• Law No. 81 of June 4, 1983

Establishes everything related to the Prevention of Sexually Transmitted Diseases or Infections in Puerto Rico. Said statute establishes a waiver of civil liability to the doctor who examines and offers treatment, and to the epidemiology technician who appointments, investigates, guides and notifies both patients positive for a Sexually Transmitted Disease (STD) or a Sexually Transmitted Infection ( STIs), as well as their sexual partners or injecting drug equipment exchange, including those under 21 years of age or mentally disabled. Interventions are carried out with people who suffer or are suspected of suffering from a sexually transmitted disease or infection, without the requirement of prior consent from parents or legal guardians. Sexually Transmitted Diseases or Infections (STDs/STIs), including Human Immunodeficiency Virus Infection (HIV), have suffered an alarming increase in recent times, both in Puerto Rico and throughout the world. One of the most affected populations in Puerto Rico are young people under 21 years of age, despite the fact that they are receiving care in terms of control and prevention of STDs/STIs or HIV.

It is important to amend Law No. 81 of June 4, 1983, in order to include other health professionals or representatives to intervene with those under 21 years of age and mentally disabled in the management of STDs/ITS/ HIV, tempering this Law to current needs. This Bill proposes that health professionals or representatives who offer Preventive Counseling or sample collection services for the detection of STDs/STIs and HIV, both in clinics and in community outreach scenarios, be relieved of responsibility. These health professionals or representatives are certified by the Department of Health or the Centers for Disease Control and Prevention to offer HIV Preventive Counseling. For this reason, this Legislative Assembly deems it necessary to approve legislation in order to provide adequate control and prevention for Sexually Transmitted Diseases or Infections and the Human Immunodeficiency Virus in order to protect the health of all of Puerto Rico. BE IT ENACTED BY THE LEGISLATURE OF PUERTO RICO: Section 1.- Subsections (a) and (g) are amended, and new subsections (h) and (i) are added to Section 1 of Act No. 81 of June 4, 1983, as amended, so that read as follows: "Article 1.- Definitions- For the purposes of this Law, the following terms shall have the meaning expressed below: (a) Sexually transmitted diseases (STDs) are those diseases that scientific research has determined are transmitted through sexual contact or needle exchange. These include: Syphilis, gonorrhea, granuloma inguinal, lymphogranuloma venereum, chancroid, nonspecific urethritis, trichomoniasis vaginitis, crab lice, genital herpes simplex Type I, genital herpes simplex Type II, hepatitis Type B, hepatitis Type C, scabies (scabies) , anogenital warts (condyloma acuminata), Chlamydia Trachomatis, bacterial vaginosis, acquired immunodeficiency syndrome (AIDS) and any other that in the future the Secretary determines through regulations as a sexually transmitted disease or infection. (b) ... (c) ... (d) ... (e) ... (f) ... (g) Physician. Person authorized to practice medicine and surgery in Puerto Rico, by obtaining a license issued by the Board of Medical Examiners of Puerto Rico. (h) Health professional or representative. It will include a person certified by the Atlanta Department of Health and/or Centers for Disease Control and Prevention to offer HIV/AIDS Preventive Counseling services. (i) Sexually Transmitted Infections. That infection that the pertinent scientific investigation has determined that they are transmitted through sexual contact or exchange of needles. Among these, the Human Immunodeficiency Virus Infection (HIV)." Section 2.- Section 4 of Act No. 81 of June 4, 1983, as amended, is hereby amended to read as follows: "Section 4.- Any doctor who diagnoses a case of sexually transmitted diseases must, within the next five (5) days following the diagnosis, notify the Program indicating the name, age, date of birth, sex, residential address and type of disease, the patient's phone number and the name, phone number and address of the doctor who recommended the test. This information will be considered confidential and will be so marked in the Program." Section 3.- Section 5 of Act No. 81 of June 4, 1983, as amended, is hereby amended to read as follows:

"Article 5. - Doctors, health professionals or representatives, and managers of civil liability laboratories. The doctor, professional or health representative certified by the Department of Health and/or the Centers for Disease Control and Prevention for the intervention in Preventive Counseling for HIV, and the person in charge of a laboratory will be released from civil liability upon send to the Program the confidential information requested in the forms provided for these purposes by the Department." Section 4.- Section 8 of Act No. 81 of June 4, 1983, as amended, is hereby amended to read as follows: "Article 8. -Doctors, health professionals or representatives - Inadmissibility in evidence.- Testimony and any Program documents that identify patients and their sexual contacts will be inadmissible in evidence, except where authorized by the patient or sexual contact. Provided, that the physician, health professional or representative shall be prevented from disclosing the content of the information that they may have become aware of as a result of their intervention with the patient or their sexual contact." Section 5.- Section 9 of Act No. 81 of June 4, 1983, as amended, is hereby amended to read as follows: "Article 9.- Investigation and examination of suspicious persons. Health doctors will use all available means to determine the existence. Medical health officers will use all available means to determine the existence of sexually transmitted diseases, as well as to determine the sources of said diseases. The health doctor who has reasonable grounds to believe that a person is suffering from or has been infected with a sexually transmitted disease, which could infect or be a source of infection for any other person, must require said person to submit to an examination doctor and take a sample of blood or other body secretions for laboratory tests that may be necessary to establish the presence or absence of said disease or infection. Provided, that the required examination shall be performed by the health physician or, at the option of the person subject to the examination, by an authorized physician who, in the opinion of the health epidemiology technician, is qualified to perform said work and has his or her approval. The authorized physician who performs said examination shall render a report thereof to the health epidemiology technician of the Department of Health, but shall not issue a certificate of immunity. Provided, further, that the health epidemiology technician may request the courts to order the person suffering from a sexually transmitted disease to attend any of the Program's clinics to receive treatment. The Department of Health will provide medical assistance to any medically indigent person suffering from a sexually transmitted disease. Section 6.- Section 10 of Act No. 81 of June 4, 1983, as amended, is hereby amended to read as follows: "Article 10.- Examination or treatment of minors or disabled persons; waiver of civil liability. Any doctor, professional or health representative who examines or treats a minor under 21 years of age, or a retarded person, or a mentally incapacitated person who suffers or is suspected of suffering from any sexually transmitted disease, is released from civil liability. without previously obtaining the consent of the parents or of the persons legally called to consent for them. In the same way, the clinics and hospitals where these services are provided will be relieved of responsibility." Section 7.- Section 16 of Act No. 81 of June 4, 1983, as amended, is hereby amended to read as follows: "Article 16.- Penalties Any person who violates the provisions of this Law, will incur in a misdemeanor and, if convicted, will be sanctioned with a prison sentence that will not exceed six (6) months or a fine that will not exceed one thousand five hundred (1,500) dollars or both penalties. at the discretion of the court." Article 8.- This Law will enter into force immediately after its approval.

Reference: Ley para la prevencin y tratamiento de enfermedades de transmisin sexual, Ley nm. 81 de 4 de junio de 1983, 24 L.P.R.A. 571-583 (2008).

• Health Insurance Portability and Accountability Act, PL 104-191, August 21, 1996, 110 Stat 1936 Disponible en la base de datos WestlawNext en la Biblioteca Virtual. Cdigo de documento: PL 104-191 (HR 3103)

Question:

1. What is the purpose of each of these laws and their relationship to the right to privacy? 2. What is the instrument used to relieve certain health professionals of any responsibility and to prevent the disclosure of confidential patient information?