An Austin, Texas orthopaedic surgeon has agreed that he and his staff will not deny or withhold medically appropriate treatment from patients solely because they are HIV-positive, according to the U.S. Department of Health and Human Services (HHS). Under a settlement agreement reached with HHS’ Office for Civil Rights (OCR), the surgeon, whose practice group sees an average of 200 patients per week, will establish a non-discrimination policy, make reasonable modifications to his procedures to avoid discrimination against individuals living with HIV/AIDS, receive comprehensive training, implement patient grievance procedures, and inform patients of their right to file a complaint with OCR.

The settlement agreement will bring the surgeon into compliance with Section 504 of the Rehabilitation Act of 1973 (Section 504). Section 504 requires recipients of federal financial assistance (often health care providers reimbursed by Medicaid) to ensure that qualified individuals with disabilities, including those with HIV/AIDS, have equal access to their programs, services or activities.

“Medical providers covered by Section 504 have a legal obligation to provide medically appropriate services to qualified individuals with disabilities,” said OCR Director Georgina Verdugo. “Under Section 504, medical providers may not deny or withhold medically appropriate treatment, as determined by reasonable medical judgment given the current state of medical knowledge, solely on the basis of a patient’s HIV status. As our investigation, violation finding, and settlement of this Austin case demonstrate, OCR is committed to ensuring that all qualified individuals with disabilities — including those with HIV/AIDS — are afforded equal access to quality medical services.”

The prevalence of HIV/AIDS in the greater Austin area has increased 63 percent since 2000 and is the third highest in the State of Texas, according to a Dec. 31, 2007, report of the Austin/Travis County Health and Human Services Department. Over 1.5 million people reside in the Austin Transitional Grant Area (TGA), which was established under the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act and includes Bastrop, Caldwell, Hays, Travis and Williamson counties. Medicaid enrolls 7.3 percent of the Austin TGA and nearly 25 percent of the population does not have public or private health insurance. For individuals living with HIV/AIDS in the Austin TGA, 49.9 percent are Caucasian, 24.8 percent are Latino, and 24.2 percent are African-American.

The settlement with the Austin orthopaedic surgeon was negotiated following OCR’s investigation of an administrative complaint filed by a Latino male patient living with HIV. The patient, a Medicaid beneficiary, sought medical treatment for a knee injury and informed the surgeon of his HIV status. The surgeon contended that if he performed surgery on the man’s knee (a bone-tendon-bone Reconstruction), blood would splatter and possibly expose him to HIV disease. Due to the patient’s HIV status, the Austin surgeon referred the patient to another surgeon located over 200 miles away.

OCR found that the Austin surgeon violated Section 504 by refusing to perform the surgery and instead referring the patient to another surgeon. In making its determination, OCR relied on the expert opinion of a physician and medical epidemiologist from the National Center for Infectious Diseases at HHS’ Centers for Disease Control and Prevention (CDC). The CDC expert opined that practicing effective “universal precautions” — medical guidelines for the prevention and management of exposures to blood and body fluids — would have been the appropriate course of action for the Austin surgeon, instead of refusing to perform the surgery.

“At CDC, we are committed to ensuring that HIV/AIDS treatment decisions are based on the latest scientific evidence,” said Thomas R. Frieden, M.D., M.P.H., director of the CDC. “We appreciate the opportunity to provide expert consultation on the risks of HIV exposure in health care settings.”

Under the settlement, the Austin surgeon will receive comprehensive training on current HIV treatment protocols, universal precautions, and infection control procedures. The Texas/Oklahoma AIDS Education and Training Center, funded by HHS’ Health Resources and Services Administration (HRSA), has offered to provide the Austin surgeon with interactive, hands-on training and on-site clinical consultation. HRSA’s AIDS Education and Training Centers (AETC) Program supports a network of 11 regional centers (and more than 130 local performance sites) that conduct targeted, multi-disciplinary, free and low-cost training to health care professionals working with existing and emerging populations affected by HIV.

HRSA Administrator Mary Wakefield, Ph.D., R.N., stated, “We are pleased that one of our AIDS Education and Training Center grantees has offered this service to a health care professional as part of an OCR settlement agreement. A key part of our mission is improving the quality of care received by patients living with HIV/AIDS and providing high quality education and training to health care professionals is an essential part of that effort.”

A copy of the OCR letter of finding and the settlement agreement, along with more information about OCR’s other civil rights enforcement activities, can be found here. In addition, an explanation of who is a qualified individual with a disability may be found here.

Source
HHS

Medical providers on the front lines of HIV care applaud the U.S. Congress for extending the Ryan White HIV/AIDS Program, helping to ensure that more than half a million low-income, uninsured, or underinsured people living with HIV/AIDS have access to lifesaving care. The HIV Medicine Association (HIVMA) and the Ryan White Medical Providers Coalition (RWMPC) are pleased with Congress’ four-year extension of this critical safety net and urge President Obama to quickly sign this important legislation.

“As HIV clinicians and researchers, many of whom have been providing HIV care since the mid-1980s, it is gratifying to see so many of our patients benefiting from the current treatment approaches, especially compared with the heartbreaking patient outcomes we saw earlier in the pandemic,” said Michael S. Saag, MD, FIDSA, HIVMA chair-elect. “These remarkable outcomes simply would not be possible without support from the Ryan White Program. We thank Congress for extending this vital program for four years, and we call on the president to quickly sign this legislation to ensure that our patients have access to the care they need.”

The Ryan White HIV/AIDS Treatment Extension Act of 2009 would authorize a 5 percent annual increase in funding for the program, which funds medical care and other services for individuals who otherwise would likely go without care. With more than 50,000 new cases of HIV infection in this country every year, HIVMA and RWMPC urge lawmakers to increase Ryan White funding annually by at least this authorized amount, if not more, during the next four years to help address the growing need for treatment.

“Even before the current recession hit, many HIV clinics and providers were struggling to maintain the level of services that have made them so effective at delivering lifesaving care to their patients,” said Kathleen Clanon, MD, RWMPC co-chair. “As the strains on our health care system grow, HIV caseloads rise, and state HIV programs are threatened by additional budget cuts, adequate funding increases for the Ryan White Program will be critical to ensuring that patients continue to receive the multidisciplinary care they need, even when they cannot afford it.”

With lawmakers finalizing health care reform legislation, the extension of the Ryan White Program is vital to ensuring there are no gaps in coverage or access to care for those living with HIV/AIDS as reforms are implemented nationwide. Additionally, health reform offers a unique opportunity to increase support for the medical home model of care provided by Ryan White programs and to integrate these programs into the reformed health care system.

“Ryan White programs, at HIV clinics around the country, are models for delivering high-quality, cost-effective care to people with chronic conditions,” said J. Kevin Carmichael, MD, RWMPC co-chair. “This patient-centered approach, known as the medical home model, treats the whole person by providing a range of services that HIV/AIDS patients need to stay healthy. It’s critical to keeping people with HIV in treatment and addressing their complex health care needs.”

Treatment advances have transformed HIV infection from a death sentence to a chronic condition for many patients, but only for those with ongoing access to medical care. “Funding through Ryan White has allowed HIV clinics across the country to develop model programs to deliver this comprehensive and coordinated care for more than a decade,” said Dr. Saag. “We could not do the work we do every day without this support, and this four-year extension will help ensure that it continues.”

Source:
John Heys

Infectious Diseases Society of America