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Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act
contagious, infectious diseases and the people with whom they came in contact, to isolate and quarantine them, or take other measures to control the spread of disease (Birkhead and Maylahn, 2000). Since the 1950s, surveillance has gradually expanded to include monitoring disease trends in populations for the purpose of initiating population-based disease-control programs. More recently, traditional models for controlling communicable diseases have also been extended to noninfectious diseases, as well as occupational, environmental, behavioral, biological, and social factors that are believed to contribute to the onset and spread of disease (Thacker, 2000). Surveillance is a process that relies on increasingly sophisticated epidemiological and statistical techniques and requires a large and complex system that stretches from the individual practitioner to the World Health Organization.
In the United States, legal authority to require reporting of diseases resides primarily at the state level. In some states, legislation specifies reporting requirements for particular diseases; in others, legislation delegates authority to the state health department or local boards of health to designate reportable disease by regulation; and some states use both (Thacker, 2000).1 Legislative authorization is necessary because health providers cannot lawfully release or disclose personal medical information about a patient without the patient’s consent.2 Health care facilities
The state’s sovereign police power, which authorizes it to adopt legislation to protect the public’s health and safety, includes the power to protect the public from the spread of communicable diseases. The state legislature may authorize counties, cities, or towns to take action within their jurisdictions (Gostin, 2000; Hall et al., 2003). The federal government also has constitutional authority to enact legislation to prevent the spread of communicable diseases introduced by immigration, commerce with foreign nations, domestic interstate commerce, acts of war, or threats to national security (U.S. Constitution, article 1, sec. 8).
Health care providers have a general common law (and, in some cases, statutory) duty to refrain from disclosing such information without the patient’s consent (e.g., Federal Privacy Act, Health Insurance Portability and Accountability Act (HIPAA) regulations). In addition, the U.S. Constitution (and some state constitutions) protect an individual’s right to privacy in his or her personal medical information and from disclosure without the individual’s consent. The Fourth Amendment to the Constitution prohibits unreasonable searches and seizures, which include the disclosure of medical information. The Due Process Clause of the Fifth and Fourteenth Amendments prohibits the federal and state governments from depriving any person of liberty without due process of law. Liberty interests are also implicated because statutes that make diseases reportable may also typically subject individuals who are reported to deprivations of liberty, such as isolation. (The Committee notes that some state AIDS or HIV reporting laws are distinct statutes in order to avoid subjecting people with HIV or AIDS to such controls.) Several federal courts of appeal have recognized that “individuals who are affected by the HIV virus clearly possess a constitutional right to privacy regarding their condition” (Doe v City of New York, 15 F3d 264, 267 [2d Cir 1994]). See also Doe v SEPTA, 72 F3d 1133 (3d Cir 1995). Such rights are not absolute,