Scenario: a nurse comes to give patient an injection for whatever reason (blood draw, insulin time, whatever). After sticking the patient, nurse goes to cap it and accidentally sticks herself with the contaminated needle, thereby potentially exposing herself to a bloodborne pathogen. Is it legal for the patient to refuse to have bloodwork drawn to determine if they have any contagious bloodborne diseases?
The reason I ask, is that I take worker’s compensation claims for an insurance company. We often get needlestick claims, and frequently the caller will let us know if the patient tested positive for HIV/AIDS/Hepatitis C (or will tell us that they have begun the patient’s “disease bloodwork” and are still waiting on the results).
But, if I were the scenario patient, and a nurse of mine stuck herself with a needle after using it on me, I wouldn’t voluntarily consent to the medical facility doing these tests on me. It’s none of their business what diseases I have. I mean, it sucks what happened, but needlesticks are an occupational hazard. It’s not my fault. And they’ll be doing bloodwork and follow-up on the employee, so if Hep C or AIDS were to pop up in 6 months, she’d know about it.
Could they compel me to part with my blood unwillingly? Would/could they just do it without asking my permission? My motivations aren’t sinister. I’m not trying to infect a bunch of nurses with AIDS by making them stick themselves with my needles. I don’t even have any bloodborne pathogens, to the best of my knowledge. I just don’t want a medical facility (or more particularly, their insurance company) to have this irrelevant information about me.
I don’t know that they actually do a test to determine if the patient is HIV or Hep positive, they would just have records of the patient’s status if the patient was admittedly HIV/Hep positive. They would treat the needlestick with prophylactic medications and follow up tests for the nurse in your situation regardless of status of the patient. But I would say that you can’t be compelled to give your blood for a test unrelated to your own treatment.
I just checked policy for where I work: blood samples will be drawn from the patient, but will not be entered into that patient’s records (or charged for, for that matter). I don’t see anything about what happens if the patient tries to decline. There may be laws related to this - for instance, certain infectious disease diagnoses (tuberculosis, HIV, certain infectious hepatitis strains) must be reported to Illinois’ public health department - so I wonder if there’s anything related to requiring this as well.
All patients’ blood and similar bodily fluids are to be treated by those handling them as if they are infectious, so it makes sense to follow through with that in terms of testing.
Here is OSHA’s policies on post-exposure testing of the source individual:
The above seems to suggest that state or local law may (1) forbid the recording of the source individual’s identity, (2) forbid the non-consensual testing of already consensually-drawn blood (when the source individual refuses a subsequent draw), or (3) implement both prohibitions.
Where these prohibitions are not in place, it appears that a facility is commanded to test the source individual’s blood that it does have in it possession—likely, the blood from the initial draw. OSHA does not seem to give any guidance regarding what to do if the blood drawn cannot both be tested for its original purpose and for post-exposure testing.
Absent specific authorization under state law (which could, incidentally, pose some Fourth Amendment issues—these private entities would be acting under the color of state law), that’s mostly correct: a non-consensual blood draw would ordinarily be a battery.
I’ve seen blood drawn from combative inpatients but that was for urgent testing for their own medical health. Like I said, I don’t know what state law requires.
Well, for Illinois I found title 77, Chapter 1, subchapter k, part 697.120, HIV testing informed consent - it looks like (b) 6. states that if a health care worker, firefighter, or EMT was exposed to your bodily fluids in a fashion that can transmit HIV, you don’t get a say in whether a HIV test is run. I have no idea what that means for an additional blood draw, though - if you were just, say, getting a vaccination and the worker got a needlestick off the needle, I don’t know if you’d be legally required to stay and give them a blood sample. I don’t understand the wording or actual effects of the administrative code here. If you were an inpatient and had already given blood but that wasn’t enough for all the testing required, they might just tell you that they need more blood without bothering to mention why.
It’s not just the testing - post-exposure prophylaxis for HIV is WEEKS of antiretrovirals whose side effects could be avoided if the patient were negative. I also think you underestimate the anxiety of waiting MONTHS to see if you’ve become infected. Occupational hazard my ass, it’s true that it happens and nurses/doctors know it does, but you seem pretty blase about life-threatening diseases and drugs with serious side effects. I do not know about the legalities of the situation, but ethically I think that a patient who refuses a confidential, free blood test that could save another person a lot of anxiety and potential misery is a Grade A Asshole. JMHO.
The reason they need to test the patients blood is for liability reasons. Nurse Jane is exposed while changing a bandage on Patient Bob. Patient Bob denies access to his blood for testing. Nurse Jane has her blood drawn directly after the exposure and is negative for Hep B, Hep C and HIV. Nurse Jane declines anti-virals, but agrees to be re-tested in six months. At the six month point, Nurse Jane tests positive for HIV.
Did she get HIV from patient Bob? It is entirely uncertain and her workman’s comp/disability claim could be denied if they can prove Nurse Jane engaged in other high risk activities that could have potentially exposed her to HIV. If Bob agreed to testing, then his HIV status would be a matter of record and the uncertainty would be cleared up.
Your hypothetical persona seems either ignorant or nasty. Possibly both. The reason they want to know whether the patient is HIV+ is so they can get post-exposure prophylaxis if necessary. If the patient’s HIV status can’t be determined because you decide it’s “none of their business”, they have to make the very difficult choice of whether they should take several months of powerful drugs with unpleasant side effects or accept the small risk of contracting HIV.
Actually, it’s kind of nasty to make them wait 6 months to find out whether they’ve contracted HIV or Hep C even if post-exposure prophylaxis isn’t an issue (which it isn’t with Hep C, AFAIK).
As a future health care provider, I think I’d feel comfortable denying care to a patient who told me in advance that they refused to be tested for HIV in the event of an accidental exposure.
Only a court could compel you to have your blood drawn–or any other medical treatment for that matter–if you refuse.
As a patient in the hospital, you have the right to determine everything that is done (or not done) to you. If you are unable to make those decisions due to mental or medical incapacity then your NOK would make those decisions. If you have no NOK, then the court would elect a guardian to make those decisons for you until you regained your capacity.
IMHO, it would be a very shitty thing to NOT consent to a HIV/Hepatitis test after a needlestick and subject the individual to unnecessary medical treatment (and significant mental distress).
As a current health care provider I can state with good certainlty that you would either be fired or lose your license (if you had one) for doing that.
Edit: To expand on that, outside of EMTALA I’m unaware of legislation forcing health care providers to treat patients. If a new patient walked into my practice and behaved inconsiderately to other patients, my staff, or myself, wouldn’t I be perfectly entitled to not accept him as a patient and refer him to someone else? If so, how is this case any different?
Agreed. Antiretrovirals for HIV can have really awful side effects, down to the potential for causing things like extremely elevated cholesterol/triglycerides, kidney problems, even diabetic/pre-diabetic symptoms requiring treatment. Refusing post-exposure testing is pretty cruel.
There will be a risk assessment though- which means that even if you refuse to give blood, you’ll still be asked all sorts of personal questions about who you have sex with, where and how, and whether you inject drugs, donate blood or have received blood products.
You can choose not to answer those questions, but someone will still ask them, because if you are determined to be “low risk” for a blood borne virus the person who was exposed may be more likely to choose to forego PEP.
I have been fortunate enough to never have had a needlestick injury with a contaminated sharp.
I have had to ask a nun whether she’d ever had sex while doing missionary work in Africa as part of a risk assessment for a staff member who had though…thankfully the nun was very understanding and not insulted at all, and was rather amused to be getting an HIV test.
People who know they are at risk of having blood borne viruses who don’t get tested and treated…are… not my favourite people.
As a mostly-relevant aside, the current standard in medicine (here, anyway) is not to recap needles but to deposit them directly in a sharps container (there’s a device on the container to unscrew the needle).
I agree that the patient can refuse any and all medical procedures, including blood draws - I don’t know how it would work to do unordered tests on the blood you already have drawn, if the patient doesn’t want to be tested for that particular disease - the patient agreed to have the blood drawn for the tests he has agreed to - I can see him winning the case in court if you add other tests later, without his consent. It’s still his blood, and his right to privacy.
Just for the record, most of the people drawing blood in hospitals are lab techs, not nurses.