ofHIV-related Information for Purposes ofProviding Post-exposure Care to a Health

Care Vorker Exposed to a Patient's Blood or Body Fluids" (DOH-4054, Rev 8/05)

• Letter to emergency response agencies -Letter to Local Health Department&

STATE OF NEW YORK

DEPARTMENT OF HEALTH

Coming Tower The Governor Neison A. Rockefeller Empire Stele Plaza.

Albany, New York 12237

Richard F. Daines, M.D. Commissioner

Wendy E. Sau,.,ders ChiefofStaff

August 1, 2008

Dear Commissioner or Director of Public Health:

The purpose of this leiter is to inform you ofa change in federal1aw that has implications for the local health departments in New York State (NYS) regarding emergency responders' access to confidential health 1nformation in cases ofpotential occupational exposure to HIV. Since 1989, ~'~{S regulationshaveprovideda processfor disclos-ureofprotectedinformationthatincludeda defined role for local health departments to become involved in certain situations, as needed. SpecifiCally, consultation with local health departments regarding risk oftransmission and disclosure is provided for. Until recentlYt the NYS regulations wl're superseded in certain instances by fed~raJ law.

As background, the original Ryan Vl-l1ite law, enacted ill 1990. contained provisions by which

emergency response agencies (i.e" fire departments, police departments, emergency medical

services) were to have a "designated officer" to field calls from employees regarding possible

exposures to communicable diseases and obtain the disease status of the patients in those

exposures from the medical facility providing treatment to that patient. This language was

included in subsequent reauthorizations of the Ryan White law umi12006, v,.-hen Public Law

109~415 eliminated them.

Despite these changes to the fe<lerallaw, emergency response agencies ill NYS can still access HIV test results on patients when there has been a bona fide risk exposure. NYS regulations now govern the manner in which disclosure ofthe HIV status of a patient may be made to emergency responders. Section63.8(m) ofTitle10oftheNewYorkCodes,RulesandRegulations (attached) provides for disclosure in such instances. Section 63.8(m) differs from the previous federal Jaw as follows:

(l)

The federal law required disclosure to a "designated officer" of the emergency response employer. Under Pa11-63.8(m), such disclosure may be made to the physicians or other medical pl'Ovid-2rs ofthe emergency responders.

(2)

The federal law did not require knowledge of the HIV status of the ~lUergency responder for disclosure of the patient's HfV Status. NYS regulations for disclosure require that the emergency responder's status is HIV-negative. If the emergency

responder's HIV status is unknO',l1, an HIV test must be offered and administered with consent ofthe emergency responder.

The following steps are new required when a significant risk exposure occurs. The involvement oflocal health departments as a resource for consilltation in Ihis process is underlined:

1.

An incident report documenting the details of the exposure, including witnesses to th0 incident, if any, is on record with supervisory staff.

2.

A request for disclosure oftlle patient's HIV status is made to the patient's physician or to the medical provider designated by the hospital or clinic to which the patient is brought. This request may be made by the exposed person (em~rgency responder) or by his or her physician as soon as possible after the alleged exposure if a decision relating to the initiation or continuation ofpost-exposure prophylactic treatment is being considered.

3.

The medical provider ofthe emergency Jesponder or the medical provider designated by the hospital or clinic rmlst review, investigate and evaluate the incident and certify that:

(a)

the information is necessary ior immediate decisions regarding initiation or continuation cfpost-exposure prophylactic treatment for the emergency responder; and

(

the emergency responder's status is either HIV negative or unknown and that ifthe person's slatu5 is unknown, the emergency responder has consented to an HrV test; and

©

if the emergency responder's test result becomes known as positive prior to the receipt of the patient's HIV status, no disclosure {lfthe patient's HIV status will be made to the emergency responder.

4.

Documentation ofthe request is placed in the medical record of the emergency responder,

5.

lfthe patient's physician or the medical provider designated by the hospital or clinic determines that a risk of tmnsmission has occurred or is likely to have occurred in the reasonable exercise ofhislher professional judgment, the patient's physician or medical provider designated by the hospital or clinic may release the HIV status ofthe patient. ifknown. The patient's physician or medical provider in thehosmital or clinic may consult with the local director or commissionerofpublichealthtodeterminewhetherarisk oftransmissionexists. Ifconsultation cceun, both the medical orovi.der oithe hospital or clinic and the local director or commissioner ofpublicheallh must beinagreementifthe mv info!J11a1ion is to bedisc!osed. In the disclosure process the name ofihe patient shall not be provided to the EMS provider. Redisclosure of the mv status of the source is prohibited except when made in confonnan<:e with Public Health Law irticle 21, iitle m.

Although preventing exposures 10 blood and body fluids is the primary means ofpreventing occupationally acquired HIV infection, appropriate post exposure management is an important element ofworkplace safety. Each emergency re:sponse agency is required to have plans in place for post exposure management. Emergency response agencies in NYS are being notified about the change in federal law. They are asked to update their policies and procedures and to make sure that personnel know of tile steps to be taken in situanons involving potential exposures to

HIV, Hospitals in NYS are also being notified, with a similar request to update their policies and

procedures,

At this cime, we ask that you review and update your Depaltmcnt's policies and procedures to ensure that they are in compliance with section 63.8(m) and that you notify any appropriate staff of the correct proce<lures to be followed when contacted by a patient's physician Of medical provider in the hospital or clinic. In cases of significant expostlJ'e, seeking medical treatment immediately is crucial. NYS Department of Health (NYSDOH) guidelines recommend that post exposure prophylaxis (PEP) should be initiated as soon as possible. ideally within two (2) hours and generally no later than 36 hours post·exposure.

N"'YSDOH AIDS Institute recommendations for PEP following occupational exposure are based on careful review of available studies and constitute the considered opinion of expert HIV clinicians, They are available for review on the NYSDOH HIV Guidelines Website at wW'N.hivguideliues,org. Ifyou need dinical assistance please contact the NYSDOH HIV Clinical Education Initiative's PEP, Testing & Diagnosis Center of Excellence (212-604-2980). This Center provides education and technical assistance to providers regarding PEP, This Cl;:oter operates the PEP Line (1~888-448-491 J), a 24-hour provider consultation line for the management of PEP.

Attached for your reference is a copy ofPart 63.8(m) and letters from the Department to

emergencyresponseagencies andhospitals inNYSnotifying themofthe statusofthefederal

law and applicable NYS regulations, Thank you for your attention to this maUer.

Sincerely,

G~kh~

Deputy Commissioner Office ofPubHc Health

Attachments; Part 63.8(m) ofTit!e 10 NYCRR Letter to emergency response agencies Letter to hospitals

[firedoc5]

Rich, is this the actual document/ letter that was sent? Someone need to run spell and grammar check on it.

The Ryan White law is a must for EMS personnel and for the medical community in general nation wide. Don't know exactly why they want to repeal it. Law makers and bureaucrats, go figure. :roll:

[Richard B the EMT]

I lifted it directly from the file sent to me, and the rest of the New York State Volunteer Ambulance and Rescue Association's District 4, and put it in as shown.

PM me, and I'll send the file to any requesting members of the city, but please mention EMT City in the subject line, or it goes into the etherial waste basket.

[firedoc5]

I lifted it directly from the file sent to me, and the rest of the New York State Volunteer Ambulance and Rescue Association's District 4, and put it in as shown.

PM me, and I'll send the file to any requesting members of the city, but please mention EMT City in the subject line, or it goes into the etherial waste basket.

Hope it didn't seem like I was questioning or doubting you, Rich. Just wondering what the source was from.

[CBEMT]

Rich, is this the actual document/ letter that was sent? Someone need to run spell and grammar check on it.

The Ryan White law is a must for EMS personnel and for the medical community in general nation wide. Don't know exactly why they want to repeal it. Law makers and bureaucrats, go figure. :roll:

It already WAS repealed, when funding for the federal AIDS law it was attached to was discontinued.

So, technically, the Ryan White law doesn't exist at the present time.

[firedoc5]

It already WAS repealed, when funding for the federal AIDS law it was attached to was discontinued.

So, technically, the Ryan White law doesn't exist at the present time.

I'm just saying it should exist. "Un-making" laws because there's no funding? I just don't understand.

[Just Plain Ruff]

I'm just saying it should exist. "Un-making" laws because there's no funding? I just don't understand.

Government work at it's best.

[CBEMT]

I'm just saying it should exist. "Un-making" laws because there's no funding? I just don't understand.

If your agency had all of its funding sources removed, would it continue to exist? Obviously I would've liked to see the law left alone, but I don't understand what's complicated about how it happened.

[firedoc5]

If your agency had all of its funding sources removed, would it continue to exist? Obviously I would've liked to see the law left alone, but I don't understand what's complicated about how it happened.

It's not at all complicated, just seems absurb. I'm not that simple minded. :tongue3: