[Suggested procedure in dealing with chronically infected staff members (infections with HBV, HCV, HIV) in medical institutions in Bremen]. / Verfahrensvorschlag zum Umgang mit chronisch infizierten Mitarbeitern (HBV-, HCV-, HIV-Infektion) in medizinischen Einrichtungen in Bremen.

The measures necessary for medical staff suffering from acute hepatitis B or C virus infection are determined by the Biological Material Act (Biostoffverordnung) and the Federal Infectious Disease Protection Law (Infektionsschutzgesetz). Problems can occur in cases of chronic hepatitis B or C virus infections, especially if the infected persons refer to doctor's professional discretion. Bremen experts from the Public Health Authority and the Medical Association, occupational, health, hygiene, juridical and data protection specialists evolved a plan for adequate action. The best possible steps which can be taken within the legal system are described. High priority has the protection of the patients and the infected professional and his or her colleagues, without breaking confidentiality. Several times this practice has been proved and it could be shown that the procedure doesn't conflict with the recommendations of the Federal Institute of Hygiene (Robert Koch-Institut) and the German Association for Virus Disease Control (Deutsche Vereinigung zur Bekämpfung der Viruserkrankungen).

Practice compliance programs: reducing therapeutic misadventures and adverse outcomes.

Contemporary medical group practice administrators navigate a complex world of challenges, questions, and ambiguous circumstances. Adverse outcomes and therapeutic misadventures have significant implications within this world. Practice compliance programs must be developed to reduce risk and liability. As with any negative behavior, event or disruptive action, therapeutic misadventure is easily identified; however, determining a strategy to correct physician behavior, attitude, and action is sensitive and difficult, requiring administrative skill, tact, and patience. This article provides corrective action strategies that can be applied to any therapeutic misadventure encountered in a typical medical group practice. Three categories are identified: problematic behavior, problematic practice patterns, and physician impairment. Measures to correct and alter physician behavior and actions are also described.

AIDS, surgery, and the Americans With Disabilities Act.

The acquired immunodeficiency syndrome and human immunodeficiency virus have had a major impact on the practice of medicine in the past 2 decades. Medical professionals are once again faced with a lethal contagious disease that has been transmitted in the health care setting to both patients and providers. Because of the stigma and fear associated with the infection, civil rights legislation, such as the Americans With Disabilities Act, has been used to protect infected individuals from inappropriate discrimination based on unwarranted fears and public hysteria. Various courts, with the backing of organized medicine and the public health authorities, have made it clear that it is illegal for a physician to refuse to treat a patient based on the patient's seropositivity. Unfortunately, various courts, with the backing of the American Medical Association and the Centers for Disease Control and Prevention, have made it clear that infected physicians are not necessarily afforded equal protection under the civil rights statutes.