U.S. Schools and Education

school photoHaving hepatitis B should not impact your education. However, we realize that people with hepatitis B often face discriminatory practices. In the U.S. education system, this primarily impacts those seeking education and training to become health care providers – students entering higher education to become physicians, nurses, physical therapists, and even x-ray and ultrasonography technicians. In some instances, it can also impact students who are asked to submit medical records when applying to private primary or secondary schools. It is important to know your rights so that if you, or someone you know, faces a discriminatory situation, you can appropriately respond.

 

What we are doing:

In the U.S., people with hepatitis B are protected under the Americans with Disabilities Act (ADA) and Title VI of the Civil Rights Act. The Hepatitis B Foundation is proud to have played a key role in a landmark settlement by the U.S. Department of Justice in 2013, which ruled that a medical school had violated the Americans with Disabilities Act (ADA) when they denied applicants because they had hepatitis B. The settlement confirmed that in the U.S., individuals seeking education and training in the health professions cannot be denied admission, threatened with dismissal, or have their higher education or professional training hindered/altered in any way because of their hepatitis B diagnosis. This was the first ADA settlement reached by the Justice Department on behalf of people with hepatitis B.

The settlement was reached based on the strength of the Centers for Disease Control and Prevention’s (CDC) recommendations for hepatitis B-infected health care providers and students, which were updated in 2012 with the support and input of HBF. These recommendations confirm that having hepatitis B is not a reason to deny or dismiss a person from studying or practicing a healthcare profession – or to put undue constraints on a person’s clinical training or practice. The recommendations offer strategies for the management of hepatitis B–infected healthcare providers and students. The U.S. Department of Health and Human Services urges all schools of medicine, dentistry, nursing, and other health-related schools to use the CDC recommendations to ensure nondiscrimination at their institution. Together, the DOJ ruling, the CDC recommendations and the HHS letter offer guidelines for how health-related schools and healthcare institutions in the U.S. can comply with federal anti-discrimination law, protect the rights of students and health care workers with hepatitis B, and prevent transmission.

 

What to do if you are facing discrimination:

Unfortunately, U.S. schools that offer education and training for health care providers often still have discriminatory policies or practices - and some schools have no hepatitis B-related policies at all, or policies that are outdated. Actions are too often guided by misperceptions and fear. Lack of knowledge about prevention and treatment of HBV infection has led to discriminatory practices. These practices can include (but are not limited to):

  • Requiring proof of hepatitis B surface antibody for enrollment, or initiation/completion of clinical rotations;
  • Requiring hepatitis B testing and denying enrollment or initiation/completion of clinical rotations for those testing hepatitis B surface antigen positive;
  • Putting limitations on clinical experiences that are not aligned with CDC recommendations, for students who test surface hepatitis B surface antigen positive.

If you have hepatitis b and are pursuing a career in the health professions in the United States, it important to do your homework before you apply to schools. You should contact schools you are interested in and find out what their policies are regarding the bullets above – do they require proof of hepatitis B surface antibody status, and will they use that information to make negative decisions about your admission or training? Ask if they have a policy for managing students with hepatitis B, and ask to see the policy in advance of applying. If they don’t have a policy, ask to see, in writing, how they manage students with hepatitis B. If you are concerned that these questions might impact admission, you can ask your questions anonymously.

If you feel that a school might have a discriminatory policy or practice, or if you are experiencing direct discrimination at a school in the U.S., you can respond in a few ways:

  • Contact the highest-level person you can within the program, and provide them with the information and documents provided above – you can educate the school about current recommendations, and ask them to change their policies to reflect the law.
  • You can talk to your hepatitis B doctor to become part of the conversation – doctors often write letters to schools on behalf of patients.
  • You can seek a Disability Rights Attorney to assist you.
  • You can contact the Hepatitis B Foundation at info@hepb.org for help working with the school. We can assist with obtaining the school’s HBV policy and educating officials at the school on the law.
  • Most powerfully, you can file a complaint with the Department of Justice. Once a complaint is received, the DOJ can investigate into the school’s policies to assess whether they are discriminatory.

 

For Health Profession Schools in the U.S.

All schools/programs in the U.S. that provide training for a health profession must adhere to the antidiscrimination guidelines set by the ADA. If you represent a school, it is recommended that you create policies and practices based upon three important documents: The 2012 CDC MMWR recommendations, the 2013 DOJ settlement, and the 2013 HHS letter to all health professions schools. These documents will help assess your current hepatitis B-related anti-discrimination policies and bring them up to date and into compliance.

It is important that schools accurately understand their responsibility to students with hepatitis B, and to base policies and practice on sound scientific evidence as well as legal requirements. As a result of the broad adoption of universal (standard) infection control precautions in the medical care setting, and the ever-increasing use of the HBV vaccine, the risk of provider-to-patient transmission of HBV has become negligible. The 2013 CDC recommendations report that “since 1991, no transmission of HBV has been reported in the United States or other developed countries from primary care providers, clinicians, medical or dental students, residents, nurses, other health-care providers, or any others who would not normally perform exposure-prone procedures.”

As stated in the MMWR recommendations, “HBV infection alone should not disqualify infected persons from the practice or study of surgery, dentistry, medicine, or allied health fields.” The recommendations go further to explicitly address the issue of medical and dental students with chronic HBV infection. Ultimately, CDC concludes that “for most chronically HBV-infected providers and students who conform to current standards for infection control, HBV infection status alone does not require any curtailing of their practices or supervised learning experiences.” According to CDC, those who perform non- or minimally-invasive procedures do not require special panel oversight, and their HBV disease should be managed as any other personal health issue would be managed.

The updated CDC recommendations were reviewed by the Consult Subcommittee of the CDC Public Health Ethics Committee which “determined that there was no scientific or ethical basis for the restrictions that some medical and dental schools have placed on HBV-infected students and concluded that such restrictions were detrimental to the professions as well as to the individual students.”

Using evidence and guidance from the CDC, DOJ and HHS documents provided here, you can develop policies and practices at your school that offer the highest protection for students and patients alike. If you need assistance with developing policies, you can contact the Hepatitis B Foundation at info@hepb.org or 215-489-4900 for more information.