Change of Law: Hospital Action Required
| To: | Hospital Chief Medical Officers, Chief Nursing Officers and Government Affairs Staff |
| From: | Jaclyn Greenberg, JD, LLM | Policy Director, Legal Affairs JaclynG@wsha.org | (206) 216-2506 |
| Subject: | Repeal of AIDS training and education requirements and other changes to modernize Washington’s laws on HIV and AIDS |
Purpose
The purpose of this bulletin is to inform hospitals and health systems about recent changes modernizing Washington’s laws on certain communicable diseases, specifically human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). These changes are in effect now.
Applicability/Scope
RCW 70.24 applies to health care facilities regulated by the Department of Health (DOH) including hospitals; as well as health care facility staff and health care providers who are members of a profession under RCW 18.130.040. The statute also applies more broadly to state and local government, corrections facilities and public schools.
Recommendation
- Review this bulletin and share with appropriate staff.
- Review hospital policies and practices related to sexually transmitted diseases and blood-borne pathogens to ensure they are consistent with the changes made by ESHB 1551, in particular:
- AIDS training and education is no longer required;
- AIDS counseling for pregnant woman and people seeking treatment for a sexually transmitted disease is no longer required; and
- Minors 14 and older may consent to treatment to prevent HIV infection without parent or guardian consent.
- Watch for more information from the state Board of Health about its rulemaking to implement ESHB 1551.
Overview
In 2014, Governor Inslee issued a proclamation to end AIDS in Washington, with a goal of reducing new HIV diagnoses by 50 percent by 2020. Thereafter, the statewide HIV treatment and prevention planning body, the HIV Planning Steering Group, put forward a set of recommendations on how the state can achieve those goals, including modernizing the state’s HIV exposure and transmission laws to reflect current science, reduce stigma and improve public health. ESHB 1551 makes numerous changes to that effect and towards achieving those goals.
Under ESHB 1551, several requirements addressing HIV and AIDS under the state’s control and treatment of sexually transmitted diseases law (RCW 70.24) have been repealed or modified.
Key changes impacting hospitals include:
- Repealing the requirements for AIDS training and education for health professions, health care facility employees, pharmacists, emergency medical personnel and others. The requirement was a condition of certification or license for many regulated professions. The following statutes have been repealed:
- RCW 70.24.260 Emergency medical personnel
- RCW 70.24.270 Health professionals
- RCW 70.24.280 Pharmacy Quality Assurance Commission
- RCW 70.24.310 Health care facility employees
Please see ESHB 1551 for a complete list of all repealed or modified statutes requiring AIDS education and training. The above list is specific to hospitals.
- Repealing the requirement for AIDS counseling. Health care practitioners are no longer required to ensure that AIDS counseling is conducted for pregnant women or people seeking treatment of sexually transmitted diseases.
- Authorizing a minor aged 14 or older to consent to treatment without parent or guardian consent to prevent HIV infection. This is in addition to existing law allowing minors 14 or older to consent to hospital, medical and surgical care related to the diagnosis or treatment of HIV.
- Modifying the process by which health care providers and health care facility staff (among others) may seek a health order requiring blood-borne pathogen testing for a person whose bodily fluids the provider or staff has been exposed to. The law change removes reference to a “substantial” exposure as the trigger for requiring testing. A less stringent standard of “exposure that presents a possible risk of transmission” is now required. The meaning and contours of that phrase will be determined by upcoming rulemaking.
- Clarifying that disease case investigators may gather specimens under a physician’s standing order. The statutory language previously contemplated a specific authorization from a physician.
Other changes to RCW 70.24 include but are not limited to:
- Changing language and definitions to reduce stigma and reflect modern science. The phrases “acquired immunodeficiency syndrome” (AIDS) and “HIV-related condition” have been repealed and references to HIV have been replaced with “blood-borne pathogen”[i] throughout the statute.
- Consolidating and expanding the state Board of Health’s rulemaking authority relating to the control of sexually transmitted diseases. The Board of Health must now undertake new rulemaking on several fronts including:
- Procedures for violations of RCW 70.24 by health care facilities or health care providers;
- Safeguards to protect the confidentiality of persons and records subject to 70.24 RCW and consistent with the state’s health privacy law, RCW 70.02;
- Reporting requirements for sexually transmitted diseases;
- Procedures for investigating a case involving a person who has a sexually transmitted disease and is engaging in specified behavior that endangers the public health (and specifying what it means to “endanger public health”);
- Defining the specimens that can be obtained and tests that can be administered for sexually transmitted diseases, blood-borne pathogens and other infections;
- Determining which categories of employment are at risk of substantial exposure to a blood-borne pathogen; and
- Defining what constitutes an exposure that presents a possible risk of transmission of a blood-borne pathogen.
- Reclassifying crimes related to transmission of HIV to lower-tier offenses and makes other modifications to criminal sanctions for STD-related activities. In particular, transmission or exposure to HIV is now considered a gross misdemeanor, rather than a felony assault.
- Providing further direction about enforcement and appeal of health orders (formerly public health orders) requiring a person to undertake certain measures to avoid “engaging in behavior that endangers public health.”
- Modifying the insurance rules related to requiring testing for blood-borne pathogens in relation to an application for coverage. Specifically, when insurers request an insured, a subscriber or a potential insured or subscriber provide the results of a blood-borne pathogen test for underwriting purposes as a condition for obtaining or renewing coverage, the insurer must provide written information to the individual explaining the test and the purpose of the test; obtain informed written consent and establish procedures for the individual to designate a health care provider or agency to receive the results indicative of infection with a blood-borne pathogen and that those results will be provided to the applicant.
WSHA’s 2020 New Law Implementation Guide
Please visit WSHA’s 2020 implementation guide online, where you will find a list of the high priority laws that WSHA is preparing resources and information on to help members implement the new laws, as well as links to resources such as this bulletin. In addition, you will find the Government Affairs team’s schedule for release of upcoming resources on other laws and additional resources for implementation.
References
ESHB 1551
Governor Proclamation – End AIDS Washington
End AIDS Washington – 2016 Steering Committee Report
RCW 18.130.040
RCW 70.24
RCW 70.02
[i] Blood-borne pathogen is defined to mean “pathogenic microorganism that is present in human blood and can cause disease in humans, including hepatitis B virus, hepatitis C virus, and human immunodeficiency virus, as well as any other pathogen specified by the board in rule.”
