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Tennesee Hepatitis Bill

I saw this posted at the Nomads hep site;

http://www.wbir.com/news/article/160543/2/Senate-passes-bill-penalizing-hepatitis-carriers-who-risk-transmission

Read and view the article.  Tennessee has already approved this bill in the senate.  For the most part they are using the wording of an existing HIV bill and inserting....including....criminalizing exposure to HBV and HCV.

Here is the HIV bill (I believe);
http://www.tennessee.gov/tccy/tnchild/39/39-13-109.htm

Here is the wording (I believe this is the one in question) of the new hepatitis bill;
http://www.capitol.tn.gov/Bills/107/Bill/SB0052.pdf

The news story quotes Dr Martha Buchanan as saying about hepatitis;

"Hepatitis is a viral disease known to lead to liver problems like cancer and cirrhosis.  Dr. Buchanan said it is treatable, but not curable and that the treatments can be quite painful for the patient."
------------------------------------------------------------------------------------------------------------

Here is a doctor that does not seem to know that Hep C is curable.  The doctor is quoted as saying so and the TV news report repeats that incorrect "fact".

I wonder if Steven Tyler knows that Hep C cannot be cured?  Someone should tell him. (sarcasm implied)
I cannot believe that a doctor can be so ignorant of the facts about HCV and that they are relaying false information and which is being used in support of passage of the bill.

Dr. Martha Buchanan is the Director of the Knox County Health Department.

http://www.knoxcounty.org/health/

When you click on the site, you are entreated....this is a Knox county funded site.....to participate in the HIV week of prayer. (?!?!?!)
How on earth does an advertisement for a church and prayer for AIDS belong on a county funded health organization site, and why does the director of that county organization not seem to know that HCV is curable?

Am I just insane or does anyone else think that this is normal or just?

By the way; I am 100% in favor of disclosure in the case of sex, but unless the state of Tennessee can provide some compelling proof that HCV sexual transmission is a compelling problem that requires criminalizing non-disclosure I think they should table the bill until they have their information right. (or delete the sexual transmission portion of the bill)

The sexual transmission rate for monogamous couples practicing heterosexual sex is in between 0 to 1%.  The HCV positive population is about 4-5% of the USA population, most of them older than 50 Years old.

In contrast, it has recently been estimated that the HPV virus may affect 50% of the male population (I don't know if this is true, but I read it online this week) and according to some sites the transmission of HPV approaches 100% efficiency.  I wonder...... if they would in theory include that virus into the bill then almost every other sex act might include a transmission of HPV.  
And yet...... to break the new proposed law in Tennessee the mere act of kissing or sex would seem to be a criminal offense unless disclosure took place first.  The odds of HCV transmission would be miniscule compared to that of transmitting HPV.  

http://hpv.emedtv.com/hpv/high-risk-hpv.html

What do you all think?  I think if they were truly basing the law on protecting the citizens they would also include HPV in addition or instead of HCV since it is more prevalent, far far far more infectious, and many more transmission events occur.  My feeling is that that the legislature dares not criminalize something that is so prevalent in Tennessee.  It is far easier to pick on HCV, a virus with a low number of infected, with a low number of sexual transmissions per capita and a virus that has a cure.....even though they don't seem to know it yet in the good state of Tennessee.

best,
Willy

(thank you and pardon me for venting)

Best Answer
446474 tn?1446347682
This whole bill is just political grandstanding. The sponsor of the bill is a well know extremist.
"He is a family-values conservative who has never married, a fathers’ rights advocate with no children, a professed preservationist who has been cited by the city for property neglect and sued by his tenants (though he is quick to point out that he has also won a suit of his own against a tenant), an advocate for education who litters his blog with spelling and grammatical errors, and a legislator who rarely manages to get his own legislation out of committee. He proposes bills more likely to generate headlines than laws."

Why people vote for these numb skulls is beyond me. But that the entire Senate voted in favor of the bill shows wide spread ignorance of health issues.

Dr. Buchanan practiced Family Medicine during her career as a physician. Obviously she is unqualified and ignorant of the transmission methods for hepatitis B&C.

Of course know of this is not new. Think of all the false pronouncements made by politicians of the new healthcare legislation.  In Arizona, medicaid patients with hep c and end Stage Liver Disease are being denied  access to a liver transplant. The last I heard 1-2 people had died do to the state's denial of services. The reason? Expert doctors testified that a liver transplant does not eliminate HCV.

Hectorsf
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Avatar universal
Good question; what does the Tennessee law even mean?

The HCV law we are talking about is based upon plugging in the language of the pre-existing HIV law.

You'll see a link to each in the first post.

The HIV law says.....
==========================
a) A person commits the offense of criminal exposure of another to human immunodeficiency virus (HIV) when, knowing that the person is infected with HIV, the person knowingly:

(1) Engages in intimate contact with another;

(2) Transfers, donates, or provides blood, tissue, semen, organs, or other potentially infectious body fluids or parts for transfusion, transplantation, insemination, or other administration to another in any manner that presents a significant risk of HIV transmission; or        ect....  please visit the link for the total text.

Item one mentions intimate contact; what is that?
Here's one portion of a definition;

Oh wait!!! There are 15 different/ distinct meanings for the word; INTIMATE.......
Did the bill mean for them all to apply?

==========================================
http://ardictionary.com/Intimate/6315

Intimate 2 Second of 15 meanings
Definition: Near; close; direct; thorough; complete.
============================================

For me that suggests that a patient who is HIV, HCV, HBV positive must disclose to their dentist, doctor, nail tech, barber etc, who is working closely....intimately with them.

Or wait...... does it mean that all infected doctors, nurses, dentists, EMT's, policemen need to notify those whom they get up close with?  That means that a good dentist would need to disclose numerous times per day.

Or a HCV+ surgeon before they would operate.  What if the patient was unconscious?  Would the doctor still be breaking the law unless they complied?

Wait now..... wouldn't that also apply to high school and college wrestling and football?  You don't get much closer than that.

What does their law mean?  I don't know.

I presume that it is about Selective Enforcement.  they have already predefined who they want to discriminate against, they have also predetermined that they won't discriminate against other more common, more easily transmittable viruses.  Maybe someone can explain that to me.

willy
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Avatar universal
Does disclose mean to dentists, barbers etc and hink how many people post here asking if they might have contracted HCV, some for little more than shaking hands.  If they all decide to press charges and go to court, it seems that could cause a real log-jam of cases and a free lunch for cheaper lawyers.  

Griz
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Avatar universal
Wow.......

Look at the Current hep C fact sheet and see if you can fins something interesting about Hep C treatment.

http://health.state.tn.us/factsheets/hepc.htm

Forget it; I'll show you;

At the bottom of the page is the final box;
===============================================
"Is there a medical treatment for hepatitis C?

The only proven treatment for hepatitis C is alpha interferon. Researchers are currently studying combination therapy with interferon and an antiviral drug called ribavirin that appears to be significantly more effective than interferon alone in inducing sustained remission."
+++++++++++++++++++++++++++++++++++++++++++++++++++++

http://www.hepatitis-central.com/hcv/ribavirin/whatis.html
This link says ribavirin has been in use since 1998, a different source was 2001.  

No matter what, the state hep C fact sheet seems to be about 10 years behind the real world, at least in this web page.

willy

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Avatar universal
Seems to be women in Tennessee responsible for beating the drum on this one...might explain the camisole.
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Avatar universal
Man....you don't miss *nuthin*.  Like your omni-potent or sumthin.

Helpful - 0
206807 tn?1331936184
I shur is
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Avatar universal
How did you know the guy that wrote the legislation was wearing a camisole?
(lol; I'll probably pay for that.  : ))

Willy
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Avatar universal
Egads... a spelling mistake in my question!  "scantily" ... not "scantly"!  Hope R Glass ain't looking!  :)

Thanks for the response, Willy.  Interesting points.  Pondering. :)
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Avatar universal
(trish wrote)
"How would you re-write this scantly written piece of legislation?
--------------------------------------------------------------

Great question!!!!

I'm not sure I have the answer, but let me try.

I can only do so knowing how I feel, and I have no pedigrees in law or specifically Tennessee law.

I am absolutely in favor of disclosing about anything....ANYTHING that we could transmit.  When they are ready to legislate that, I would consider voting approval.  They are not doing that however.  They are specifically singling out HCV.  They are LABELING it as a STD whereas I think we should fight that label since it clearly does not apply in many situations.  They are not attempting to legislate all STDs, for some reason, just HCV (which I object to) and HBV.  They are not going after those STD's with a far, far higher transmission rate, percentage wise (HPV may approach 100% efficiency, heterosexual HCV transmission may be less than 1%).  They are not going after the most infected group; HPV may be 50% in some places and in a younger demographic, implying greater frequency.  HCV tends to have a much older demographic, less sex, less frequent sex, less vigorous sex, and consequently a low, very low rate of transmission.

They are not going after the actual number of exposures per annum.

They are not going after the highest number of infections.

They are not going after the incurable disease.

They are "selling" that HCV is a STD when in fact for most relationships monogamous heterosexual couples have not been able to transmit to their partners after decades of marriage.  That is a travesty of justice IMHO.

It is their insistence that HCV must be included  they are making the law effect the exposure, not the actual transmission which is one area that the law could be tweeked.
(ie; if you infect a person without telling them, THEN the law would kick in, not based on mere so called exposure)

They are equating sexual exposure to IVDU exposure when the transmission rates may be 1000 times higher for sharing a needle.  IF you take a vial of my blood and inject it you WILL be infected with HCV.  On the other hand.....I might have sex 1000 times with a woman without transmitting my HCV.  I know that makes me sound pathetic.  : )  The risk is not there.  But they will legislate it as though it was.  That creates a society of pariahs.  They are misinforming people about HCV to pass their law.  They are telling people that it is incurable; a blatant lie or a foolish and unforgivable error in their reporting.

I am in favor or reducing exposures and transmission rates.  So, what are those rates?  Did this even get any discussion?  I would like to see the stats on HCV sexual transmission.  Maybe it's a problem that I'm unaware of.  If there is no problem it seems like putting in a traffic light without investigating the need for the light.

If you want to criminalize the IVDU portion of the law; go for it.  I think the sexual transmission issue is a red herring.  They want to feel good about something while they are doing....overlooking other actual problems.  I don't feel that 5% of the society (the estimate of current % of HCV infected in the USA) needs the additional stigma, particularly when falsehoods are used to sell it.  I think that heterosexual transmission of HCV should NOT be considered a STD.  Either drop it from the bill or if you mean MSM transmission say so.

What do other states do?  I'm not a legal scholar.  I would venture that other states can interpret a few laws to be used without writing new ones to traumatize it citizens.

Reckless endangerment is one that comes to mind but each state already has statutes in place.

In many places they consider; no harm; no foul.  In this case the mere act of having sex means prosecution regardless of whether transmission occurs.  Maybe they are trying to regulate sex, not transmission.  : )

One other such change if you don't want to drop the HCV is to instead simply make it so for ALL STD's.  My feeling is that they don't want to do that.  That would "criminalize" too large a population in Tennessee.  That may sound snide or sarcastic but it is true; there is a crisis in STDs and something should be done.  (lets put a traffic light in a cornfield)  : )

I actually applaud the notion of trying to slow down the epidemic of STDs.  The only problem is they are attacking a problem where one barely exists.  They are carefully looking away from the much larger problem which the more virulent STDs cause our society.

I think the Tennessee Trotters are just trying to *look* good instead of actually DO good.

I also wonder if a national policy should come about instead of a Scopes inspired - HCV Tennessee Transmission law.  I am not getting the feeling our best minds are working on it.

Those are some of my musings, but perhaps if I saw their data or argument I would be convinced.  What I hear is falsehoods.

What I think I see is that HCV infected are a shrinking group; many of us will die, many of us will soon be cured (yes, it can be cured despite what they were told) and that DOCTORS refer to HCV as self limiting; most of us die without transmitting.  The CDC and knowledgeable doctors tell monogamous heterosexual couples that they do not need to provide barriers during sex to prevent transmission.  Forgetaboutit.

best,
Willy
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Avatar universal
I just read the legislation.  It's very vague.  It criminalizes exposing someone to Hep B or Hep C without a preponderance of evidence there was adequate disclosure, whether someone is subsequently infected or not.

There isn't anything in this legislation that says HIV, HBV and HCV are transmitted in the same manner.  I didn't see anything about sexual transmission either.  I saw that exposure to either without proper disclosure was considered an offence however it doesn't spell out how that transmission occurs or what constitutes adequate disclosure.  There's a fair bit left open to interpretation.  I don't know nearly enough about legal matters though I would suppose this was vetted by their legal team and determined this legislation covered their intent.  It appears that the interpretation and application of this legislation would be left up to the police to determine if a criminal offense has occurred in determining whether to charge someone and up to the justice system to determine a finding of guilty or not-guilty?

That means that if you're an IVDU and you don't tell the persons you're sharing works with that you have HCV, that's now a criminal offense.  

Should people with HCV, HBV and HIV explain the risk when engaging in behaviour that can open up the other person to the possibility of transmission?  Should it be a criminal offense if they don't and at what point is non-disclosure considered criminal?  In the absence of a condom?

It's an interesting question and one debated within and without the HIV community as people get prosecuted for unprotected sex without warning the other person they ran the risk of contracting HIV.  A number of people in the HIV community don't think this should be considered a criminal offense.

How would you re-write this scantly written piece of legislation?
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Avatar universal
There is a publication in Canada that reaches alot of Hep C folks...think I'll just send this on in...and what's going on in Arizona also.
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Avatar universal
Ranked, top seven
Newspaper                        City           Circulation                   Owner
  Nashville Tennessean         Nashville    127,538      Gannett Company, Inc.
  Memphis Commercial Appeal Memphis    121,684      E.W. Scripps Company
  Knoxville News Sentinel         Knoxville     91,697      E.W. Scripps Company
  Chattanooga Times Free Press Chattanooga  73,177      Wehco Media Inc.
  Memphis Flyer (city guides) Memphis     51,486      Contemporary Media, Inc.
  Nashville Scene (city guides) Nashville     50,380      City Press LLC
  Nashville City Paper         Nashville     48,000       SouthComm Inc.
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Avatar universal
Thank you.  

Years ago when I was about 19, I was in a little place called Murfreesboro, Tennessee.  Lovely area.  Saw the Smoky Mountains and thought they were so beautiful, I'd like to come back and live there some day.  

This kind of stuff drives me nuts.  Thanks for the info.  

Willy .... regardless of what people feel about Russell Brand...he IS involved with Hep C causes and he just might get on this.  Worth a shot.
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148588 tn?1465778809
http://ipl.org/IPLBrowse/GetSubject?vid=11&cid=5&tid=9724&parent=8771
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Avatar universal
Highest circulation Tennessee newspapers

http://www.mondonewspapers.com/usa/circulation/tennessee.html
==================

Hmmmmm Steven Tyler has a website....
http://www.steventyler.com/talk/

Russell Brand has a website (I think he owes us one)
http://www.russellbrand.tv/

http://en.wikipedia.org/wiki/List_of_people_with_hepatitis_C

I wonder if people would bother contacting the legislators in Tenn to prevent them from doing further damage to those infected with this disease?

In doing a little research into this legislation, i started wondering why I have not heard of other states doing this?  Why is it not on the books or just how is it dealt with in other states?  Perhaps that would provide some measure of a model for them to follow.  

To repeat, I'm all for impeding the transmission of HCV, but I'm not aware that there has been a significant problem with HCV infection via sexual transmission; not enough to stigmatize 5% of the United States population.  Certainly no justification for using lies or bad information to pass the bill.

willy
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Avatar universal
Anyway....I'll write you a PM, Willy.  Don't want to take up space with stupid questions from a Canadian on stuff I'm curious about.  I'll bug you in PM instead.  ;-P
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Avatar universal
What are the major newspapers in Tennessee?
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Avatar universal
I wrote the news station.  I considered calling or e-mailing the doctor.

The thing is that it is too late to "educate" the doctor.  The bill has already passed the Tenn senate.  I think the the only way is a media blitz, or writing the individual members of the house of representatives.  

IF it were in the news that the information they are passing is incorrect, that may impact things.  If there was a petition or some public economic threat, that might garner some support.  At this point, the only thing I can think is make sure that ......if you are HCV positive...or ever have been that you pass on the choice of ever contributing any money to their economy.  That would mean internet purchases, tourism, etc.

I don't have an issue with a lot of the bill.... but the sexual transmission portion needs to go.....for lots of reasons already noted.  I feel that we should assert that HCV is not a STD so far as heterosexual transmission goes.  

Why would you ever do something to help a state that discriminates?  We pose no threat; doctors routinely tell couples that they do not need any enhanced protection during sex to discourage the transmission of HCV.

I suppose one could call or write their own state and federal reps and let them know how you feel.

The thing is..... this disease is going to go away.  It is soon going to reach a 70-80% cure rate.  Most of us are older and not "out there" in the dating circuit much.  

I just really wish they would drop the sexual transmission clause since it barely applies to HCV and yet would cause a huge amount of stigma.  

This is ESPECIALLY true when they are passing nonsense and lies such as the disease has no cure.

Someone want to ask Steven Tyler to intercede?  Or other media people?
Facebook?
Twitter?

The media is tied into twitter; maybe that would be a good way to reach the Reps that have yet to vote.  maybe that would be a way to reach other public officials or media.

best,
Willy
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Avatar universal
I don't know where to post....here or the other thread.....kind of needs a person in Tennessee .. or Arizona....with Hep C...to file a lawsuit?  Class action lawsuit?  Something?  How does this happen with no noise?  Maybe that's a very naive question....but asking.....
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148588 tn?1465778809
Thank you for posting this. Confirms my opinions about politicians and the people who elect them. Other than that I better keep quiet.
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96938 tn?1189799858
It was not clear in the article if this new Tennessee law was applicable to just family members.
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