Legal Issues in Treating AIDS Patients
Fitzgerald, Walter L Jr; Wilson, Dennis B, Drug Topics
Until recently, AIDS has not been a major concern for pharmacists, and there has been no significant associated liability between the practice of pharmacy and AIDS. However, as the role of the pharmacist expands to encompass activities that have been performed historically by other health-care professionals, the potential liability and personal health consequences of the pharmacist will increase.
Through expanding pharmacy practice roles, pharmacists now have more direct patient contact than ever before. More and more pharmacists are giving injections, drawing patients' blood, and performing certain physical assessments. These new areas of practice will increase not only the personal risk potential but increase as well the possible legal liability of pharmacists.
Until recently, the theories and issues discussed below have most often involved physicians and nurses. Only now are pharmacists becoming involved in situations where their potential liability is that of the other health-care providers.
Brief overview of AIDS
Human immunodeficiency virus (HIV)/ acquired immune deficiency syndrome (AIDS) is one of this century's most serious public health challenges. AIDS is now the leading cause of death among adults between the ages of 25 and 44. Additionally, AIDS has now become the most litigated disease in American history. As the epidemic has grown, so have the number and types of lawsuits against health-care providers.
HIV is the virus that damages the immune system and eventually leads to AIDS. HIV was first identified in 1983. Persons testing positive for HIV are not considered to have AIDS until they meet specific diagnostic criteria provided by the Centers for Disease Control & Prevention (CDC). The disease is characterized by a decrease in the number of certain blood cells responsible for the immune response in humans that enables the body to fight off infections. Also typical is the presence of certain "specific indicator diseases," such as Kaposi's sarcoma and pulmonary tuberculosis.
A person infected with HIV may remain free of symptoms and in relatively good health for many years. Nonetheless, the virus continues to reproduce and depress the immune system. Eventually, individuals become vulnerable to many opportunistic infections, leading ultimately to death. At this time, there is no vaccine or cure for AIDS.
HIV can be transmitted in only a limited number of ways, involving the exchange of specific infected body fluids. This transmission can occur via:
the exchange of blood, semen, and/or vaginal secretions during sexual intercourse;
the sharing of unsterilized needles used in intravenous drug injections; and
donations of blood or blood products, semen, breast milk, organs, and other human tissue.
In March 1985, a blood test became available to determine infection with HIV. The Enzyme-Linked Immunosorbent Assay (ELISA) detects the presence of HIV antibodies. If the ELISA test is positive, it is repeated; then a more specific Western Blot test is performed to confirm HIV infection.
When used concurrently, these tests have an accuracy rate of 99.9%. However, it is important to understand that the tests detect only the presence of antibodies to the virus, and not the virus itself; it can take from six weeks to six months after exposure for a person to form antibodies to the virus. Thus, even a person who is testing negative for the presence of HIV antibodies may have the virus-as yet undetected-and be capable of passing it on to others.
It is for this reason that donor blood is not completely safe even after it has been tested for the virus. In 1984, researchers confirmed 18n cases of transfusion recipients who showed symptoms of AIDS but with no other risk factors for development of the disease. Because of this, many blood banks and hospitals began screening donors and rejecting blood altogether from individuals considered to be at high risk for HIV infection. …