2014 Indiana Code TITLE 16. HEALTH ARTICLE 41. PUBLIC HEALTH MEASURES FOR THE PREVENTION AND CONTROL OF DISEASE CHAPTER 6. COMMUNICABLE DISEASE: MANDATORY TESTING OF INDIVIDUALS WITH COMMUNICABLE OR DANGEROUS DISEASES
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IC 16-41-6
Chapter 6. Communicable Disease: Mandatory Testing of
Individuals With Communicable or Dangerous Diseases
IC 16-41-6-0.5
"Standard licensed diagnostic test for HIV"
Sec. 0.5. As used in this chapter, "standard licensed diagnostic test
for HIV" means a test recognized by the state department as a
standard licensed diagnostic test for the antibody or antigen to HIV.
As added by P.L.237-2003, SEC.5.
IC 16-41-6-1
HIV screening and testing
Sec. 1. (a) As used in this section, "physician's authorized
representative" means:
(1) an advanced practice nurse (as defined by IC 25-23-1-1(b))
who is operating in collaboration with a licensed physician; or
(2) an individual acting under the supervision of a licensed
physician and within the individual's scope of employment.
(b) If a physician or the physician's authorized representative
determines that it is medically necessary to conduct an HIV test on
an individual under the care of a physician, the physician or
physician's authorized representative may order the test if the
physician or the physician's authorized representative:
(1) informs the patient of the test;
(2) provides an explanation of the test; and
(3) informs the patient of the patient's right to refuse the test.
Subject to subsection (d), if the patient refuses the test, the physician
or the physician's authorized representative may not perform the test
and shall document the patient's refusal in the patient's medical
record.
(c) After ordering an HIV test for a patient, the physician or the
physician's authorized representative shall:
(1) discuss with the patient the availability of counseling
concerning the test results; and
(2) notify the patient of the test results.
If a test conducted under this section indicates that a patient is HIV
infected, in addition to the requirements set forth in IC 16-41-2, the
physician or the physician's authorized representative shall inform the
patient of treatment and referral options available to the patient.
(d) A physician or a physician's authorized representative may
order an HIV test to be performed without informing the patient or
the patient's representative (as defined in IC 16-36-1-2) of the test or
regardless of the patient's or the patient's representative's refusal of
the HIV test if any of the following conditions apply:
(1) If ordered by a physician, consent can be implied due to
emergency circumstances and the test is medically necessary to
diagnose or treat the patient's condition.
(2) Under a court order based on clear and convincing evidence
of a serious and present health threat to others posed by an
individual. A hearing held under this subdivision shall be held
in camera at the request of the individual.
(3) If the test is done on blood collected or tested anonymously
as part of an epidemiologic survey under IC 16-41-2-3 or
IC 16-41-17-10(a)(5).
(4) The test is ordered under section 4 of this chapter.
(5) The test is required or authorized under IC 11-10-3-2.5.
(6) The individual upon whom the test will be performed is
described in IC 16-41-8-6 or IC 16-41-10-2.5.
(7) A court has ordered the individual to undergo testing for
HIV under IC 35-38-1-10.5(a) or IC 35-38-2-2.3(a)(17).
(8) Both of the following are met:
(A) The individual is not capable of providing consent and
an authorized representative of the individual is not
immediately available to provide consent or refusal of the
test.
(B) A health care provider acting within the scope of the
health care provider's employment comes into contact with
the blood or body fluids of the individual in a manner that
has been epidemiologically demonstrated to transmit HIV.
(e) The state department shall make HIV testing and treatment
information from the federal Centers for Disease Control and
Prevention available to health care providers.
(f) The state department may adopt rules under IC 4-22-2
necessary to implement this section.
As added by P.L.2-1993, SEC.24. Amended by P.L.106-1998, SEC.1;
P.L.293-2001, SEC.3; P.L.212-2003, SEC.4; P.L.237-2003, SEC.6;
P.L.97-2004, SEC.67; P.L.125-2007, SEC.1; P.L.94-2010, SEC.4;
P.L.116-2012, SEC.1; P.L.147-2012, SEC.4.
IC 16-41-6-2
Informed consent; court ordered examinations
Sec. 2. (a) As used in this section, "informed consent" means
authorization for physical examination, made without undue
inducement or any form of force, fraud, constraint, deceit, duress, or
coercion after the following:
(1) A fair explanation of the examination, including the purpose,
potential uses, limitations, and the fair meaning of the
examination results.
(2) A fair explanation of the procedures to be followed,
including the following:
(A) The voluntary nature of the examination.
(B) The right to withdraw consent to the examination process
at any time.
(C) The right to anonymity to the extent provided by law
with respect to participation in the examination and
disclosure of examination results.
(D) The right to confidential treatment to the extent provided
by law of information identifying the subject of the
examination and the results of the examination.
(b) If the state health commissioner, the state health
commissioner's legally authorized agent, or local health official has
reasonable grounds to believe that an individual may have a
communicable disease or other disease that is a danger to health, the
state health commissioner, the state health commissioner's legally
authorized agent, or local health officer may ask the individual for
written informed consent to be examined to prevent the transmission
of the disease to other individuals.
(c) If the individual, when requested, refuses such an examination,
the state health commissioner, the state health commissioner's legally
authorized agent, or local health officer may compel the examination
only upon a court order based on clear and convincing evidence of a
serious and present health threat to others posed by the individual.
(d) A hearing held under this section shall be held in camera at the
request of the individual.
As added by P.L.2-1993, SEC.24.
IC 16-41-6-2.5
Repealed
(Repealed by P.L.237-2003, SEC.18.)
IC 16-41-6-3
Violations
Sec. 3. (a) Except as otherwise provided, a person who recklessly
violates or fails to comply with this chapter commits a Class B
misdemeanor.
(b) Each day a violation continues constitutes a separate offense.
As added by P.L.2-1993, SEC.24.
IC 16-41-6-4
Testing newborn infants; confidentiality; notice; information on
treatment options; objecting; rules; application for funds under
Ryan White CARE Amendments
Sec. 4. (a) Subject to subsection (f), if:
(1) the mother of a newborn infant has not had a test performed
under section 5 or 6 of this chapter;
(2) the mother of a newborn infant has refused a test for the
newborn infant to detect HIV or the antibody or antigen to HIV;
and
(3) a physician believes that testing the newborn infant is
medically necessary;
the physician overseeing the care of the newborn infant may order a
confidential test for the newborn infant in order to detect HIV or the
antibody or antigen to HIV. The test must be ordered at the earliest
feasible time not exceeding forty-eight (48) hours after the birth of
the infant.
(b) If the physician orders a test under subsection (a), the
physician must:
(1) notify the mother of the newborn infant of the test; and
(2) provide HIV information and counseling to the mother. The
information and counseling must include the following:
(A) The purpose of the test.
(B) The risks and benefits of the test.
(C) A description of the methods of HIV transmission.
(D) A discussion of risk reduction behavior modifications,
including methods to reduce the risk of perinatal HIV
transmission and HIV transmission through breast milk.
(E) Referral information to other HIV prevention, health
care, and psychosocial services.
(c) The confidentiality provisions of IC 16-41-2-3 apply to this
section.
(d) The results of the confidential test ordered under subsection (a)
must be released to the mother of the newborn infant.
(e) If a test ordered under subsection (a) is positive, the person
who provides the results of the test shall inform the mother of the
newborn infant of treatment options or referral options available to
the newborn infant.
(f) If a parent of the newborn infant objects in writing for reasons
pertaining to religious beliefs, the newborn infant is exempt from the
test under subsection (a).
(g) The state department shall adopt rules under IC 4-22-2 to carry
out this section.
(h) The results of a test performed under this section are
confidential.
(i) The state department shall apply for funds under Section 2625
of the Ryan White CARE Amendments of 1996 (42 U.S.C. 300ff-21
et seq.) to pay for all tests conducted under subsection (a).
As added by P.L.106-1998, SEC.2. Amended by P.L.237-2003,
SEC.7; P.L.220-2011, SEC.319.
IC 16-41-6-5
Ordering and submitting a pregnant woman's blood sample for
testing
Sec. 5. (a) This section applies to:
(1) a physician licensed under IC 25-22.5; or
(2) an advanced practice nurse licensed under IC 25-23;
who provides prenatal care within the scope of the provider's license.
(b) Subject to section 8 of this chapter, an individual described in
subsection (a) who:
(1) diagnoses the pregnancy of a woman; or
(2) is primarily responsible for providing prenatal care to a
pregnant woman;
shall order to be taken a sample of the pregnant woman's blood and
shall submit the sample to an approved laboratory for a standard
licensed diagnostic test for HIV.
As added by P.L.237-2003, SEC.8.
IC 16-41-6-6
No written evidence of testing; ordering and submitting sample
Sec. 6. Subject to section 8 of this chapter, if, at the time of
delivery, there is no written evidence that a standard licensed
diagnostic test for HIV has been performed under section 5 of this
chapter, the physician or advanced practice nurse in attendance at the
delivery shall order to be taken a sample of the woman's blood at the
time of the delivery and shall submit the sample to an approved
laboratory for a standard licensed diagnostic test for HIV.
As added by P.L.237-2003, SEC.9.
IC 16-41-6-7
Right to refuse test
Sec. 7. A pregnant woman has a right to refuse a test under section
5 or 6 of this chapter.
As added by P.L.237-2003, SEC.10.
IC 16-41-6-8
Informing pregnant woman of information; documenting
information given and a refusal of test; information if test results
positive; confidentiality
Sec. 8. (a) This section applies to a physician or an advanced
practice nurse who orders an HIV test under section 5 or 6 of this
chapter or to the physician's or nurse's designee.
(b) An individual described in subsection (a) shall:
(1) inform the pregnant woman that:
(A) the individual is required by law to order an HIV test
unless the pregnant woman refuses; and
(B) the pregnant woman has a right to refuse the test; and
(2) explain to the pregnant woman:
(A) the purpose of the test; and
(B) the risks and benefits of the test.
(c) An individual described in subsection (a) shall document in the
pregnant woman's medical records that the pregnant woman received
the information required under subsection (b).
(d) If a pregnant woman refuses to consent to an HIV test, the
refusal must be noted by an individual described in subsection (a) in
the pregnant woman's medical records.
(e) If a test ordered under section 5 or 6 of this chapter is positive,
an individual described in subsection (a):
(1) shall inform the pregnant woman of the test results;
(2) shall inform the pregnant woman of the treatment options or
referral options available to the pregnant woman; and
(3) shall:
(A) provide the pregnant woman with a description of the
methods of HIV transmission;
(B) discuss risk reduction behavior modifications with the
pregnant woman, including methods to reduce the risk of
perinatal HIV transmission and HIV transmission through
breast milk; and
(C) provide the pregnant woman with referral information to
other HIV prevention, health care, and psychosocial services.
(f) The provisions of IC 16-41-2-3 apply to a positive HIV test
under section 5 or 6 of this chapter.
(g) The results of a test performed under section 5 or 6 of this
chapter are confidential.
(h) As a routine component of prenatal care, every individual
described in subsection (a) is required to provide information and
counseling regarding HIV and the standard licensed diagnostic test
for HIV and to offer and recommend the standard licensed diagnostic
test for HIV.
(i) An individual described in subsection (a) shall document:
(1) the oral or written consent of the pregnant woman to be
tested; and
(2) that the pregnant woman was counseled and provided the
required information set forth in subsection (b) to ensure that an
informed decision has been made.
(j) A pregnant woman who refuses a test under this section must
do so in writing.
As added by P.L.237-2003, SEC.11. Amended by P.L.97-2004,
SEC.68; P.L.112-2011, SEC.1.
IC 16-41-6-9
Information on confidential part of birth certificate
Sec. 9. The state department shall require, on the confidential part
of each birth certificate and stillbirth certificate retained by the state
department, in addition to the information otherwise required to be
included on the certificate, the following information:
(1) Whether a standard licensed diagnostic test for HIV was
performed on the woman who bore the child.
(2) If a standard licensed diagnostic test for HIV was performed:
(A) the date the blood specimen was taken; and
(B) whether the test was performed during pregnancy or at
the time of delivery.
(3) If a standard licensed diagnostic test for HIV was not
performed, the reason the test was not performed.
As added by P.L.237-2003, SEC.12.
IC 16-41-6-10
Distributing information on HIV treatment options
Sec. 10. The state department shall distribute to physicians and to
other individuals who are allowed by law to attend a pregnant woman
information available from the federal Centers for Disease Control
and Prevention that explains the treatment options available to an
individual who has a positive test for HIV.
As added by P.L.237-2003, SEC.13.
IC 16-41-6-11
Rules
Sec. 11. (a) The state department shall adopt rules under IC 4-22-2
that include procedures:
(1) to inform the woman of the test results under this chapter,
whether they are positive or negative;
(2) for explaining the side effects of any treatment for HIV if the
test results under this chapter are positive; and
(3) to establish a process for a woman who tests positive under
this chapter to appeal the woman's status on a waiting list on a
treatment program for which the woman is eligible. The rule
must:
(A) include a requirement that the state department make a
determination in the process described in this subdivision not
later than seventy-two (72) hours after the state department
receives all the requested medical information; and
(B) set forth the necessary medical information that must be
provided to the state department and reviewed by the state
department in the process described in this subdivision.
(b) The state department shall maintain rules under IC 4-22-2 that
set forth standards to provide to women who are pregnant, before
delivery, at delivery, and after delivery, information concerning HIV.
The rules must include:
(1) an explanation of the nature of AIDS and HIV;
(2) information concerning discrimination and legal protections;
(3) information concerning the duty to notify persons at risk as
described in IC 16-41-7-1;
(4) information about risk behaviors for HIV transmission;
(5) information about the risk of transmission through breast
feeding;
(6) notification that if the woman chooses not to be tested for
HIV before delivery, at delivery the child will be tested subject
to section 4 of this chapter;
(7) procedures for obtaining informed, written consent for
testing under this chapter;
(8) procedures for post-test counseling by a health care provider
when the test results are communicated to the woman, whether
the results are positive or negative;
(9) procedures for referral for physical and emotional services
if the test results are positive;
(10) procedures for explaining the importance of immediate
entry into medical care if the test results are positive; and
(11) procedures for explaining that giving birth by cesarean
section may lessen the likelihood of passing on HIV to the child
during childbirth, especially when done in combination with
medications, if the test results are positive.
As added by P.L.237-2003, SEC.14.
IC 16-41-6-12
Completing HIV test history and assessment form; retaining copy
of form in patient's medical file; systemwide evaluation of prenatal
HIV testing
Sec. 12. (a) The state department shall provide that an HIV test
history and assessment form from the patient's medical records or an
interview with the patient must be filled out. The state department
shall develop the form to determine if:
(1) the patient is HIV positive and has been informed; or
(2) the patient was tested during the current pregnancy and
tested negative or was not tested during the current pregnancy
and the HIV status is unknown.
(b) The form required under subsection (a) must identify what
special support or assistance for continued medical care the patient
might need as a result of a positive test.
(c) A copy of the form must be:
(1) kept in the patient's medical file;
(2) kept in the baby's medical file; and
(3) given to the doctor in the hospital designated to administer
the newborn HIV testing program.
(d) The state department must maintain a systemwide evaluation
of prenatal HIV testing in Indiana. The state department shall
prescribe the HIV test history and assessment form and a newborn
blood screening form. The state department shall remove all
identifying information from the maternal test history before the state
department performs its analyses and shall not maintain HIV test
history data with identifying information.
As added by P.L.237-2003, SEC.15.
IC 16-41-6-13
Treatment program access for women who test positive for HIV
Sec. 13. (a) Women who:
(1) meet all qualifications to participate in the children's health
insurance program, the AIDS drug assistance program, the
health insurance assistance program, or any other health care
program of the state; and
(2) test positive under section 5 or 6 of this chapter;
shall be given first priority on a waiting list for the program if a
waiting list exists. If a program does not have a waiting list, the
woman described in this subsection shall be automatically approved
and accepted into the program.
(b) If the state department determines during the process described
in section 11(a)(3) of this chapter that the treatment of a woman who
tests positive under this chapter should not be interrupted because of
medical necessity, the woman may enter a program described in
subsection (a) regardless of the existence of a waiting list for the
program.
As added by P.L.237-2003, SEC.16.
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