Mid-Atlantic Health Law TOPICS

Recently, the Maryland Court of Special Appeals ruled that health care providers are not required to notify family members of a patient's HIV status. In Lemon V. Stewart, the court stated that a health care provider's duty to diagnose, evaluate and treat a patient generally concerns only the patient. Maryland's highest court, the Court of Appeals, agreed to allow this decision to stand.

A. The Facts

In July, 1991, Mr. Herbert Lemon, Sr., an intravenous drug user; was admitted to a Baltimore area hospital with neurological complaints. A few days later; hospital staff administered an Enzyme-Linked Immunosorbent Assay test and a Western Blot test and sent the tests to an outside laboratory for analysis. Mr. Lemon was discharged before the test results, indicating that he was HIV positive, were received by the hospital.

While recuperating at his sister's home, Mr. Lemon received varying degrees of care from fourteen relatives. Each maintained that they had frequent contact with Lemon, including helping him with his personal hygiene.

Less than a year later; Mr. Lemon was readmitted to the same hospital under the care of Dr. Stewart. It was then that Mr. Lemon was informed that he was HIV positive.

Although Mr. Lemon's relatives tested negative for HIV they sued the hospital, the outside laboratory, Dr. Stewart and Baltimore City's health department. The suit alleged that the defendants had a duty to notify each other of Mr. Lemon's test results, to notify Lemon's relatives of his HIV status, to inform Lemon himself, and to inform the City's health officials.

B. The Decision

In its opinion, the court noted that medical evidence has not shown that contacts such as those experienced by Lemon's relatives, cause transmission of HIV There was no direct transmission of Lemon's blood to any relatives' blood, nor was there any contact between Lemon and a spouse, other sexual partner or needle-sharer during his convalescence.

However, the court agreed that the hospital and Dr. Stewart had a duty to inform Lemon of his HIV status. Had any of the relatives been a sexual or needle-sharing partner of Mr. Lemon, the court stated that they could have a reason to sue. This, however, was not the case.

Rejecting the remaining claims, the court held that to require health care providers to disclose a patient's medical condition to third parties "would constitute a wholly unwarranted invasion of the patient's privacy."

The court stated that a patient has a right to assume that his or her medical condition will not be disclosed to others by a provider without the patient's consent. This is especially true with respect to a patient's HIV status where such knowledge by a third party could subject the patient to ostracism and discrimination.

C. Current Maryland Law

Current Maryland law in this area is quite specific. It requires physicians or physicians' designees who obtain a positive result from an HIV antibody test: (1) to notify the individual of the positive result; (2) to provide the individual with a Department of Health and Mental Hygiene publication describing available counseling services; (3) to counsel the individual to inform all sexual and needle-sharing partners of the patient's HIV status; and (4) to offer to assist in notifying the individual's sexual and needle-sharing partners.

If the individual refuses to disclose the condition to his or her sexual or needle-sharing partners, then the physician may, but is not required to, inform the local health officer and/or the individual's sexual or needle-sharing partners of the individual's identity and condition.

A physician acting in good faith to provide such notification may not be held liable for a breach of patient confidentiality. Similarly, a hospital or health care provider acting in good faith pursuant to a physician's order to perform or interpret a test for HIV may not be held liable for a physician's decision to disclose or not to disclose information related to a positive test result to a local health officer and/or to a patient's sexual or needle- sharing partners.