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Ethical/legal question

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MCG

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What are the guidelines for breaking confidentiality with your patient regarding putting others at risk for STD's. Does this rule only apply to HIV, or does it encompass all STD's?
 

DrSmiles

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Surprisingly, AIDS is a reportable disease in all 50 states, but HIV is not required to be reported and it is left up to the state to decide on if it should be reported. Even California didn't make HIV a reportable disease until July of 2002. Seems odd, doesn't it? So roughly 20 states do not report HIV.
 

MCG

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I think my question is being misunderstood, i want to know when to break confidentiality with a pt. who has tested positive for an STD, who is unwillingly keeping this from his wife, girlfriend, etc. i know you are obligated to tell the partner if the pt. is HIV + and refuses to, and continues to be sexually active, but does this apply to the other STD's?
 

TysonCook

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Pretty sure it depends on the states health dept. Several states require the reporting of differetn dz such as STD's and TB, but once you contact them, they take over w/notifying the family and others. At least in my experience in the ER the Health Dept really works w/the patient and at the least can send out a letter to those thought to be exposed that is generalized and anonymous which would be like "It has come to our attn that in the previous X months you may have come into contact w/ an individual that has tested positive for X. Sites/resources for further testing...."

Also, I randomly found out that if a pt is + for certain dz's and refuses to take medication on schedule, a judge can legally have them thrown in jail for propigating a dz, or at least in Ohio.

As far as a pt refusing to help at all, it depends on the state law, which range from nada, to jailtime for sexual contact, to being held in a kind of contempt. All this depends on every states law.
 
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