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Revealing Patients HIV Status

by Attorney Frank E. Reardon

September 1993

REARDON LAW OFFICE

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     A California Appeals Court recently found a physician liable for the disclosure of a patient's HIV positive status in a medical report on a worker's compensation claim.  This decision underscores the growing need of doctors to be extremely cautious in divulging whether a patient is HIV positive.

            This California case, Urbaniak v. Newton, dealt with a machinist, Mr. Urbaniak, who suffered a head and back injury while at work.  Urbaniak claimed that the injury had led to debilitating pain that prevented him from doing his job as a machinist.  Ultimately, he brought a workers' compensation claim against his employer.  After the claim was filed, the employer's law firm sought to have Urbaniak examined by a neurologist.  He consented to the examination.

            As part of the neurological examination, the physician attached metal electrodes onto Urbaniak's body.  During the course of this examination, the metal electrodes drew blood, which was not unusual for this particular type of procedure.  After the examination was completed, Urbaniak told the nurse that he was HIV positive.

            Mr. Urbaniak was concerned about the possibility of spreading the virus to other patients.  His concern was sparked when he saw the electrodes draw blood.  He allegedly told the nurse that he was HIV positive and that she should be careful to sterilize the equipment used on him.

            Mr. Urbaniak also alleged that he told that same nurse that he did not want his HIV status listed in the medical report. However, in his medical report, the physician did note that Urbaniak was HIV positive.  The doctor divulged this informantion because he thought the source of the disabling head and shoulder pain and tension might be related to Urbaniak's medical condition as an AIDS patient.  As the court quoted from the physician's report:

                       

"It seems more probable that, psychosocial, character-ological or other factors played a significant role inthe accentuation of symptomatology.  Here it is worth noting that the patient informed me that he has been diagnosed as HLV-III positive.  It would not be surprising that under the circumstances of concerns about potentially serious health matters, he might have some increase in symptomatology due to increased muscle tension."

 

 

The report was sent to the insurance company and ultimately to the Workers Compensation Appeals Board.  The insurance company terminated payments to Urbaniak's chiropractor and sent the chiropractor a copy of the medical report as justification for the  discontinuance of payments for these services.  Mr. Urbaniak brought suit against the physician and others for invasion of privacy.  The trial court entered a judgment of dismissal and Urbaniak appealed.  The Appeals court reversed the dismissal in part.  The question for the court was whether the disclosure of Urbaniak's HIV status constituted an "improper use of information properly obtained". The court reasoned that the patient had a reasonable expectation of privacy that his disclosure that he was HIV positive would not be disseminated in the medical report.  Moreover, the court stressed that a failure to protect the patient's privacy in this type of situation would subvert a public interest which favors communication of a patient's HIV status to his or her physician. Thus the court held that the patient's right to privacy arises in the disclosure of his or her HIV positive status to a health care worker for the purpose of alerting that worker for the need to take certain safety precautions.

            Interestingly, the court rejected the argument by Urbaniak that the disclosure in the medical report that he was HIV positive violated the California statute restricting the divulgence of the results of a blood test for the AIDS virus without the written consent of the patient.

            Massachusetts has a similar statute regarding the disclosure of the results of an AIDS blood test.  This decision does not foreshadow any expansion of the definition of blood "test" to include medical histories and the like.

            However, physicians should be extremely cautious in disseminating information regarding their patients' HIV status.  Doctors and other health care providers should try and restrict the use of this information to those instances where it is essential to the diagnosis.  As this California case implies, however, even if a doctor believes a patient's HIV positive condition is relevant, he may be liable for invasion of privacy if a court determines such dissemination to be an improper use of this sensitive information.