AIDS Confidentiality Loses Out

Kentucky Supreme Court sharply split in workers’ compensation case

In a sharp 4-3 split, the Kentucky Supreme Court decided March 17 that the requirements of the state’s workers’ compensation law take priority over the state’s HIV confidentiality statute.

Rejecting a claim of breach of confidentiality, the court held that a doctor did not violate the law by including information about a patient’s HIV status in medical notes submitted to his employer when the employee applied for compensation in treating a work-related injury.

Justice J. William Graves wrote the opinion for the court, and Justice Will T. Scott wrote for the dissenters.

Steven Barnett, an HIV-positive man employed as a veterinary assistant, sustained a cat bite at work, and was admitted to the hospital when the bite became infected. When Barnett disclosed to the treating physician that he was HIV-positive, he was referred for treatment to Dr. Julio Melo, an infectious disease specialist, to determine appropriate treatment in light of his regimen of HIV medications.

Because his treatment stemmed from a work-related injury, Barnett sought to have the medical expenses covered under workers compensation. He executed a hospital form authorizing release of his medical information, specifically including HIV-related information, to “any physician rendering care, health, sickness and accident insurance carrier, workers compensation carrier and employer in the event of an on-the-job injury.”

Kentucky workers’ compensation claim forms require the treating physician to submit copies of their medical notes to employers and their insurers, but do not specifically address the issue of HIV-related information.

Melo submitted the forms with his notes attached so that he could be paid for his services. His notes included reference to Barnett’s HIV-status. Barnett had been careful not to disclose his HIV status at work, and his employer first became aware that he was HIV-positive after receiving the copy of Melo’s notes. Barnett subsequently quit his job, claiming that “the office environment had become uncomfortable,” according to the court’s opinion.

Barnett filed suit against Melo, claiming breach of medical confidentiality and violation of privacy. Melo filed a motion for summary judgment, arguing that he had merely been complying with the workers’ compensation statute, which required him to disclose information concerning medical treatment in order to get paid. The trial court granted the motion, and Barnett appealed. The court of appeals reversed and ordered a trial, and then Melo appealed.

Justice Graves found that the workers’ compensation statute, by its terms, imposed a duty on the doctor to provide medical information to the patient’s employer.

“When Barnett sought medical benefits provided by the workers’ compensation law,” wrote Graves, “he became subject to the provisions of that Act.” Graves noted that an employee claiming work-related compensation must “execute a waiver and consent of any physician-patient… privilege with respect to any condition or complaint reasonably related” to the claim.

On the other hand, Kentucky has an HIV confidentiality law, which provides that anybody who obtains knowledge of an HIV test result may not reveal it without the permission of the test subject, except to other health care providers in connection with treatment. That law specifically provides that “a general authorization for the release of medical or other information is NOT sufficient for this purpose.”

Graves and the majority of the court apparently found this an easy call, since the entire analysis boils down to just a few sentences of his opinion.

“By seeking benefits under the Act, Barnett placed his medical condition in issue,” wrote Graves “Barnett was required to execute a release for medical information concerning his treatment for the work-related injury.”

Justice Scott sharply disagreed with this conclusion. He contended that the statutory requirement that the doctor include his medical notes “allows the health care provider, where appropriate, to provide documentation that does not include references to sensitive information, i.e., HIV/AIDS information.” Scott wrote that Melo’s argument that he was required to turn over his notes containing the HIV-related information was “not compelling.”

Scott argued that the specific requirements of the HIV confidentiality law should prevail over the more general requirements of the workers’ compensation law, but argued that the “most compelling ground for resolution… is the public policy concern evidenced by the loss of employment resulting from this case.”

Scott pointed out that Melo had testified that he was aware of the requirements of the HIV confidentiality law.

“Moreover,” he wrote, “Dr. Melo, an infectious disease specialist, practices predominantly in a field of medicine which demands a higher degree of attention to the rights of his patients. We do consider that physicians are trained in medicine, not the intricacies of the law, and that even judges struggle with the proper interpretation of these complicated issues. Yet we cannot ignore the impact disclosure can have on an affected person’s life.”

Lambda Legal and several Kentucky AIDS organizations filed amicus briefs in support of Barnett’s case.