Opinion ID: 2514133
Heading Depth: 1
Heading Rank: 5

Heading: Duty to Report to Public Agencies

Text: Instruction No. 15 also addressed the district court's holding that Bonnie's physicians had a duty to report Bonnie's hepatitis B status to the local health department. The version of K.S.A. 65-118 in effect in 1990 said: Whenever any person licensed to practice the healing arts ... knows or has information indicating that a person is suffering from or has died from an infectious or contagious disease, such knowledge or information shall be reported immediately to the county ... board of health ..., together with the name and address of the person who has or is suspected of having the infectious or contagious disease.... The Kansas Department of Health and Environment (KDHE) has adopted rules relating to the reporting of infectious or contagious diseases. See K.A.R. 28-1-2. K.S.A. 65-101(a)(6) authorizes the Secretary of Health and Environment to adopt rules and regulations to carry out the Secretary's 65-101(a) responsibilities, including reporting requirements. K.S.A. 65-101(a)(1). K.A.R. 28-1-1(h) defines disease as a definite morbid process having a characteristic train of symptoms. K.A.R. 28-1-2 lists infectious or contagious diseases and was amended in 1990. K.A.R. 28-1-2(a) (1989) listed hepatitis, type A (infectious), K.A.R. 28-1-2(a)(20); type B (serum), K.A.R. 28-1-2(a)(21); and type non-A non-B, K.A.R. 28-1-2(a)(22). Dr. Donnell cites K.S.A. 1990 Supp. 65-6004 to support his argument that defendants had no duty to warn others of Bonnie's hepatitis B status. In 1990, 60-6004 pertained only to the reporting of AIDS test results and does not apply here. (K.S.A. 65-6004 was amended in 1996 to include an infectious disease. See K.S.A. 2000 Supp. 65-6004[a]). Dr. Gianfranco Pezzino, the State Epidemiologist with KDHE, a witness for defendants, testified that in 1990 chronic hepatitis was not reportable in Kansas and is not reportable today. He was familiar with the administrative regulations as head of the epidemiology division of the agency charged with adopting the regulations. Viral hepatitis on the list of reportable diseases but not chronic hepatitis. The district court's Instruction No. 17 requested by Audra referenced K.A.R. 28-1-2(16), viral hepatitis. According to Dr. Pezzino, the case definition for viral hepatitis is an acute illness with discrete onset of symptoms of jaundice or elevated serum enzymes. He was reading from a standardized case put together by the Centers for Disease Control and Department of Epidemiology. Carol Borger, R.N., administrator of the Butler County Health Department, was a witness for plaintiffs. On cross-examination she was asked by counsel for Dr. Brown: Q. Those forms and formats as you got in 1990 specifically pointed out you do not report cases of chronic hepatitisor chronic carriers, isn't that a fact? A. I believe that's what the form says. We also note in the record a letter of May 27, 1992, from Keck R. Hartman, M.D., to Larry R. Hund, M.D., reporting that Bonnie is a hepatitis B carrier with a positive surface antigen. I checked her enzymes and they are normal which indicates she does not have chronic active disease. On cross-examination Bonnie agreed that she had been told that she was symptom free at this point in time. Dr. Larry W. Rumans, who has an active practice in infectious diseases, a witness for Audra, testified the reporting standards were generated by KDHE, often at the request of the Centers for Disease Control. According to him, the reporting requirement is the same regardless of whether hepatitis chronic or acute. He opined that the health department should have been notified that Mrs. Nold had chronic hepatitis B. The existence or nonexistence of a reporting duty under K.S.A. 65-118 remains an issue on remand. Questions that may arise include: What type of hepatitis did Bonnie have in 1990? What reporting did the applicable KDHE regulation require? Is there a medical distinction between viral hepatitis and chronic hepatitis? What significance does the K.A.R. 28-1-1(h) definition of disease have? If Bonnie's hepatitis B in 1990 was symptom free did she have a disease under 28-1-1(h)? It would seem that if there is a medical distinction between viral and chronic, and if Bonnie's hepatitis B in 1990 was not viral, none of the defendant physicians could have had a K.S.A. 65-118 or K.A.R. 28-1-2(16) reporting duty. If her hepatitis B in 1990 was viral, it appears at least some of the defendants would have had a reporting duty. We do not prejudge this question. Resolution will rest with the district court, assisted by expert medical testimony and experienced medical malpractice counsel.