Republic of the Philippines RECEIVED
8

HOUSE OF REPRESENTATIVES f JUL
Quezon City

EIGHTEENTH CONGRESS
First Regular Session

HOUSE BILL NO. 2428

Z ~ INTRODUCED BY REPRESENTATIVE ALFRED VARGAS

EXPLANATORY NOTE

Hepatitis B and C infections are significant public health problems in the country. Both can
cause chronic and are strongly linked with the development of liver cirrhosis and liver cancer
which are incurable and fatal. Globally, around 57% of liver cirrhosis cases are attributed to
Hepatitis B and C. An estimated 240 million people are chronically infected with hepatitis B,
and more than 686,000 people die every year from complication due to the disease. In the
Philippines, the Department of Health (DOH) estimates that 10% to 16% of Filipino adults,
suffer from chronic hepatitis B infection, and this accounts for more than two thirds of all
cases of liver cancer, the second leading cause of cancer deaths in the country

Majority of people with blood borne viral hepatitis are asymptomatic and could unknowingly
transmit the disease. Nevertheless, measures are available to prevent the transmission of the
disease primarily through the limitation of the exposure of uninfected individuals to infected
blood and other bodily fluids. In addition, an effective vaccine for Hepatitis B is widely
available and has been included in the government's Expanded Program on Immunization.
An important aspect of preventing Hepatitis B and C transmission is public awareness on this
decease

Infection with blood borne viral hepatitis has a significant social impact not just from the
disease but from fear, stigma, and discrimination. It has been reported that Filipinos with viral
hepatitis find themselves subject to discrimination in the workplace. There are instances when
individuals with positive blood tests are terminated or are not considered for employment
even for jobs that have very low risk of disease transmission

The Department of Labor and Employment (DOLE) Department Advisory No. 05 (Series of
2010) also known as the Guidelines for the Implementation of a Workplace Policy and
Program on Hepatitis B was issued to protect the rights of workers with HBV and HCV
Despite this, cases of discrimination of HBV and HCV positive individuals persist. This
situation highlights the need to revise our policy on Hepatitis B and Hepatitis C Testing to
ensure that the rights of all Filipinos to privacy and confidentiality when it comes to their
health conditions are protected and to improve access of HBV and HCV positive individuals
to quality health care. Hence, the immediate passage of this measure is earnestly sought.



Republic of the Philippines
HOUSE OF REPRESENTATIVES
‘Quezon City, Philippines

EIGHTEENTH CONGRESS
First Regular Session

House BILL No, "428 _

VTRODUCED BY REPRESENTATIVE ALFRED VARGAS.

AN ACT INSTITUTING A POLICY ON
BLOODBORNE VIRAL HEPATITIS TESTING AND SCREE!

Be it enacted by the Senate and the House of Representatives of the Philippines
in Congress assembled:

Section 1. Short Title. - This Act shall be known as the “Bloodborne Viral Hepatitis
Testing Act of 2019”

Section 2. Declaration of Policy. \t is hereby declared that the policy of the State is to
promote health and well-being of the population through prevention, early detection and
treatment of diseases like bloodborne viral hepatitis, as well as, to protect the rights of
people living with these diseases who suffer from stigma and discrimination through the
promotion of voluntary and confidential testing of blood borne viral hepatitis and the
prohibition of mandatory and routine screening of the same.

Section 3. Definition. For the purposes of this Act, the following definitions shall apply:

(a) Bloodborne Viral Hepatitis refers to the disease caused by both Hepatitis B and
Hepatitis C virus which can be transmitted by exposure to infected blood and other
body fluids, producing, among others, jaundice and chronic inflammation of the
liver.

(b) Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV), refers to the virus that
causes Hepatitis B and Hepatitis C respectively. A safe and effective vaccine is
available for Hepatitis B while there is none for Hepatitis C. Treatment modalities
are available to effectively manage the symptoms and to prevent complications
caused by these diseases.

(c) Hepatitis Testing or Screening refers to any facility-based or mobile medical
procedure that is conducted to determine the presence or absence of Hepatitis B or
C or the circulating viral burden in a person's body.


(4) Workplace refers to the office, premises or worksite, whether in the private or the
public sector, including governm nt agencies, their subdivisions, instrumentalities,
and government-owned and cont olled corporations, where a worker is temporarily
or habitually assigned. Where there is a no fixed or definite workplace, the term
shall include the place where a worker performs regular work, or where a worker
regularly reports to render service or to take an assignment

(e) Universal Precautions refers to the practice of avoiding contact with bodily fluids,
assuming it to be infected, by means of non-porous articles or other personal
protective equipment

(0) Exposure-prone Procedures (EPP) refers to invasive procedures where there is a
risk that injury to the worker may result in the exposure of the patient's open tissues
to the blood of the worker, including procedures where the worker’s gloved hands
may be in contact with sharp tissue (e.g. spicules of bone or teeth) inside

Section 4. Voluntary Hepatitis Testing — As a matter of policy, the State shall encourage
voluntary hepatitis testing. Written consent of the person taking the test or the parent or legal
guardian of a minor or legally incapacitated ta cing the test, must be obtained before such testing.

The conduct of hepatitis testing as a pre-requisite for hiring, employment, renewal of
employment r continued employment, or as part of a routine health check-up without clinical
indication or medical justification, or as a pre-requisite for admission to, basis for expulsion
from or any disciplinary action in educational institutions, shall be prohibited.

Section 5. Confidentiality of Hepatitis Testing — n all cases, access to all information related
to a person's HBV or HCV status including the results of hepatitis testing shall be kept strictly
confidential except when disclosed with the written consent of the individual or the parent or
legal guardian of the minor or legally incapacitated whose HBV or HCV status is involved,
unless otherwise required by law.

Section 6. Counselling and Referral for Further Management ~ Ail hepatitis testing shall
include counselling which should be able to provide the individual who took the test information
‘on measures to prevent transmission and if necessary a referral to a health practitioner for further
evaluation and management

Section 7. Exceptions to Voluntary Hepatitis Screening and Testing. ~ Compulsory testing for
blood bore viral hepatitis shall be allowed only in the following instances:

a. When it is necessary to test a person, who is charged with any of the offenses
punishable under Article 264, 266, 335 and 338 of the Revised Penal Code, as
amended by Republic Act No. 8353, otherwise known as the Anti-Rape Law of
1997;

b. As a prerequisite in the donation of blood in compliance with the provisions of
Republic Act No. 7170, otherwise known as the Organ Donation Act, and Republic
Act No. 7719, otherwise known as the National Blood Services Act:

¢. As part of surveillance and management of blood bome hepatitis among health care
workers involved in exposure prone procedures. Provided that, it shall not be a pre~
requisite for admission to or a basis for expulsion or any disciplinary action in an
educational institution for health care workers or for employment or re-employment
ina health care facility; Provided further that, positive results of such testing shall
not be used as justification for the termination of a health care worker employed in
ahealth facility


Section 8. Testing for Organ Donation. ~ Lawful consent to HBV and HCV testing of a donated
human body, organ, tissue, or blood shall be considered as having been given when:

a) A person volunteers or freely agree to donate one’s blood, organ, or tissue for
transfusion, transplantation, or research; and

b) A legacy and a donation are executed in accordance with Sections 3 and 4
respectively, of Republic Act No. 7170 otherwise known as the Organ Donation
Act of 1991

Section 9. Hepatitis Testing Among Individuals with Clinical Justification for Testing ~
Hepatitis testing shall be highly encouraged among individuals who, based on a reasonable
‘assessment of a physician, shall benefit from the conduct of said testing, Provided that,
voluntary consent must be obtained prior to such testing, adequate counselling must be
provided, and that any individual who refuses to undergo such testing shall not be subjected to
discriminatory acts as defined in Section 12

Section 10. Prevention, Detection, and Management of Blood Borne Hepatitis in Workplace
Settings with High-Risk of Transmission —|n institutions or workplace settings with high-risk
‘of transmission like hospitals, health facilities, diagnostic clinics, blood donation centers,
among others, measures to interrupt transmission of blood borne viral hepatitis from health
provider to patient and vice versa shall be adopted, including but not limited to

(a) Routine surveillance of personnel performing exposure prone procedures and
provision of support and access to treatment for those with positive results;

(b) Hepatitis B vaccination for all personnel if they have no documented evidence of
pre-existing, immunity;

(c) Strict adherence and practice of universal precautions and provision of personal
protective equipment for workers whose work entails exposure to blood and other

body fluids;

(d) Provision and maintenance of adequate hygiene facilities and mechanisms to
ensure proper disposal of infectious and potentially contaminated materials;

(e) Development of protocols for the management of health workers exposed to agents
contaminated with blood bome infectious diseases in all health care and health
care-related institutions and facilities;

(f) Education and training on the prevention transmission of blood borne hepatitis and
other infectious diseases in the workplace;

(g) Development of a protocol for the confidential management of restrictions on the
conduct of EPPs and reasonable reassignment of personnel with restrictions to
conduct EPP to other work assignments based on the person's clinical status and
based on best available scientific evidence:

Section 11. Regulation of Hepatitis Testing Services. - To ensure access to voluntary and
confidential hepatitis testing, the DOH shall

fa Regulate public and private facilities that conduct hepatitis testing services.
Provided, that only DOH-accredited hepatitis testing facilities shall be allowed to
conduct such testing.


Section 12.
prohibited

a

8

Section 13.

Develop the guidelines for voluntary and confidential hepatitis testing including
protocols for counselling and referral to health providers for further evaluation and
‘management;

Discriminatory Acts ~ The following discriminatory acts and practices shall be

Discrimination in any form, from pre-employment to post employment, including
hiring, assignment, promotion, based on the actual or perceived HBV or HCV
status of an individual, non-disclosure of one’s own or another person's HBV and
HCV status, or refusal to undergo hepatitis testing;

‘Termination from work on the sole basis of actual, perceived, or suspected HBV
or HCV, non-disclosure of one’s own or another person’s HBV and HCV status,
or refusal to undergo hepatitis testing;

Refusal of admission, expulsion, segregation, imposition of harsher disciplinary
actions, or denial of benefits or services of a student or a prospective student solely
or partially on the basis of actual, perceived or suspected HBV or HCV. non-
disclosure of said status, or refusal to undergo hepatitis testing.

Exclusion from health, accident, or life insurance. credit and loan services,
including the extension of such loan or insurance facilities, or an individual solely
or partially on the basis of actual, perceived, or suspected HBV and HCV status:
Provided, That the person with positive HBV and HCV has not misrepresented
the fact to the insurance company or loan or credit service provider upon
application;

Denial of or provision of subpar health services or being charged with a higher fee,
on the basis of actual, perceived or suspected HBV or HCV status, non-disclosure
of said status, or refusal to undergo hepatitis testing;

Denial and deprivation of private health insurance under a Health Maintenance
Organization (HMO) and private life insurance coverage under a life insurance
company on the basis of the person's HBV and HCV status: Provided, That the
person with positive HBV and HCV has not misrepresented such fact to the Health
Maintenance Organization (HMO) and private life insurance company upon
application.

Other similar or analogous discriminatory acts

Protection of Workers with Blood Borne Viral Hepatitis ~ Employers shall adopt

all reasonable measures to accommodate workers who are HBV positive, HCV-positive, or

affected by

a Hepatitis B or Hepatitis C-related illness who voluntary disclose their status to

their employer, including but not limited to flexible leave arrangements, re-scheduling of work
hours, and workforce re-integration assistance, and facilitation of access to treatment.

Section 14.

Education and Blood Borne Viral Hepatitis ~ The DOH together with other

partners in the health sector shall strengthen the nationwide program on prevention of blood

‘borne viral

hepatitis by raising awareness on the disease and disease prevention, promoting

universal coverage of Hepatitis B vaccination, and advocating for voluntary hepatitis testing in
the general population,


Section 15. Penalties ~ Violations of any provision of this Act including, but not limited to,
those related to the non-compulsory nature of Hepatitis B and C testing, discrimination in the
workplace and confidentiality, shall be punished with imprisonment of not less than six (6)
months but not greater than four (4) years, and a fine not exceeding Fifty Thousand Pesos
(P50,000.00). In addition, the license or permits of establishments, companies and other
institutions found guilty of committing the discriminatory acts and policies described in this
Act, shall be revoked.

Seetion 16. Implementing Rules and Regulations ~ The DOH and DOLE, in coordination with
other relevant government agencies and private organizations and non-governmental
‘organizations shall issue the Implementation Rules and Regulations necessary for the effective
implementation of this Act within ninety (90) days from the effectivity thereof.

Section 17. Appropriations ~ The amounts necessary for the initial implementation of the
provisions of this Act shall be charged against the current year's appropriations of the DOH.
Thereafter, the expenses for its continued implementation shall be included in the General
Appropriations Act from funds appropriated to the DOH

Section 18. Separability Clause ~ \f any provision of this Act is declared unconstitutional or
invalid by a court of competent jurisdiction, the remaining provisions not affected thereby shall
continue to be in full force and effect.

Section 19. Repealing Clause ~ All laws, decrees, executive orders, department or
‘memorandum orders and other administrative issuances, or parts thereof, which are inconsistent
with the provisions of this Act are hereby modified, superseded or repealed accordingly.

Section 20. Effectivity — This Act shall take effect fifteen (15) days after publication in the
Official Gazette or in at least two (2) newspapers of general circulation

Approved,