Nobody expects Dr. Elizabeth Richardson, Hamilton's medical officer of health, to spill her guts over her department's dealings with an HIV patient who is facing murder and sexual assault charges for allegedly spreading the lethal virus.

After all, we all understand that a Brantford woman is suing the city for more than $6 million over the issue.

The woman, who is infected with HIV, alleges city police and the health department knew she was sleeping with the accused, Johnson Aziga, but failed to warn her that he was an HIV carrier.

Since the city is now preparing its statement of defence, it makes perfect sense for Richardson to tread carefully and withhold any details about the case that could damage the city's legal position.

But for awhile there, it looked as if she was going well beyond playing it cool.

In fact, it looked as if she had forgotten the hard-won lessons about the need for timely and open communication with the public that were hammered home in the aftermath of the 2006 legionella outbreak.

Citing the current lawsuit, Richardson this week simply refused to discuss the matter when The Spectator first asked her to talk in generic terms about the city's policies on patient confidentiality and partner notification.

That was on Tuesday.

By yesterday, the landscape shifted and Richardson had found her tongue.

What transpired over those few days?

Richardson says she clammed up initially because the allegations are connected to the city's policies and she wasn't sure what she could say.

"I wanted to make sure what we could talk about without making a legal misstep," she says.

That's reasonable enough. It's too bad Richardson didn't just say that to the reporter instead of refusing to answer questions. If she had straightforwardly asked for time to get her legs under her, she would have given the impression of co-operating rather than stonewalling.

She didn't and now the impression lingers.

Live and learn.

To be fair to Richardson, though, this is an incredibly complex case for the city and public health.

Because of privacy and health information protection laws, Richardson says she can't even deny the allegations, at least at this point.

"I can't tell you whether we've actually been involved in that case or not because of the situation of confidentiality," she says.

"It's one of the struggles for us in the new privacy environment -- what can we even put in our statement of defence, quite frankly, without breaking confidentiality."

Nonetheless, Richardson says her department always follows regular practices and policies when dealing with sexually transmitted diseases, of which about 1,400 cases are reported each year, including HIV.

First they contact the reported person to make sure they've been treated, educate them about not infecting others, then get the names and follow up with their contacts.

But even then there's a lot of confidentiality in the process.

For example, they don't tell the contact where they got his or her name from. In other words, they protect the identity of the reported carrier.

"That's been a standard of care for decades," Richardson says.

Public health does have legislated power to order people to receive treatment.

And, in the case of communicable diseases such as HIV, if they receive information the person is not complying, the next step is to levy fines or ask the courts to intercede.

Richardson says the debate around the interplay between taking legal action and trying to work with people has been going on for decades.

Presumably the lawsuit and Aziga's trial will bring it into much sharper focus.

Andrew Dreschel's commentary appears Monday, Wednesday and Friday.

adreschel@thespec.com

905-526-3495