High-Risk Ob/Gyn Patient Denied Care For Refusing HIV Test: Nurse Not Legally Liable

Legal Eagle Eye Newsletter for the Nursing Profession

May 1996   

  The court upheld the right of the nurse midwife who was providing most of her prenatal care and the medical doctor who ran the clinic to implement a policy to deny care to patients legitimately considered high-risk for HIV who refused HIV testing.

  The patient, a recent immigrant from Nigeria, was considered at high risk for HIV infection under policies established for the clinic by its physician director.

  However, the court left it open for the patient and her husband to present any evidence they believed existed that the clinic had discriminated against them on the basis of national origin or race. If the problem with the patient’s potential HIV status proved a mere pretext for such bias, the suit would be allowed to go forward.  UNITED STATES DISTRICT COURT, GEORGIA, 1994.

   The patient was a recent immigrant from Nigeria. After arriving in the U.S., she married a U.S. citizen who himself was an African immigrant, and became pregnant. She phoned a physician referral service in the Atlanta area for prenatal care. It referred her to the ob/gyn specialty clinic in question, where there were employed numerous healthcare professionals including osteopathic physicians, medical doctors, an ultrasound technician and a state-certified nurse midwife.

   The clinic had a firm policy, promulgated by its physician medical director, that all women patients whom it considered high-risk for HIV would have to be tested to continue to receive prenatal, perinatal or other ob/gyn care at the clinic. Among the factors leading to consideration as high-risk for HIV was emigration from a high-risk country such as Nigeria.

   The patient refused to answer questions on a written questionnaire about whether she had ever been tested for HIV, about her and her husband’s emigration from Africa and about her husband’s other known sexual partners. She stated she believed that knowledge of her own HIV-positive status would cause her to die from AIDS.

   At her next visit, the patient was told directly by the nurse midwife who had begun to see her for prenatal care that she could not continue receiving care unless she and her husband consented to HIV testing. She refused and did not return. After numerous phone calls by the husband complaining about his wife’s treatment, suit was filed against the clinic, the physician director and the nurse midwife.

   The U.S. District Court in Georgia ruled that unless racial or national origin discrimination could be demonstrated, apart from the concern over the patient’s potential HIV status, there was no basis for this suit. Atakpa vs. Ob-Gyn, 912 F. Supp. 1566 (N.D.Ga., 1994).