# Health - General (GHG)

## Title 18. Disease Prevention

### Subtitle 3. Specific Diseases

#### Section 18-301

(a) Except for a physician or a dentist, a person may not:

  (1) Treat or prescribe a treatment for cancer; or

  (2) Represent to the public that the person can cure, treat, or prescribe a treatment for cancer.

(b) A person may not sell, offer to sell, or give away a drug, medicine, or device that the manufacturer or seller represents as a cancer cure unless a physician or dentist prescribes the drug, medicine, or device.

#### Section 18-303

(a)

  (1) The Secretary shall establish and promote a statewide public information campaign on diethylstilbestrol (DES).

  (2) The public information campaign shall:

    (i) Try to reach each individual who has been exposed to diethylstilbestrol and each offspring of those individuals, to encourage the individuals and offspring to seek medical care for the prevention or treatment of cancer that results from the exposure to diethylstilbestrol; and

    (ii) Include any other matter that the Secretary considers appropriate.

(b) The Secretary shall expand existing cancer screening programs to detect any cancer or other abnormal condition that results from exposure to diethylstilbestrol, including breast, cervical, testicular, or vaginal cancer or vaginal adenosis.

(c) The Secretary shall establish a program to train physicians, physician's assistants, and nurses in:

  (1) Identifying individuals who have been exposed to diethylstilbestrol;

  (2) Diagnosing and treating any cancer or other abnormal condition that results from the exposure; and

  (3) Preventing exposure to diethylstilbestrol.

(d) To carry out this section, the Secretary:

  (1) On request, shall receive the help of or information from any agency of this State or of a political subdivision; and

  (2) May contract for any necessary services.

(e)

  (1) The Secretary may set a sliding fee schedule for services provided under this section.

  (2) This State shall reimburse a provider of screening and diagnosis under this section in the amount that the screening and diagnosis exceeds the total of the fee charged for the service and of all third party payments for the service.

#### Section 18-304

A person who violates any provision of Sec. 18-301 or Sec. 18-302 of this subtitle is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $5,000 or imprisonment not exceeding 5 years or both.

#### Section 18-307

(a) This section does not apply to a woman who objects to a standard serological syphilis test because the test is against the religious beliefs and practices of the woman.

(b)

  (1) The health care provider attending a woman for pregnancy shall submit to a medical laboratory:

    (i) A blood sample taken from the woman at the time that the health care provider first examines the woman;

    (ii) A blood sample taken from the woman in the third trimester at:

      (1) The prenatal visit at 28 weeks of gestation; or

      (2) The first prenatal visit after 28 weeks of gestation; and

    (iii)

      (1) A blood sample taken from the woman who delivers a live born infant at the time of delivery; or

      (2) A blood sample taken from the woman who delivers a stillborn infant:

      (A) At 20 weeks of gestation or later; or

      (B) Weighing at least 500 grams.

  (2) The medical laboratory to which a blood sample is submitted shall do a standard serological syphilis test that is approved by the Department.

(c) A hospital shall determine the syphilis serologic status of the mother before discharging the newborn for the purposes of neonatal evaluation and treatment.

(d) The Department may adopt rules, regulations, and standards under this section.

#### Section 18-308

(a) Immediately after the birth of a child, the attending physician or attending nurse midwife shall use in the eyes of the child a prophylactic, approved by the Department, against gonococcal ophthalmia neonatorum.

(b) If, within 2 weeks after the birth of a child, an eye of the child becomes inflamed or swollen:

  (1) The attending physician shall test to determine if gonococcal ophthalmia neonatorum is the cause of the inflammation or swelling; or

  (2) If there is no attending physician, any other individual who has care of the child shall report the condition immediately to a physician or to the health officer for the county where the child is located, so that testing may be done.

(c) Within 48 hours after a physician knows that a child under the physician's care has gonococcal ophthalmia neonatorum, the physician shall submit a report to the Department.

(d) An individual other than a physician may not treat the inflammation or swelling.

(e) A person who violates any provision of subsection (b)(2) or (d) of this section is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $100 or imprisonment not exceeding 6 months or both.

#### Section 18-309

(a)

  (1) To the extent that funds are available for this purpose, the Secretary, in collaboration with other State agencies, shall establish and promote a statewide public information, awareness, and education campaign on Fetal Alcohol Syndrome and other effects of prenatal alcohol exposure.

  (2) The campaign shall:

    (i) Reach out to the general public and specific populations determined to be at high risk for contracting Fetal Alcohol Syndrome;

    (ii) Disseminate the information about Fetal Alcohol Syndrome through written materials, television, radio, posters, or any other medium the Secretary considers appropriate and effective for conveying the information;

    (iii) Distribute informational materials free of charge to prenatal clinics and to establishments that serve alcoholic beverages; and

    (iv) Include any other matter that the Secretary considers appropriate.

(b) To carry out this section, the Secretary:

  (1) On request, shall receive aid or information from any agency of this State, or from a political subdivision;

  (2) May request the services of interested advocacy groups; and

  (3) May contract for any necessary services.

#### Section 18-312

In Part III of this subtitle, "public health veterinarian" means the veterinarian whom the Secretary designates as responsible for the veterinary public health program of the Department.

#### Section 18-313

The Secretary of Health shall provide a statewide system:

(1) To control rabies;

(2) To grant authority to the public health veterinarian and the local health officer in matters pertaining to the disposition of animals that bite or otherwise expose rabies to an individual;

(3) To assist local political subdivisions regarding the laboratory testing of rabid animals;

(4) To treat each individual who is exposed or suspected of having been exposed to rabies;

(5) To distribute, in accordance with the conditions set by the Secretary of Agriculture, the biological products that are needed to prevent and treat rabies; and

(6) To allow a veterinary technician, as defined in Sec. 2-301 of the Agriculture Article, or other clinical staff who work in or for an animal shelter, as defined in Sec. 2-1701 of the Agriculture Article, or an animal control facility, as defined in Sec. 2-305 of the Agriculture Article, to administer rabies vaccines if:

  (i) The animal shelter or animal control facility is licensed to administer drugs under Sec. 2-305 of the Agriculture Article;

  (ii) The animal being vaccinated is under the custody or control of an animal shelter or animal control facility;

  (iii) The veterinary practitioner who signs the rabies vaccination certificate has ensured that the individual administering the rabies vaccine was appropriately trained on administering rabies vaccines, including proper storage, handling, administration, and management of adverse reactions; and

  (iv) The individual administering the vaccine is identified on the rabies vaccination certificate.

#### Section 18-314

The Department shall provide preexposure immunization, without charge, to any individual who provides rabies control services at the request of the Department.

#### Section 18-315

(a) With the county health department for each county, the Department shall provide for an antirabies clinic in the county.

(b) Each clinic shall be staffed by a graduate veterinarian.

(c) The clinic for a county shall be offered on or before June 30 of each year, on the date and at the location that the Department and the health department for the county determine.

(d) Each county health department may charge fees that are set so as to produce funds to cover the cost of material and services that the clinic provides.

(e) The public health veterinarian shall set the vaccination procedures to be used at the clinics.

#### Section 18-316

(a)

  (1) Except as provided in paragraph (2) of this subsection, an individual immediately shall report to the local police or sheriff if the individual:

    (i) Knows that a dog, cat, or other warm blooded animal has bitten, scratched, or otherwise exposed an individual to a possible rabies infection; or

    (ii) Suspects that an animal has rabies.

  (2) In Frederick County, the individual shall report to the animal control center of Frederick County.

(b) On receipt of a report under this section, the police, sheriff, or animal control center staff shall:

  (1) Notify the health officer for the county where the report is made; and

  (2) Enforce all orders of the health officer and the public health veterinarian.

(c) If the public health veterinarian or the local health officer issues an order to surrender an animal that is suspected of having rabies, a person may not hide or secret the animal:

  (1) In the custody of the person; or

  (2) In the custody or with the cooperation of any other person.

(d) A person who fails or refuses to comply with any provision of this section or any order issued under this section is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $500.

#### Section 18-317

The Department shall pay the cost of any antirabies treatment that an individual requires, if the individual is unable to pay for the treatment.

#### Section 18-318

(a) Each person who owns or keeps a dog, cat, or ferret that is 4 months old or older shall have the dog, cat, or ferret vaccinated adequately against rabies.

(b)

  (1) A county may not register or license a dog, cat, or ferret unless the person who owns or keeps the dog, cat, or ferret submits, with the application for registration or license, proof that the dog, cat, or ferret has been vaccinated adequately against rabies.

  (2) The public health veterinarian shall determine the proof of vaccination that is acceptable.

#### Section 18-319

(a) A licensed veterinarian who vaccinates a dog, cat, or ferret against rabies:

  (1) May select the vaccine to be used;

  (2) Shall administer the vaccine in a manner that is consistent with the recommendations of the National Association of State Public Health Veterinarians;

  (3) Shall issue to the owner of the dog, cat, or ferret a vaccination certificate, on the form that the Department approves; and

  (4) Shall keep a record of the vaccination for a period of 5 years.

(b) The information in the rabies vaccination record that a licensed veterinarian keeps may not be used:

  (1) To license the dog, cat, or ferret; or

  (2) To tax the owner of the dog, cat, or ferret.

#### Section 18-320

(a) Except as provided in subsection (e) of this section, an apparently healthy dog, cat, or ferret that has been adequately vaccinated against rabies in accordance with Sec. 18-318 of this subtitle or any other animal that bites a human or otherwise exposes a human to rabies shall be quarantined as provided in subsection (b) of this section.

(b) An animal under quarantine shall be quarantined in a place, which may include the residence of the owner, in the manner designated by the local health officer or the public health veterinarian for a suitable period as determined by the health officer or the public health veterinarian.

(c)

  (1) At any time during the quarantine period, the public health veterinarian or local health officer may order the owner of a biting animal to have the animal monitored for rabies by a licensed veterinarian.

  (2) The owner of the animal shall pay for the cost of any examination or other associated cost.

(d) An animal under quarantine may not be moved from the place of quarantine without the written permission of the local health officer or public health veterinarian.

(e) The public health veterinarian or local health officer or the designee of the public health veterinarian or local health officer may order the immediate and humane destruction of a biting animal for rabies testing if:

  (1) It is necessary to preserve human health;

  (2) A licensed veterinarian determines that a quarantined animal is inhumanely suffering; or

  (3) The animal is considered wild and is not claimed by an owner within 24 hours.

#### Section 18-322

(a) The Secretary shall keep a register of each individual who has tuberculosis.

(b) The Secretary:

  (1) Shall have exclusive control of the register; and

  (2) May not disclose information in the register about any individual to any person who is not authorized by law to have the information.

#### Section 18-323

The Secretary shall provide printed instructions and any supplies that the Secretary considers necessary to prevent and control the spread of tuberculosis, on the request of any health officer or any physician attending an individual who has tuberculosis.

#### Section 18-324

(a) The Secretary or a health officer may have an individual examined, if the Secretary or the health officer knows or is notified in writing by a physician that the individual is suspected of having tuberculosis.

(b)

  (1) If, after the examination, the Secretary or the health officer finds that the individual has tuberculosis and that the condition of the individual endangers, or may endanger, the public health of the community, the Secretary or the health officer may order the individual to receive appropriate medical care.

  (2) If the individual fails to comply with the order, the Secretary or the health officer may order the individual to be placed in any of the following types of medical quarantine in order to protect the public health:

    (i) Medical isolation at home;

    (ii) Domiciliary care, nursing home care, or hospital care; or

    (iii) Other medically appropriate living arrangement.

  (3) The order of the Secretary or the health officer may also contain such other conditions as the Secretary or the health officer believes are necessary to protect either the health of the infected individual or the public health.

(c) The Secretary or a health officer may not require an individual to have a physical examination, other than a chest X-ray and to render sputum samples. The Secretary or a health officer may not restrict the right of the individual to select a treatment method, if the individual:

  (1) In good faith relies on spiritual means through prayer for healing; and

  (2) Complies with the laws, rules, and regulations that relate to sanitation for and quarantine of infectious, contagious, and communicable diseases.

#### Section 18-325

(a) An individual may not refuse to comply with the placement ordered under Sec. 18-324 of this subtitle.

(b) While an individual is in any placement for tuberculosis treatment, the individual may not:

  (1) Behave in a disorderly manner; or

  (2) Leave the placement before being discharged properly.

(c) An individual who violates any provision of this section is guilty of a misdemeanor and on conviction shall be imprisoned in a penal institution with facilities for tuberculosis treatment until the Secretary or the Health Department of Baltimore City finds that the condition of the individual no longer endangers the health of the community, or the Secretary obtains a court order that states that the individual:

  (1) Is to be moved to a specified less restrictive setting for continuation of treatment;

  (2) Must comply with the treatment until the Secretary determines the treatment has been completed;

  (3) May not behave in a disorderly manner or leave the placement until the Secretary determines that the individual has completed the treatment; and

  (4) Following a hearing, will be reimprisoned until the Secretary determines that the individual has completed the treatment, if the individual does not comply with the terms of the order.

#### Section 18-333

(a)

  (1) The Secretary shall establish and promote a statewide public information program on acquired immune deficiency syndrome (AIDS).

  (2) The public information program shall:

    (i) Attempt to reach individuals at risk for contracting AIDS;

    (ii) Encourage those individuals at risk for contracting AIDS to take the necessary precautions to prevent transmission of the HTLV-III virus; and

    (iii) Include any other aspects that the Secretary considers appropriate.

(b) The Secretary shall establish a program to train physicians, physician's assistants, nurses, and other health professionals in:

  (1) Diagnosing and treating AIDS or other conditions associated with AIDS; and

  (2) Methods to prevent the transmission of the HTLV-III virus.

(c) To carry out this section, the Secretary:

  (1) On request, shall receive the help of or information from any agency of this State or of a political subdivision; and

  (2) May contract for any necessary services.

(d) The Secretary may set a sliding fee schedule for services provided under this section.

#### Section 18-334

(a)

  (1) In this section the following words have the meanings indicated.

  (2) "HIV" means the human immunodeficiency virus that causes acquired immune deficiency syndrome.

  (3) "Institution" means:

    (i) An ambulatory surgical facility or center, as defined in Sec. 19-114 of this article;

    (ii) A health maintenance organization, as defined in Sec. 19-701 of this article;

    (iii) A hospital or related institution, as defined in Sec. 19-301 of this article;

    (iv) A tissue bank; or

    (v) The office of 1 or more physicians.

  (4) "Laboratory" means a public laboratory, medical laboratory, or medical test unit as those terms are defined in Title 17 of this article.

  (5) "Physician" means a person licensed to practice under Title 14 of the Health Occupations Article.

  (6)

    (i) "Tissue bank" means an establishment that obtains, stores, processes, distributes, or sells human blood or other human tissue for use in the human body.

    (ii) "Tissue bank" includes a blood bank or sperm bank.

(b)

  (1) Subject to the provisions of paragraph (2) of this subsection, an institution that obtains or processes semen, blood, or tissue shall obtain and send a blood sample from each potential donor of semen, blood, or tissue to a laboratory approved by the Department to test for HIV antibodies.

  (2) Before obtaining a blood sample from a potential semen, blood, or tissue donor the institution shall:

    (i) Inform the potential donor, in layman's terms, that a blood sample of the donor will be tested for HIV antibodies and if the donor's blood sample tests positive for HIV antibodies the result will be reported to the Department; and

    (ii) Obtain written consent from the potential donor on a form provided by the Department for the administration of the HIV antibody tests and for the disclosure of a positive test result to the Department.

(c) An institution that obtains a positive HIV antibody test result under subsection (b) of this section shall:

  (1) Notify the potential donor from whom the blood sample was obtained of the positive result;

  (2) Inform the individual of available counseling; and

  (3) Report the result to the Department on the form the Department provides.

(d) A test result reported by an institution under subsection (c) of this section may not contain any information that identifies the subject of the test.

(e) An institution may not use a semen, blood, or tissue specimen from a donor with a positive HIV antibody test result obtained under the provisions of this section.

#### Section 18-335

To properly ensure the quality and effectiveness of condoms sold by means of a vending machine or other automatic devices, the Secretary shall adopt regulations:

(1) To protect the health, welfare, and safety of the public; and

(2) To provide for the enforcement of this section.

#### Section 18-336

(a)

  (1) In this section the following words have the meanings indicated.

  (2) "Health care facility" has the same meaning stated in Sec. 18-338.2 of this subtitle.

  (3) "Health care provider" means a physician, nurse, or designee of a health care facility.

  (4) "HIV" means the human immunodeficiency virus that causes acquired immune deficiency syndrome.

(b)

  (1) Except as provided in Title 11, Subtitle 1, Part II of the Criminal Procedure Article or Sec. 18-338.3 of this subtitle, before obtaining a fluid or tissue sample from the body of an individual for the purpose of testing the fluid or tissue for the presence of HIV infection, a health care provider shall:

    (i) Inform the individual verbally or in writing that HIV testing will be performed on a specimen obtained from the individual unless the individual refuses HIV testing;

    (ii) Provide the individual verbal or written information or show a video that includes an explanation of HIV infection and the meaning of positive and negative test results;

    (iii) Offer the individual an opportunity to ask questions and decline HIV testing; and

    (iv) If the individual refuses HIV testing, document in the medical record the individual's decision.

  (2)

    (i) Consent for HIV testing shall be included in a patient's general informed consent for medical care in the same category as other screening and diagnostic tests.

    (ii) Except as otherwise provided in this section, a health care provider may not be required to obtain consent for HIV testing using a separate consent form.

  (3) A health care provider shall make available to individuals for whom HIV testing is performed easily understood informational materials in the languages of the commonly encountered populations of the health care provider.

(c) Subject to subsection (b) of this section, a health care provider shall obtain a fluid or tissue sample for the purpose of testing the fluid or tissue for the presence of HIV infection from:

  (1) A pregnant woman during delivery; and

  (2) A newborn when the pregnant woman's HIV status is unknown.

(d)

  (1) If the HIV test is ordered at a location that is not a health care facility, informed consent shall be in writing and signed by the individual on an informed consent for HIV testing document that is approved by the Department.

  (2) The informed consent for HIV testing document shall be distinct and separate from all other consent forms.

  (3) A patient identifying number obtained from an anonymous and confidential test site which is approved by the Department may be evidence of a patient's informed consent in lieu of a patient's signature.

(e) An individual's refusal to undergo an HIV test or a positive test result may not be used as the sole basis by an institution or laboratory to deny services or treatment.

(f) If the individual is unable to give informed consent, substitute consent may be given under Sec. 5-605 of this article.

(g) A health care provider who obtains a result from an HIV test conducted in accordance with the provisions of subsection (b) of this section shall:

  (1) Notify the individual from whom the fluid or tissue sample was obtained of the result; and

  (2) If the test is positive:

    (i) Provide a referral for treatment and supportive services;

    (ii) Counsel the individual to inform all sexual and needle-sharing partners of the individual's positive HIV status;

    (iii) Offer to assist in notifying the individual's sexual and needle-sharing partners or refer the individual to the local health officer to assist the individual with notifying the individual's sexual and needle-sharing partners; and

    (iv) If necessary, take action appropriate to comply with Sec. 18-337 of this subtitle.

(h) Local health officers shall make available to health care providers in their jurisdiction information on referral resources for an individual with an HIV positive status, including counseling, testing, needs assessment, treatment, and support services.

#### Section 18-337

(a) In this section, "health care provider" means a physician, a physician's designee, or a designee of a health care facility licensed or otherwise authorized to provide health care services.

(b) If an individual informed of the individual's HIV positive status under Sec. 18-336 of this subtitle refuses to notify the individual's sexual and needle-sharing partners, the individual's physician may inform the local health officer and/or the individual's sexual and needle-sharing partners of:

  (1) The individual's identity; and

  (2) The circumstances giving rise to the notification.

(c) When the local health officer is notified, the health officer shall enforce the provisions of Sec.Sec. 18-208 through 18-213.1 of this title:

  (1) Within a reasonable time; and

  (2) To the extent feasible.

(d) Each local health officer shall refer the infected individual and any known sexual or needle-sharing partners of the individual to appropriate services for the care, support, and treatment for HIV infected individuals.

(e) A physician acting in good faith to provide notification in accordance with this section may not be held liable in any cause of action related to a breach of patient confidentiality.

(f) A physician acting in good faith may not be held liable in any cause of action for choosing not to disclose information related to a positive test result for the presence of human immunodeficiency virus to an individual's sexual and needle-sharing partners.

(g) A hospital or any other health care provider acting in good faith pursuant to a physician's order to perform or interpret a test for the presence of HIV may not be held liable in any cause of action related to:

  (1) A breach of patient confidentiality; or

  (2) A physician's decision to disclose or not to disclose information related to a positive test result to a local health officer and/or an individual's sexual and needle-sharing partners.

#### Section 18-338

(a)

  (1) In this section the following words have the meanings indicated.

  (2) "Correctional employee" means:

    (i) A person who is employed by a correctional institution; or

    (ii) A person who performs duties in a correctional institution by virtue of federal, State, or local government employment.

  (3) "Correctional institution" means a place of detention or correctional confinement operated by or for the State or a local government.

  (4) "Court" means a district or circuit court of the State.

  (5) "Exposure" means, as between a correctional employee and an incarcerated individual:

    (i) Percutaneous contact with blood, semen, or blood contaminated fluids;

    (ii) Mucocutaneous contact with blood, semen, or blood contaminated fluids;

    (iii) Open wound, including dermatitis, exudative lesions, or chapped skin, contact with blood, semen, or blood contaminated fluids; and

    (iv) Intact skin contact with large amounts of blood, semen, or blood contaminated fluids for a prolonged period.

  (6) "Health care provider" means:

    (i) Any person, including a physician or hospital, who is licensed or otherwise authorized in this State to provide health care services and is under contract with or operated by the correctional facility; or

    (ii) An employee's private physician.

(b) An incarcerated individual shall furnish to the correctional institution a blood sample or buccal (cheek) swab to be tested for the presence of human immunodeficiency virus (HIV) when:

  (1) There has been an exposure involving the incarcerated individual;

  (2) The exposure occurred in connection with the incarcerated individual's violation of institutional regulations;

  (3) The incarcerated individual has been found guilty of the violation of institutional regulations described in paragraph (2) of this subsection;

  (4) The correctional employee involved in the exposure has given written notice of the exposure to the managing official of the correctional institution, or the official's designee; and

  (5) The exposure is confirmed by a health care provider.

(c) The correctional institution shall collect the blood sample from the incarcerated individual, and shall have the sample tested for human immunodeficiency virus (HIV) by a test and test procedure approved by the Department.

(d)

  (1) If the incarcerated individual refuses to furnish to the correctional institution a blood sample or buccal (cheek) swab to be tested for the presence of human immunodeficiency virus (HIV) as required under subsection (b) of this section, a court may order the incarcerated individual to furnish the blood sample or buccal (cheek) swab if:

    (i) The correctional employee involved in the exposure or the correctional employee's representative requests the testing in writing to the State's Attorney in the county where the exposure occurred; and

    (ii) The court finds probable cause to believe that the exposure occurred.

  (2) Before ordering a test under paragraph (1) of this subsection and subject to the provisions of paragraph (6) of this subsection, the court shall hold a hearing at which the correctional employee or the correctional employee's representative and the incarcerated individual or the incarcerated individual's representative have the right to be present.

  (3) The correctional employee or the correctional employee's representative and the incarcerated individual or the incarcerated individual's representative shall be notified of:

    (i) The date, time, and location of the hearing; and

    (ii) Their right to be present at the hearing.

  (4) During the hearing, the court may admit into evidence only affidavits, counter-affidavits, and medical records that:

    (i) Relate to the material facts of the case; and

    (ii) Support or rebut a finding of probable cause to issue a court order.

  (5) The written request of the correctional employee or the correctional employee's representative shall be:

    (i) Filed by the State's Attorney with the court; and

    (ii) Sealed by the court.

  (6) Except for good cause, the court shall:

    (i) Hold the hearing within 15 days after the State's Attorney's presentment to the court of the written request of the correctional employee or the correctional employee's representative; and

    (ii) Issue an order granting or denying the request within 3 days after the conclusion of the hearing.

(e) The correctional employee shall be notified of the results of the test for the presence of human immunodeficiency virus (HIV) conducted under the provisions of this section.

(f) The notification required under subsection (e) of this section shall:

  (1) Be made within 48 hours of confirmation of the incarcerated individual's diagnosis;

  (2) Include subsequent written confirmation of the possible exposure to human immunodeficiency virus (HIV); and

  (3) To the extent possible, be made in a manner that will protect the confidentiality of the correctional employee and the incarcerated individual.

(g) If the results of the blood sample test are positive for the presence of human immunodeficiency virus (HIV), then the correctional employee and the incarcerated individual shall be provided appropriate counseling.

(h) All correctional institutions shall develop written procedures to carry out the provisions of this section.

(i) A health care provider acting in good faith to provide notification in accordance with this section may not be held liable in any cause of action related to a breach of patient confidentiality.

(j) A health care provider acting in good faith to provide notification in accordance with this section may not be held liable in any cause of action for:

  (1) The failure to give the required notice, if the correctional employee fails to properly initiate the notification procedures developed by the correctional institution under subsection (h) of this section; or

  (2) The failure of the managing official of the correctional institution within which the correctional employee is employed to subsequently notify the correctional employee of the possible exposure to human immunodeficiency virus (HIV).

(k) A health care provider may not be held liable in any cause of action related to obtaining a blood sample or performing and interpreting an approved HIV test without the incarcerated individual's informed consent.

#### Section 18-338.1

(a)

  (1) In this section the following words have the meanings indicated.

  (2)

    (i) "Body fluids" means:

      (1) Any fluid containing visible blood, semen, or vaginal secretions; or

      (2) Cerebrospinal fluid, synovial, or amniotic fluid.

    (ii) "Body fluid" does not include saliva, stool, nasal secretions, sputum, tears, urine, or vomitus.

  (3) "Exposure" means as between a patient and a health care provider:

    (i) Percutaneous contact with blood or body fluids;

    (ii) Mucocutaneous contact with blood or body fluids;

    (iii) Open wound, including dermatitis, exudative lesions, or chapped skin, contact with blood or body fluids for a prolonged period; or

    (iv) Intact skin contact with large amounts of blood or body fluids for a prolonged period.

  (4) "Health care facility" means a facility or office where health or medical care is provided to patients by a health care provider, including:

    (i) A health care facility as defined in Sec. 19-114(d)(1) of this article;

    (ii) A facility operated by the Department or a health officer;

    (iii) The office of a health care provider; or

    (iv) A medical laboratory.

  (5)

    (i) "Health care provider" means a person who is licensed, certified, or otherwise authorized under the Health Occupations Article to provide health or medical care in:

      (1) The ordinary course of business or practice of a profession; or

      (2) In an approved education or training program.

    (ii) "Health care provider" includes any agent or employee of a health care facility.

    (iii) "Health care provider" does not include any individual who is eligible to receive notification under the provisions of Sec. 18-213 of this title, including any law enforcement officer or any member of any fire department, ambulance company, or rescue squad.

  (6) "HIV" means the human immunodeficiency virus that causes acquired immune deficiency syndrome.

(b) Except as provided in Sec. 18-338.3 of this subtitle, a physician, nurse, or designee of a health care facility shall, at the request of an exposed health care provider, seek the informed consent of a patient to test a blood sample of the patient for the presence of HIV when:

  (1) There has been an exposure between the patient and the health care provider;

  (2) The health care provider involved in the exposure has given prompt written notice of the exposure, in accordance with the standards of the health care facility, to the chief executive officer or the chief executive officer's designee of the health care facility where the exposure occurred;

  (3) The exposure occurred based on the judgment of a physician who is not the health care provider involved in the exposure; and

  (4) The health care provider involved in the exposure has given informed consent and has submitted a blood sample to be tested for the presence of HIV in accordance with the provisions of subsection (d) of this section.

(c) If, by virtue of the physical or mental condition of a patient, a physician, nurse, or designee of a health care facility is unable to obtain the informed consent of the patient to test a blood sample of the patient for the presence of HIV in accordance with subsection (b) of this section, the physician, nurse, or designee of the health care facility shall seek the consent of any person who has authority to consent to medical care for the patient as provided under Sec. 5-605 of this article or as otherwise authorized by law.

(d) If the patient's informed consent has been obtained in accordance with subsection (b) of this section or substitute consent has been obtained in accordance with subsection (c) of this section and the other requirements of subsection (b) of this section have been satisfied, a physician or the physician's designee shall:

  (1) Collect the blood sample from the patient and health care provider involved in the exposure; and

  (2) Have the blood samples tested for the presence of HIV using a test procedure approved by the Department.

(e) When a physician obtains the results of a test for the presence of HIV that was conducted in accordance with the provisions of subsection (d) of this section, the physician or a designee of the health care facility shall directly notify the health care provider and the patient of the results of the patient's HIV test.

(f) The notification required under subsection (e) of this section shall:

  (1) Be made within 48 hours of confirmation of the results of the patient's HIV test;

  (2) Include subsequent written confirmation of the possible exposure to HIV; and

  (3) To the extent possible, be made in a manner that will protect the confidentiality of the health care provider and the patient.

(g) If the results of a test for the presence of HIV that was conducted in accordance with the provisions of subsection (d) of this section are positive, a physician or the physician's designee shall provide or arrange for the provision of appropriate counseling to the health care provider and the patient.

(h)

  (1) Notwithstanding the provisions of Title 4, Subtitle 3 of this article, the records, including any physician order for an HIV test or the results of an HIV test performed on a blood sample of a patient or a health care provider in accordance with the provisions of this section, may not be documented in the medical record of the patient or health care provider.

  (2) The health care facility shall maintain a separate confidential record or incident report for all HIV tests performed on a blood sample of a patient or health care provider in accordance with the provisions of this section.

  (3) The health care facility shall adopt procedures for the confidential testing of blood samples obtained in accordance with the provisions of this section.

  (4) Except as provided in paragraph (5) of this subsection, the records, including any physician order for an HIV test or the results, of any HIV test performed on a blood sample of a patient or health care provider in accordance with the provisions of this section are:

    (i) Confidential; and

    (ii) Not discoverable or admissible in evidence in any criminal, civil, or administrative action.

  (5) If the identity of the patient or any other information that could be readily associated with the identity of the patient is not disclosed, the results of an HIV test performed on a patient or health care provider in accordance with the provisions of this section may be introduced into evidence in any criminal, civil, or administrative action including the adjudication of a workers' compensation claim.

(i) The costs incurred in performing an HIV test on a patient or health care provider in accordance with the provisions of this section shall be paid by the health care facility.

(j) All health care facilities shall develop written procedures to implement the provisions of this section.

(k) A health care provider or health care facility acting in good faith to provide notification or maintain the confidentiality of the results of a test for the presence of HIV in accordance with the provisions of this section may not be held liable in any cause of action related to a breach of patient or health care provider confidentiality.

(l) The Medical and Chirurgical Faculty of the State of Maryland in consultation with the Centers for Disease Control and Prevention, the Maryland Hospital Association, and the Maryland Department of Health shall develop a practice protocol for physicians who are infected with HIV.

#### Section 18-338.2

(a)

  (1) In this section the following words have the meanings indicated.

  (2) "Health care facility" means a facility or office where health or medical care is provided to patients by a health care provider, including:

    (i) A hospital as defined in Sec. 19-301 of this article;

    (ii) A facility operated by the Department or a health officer; and

    (iii) The office of a health care provider.

  (3) "Health care provider" means a physician, nurse, licensed direct-entry midwife, or designee of a health care facility.

  (4) "HIV" means the human immunodeficiency virus that causes acquired immune deficiency syndrome (AIDS).

  (5) "Prenatal care" means obstetric and gynecologic services performed as part of a prenatal care program, including:

    (i) Screening;

    (ii) Physical examination;

    (iii) Laboratory and diagnostic testing procedures and interpretation; and

    (iv) Counseling.

(b) The Department, in consultation with stakeholders, shall adopt regulations establishing requirements for prenatal HIV testing.

(c)

  (1) A health care provider who provides prenatal medical care shall

  follow the requirements for prenatal HIV testing that are adopted by the Department.

  (2) The Department shall provide the requirements established under subsection (b) of this section to:

    (i) Hospitals that offer obstetric services;

    (ii) The American College of Obstetricians and Gynecologists;

    (iii) The American College of Nurse Midwives; and

    (iv) The Association of Independent Midwives of Maryland.

(d)

  (1) Except as otherwise provided in paragraph (2) of this subsection, the record of an HIV test performed under this section is confidential and not discoverable or admissible in evidence in any criminal, civil, or administrative action.

  (2) Provided that the identity or any other information that could readily be associated with the identity of the pregnant woman is not disclosed, the results of an HIV test performed under this section may be introduced into evidence in any criminal, civil, or administrative action, including the adjudication of a workers' compensation claim.

(e) A health care provider may not be subject to disciplinary action by the professional licensing board that licenses the health care provider for following the requirements for prenatal HIV testing established by the Department.

#### Section 18-338.3

(a)

  (1) In this section the following words have the meanings indicated.

  (2)

    (i) "Body fluids" means:

      (1) Any fluid containing visible blood, semen, or vaginal secretions; or

      (2) Cerebrospinal fluid, synovial fluid, or amniotic fluid.

    (ii) "Body fluids" does not include saliva, stool, nasal secretions, sputum, tears, urine, or vomitus.

  (3) "Exposure" means:

    (i) Percutaneous contact with blood or body fluids;

    (ii) Mucocutaneous contact with blood or body fluids;

    (iii) Open wound, including dermatitis, exudative lesions, or chapped skin, contact with blood or body fluids for a prolonged period; or

    (iv) Intact skin contact with large amounts of blood or body fluids for a prolonged period.

  (4) "First responder" means an individual who:

    (i) Is licensed or certified under Sec. 13-516 of the Education Article; and

    (ii) Provides services to an individual before the individual is admitted to a hospital.

  (5)

    (i) "Health care provider" means an individual who is licensed, certified, or otherwise authorized under the Health Occupations Article or this article to provide health or medical care in:

      (1) The ordinary course of business or practice of a profession; or

      (2) An approved education or training program.

    (ii) "Health care provider" includes any agent or employee of a hospital.

    (iii) "Health care provider" does not include an individual who is eligible to receive notification under the provisions of Sec. 18-213 of this title, including any law enforcement officer or any member of any fire department, ambulance company, or rescue squad.

  (6) "HIV" means the human immunodeficiency virus that causes acquired immune deficiency syndrome.

  (7) "Hospital" has the meaning stated in Sec. 19-301 of this article.

  (8) "Public safety worker" means:

    (i) A career or volunteer member of a fire, rescue, or emergency medical services department, company, squad, or auxiliary;

    (ii) A law enforcement officer;

    (iii) The State Fire Marshal or a sworn member of the State Fire Marshal's office; or

    (iv) A forensic scientist who works under the direction of a law enforcement agency.

(b) Notwithstanding the provisions of Sec. 18-338.1 of this subtitle, the designated infectious disease/communicable disease officer of a hospital shall order a test for the presence of antibodies to the human immunodeficiency virus (HIV) under subsection (d) of this section when:

  (1) There has been an exposure in a hospital between a patient and a health care provider, an exposure between a patient and a first responder, or an exposure between a patient and a public safety worker before admission of the patient to a hospital, that, in accordance with the Centers for Disease Control and Prevention recommendations, would warrant recommending or offering chemoprophylaxis treatment for the health care provider, first responder, or public safety worker;

  (2)

    (i) Informed consent, or substitute consent as required under Sec. 18-338.1(c) of this subtitle, of the patient to test a blood sample of the patient for the presence of HIV was sought and the patient was unavailable or unable to consent; or

    (ii) Informed consent, or substitute consent as required under Sec. 18-338.1(c) of this subtitle, of the patient to test a blood sample already obtained from the patient for the presence of HIV was sought, the patient refused, and the patient was informed of the provisions of this subsection;

  (3)

    (i) In accordance with hospital procedures, the health care provider involved in the exposure has given prompt notice of the exposure to the designated hospital infectious disease/communicable disease officer where the exposure occurred; or

    (ii)

      (1)

        (A) The first responder involved in the exposure has given prompt notice to the medical director with jurisdiction over the first responder; or

      (B) The public safety worker involved in the exposure has given prompt notice to the medical director with jurisdiction over the public safety worker; and

      (2) The medical director has given prompt notice to the designated hospital infectious disease/communicable disease officer where the patient is admitted;

  (4) The health care provider, first responder, or public safety worker involved in the exposure has given informed consent and has submitted a blood sample to be tested for the presence of HIV; and

  (5) The designated hospital infectious disease/communicable disease officer has made a determination, in accordance with the Centers for Disease Control and Prevention recommendations, that the testing of blood samples or other body fluids of the patient for the presence of antibodies to the human immunodeficiency virus (HIV) would be helpful in managing the risk of disease and health outcome of the health care provider, first responder, or public safety worker.

(c) If there has been an exposure between a first responder and an individual or a public safety worker and an individual before the admission of the individual to a hospital:

  (1) The first responder or public safety worker shall give notice to the first responder's or public safety worker's medical director in accordance with subsection (b)(3)(ii)1 of this section;

  (2) The medical director shall act as an intermediary at all times between the first responder or public safety worker and the designated hospital infectious disease/communicable disease officer; and

  (3) The medical director and the designated hospital infectious disease/communicable disease officer shall ensure that all communications and information related to the exposure of the first responder or public safety worker are confidential.

(d) If the requirements of subsections (b) and (c) of this section are satisfied, the designated hospital infectious disease/communicable disease officer shall order tests to be conducted for the presence of antibodies to the human immunodeficiency virus (HIV) using a test procedure approved by the Department on:

  (1) Blood samples already obtained from the patient; or

  (2) Blood samples or other body fluids collected for the purpose of HIV testing under this section.

(e) When the designated hospital infectious disease/communicable disease officer obtains the results of an HIV test conducted in accordance with the provisions of subsection (d) of this section, the designated hospital infectious disease/communicable disease officer shall attempt to directly notify the patient of the results of the HIV test and, to the extent possible, in a manner that will protect the confidentiality of the health care provider, the first responder, or the public safety worker and the patient.

(f) If the results of an HIV test conducted in accordance with the provisions of subsection (d) of this section are positive, the designated hospital infectious disease/communicable disease officer shall provide or arrange for the provision of appropriate counseling and treatment recommendations to the health care provider, first responder, or public safety worker and the patient.

(g)

  (1) Notwithstanding the provisions of Title 4, Subtitle 3 of this article, the medical records, including any physician order for an HIV test or the results of an HIV test conducted under this section, may not be documented in the medical record of the patient, health care provider, first responder, or public safety worker.

  (2) The hospital where the exposure occurred shall maintain a separate confidential record or incident report for all HIV tests conducted under this section.

  (3) Each hospital shall adopt procedures for the confidential HIV testing of blood samples or other body fluids used or collected for purposes of this section.

  (4) Except as provided in paragraph (5) of this subsection, the medical records, including any physician order for an HIV test or the results of any HIV test conducted under this section, are:

    (i) Confidential; and

    (ii) Not discoverable or admissible in evidence in any criminal, civil, or administrative action.

  (5) If the identity of the patient or any other information that could be readily associated with the identity of the patient is not disclosed, the results of an HIV test conducted on a patient for purposes of this section may be introduced into evidence in any criminal, civil, or administrative action including the adjudication of a workers' compensation claim.

(h) The costs incurred in performing an HIV test on a patient in accordance with the provisions of this section shall be paid by the hospital.

(i) Each hospital shall develop written procedures to implement the provisions of this section.

(j) A health care provider, first responder, public safety worker, or hospital or designee of a hospital acting in good faith to provide notification or maintain the confidentiality of the results of a test conducted under this section may not be held liable in any cause of action related to a breach of patient, health care provider, first responder, or public safety worker confidentiality.

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Md. Code Ann., Health-Gen. (as displayed at mgaleg.maryland.gov, October 16, 2026)