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Could a PHNS be liable if another TB case results due to a delay by the lead physician in contacting a school about starting a TB contact investigation?

Monday January 20, 2014
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Dear Nancy,

Could a Public Health Nurse Supervisor be held liable if another TB case results because of a several month delay by the lead ordering physician in communicating to a school whether a TB contact investigation should be expanded? In this scenario, the physician told the PHNS not to contact the school. In our county, the PHNS does not start the investigation until there are orders from
the physician.


Dear Nancy replies:

Dear Rose,

Your question raises several legal issues. First, it seems odd that a physician would be a gatekeeper of information such as this when there is a real, potential threat to others in the community, including a school because in your county an investigation can only be initiated by a physician. Where is this directive located? Who/what agency is its author? What does your state's public health statute say about who initiates any public health investigation? Is a TB case a required (mandated) disease for a contact investigation? It does not make sense that only one healthcare provider would be responsible for reporting it once the diagnosis was made.

It also is unclear from your question what the relationship is between you and the lead physician. Do you work in the same agency, such as the public health department? Is he or she a consultant or are you a consultant in some way?

A second concern for you to consider is what your state nurse practice act requires of you. It may require you, independent of other state laws and as a nurse licensee, to report communicable diseases to a specified agency. Be sure to check the rules in the act as well.

It would be best for you to consult with a nurse attorney or other attorney in your state who works with nurse licensees that can specifically advise you in this situation generally, and specifically concerning any potential liability so you know what to do the next time a communicable disease
is diagnosed.


Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.