Introduced Version






SENATE BILL No. 458

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DIGEST OF INTRODUCED BILL



Citations Affected: IC 16-18-2 ; IC 16-41-6.

Synopsis: HIV testing of pregnant women. Requires that a pregnant woman be tested for HIV during pregnancy or at the time of delivery unless she refuses. Requires that a pregnant woman's refusal to consent to the test be documented in the woman's medical records. Specifies certain information regarding HIV testing, transmission, prevention, and treatment that must be provided to a pregnant woman. Requires that information regarding the HIV testing status of a pregnant woman be included on the confidential part of the birth or stillbirth certificate. Requires the results of the tests to be confidential. Requires the state department of health to distribute written materials explaining treatment options for individuals who have a positive HIV test. Repeals a provision concerning voluntary HIV testing for pregnant women and a provision containing an obsolete definition.

Effective: Upon passage; July 1, 2002.





Miller




    January 14, 2002, read first time and referred to Committee on Health and Provider Services.







Introduced

Second Regular Session 112th General Assembly (2002)


PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana Constitution) is being amended, the text of the existing provision will appear in this style type, additions will appear in this style type, and deletions will appear in this style type.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional provision adopted), the text of the new provision will appear in this style type. Also, the word NEW will appear in that style type in the introductory clause of each SECTION that adds a new provision to the Indiana Code or the Indiana Constitution.
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SENATE BILL No. 458



    A BILL FOR AN ACT to amend the Indiana Code concerning health.

Be it enacted by the General Assembly of the State of Indiana:

    SECTION 1. IC 16-18-2-337.8 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2002]: Sec. 337.8. "Standard serological test for HIV", for purposes of IC 16-41-6 , has the meaning set forth in IC 16-41-6-0.5.
    SECTION 2. IC 16-41-6-0.5 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2002]: Sec. 0.5. As used in this chapter, "standard serological test for HIV" means a test recognized by the state department as a standard serological test for the antibody or antigen to HIV.
    SECTION 3. IC 16-41-6-1 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2002]: Sec. 1. (a) Except as provided in subsection (b), a person may not perform a screening or confirmatory test for the antibody or antigen to the human immunodeficiency virus HIV without the consent of the individual to be tested or a representative as authorized under IC 16-36-1. A physician ordering the test or the physician's authorized representative

shall document whether or not the individual has consented. The test for the antibody or antigen to HIV may not be performed on a woman described in section 5, 6, or 7 of this chapter if the woman refuses under section 8 of this chapter to consent to the test.
    (b) The test for the antibody or antigen to HIV may be performed if one (1) of the following conditions exists:
        (1) If ordered by a physician who has obtained a health care consent under IC 16-36-1 or an implied consent under 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 subsection 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.
    (c) A court may order a person to undergo testing for HIV under IC 35-38-1-10.5 (a) or IC 35-38-2-2.3 (a)(16).
    SECTION 4. IC 16-41-6-4 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2002]: Sec. 4. (a) Subject to subsection (e), (f), if:
        (1) the mother of a newborn infant has not had a test performed under IC 16-41-6-2.5 section 5, 6, or 7 of this chapter;
        (2) the mother of a newborn infant has refused a test for the newborn infant to detect the human immunodeficiency virus 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 the human immunodeficiency virus 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 human immunodeficiency virus 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 physician who ordered the test shall inform the mother of the newborn infant of:
        (1) all treatment options available to the newborn infant; and
        (2) the prognostic implications of the disease.

     (f) If the 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).
    (f) (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.
    SECTION 5. IC 16-41-6-5 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2002]: 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 9 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 serological test for HIV.

    SECTION 6. IC 16-41-6-6 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2002]: Sec. 6. (a) Subject to sections 8 and 9 of this chapter, an individual other than a physician who is permitted by law to attend

a pregnant woman but who is not permitted by law to take blood specimens shall request that a licensed physician order to be taken a sample of the pregnant woman's blood.
    (b) A licensed physician who orders a blood sample under subsection (a) shall submit the sample to an approved laboratory for a standard serological test for HIV.

    SECTION 7. IC 16-41-6-7 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2002]: Sec. 7. Subject to section 9 of this chapter, if, at the time of delivery, there is no written evidence that a standard serological test for HIV has been performed under section 5 or 6 of this chapter, the individual 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 serological test for HIV.
    SECTION 8. IC 16-41-6-8 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2002]: Sec. 8. A pregnant woman has a right to refuse a test under section 5, 6, or 7 of this chapter.
    SECTION 9. IC 16-41-6-9 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2002]: Sec. 9. (a) This section applies to:
        (1) a physician or an advanced practice nurse who orders an HIV test under section 5 of this chapter or to the physician's or nurse's designee;
        (2) an individual other than a physician permitted by law to attend a pregnant woman who requests that a licensed physician order to be taken a sample of a pregnant woman's blood for an HIV test under section 6 of this chapter; and
        (3) an individual who, in attendance at the delivery of a child, orders an HIV test under section 7 of this chapter.
    (b) An individual described in subsection (a) shall inform the pregnant woman that:
        (1) the individual is required by law to:
            (A) if the individual is an individual described in subsection (a)(1) or (a)(3), order an HIV test; or
            (B) if the individual is an individual described in subsection (a)(2), request that a licensed physician order an HIV test;
        unless the pregnant woman refuses; and
        (2) the pregnant woman has a right to refuse the test.
    (c) An individual described in subsection (a) shall:
        (1) provide the pregnant woman with a description of the

methods of HIV transmission;
        (2) 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;
        (3) provide the pregnant woman with referral information to other HIV prevention, health care, and psychosocial services; and
        (4) explain to the pregnant woman:
            (A) the purpose of the test; and
            (B) the risks and benefits of the test.
    (d) An individual described in subsection (a) shall document in the pregnant woman's medical records that the pregnant woman received the information required under subsections (b) and (c).
    (e) If a pregnant woman refuses to consent to an HIV test, the refusal must be noted in the pregnant woman's medical records.
    (f) If a test ordered under section 5, 6, or 7 of this chapter is positive:
        (1) an individual described in subsection (a) shall inform the pregnant woman of all treatment options available to the pregnant woman; and
        (2) an individual described in subsection (a)(1) shall inform the pregnant woman of the prognostic implications of the disease.
    (g) The confidentiality provisions of IC 16-41-2-3 apply to a positive HIV test under section 5, 6, or 7 of this chapter.
    (h) The results of a test performed under section 5, 6, or 7 are confidential.

    SECTION 10. IC 16-41-6-10 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2002]: Sec. 10. 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 serological test for HIV was performed on the woman who bore the child.
        (2) If a standard serological test for HIV was performed:
            (A) on 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 serological test for HIV was not performed,

the reason why the test was not performed.
    SECTION 11. IC 16-41-6-11 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 11. 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.
    SECTION 12. THE FOLLOWING ARE REPEALED [EFFECTIVE JULY 1, 2002]: IC 16-18-2-290.5 ; IC 16-41-6-2.5.
    SECTION 13. An emergency is declared for this act.