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

Faya v. Almaraz, 620 A.2d 327 (Md. 1993).

Appellants' Brief, Faya v. Almaraz, 620 A.2d 327 (Md. 1993), at 3.

Appellants' Brief, Faya v. Almaraz, 620 A.2d 327 (Md. 1993), at 5.

Appellees' Brief, supra note 2, at 4.

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.

Faya v. Almaraz, supra note 1, at 330.

Id. at 334.

Id. at 330–31.

Appellants' Brief, supra note 3, at 34.

Faya v. Almaraz, supra note 1, at 330.

Id. at 333.

Moran v. Faberge, 332 A.2d 11, 273 Md. 538 (1975).

Faya v. Almaraz, supra note 1, at 333.

Id. at 334, note 6.

Id. at 333.

747 F. Supp. 285 (E.D. Pa. 1990).

Funeral Services by Gregory, Inc. v. Bluefield Community Hospital , 413 S.E.2d 79, 186 W.Va. 424 (1991).

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).

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.

Brief Appellees' , supra note 2, at 6.

1992 WL 276717 (Tenn. App. 1992).

Faya v. Almaraz, supra note 1, at 337.

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).

Id. at 337.

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.

379 A.2d 1014 at 1020, 281 Md. 432 at 439 (1977).

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. 33–34ff. and 135–37ff., for the best discussion of the theoretical and historical development of the Canterbury decision.

Pegalis Steven E. Wachsman Harvey F. , American Law of Medical Malpractice 2d (New York: CBC, Vol. 1, 1992), pp. 193–202ff.

Harnish v. Children's Hospital Medical Center, 439 N.E.2d 240, 387 Mass. 152 at 156.

See, for example, Douthwaite Graham , Jury Instructions on Medical Issues (Charlottesville: Michie Co., 4th ed., 1992), pp. 319–22.

Kissinger v. Lofgren, 836 F.2d 678 (1st Cir. Mass. 1988).

Precourt v. Frederick, 481 N.E.2d 1144 at 114 (1985).

Gostin Lawrence O. , “HIV-infected Physicians and the Practice of Seriously Invasive Procedures,” Hastings Center Report, 19, no. 1 (Jan.–Feb. 1989): 33.

Henderson v. Milobsky, 595 F.2d 654 (D.C. Cir. 1978).

Ruffer v. St. Francis Cabrini Hospital, 7 P.2d 1288, 56 Wash. App. 625 (1990).

Daniels Norman , “HIV-infected Health Care Professionals: Public Threat or Public Sacrifice,” Milbank Quarterly, 7, no. 1 (1992): 17.

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): 43–79; and Lunde Janice K. , “Informed Consent and the HIV-Positive Physician,” Medical Trial Quarterly, 38 (1991): 186.

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.

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. , “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 EH. Robinson R.G. Gill O.N. , “Management of Patients Treated by a Surgeon with HIV Infection,” Lancet, 335 (1990): 113–14.

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.

Leary Warren E. , “Mandatory AIDS Tests for Doctors Opposed,” The New York Times, July 31, 1992, sec. All.

CDC, “Update: Investigations of Persons Treated by HIV-infected Health Care Workers—United States,” MMWR, 42, no. 17 (1993): 329–31.

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 11–17).

Appellants' Brief, supra note 3, at 14.

592 A.2d 1251 (N.J. Super L. 1991).

Appellants' Brief, supra note 3, at 18.

Faya v. Almaraz, supra note 1, at 333.

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.

Appellees' Brief, supra note 2, at 37.

Daniels N. , “HIV-infected Professionals, Patient Rights, and the ‘Switching Dilemma’,” JAMA, 267 (1992): 1368–71.

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.

Daniels , supra note 53.

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.

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.

Restatements, Second, Torts, § 293 (1965), Reporter's Comment (c).

Faden Beauchamp King , supra note 30, at 46.

Glantz Mariner Annas , supra note 40, at 61.

Gerbert Maguire Hulley Coates , supra note 54.

CDC, “HIV Epidemic and AIDS: Trends in Knowledge, United States, 1987, 1988,” MMWR, 38, no. 20 (1989): 353–58.

Maroulis , supra note 21, at 227 (trial judge agreed that fear was unfounded and granted the defendant's motion for summary judgment).

Kerins v. Hartley, 17 Cal. App. 4th 713 (1993).

“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.

592 A.2d 1251 (N.J. Super L. 1991).

Id. at 1280.

Id. at 1283.

Appellants' Brief, supra note 3, at 17–21.

Maroulis , supra note 21, passim.

Carroll v. Sisters of Saint Francis Health Services, Inc. , 1992 WL 276717 (Tenn. App. 1992).

Hermann Donald H.J. , “AIDS Update: Fear of Infection,” Medical Malpractice: Law & Strategy, X, no. 1 (1992): 7.

See Faden Beauchamp King , supra note 30, at 114–50, esp. 132–37.

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.

Spielman Bethany , “Expanding the Boundaries of Informed Consent: Disclosing Alcoholism and HIV Status to Patients,” Amer. J. Med., 93 (1992): 216–18.

§ 504, 29 U.S.C. § 794(a) (1988).

42 U.S.C. § 12101–12213 (1990).

480 U.S. 273 (1987).

840 F.2d 701 (9th Cir. 1988).

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.

Gostin Larry , “The HIV-infected Health Care Professional: Public Policy, Discrimination, and Patient Safety,” Law, Medicine & Health Care, 18, no. 4 (1990): 303–10.

Preuss Charles F. , “Federal Preemption of State Tort Actions: When and How,” Defense Counsel Journal, 57 (1990): 434.

Rice v. Santa Fe Elevator Corp., 331 U.S. 218, 239 (1947), quoted in Preuss, supra note 82, at 436.

909 F.2d 820 (5th Cir. 1990).

Bradley v. University of Texas, M.D. Anderson Center , 3 F.3d 999 (5th Cir. 1993).

Harrison Robert W. Thompson Kris P. , “Defending Practitioners Who Are HIV Positive,” Medical Malpractice: Law & Strategy, X, no. 11 (1993): 6–7.

Restatements, Second, Torts, § 291 (1965).

Fajfar Mark , “An Economic Analysis of Informed Consent to Medical Care,” Georgetown Law Journal, 80 (1992): 1941.

Daniels , supra note 53.

Behringer v. The Medical Center at Princeton , 592 A.2d at 1281–82.

Doe v. Northwestern University , No. 93–8847, July 13, 1993.

“AIDS Review Asked,” National Law Journal, January 31 (1994): 6.

Lumsdon Kevin , “HIV-Positive Health Care Workers Pose Legal Safety Challenges for Hospitals,” Hospitals, 66, no. 18 (1992): 24–32.

“In Test of AIDS Law, Pa. OK's Disclosure,” Medical Malpractice: Law & Strategy, XI, no. 1 (1993): 1.

Doyle Sean C. , “HIV-Positive, Equal Protection Negative,” Georgetown Law Journal, 81 (1992): 375.

Gostin , supra note 74, at 248–56.

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).

For example, Brody Howard , “Transparency: Informed Consent in Primary Care,” Hastings Center Report, 19, no. 5 (Sept./Oct., 1989): 5–9.