BILL NUMBER: SB 843 CHAPTERED 09/21/02 CHAPTER 763 FILED WITH SECRETARY OF STATE SEPTEMBER 21, 2002 APPROVED BY GOVERNOR SEPTEMBER 20, 2002 PASSED THE SENATE AUGUST 26, 2002 PASSED THE ASSEMBLY AUGUST 15, 2002 AMENDED IN ASSEMBLY JUNE 30, 2002 AMENDED IN ASSEMBLY MAY 29, 2002 AMENDED IN ASSEMBLY FEBRUARY 14, 2002 AMENDED IN SENATE APRIL 18, 2001 INTRODUCED BY Senator Perata (Coauthor: Assembly Member Chan) FEBRUARY 23, 2001 An act to amend Sections 121361 and 121362 of, and to add and repeal Section 121360.5 of, the Health and Safety Code, relating to communicable diseases. LEGISLATIVE COUNSEL'S DIGEST SB 843, Perata. Omnibus Tuberculosis Control and Prevention Act of 2002. Existing law establishes various communicable disease prevention and control programs, including one for tuberculosis. That program provides for testing of various persons for tuberculosis by prescribed licensed health professionals. This bill would enact the Omnibus Tuberculosis Control and Prevention Act of 2002. This bill would until January 1, 2006, permit any local health department to provide for certification, by the local health officer, of tuberculin skin test technicians, as defined, in accordance with specified requirements. Existing law requires each health care provider who treats a person for active tuberculosis disease, each person in charge of a health facility, or each person in charge of a clinic providing outpatient treatment for active tuberculosis disease to promptly provide a disease notification report and written treatment plan to the local health officer at the times that the health officer requires, but no less frequently than when there are reasonable grounds to believe that a person has active tuberculosis disease, and when a person ceases treatment for tuberculosis disease. Existing law prohibits a health facility, local detention facility, or state correctional institution from discharging or releasing a person known to have active tuberculosis disease or a person the medical staff of the health facility or of the penal institution has reasonable grounds to believe has active tuberculosis disease, unless the notification report and individual treatment plan requirements specified above have been met. This bill would provide that when a person described above is released on parole from a state correctional institution, the notification and written treatment plan shall be provided to both the local health officer for the county in which the parolee intends to reside and the local health officer for the county in which the state correctional institution is located. It would require the Department of Corrections to inform the parole agent, and other parole officials as necessary, that the person has active or suspected active tuberculosis disease and provide information regarding the need for evaluation or treatment. In addition, the bill would require the parole agent and other parole officials to coordinate with the local health officer in supervising the person's compliance with medical evaluation or treatment related to tuberculosis, and to notify the local health officer if the person's parole is suspended as a result of having absconded from supervision. The imposition of new duties on local health officers in connection with these provisions would create a state-mandated local program. Existing law provides that in the case of a parolee under the jurisdiction of the Department of Corrections, the local health officer shall notify the medical officer of the parole region or the physician and surgeon designated by the Director of Corrections when there are reasonable grounds to believe that the parolee has active tuberculosis disease and when the parolee ceases treatment for tuberculosis. This bill would instead require the local health officer to notify the assigned parole agent, when known, or the regional parole administrator. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement, including the creation of a State Mandates Claims Fund to pay the costs of mandates that do not exceed $1,000,000 statewide and other procedures for claims whose statewide costs exceed $1,000,000. This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. (a) The Legislature finds and declares all of the following: (1) Each year, approximately 3,000 Californians develop tuberculosis (TB). Tuberculosis is a contagious disease transmitted through the air by bacteria when a person with active tuberculosis disease coughs or sneezes, and another person breathes in the tuberculosis bacteria. (2) For each reported case of active tuberculosis disease, public health officials identify 10 or more individuals who have been directly exposed to the disease and are at risk of developing latent tuberculosis infection. These individuals who have been exposed to the disease are at the highest risk of developing active tuberculosis disease soon after exposure. Finding and screening individuals who have been recently exposed to active tuberculosis disease, referred to as "contact investigation," is essential in preventing outbreaks of tuberculosis in communities. (3) Public health officials estimate that as many as 3.4 million Californians may now be infected (latent tuberculosis infection) with the bacteria that can cause active tuberculosis disease. If undetected and untreated, an estimated 5 to 10 percent of persons in California, or 170,000 to 340,000 people, with latent tuberculosis infection will, throughout the course of their lives, develop active tuberculosis disease, thus continuing the cycle of transmission. (4) Because persons with latent tuberculosis infection have no symptoms, the only way to detect their infection is by a tuberculin skin test. (5) Tuberculin skin tests may now be placed and measured only by certain licensed health professionals, which do not include public health tuberculosis workers who are not licensed health professionals, but who are employed by, or under contract with, a city or county health department. (6) The National Institute of Medicine's report on tuberculosis clearly recommends increased efforts at contact investigation, targeted skin testing, and bringing under treatment those individuals with latent tuberculosis infection in order to prevent the progression to active, transmissible, tuberculosis disease. (b) It is the intent of the Legislature to enact legislation to permit any city or county health department to provide for certification, by the local health officer, of tuberculin skin test technicians, who are public health tuberculosis workers, and to authorize tuberculin skin test technicians to place and measure skin tests for tuberculosis for the local health department, in order to increase the number of persons qualified to administer tests and to thereby more effectively, and more cost-effectively, control the spread and contagion of this communicable disease. SEC. 2. This act shall be known, and may be cited, as the Omnibus Tuberculosis Control and Prevention Act of 2002. SEC. 3. Section 121360.5 is added to the Health and Safety Code, to read: 121360.5. (a) Any city or county health department may provide for one-year certification of tuberculin skin test technicians by local health officers. (b) For purposes of this section, a "certified tuberculin skin test technician" is an unlicensed public health tuberculosis worker employed by, or under contract with, a local public health department, and who is certified by a local health officer to place and measure skin tests in the local health department's jurisdiction. (c) A certified tuberculin skin test technician may perform the functions for which he or she is certified only if he or she meets all of the following requirements: (1) The certified tuberculin skin test technician is working under the direction of the local health officer or the tuberculosis controller. (2) The certified tuberculin skin test technician is working under the supervision of a licensed health professional. (d) A certified tuberculin skin test technician may perform intradermal injections only for the purpose of placing a tuberculin skin test and measuring the test result. (e) A certified tuberculin skin test technician may not be certified to interpret, and may not interpret, the results of a tuberculin skin test. (f) In order to be certified as a tuberculin skin test technician by a local health officer, a person shall meet all of the following requirements, and provide to the local health officer appropriate documentation establishing that he or she has met those requirements: (1) The person has a high school diploma, or its equivalent. (2) The person has completed a standardized course approved by the California Tuberculosis Controllers Association (CTCA), which shall include at least 24 hours of instruction in all of the following areas: Didactic instruction on tuberculosis control principles and instruction on the proper placement and measurement of tuberculin skin tests, equipment usage, basic infection control, universal precautions, and appropriate disposal of sharps, needles, and medical waste, client preparation and education, safety, communication, professional behavior, and the importance of confidentiality. A certification of satisfactory completion of this CTCA-approved course shall be dated and signed by the local health officer, and shall contain the name and social security number of the tuberculin skin test technician, and the printed name, the jurisdiction, and the telephone number of the certifying local health officer. (3) The person has completed practical instruction including placing at least 30 successful intradermal tuberculin skin tests, supervised by a licensed physician or registered nurse at the local health department, and 30 correct measurements of intradermal tuberculin skin tests, at least 15 of which are deemed positive by the licensed physician or registered nurse supervising the practical instruction. A certification of the satisfactory completion of this practical instruction shall be dated and signed by the licensed physician or registered nurse supervising the practical instruction. (g) The certification may be renewed, and the local health department shall provide a certificate of renewal, if the certificate holder has completed inservice training, including all of the following: (1) At least three hours of a CTCA-approved standardized training course to assure continued competency. This training shall include, but not be limited to, fundamental principles of tuberculin skin testing. (2) Practical instruction, under the supervision of a licensed physician or registered nurse at the local health department, including the successful placement and correct measurement of 10 tuberculin skin tests, at least five of which are deemed positive by the licensed physician or registered nurse supervising the practical instruction. (h) The local health officer or the tuberculosis controller may deny or revoke the certification of a tuberculin skin test technician if the local health officer or the tuberculosis controller finds that the technician is not in compliance with this section. (i) This section shall remain in effect only until January 1, 2006, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2006, deletes or extends that date. SEC. 4. Section 121361 of the Health and Safety Code is amended to read: 121361. (a) (1) A health facility, local detention facility, or state correctional institution shall not discharge or release any of the following persons unless subdivision (e) is complied with: (A) A person known to have active tuberculosis disease. (B) A person who the medical staff of the health facility or of the penal institution has reasonable grounds to believe has active tuberculosis disease. (2) In addition, persons specified in this subdivision may be discharged from a health facility only after a written treatment plan described in Section 121362 is approved by a local health officer of the jurisdiction in which the health facility is located. Any treatment plan submitted for approval pursuant to this paragraph shall be reviewed by the local health officer within 24 hours of receipt of that plan. (3) The approval requirement of paragraph (2) shall not apply to any transfer to a general acute care hospital when the transfer is due to an immediate need for a higher level of care, nor to any transfer from any health facility to a correctional institution. Transfers or discharges described in this paragraph shall occur only after the notification and treatment plan required by Section 121362 have been received by the local health officer. (4) This subdivision shall not apply to any transfer within the state correctional system or to any interfacility transfer occurring within a local detention facility system. (b) No health facility shall, without first complying with subdivision (e), transfer a person described in subparagraph (A) or (B) of paragraph (1) of subdivision (a) to another health facility. This subdivision shall not apply to any transfer within the state correctional system or to any interfacility transfer occurring within a local detention facility system. (c) No state correctional institution or local detention facility shall transfer a person described in subparagraph (A) or (B) of paragraph (1) of subdivision (a) from a state to a local, or from a local to a state, penal institution unless notification and a written treatment plan are received by the chief medical officer of the penal institution receiving the person. (d) No local detention facility shall transfer a person described in subparagraph (A) or (B) of paragraph (1) of subdivision (a) to a local detention facility in another jurisdiction unless subdivision (e) is complied with and notification and a written treatment plan are received by the chief medical officer of the local detention facility receiving the person. (e) (1) Any discharge, release, or transfer described in subdivisions (a), (b), (c), and (d) may occur only after notification and a written treatment plan pursuant to Section 121362 has been received by the local health officer. When prior notification would jeopardize the person's health, the public safety, or the safety and security of the penal institution, the notification and treatment plan shall be submitted within 24 hours of discharge, release, or transfer. (2) When a person described in paragraph (1) of subdivision (a) is released on parole from a state correctional institution, the notification and written treatment plan specified in this subdivision shall be provided to both the local health officer for the county in which the parolee intends to reside and the local health officer for the county in which the state correctional institution is located. (3) Notwithstanding any other provision of law, the Department of Corrections shall inform the parole agent, and other parole officials as necessary, that the person described in paragraph (1) of subdivision (a) has active or suspected active tuberculosis disease and provide information regarding the need for evaluation or treatment. The parole agent and other parole officials shall coordinate with the local health officer in supervising the person's compliance with medical evaluation or treatment related to tuberculosis, and shall notify the local health officer if the person' s parole is suspended as a result of having absconded from supervision. (f) No health facility that declines to discharge, release, or transfer a person pursuant to this section shall be civilly or criminally liable or subject to administrative sanction therefor. This subdivision shall apply only if the health facility complies with this section and acts in good faith. (g) Nothing in this section shall relieve a local health officer of any other duty imposed by this chapter. SEC. 5. Section 121362 of the Health and Safety Code is amended to read: 121362. Each health care provider who treats a person for active tuberculosis disease, each person in charge of a health facility, or each person in charge of a clinic providing outpatient treatment for active tuberculosis disease shall promptly report to the local health officer at the times that the health officer requires, but no less frequently than when there are reasonable grounds to believe that a person has active tuberculosis disease, and when a person ceases treatment for tuberculosis disease. Situations in which the provider may conclude that the patient has ceased treatment include times when the patient fails to keep an appointment, relocates without transferring care, or discontinues care. The initial disease notification report shall include an individual treatment plan that includes the patient's name, address, date of birth, tuberculin skin test results, pertinent radiologic, microbiologic, and pathologic reports, whether final or pending, and any other information required by the local health officer. Subsequent reports shall provide updated clinical status and laboratory results, assessment of treatment adherence, name of current care provider if the patient transfers care, and any other information required by the local health officer. A facility discharge, release, or transfer report shall include all pertinent and updated information required by the local health officer not previously reported on any initial or subsequent report, and shall specifically include a verified patient address, the name of the medical provider who has specifically agreed to provide medical care, clinical information used to assess the current infectious state, and any other information required by the local health officer. Each health care provider who treats a person with active tuberculosis disease, and each person in charge of a health facility or a clinic providing outpatient treatment for active tuberculosis disease, shall maintain written documentation of each patient's adherence to his or her individual treatment plan. Nothing in this section shall authorize the disclosure of test results for human immunodeficiency virus (HIV) unless authorized by Chapter 7 (commencing with Section 120975) of, Chapter 8 (commencing with Section 121025) of, and Chapter 10 (commencing with Section 121075) of Part 4 of Division 105. In the case of a parolee under the jurisdiction of the Department of Corrections, the local health officer shall notify the assigned parole agent, when known, or the regional parole administrator, when there are reasonable grounds to believe that the parolee has active tuberculosis disease and when the parolee ceases treatment for tuberculosis. Situations where the local health officer may conclude that the parolee has ceased treatment include times when the parolee fails to keep an appointment, relocates without transferring care, or discontinues care. SEC. 6. Notwithstanding Section 17610 of the Government Code, if the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code. If the statewide cost of the claim for reimbursement does not exceed one million dollars ($1,000,000), reimbursement shall be made from the State Mandates Claims Fund.