TB Test Ethics and Regulations 3 — Questions and Answers
Question 1: Which ethical principle is most directly violated when a clinician administers a TB test to a patient without explaining the procedure or obtaining consent?
- Beneficence
- Justice
- Autonomy (Correct answer)
- Non-maleficence
Correct answer: Autonomy
Failing to obtain informed consent violates patient autonomy, the principle that individuals have the right to make informed decisions about their own care.
Question 2: A state law requires reporting of latent TB infection (LTBI) to the health department. A clinician in that state is treating a patient with LTBI. What must the clinician do?
- Report only if the patient is non-compliant with treatment
- Report the case in accordance with the state law, regardless of treatment status (Correct answer)
- Obtain patient consent before reporting, as LTBI is not contagious
- Report only after the patient has completed preventive therapy
Correct answer: Report the case in accordance with the state law, regardless of treatment status
Clinicians must comply with applicable state reporting laws; if the state mandates LTBI reporting, it supersedes individual provider discretion.
Question 3: An employee tests positive on their annual TB screening IGRA. The employer demands the full lab report including unrelated health information in the same document. What should the healthcare provider do?
- Release the entire document to satisfy the employer's request
- Provide only the TB test result relevant to the occupational requirement and withhold unrelated PHI (Correct answer)
- Refuse to release any information without a court order
- Ask the patient to handle the disclosure directly with their employer
Correct answer: Provide only the TB test result relevant to the occupational requirement and withhold unrelated PHI
HIPAA's minimum necessary standard requires disclosing only the information needed for the specific purpose; unrelated PHI must be protected.
Question 4: What is the primary purpose of a TB control program's contact investigation following an infectious TB case?
- To identify and penalize the source of the infection
- To identify exposed individuals, test them, and offer preventive treatment to limit transmission (Correct answer)
- To quarantine the patient's entire household indefinitely
- To document the outbreak for epidemiological research only
Correct answer: To identify exposed individuals, test them, and offer preventive treatment to limit transmission
Contact investigations aim to find those exposed, test for infection, and provide preventive therapy to interrupt TB transmission chains.
Question 5: A healthcare worker with a newly positive TST refuses to have a chest X-ray to rule out active TB disease. Under occupational health regulations, what can the employer typically require?
- Nothing; the worker's refusal must be accepted unconditionally
- Removal from direct patient care until evaluation for active TB disease is completed (Correct answer)
- Immediate termination without due process
- Mandatory admission to an infectious disease unit
Correct answer: Removal from direct patient care until evaluation for active TB disease is completed
Employers may restrict a worker's duties to protect patients and coworkers until active TB is ruled out, consistent with OSHA and CDC guidance.
Question 6: Which of the following actions by a TST administrator constitutes a breach of professional ethics?
- Documenting a 0 mm induration as negative
- Informing the patient that a positive result requires further evaluation
- Inflating a borderline induration measurement to ensure the patient receives treatment (Correct answer)
- Referring a positive TST result to a physician for follow-up
Correct answer: Inflating a borderline induration measurement to ensure the patient receives treatment
Intentionally altering measurements to influence clinical outcomes is falsification of medical records and a serious ethical violation.
Question 7: Which federal law protects employees in most healthcare settings from retaliation if they refuse to work in conditions that pose a clear and imminent TB exposure risk?
- Americans with Disabilities Act (ADA)
- Occupational Safety and Health Act (OSH Act) (Correct answer)
- Health Insurance Portability and Accountability Act (HIPAA)
- Family and Medical Leave Act (FMLA)
Correct answer: Occupational Safety and Health Act (OSH Act)
The OSH Act's whistleblower protection provisions shield employees who report or refuse to work in imminent-danger conditions, including infectious disease exposures.
TB Test Ethics and Regulations 3
Which ethical principle is most directly violated when a clinician administers a TB test to a patient without explaining the procedure or obtaining consent?