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Patient ordered to take HIV test

| Thursday, Nov. 18, 2004

Kimberly Pitts got what she wanted in court, but she could still get bad news.

Pitts, a nurse at Mercy Hospital's North Shore Campus, was accidentally stuck with a needle while giving a patient insulin on Oct. 31. Allegheny County Common Pleas Judge Robert P. Horgos signed a court order Wednesday compelling the patient, known only as John Doe, to undergo testing for HIV.

"Out of reciprocity, he should look to comply" with the court order, Horgos said. "We need people like Ms. Pitts who are concerned for the helpless who need treatment. There are very few safeguards in place here for people like her."

The patient refused to voluntarily take the HIV test, said Pitts' attorney, Gayle Godfrey. Neither the patient nor anyone representing him appeared in court yesterday. Pitts also did not appear in court.

John Doe has hepatitis C and a history of heroin abuse, which puts him in a high-risk category for HIV, according to court documents. He was admitted to Mercy for psychiatric treatment, Pitts' petition said.

Horgos' order requires the patient to submit to the HIV test at Mercy by Monday.

But there is no guarantee he will appear.

He didn't respond to Pitts' petition, and there is no way to know whether he even is aware of the court proceedings, Godfrey acknowledged.

Horgos declined to speculate what might happen if John Doe does not appear for testing, but he said further legal action could be forthcoming. The patient could be held for contempt, the judge said.

Without a court order, a patient must consent before an HIV test can be administered.

For health care workers possibly exposed to HIV, the U.S. Centers for Disease Control and Prevention recommends a four-week course of drugs, commonly known as a "cocktail."

The cocktail is highly toxic, said Karen Daley, former president of the Massachusetts Nurses Association. Daley contracted both hepatitis C and HIV from an accidental needle stick in 1998. She fought for legislation to make needle use in hospitals safer.

"This sounds like an issue that faces half the nurses in the country every year," Daley said Tuesday from her home in Stoughton, Mass. "It is a serious public policy issue. There is no mandated testing in cases like this. "Concerns for patient privacy have really risen to the top of the discussion, but there are ways to protect that privacy and still reassure nurses and other health care workers."

Daley championed the Needlestick Safety and Prevention Act of 2000, which was signed into law by President Clinton. The law requires hospitals and other health care facilities to use retracting needles, and workers must cover or blunt needles as soon as they are used.

In the case of an accidental stick, Daley said, time is critical. In Pitts' case, the prime window to take the drug cocktail has passed, she said. Pitts' reluctance to take the cocktail because of the side-effects is understandable because it can cause anemia and liver damage, Daley said.

"But I think you have to weigh which is the greater concern," she said.

Pitts still could test negative for HIV, even if John Doe tests positive, Daley said. The risk of HIV infection after a needle stick exposure to infected blood is about 1 in 300, according to the CDC. So even if John Doe tests positive, Pitts still might not contract HIV.

About 2,500 health care workers develop HIV or hepatitis B or C annually after needle sticks, according to the Emergency Nurses Association, and 800,000 health care workers are stuck every year, according to the American Nurses Association.

Daley, who is no longer in practice, is completing a doctorate at Boston College. Her dissertation focuses on the emotional effects of contracting HIV from a needle stick.

"It's a very tough road," she said.

Pitts' lawyer Godfrey said little after yesterday's court hearing, except that his client is having "a very difficult time."

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