Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 20 - Division of Community and Public Health › Chapter 26 - Sexually Transmitted Diseases › Section 19 CSR 20-26.060 - Voluntary Evaluation for Human Immunodeficiency Virus (HIV)- and Hepatitis B Virus (HBV)-Infected Health Care Professionals Who Perform Invasive Procedures

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes procedures for the
				  voluntary evaluation of human immunodeficiency virus- and hepatitis B
				  virus-infected health care professionals who perform invasive procedures in
				  order to determine whether practice restrictions or limitations should be
				  applied, as defined in section
				  191.700,
				  RSMo.
(1) The definitions in
				19
				CSR 20-26.050 shall be used in the interpretation of
				this rule.
(2) Any health care
				professional who performs invasive procedures is advised to know his/her human
				immunodeficiency virus (HIV) antibody status and hepatitis B surface antigen
				(HBsAg) status. If HBsAg is present, the presence or absence of hepatitis B e
				antigen (HBeAg) shall be determined. If a significant occupational exposure
				occurs which could place the health care professional at risk of acquiring HIV
				or hepatitis B virus (HBV) infection, appropriate post-exposure evaluation
				should be undertaken.
(3) HIV- or
				HBV-infected health care professionals who perform invasive procedures may be
				voluntarily evaluated by an expert review panel appointed by the department
				according to section
				191.700,
				RSMo. This panel shall follow subsections (3)(A)-(P) of this rule.
(A) Health care professionals infected with
				HIV or HBV who perform invasive procedures and who choose to be evaluated by an
				expert review panel appointed by the department according to section
				191.700,
				RSMo shall apply for the evaluation in writing to the director. Directors of
				health care facilities (chief administrative officers or equivalents) allowed
				by 191.700.2(1), RSMo to seek evaluation of infected health care professionals
				who perform invasive procedures shall, with the consent of the infected health
				care professional and after consultation with the professional's private
				physician, apply in writing to the director of the Department of
				Health.
(B) Upon receipt of a
				written request for evaluation, the director shall appoint an expert review
				panel by utilizing the following criteria:
1.
				The panel shall include those individuals specified by 191.700.2(2)(a)-(d),
				RSMo and may include additional individuals if the director determines this is
				necessary; and
2. The director
				shall seek input from appropriate professional organizations in making his/her
				appointments.
(C) The
				subject of the evaluation shall provide the director with a list of all health
				care facilities and community-based practices, regardless of location, where
				the subject performs invasive procedures.
(D) The expert review panel shall utilize the
				following to evaluate the health care professional's practice:
1. Criteria specified in 191.700.2(3),
				RSMo;
2. Verification of the health
				care professional's licensure status;
3. Current, scientific evidence that is
				available; and
4. Panel members'
				professional judgments.
(E) Panel members shall be subject to the
				requirements of section 191.656, RSMo regarding the confidentiality of
				information on an HIV-infected health care professional's infection
				status.
(F) The health care
				professional shall be allowed to appear before the panel and present any
				information which s/he believes to be pertinent to the panel's task. The health
				care professional's personal physician(s) and any other individual(s) the
				health care professional believes can provide pertinent input into the process
				shall be allowed to appear before the panel.
(G) The panel may recommend that restrictions
				or limitations be placed on the practice of the health care
				professional.
(H) The panel shall
				require the health care professional to notify any affected patient in a timely
				manner whenever a parenteral or mucous membrane exposure to the health care
				professional's blood occurs.
(I)
				The panel's findings and recommendations shall be conveyed in writing to the
				health care professional and to the director.
(J) The director shall disclose to the chief
				administrative officer or equivalent individual in each health care facility or
				community-based practice where the health care professional is performing
				invasive procedures any restrictions or limitations placed on his/her practice
				by the panel.
(K) If the health
				care professional seeks to affiliate with an additional health care facility or
				community-based practice, regardless of its location, where s/he will be
				performing invasive procedures, s/he shall disclose to the chief administrative
				officer or equivalent individual in that facility or practice the findings of
				the review panel, and any restrictions or limitations placed on his/her
				practice by the panel, prior to the affiliation and the provision of patient
				care. S/he shall also advise the department of the new practice
				location.
(L) If the health care
				professional plans to begin performing invasive procedures at a health care
				facility or community-based practice where s/he is currently affiliated but not
				presently performing those procedures, s/he shall disclose to the chief
				administrative officer or equivalent individual in that facility or practice
				the findings of the review panel, and any restrictions or limitations placed on
				his/her practice by the panel, prior to the performance of any invasive
				procedures, and report his/her intention to begin performing invasive
				procedures in writing to the director prior to beginning to perform these
				procedures.
(M) If the review panel
				places restrictions or limitations on the health care professional's practice,
				it shall be the responsibility of each health care facility where s/he is
				employed and performing invasive procedures to monitor him/her for compliance
				at appropriate intervals, at least annually, based on his/her medical status
				and the types and frequencies of invasive procedures s/he performs. If a
				facility finds the health care professional to be noncompliant, it shall report
				this in writing to the appropriate state board, as provided under Chapters 330,
				332, 334 or 335, RSMo, and to the director.
(N) If the review panel places restrictions
				or limitations on the practice of a health care professional who performs
				invasive procedures in a community-based setting, it shall be the
				responsibility of the department to monitor him/her for compliance in this
				setting at appropriate intervals, at least annually, based on his/her medical
				status and the types and frequencies of invasive procedures s/he performs. If
				the department finds the health care professional to be noncompliant, it shall
				report this in writing to the appropriate state board, as provided under
				Chapters 330, 332, 334 or 335, RSMo, and to the director.
(O) If the director becomes aware that the
				infected health care professional is noncom-pliant with practice restrictions
				or limitations at any location where s/he is performing invasive procedures,
				the director shall report this noncompliance to the chief administrative
				officer or equivalent individual in each health care facility and
				community-based practice where the health care professional performs invasive
				procedures.
(P) The panel shall
				require, as necessary, that the infected health care professional undergo
				periodic reviews to determine if the decision to place or not to place
				restrictions or limitations on his/her practice needs to be modified because of
				changes in his/her medical condition or some other relevant circumstance. If a
				review results in the panel making such a modification, this modification shall
				be conveyed in writing to the health care professional and the director. If the
				modification results in restrictions or limitations, or further restrictions or
				limitations, being placed on the health care professional, the director shall
				disclose this modification to the chief administrative officer or equivalent
				individual in each health care facility or community-based practice where the
				health care professional is performing invasive procedures.
(Q) If restrictions or limitations have been
				placed on a health care professional's practice by the panel and if later there
				is a change in the individual's medical condition or some other relevant
				circumstance, and as a result s/he believes that the restrictions or
				limitations should be modified, s/he may request in writing to the director
				that the panel consider such a modification. A similar written request may also
				be made by the director or chief administrative officer of a health care
				facility with the consent of the infected health care professional and after
				consultation with his/her private physician. The panel shall review the
				information and determine whether modification is necessary. If a modification
				is made, this shall be conveyed in writing to the health care professional and
				the director. If the modification results in further restrictions or
				limitations being placed on the health care professional, the director shall
				disclose this modification to the chief administrative officer or equivalent
				individual in each health care facility or community-based practice where the
				health care professional is performing invasive procedures.