Draft of Ethics standards May 21, 2005

DRAFT

International Family AIDS Program and Centro del Día

Mission Statement and Definition of Quality Care

The International Family AIDS Program(Centro de  Día) at Complejo  Micaeliano is:

• A Center of Excellence in filling the medical and social needs of persons living with HIV and their families in the Eastern Dominican Republic by delivering quality medical care.
• A teaching facility for medical students and residents from both the US and the Dominican Republic
• A center for research on medical and epidemiologic methods for control of HIV

Quality medical care includes:

· Weighing, height measurement, if appropriate, and recording of vital signs at patient intake.

· History taking, review of systems, physical examination, ordering of appropriate diagnostic testing, differential diagnosis, and institution of appropriate therapy by physicians for all patients.

· Easily legible, well-documented information entered into the medical record for each clinic visit. This includes but is not limited to dates of treatment, intake information, medical progress notes, laboratory tests ordered, medications dispensed and dates of initiation and termination (or change in regimen).

· Education of the client/patient about his/her condition and any medications to be taken, including side effects to be watched for.

· Counseling and support available to all patients.

· Directly observed therapy and/or home visits when indicated.

· Provision of telephone or other contact information to patients for questions and emergencies

· Recording accurate contact information so that the patient can be located for followup

· Continuous stocking and availability of medication for HIV and related conditions to prevent lapses that may lead to resistance.

· Provision of social supports in a dignified and caring manner, including nutritional, housing, transportation, and other resources, to aid in adherence,

●Availability and Accessibility:

• The diverse services provided by IFAP at Complejo Micaeliano and other sites should be available to all persons living with HIV and their families, as well as all persons who do not know their HIV status but wish to know.
• The clinic will be open at well-known hours (8:00a.m.-12:00 p.m., 2:00 p.m.-5:00 p.m.) and have enough capacity to see all patients who cannot reasonably return for a visit the following day.During working hours, there will not be arbitrary cut-off times to reduce walk-ins, although patients that arrive shortly before noon may be asked to wait until 2:00 p.m. to be seen, if they do not have an emergency. 
• Appointments will be available to patients, as well as options to come without appointments for sick-visits. 
• Because travel may constitute for many patients hardship and expense, all efforts will be made to have as many services as possible provided when a patient is at the clinic, and to find ways to reduce inconvenience for patients.
• Patients should not be referred to other facilities that are less convenient for them for services that can be rendered at Complejo Micaeliano because they came in shortly before noon, or because they have missed appointment(s) in the past.

●Non-Discrimination:

• Services will be provided to patients regardless of race, nationality, religion, gender, marital status, employment, income, social class, parity, sexual orientation, mental status, previous behavior, or use of other facilities.

●Respect and Courtesy:

• Patients and staff are expected to treat each other with respect and courtesy.
• Under no circumstances will patients be reprimanded, scolded, or blamed for health events by staff-members; all feed-back to patients will be done in a way that supports their autonomy, and does not expose them to embarrassment.
• Staff members will not air differences of opinion or reprimand other staff-members in the presence of other staff, visitors or patients.
• Receipt of services or benefits is not conditional on reproductive or contraceptive choices, and no staff member may suggest that this is the case. 
• Staff meetings will be scheduled in advance, with an agenda, and  conducted in a way that does not compromise patient care, the functioning of the clinic, or create embarrassment. .
• Violent or abusive behavior will not be tolerated.  In the event of inappropriate behavior, proper authorities may be summoned.
• Interruptions during patient visits by other medical staff and by telephone calls should be minimized.

●Confidentiality:

• Medical information--including medical history, laboratory results, instructions, corrections, and criticisms-- shared between patients and healthcare providers is considered private and privileged.
• Discussions between staff and clients will be conducted in a private setting with a minimum of interruptions

• Written records will be protected from loss or unauthorized use, and in general may not be removed from the clinic
• Medical information is to be used only for  providing and evaluating medical care, authorized research, or other medical or legally required purposes, and not for business, political, or personal decisions outside the clinic.

●HIV status issues

• HIV status is to be protected with great care and shall not be revealed to another person, even family members, without express permission of the patient.

• Contacts named by clients may be followed up, but without revealing the source of the information.
• No one may be tested for HIV without proper consent and understanding.(Testing anyone without their consent, or divulging, or allowing the divulging of a patient’s serostatus to anyone, is a crime in the Dominican Republic (RD Ley 55-33). )

● Clinic Time and Facilities

• During working hours, staff activities are to be directed toward clinic business and not to personal pursuits
• Clinic equipment and supplies--including vehicles, computers, internet access, and telephones, and medications--are for clinic business, and not for personal use. 
• Access to internet searching and email for reasonable amounts of personal use is provided to encourage learning computer skills.
• Patient care at all times takes priority over visits by pharmaceutical representatives, .