About nine months ago, a hepatitis C advocate contacted me and asked if I would be open to having a discussion on hepatitis C among healthcare professionals. Specifically, should we disclose or shouldn’t we? He talked about hepatitis C-positive medical professionals faced with the dilemma of disclosing their hepatitis C status to their employer. Some who divulged their status were terminated. There are also cases of those who were denied a job because pre-employment screening revealed that they had hepatitis C.
He wrote, “What aggravates me the most about it is that most of these dedicated medical professionals where infected doing their job. Many were infected when precautionary measures were not as stringent as they are today. They understood the risks when undertaking and committing to the profession, and simply took it as part of being in the line of duty…to prevent them from continuing to pursue their career due to their viral infection is just WRONG!”
I said I would write the article, and then I didn’t. I procrastinated because it is a tough subject. The public is afraid. My experience with some patients is that they don’t trust health care professionals. Look at what we did to the health care workers who returned after doing a stint with Ebola – the toughest medical job there is. The press dogged them; we tried to ostracize them. Kaci Hickox, the nurse who defied the ridiculous New Jersey quarantine, was called the “Ebola nurse.” She never had Ebola.
As a nurse, I have been publicly attacked for “exposing patients to hepatitis C.” For the record, patients were never at risk of acquiring hepatitis C from me. However, I don’t need to defend myself. The evidence speaks for itself. The U.S. Centers for Disease Control and Prevention (CDC) does not recommend restrictions for HCV-infected health care workers. The CDC recommends that we follow good infection control practices. It isn’t legal to terminate health care workers with hepatitis C who perform their jobs safely. However, we all know that terminations are conducted in a variety of ways, and the reasons can be covered up.
So, why did it take me so long to write this? There is another side—the dirty side of medicine that we in health care don’t want to acknowledge—medical harm. Sometimes our medical system fails us. If you spend any time reading news on the Internet, you probably heard about the oral surgeon in Tulsa, OK who may have exposed as many as 5,000 patients to HIV, hepatitis B and hepatitis C. Or, perhaps you read about the travelling health care technician, David Kwiatkowski, who left a trail of hepatitis C infections behind him. Kwiatkowski was a hepatitis C-positive injection drug user who helped himself to potent pain and anesthesia drugs meant for patients. He refilled the syringes with sterile saline. Not only did he expose patients to hepatitis C, he also put them at risk of insufficient pain relief or anesthesia.
I read these stories and I understand why patients are afraid. The world is a scary place, and the one place we want a guarantee of safety is in health care. I have been on both sides of this debate, as both nurse and as patient. As a patient, I was the victim of a lab technician who reused needles. I already had hepatitis C. I was more concerned about anyone who had their blood drawn after me than I was by what I could have contracted from those who were before me.
I won’t let a few bad apples spoil the entire barrel. Nearly every medical professional I know is amazing. When I think of the work that Kaci Hickox and other Ebola Warriors did, I am humbled.
So, should we disclose our hepatitis C status? I don’t know. I already have, so for me it is a moot point. On one hand, speaking up is how we confront stigma. Disclosure is a radical act. On the other hand, the risk is huge, and it cannot be undone. It is sad to watch good people drummed out of their jobs. I think it is a personal decision. What do you think?