Mandatory Blood Testing Act, 2006

Policy

Category: General Community Health
Subject: Mandatory Blood Testing Act, 2006
Division: Community Health and Wellness
Policy Number: CA.73.01.101
Effective Date:  September 15, 2014

POLICY STATEMENT

Wellington-Dufferin-Guelph Public Health (WDGPH) is committed to ensure that applications under the Mandatory Blood Testing Act, 2006 (MBTA) are processed in accordance with the MBTA and Ontario Regulation 449/07.

Applications are time sensitive and are reviewed for both completeness and adherence to mandatory conditions.

Applications can be obtained from the Ministry of Community Safety and Correctional Services website http://www.mcscs.jus.gov.on.ca.

The MBTA reduces the time for getting a mandatory blood test to less than three weeks. This law makes sure that police officers, firefighters, correctional services staff and others get faster access to information that can help them decide the best ways to reduce the chances of getting sick should they be exposed to a serious disease.

Diseases listed as communicable diseases under the MBTA include:

  • Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS);
  • Hepatitis B; and
  • Hepatitis C.

The MBTA applies to a person in any of the following circumstances:

  • As a result of being a victim of crime;
  • While providing emergency health care services or emergency first aid to the person; or
  • In the course of his or her duties, if the person belongs to an identified group of individuals, including:
    • Persons who are employed in a correctional institution, place of open custody or place of secure custody;
    • Police officers, civilian employees of a police service, First Nations constables and auxiliary members of a police service;
    • Firefighters (including volunteer firefighters);
    • Paramedics and emergency medical attendants;
    • Members of the College of Nurses of Ontario;
    • Paramedic students engaged in field training;
    • ​Members of the College of Physicians and Surgeons; and
    • Medical students in training.

Anyone in these categories may apply to a Medical Officer of Health (MOH) to have a blood sample of another person analyzed if he or she has come into contact with a bodily substance from that person in any of the aforementioned circumstances. Applications must be submitted to the MOH in the health unit where the respondent lives.

The MOH is responsible for screening the application to make sure it meets the requirements of the MBTA and for seeking voluntary compliance from the respondent. The MOH in the health unit where the respondent lives must receive an application no more than seven days after the date of the occurrence. If the deadline for the application falls on a Saturday, Sunday or holiday, it will be extended by one day.

SCOPE

This policy applies to the MOH, management,  receptionists, on-call staff and all employees assigned to work in the Clinical Services and School Health teams including nurses, clinical support and student nurses.

DEFINITIONS

Mandatory Blood Testing Act – directs the process for blood testing in specific circumstances involving emergency responders, good Samaritans and victims of crime. It enables police officers, firefighters, correctional services staff, paramedics and others who in the course of their work may be exposed to the blood or body fluid of others, to apply to request information about the source person’s blood with respect to hepatitis B, C and HIV/AIDS.  

Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) – a disease of the human immune system caused by infection with human immunodeficiency virus.

Hepatitis B – an infectious inflammatory illness of the liver caused by the hepatitis B virus (HBV).

Hepatitis C – an infectious disease affecting primarily the liver caused by the hepatitis C virus (HCV). The infection is often asymptomatic, but chronic infection can lead to scarring of the liver and ultimately to cirrhosis, which is generally apparent after many years.

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Procedure:  CA.73.02.101 Mandatory Blood Testing Act, 2006
Mandatory Blood Testing Act, 2006
Ontario Regulation 449/07
Ministry of Community Safety and Correctional Services website http://www.mcscs.jus.gov.on.ca
http://www.e-laws.gov.on.ca/html/regs/english/elaws_regs_070449_e.htm
http://www.e-laws.gov.on.ca/html/source/statutes/english/2006/elaws_src_…

APPROVED BY

Rita Sethi  


Procedure

Category: General Community Health
Subject: Mandatory Blood Testing Act, 2006
Division: Community Health and Wellness
Procedure Number: CA.73.02.101
Effective Date: August 1, 2015

PROCEDURE

Inquiries Pertaining to Blood-Borne Disease Exposure:

All Staff will:

Refer all calls about blood-borne disease exposure to any of the following Community Health and Wellness personnel:

  • Any NURSE on the Clinical Services Team;
  • Manager, Clinical Services; or
  • Director, Community Health and Wellness.

Refer all inquiries about application under Mandatory Blood Testing Act, 2006 (MBTA) to any of the following:

  • Director, Community Health and Wellness or designate;
  • Manager, Clinical Services or designate; or
  • Medical Officer of Health (MOH) or designate.

All forms for application for MBTA are located in the appendices or at: http://www.mcscs.jus.gov.on.ca/english/LinksResources/MandatoryBloodTest…

Application under MBTA received during normal business hours:

Receptionist will:

  • Immediately date stamp applications when received, including exact time the application was presented to the receptionist; and
  • Forward application immediately to the Manager, Clinical Services and Director, Community Health and Wellness. It must be confirmed that the application was received by the individual within one hour of receipt by reception. If the Manager, Clinical Services and Director, Community Health and Wellness are unavailable, it will be forwarded to the MOH.

Manager, Clinical Services and/or Director, Community Health and Wellness will:

  • Notify MOH or designate of receipt of application;
  • Complete CA.30.04.100 Medical Officer of Health Flow Chart in consultation with the MOH; and
  • Ensure all documents submitted by the Applicant and any subsequent public health forms contain the Application Code.

Application will be assigned an Application code as follows:  Year - ####, the number will be assigned sequentially beginning with 001 for each calendar year, e.g.  2007-001.

Timeline adherence:

For applications received within seven days following the occurrence:  proceed with the Mandatory Requirements Checklist in the CA.30.04.100 Medical Officer of Health Flow Chart to ensure conditions have been met.  Proceed with application process below.

Applications received more than seven days following the occurrence will be immediately dismissed by the MOH.

Application Process:
  1. Notify MOH of dismissal;
  2. Complete CA.30.04.101  Dismissal Letter indicating the reason for dismissal, being that the application was received more than seven days after the occurrence;
  3. Document on CA.30.04.100 Medical Officer of Health Flow Chart, that the application was dismissed;
  4. Acquire MOH signature on all documents;
  5. File all documents submitted by the Applicant and the CA.30.04.100 Medical Officer of Health Flow Chart by Application Code; and
  6. Store files by Application Code in a locked file in the office of the Director, Community Health and Wellness.

Note:  A “day” includes all days of the week. If a stated deadline for the number of days ends on a Saturday, Sunday or statutory holiday the deadline shall be extended by one day.  An application that is faxed is deemed received on the day it is faxed if sent before 4:00 pm and considered received on the next day if sent at, or after, 4:00 pm.

Mandatory Conditions Assessment:
  1. Review MBTA Form 1 – Physician Report and Form 2 – Applicant Report to determine if all mandatory conditions have been met.  Document review on the CA.30.04.100 Medical Officer of Health Flow Chart.
  2. If all mandatory conditions as per Ontario Regulation 449/07 s.4 are met, proceed with Voluntary Process below.
  3. If document fails to meet all mandatory conditions:
  • Notify MOH of dismissal;
  • Complete CA.30.04.101  Dismissal Letter indicating the reason for dismissal;
  • Document that the application was dismissed;
  • Acquire MOH signature on all documents;
  • Mail completed CA.30.04.101  Dismissal Letter to Applicant by registered mail within two days of the dismissal being made by the MOH;
  • Retain a copy of the CA.30.04.101  Dismissal Letter in the application file;
  • File all documents submitted by the Applicant by Applicant Code; and
  • Store files by Application Code in a locked file in the MOH office.
Voluntary Process:

Upon determining that the application meets all mandatory requirements, the Director, Community Health and Wellness and/or Manager, Clinical Services, in consultation with the MOH, will initiate a CA.30.04.102 Voluntary Process Documentation form.

The Manager, Clinical Services will assign a Public Health Nurse to the case and provide all necessary documentation and details. 

The Nurse will:

  • Follow normal contact tracing procedures to obtain voluntary testing;
  • Make ongoing reasonable attempts to reach the Respondent by phone at various times (including evenings) throughout the two-day period.  Document all attempts on the CA.30.04.102 Voluntary Process Documentation form;
  • Contact the Manager or Director to assess and discuss alternative methods of reaching the Respondent, if unable to contact client by phone in the first 24 hours after receiving the application;
    Alternative contact methods to be considered, taking into account staff safety and circumstances of the incident:
    • Home visit accompanied by another staff;
    • Home visit accompanied by local police; and
    • Use a process server to deliver notice to contact WDGPH immediately.
  • Upon making contact with the Respondent, book an appointment at the nearest office location for the Respondent to provide him/her with more detailed information on the requirements of the MBTA and sign the Voluntary Consent Form.  The nurse must schedule this appointment when there are other staff present in the office;
  • Note:  appointment must be booked as soon as possible.  If unable to book an appointment prior to the deadline for submission to Capacity and Consent Board, advise the MOH and Director, Community Health and Wellness.
  • In accordance with regulation, disclose to the Respondent the information pertaining to the occurrence as outlined in the application and physician report, but will not disclose information pertaining to the Applicant’s personal information;
  • Provide the Respondent with Form 3 – Respondent Report at the appointment;
  • Have the Respondent complete Form 3 – Respondent Report;
  • Make a copy of the completed Form 3 – Respondent Report for the Respondent and keep the original with the record;
  • Review all of the following information at the appointment:
    • What an order under MBTA is;
    • What the application process is;
    • Definition of Respondent;
    • Why a blood sample is being requested;
    • What the voluntary testing process is;
    • What happens if Respondent agrees to testing;
    • The process to follow if the Respondent is known to be seropositive for any of the diseases; and
    • What happens if Respondent refuses to be voluntarily tested.
  • Obtain information from the Respondent pertaining to any known serostatus for hepatitis B, hepatitis C, and HIV;
  • If the Respondent voluntarily submits to testing, complete CA.30.04.103 Informed Consent to Participate in Voluntary Blood Sample Process form.  Place a photocopy of the consent in the file, provide the Respondent with a copy and fax a copy to the Respondent’s physician;

Note:  if the Respondent does not have a physician, arrangements must be made for him/her to obtain results.

  • Arrange for blood testing to be done at a local laboratory.  Ensure section A & B of the MBTA laboratory requisition are complete (MOH is physician ordering testing).  Place requisition and accompanying MBTA seal into an envelope.  Ensure envelope is sealed and sign name over the sealed flap. Advise Respondent he/she must take the sealed envelope to the laboratory where testing has been arranged. WDGPH nurses may draw the blood sample, if necessary;
  • Follow-up with the laboratory to confirm the Respondent has had blood drawn and couriered directly to Central Public Health Lab in Toronto. Toronto Public Health Lab has a Purolator Courier account that covers the expense of sending the sample to Toronto. The nurse will advise the lab to notify Toronto Public Health Lab that a MBTA sample is being sent to them for processing;
  • Record on CA.30.04.102 Voluntary Process Documentation form that the process was successful and forward all documents to the MOH; and
  • If unable to reach the Respondent or if the Respondent refuses to book an appointment or fails to show up to the appointment, advise the MOH immediately of inability to complete the voluntary process.
Refusal/ failure to submit to a blood test:

If the Respondent refuses to submit to voluntary blood testing or if despite reasonable efforts the Respondent cannot be located in that time, the WDGPH must submit the application to the Capacity and Consent Board (CCB) by the end of the second day after WDGPH received the application:

  • Record that the voluntary process was unsuccessful and forward to the CCB the following:
    • CA.30.04.100 Medical Officer of Health Flow Chart
    • CA.30.04.102 Voluntary Process Documentation form
    • CA.30.04.108 Referral to Consent and Capacity Review Board
    • Form 1 – Physician Report
    • Form 2 – Applicant Report
  • Notify the Applicant that the application has been referred to the Consent and Capacity Board for review via telephone;
  • Retain a copy of the application and physician report for the file; and
  • File documentation by the Application code in a locked filing cabinet in the Director, Community of Health and Wellness office.

If the Respondent voluntarily provides a blood sample or other evidence of his or her seropositivity respecting the listed communicable disease after the application has been forwarded to CCB, but before the CCB commences its hearing, the MOH will withdraw the referral of the application.

Upon receipt of a copy of the laboratory requisition indicating a voluntary blood sample has not been taken from the Respondent due to failure to satisfactorily verify the person’s identity prior to taking blood sample, the MOH will notify the Applicant in writing. CA.30.04.104 Failure to Obtain Blood Sample form will be sent by registered mail indicating that a blood sample was not obtained for reasons outlined in Ontario Regulation 499/07 s.14 (2)(b).

Upon receipt of a laboratory requisition indicating the blood sample was provided but not analyzed as per Ont. Reg. 499/07 x 16(3)(a), the MOH will notify the Applicant in writing.  CA.30.04.105 Failure to Analyze Blood Sample form will be sent by registered mail. 

Note:  Applicant may resubmit the application within seven days of being notified by the MOH or Board of Health if the Respondent provided a blood sample but it was not analyzed. The resubmitted application must include the same Applicant Report and Physician Report included in the original application, the results of the Applicant’s base line testing, if available, and a copy of the written notice given by the MOH or Board of Health. The resubmitted application must be received by the MOH of the health unit for the area where the Respondent lives not more than seven days after the day on which the Applicant received the notice given under Ont. Reg. 499/07 s. 16 (4).

Notifying the Applicant of results:
  • Upon receipt of the report of blood analysis on the blood sample submitted under voluntary process, or other evidence of Respondent’s seropositivity respecting HIV, hepatitis B and hepatitis C, the MOH will provide an order for the report to distributed to the Applicant’s physician;
  • Forward a copy of the report stapled to the CA.30.04.106 Applicant Physician Letter to the Applicant’s physician;
  • Notify the Applicant in writing using CA.30.04.107 Application Discharged  via registered mail;
  • Forward a copy of test results to the Respondent’s physician if previous consent was given by the Respondent;
  • Place copy of all letters sent in file; and
  • File documentation by the Application code in a locked filing cabinet in the office of the Director of Community of Health and Wellness.
Weekend and On-Call Receipt of Application: Employee working On-Call will:
  • Immediately date and time stamp applications when received; and
  • Forward application immediately to the Manager, Clinical Services and Director, Community Health and Wellness. It must be confirmed that the application was received by the individual within one hour of receipt by employee. If the Manager, Clinical Services and Director, Community Health and Wellness are unavailable, it will be forwarded to the MOH.

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Policy:  CA.73.01.101 Mandatory Blood Testing Act, 2006
Mandatory Blood Test Act, 2006
Ontario Regulation 449/07
Ministry of Community Safety and Correctional Services website http://www.mcscs.jus.gov.on.ca
CA.30.04.100 Medical Officer of Health Flow Chart (CHGEN(F)1)
CA.30.04.101 Dismissal Letter (CHGEN(L)1)
CA.30.04.102 Voluntary Process Documentation Form (CHGEN(F)2)
CA.30.04.103 Informed Consent to Participate in Voluntary Blood Sample Process Form (CHGEN(F)4)
CA.30.04.104 Failure to Obtain Blood Sample (CHGEN(L)2)
CA.30.04.105 Failure to Analyze Blood Sample (CHGEN(L)3)
CA.30.04.106 Applicant Physician Letter (CHGEN(L)5)
CA.30.04.107 Application Discharged letter (CHGEN(L)4)
CA.30.04.108 Referral to Consent and Capacity Review Board (new)

Form 1 – Physician Report|
http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/GetFileAttach/…$File/008-11-001E.pdf

Form 2 – Applicant Report http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/GetFileAttach/…$File/008-11-002E.pdf

Form 3 – Respondent Report http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/GetFileAttach/…$File/008-11-003E.pdf

CONTACT FOR INQUIRIES

Director, Community Health and Wellness

APPROVED BY

Director, Community Health and Wellness