HEPATITIS C Discrimination in the hospital setting

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HEPATITIS CDiscrimination in the hospitalsetting

• Sinéad Sheils/Sue Mason
• Hepatitis C CNC
• Royal Prince Alfred Hospital

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Discrimination in the hospital setting

• Several government enquires and research reports
  have demonstrated that discrimination is a
  significant issue for people with HCV.
• The C change report (ABD, 2001) found that
  discrimination is prevalent within health care
  settings.
• Other studies have reported patients being
  refused medical treatment because of HCV
  infection.

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Impact of discrimination

• Incidents of discrimination have a big impact on
  individuals who may choose to avoid further
  contact with health care settings
• Can lead to ill health unnecessarily
• Each episode of discrimination undermines the
  professional relationship between an individual
  all HCW/health professionals

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Case 1

• Distraught wife of someone on treatment for
  hepatitis C phoned. She had taken their 3 month
  old baby to a paediatrician who told the woman
  that there was a chance baby had HCV that baby
  should be tested. So the baby was held down
  whilst 6 tubes of blood were collected.The
  incident had huge emotional toll on both husband
  wife.

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Case 2

• Man was travelling with work found he was
  missing a needle for his interferon redipen
  injection due that evening. By the time he
  phoned, he had approached the local pharmacy
  AE dept. He expressed his dismay at the
  unpleasant response he had received at both
  locations. After he explained what he was trying
  to acquire why, HCWs manner had changed from
  being pleasant to being really unhelpful,
  unpleasant totally dismissive. One health
  professional suggested that he was drug seeking.
  

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Case 3

• Woman phoned very upset angry. She had just
  disclosed HCV ve status to an anaesthetist in
  pre admission clinic. She felt his manner
  change immediately he questioned her
  intensively on how she had acquired HCV. He
  focussed on this health issue for what she felt
  was an inappropriate length of time, rather than
  the main reason for her attending the clinic.
  Additionally he had poor quality information
  about transmission disease progression. She
  felt extremely uncomfortable was very angry
  when she contacted us as this had happened in our
  health care setting.

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And more ...

• HCV status written in bold ink at front of
  peoples hospital notes
• A woman was refused placement on waiting list for
  lung transplant as she had hepatitis C
• Many instances of non-specific changes in
  attitude that people feel when they disclose to
  HCW that they have hepatitis C

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Protecting from discrimination

• Building trust
• Ensuring privacy/confidentiality
• flexible appt schedules/before work or phone
  appts to prevent attention by employer
• sick certificates/attendance letters being worded
  in general terms
• caution with identification on telephone at home
  and/or work
• using non-judgmental language
• having an accepting attitude

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• encourage general awareness of existence of
  discrimination anti discrimination legislation
• discuss disclosure issues advise to consider
  carefully prior to disclosure
• consider reported incidents individually
• promote participate in implementation of
  education training programs for HCW
• Implement tactics to assist people through
  hospital system

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• Supporting individuals with hepatitis C who are
  HCW
• very aware of hepatitis c related discrimination
  by employers/work colleagues
• Use of alias or incomplete names for
  identification

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And lastly Education

• Needs clever approach to encourage HCW to
  evaluate their own attitudes values, whilst
  making the education experience relevant to them
• Collaborative approach from educators experts
  across the Area
• Needs to target all HCW from early in their
  career with regular updates

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