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Surgical employment and HCV
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Surgical employment and HCV

Dear Dr,
I was treated 15 years ago for HCV and have had routine RNA tests which have come back non-detectable. I have had 3 RNA tests from 3 different labs over the past 6 months with the same results. I am a surgical assistant and have been offered a job, which I accepted from a very large hospital institution. I have now been waiting 6 weeks for them to decide on whether or not I am eligible to start orientation. The employee health nurse states that the virus could return at any moment, which I know is false. Is my 30 years experience as a surgical assistant over? This is devastating to me ans my family. I cannot seem to convince the decision makers that antibodies are not contagious. I was honest on my post offer healthcare questionaire because I had a letter from my gastro who stated I was cured and of no risk for transmission. Do not know what to do. Please help.  
40 Comments Post a Comment
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We are not doctors  here on this forum. It seems to me that with all of the evidence you have that you have been cured of the virus, this may be a case of discrimination. I would consult an attorney.

All the best to you.
Nan
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Where do you live?   If you live in the United States I would find this talk about the employment nurses claim that Hepatitis C can come back at anytime strange.   I know  a nurse who had applied at hospital and they did indeed test her for a viral load due to the fact she was Hep C positive.  I would expect that this would happen due to the fact it is a hospital.  Before you start calling attorneys and thinking this might be a career stopper....call the place where your employment health exam and ask if this is the reason your not starting orientation.  I would find it very strange that this is the reason your being denied employment.  

You have been dealing with this for many years.  Is this a new profession?
Medical professionals no this isn't a career killer.   Maybe a concern due to high risk if you work surgery and had Chronic Hep C.   They could find this risky.  But as you say...you don't have hep C.
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FYI: My nurse friend was hired because she had no viral load.  I don't think this is the reason your not starting orientation.  They just might be waiting for
all your paperwork.  Something very typical in large institutions.  
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I live in Florida. I was even issued a parking decal and was scheduled to start orientation on 4/28. The employee health nurse and her boss informed me that I could not show up for orientation on 4/25, the Friday before orientation. Getting very anxious and I cannot understand why a positive HCV antibody with three RNA QA's that have come back as "non-detectable" is holding me back from I job a truly want. One major note, I have assisted at this institution for the past 15 years as aprivate contractor.
They only tested for the antibody because I am honest and answer the healthcare questionaire that asked if I had any of the following diseases in the past?  HBV, HCV, or HIV. I said yes to HCV with a letter from my gastro stating I am cured.  
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I live in Florida. I was even issued a parking decal and was scheduled to start orientation on 4/28. The employee health nurse and her boss informed me that I could not show up for orientation on 4/25, the Friday before orientation. Getting very anxious and I cannot understand why a positive HCV antibody with three RNA QA's that have come back as "non-detectable" is holding me back from I job a truly want. One major note, I have assisted at this institution for the past 15 years as aprivate contractor.
They only tested for the antibody because I am honest and answer the healthcare questionaire that asked if I had any of the following diseases in the past?  HBV, HCV, or HIV. I said yes to HCV with a letter from my gastro stating I am cured.  
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So you treated your hepatitis C 15 years ago before working at this hospital as a private contractor?
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Far as I remember- the CDC regulation only applies to Hep. B. There is no regulation for Hep C as of yet. You can look it up on CDC web site. You should of not answer that question at all, just say no everywhere from now on- it is not anybody's business. I would really want to see them deny your employment based on this- have it in writing and take them in court. I know that idiot who was doing drugs and infected patients ruined it for others, but I do not see it to be legal to deny you position.
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yes! And I have had the same gastro whom I have seen regularly who has stated in writing that I have been under his care for 15 years, virus is eradicated, that I am of no risk for transmission and should not be restricted from tasks. The hospital is evaluating this and have been so for 5 weeks and not even communicating with me. The OR director is just waiting and holding my postion until she heres from someone to tell her otherwise. I think they are either guinely trying to work this out, or they are running this through their legal system to see how to get out of hiring me. The OR and the surgeons really want me, but employee health is creating a big obstacle. My family and I are quite devastated, but holding on to our strong faith in the Lord to win this battle for us.  
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I dont know why you even want to work for the large hospital. What happened to your old job? Did you let it go? I would not recommend to be upset if they do not hire you. They fire people left and right- no appreciation for the talent or experience. Hospitals suck big time.  
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I see your point, however I will not reduce myself to lying on my healthcare questionaire. It asked "had" I have....., not "do" you have. The ADA states that lying on an application is not acceptable, however it also states that once a job has been offered and accepted, the burden is then on the employer to prove that I would pose a "direct" threat to myself, or others. How could I be a direct threat if I have NO virus? This nurse thinks it is in a dormant, resting, or remission state. She said there is no studies that show a complete cure and that it could come back at any moment. I am sort of in a catch 22. If my gastro says I am cured, then do I really have a disability that would be covered under the ADA (American Disabilities Act)?
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I was dumped by United Health Care in November. I have no other choice and the surgeons and staff are wonderful. They made me a great offer that I was actually thrilled about. I could no longer survive in the managed care world. Thanks to Obamacare, the squeeze is being put on the managed care companies to severely restrict who they will pay. CSFA's, CSA's, and SA-C's are really feeling the squeeze. I may just have to learn how to drive a truck! Praying for a miracle right now, though. God is bigger and more powerful than some employee health nurse with a bad attitude.
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....have I "had"?
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Don't get discouraged.  They are holding your job.  If big university hospital don't think this is a big deal... I'm sure this one will come to the conclusion that it isn't.   I would ask what the policy is on hiring employees who have tested positive for hepatitis C is.  Also, Hepatitis C treatment has made huge advancements and a large population isn't aware of it.  I'm sure policy might have to be re-written in this hospital.  Sounds like you are still working at the hospital so HR is taking their time.  

Let us know what happens.  
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Does anyone know if this is the policy at ALL hospitals? Need to work to support my family. Does anyone have data that shows(from a reserch or reputable source) that HCV can be cured and eradicated as well as no risk of transmission? If so, please post such info. Thanks
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It's not the policy at all hospitals.  I know this to be a fact.  
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No, I am not working! That is the huge problem for me. I shut down my business and anyway, once I exposed my PAST infection, they suspended my assisting privileges until things were settled on what they were going to do. Monday will be the 4th orientation I will be missing if I do not get an authorization this week. They only do orientations every two weeks.
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Look at CDC web site. It used to say, no limitations for healthcare workers with hep C. Also you can search for Hep C cure definition.
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Where disclosing you have or had hepatitis C would be important is if you are
putting someone in danger of being infected.  I know this to be true with other types of employment.  You could have said No to that question.  You don't have to disclose if it has nothing to do with the job.  In this case....it has nothing to do with the job you will be doing.  That question doesn't apply to you.  Your not putting anyone in danger.  If you had hepatitis C and failed to use universal protections...there could be an issue.  

Bottom line it's required to use universal protection in numerous professions.
Anyone who has taken a first aid class is taught these very basic requirements to protect yourself and others.  

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You are being denied your livelihood. As i previously posted, you should consult an attorney for legal advice.

Nan
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Yes, you are right. It does state that. Also, the SHEA website has guidelines that support me as well. The Society for Healthcare Epidemiolgy of America. They state that guidelines of restrictions should be imposed when you have a viral level greater than10(4) GE/ml. Less than that, no restrictions should be imposed. Again, I have NO level. But, this employee health nurse knows it all and will not listen to me. I have even printed out all of the info I could find and she thinks she knows more than research panels.
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I may have to. Florida is a Work-at-will state which says either party can terminate for any reason. It is not a right-to-work state, like labor unions. I don't know much about law, but thjere are employment/discrimination attorneys everywhere down here. I am not a minority so I do not know how much weight a law suit would have. But, I suppose it is worth a try. I just want to work, not sue!
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The problem is trustinjesus hasn't been hired yet.   They were working as a contracted employee.  Employment that the employer can terminate at will.

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You might want to contact the American Civil Liberties Union before you start throwing your money at a discrimination/employment attorney.  You may find out you don't have a case before.   The issues are...you weren't an employee and your not disabled.  Tough situation.

Best to you
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Could you name any major healthcare institutions who would hire surgical assistants/nurses who have had PAST HCV infections who are now considered cured with non-detectable RNA testing?
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That would be hospitals that hire those who tested positive for Hepatitis C Antibodies only that don't have a viral load? The answer to your question is major University Hospitals.  Guess there's something to be said about higher education.  

I do know requirements in Nursing & Nursing education have recently changed or about to change.  I don't know how this will effect your state.  On the west coast it will require updating nursing education to a higher level to
continue working in that field.

Best to you
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Can you tell me why you had 3 RNA (Viral load test) in the last 6?  Where you recently exposed at work?
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I know for a FACT THIS IS NOT TRUE OF ALL HOSPITALS  keep your head up!  If you are denied the job, get copies of why and how there decision making chose to eliminate you from the position.  I'm not sure how you got the virus but statiscally being  in the medical field puts you at  a much higher risk.  God forbid that's how you contracted it, and then to be denied a job because of it.  Good Luck Kelly
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Kelly is right.  People that work in the medical field are at a much higher risk.  
A surgery assistant would be an increased risk and if you has a viral load this could be an issue.   But you don't!...and it makes no sense your being denied
based on the fact your Hepatitis C positive without a viral load.  

The 3 RNA tests in the last 6 months may have something to do with why the claim of the virus could return at anytime.  When was your last RNA test?

Any responsible hospital  institution in going to test you for Hepatitis C and give you an RNA test if positive. Their not going to rely on what you gave them.   This is complicated for insurance/employment.  It takes time to get all the records needed for something like this.   6 weeks isn't that long.  Yes you could be starving but that's not their concern.  Safety is their concern. Don't give up on this job.  Large institution are notorious for slow walking paperwork.  I use to get upset about it.   Now I except it as a way to not rush things and miss something in the process.  



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Thanks for everyone's feedback. I was told last week that the door has not yet been closed or the employment offer retracted. They are still looking into this and a policy change must be reviewed. The Chief of the department and the Director of Surgical Services have gone to bat for me, but no conclusion has been made. The surgeons and staff have indicated that they truly want me as a member of their team. I have worked with some of the surgeons and team members for 15-20 years. It doesn't make sense that an outdated policy or speculative fear from HCV hysteria could cost me a job.  
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I took it upon myself to get myself retested to make sure it had not returned. No, I had not been exposed. I was, like them, afraid it may have the ability to return. Since then, however, I am now aware that the virus doesn't remain dormant or in remission. I was transitioning into a job with a physician group and just wanted to be sure. So, I had a test (qualitative analysis) done privately and the VA did one for me. Of course they did the cheaper one (quantitative analysis....and I did not have to wait). The third one was done by the hospital that offered me the job. They only did it because of the positive antibody test. My gastro told me that unless I get reinoculated/reinfected, it is not going to return. It is eradicated. That is hard for the employee health nurse to understand. You would think that the hospital infection control team would be "up to date" on all of the huge advances made in the HCV fight throughout the past decade. My gastro said that very soon, HCV will be a non-issue and vaccination will not be too far off. I just now need to "be still, and know God is with me"!
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Let us know when you start orientation.  

Best to you
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I'm so sorry. It sounds like total idiocy on the part of the potential employers, but we are talking Florida here - the state with governors and legislators who openly say they don't believe in science. If you look into legal help I'd recommend trying to fight it as a violation of federal laws rather than state laws, which are probably nonexistent anyway.
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I was watching this webinar on treatment options for Hep C provided by the American Liver Foundation and at approx. 47 minutes into the webinar a question relevant to your question here came up. The response was a health care provider does NOT have to disclose their HCV status to their employer.
\
You may want to watch the webinar:
http://hepc.liverfoundation.org/resources/webinars/treatment-options-and-the-patient-experience/

Nan
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The webinar nan references states you don't have to tell your employer that you have Hepatitis C .  It's your personal medical information.  The medical profession requires the use of universal protections so you are covered as long as your actively using Universal protections.  
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Thanks for all of your advice on this blog. You all have been so very helpful and concerned. The only I see with NOT disclosing the truth, besides the obvious, is that if you should get a needle stick in the OR, the employee health nurse will draw for infectious disease "base lines". The anti-HCV would then show positive and they would ask me about it. Then I would have to lie again. Going to bed now. Worked all afternoon putting together packets for 30 physicians who have used me for the past 15+ years and unleashing THEM on the hospital with all the facts I have uncovered. They are so wrong on this and just need to get UP-TO-DATE on HCV. They have policies that were drafted in the 90's and a very prideful young nurse who thinks she knows EVERYTHING! She would not even take any of my information because she said she has already seen everything. I am also dropping off a packet for the VP of Medical Affairs, a retired internist. You would think he would have knowledge on all of this....wouldn't you!
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kelly55,
How do you know this is not the fact for ALL hospitals. It is now looking like the door has now closed on me as I am not getting ANY responses back from the hospital. I have e-mailed and written letters and NOTHING! I am forced now to seek some legal help. Perhaps they will respond to a lawyer's letter. This is very depressing for me and my family! We have had no income for 8 weeks now....waiting for a hospital that has pretty much lied to me saying they are "looking into it and just be patient". My major concern is that this positive HCV antibody is going to be an obstacle whereever I apply. Again, I have been "non-detectable for over 15 years!
I wish there were activist groups for HCV with the same power and money as the HIV activists.
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Just to UPDATE everyone on this post! The major healthcare institution has "revised" and updated their policy on healthcare workers with HCV. I started this past week after a very long summer.....waiting for an answer. PRAISE GOD...a miracle has in fact happened and to Him, I give all the honor. I was told I will be required to be tested probably every 6 months to check for viral levels. They are going to follow SHEAS guidelines.
My career is no longer a thing of the past, but once again a future. I am back now as a fulltime surgical assistant.    
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Thanks for letting us know the outcome.  It takes time to change policy.  The sad part is the employee pays the price.  Glad to hear your career is back on course.  

Best to you
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t:  Congratulations!  As DwBh said, change takes time --- but not only is the change a benefit to you but to all those who will follow.  You are a part of making history.  It  may not  feel that way to you now - you just wanted your job and your life back - but down the road you will see that not only did this help ou, but others. A large institution usually sets the example, policy sample , etc.,  To Him be th glory, indeed!

Good lickmin your new life.
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Oops!  I meant Good Luck in your new life. (Sorry about the typing).
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