Ethics of workplace disclosure of medical condition

January 16, 2017 8:29 AM

My sister was recently diagnosed with methicillin-resistant Staphylococcus aureus (MRSA), with several open lesions. She is NOT planning to disclose this at work, but the nature of her job requires frequent contact with a vulnerable population. Is there something I need to do?

She works as a 1:1 caregiver at a group home serving adults with physical and intellectual disabilities. She refuses to take her prescribed antibiotics because she feels her boyfriend, who is also infected* and unwilling to seek treatment, will just reinfect her. Her reasons for not disclosing are unclear to me, but it is likely that mental illness is playing a role.

I just keep thinking about how awful it would be if a client ended up with MRSA as a result of contact with her. For those unfamiliar with MRSA, once a person has been colonized, they can spread the infection even when asymptomatic. In healthy people, the infection is usually treatable, but it is incredibly dangerous for anyone immunocompromised.

*Boyfriend is a CNA at a nursing home (!), which is quite possibly even worse from a disease transmission standpoint.

Mayo Clinic info on MRSA

Two questions:
1. Am I obligated to do anything about this? I realize she'll be at risk of losing her job, but people actually DIE from MRSA infections. If her work were in nearly any other field, I would butt out.
2. What about the boyfriend? Is that none of my business?

posted by easy, lucky, free to Human Relations (40 answers total)

People could die. You need to contact their employers.
posted by cakelite at 8:39 AM on January 16, 2017 [78 favorites]

OMG, she needs to take her antibiotics! TBH, if it were me, I'd have a come to jesus talk with her, and openly threaten to report her.
posted by cotton dress sock at 8:41 AM on January 16, 2017 [18 favorites]

This is a time to put the greater good above the good of people you love. She has to report and comply.
posted by Etrigan at 8:42 AM on January 16, 2017 [8 favorites]

You need to contact both of their employers immediately. HIPAA doesn't apply to you. Lots of people could get very sick and die because of this, including your sister. I'm so sorry.
posted by checkitnice at 8:45 AM on January 16, 2017 [33 favorites]

Keep in mind that if you give her an ultimatum about taking her antibiotics she might just lie to you about taking antibiotics.

As big of a breach of privacy and trust as it is, I'd report her to her job or whatever health department monitors her job. An epidemic of MRSA would be hellish in as vulnerable a population.
posted by lydhre at 8:46 AM on January 16, 2017 [14 favorites]

including your sister.

Yes, how does she not understand... She needs to be educated on the risks, forcibly if necessary... She won't hear you (or her doctor) at all? Can anybody in your family reach her? What is she afraid of, losing money? No PTO? Is she afraid of her boyfriend? If no one can get through to her, yeah you do need to report... But first try to talk to her again, with an understanding of her concerns...
posted by cotton dress sock at 8:59 AM on January 16, 2017 [3 favorites]

Yes, the clients need to be protected, but so does your sister. If she's already infected, this could lead to a lot of terrible things, including death, if she doesn't start treatment. Reporting her will be a breach of trust, but may also keep her from (more) serious illness, or worse.
posted by xingcat at 9:05 AM on January 16, 2017 [5 favorites]

I would call her one workday morning and say something along the lines of, "Today you are going to make your status clear to your employer. I am going to phone them towards the end of the working day to ask if you have made your status clear. If you have not, I will explain it to them.

I am doing this because I love you, and if I fail to do this somebody could die and neither of us would be able to live with ourselves. You know I will always be here for you; in this instance, this is what being here for you looks like. I am sorry it's come to this, but the sooner this issue is dealt with the better for our family and the better for your patients. I love you."

And then the same conversation for the boyfriend.
posted by matthew.alexander at 9:05 AM on January 16, 2017 [13 favorites]

Report them to their employers immediately. Her health is at a huge risk, his health is at a huge risk, and the health of the people they both work with, people who have zero choice in the matter, is at a huge risk. Your sister and her boyfriend are chosing not to treat themselves. Their clients/patients have no such choice.

As a sidebar: Reporting means not working, etc. etc. she could lose her job and run out of money. Or, someone dies as a result of her infection (or her boyfriend's, or both) and they get sued into the next millennium. I personally do not care at all if they do, but if that is going to be her reasoning for continuing to go to work (money and the lack thereof), perhaps the threat of massive litigation is, ah, motivation.
posted by oflinkey at 9:08 AM on January 16, 2017 [3 favorites]

Keep in mind that if you give her an ultimatum ... she might just lie

This was my immediate thought, too. If her judgement is so clouded that she thinks it's a good idea to refuse antibiotics and expose vulnerable people to a dangerous illness, then you shouldn't trust her not to lie to you if you put pressure on her.

You're in a really unpleasant position, but the right thing to do isn't difficult to see: make absolutely sure that both employers know about this very, very soon. Deal with the un-fun consequences later.
posted by jon1270 at 9:12 AM on January 16, 2017 [9 favorites]

Hello! This is your friend on the internet talking....my imunocompromised husband died from an infection. I miss him Every. Single. Day. Death can happen and it's not just hypothetical.
posted by mightshould at 9:25 AM on January 16, 2017 [112 favorites]

I just want to underscore the importance of you taking action. A good friend lost his (otherwise healthy) father to a MRSA infection.
posted by roger ackroyd at 9:25 AM on January 16, 2017 [7 favorites]

I would consider calling the local Public Health department if I were faced with your dilemma. That way, professionals can evaluate the situation and talk to her and you don't risk your relationship with her as she doesn't sound receptive in the first place. I'm sorry you're in such a tough spot!
posted by ticketmaster10 at 9:28 AM on January 16, 2017 [30 favorites]

Nthing everyone above, did the boyfriend give her this? She seems pretty nonchalant about something that should merit a reaction with a bit more gravitas. This isn't a cold or flu, just looking at the images are frightening. Why is she so disconnected about this? And her reasoning to not treat because her boyfriend will reinfect her?!? Um...DTMFA.
posted by lunastellasol at 9:28 AM on January 16, 2017 [2 favorites]

I'm going to nth what everyone else has already said, and I'm only reiterating it in case it helps to see many people are backing you up on this, because I'm sure this must be a terrible position to be in.

You absolutely should report this to both your sister's place of employment and her boyfriend's place of employment. I think protecting the innocent people whose health and lives are at risk needs to be the priority here.
posted by litera scripta manet at 9:33 AM on January 16, 2017 [4 favorites]

Purposely not reporting something like that could have criminal repercussions too. Purposely spreading a disease, which one could argue she is doing, is a crime in some places. Not to mention it seems like it could easily fall under a broad law like reckless endangerment if the State was motivated to make an example out of her . If she won't respond to common sense maybe fear of incarceration will get through to her.

Also N'thing the suggestion above that you call the public health department instead of calling her employer directly. For one thing, that minimizes the potential of her employer covering up any exposure that may have already happened.
posted by COD at 9:59 AM on January 16, 2017 [3 favorites]

Response by poster: Thank you, everyone! Honestly, I was bracing myself for a bunch of responses telling me thst this situation is none of my business, but I really appreciate the reality check. More details:

I'm going to brace myself and do what needs to be done. Does anyone have suggestions for how I might go about doing this? I am sure she won't be receptive to me, whether I try to reason with her or issue an ultimatum. Our mother has already spoken to her and received a response along the lines of, "I am an adult and I can make my own decisions!" My relationship with both my sister and my mother is rather fraught, mostly consequent to issues like this one. As I mentioned, mental illness plays a part.

Her relationship with her boyfriend is quite new. Last September (2016), she abruptly left her husband/his kids and moved in with this new guy. I have only spoken to him twice. He physically threatened me (small, female, living alone at the time) the last time we interacted, and given this and a few other red flags, I would like to be assured that my report is anonymous. My sister thinks he is a great guy. Though he is employed full-time, he claims that he has no insurance benefits, which is why he hasn't seen a doctor for the current symptoms. My sister was diagnosed by a doctor and says that the boyfriend has had a positive MRSA culture and currently has lesions which appear similar to the ones she has.

Thanks again, all. mightshould, I am deeply sorry that you lost your husband.
posted by easy, lucky, free at 10:09 AM on January 16, 2017 [13 favorites]

You can't reason with an unreasonable person. You need to call their employers and the public health agency (in case their employers don't do anything), period. Imagine being the family member of one of the patients they work with. Wouldn't you be livid to find out that their caretaker could have passed on a deadly infection and no one did anything?
posted by AFABulous at 10:18 AM on January 16, 2017 [14 favorites]

You want to report it anonymously? Type it up on a piece of paper and drop it in the mail. Or call from a pay phone and don't give your name.
posted by salvia at 10:22 AM on January 16, 2017 [1 favorite]

Might the doctor be helpful to you? Do they need to report this? It might be a way to stay a bit more anonymous. This is just a guess, but it might worth asking about.
posted by Vaike at 10:22 AM on January 16, 2017 [1 favorite]

I would call the Dept of Public Health first, they might have a protocol for dealing with this kind of situation; you don't know how she will react if/when confronted by her employer. I'm sorry you have to do such a hard thing.
posted by Room 641-A at 10:26 AM on January 16, 2017 [27 favorites]

I wonder if there are other factors at play, here, like addiction. Her abrupt change in life, hostile boyfriend, odd illness...it all sounds like a major life problem to me. Anyway, good luck! Your instincts are right on the mark, in my opinion. She's endangering others, which should not be allowed to continue. It quite frankly freaks me out that she's this cavalier with the lives of the people in her care.
posted by clone boulevard at 10:43 AM on January 16, 2017 [8 favorites]

If you don't want to contact the employers, you can contact your local OSHA office and/or the CDC.
posted by juniperesque at 10:55 AM on January 16, 2017 [3 favorites]

Wow. I don't want to scare you, but - this could kill your sister. This could kill the people she's caregiving for and it's quite possible they've already been exposed; alerting the home will enable them to react more quickly and more effectively if symptoms do appear. You're quite right to be taking this step.

Like juniperesque I recommend contacting your state CDC outpost, alerting them to the places both your sister and her boyfriend works in. This exact kind of "could be horrific outbreak if not treated, needs close attention" situation is why the EIS exists.

Your sister is in a dangerous place all around. Best of luck to her.
posted by hapaxes.legomenon at 11:19 AM on January 16, 2017 [7 favorites]

Don't know where you are, but I just googled up my city's Department of Public Health, and they have a Communicable Disease Reporting page, including contact info and who should report. Your city or county has something similar. Call and tell them what you know and get guidance from them.
posted by rtha at 11:20 AM on January 16, 2017 [6 favorites]

MRSA isn't on the list of reportable diseases that rtha linked to.

I'm going to go against the grain and say that it isn't likely to be something her employer takes action on. Standard precautions should prevent the spread of MRSA to a healthcare worker from a patient and vice versa.
posted by MadMadam at 11:30 AM on January 16, 2017 [1 favorite]

N'thing that you have to report this. It's far over the border into WTF territory.
posted by spitbull at 11:32 AM on January 16, 2017 [5 favorites]

I'm going to go against the grain and say that it isn't likely to be something her employer takes action on. Standard precautions should prevent the spread of MRSA to a healthcare worker from a patient and vice versa.

Protocols probably vary depending on the location and facility, but e.g. when a patient who visited the diabetes clinic I used to work at turned out to have MRSA, all the personnel who had been in contact with her (and we're talking about very casual contact with dieticians and NP's here, basically limited to just shaking hands) got immediately tested and were asked to not have any contact with patients before their own results were cleared. I'd say there's a good chance the employer takes this seriously, as they should.
posted by sively at 11:44 AM on January 16, 2017 [8 favorites]

> MRSA isn't on the list of reportable diseases that rtha linked to.

The list includes "any unusual diseases" and that is classed as "report immediately by telephone." I'm also betting that the DPH is not going to punish the OP in any way for just calling their relevant line to ask questions.
posted by rtha at 11:49 AM on January 16, 2017 [4 favorites]

I also recommend contacting the Dept of Public Health before discussing it with your sister or contacting her place of employment. For two reasons: 1) Maybe her place of employment will brush it off completely, either because they don't want to deal with the loss of staff, or because they don't prioritize the patients over the hassle. 2) If you are reporting it in the future, you do not want to suggest to your (potentially) mentally ill sister that it was you who reported her. Her actions are so beyond right now that you really don't know what she's capable of if she knows it's you who got her fired. I would make sure someone with some outside authority knows about this.
posted by thegreatfleecircus at 11:52 AM on January 16, 2017 [2 favorites]

I have only spoken to him twice. He physically threatened me (small, female, living alone at the time) the last time we interacted, and given this and a few other red flags, I would like to be assured that my report is anonymous.

Yep, don't tell your sister, for her sake as well as your own. But do inform the employers at both locations about the health issues. Do keep an eye on her and other family members where this individual is concerned, including reporting your concerns to the police in case he causes trouble.
posted by TrishaU at 11:56 AM on January 16, 2017 [1 favorite]

Standard precautions should prevent the spread of MRSA to a healthcare worker from a patient and vice versa.

Sorry, but that's not true, particularly when "open sores" are involved.

CDC link describing MRSA precautions. For hospitalized patients, at least, this involves single-use disposable gowns, gloves, and sometimes face masks as well, for anyone who enters the room, in addition to the usual Purell/handwashing technique. I doubt that these precautions are standard for group home caregivers.

OP, the department of health should have an anonymous reporting line. You may have to call the main line and ask to be transferred.
posted by basalganglia at 11:59 AM on January 16, 2017 [8 favorites]

Response by poster: Thank you all, once again. It is too late to make the call to the Department of Public Health today, but I plan to call tomorrow.

I hate doing this, and have agonized for a few days, but I keep coming back to this: my grandpa, who is truly the best man I have ever had the privilege of knowing, had a nosocomial MRSA infection a few years ago. He was in a truly horrifying amount of pain, had red man syndrome after receiving IV vancomycin (the first-line treatment for MRSA), needed a second invasive surgery, and eventually developed ICU psychosis, which was awful. When a nurse asked him if he was experiencing pain, he actually cried, and he is the archetype of the stoic Midwesterner. I don't think I could live with myself if I didn't do what needs to be done here. Nobody deserves to suffer like that, especially not people who have physical or intellectual disabilities and might be less able to report their symptoms.
posted by easy, lucky, free at 3:42 PM on January 16, 2017 [32 favorites]

I would also warn your [ex]brother-in-law, in case she has had contact with him or the kids since her diagnosis.
posted by SuperSquirrel at 4:04 PM on January 16, 2017 [11 favorites]

You're doing the right thing. It will be hard. It's still the right thing. Bless you for facing up to this.
posted by wenestvedt at 8:01 PM on January 16, 2017 [2 favorites]

This is so hard for you but please, please, PLEASE stay true to your convictions to protect innocents. If you want to memail me, *I* will call and report them. My cousin's nephew, orphaned at two months due to an MRSA, is more than enough reason for me to act.
posted by cyndigo at 9:11 PM on January 16, 2017 [6 favorites]

MRSA is contact precautions, not standard precautions; which means that caregivers entering the patient room don gown/gloves. Unfortunately I doubt that your sister's clients will be donning gloves and gown.

What a shitty situation. You are doing the right thing.
posted by pintapicasso at 9:50 PM on January 16, 2017 [7 favorites]

If you report on your sister and she knows it was you, consider that there is no way to anonymously report on her boyfriend as well. One can imagine that they will compare notes.

This is however indeed just as absurdly serious as other posters are suggesting. Vulnerable people are being threatened with hideous impairment and death by their lack of compassion, or adulting skills, or whatever it is. Public health on this level truly is the one thing that trumps all other values, its more important than family. You are doing the right thing.
posted by Blasdelb at 3:28 AM on January 17, 2017 [2 favorites]

Another internet stranger here to tell you you're doing the right thing, and that I hope you've called. My uncle, who was not thought to be immunocompromised, died of MRSA last summer. His daughters would give anything to have him back.
posted by ImproviseOrDie at 7:55 AM on January 17, 2017 [2 favorites]

Any update on this?
posted by blueberry at 10:25 AM on February 3, 2017 [1 favorite]