U.S. Department of Health and Human Services, Office for Civil Rights and Anonymous, Settlement Agreement (2009)

The Office for Civil Rights (OCR) brokered this settlement agreement between a patient with HIV and an orthopedic surgeon who refused to perform knee surgery on the patient because of the patient's HIV status. OCR first issued a letter of finding indicating that the surgeon had discriminated against the patient in violation of Section 504 of the Rehabilitation Act and then followed up with this agreement. The terms of the agreement require the surgeon to "make reasonable modifications in policies, practices, or procedures when the modifications are necessary to avoid discrimination on the basis of disability" and ensure that his staff comply with the non-discrimination policy. The agreement further requires that the surgeon "not deny or withhold medically appropriate treatment (as determined by reasonable medical judgment given the current state of medical knowledge) on the basis of a patient's HIV disease status." If there is a question about the appropriateness of a procedure for a patient with HIV, the surgeon must first consult with an infectious disease specialist before making a decision and a recommendation to the patient. The surgeon must also strictly adhere to universal precautions when treating any patient, and must prominently display the non-discrimination policy where patients can easily see it. Lastly, the surgeon was given 120 days within which to complete six hours of training on (1) a general overview of HIV disease, (2) a physician's ethical obligation to treat patients with HIV, (3) prevention of HIV transmission during surgery and other medical procedures, (4) infection control procedures, (5) universal precautions, and (6) the use of post-exposure prophylaxis.

Once the terms are met, the surgeon must report back to OCR with a copy of the non-discrimination policy notice, documentation of completed training by an approved trainer, and letters describing any grievances filed against the surgeon by patients with disabilities.