North Carolina's Response to the Corona Virus

The Corona Virus and North Carolina Clinics

          Our state has issued a corona virus “guidance” to all “healthcare providers.”  The term “healthcare providers” covers physicians as well and others who do not treat patients for the flu such as dentists, physical therapists, optometrists, and pharmacists,  The following tips will help non-physician providers comply with the guidance and avoid legal problems that may arise.

All non-physician providers should:

1.      Take infection control measures appropriate to the clinic setting,

2.    Consider postponing non-emergency care when the patient appears to have a respiratory illness,

3.      Comply with HIPAA, and

4.    Enact corona virus policies that do not discriminate on the basis of national origin. 

Notices

Our state asks all “health care providers” to post signs about the corona virus. North Carolina has not given us a sign template.  The Texas sign tells patients to let “staff” know whether they have been “ANYWHERE IN CHINA” in the 14 days prior to the appearance of symptoms.  North Carolina asks patients to tell providers whether they have traveled to “areas with ongoing corona virus transmission in the last 14 days”.  Unfortunately, this assumes that patients know which countries are of concern. 

Our signs should simply ask patients to report flu like symptoms upon checking in.  The signs should list CDC flu symptoms such as fever, cough, sore throat, runny nose, body aches, headaches and fatigue.

Patient Evaluation and Additional Protocols

Our state asks “healthcare providers” to evaluate patients for any “respiratory infections” including the flu.  Although non-physician providers are not licensed or equipped to diagnose the flu or the corona virus, anyone can determine whether the patient has flu-like symptoms.

Other North Carolina corona virus protocols address managing the patient, the clinic environment, diagnostic testing, and visitor access as well as using personal protective equipment.  Some of these protocols clearly do not apply to non-physician providers.  Still, all providers should adopt those practices that do apply to their clinic setting.

What to Do When Patients Report Flu-like Symptoms

If the patient reports flu-like symptoms, non-physician providers should consider rescheduling the patient.  If rescheduling would endanger the patient, the provider should ask questions about recent international travel or other exposure to the corona virus, such as being near people who are known to be infected.  To comply with HIPAA, this discussion should take place outside of the view and hearing of other patients.  If the patient reports having been in “areas with ongoing corona virus transmission” within the past 14 days, the provider should call the NC Communicable Disease hot-line at 1- 919-733-3419 to consult with experts on the virus.

Recommended Office Policies

The clinic should enact an office policy that references the parts of the N.C. guidelines that apply to the clinic.  That policy should clearly state that it applies to ALL patients who present with symptoms of the flu.  Although the virus may have originated in China, the evidence clearly indicates that people of many different countries have been infected by the virus.  A provider who only asks questions of people from China is ignoring the data and contributing to the spread of the virus.  He or she also risks being charged with illegal discrimination. Finally, the policy should require documentation of the discussions with the patient that relate to the above.

This flu will eventually go away.  Meanwhile, providers must comply with DHHS guidelines as well as other relevant federal and state laws.

Thanks for reading.   Patrice Walker

[1]https://epi.dph.ncdhhs.gov/cd/coronavirus/_Interim%20Guidance%20for%20Healthcare%20Settings.pdf?ver=1.4.  DHHS updates those guidelines frequently, so please check them often for new information.