Current through Register Vol. 46, No. 39, September 25, 2024
(a) When
contact notification is conducted based on the mandated reporting of cases of
HIV infection, HIV-related illness and AIDS and the reporting of known contacts
of such cases, and/or provided by the protected individual, all information
collected in the course of these contact notification activities, including
screening to assess risk of domestic violence, shall be kept confidential as
required by Public Health Law, article 21, title III, and shall not be
disclosed except when in the judgment of the public health official necessary
to other authorized public health officials for conducting accurate and
complete epidemiological monitoring of the HIV/AIDS epidemic and for conducting
contact notification activities except that contact names and locating
information may be disclosed to public health officials in other jurisdictions
when necessary to notify the contact: no information about the protected
individual will be released to any person in this process. Disclosures and
notifications shall be made as follows:
(1)
Physicians and other persons required to report as provided for in section
63.4
of this Part must indicate on the reporting form whether they have conducted
post-test counseling and an assessment of the risk of domestic violence in
conformance with a domestic violence screening protocol developed by the
Commissioner, whether they plan to undertake contact notification activities,
have completed notification of contacts or are making a referral for partner
notification assistance to authorized public health officials. If the physician
or other mandated reporter chooses to conduct notification, the results of
those activities, including information specified by the Commissioner on forms
supplied by the Commissioner, or their equivalent, must be forwarded to the
appropriate authorized public health official, pursuant to section
63.4
of this Part.
(2) The commissioner
shall forward initial reports from physicians and other mandated reporters,
including the names and addresses of the reported case and of the known
contacts, and/or contacts provided by the protected person, the status of
provider initiated contact notification activities and the determination of
risk of domestic violence, if any, to the authorized public health official in
the county where the reported case resides.
(3) Consistent with guidelines acceptable to
the commissioner in conformance with article 21 of the Public Health Law,
authorized public health officials, upon determination that the reported case,
reported contacts, or any other case merits contact notification in order to
protect the public health, shall make a good faith effort to seek the
cooperation of the protected individual to name contacts they wish to have
notified, to notify the known contacts and to inform the public health official
in the jurisdiction where any additional contacts reside, when necessary to
notify such contacts. No information about the protected individual will be
released to any person in this process.
(b) Authorized public health officials shall
consider the following as important factors in determining the priority for
which cases merit contact notification in order to protect the public health:
(1) reported contacts, including spouses
known to the reporting physician or other diagnostic provider, or who the
protected individual wishes to have notified, unless the provider certifies
that these known contacts have already been notified;
(2) protected individuals who are newly
diagnosed with HIV infection; and
(3) protected individuals who were previously
diagnosed with HIV infection, and who show evidence of : being out of medical
care; not being virally suppressed; recent sexually transmitted diseases; or
having recently moved into New York State.
(c) In cases which merit contact
notification, if an indication of risk of domestic violence has been
identified, pursuant to a protocol acceptable to the commissioner, the
authorized public health official, in consultation with the reporting
physician, must be satisfied in his/her professional judgment that reasonable
arrangements, efforts or referrals to address the safety of affected persons
have been made if and when the notification is to proceed. Such consultation
shall also consider information, if available, requested from the protected
person, or from a domestic violence service provider pursuant to a signed
release.
(d) Authorized public
health officials shall conduct contact notification activities consistent with
guidelines acceptable to the commissioner which will recognize the special
needs of adolescents, individuals in residential and institutional settings,
and other vulnerable populations.
(e) Authorized public health officials will
respond to all requests from HIV infected individuals and their health care
providers for assistance in notifying contacts.
(f) When contact notification is conducted by
authorized public health officials, such officials shall:
(1) confirm that post-test counseling of the
protected person is completed;
(2)
when communication with the protected person is necessary, communicate with the
protected person in a confidential, private and safe manner to seek cooperation
in contact notification activities, to verify the information about the
identity or location of known contacts, to conduct or confirm a screen for
domestic violence and if applicable, to make referrals regarding domestic
violence, prior to any notification of contacts. If communication cannot be
made in a confidential, private and safe manner, it shall be deferred until
these requirements can be met; and
(3) in circumstances where the protected
individual cannot be contacted for post-test counseling or declines to be
assessed for risk of domestic violence in relation to known contacts, the
authorized public health official shall make the determination of whether to
proceed with notification of known contacts, in consultation with the reporting
physician.
(g) All
persons notifying contacts shall provide counseling or make referrals or
appointments for counseling and testing as appropriate. Such counseling must
address coping emotionally with potential exposure to HIV, domestic violence
issues, an explanation regarding the nature of HIV infection and HIV-related
illness, availability of anonymous and confidential testing, information on
preventing exposure or transmission of HIV infection, information regarding
discrimination problems that might occur as a result of disclosure of
HIV-related information, and legal protections against such disclosures. All
notifications shall be in person, except where circumstances reasonably prevent
doing so, e.g., at the request of the contact.
(h) If a protected person is now deceased,
contacts (e.g., spouse) are known to the physician and the physician believes
the protected person had not informed such contacts, the physician or his/her
agent may notify such contacts or shall request the authorized public health
official to notify the contacts, without identifying the protected individual
to the contact.
(i) A physician or
authorized public health official shall have no obligation to identify or
locate any contact, except as provided pursuant to Public Health Law article
21, title III. No criminal sanction or civil liability shall arise against a
physician, his/her employer or designated agent, health facility, health care
provider or authorized public health official for the disclosure of
confidential HIV-related information to a contact or to a person consenting to
health care for the contact when in compliance with article 27-F, or for the
failure to disclose such information to a contact or to a person consenting to
health care for the contact.
(j)
Municipal health commissioners must provide HIV contact notification services
and shall forward to the Department, summary data and all identifiable
information related to notification activities upon completion of such activity
unless otherwise determined by the Commissioner. Information identifying the
contact collected in the course of contact notification activities by
authorized public health officials shall not be maintained at the State or
local level for longer than administratively necessary. The Department or local
health department shall establish a records retention and disposition schedule
for destruction of these records.
(k) For the purposes of notifying contacts
under Public Health Law section
2782(1)(d), blood
transfusion and organ and tissue transplantation present a risk of HIV
transmission. Notifying contacts potentially exposed to HIV through tissues,
organs, or transfused blood under a federally mandated recipient notification
program or guidelines acceptable to the commissioner shall be sufficient to
meet the notification requirements of article 21, title III and article 27-F.
Blood banks, organ procurement organizations, and tissue banks may disclose the
HIV status of a donation to a donor's provider for the purposes of notifying
known contacts of a donor.
(l) When
contact notification is initiated by a physician not related to reporting
mandates or article 21, title III, but based on authority to notify an
identified spouse, sex partner, hypodermic needle and syringe partner under
Public Health Law section
2782(4), physicians or
their agents and authorized public health officials may conduct contact
notification as follows:
(1) a physician or
his/her agent may, without the protected person's consent, notify such contact
or report such contact to the authorized public health official for the purpose
of notifying a contact when:
(i) the
physician believes disclosure is medically appropriate and a significant risk
of infection may exist to the contact;
(ii) the protected person has been counseled
to notify his/her contacts or the physician has taken all reasonable efforts to
attempt to counsel the person; and
(iii) domestic violence screening in
accordance with the screening protocol has been applied;
(2) the physician must inform the protected
person of the physician's intent to notify such contacts and of their
responsibility to report the case and such contacts to the commissioner, and
inform the protected person that he/she may express a preference whether
contact notification shall be made by the physician or authorized public health
official, and that the protected individual's name or other information about
them is not disclosed to any person during the contact notification
process;
(3) if the protected
person's preference is for the authorized public health official to notify
contacts or if the protected person's preference is for the physician to notify
contacts but the physician chooses not to do so, he/she shall notify the
protected person of his/her decision to contact the authorized public health
official and shall forward names and addresses of the case and contacts to the
authorized public health official, who shall take reasonable measures to notify
such contacts. If the protected person's preference is for the physician to
notify contacts and the physician elects to do so, the physician or his/her
agent may then notify contacts; and
(4) the physician must report to the
authorized public health official regarding the success or failure of such
efforts, including the names and addresses of the cases and contacts. If
contacts have not been notified or notification cannot be verified by the
physician or his/her agent, public health officers shall take reasonable
measures to inform the contact as set forth in subdivisions (b) through (g) of
this section.
(m) When
the requirements of this section have been met, physicians and other diagnostic
providers may disclose HIV-related information, without a release of
confidential HIV-related information, to physicians or other diagnostic
providers of persons whom the protected individual may have exposed to HIV
under the circumstances noted below that present a risk of transmission of HIV,
except that disclosures related to exposures of emergency response employees
governed by Federal law shall continue to be governed by such law:
(1) the incident must involve exposure to
blood, semen, vaginal secretions, breast milk, tissue or the following body
fluids: cerebrospinal, amniotic, peritoneal, synovial, pericardial and
pleural;
(2) a person has contact
with the body substances, as noted in paragraph (1) of this subdivision, of
another to mucus membranes (e.g., eyes, nose, mouth), non-intact skin (e.g.,
open wound, skin with a dermatitis condition, abraded areas) or to the vascular
system. Examples of such contact may include needlesticks, puncture wound
injuries and direct saturation or permeation of non-intact skin by potentially
infectious substances. These circumstances shall not include those delineated
in section
63.10(d)
of this Part; and
(3) the exposure
incident occurred to staff, employees or volunteers in the performance of
employment or professional duties:
(i) in a
medical or dental office;
(ii) in a
facility regulated, authorized or supervised by the Department of Health,
Office of Mental Health, Office for People With Developmental Disabilities,
Office of Children and Family Services, Office of Alcoholism and Substance
Abuse Services, Department of Corrections and Community Supervision;
or
(iii) involved an emergency
response employee, paid or volunteer, including an emergency medical
technician, a firefighter, a law enforcement officer (e.g., police, probation,
parole officer) or local correctional officer or medical staff;
(4) an incident report documenting
the details of the exposure, including witnesses to the incident, if any, is on
record with supervisory staff;
(5)
a request for disclosure of HIV status is made to the provider of the source or
to the medical officer designated by the facility by the exposed person or by
the provider of the exposed person as soon as possible after the alleged
exposure if a decision relating to the initiation or continuation of
post-exposure prophylactic treatment is being considered;
(6) documentation of the request is placed in
the medical record of the exposed person; and
(7) if the provider of the source or the
medical officer designated by the facility determines that a risk of
transmission has occurred or is likely to have occurred in the reasonable
exercise of his/her professional judgment, the provider or medical officer may
release the HIV status of the source, if known. The provider or medical officer
may consult with the municipal health commissioner or district health officer
to determine whether a risk of transmission exists. If consultation occurs,
both the provider and the local health officer must be in agreement if the HIV
information is to be disclosed. In the disclosure process the name of the
source shall not be provided to the exposed person. Redisclosure of the HIV
status of the source is prohibited except when made in conformance with Public
Health Law article 21, title III.
(n) In cases of anonymous testing of an
occupational exposure source patient who is deceased, comatose or otherwise
unable to provide consent, and no person authorized to consent on behalf of the
source person is immediately available, as provided for in Public Health Law
section
2781(6)(e), the results of
such anonymous test, but not the identity of the source person, shall be
disclosed only to the attending health care professional of the exposed person
solely for the purpose of assisting the exposed person in making appropriate
decisions regarding post-exposure medical treatment. The results of the test
shall not be disclosed to the source person or placed in the source person's
medical record.
