Dr Robinson I appreciate the problems which you have outlined in your CMAJ letter (2001; 164(2): 173). You are out there on the frontlines exposed to the trauma of needle stick injury. You are spot on regarding your observations. Unfortunately when you sustain such an injury you may not have been observing 'universal precautions' and liability may be yours.
In 1998 the following motion was proposed at General Council in Whitehorse which might have offered you some protection. 'The CMA reccommends all patients undergoing any procedure where a health care worker could be accidentally exposed to the patient's body fluids be required to sign a waiver that would allow appropriate testing of that patient's serological status for HIV and hepatitis if such exposure should occur while maintaining patient confidentiality.'
At the annual meeting in 1999 this motion was adopted by a two thirds majority. One year ago however (CMAJ 2000 Jan 25)an editorial by Dr's Tyndall and Schechter opposed this 'Let's waive the waiver' on the grounds that it was vague,impractical, detrimental, pointless and unneccessary. I have responded to their concerns in the electronic BMJ (Jan 27 2000) but debate was not entertained. At the CMA annual meeting in 2000 their philosophy prevailed and the motion was withdrawn.
During this time attempts were made to manoeuvre a bill through parliament (Bill C-244) which would enable obtaining a court order for HIV screening from a contact where accidental or intentional needlestick trauma had resulted to a samaritan assisting in first aid or medical procedeure. After two readings this bill was killed by an early election call. The silence on this matter expressed by organized medicine was deafening!
Right again Dr Robinson. Ethics specialists (and editors) probably don't have anyone's blood on them at the end of the day. 'The pen is mightier than the sword' or for that matter the hollow needle.
James E Parker
Retired Paediatrian
Abbotsford B.C.