On what grounds was she discriminated against?

Dav010

drunkmonkey wrote: »

There's a bit of an issue in the UK at the moment with HIV and Hepatitis caused by a hygienist. https://www.google.ie/amp/s/www.bbc.com/news/amp/uk-england-beds-bucks-herts-48339679

Your dealing with serious infections, the dentist made the right call under the circumstances. It's wasn't safe to proceed.

No, the dentist made the wrong call, paid a financial penalty and I suspect will have a very difficult hearing in front of The Dental Council Disciplinary Panel in the near future.

The article you linked relates to incredibly poor cross infection practice, the Hygienist will be removed from the Register in due course.

wiggle16

Force Carrier wrote: »

Blood or saliva. But the chances are miniscule. Also the dentist wpould have to be not wearing her gloves and have an open cut.

You cannot get it from saliva. You can get it from blood, semen, breast milk and vaginal secretions. The virus can't survive in saliva, I think it's too vulnerable to the enzymes in it.

A person who is aware that they have HIV and is on medication for it will have an extremely low viral load, meaning it is very difficult for them to pass on the virus to someone else. There is still a risk, but it's extremely low.

A person who doesn't know that they are HIV positive has a much, much higher chance of passing on the virus to someone else because it is actively replicating in their bloodstream. But it is still relatively "difficult" to pass it on.

Since a dentist can't tell the difference between someone who has HIV but doesn't know it and someone who does not have HIV, or someone who has another blood borne disease like hepatitis, the precautions and sterilisation of instruments are or should be the same for everyone.

As another poster said, it's astonishing that in 2019 there is still so much ignorance around HIV. The dentist should have known all of this.

I don't know what the award itself accomplishes though, it seems quite penal. An apology and a commitment to making themselves more HIV aware through training would have been fair. There's a difference between a blunder made out of ignorance and willful discrimination and it would seem the law doesn't draw a distinction between the two.

Peregrinus

What Wiggle16 said. Any patient is potentially infective, and not just with HIV, and dentists and other medical and paramedical professionals should routinely be taking safeguards against infection. If you feel the need to refuse treatment to a patient who might be infectious, this just tells me that you're not taking the proper safeguards, and shouldn't be allowed to practice.

Anteayer

Speaking of which is it normal to be asked about whether you've had gay sex in a questionnaire in a dentists? It's a few years ago but I was really surprised to see that on a new patient form in a dentists in Cork City. Can't say it's a current form as this was maybe 8 years ago.

At the time I found it very intrusive line of questioning on a form.

I changed dentist as I just didn't find the guy particularly good and was never asked anything like that by my current dentist, who is incidentally way way better from a technical skills point of view too!

slipperyox

GM228 wrote: »

HIV is covered under disability under the Equal Status Act 2000:-

A virus is not an organism. ie not a living thing biologically speaking

Peregrinus

What were the other questions on the questionaire? Did it look to be a questionaire directed at identfying risk of blood-borne diseases? And do you recall why were you at the dentist - just a checkup, or some bigger procedure?

But, short answer: no, this isn't normal. Having had gay sex - or any kind of sex - has no implications for dental health.

slipperyox

Peregrinus wrote: »

What were the other questions on the questionaire? Did it look to be a questionaire directed at identfying risk of blood-borne diseases? And do you recall why were you at the dentist - just a checkup, or some bigger procedure?

But, short answer: no, this isn't normal. Having had gay sex - or any kind of sex - has no implications for dental health.

If over 50% of HIV cases in Ireland are within the gay community. And they account for a tiny proportion of the population as a whole. Then a high risk group needs caution from a health and safety prospective?

Peregrinus

slipperyox wrote: »

If over 50% of HIV cases in Ireland are within the gay community. And they account for a tiny proportion of the population as a whole. Then a high risk group needs caution from a health and safety prospective?

No, the entire population needs caution. As others have pointed out, the biggest risk is presented by the person who doesn't expect to be infected, doesn't know they are infected and so isn't being treated for infection, and the questionair won't identify those. So the most dangerous (in terms of infection risk) patients are likely to be in the group that answers "no, I've never had gay sex".

This is pretty basic stuff. All medics and paramedics are taught early on that, with any procedure involvling blood, the patient should always be treated as potentially infective.

slipperyox

Risk assessment is done quite simply.

Whats the worst that can happen?
How likely is that to happen?

Regards investigation of above, A questionnaire is reasonable, especially based on the likelyhood aspect.

Peregrinus

slipperyox wrote: »

Risk assessment is done quite simply.

Whats the worst that can happen?
How likely is that to happen?

Regards investigation of above, A questionnaire is reasonable, especially based on the likelyhood aspect.

Not at all. The questionaire doesn't give you any useful information, since you have to take the same anti-infection procedures with every patient, regardless of the answer to the question - any member of either group could be infectious. So there doesn't seem to be any point in asking the question.

Anteayer

Dav010 wrote: »

I’m sorry, but I’m going to have to call BS on this. No Dentist would risk such a question on the medical form as it would leave the Dentist open to an accusation of blatant discrimination on the grounds of both sexual orientation and potentially disability if the Dentist assumed a greater likelihood of HIV. The ethics classes all students take, the conferences and lectures we attend on this subject all outline that such discrimination or appearance of it is a guaranteed medicolegal minefield, it is inconceivable that a Dentist would ask about sexual orientation on a medical questionnaire.

The only medical questionnaire I can think where this question might arise would be an STI Clinic where data is being studied by HPSC on infection rates and transmission.

Absolutely not BS. it was on the form. I was early 20s at the time and didn't challenge it. So thinking about time frame that's about 12 years ago actually, so probably irrelevant now but I do not post BS and I'm mentioning it because I'm still surprised it was on a form in the early 2000s. I'm being vague because I'm trying to figure out what year exactly it was based on other events. I'm guessing about 2006.

It looked to be based on the questions that were on the blood donor forms at the time and still are today. I wouldn't even contemplate giving blood as I know even having a completely boring and safe sex life I'm excluded. I'm not arguing that that point, but as you're probably aware the current rules basically require gay males to be celibate for 12 months and those questions are asked.

At the time I knew I was excluded from giving blood so I guess I assumed the question was normal / likely to be asked anytime I went to hospital or a dentist.

I was handed a two page form which included that question amongst a whole load of other stuff about medical history.

I've actually never seen anything like it in any other dental practice before or since.

I've been to a few dentists over the years (maybe 5 or so as I've moved around) and I've only every been asked extremely rudimentary details. The most recent one had a tick box asking questions about medical treatment, specifically looking for information about Bisphosphonates, used to treat osteoporosis etc. Any questions were very specific to dentistry e.g. about cardiac surgery and valve replacement and so on where you might need antibiotics before major treatments.

If you don't want to believe I was asked! I'm not really sure what to respond with. All I know is I was really taken aback by the question and at the time I declined to answer it and then felt incredibly guilty for not answering it.
They didn't react to the incomplete bit I wasn't fully out, and it was a while back so being gay was still a relatively sensitive topic, I was only out to a very small number of people at the time.

It was only for a checkup and I didn't go back to him ever again but it stuck in my memory because I just remember it being so excruciatingly akward.

I know I was starting out with a new dentist a few years later and I was dreading the registration form but was pleasantly surprised that the questions on it were normal.

I would say though, thinking back on it, it definitely put me off seeking medical attention for a few things, even though I did get STI tests done regularly, I didn't necessarily want to discuss my sexual orientation outside that context. So I probably did actually avoid doctors and stuck with one dentist. I mean, for example, I know I was expecting to and dreading having to answer that question in A&E and was also surprised it absolutely didn't come up and that was entirely because they dentist's form had asked me previously.

It did make me feel really like I was some kind of high risk to everyone and I was kind of paranoid about STIs anyway to the point that I would probably be nearly OCD about them in some ways myself and take so few risks that it would have limited my sex life so it kind of added to my paranoia about it and just made me feel awful generally.

Sorry if this is a bit meandering but I just want to underline that I'm not posting BS. Go look at my posting history if you want.

Why would I make this up?!
Sorry I posted at all now. Seems a lot of people don't even want to believe that homophobia is an actual issue here. Much like the way people don't want to believe racism happens in Ireland.

drunkmonkey

Peregrinus wrote: »

As others have pointed out, the biggest risk is presented by the person who doesn't expect to be infected, doesn't know they are infected and so isn't being treated for infection, and the questionair won't identify those. So the most dangerous (in terms of infection risk) patients are likely to be in the group that answers "no, I've never had gay sex".

That doesn't make sense, how can the group least at risk be the most dangerous. Surely if a man answers yes to the question then there in the most dangerous group.

Anteayer

Well, you'd assume that a dentist simply takes every precaution around transmissible diseases and hygiene in general. I mean while most of their procedures aren't hugely invasive, some are and if is basically a surgical theater of sorts.

I wouldn't expect a dentist should be putting themselves or other patients at any kind of risk of getting blood to blood contact.

I mean apart from HIV there are loads of viruses that could be transmitted by bad hygiene practices in a dental surgery - hepatitis or even the herpes simplex virus that causes cold sores.

You'd expect a dentist to take normal surgical precautions - gloves changed, surfaces holding instruments kept sterilised, instruments all properly sterilised, hand pieces properly sterilised and so on.

I wouldn't be very comfortable if they had a situation that could potentially transmit HIV between patients or to themselves and were relying solely on questionnaires and risk assessment to avoid that.

I remember the only time I've ever felt really at risk was in a barbers. She cut my neck with a blade and I started bleeding, enough that she kept trying to apply a styptic pencil (aluminium sulphate pencil that you might use to seal up razor cuts) but something that should never be shared!!

I literally jumped out of the seat when she started approaching me with this thing and she kept on pushing it. Literally had yell "get away from me! Stop! Don't touch me with that!" I ended up standing up, taking the bib off and just leaving and she started yelling at me to pay! (Which I did).

I just went to a pharmacy and got antiseptic wipes and cleaned myself up, but thinking back on it, I could probably have followed up.

I always want to see clearly that the blades used in barber's are changed in front of me. I'm extremely paranoid about it since that incident as I'm not convinced there's much or any proper regulation of this stuff in Ireland.

Who actually regulates barbers in Ireland for health and safety and so on? The HSE? I couldn't seem to find any information at the time and I was going abroad soon after and just never got around to following up properly.

I assume dentists are regulated by their own body and probably HIQA must have some role at this stage?

I've found hygiene standards in dental surgeries here vary a lot.
Just as an example, one guy I went to was in a fairly worn out looking surgery. The place looked shabby and I wasn't comfortable with it and other surgeries I've been in have been absolutely gleaming, with all the hand pieces (drill drives) and surfaces covered in plastic that was disposed of.

The standards just seem really variable and it's not something I would expect

Peregrinus

drunkmonkey wrote: »

That doesn't make sense, how can the group least at risk be the most dangerous. Surely if a man answers yes to the question then there in the most dangerous group.

No. The most infectious person is the person who has HIV infection, doesn't know it, and isn't being treated for it. That person is much more infections than someone who is receiving treatment, since one of the effects of treatment is a reduction in infectivity.

Obviously, whether or not you've had gay sex, you could be infected with HIV, because gay sex is not the only vector of transmission. So both groups - those who answer yes, and those who answer no - are likely to contain infected people, and they are likely to contain people who do not know they are infected, and who are not receiving treatment. The people who haven't had gay sex (or had blood transfusions, or come in contact with infected needles) are less likely to be infected but, if they are infected, they are more likely to be unaware of the fact (because they've had no reason to be tested) and so to be untreated, so you would expect the most infectious people to be over-repfresented in the group who answer "no" to gay sex.

So every patient should be treated as potentially infectious, regardless of what answer they give to the question, and precautions against transmission should be taken with all patients. This is epidemiology 101, really. So the answer to the question doesn't affect in any way the treatment you will offer patients, or the precautionary measures you will adopt when administering that treatment. So in this context there is no reason to ask the question.

Dav010

drunkmonkey wrote: »

That doesn't make sense, how can the group least at risk be the most dangerous. Surely if a man answers yes to the question then there in the most dangerous group.

Most people who are diagnosed do not know specifically when they contracted the virus, one third of those diagnosed in Ireland in 2017 are heterosexual, many will have visited GPs/Dentists during the period between infection and diagnosis and will have been unaware of their status. Those that have been diagnosed will be recieiving treatment to reduce viral load and will therefore be less likely to transmit.

Honestly, the ignorance on this is staggering.

.......

drunkmonkey wrote: »

If it's infections and they have no experience of proper procedures in dealing with someone with it absolutely yes they should be able to say no.
There is blood involved, I assume if HIV blood mixes with yours it could mean trouble.
I could be wrong and you can't transfer it by mixing blood, I haven't looked it up it's just an assumption I've held for as long as I can remember. Probably just like the dentist.

Its difficult to believe that you are this ignorant about HIV.

Please inform yourself.

drunkmonkey

Dav010 wrote: »

Most people who are diagnosed do not know specifically when they contracted the virus, one third of those diagnosed in Ireland in 2017 are heterosexual, many will have visited GPs/Dentists during the period between infection and diagnosis and will have been unaware of their status. Those that have been diagnosed will be recieiving treatment to reduce viral load and will therefore be less likely to transmit.

Honestly, the ignorance on this is staggering.

I was talking about the question in the questionnaire, from what I gather your backing up the statement that a man who says they have sex with men is less of a risk than the chap that says he doesn't. I would have thought the opposite. I think generally people would assume the same.
It's nothing to do with having a diagnosis, it's about a risk group based on one question.
Two men present in front of you one is gay and has sex with men the other is straight I don't see in what alternative universe you think the straight guy is more of a risk of having HIV based on only those facts.

Peregrinus

drunkmonkey wrote: »

I was talking about the question in the questionnaire, from what I gather your backing up the statement that a man who says they have sex with men is less of a risk than the chap that says he doesn't. I would have thought the opposite. I think generally people would assume the same.
It's nothing to do with having a diagnosis, it's about a risk group based on one question.
Two men present in front of you one is gay and has sex with men the other is straight I don't see in what alternative universe you think the straight guy is more of a risk of having HIV based on only those facts.

He is more at risk of being infected with HIV, but less at risk of having an untreated HIV infection. And the patient with the untreated HIV infection is the most infectious.

But take a step back. The purpose of this questionaire is not to find out which patients have HIV infecction, or are at greatest risk of having it. The dentist doesn't offer treatment for HIV infection, so identifying HIV+ patients is not something he needs to do to practice dentistry.

The purpose of this questionaire is to protect the dentist and the dental technicians from becoming infected themselves by coming into contact with contaminated blood.

From that point of view, you don't need to know which patients are at greatest risk of being infectious; you need to know which patients are at any material risk of being infectious. And the answer to that question is "all of them".

Look at it this way: if you identify the "had-gay-sex" patients and take special precautions with them, that means there are precautions which you could take with other patients, but don't. But, as already pointed out, one-third of your infected patients are probably in that other group, and they probably include a disproportionate number of the most infectious cases. So why are you not taking the same precautions with that group?

A questionaire which identifies a group that probably contains some of the infected patients is useless, since you need to take precautions with all of the infected patients. And of course the only way to do that is to take precautions with all of the patients.

wiggle16

drunkmonkey wrote: »

Two men present in front of you one is gay and has sex with men the other is straight I don't see in what alternative universe you think the straight guy is more of a risk of having HIV based on only those facts.

It's not about who is more at risk of having it. Peregrinus is trying to illustrate how a questionaire is worth sweet f*ck all with regards to managing the risk of infection.

Neither the gay nor the straight man are more inherently dangerous than the other.

However, if one of them does have HIV, there is an argument to be made that the straight man is possibly the more infectious. This is because:
- He is less likely to know he has HIV
- Because he is less likely to have got himself tested for it
- So he is not going to be on treatment for it
- So his viral load is likely to be much higher

.......

drunkmonkey wrote: »

I was talking about the question in the questionnaire, from what I gather your backing up the statement that a man who says they have sex with men is less of a risk than the chap that says he doesn't. I would have thought the opposite. I think generally people would assume the same.
It's nothing to do with having a diagnosis, it's about a risk group based on one question.
Two men present in front of you one is gay and has sex with men the other is straight I don't see in what alternative universe you think the straight guy is more of a risk of having HIV based on only those facts.

You are missing the difference between someone in an at risk group and someone with a high risk of passing on infection.

drunkmonkey

Peregrinus wrote: »

He is more at risk of being infected with HIV, but less at risk of having an untreated HIV infection. And the patient with the untreated HIV infection is the most infectious.

But take a step back. The purpose of this questionaire is not to find out which patients have HIV infecction, or are at greatest risk of having it. The dentist doesn't offer treatment for HIV infection, so identifying HIV+ patients is not something he needs to do to practice dentistry.

I 100% get that you have to assume everyone has an infection and use best practices based on that assumption. We can't assume all dentists and their staff are created equally though, hence the chance of an infection as we can see demonstrated from the case in the UK. Even though I'm not sure if anyone was infected but at least there being proactive in minimising any risk to the public.

I still don't get how the person in the at risk group is less of a risk of having untreated HIV. Unless someone is getting tested regularly I'd still put the guy who answered no in the less at risk group based on probability. I know you have to assume they all have it to protect everyone.

You've thrown out ignorance a few times, is that what the dentist is guilty of, is not knowing something a crime. It's been treated as one in this case.
The dentist didn't have the full facts around what they were dealing with and stopped the procedure. That's not discrimination, that's a medical professional being cautious. Could it have been an older dentist, do you need to keep doing exams after your qualify if your in your own practice?

If they stuck up a poster saying no Catholics allowed that would be discrimination in my book.

This is all back to the compensation culture. Cap payments for hurt feelings at €250 and see how many people take a case. The letter of apology and the commitment to educate people in the practice is a win without having to hand over 10k.

slipperyox

Dav010 wrote: »

Most people who are diagnosed do not know specifically when they contracted the virus, one third of those diagnosed in Ireland in 2017 are heterosexual, many will have visited GPs/Dentists during the period between infection and diagnosis and will have been unaware of their status. Those that have been diagnosed will be recieiving treatment to reduce viral load and will therefore be less likely to transmit.

Honestly, the ignorance on this is staggering.

Your valuing of kindness over truth is staggering. Both groups will have equal undiagnosed, 33% hetero, 66% gay. Gay is still higher risk.



Still, fact is, over 50% of the countries HIV is within the gay community. And they represent a tiny proportion of the population as a whole. Hence are a high risk group. Not unreasonable to use a questionnaire to risk assess.

And interestingly, HIV in heterosexuals would be much higher if it wasn't for the fact that women are coy;)

Victor

Force Carrier wrote: »

I think the probability of the hiv patient biting the dentist is infinitesimal.

Dentist: OK, close you mouth.
Me: [Closes mouth.]
Dentist: Ow! After I take out my fingers.
Me: I can see neither my mouth nor your fingers. Let this be a learning moment.

Further again, transmission blood to blood of hiv is minute odds.

Did you say this correctly?

There is just a handfull of documented cases of hiv transmission via bite in the 40 years history.

Dentistry has a moderate to high level of bleeding risk, so much that active measures are taken to suppress it. It also has a high risk of biting.

Effects wrote: »

If the HIV positive person is on modern medication, they can't transmit it by any means.

There are different strains of HIV. Medication may not work with all of them.

drunkmonkey

Just looking at some of the stats. A fair questionnaire would probably be classed as discriminatory even though it shouldn't be as it's trying to obtain information the patient might not be aware of it.
Some of the questions would have to be..
Were you born in Europe?
Are you white?
Are you male or female?

None of them are asking about partner preferences but can you give an indication of the probability of someone having HIV.
In this case I notice it was a she. The odds of that being a white Irish girl are very low compared to a female born outside europe of a non celtic origin.

GM228

slipperyox wrote: »

A virus is not an organism. ie not a living thing biologically speaking

Oh the great dead or alive debate for a virus

Yes indeed you are correct in biological terms, a virus is a non-living organism, a term which in biological terms is contradictory because it's strictest biological definition requires life, it's more accurate to say it's an organisation (i.e a non life which has some qualities of life), as opposed to an organism in biological terms. There has been great debate between some of the worlds greatest biologists as to an accurate definition of organism and where a virus may fit in.

However, that all aside, organism is not defined in biological terms (or indeed any terms) in statute and so it's ordinary non biological definition prevails.

wiggle16

drunkmonkey wrote: »

Just looking at some of the stats. A fair questionnaire would probably be classed as discriminatory even though it shouldn't be as it's trying to obtain information the patient might not be aware of it.
Some of the questions would have to be..
Were you born in Europe?
Are you white?
Are you male or female?

None of them are asking about partner preferences but can you give an indication of the probability of someone having HIV.
In this case I notice it was a she. The odds of that being a white Irish girl are very low compared to a female born outside europe of a non celtic origin.

Oh for God's sake.......

You do realise white Irish girls can acquire HIV as easily as anyone else?

You're not getting it. The questionaire tells the dentist nothing. He should be taking the same precautions for every patient because not everyone who has HIV knows they have it and not everyone who has a blood borne disease has HIV. Even white Irish girls.

Knowing that someone is at a higher risk of contracting HIV gives the dentist no useful information whatsoever.

wiggle16

drunkmonkey wrote: »

This is all back to the compensation culture. Cap payments for hurt feelings at €250 and see how many people take a case. The letter of apology and the commitment to educate people in the practice is a win without having to hand over 10k.

More to the point of the thread though, I do agree with you here.

hullaballoo

It should be the opposite. There should be minimum damages for proven discrimination of €20,000.00.

It's a very crude analysis, although unsurprising, to refer to "damages for hurt feelings" and putting some arbitrary nominal value on that.

People forget themselves, I think, when they see others getting damages. Leaving aside the tired debate about frauds, people who commit wrongs against others in a wide variety of ways should not end up with no more than a nominal order against them.

We do not want a society where people can be negligent or reckless with regard to other members of the society because there are no consequences. We want a society where people who do not abide by the rules of our society, whatever the nature of those rules, do not get away scot-free.

Damages play an important role in our society in order to act as a deterrent for errant behaviour that isn't quite criminal.

I would just note that I am talking generally here about wide-ranging topics or areas where damages play a role. The debate around damages in personal injuries is not a topic for this thread. I don't want to have to go about doing a big, bold mod warning on this so take this as the warning. That's a topic for another thread.

wiggle16

In a general sense, I agree with you with regards discrimination. My point (albeit made earlier in the thread) is that this does not seem to have been a case of wilful discrimination, but one of a poor decision made out of ignorance. There is a distinction to be drawn between the two which the law (in my understanding) doesn't seem to make.

The dentist, afaik, did not base his decision not to treat her upon any bigotry towards HIV positive people. It appears he was ignorant of the fact that it is the same as any other blood borne disease, at least to the extent that it relates to the precautions taken to prevent the spread of disease in dentistry.

Myself I think an award like this is penal. If it were wilful discrimination, I would certainly agree with you. The woman's feelings were understandably very hurt and I'm sure she found it distressing (to put it lightly) but it should come down to the intention behind the incident.

The dentist absolutely should have been aware of the points brought up in the thread, but I still think ten grand is excessive. An unreserved apology and an undertaking to retrain himself and all staff seems fair to me for what seems to have been an ignorant blunder rather than "discrimination".

hullaballoo

If it was wilful and borne out of malice, the damages should be markedly higher again.

I don't think excusing the wrong as being a matter of ignorance is in any way defensible from a societal perspective.