Hostname: page-component-848d4c4894-m9kch Total loading time: 0 Render date: 2024-05-19T15:49:22.277Z Has data issue: false hasContentIssue false

Nothing to Fear But Fear itself: HIV-Infected Physicians and the Law of Informed Consent

Published online by Cambridge University Press:  01 January 2021

Extract

On March 9, 1993, in the first ruling of its kind, the Maryland Court of Appeals declared that physicians and hospitals may be sued for failing to inform patients of a practitioner’s human immunodeficiency virus (HIV) status. What is more significant, these suits may be pursued even in instances when the physician has followed universal precautions and the patient did not contract the virus that causes acquired immunodeficiency syndrome (AIDS). The Maryland court addressed two central questions in Faya v. Almaraz. First, do HIV-infected physicians have a legal duty to inform their patients of their HIV status? And, second, can patients recover damages for fear induced by a physician’s conduct? While one finds numerous precedents that authorize actions to recover damages based purely on fear of disease and emotional distress, the Faya court’s holdings on the issue significantly expand the scope of potential liability. Moreover, the court’s analysis of the informed consent and HIV-infected physician issue is incomplete, inconsistent, and represents an unjustified and unwise departure from traditional informed consent theory. It, and its progeny, may have widespread and dire repercussions.

Type
Article
Copyright
Copyright © American Society of Law, Medicine and Ethics 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Faya v. Almaraz, 620 A.2d 327 (Md. 1993).Google Scholar
Appellants' Brief, Faya v. Almaraz, 620 A.2d 327 (Md. 1993), at 3.Google Scholar
Appellants' Brief, Faya v. Almaraz, 620 A.2d 327 (Md. 1993), at 5.Google Scholar
Appellees' Brief, supra note 2, at 4.Google Scholar
For an excellent summary of these common law actions and their application to HIV-related cases, see Hermann, Donald H.J., Burris, Scott, “Torts: Private Lawsuits about HIV,” in Burris, S., Dalton, H.L., Miller, J.L., eds., AIDS Law Today: A New Guide for the Public (New Haven: Yale University Press, 1993), pp. 334–65.Google Scholar
Faya v. Almaraz, supra note 1, at 330.Google Scholar
Id. at 334.Google Scholar
Id. at 330–31.Google Scholar
Appellants' Brief, supra note 3, at 34.Google Scholar
Faya v. Almaraz, supra note 1, at 330.Google Scholar
Id. at 333.Google Scholar
Moran v. Faberge, 332 A.2d 11, 273 Md. 538 (1975).Google Scholar
Faya v. Almaraz, supra note 1, at 333.Google Scholar
Id. at 334, note 6.Google Scholar
Id. at 333.Google Scholar
747 F. Supp. 285 (E.D. Pa. 1990).Google Scholar
Id. at 287.Google Scholar
Funeral Services by Gregory, Inc. v. Bluefield Community Hospital, 413 S.E.2d 79, 186 W.Va. 424 (1991).Google Scholar
For example, Doe v. Doe, 136 Misc.2d 1015, 519 N.Y.S.2d 595 (Supp. 1987) (recovery denied for “AIDS phobia” based on husband's homosexual affair, where both spouses tested negative for HIV); and Hare v. State, 173 A.D.2d 535, 570 N.Y.S.2d 125 (2 Dept. 1991) (where an employee, bitten by inmate, failed to test positive for HIV and failed to prove that the inmate was HIV-infected).Google Scholar
See Maroulis, James C., “Can HIV-Negative Plaintiffs Recover Emotional Distress Damages for their Fear of AIDS?,” Fordham Law Review, 62 (1993): 235, for a comprehensive survey and discussion of fear-of-AIDS precedents.Google Scholar
Appellees’ Brief, supra note 2, at 6.Google Scholar
1992 WL 276717 (Tenn. App. 1992).Google Scholar
Faya v. Almaraz, supra note 1, at 337.Google Scholar
Id. at 338–89. The Faya court also limited recoverable emotional damages, as do most courts, to the extent that the plaintiffs can “objectively demonstrate their existence” by physical symptoms (that is, sleeplessness, loss of appetite, depression, and so forth).Google Scholar
Id. at 337.Google Scholar
Because intentional acts typically are excluded from coverage under medical liability insurance contracts, it is likely that plaintiffs' attorneys will plead cases under a negligence theory where possible.Google Scholar
379 A.2d 1014 at 1020, 281 Md. 432 at 439 (1977).Google Scholar
Canterbury v. Spence, 464 F.2d 772, 150 A.DC 263 (1972). See Faden, Ruth R., Beauchamp, Tom L., with King, Nancy M.P., A History and Theory of Informed Consent (New York: Oxford University Press, 1986), pp. 3334ff. and 135–37ff., for the best discussion of the theoretical and historical development of the Canterbury decision.Google Scholar
Pegalis, Steven E., Wachsman, Harvey F., American Law of Medical Malpractice 2d (New York: CBC, Vol. 1, 1992), pp. 193202ff.Google Scholar
Harnish v. Children's Hospital Medical Center, 439 N.E.2d 240, 387 Mass. 152 at 156.Google Scholar
See, for example, Douthwaite, Graham, Jury Instructions on Medical Issues (Charlottesville: Michie Co., 4th ed., 1992), pp. 319–22.Google Scholar
Kissinger v. Lofgren, 836 F.2d 678 (1st Cir. Mass. 1988).Google Scholar
Precourt v. Frederick, 481 N.E.2d 1144 at 114 (1985).Google Scholar
Gostin, Lawrence O., “HIV-infected Physicians and the Practice of Seriously Invasive Procedures,” Hastings Center Report, 19, no. 1 (Jan.–Feb. 1989): 33.Google Scholar
Henderson v. Milobsky, 595 F.2d 654 (D.C. Cir. 1978).Google Scholar
Ruffer v. St. Francis Cabrini Hospital, 7 P.2d 1288, 56 Wash. App. 625 (1990).Google Scholar
Daniels, Norman, “HIV-infected Health Care Professionals: Public Threat or Public Sacrifice,” Milbank Quarterly, 7, no. 1 (1992): 17.Google Scholar
This issue has been discussed most ably in Gostin, , supra note 36; Daniels, , supra note 39; Glantz, Leonard H., Mariner, Wendy K., Annas, George, “Risky Business: Setting Public Health Policy for HIV-infected Health Care Professionals,” Milbank Quarterly, 70, no. 1 (1992): 4379; and Lunde, Janice K., “Informed Consent and the HIV-Positive Physician,” Medical Trial Quarterly, 38 (1991): 186.Google Scholar
For example, see Breo, Dennis L., “The Dental AIDS Cases—Murder or and Unsolvable Mystery?,” JAMA, 270 (1993): 2732–34; and Barr, Stephen, “What if the Dentist Didn't Do It?,” The New York Times, April 16, 1994, sec. All.Google Scholar
For example, Mishu, B., Schaffner, W., Horan, J.M., Wood, L.H., Hutcheson, R.H., McNabb, P.C., “A Surgeon with AIDS: Lack of Evidence of Transmission to Patients,” JAMA, 264 (1990): 467–70; Danila, R.N., MacDonald, K.L., Rhame, F.S. et al., “A Look-Back Investigation of Patients of an HIV-infected Physician,” N. Engl. J. Med., 325 (1991): 1406–11; Dickinson, G.M., Morhart, R.E., Klimas, N.G., Bandea, C.I., Laracuente, J.M., Bisno, A.L., “Absence of HIV Transmission from an Infected Dentist to His Patients: An Epidemiologic and DNA Sequence Analysis,” JAMA, 269 (1993): 1802-06; von Reyn, C.F., Gilbert, T.T., Shaw, F.E., Parsonnet, K.C., Abramson, J.E., Smith, M.G., “Absence of HIV Transmission from an Infected Orthopedic Surgeon: A 13-Year Look Back Study,” JAMA, 269 (1993): 1807-11; Armstrong, F.P., Miner, J.C., Wolfe, W.H., “Investigations of a Health Care Worker with Symptomatic Human Immunodeficiency Virus Infection: An Epidemiological Approach,” Mil. Med., 152 (1987): 414-18; and Porter, J.D., Cruickshank, J.G., Gentle, P.H., Robinson, R.G., Gill, O.N., “Management of Patients Treated by a Surgeon with HIV Infection,” Lancet, 335 (1990): 113-14.CrossRefGoogle Scholar
Rogers, A.S., Froggatt, J.W., Townsend, T., Gordon, T., Leigh Brown, A.J., Holmes, E.C., Zhang, L.Q., Moses, H., “Investigation of Potential HIV Transmission to the Patients of an HIV-infected Surgeon,” JAMA, 269 (1993): 1795–801.CrossRefGoogle Scholar
Leary, Warren E., “Mandatory AIDS Tests for Doctors Opposed,” The New York Times, July 31, 1992, sec. All.Google Scholar
CDC, “Update: Investigations of Persons Treated by HIV-infected Health Care Workers—United States,” MMWR, 42, no. 17 (1993): 329–31.Google Scholar
These figures are drawn from Daniels, supra note 39, at 13. Daniels's discussion of the statistical risks of physician-to-patient transmission is especially cogent and helpful (see pages 1117).Google Scholar
Appellants' Brief, supra note 3, at 14.Google Scholar
592 A.2d 1251 (N.J. Super L. 1991).Google Scholar
Appellants' Brief, supra note 3, at 18.Google Scholar
Faya v. Almaraz, supra note 1, at 333.Google Scholar
In those jurisdictions that adhere to the professional standard of disclosure in informed consent, plaintiffs must produce expert testimony to demonstrate that prevailing practice provided patients with information regarding the treating physician's HIV status. It is unclear how much weight an individual expert would place on the AMA recommendations.Google Scholar
Appellees' Brief, supra note 2, at 37.Google Scholar
Daniels, N., “HIV-infected Professionals, Patient Rights, and the ‘Switching Dilemma’,” JAMA, 267 (1992): 1368–71.CrossRefGoogle Scholar
Blendon, R.J., Donelan, K., “Discrimination Against People with AIDS,” N. Engl. J. Med., 319 (1988): 1022–26; and Gerbert, B., Maguire, B.T., Hulley, S.B., Coates, T.J., “Physicians and Acquired Immunodeficiency Syndrome: What Patients Think about Human Immunodeficiency in Medical Practice,” JAMA, 262 (1989): 1969-72.CrossRefGoogle Scholar
Daniels, , supra note 53.Google Scholar
Strausberg, Gary I., Getz, Randal D., “Health Care Workers with AIDS: Duties, Rights, and Potential Tort Liability,” University of Baltimore Law Review, 21 (1993): 302.Google Scholar
Page Keeton, W., Dobbs, Dan B., Keeton, Robert E., Owen, David G., Prosser and Keeton on The Law of Torts (St. Paul, Minn.: West Publishing, 5th ed., 1984), p. 175.Google Scholar
Restatements, Second, Torts, § 293 (1965), Reporter's Comment (c).Google Scholar
Faden, , Beauchamp, , King, , supra note 30, at 46.Google Scholar
Glantz, , Mariner, , Annas, , supra note 40, at 61.Google Scholar
Gerbert, , Maguire, , Hulley, , Coates, , supra note 54.Google Scholar
CDC, “HIV Epidemic and AIDS: Trends in Knowledge, United States, 1987, 1988,” MMWR, 38, no. 20 (1989): 353–58.Google Scholar
Maroulis, , supra note 21, at 227 (trial judge agreed that fear was unfounded and granted the defendant's motion for summary judgment).Google Scholar
Kerins v. Hartley, 17 Cal. App. 4th 713 (1993).CrossRefGoogle Scholar
“Suit over AIDS Fear, Religious Beliefs,” Medical Malpractice: Law & Strategy, XI, no. 4 (1994): 1; and “Jehovah's Witness Wins $500,000 on Blood Claim,” Medical Malpractice: Law & Strategy, XI, no. 5 (1994): 3.Google Scholar
592 A.2d 1251 (N.J. Super L. 1991).Google Scholar
Id. at 1280.Google Scholar
Id. at 1283.Google Scholar
Appellants' Brief, supra note 3, at 17–21.Google Scholar
Maroulis, , supra note 21, passim.Google Scholar
Carroll v. Sisters of Saint Francis Health Services, Inc., 1992 WL 276717 (Tenn. App. 1992).Google Scholar
Hermann, Donald H.J., “AIDS Update: Fear of Infection,” Medical Malpractice: Law & Strategy, X, no. 1 (1992): 7.Google Scholar
See Faden, , Beauchamp, , King, , supra note 30, at 114–50, esp. 132–37.Google Scholar
Gostin has discussed how courts in analogous circumstances have similarly misunderstood the relationship between probability and severity of risk. See Gostin, Lawrence O., “The Americans With Disabilities Act and the U.S. Health Care System,” Health Affairs, 11 (Fall, 1992): 255.CrossRefGoogle Scholar
Spielman, Bethany, “Expanding the Boundaries of Informed Consent: Disclosing Alcoholism and HIV Status to Patients,” Amer. J. Med., 93 (1992): 216–18.Google Scholar
§ 504, 29 U.S.C. § 794(a) (1988).Google Scholar
42 U.S.C. § 12101–12213 (1990).Google Scholar
480 U.S. 273 (1987).Google Scholar
840 F.2d 701 (9th Cir. 1988).Google Scholar
Glantz, , Mariner, , Annas, , supra note 40, at 63; and Barnes, Mark, Rango, Nicholas A., Burke, Gary R., Chiarello, Linda, “The HIV–infected Health Care Professional: Employment Policies and Public Health,” Law, Medicine & Health Care, 18, no. 4 (1990): 311–30.Google Scholar
Gostin, Larry, “The HIV-infected Health Care Professional: Public Policy, Discrimination, and Patient Safety,” Law, Medicine & Health Care, 18, no. 4 (1990): 303–10.CrossRefGoogle Scholar
Preuss, Charles F., “Federal Preemption of State Tort Actions: When and How,” Defense Counsel Journal, 57 (1990): 434.Google Scholar
Rice v. Santa Fe Elevator Corp., 331 U.S. 218, 239 (1947), quoted in Preuss, supra note 82, at 436.Google Scholar
909 F.2d 820 (5th Cir. 1990).Google Scholar
Bradley v. University of Texas, M.D. Anderson Center, 3 F.3d 999 (5th Cir. 1993).Google Scholar
Harrison, Robert W., Thompson, Kris P., “Defending Practitioners Who Are HIV Positive,” Medical Malpractice: Law & Strategy, X, no. 11 (1993): 67.Google Scholar
Restatements, Second, Torts, § 291 (1965).Google Scholar
Fajfar, Mark, “An Economic Analysis of Informed Consent to Medical Care,” Georgetown Law Journal, 80 (1992): 1941.Google Scholar
Daniels, , supra note 53.Google Scholar
Behringer v. The Medical Center at Princeton, 592 A.2d at 1281–82.Google Scholar
Doe v. Northwestern University, No. 93–8847, July 13, 1993.Google Scholar
“AIDS Review Asked,” National Law Journal, January 31 (1994): 6.Google Scholar
Lumsdon, Kevin, “HIV-Positive Health Care Workers Pose Legal Safety Challenges for Hospitals,” Hospitals, 66, no. 18 (1992): 2432.Google Scholar
“In Test of AIDS Law, Pa. OK's Disclosure,” Medical Malpractice: Law & Strategy, XI, no. 1 (1993): 1.Google Scholar
Doyle, Sean C., “HIV-Positive, Equal Protection Negative,” Georgetown Law Journal, 81 (1992): 375.Google Scholar
Gostin, , supra note 74, at 248–56.Google Scholar
For example, Murphy, Timothy F., “Health Care Workers with HIV and a Patient's Right to Know,” Ethics in an Epidemic (Berkeley: University of California Press, forthcoming, 1994).Google Scholar
For example, Brody, Howard, “Transparency: Informed Consent in Primary Care,” Hastings Center Report, 19, no. 5 (Sept./Oct., 1989): 59.Google Scholar