191.700. Testing of all health care professionals not justified--voluntary and confidential evaluation of infected professional, procedure--expert review panel qualifications, powers and duties, pract
Testing of all health care professionals not justified--voluntary andconfidential evaluation of infected professional, procedure--expertreview panel qualifications, powers and duties, practicerestrictions, when--health care facilities informed only ofrestrictions--violations, complaints made to appropriate boards.
191.700. 1. The current assessment by the Centers for Disease Controlof the risk that infected health care professionals will transmit HIV or HBVto patients during invasive procedures does not justify mandatory testing todetect infection with those viruses. Health care professionals who performinvasive procedures are advised, however, to know their HIV antibody statusand their hepatitis B antigen status.
2. (1) The department of health and senior services shall establish andoversee a voluntary evaluation process for health care professionals infectedwith HIV or HBV who perform invasive procedures. This evaluation process maybe accessed directly by an infected health care professional, or by thedirector of a health care facility with the consent of the infected healthcare professional and after consultation with his private physician.
(2) The confidential and individualized evaluation shall be conducted byan expert review panel appointed by the department of health and seniorservices. Each panel shall include at least such individuals as:
(a) The health care professional's private physician;
(b) An infectious disease specialist with expertise in the epidemiologyof HIV and HBV transmission who is not involved in the care of the health careprofessional;
(c) A health care professional with expertise in the proceduresperformed by the infected health care professional; and
(d) A state or local public health official.
(3) The department of health and senior services, in cooperation withappropriate state regulatory authorities or bodies responsible for licensingthe respective health care professionals and with professional societies,shall develop uniform evaluation criteria which shall be used in determiningwhether, and under what circumstances, any restrictions or limitations shouldbe placed on an individual health care professional's medical practice. Thesecriteria shall, consistent with guidelines from the Centers for DiseaseControl, include at least the following inquiries:
(a) Whether the health care professional performs procedures in whichinjury could result in that individual's blood contamination of a patient'sbody cavity, subcutaneous tissues, or mucous membranes;
(b) The nature of the invasive procedures performed by the health careprofessional and the techniques used, skill and experience, and compliancewith infection control practices demonstrated by that individual; and
(c) Whether the presence of physical or mental impairments may interferewith the health care professional's ability to perform such invasiveprocedures safely.
(4) (a) The individualized evaluation and the recommendations of thepanel shall be based on the premise that HIV or HBV infection alone does notjustify limiting the health care professional's duties.
(b) The panel may determine which procedures the health careprofessional may or may not perform, or perform with modifications. If thepanel is uncertain about whether a procedure may pose some risk of HIV or HBVtransmission, it may recommend that such procedures be performed only afterthe patients have been informed of the health care professional's infectionstatus.
(5) (a) Information obtained during the evaluation process shall beconfidential and shall not be disclosed except to health care facilities wherethe health care professional provides patient care. The department of healthand senior services may only notify or disclose to such facilities thepractice restrictions and limitations imposed on the health care professional. Such restrictions and limitations shall be disclosed only to those employedby such health care facilities who have a reasonable need to know theinformation.
(b) Practice restrictions or limitations recommended by the departmentof health and senior services shall be monitored by the health care facilitiesin which the infected health care professional is employed. If practicerestrictions or limitations are placed on community based health careprofessionals, periodic monitoring to ensure compliance shall be performed bythe department of health and senior services.
(c) Health care professionals whose practices are restricted or limitedbecause of their HIV or HBV infection status shall, whenever possible, beprovided opportunities to continue appropriate patient care activities.
(d) Health care facilities regulated under sections 197.010 to 197.120,RSMo, may maintain or establish peer review panels that operate under theregulations developed by the department of health and senior services and therecommendations of the Centers for Disease Control of the United States PublicHealth Service.
(e) Any violation of practice restrictions or limitations by a healthcare professional shall constitute either an act violative of professionaltrust and confidence, or failure or refusal to properly guard againstcontagious infections or communicable diseases or the spread thereof, or both,as these terms are used in sections 330.160, RSMo, 332.321, RSMo, 334.100,RSMo, and 335.066, RSMo. Complaints of possible violations of practicerestrictions or limitations may be made to the appropriate state board, asprovided under chapter 330, RSMo, chapter 332, RSMo, chapter 334, RSMo, orchapter 335, RSMo.
3. The department of health and senior services shall, from time totime, review established standards for preventing the transmission of HIV orHBV from health care professionals to patients and, consistent with currentmedical knowledge and revised or updated guidelines from the Centers forDisease Control, modify existing standards and require additional minimumstandards, as appropriate.
4. Notwithstanding the provisions of sections 191.650 to 191.698, thedepartment of health and senior services may exercise the general authorityand power under section 192.020, RSMo, to intervene in instances where thereis reason to believe that a health care professional is practicing in a mannerthat creates a grave and unjustifiable risk of injury to others.
(L. 1992 S.B. 511 & 556 § 191.694 subsecs. 6 to 9)