THE RYAN WHITE CARE ACT: IMPACT ON EMERGENCY RESPONSE EMPLOYEES
CAPITOL CONNECTION
Emergency response employees (EREs) across the country will benefit from the Ryan White Comprehensive AIDS Resources Emergency Act (CARE) of 1990, effective as of April 20, 1994. CARE was issued through the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. The provisions of this act, also referred to as the Ryan White Law, were published in the Federal Register on March 21, 1994. Included are a list of lifethreatening infectious diseases, guidelines concerning the law, and the rationale for implementing the law.
DEFINITION OF TERMS
The law defines EREs as firefighters, law enforcement officers, paramedics, emergency medical technicians, and other persons who, in the course of their professional duties, respond to emergencies in the geographical area involved—without regard to whether they are compensated or not.
A medical facility is any facility that receives victims of emergencies transported by EREs.
CARE’S OBJECTIVE
The law establishes a system for notifying EREs who, while performing their duties, have been exposed to certain diseases through the patients they transport to a medical facility. The law does not mandate the testing of patients for disease.
The law covers the following diseases, which are categorized as airborne, bloodborne, or uncommon or rare.
The law requires each state’s public health officer to select a “designated officer” (DO) for every ERE “employer” in the state. The DO acts as the liaison between medical facilities and EREs.
THE NOTIFICATION PROCESS
The responsibility for initiating the notification process in the case of an ERE exposure varies according to the nature of the disease.
Airborne disease. Since an airborne pathogen exposure is difficult to determine because an ERE could share air space with a patient who later may be determined to be TB infectious, the burden is on the medical facility to notify the DO of the EREs who “transported” the patient within 48 hours of making the determination. If your agency does not actually transport the patient, your DO does not have to be notified, according to the language of the law.
Bloodborne and uncommon or rare disease. When an ERE is exposed to any disease in these categories, it is usually quite evident. As far as bloodborne exposure is concerned, the Ryan White Law “dovetails” into OSH A Standard 29 CFR 1910.1030, Occupational Exposure to Blood Pathogens. By following proper postexposure evaluation and follow-up pursuant to the bloodborne pathogens standard, the Ryan White Law should make it easier to obtain information from the medical facility. For a possible exposure to bloodborne and uncommon or rare diseases, the DO must present a signed, written request, along with facts collected, to the medical facility. The medical facility will determine whether a true exposure has occurred. If the determination is that an ERE was exposed, the medical facility will review the medical records of the source patient for diagnostic test results, signs, and symptoms pertaining to any of the diseases covered by the law. As noted above, the Ryan White Law does not mandate testing of the source patient; state laws (such as in the state of Florida, for example) may, however. The medical facility then would notify the DO in writing within 48 hours (mandated by the law) of the request.
STATE LAWS
Some states may have laws that already provide for a notification process. If a state has laws that are in “substantial compliance” with the ERE provisions of the Ryan White Law, the chief executive officer of the state must certify this to the secretary of the Department of Health and Human Services. If this is done, the Ryan White Law shall not apply. However, the secretary retains the authority to “commence a civil action to obtain temporary or permanent injunctive relief with respect to any violation of the act.”
This law should assist us in our efforts to be well-informed when exposed to some of the diseases that may harm us and our loved ones. We must not forget that if we follow “universal precautions,” chances are that we will not have a true “exposure”; however, accidents do happen.
For more information, write Dr. Robert Mullan; Center for Disease Control and Prevention, 1600 Clifton Road, NE, M/S F40; Atlanta, GA 30333; or call (404)-639-0983.
