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Resource Manual for Support of Dentists with HBV, HIV, TB and Other
Infectious Diseases Legal Issues Infected practitioners have various
legal rights and responsibilities, as do persons with whom they
associate. There are civil rights laws prohibiting discrimination
against persons with disabilities, which afford numerous protections to
infected providers and those who associate with them. These and other
state laws (e.g., pertaining to confidentiality and practice
restrictions) may bear upon an infected provider's practice. The law regarding infected
practitioners should be driven by science. For example, for the same
reason that HIV-infected patients have certain legal rights to
treatment, HIV-infected providers have certain rights to practice: in
each case, the common thread driving the law is the generally accepted
scientific proposition that universal precautions work. Because much of
the law concerning infected providers arises in the HIV/AIDS context,
this chapter emphasizes that model. The legal issues facing HIV-infected
health care workers in their practices are arguably important for all
health care providers, whether they themselves are HIV-infected or
not. For example, unwarranted restrictions imposed on HIV-infected
providers have the potential to undermine the critical patient education
message that treatment is safe when universal precautions are followed. Anti-Discrimination Laws A number of civil rights laws
prohibit unwarranted discrimination against persons with infectious
diseases. At the federal level, these are the Americans with
Disabilities Act (AwDA) and the Rehabilitation Act (Rehab Act); similar
state and local laws may also apply. Under the AwDA, a person is
considered to have a disability if she/he has a physical or mental
impairment that substantially limits a major life activity (such as
breathing, walking, working, etc.), has a record of such an impairment,
or is perceived as having such an impairment. Accordingly, most courts
are likely to treat HIV/AIDS, Hepatitis and TB as both infectious
diseases and disabilities for legal purposes. Protections for persons with
disabilities under the civil rights laws are far reaching, extending to
employment, public accommodations (commercially available services such
as medical care, entertainment, etc.) and services provided by public
entities (including units of state and local government, such as state
hospitals). The Rehab Act affords protection for persons with handicaps
employed in businesses of all sizes, when the employer receives
Medicare, Medicaid or other federal funding. These federal laws set the
minimum standards. State and local laws may provide persons with
disabilities even more rights and/or legal remedies. In addition to expanding protections
for people with disabilities, the AwDA provides powerful new protections
against discrimination for individuals who have associations or
relationships with people with disabilities; e.g., their friends, family
and probably even their professional advisors. The anti-discrimination laws provide
various remedies for aggrieved persons. Infected providers who believe
they have been discriminated against should consult with their legal
counsel regarding their rights. The remedies available to individuals
who suffer discrimination vary according to the statute under which a
claim is filed. A successful plaintiff in an discrimination suit may be
able to secure fines, damages, injunctive relief (e.g., reinstatement or
orders preventing further discrimination) and attorneys fees. Public Accommodations The AwDA's prohibition of
discrimination in places of public accommodation (Title 111) affords
protections to all persons with disabilities, including infected
providers, in numerous important avenues of their lives; e.g., health
care, food service, entertainment and other service industries are all
covered by this portion of the law. Supplementing the federal laws' duty
of equal treatment, most states and units of local government have
similar public accommodations provisions that apply to individuals with
disabilities, which may afford even greater protections. The AwDA's general rule prohibiting
discrimination against persons with disabilities by places of public
accommodation provides:
"[n]o individual shall be discriminated
against on the basis of disability in the full and equal enjoyment of
the goods, services, facilities, privileges, advantages, or
accommodations of any place of public accommodation by any person who
owns, leases (or leases to), or operates a place of public
accommodation."
The law refers to behavior that will
constitute discrimination such as a denial of participation, provision
of only an unequal benefit, and provision of a separate benefit. In
addition, the AwDA grants persons with disabilities the right to enjoy
public accommodations in an integrated (as opposed to segregated)
setting, and the right to participate in integrated programs. The AwDA
prohibits the use of administrative methods that have the effect of
discriminating against the persons with disabilities (e.g., unwarranted
eligibility criteria that screen out people with disabilities), and the
modification of policies and practices or procedures to limit access to
the public service or accommodation in question. Finally, the AwDA's
prohibition against "associational discrimination" protects even
able-bodied individuals who associate with persons with disabilities.
The AwDA and the Rehab Act provide a
defense if the disabled individual cannot be accommodated without
creating a "direct threat" to the health and safety of others. "Direct
threat" is defined as a "significant risk to the health and safety of
others that cannot be eliminated by a modification of policies . . . or
procedures . . ." While the construction of the direct threat defense is
unclear, courts have held that it is necessary to make an individualized
assessment of the nature of the risk, the probability of injury, and the
possible reasonable modification of policies. It should be noted that
the threat of transmission varies depending on the infectious disease in
question. For example, a dentist seeking certain services may be viewed
as posing a direct threat if she/he has a highly communicable disease
such as active TB, as opposed to HIV, which can only be transmitted via
blood or certain other body fluids. Further, if the threat can be
satisfactorily modified, perhaps via the use of special precautions,
even a dentist with active TB might be entitled to certain services,
such as emergency medical care.
Employment
The AwDA's employment law provisions
(Title 1) prohibit all employers with 15 or more employees from
discriminating in employment. Although infected providers who are
employed in small dental practices may not be covered by this portion of
the AwDA, they may nevertheless have federal employment law rights under
the Rehab Act, which is a similar law that applies to all
employers who receive certain federal funds. In addition, more stringent
state and local laws may also apply.
The AwDA prohibits a covered employer
from discriminating against a qualified person with a disability in all
aspects of the employment relationship. This prohibition extends to job
application procedures, hiring and firing, job training or advancement,
compensation and benefits, and other terms, conditions and privileges of
employment. To qualify for Title I protection, the person must be "a
qualified individual with a disability" able to perform the "essential
functions of the job' with or without a "reasonable accommodation."
Discrimination under the AwDA includes the failure by an employer to
make reasonable accommodations to the known limitations of a person with
a disability. The term "reasonable accommodation" is defined to include
"modifications or adjustments to a job application process, work
environment or the manner in which a job is performed that enable a
qualified individual with a disability to be considered for or able to
perform the job." Examples include removal of structural barriers,
modified work schedules (such as flex time), provision of auxiliary
aids, job restructuring or reassignment. An employer is not required to
make an accommodation that would cause an "undue hardship" on its
business, allowing a financial defense to employers.
The AwDA does not prevent employers
from using "qualification standards" that relate to the essential
functions of the job in question and are consistent with business
necessity. However, the use of qualification standards as a pretext to
screen out individuals with disabilities is not permissible.
Employers covered by the AwDA can
terminate or refuse to hire a person based on the presence of a "direct
threat" to the health and safety of others. As in the public
accommodations context, the direct threat standard sets a very high
threshold, requires an individualized determination and (according to
regulations interpreting the AwDA) must be based on current public
health expertise. For example, it would be inappropriate for an employer
to impose practice restrictions on an HIV-infected dentist without
establishing that universal precautions would not eliminate or
satisfactorily minimize any threat of transmission.
Currently, there is no scientific
evidence to indicate that HIV- infected health care providers pose an
identifiable risk of HIV transmission to their patients . . . The ADA
strongly affirms that universal precautions are an effective and
adequate means of preventing the transmission of HIV from dental health
care workers to patient and patient to dental health care worker.
Practice Issues
A driving legal theme relative to
practice issues, and certainly one of critical concern to many infected
providers, is that of confidentiality. Just as an infected
patient's health care information is protected by both state and federal
laws, an infected health care worker's status is generally protected
from disclosure by statutes mandating confidentiality. Similarly, the
United States and state constitutions recognize an individual's right to
privacy with respect to health care information. However, the right to
privacy is not absolute, and courts are being confronted with the task
of balancing the privacy right of an individual health care worker with
the competing need for the public disclosure of relevant information to
patients. A particularly sensitive situation can arise when a provider
is asked by a patient, before treatment, about the provider's HIV
status. Whether a provider has a duty to disclose at that point is
likely to turn, in large part, on whether the information must be
disclosed to secure informed consent under state law.
The necessary balance between provider
and patient rights plays out in numerous arenas. To begin with, there
may be various state mandated practice restrictions and/or reporting
requirements. In addition, the balance must often be struck in the
context of various business relationships, including employment, medical
staff, insurance, managed care and practice sales.
The remainder of this chapter addresses
the above issues. It closes with an indication of how an infected
dentist's relationships with his/her friends, family, and advisors may
be shaped by similar confidentiality issues and other related legal
concerns.
State Mandated Restrictions and
Disclosure
CDC and State Guidelines
Despite the protections provided by
federal anti-discrimination laws, some restrictions on HIV-infected
health care workers have been recognized. The Centers for Disease
Control and Prevention (CDC) has established guidelines for practice
restrictions on health care workers with HIV. In 1991, Congress enacted
a law requiring states, as a condition of federal funding, to adopt the
CDC guidelines or equivalent regulations restricting the practice of
HIV-infected health care workers. Pursuant to that law, forty-six states
have adopted either the guidelines or their equivalents. The four
remaining states, Indiana, Kentucky, Nebraska and New Jersey, have
received extensions of time to comply with the law (as of this writing).
The CDC guidelines base their
restrictions on the definition of "invasive procedures" which are
generally defined to include procedures that involve surgical entry into
tissues, cavities, or organs or repair of major traumatic injuries. The
guidelines suggest that health care professionals who perform such
invasive procedures should know their HIV status and, if positive, they
should not perform exposure-prone procedures unless they have sought
counsel from an expert review panel.
The guidelines do not mandate that
HIV-infected health care workers notify patients or stop working.
Rather, the CDC guidelines and state equivalents, along with the
policies of most national health care societies, support case by case
evaluation of what practice restrictions, if any, should be imposed on
the provider in question. This would typically be done by an expert
review panel in the state where the provider practices. In some states,
submission to such a panel is mandatory. In others, where it is
permissive, voluntary submission to such a panel can be good risk
management and may help protect against frivolous litigation. It should
be noted that the state requirements may establish a standard of care,
which can make compliance even more important; e.g., many states
"strongly encourage" that all at-risk health care workers know their
status, whereas in other states this is a mandate.
Assuming that state expert review
panels are covered by the Americans with Disabilities Act prohibiting
discrimination by units of state and local government (Title 11), their
activities must be conducted on a non-discriminatory basis. This
suggests that any practice restrictions recommended by such review
panels must be rooted in science, rather than based on unsupported
fears. While there is no case law addressing the issue, it would seem
reasonable for a panel to consider, on a case by case basis:
(This last factor should not result in
disqualification unless a non-infected provider with the same functional
defects, e.g., due to Alzheimers or other conditions, would also be
disqualified.)
If after considering such factors the
panel determines that there is no meaningful risk of transmission, the
panel would be hard pressed to find a legal basis to restrict the
provider's practice.
Mandatory Reporting
It is believed that few state boards
require HIV-infected providers to report their status, but providers
should know what is required. As state entities, licensing boards need
to comply with the AwDA's prohibition of discrimination by units of
state and local government (Title 11). Accordingly, disclosure to state
boards can arguably be required only if supported by sound science;
e.g., evidence that mandatory disclosure would reduce a significant risk
of transmission.
Mandatory Testing of Providers
The legal status of state mandated HIV
testing requirements for health care providers is as yet undecided under
the AwDA and Rehab Act. Public health experts and most major health care
societies oppose mandatory testing for a variety of reasons, including
cost and the fact that test results do not provide current information.
The analysis of the legality of mandatory testing may ultimately be
patterned after the balancing test that has been applied in
confidentiality decisions, by weighing the privacy right of the dentist
against the interest of the patient to know the HIV-status of his or her
health care provider.
Practice Sales
Legal and ethical issues may arise in
connection with the sale by an infected provider of his or her practice.
The legal concerns relate principally to whether there is a duty to
disclose one's status to potential purchasers. The answer to this
question will likely turn on state and/or local law. For example, is
there a state statute mandating disclosure? Is there a common law or
ethical duty to disclose material facts that bear upon the value of the
practice? An obviously inexact analogy may be made to whether a
homeowner has legal or ethical duties to disclose, before sale, that
his/her house has a leaky roof or floods. Is there a local ordinance
that requires disclosure, or at least disclosure if asked? In contrast,
does a state statute expressly provide that a seller's infections
disease status need not be disclosed? Consider the hypothetical
situation of an infected dentist who has maintained the value of his/her
practice by keeping his/her infected status confidential, believing that
the value of the practice would drop significantly once the patients
learn of the dentist's status. In balancing the buyer's and seller's
interests, a court considering fraud or negligence claims would likely
address a variety of public policy considerations.
"Fear of AIDS" Cases
In addition to finding that a health
care provider's right to privacy is superseded by the interest of
patients in knowing the provider's health care status, courts in a few
states, but not others, have recognized a right of action where patients
are not informed that their health care provider is HIV positive. These
cases, often referred to as "fear of AIDS" cases, have opened some
HIV-infected health care providers up to liability for treating
patients, even absent any proof of transmission. The permissibility of
these so-called "fear of AIDS" cases varies according to state law.
The "fear of AIDS" cases reflect an
especially broad reading of the law of negligent infliction of emotional
distress because they allow patients to pursue a cause of action without
showing actual exposure to HIV. In the few jurisdictions that have
allowed "fear of AIDS" cases, HIV-infected providers typically need to
inform patients of their HIV-status in order to secure informed consent;
otherwise, they may face the prospect of non-infected patients, upon
learning that their provider was infected, pursuing claims on the basis
that they fear they will contract HIV.
In many states, claims for emotional
distress based on "fear of AIDS" have not been allowed or have been
severely restricted. For example, one state supreme court has held that
in order to recover emotional damages based on the fear of contracting
AIDS, the plaintiff must prove actual exposure to HIV. Another state
supreme court has ruled that emotional distress is not an injury unless
the plaintiff can plead and prove that "the fear stems from a knowledge,
corroborated by reliable medical and scientific opinion, that it is more
likely than not that the feared cancer will develop in the future."
Similar decisions have applied this standard to fear of AIDS cases.
Indeed, the overall trend seems to be that more courts are disallowing
or restricting "fear of AIDS" claims than allowing them.
When a health care provider
consistently uses universal precautions, a patient who contracts AIDS
may have a difficult time establishing that the provider should be held
liable for transmission of HIV. Nevertheless, because some states allow
"fear of AIDS" claims and others do not, infected providers should keep
abreast of their state law in this regard.
Business Restrictions and Disclosure
Employer Restrictions on Infected
Health Care Workers
The AwDA and Rehab Act clearly prohibit
employers from restricting the practice of infected health care workers
who pose no risk of transmission. However, it is not entirely clear
whether the remote risk posed by certain health care workers may be
found by courts to present a "direct threat" giving rise to a statutory
exception. "Direct threat" is defined as a "significant risk to the
health and safety of others that cannot be eliminated by a modification
of policies . . . or procedures . . ." Because the federal statutes
clearly require the existence of a significant risk, a minimal risk is
unlikely to allow for discrimination.
There is very limited case law
interpreting the "direct threat" defense. While the construction of the
defense is not yet clear, courts have held that it is necessary to make
an individualized assessment of the nature of the risk, the probability
of the injury, and the possible reasonable modification of policies.
Outside the health care context, courts applying such analysis have
consistently found that HIV does not constitute a direct threat.
Some courts have found that certain
HIV-infected health care providers who undertake invasive procedures
pose a direct threat of transmission that cannot be reduced to an
acceptable level through the use of universal precautions. Accordingly,
those courts have held that a provider's practice could be restricted
and/or that the provider must inform patients of his/her status - in
other words, that an individual health care worker's right to privacy is
superseded by the patient's interest in knowing the HIV status of
his/her health care providers. In contrast, another court found that the
risk of transmission during a routine physical exam by a infected
physician using universal precautions was not significant.
It should be noted that the cases
finding against infected providers are arguably not in line with the
general rule that informed consent does not require the disclosure of
remote or statistically insignificant risks. Further, to date no court
has reached a similar result concerning "direct threat" when assessing
the duty to treat HIV-infected patients, in that context, scientific
testimony about the efficacy of universal precautions has driven the
law. The case law on this issue can be expected to evolve, and should be
driven by science. Expert testimony, along with the recognition of the
efficacy of universal precautions, is likely to be very influential in
the determination of what constitutes a direct threat.
Managed Care and Insurance
Do the civil rights laws apply if
managed care organizations and malpractice insurance providers, through
contractual provisions, require that participants of their programs not
carry an infectious disease and/or seek to compel testing? While this
issue has yet to be resolved by case law, a strong argument could be
made that the question is not whether the laws apply, but which part of
the laws apply. For example, dentist employees may be protected by the
AwDA and/or the Rehab Act; likewise, even non-employee dentists may have
protections under those laws, given a trend for courts to treat such
individuals as employees under the civil rights laws.
Providers confronted by managed care
companies with such contract provisions, whether they have an infectious
disease such as HIV or not, could argue that they are entitled to
protections as employees of those entities under the anti-discrimination
laws; in contrast, insurance companies would more likely be subject to
claims characterizing them as public accommodations.
Assuming that managed care and
insurance companies are covered by at least one applicable provision of
the anti-discrimination laws, the question then arises as to what types
of contract provisions would violate the law. Disclosure of a provider's
HIV status could probably be compelled only if there is a need for the
information and a possible non-discriminatory usage. For example,
blanket contract provisions that require providers to report
communicable diseases and cease practicing until a cure is found would
be of questionable legality.
Friends, Family and Advisors
As noted above, the AwDA provides
powerful new protections against discrimination for individuals who have
associations or relationships with people with disabilities; e.g., their
friends, family, professional advisors (although there are not yet any
cases on this point), and others. As a general rule, such individuals
are entitled to be free from discrimination by virtue of their
associations with persons with disabilities. It should be noted,
however, that only the person with a disability, not the persons with
whom she/he associates, is entitled to a "reasonable accommodation."
There are excellent and important
reasons to provide assistance to persons with disabilities. However,
individuals who provide such assistance may wish to keep in mind that
doing so is not without legal risk. For example, those giving
professional advice can be sued for malpractice, e.g., for giving bad
advice, making bad referrals, etc. Those giving advice beyond their area
of expertise may have risk, such as being charged with practicing
without a license. A sound approach is to provide good advice, within
one's area of expertise, and to secure professional liability insurance
where appropriate.
Infected dentists concerned about
confidentiality may wish to keep in mind that state law will typically
define what communications be protected as legally confidential. This
will often turn on the person(s) with whom the information is shared.
For example, sharing one's HIV status with one's doctor or lawyer is
generally protected pursuant to state confidentiality statutes. However,
offering the same information to one's friends may not be cloaked with
the same legal protections. Infected dentists will obviously want to
make informed choices about sharing information about their status, and
these legal concerns are only one aspect of that decision.
Ethical Considerations
The dentist-patient relationship is
characterized by fiduciary duties that distinguish the profession from
other occupations. These duties are incorporated in the
ADA Principles of Ethics and Code of Professional Conduct (Code).
The overriding ethical duty of dentists is service to the public. Legal
and ethical duties often track each other, but they are not the same.
Typically, ethical duties exceed legal requirements. The analysis by the
infected practitioner cannot stop with his or her legal rights and
responsibilities, but must include consideration of the question, "What
should I do, even if the law does not require it?"
The ADA Council on Ethics, Bylaws and
Judicial Affairs has issued the following interpretation of the Code
dealing with infected dentists:
"A dentist who becomes ill from any
disease or impaired in anyway shall, with consultation and advice from a
qualified physician or other authority, limit the activities of practice
to those areas that do not endanger the patients or members of the
dental staff."
(Advisory Opinion No. 1 to Code, Section 1-C, Community Service)
There are no decisions applying this
advisory opinion to a specific set of facts, so only general comments
about its implications are possible. Certainly, there is nothing in the
advisory opinion that automatically requires an infected dentist to
limit his or her practice without regard to risk. On the contrary, the
advisory opinion specifically ties the dentist's ethical duty to limit
his or her practice to the concept of patient and staff endangerment and
requires the dentist to seek advice from a qualified physician or other
authority. This is consistent with the procedure discussed previously
for expert review panels to make individualized risk assessments and
decide on a case by case basis what practice restrictions, if any,
should apply to a particular practitioner. A crucial element in any risk
assessment will always be the dentist's scrupulous adherence to
universal precautions.
A related issue is the ethical duty of
infected practitioners to disclose their disease status to their
patients. The Code respects the principal of patient autonomy,
that is, the right of competent individuals to make decisions about what
treatments will be rendered to their bodies. The Code states,
"The dentist should inform the patient
of the proposed treatment, and any reasonable alternatives, in a manner
that allows the patient to become involved in treatment decisions."
(Code, Section 1-M, Patient Involvement)
No one disputes that patients need
information about the risk of the proposed treatment in order to become
involved in treatment decisions. The problem is deciding what risks the
practitioner should disclose. Ethicists agree that dentists should
disclose all risks that are likely to occur and may cause death or
serious harm. They differ over whether there is an ethical obligation to
disclose risks that are extremely remote but involve potentially serious
consequences if the information is something the patient would want to
know. Some ethicists would argue that the dentist's HIV status is in
this category.
There are no easy answers. However, it
is difficult to reconcile an across-the-board duty to disclose with the
position that HIV infection alone does not automatically disqualify one
from practice. Unfortunately, disclosure of HIV status by an infected
dentist in the climate of fear surrounding AIDS is tantamount to
withdrawing from practice. Many, if not most, patients would probably
seek dental services elsewhere, if they knew their dentist was
HIV-infected, even though the risk of disease transmission to the
patient was virtually nonexistent.
Patients are not governed by the same
rules on confidentiality as practitioners. Disclosure to one patient is
likely to result in the information reaching other patients and the
larger community. The names of HIV-infected practitioners have appeared
in the press. The potentially devastating effects of such publicity on
family, friends and the individual practitioner should also be
considered in analyzing the dentist's ethical duty.
Conclusion
It is beyond the scope of this chapter
to provide a definitive analysis of the various laws and ethical
considerations that may effect a provider with an infectious disease.
The law is fluid, and blanket guidance is neither available nor
appropriate. The profession's understanding of the ethical obligations
of infected practitioners is also evolving. An infected dentist can be
well served by becoming familiar with the general legal and ethical
issues and obtaining expert legal counsel. The need for appropriate
counsel can be one of the most critical issues facing the infected
dentist, and it can be important to retain counsel before
important decisions, such as disclosure to state review boards,
insurance carriers, potential purchasers of a practice, employers, etc.,
need to be made. An attorney who is familiar with disability law and
dental practice issues, who follows the rapidly evolving case law, and
who has had experience with other infected providers, can be an
invaluable resource for the infected dentist.
Selected Readings
American Dental Association. ADA
principles of ethics and code of professional conduct. Chicago: ADA;
1994.
Burris, S. Public health, AIDS
exceptionalism and the law. John Marshall Law Review 1994; 27:251-272.
Center for Disease Control.
Recommendations for preventing transmission of human immunodeficiency
virus and hepatitis B virus to patients during exposure-prone invasive
procedures. Morbidity and Mortality Weekly Report 1991;40:1-8.
Douglas, D. Lawsuits challenge HIV
disclosure. AGD Impact. January 1994; 8-12.
Gautier, E. The legal rights and
obligations of HIV-infected health care workers. San Francisco: The
American Association of Physicians for Human Rights. 1993, phone
415-255-4547. A concise booklet, question and answer format providing an
overview of pertinent issues.
Gostin, L. The HIV-infected health care
professional. Public Policy, Discrimination and Patient Safety. Archives
of Internal Medicine, 1991; 151:663-665.
HIV/AIDS and health care industry
liability: an annotated bibliography. AIDS law symposium: legal, ethical
and policy issues. John Marshall Law Review, 1994; 27. Order by phone:
312-987-1415. Literature to date, along with brief summary of each
entry.
LeBlang, T.R. Obligations of
HIV-infected health professionals. John Marshall Law Review 1994; 2 7:31
7-330.
Margolis, Thomas E. Health care workers
and AIDS. The Journal of Legal Medicine, 1992;13:357-396. Concise
history of legal issues regarding HIV impacted providers.
Rubin, M., Miltko, S.M. Evolving
HIV/AIDS legal issues. Part 11. The rights and obligations of
HIV-infected health care providers. Paper delivered to National Health
Lawyers Association. November 10-11, 1994. (Available through ADA
Library).
Shuster, E.A. Surgeon with AIDS: a
threat to patient safety? The case of William H. Berringer. American
Journal of Medicine 1993; 94:93-99.
Resources*
American Dental Association - Legal
Affairs
211 E. Chicago Avenue
Also,
ADA Principles of Ethics and Code of Professional Conduct.
Chicago: ADA; 1994.
*AIDS Policy and Law
Buraff Publications
*American Association of Physicians for Human Rights
MERP Program
*American Bar Association
AIDS Coordination Project
*American Civil Liberties Union
AIDS Project
*Intergovernmental Health Policy Project
AIDS Policy Center
*Lambda Legal Defense and Education Fund
666 Broadway
The American Dental Association wishes
to express its appreciation to the Lambda Legal Defense and Education
Fund, Inc., for its review and comments on this chapter.
*Legalnet
Stetson College of Law
*National Health Law Program
2025 M Street, NW
*The National Lawyers Guild
HIV/AIDS Committee
Email:
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