BILL NUMBER: AB 1091 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 21, 2003
INTRODUCED BY Assembly Member Negrete McLeod
(Coauthors: Assembly Members Pavley and Yee)
FEBRUARY 20, 2003
An act to amend Sections 104190, 104191, 104192,
and 104193 of , and to add Section 104195 to,
the Health and Safety Code, relating to disease prevention.
LEGISLATIVE COUNSEL'S DIGEST
AB 1091, as amended, Negrete McLeod. Lyme Disease
disease .
Existing law establishes the Lyme Disease Advisory Committee in
the State Department of Health Services, composed of specified
members appointed by the Director of Health Services. Existing law
requires the department and the committee to perform various
functions and duties with respect to, among other things, the
dissemination of information regarding Lyme disease to the public and
the medical community.
This bill would revise the composition and duties of the Lyme
Disease Advisory Committee. It would also revise the duties of the
department with respect to Lyme disease prevention and data
collection.
Existing regulatory law requires licensed physicians and health
care providers to report cases of specified reportable diseases,
including Lyme disease, within 7 calendar days of detection to a
local health authority. Existing regulatory law also requires each
local health officer to report cases of specified reportable diseases
to the State Department of Health Services on a weekly basis.
This bill would establish procedures for the direct reporting of
Lyme disease to the department.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. (a) The Legislature finds and declares all of the
following:
(1) The enactment of Senate Bill 1115 (Ch. 668, Stats. 1999)
established the Lyme Disease Advisory Committee and an information
program in order to publicize Lyme disease, a bacterial infection,
and address this major and increasing public health hazard in
California.
(2) The cardinal criterion for the designation of Lyme disease, or
any other human infectious disease, is the diagnosis by a physician
and surgeon or other licensed health care practitioner, including a
dentist, podiatrist, or nurse practitioner, licensed for practice in
California. The denial or disavowal by a nonphysician of a diagnosis
made by a licensed physician and surgeon, or other health care
practitioner by a nonphysician who has not examined the patient
constitutes the unlicensed practice of medicine.
(3) Not all people who are bitten by a western black-legged tick
or nymph, which are capable of carrying Lyme disease and other
coinfections, realize that they have been bitten. The risk of
infection from the nymph is even greater than from the adult tick in
California. An actuarial study by the Lyme Disease Foundation, Inc.,
and the Society of Actuaries found that, of 503 physician-diagnosed
Lyme disease patients, only 30 percent realized they had been bitten,
and 55 percent did not report a rash. Dr. Joseph Burrascano, Jr.,
M.D., in "The New Lyme Disease Diagnostic Hints and Treatment
Guidelines for Tick Borne Illnesses," (Fourteenth edition, 2002)
reported that erythema migrans, the rash that is diagnostic of Lyme
disease, was present in fewer than one-half of Lyme disease patients.
People who develop this rash, which is an initial indicator of Lyme
disease, should seek immediate antibiotic treatment while the rash
is visible and a correct diagnosis can be made.
(4) Some doctors and insurers claim that there is no Lyme disease
in California, certainly not in southern California, or that it is
very rare. These are voices of ignorance, clearly contradicted by
the continuing fact that Lyme disease is a prevalent and growing
public health problem in California.
(5) Some doctors and insurers claim that if a month of antibiotic
treatment fails to cure a patient, then the initial diagnosis of Lyme
disease was incorrect. This belief is proven incorrect by numerous
reports of persistent infection in spite of treatment in
peer-reviewed scientific literature, including reports that indicate
positive cultures from the brain, spleen, heart, eye, spinal fluid,
lymph nodes, joints, and joint fluid. Other infectious diseases,
such as syphilis, tuberculosis, and HIV/AIDS, require months of
antibiotic treatment. Indeed, the recently approved treatment
guidelines for tuberculosis are two antimicrobials for 18 months
each.
(6) Some individuals affected by the advanced stages of Lyme
disease have suffered irreparable damage to their health, careers,
and family. Common symptoms can be musculoskeletal (joint
inflammation, pain, and arthritis), cardiac (heart block,
palpitations, and tachycardia), and neurologic (extreme fatigue,
memory loss, inability to concentrate, and facial palsy). The
neurologic symptoms are at times mistaken for multiple sclerosis or
early Parkinson's disease. Many victims suffer permanent physical or
mental damage, or both, as a result of misdiagnosis, ignorance of
the disease, and lack of effective treatment. Lyme disease can be
fatal.
(7) The key problems of undertreatment and misdiagnosis are in
part due to the need for further scientific development and
understanding of Lyme disease and also due to the need for current
medical education about this infectious disease, which has some
parallels to syphilis in its changing symptomatology. Lyme disease
mimics many other diseases. It is called the second "Great Imitator"
after syphilis. Thus, it can be difficult to diagnose. The
infectious agent, Borrelia burgdorferi (Bb), is a spiral shaped
bacterium (spirochete) like syphilis that can invade any organ in the
body. Patients are often diagnosed with more familiar conditions,
including chronic fatigue, fibromyalgia, and multiple sclerosis, for
which there is no "cure," just palliative remedies. If untreated,
Lyme disease invades multiple organs of the body including the brain
and nervous system, and victims become increasingly disabled over
time. In later stages of the disease, if antibiotic therapy is
terminated before active clinical symptoms have cleared, relapse is
likely. Prolonged antibiotic treatment by oral, intramuscular, or
intravenous means, may be necessary. The absence of positive
laboratory proof is not conclusive proof of the absence of the
disease.
(b) The Legislature finds and declares the following concerning
the reporting of Lyme disease:
(1) According to United States Centers for Disease Control and
Prevention (CDC) statistics, the reported number of Lyme disease
cases reached a record level of 17,730 cases in 2001, an increase of
87 percent over the previous decade. The increase in reporting is a
reflection of the improved reporting standards, the national
application of those standards, increased awareness, and the
increased incidence of Lyme disease. Lyme disease is now a
reportable disease in all 50 states. The CDC states that Lyme
disease accounts for more than 95 percent of vector-borne illness in
the United States. Even so, the CDC believes that only one in 10
cases are actually reported. Stated otherwise, the CDC is saying
that their surveillance criteria do not recognize or include 90
percent of Lyme disease patients.
(2) The CDC surveillance criteria are complex and multifaceted
and, in part, outdated so their use by the department results in the
denial of many reported Lyme disease cases. The CDC, however, has
publicly advised that its surveillance criteria are not intended as a
basis for clinical diagnosis, insurance reimbursement, or treatment
guidelines. These CDC surveillance criteria seriously underrepresent
the actual prevalence of Lyme disease. According to a recent
Georgia survey of 1331 physicians, 710 were respondents who diagnosed
578 Lyme disease cases over the preceding 12 months, an amount of
diagnoses that greatly exceeds the 434 cases reported by the CDC for
Georgia over a 10-year period. (Boltri JM et al. Patterns of Lyme
disease diagnosis and treatment by family physicians in a
southeastern state. J Community Health 2002, Dec, 27. (6):395-402).
These statistics again illustrate that the use of CDC criteria
results in a gross underreporting of Lyme disease.
(3) It is the intent of the Legislature to recognize and require
the reporting of diagnoses of Lyme disease by licensed physicians and
health care practitioners and of positive laboratory test results of
Lyme disease to the department and that the department not be
allowed to set them aside or deny them because of CDC surveillance
criteria. The primary concern must be the clinical diagnosis, which
is critical to the reality of patients' care.
(4) The International Lyme and Associated Diseases Society (ILADS)
has issued a position paper highly critical of the CDC's criteria
for diagnosing Lyme disease. Their two-tiered approach using an
Elisa test, which is outdated and unreliable, and confirming
positives by use of both Western blot tests (IgG and IgM), misses
many patients since the CDC criteria require five of 10 bands to be
positive but omit two of the critical bands. If two or more bands
23-25, 31, 34, 39, and 41 kDa are evident, then it is a positive
measure of the presence of antibodies to borrelia burgdorferi (Bb), a
spiral shaped bacteria that is the infectious cause of LD, and
assures certainty of exposure to Bb.
(5) Lyme disease is laboratory reportable in Ohio, New York,
Maine, Massachusetts, and Pennsylvania. Despite the fact that over
10 percent of the national population resides in California, new Lyme
disease cases reported in California accounted for only one-half of
1 percent of the national total, indicative of very substantial
underreporting and that the state reporting procedures and use of CDC
criteria for Lyme disease are in need of revision. The Senate of
Texas, in issuing its November 2000 report on the Prevalence of Tick
Borne Illness noted that "the rate of occurrence of tick-borne
illness in the United States has increased dramatically over the last
few years. This growth is second only to AIDS/HIV among infectious
diseases."
(6) Information on laboratory reporting was obtained from several
states. Maryland saw "a jump in number of reported cases when (it)
turned to laboratory reporting in 1996." Massachusetts has a
centralized reporting system much of it electronic (automatic). The
"number of cases increased significantly when (they) instituted
laboratory and active surveillance." Minnesota also has a centralized
case evaluation with 2,400 laboratory reports received.
(7) Section 2500(j) of Title 17 of the California Code of
Regulations lists reportable communicable diseases, including Lyme
disease. Failure to report within seven days of identification of
Lyme disease is a misdemeanor. However, the department's "Lyme
Disease Case Report form 8470" is quite detailed and the experience
of some physicians is that their reports of Lyme disease are often
questioned or seldom recorded with the consequence that since these
reports are sent to the department through the county health officer,
then these county health records later have to be undone. The
process has seriously discouraged physician reporting. The
department should not be second guessing a physician's diagnosis.
(8) The sophistication of laboratory tests for the diagnosis of
Lyme disease is improving but could benefit from further development
and standardization. Some of the still commonly used tests, like
Enzyme-Linked Immuno Sorbent Assay (ELISA), are now considered
outdated, not standardized, and only marginally reliable due to
insufficient sensitivity and frequency of false positives from other
diseases. A 1997 study by Bakken LL et. al., proved that ELISA was
woefully inadequate as a screening test and invalidated the two-step
protocol. (Interlaboratory Comparison of Test results for Detection
of Lyme disease by 516 participants in the Wisconsin State Laboratory
of Hygiene/College of American Pathologists Proficiency Testing
Program. J Clin. Micro 35:537-543). To perform sophisticated Lyme
disease testing requires a state-of-the-art laboratory, such as the
federal Clinical Laboratory Improvement Act (CLIA; 42 U.S.C. Sec.
263a and following) licensed laboratories, which provide services to
patients in California, and public health service laboratories in
California deemed by the department to meet comparable standards. It
is estimated that collectively the total of positively
lab-identified California Lyme disease patients could exceed 1,500 a
year in contrast to the 92 cases recorded by the department in 2001
or the 1,191 cases recorded by the department over the decade.
(9) It is the intent of the Legislature in enacting this act that
the reporting provisions of Section 2500 of Title 17 of the
California Code of Regulations, which require specified laboratories
to report certain communicable diseases, be expanded to include Lyme
disease.
(c) It is the intent of the Legislature that accurate information
on Lyme disease diagnosis and scientifically recognized laboratory
tests be included in the curricula of all state medical, pharmacy,
veterinary, and nursing schools and of all continuing medical
education courses for health care practitioners and school nurses.
SEC. 2. (a) The Legislature finds and declares the following
concerning Lyme disease:
(1) Despite current efforts, Lyme disease remains a significant
problem for numerous reasons, including insufficient awareness among
practicing physicians of the varying symptoms, diagnostic tests, and
treatment protocols that may be effective in the treatment of Lyme
disease. Of the total number of Lyme disease cases reported
nationwide, 25 percent of those cases are children under the age of
15 years.
(2) The Medical Board of California reports that, in October 2002,
the number of licensed state resident physicians was 86,934 while
the comparable number for osteopathic physicians was 2,115, a total
of over 89,000 licensed physicians. If it is assumed that 25 percent
of these licensed physicians are retired or otherwise not in active
practice, then the total number of licensed practicing medical
practitioners is around 66,750. Informally, Lyme disease patients
have identified fewer than 50 California physicians who regularly
diagnose Lyme disease and prescribe appropriately for it, less than
one-tenth of 1 percent of the total number of licensed practicing
physicians in the state. Thus, there is a very serious access
problem to qualified medical care services for Lyme disease patients.
(3) The Western black-legged tick has been found in 55 of the 58
counties in California, but is most common in the humid coastal areas
and on the western slope of the Sierra Nevada range, including areas
in southern California. While the Western black-legged tick or
nymph may carry and spread the infection of Lyme disease, it may also
carry coinfections, such as Babesiosis or Ehrlichiosis, among
others, which are also reportable diseases. A coinfection complicates
the diagnosis and treatment of Lyme disease. Thus, while the risk
of acquiring Lyme disease varies by geographic area of exposure, it
is a substantial public health hazard throughout most of the state
and particularly for those who must work in those areas that are
endemic with Lyme disease or for those who camp or hike through them.
(4) Lyme-infected adult ticks or nymphs have been identified in 41
counties in California to date and cases of Lyme disease have now
been reported from 54 counties. However, Mendocino County is the
only county in California that has had an ongoing assessment for Lyme
disease risk to date. In one small rural community, 37 percent of
the residents had definite or probable Lyme disease while 24 percent
were seropositive.
(5) The key problems of undertreatment and misdiagnosis are in
part due to the need for further scientific development and
understanding of Lyme disease and also due to the need for current
medical education about this infectious disease, which has some
parallels to syphilis in its changing symptomatology. Lyme disease
mimics many other diseases. It is called the second "Great Imitator"
after syphilis. Thus, it can be difficult to diagnose. The
infectious agent, Borrelia burgdorferi (Bb), is a spiral shaped
bacterium (spirochete), like syphilis, that can invade any organ in
the body. Patients are often diagnosed as having familiar conditions,
including chronic fatigue, fibromyalgia, multiple sclerosis, for
which there is no "cure," just palliative remedies, in place of Lyme
disease. Left untreated, Lyme disease invades multiple organs of the
body, including the brain and nervous system. Victims become
increasingly disabled over time. Lyme disease can be fatal. In
later stages of the disease, if antibiotic therapy is terminated
before active clinical symptoms have cleared, relapse is likely.
Prolonged antibiotic treatment by oral, intramuscular, or intravenous
means may be necessary. The absence of positive laboratory proof is
not conclusive proof of the absence of the disease.
(6) According to United States Centers for Disease Control and
Prevention (CDC) statistics, the reported number of Lyme disease
cases reached a record level of 17,730 cases in 2001, an increase of
87 percent over the previous decade. The increase in reporting is a
reflection of the improved reporting standards, the national
application of those standards, increased awareness, and the
increased incidence of Lyme disease. Lyme disease is now a
reportable disease in all 50 states. The CDC states that Lyme
disease accounts for more than 95 percent of vector-borne illness in
the United States. Even so, the CDC believes that only one in 10
cases is actually reported. Stated otherwise, the CDC is saying that
their surveillance criteria do not recognize or include 90 percent
of Lyme disease patients.
(7)
(5) It is the intent of the Legislature that accurate
information on tick-borne illness be included in the curricula of all
state medical, pharmacy, veterinary, and nursing schools, and of all
continuing medical education courses for health care practitioners
and school nurses. Physician education is the key to more accessible
and better health care.
(b) The Legislature finds and declares all of the following with
respect to the Lyme Disease Advisory Committee (LDAC):
(1) The enactment of Senate Bill 1115 (Ch. 668, Stats. 1999)
established the LDAC and an information program in order to publicize
Lyme disease, a bacterial infection, and address this major and
increasing public health hazard in California.
(2) The creation of this committee gave encouragement to Lyme
disease patients and their families and it has been broadly favored
in the Lyme disease community.
(3) The statute specified that five member representatives would
serve on the committee, but did not limit the committee to that
number. There are currently 10 members on the LDAC who serve at the
pleasure of the Director of the State Department of Health Services.
(4)
(1) While these members serve without compensation, the
current law provides that members may be reimbursed for travel and
necessary expenses incurred in the performance of their duties.
Given the current shortfall in the State Budget, it is the intent of
the Legislature to limit travel reimbursement to travel costs
incurred to attend committee meetings, if essential for a member's
attendance, but not to exceed $2500 per year through the year 2006.
(5)
(2) Since the creation of the LDAC is viewed as a valuable
asset and forum by the Lyme disease community, it is the intent of
the Legislature to establish terms of office for members of
the committee to assure its continuity and provide added
stability.
(6)
(3) For the committee to proceed in its formulation of
constructive solutions to the debilitation caused by Lyme disease, it
is essential that it be composed of individuals with the best
scientific, professional, and patient expertise possible. Therefore,
it is the intent of the Legislature to set forth the
expertise required of committee members and to require that
only those meeting these significant levels of expertise
may continue to serve on the committee, and all individuals who are
appointed to fill vacancies must also possess the specified
required expertise.
(7) Enacting differing expertise requirements concerning the
(4) Requiring committee members to have differing areas
of expertise will assure a diversity of talent to address the
public health problems of Lyme disease. To the extent feasible, a
reasonable geographic diversity among members should be sought as
well.
SEC. 2.
SEC. 3. Section 104190 of the Health and Safety Code is
amended to read:
104190. As used in this article the following definitions apply:
(a) "Disease" means Lyme disease recognized by the presence of the
spirochete (borrelia burgdorferi), a spiral-shaped bacterium, in the
human body, or coinfection with tick-borne diseases, such as
Babesiosis and Ehrlichiosis.
(b) "Long-term antibiotic or antimicrobial therapy" means the
administration of oral, intramuscular, or intravenous antibiotics
for periods of greater than four weeks.
(c) "Lyme Disease Support Network" means the groups
organized through hospitals and volunteer organizations to counsel
and provide support to those individuals who have contracted the
disease.
SEC. 3.
SEC. 4. Section 104191 of the Health and Safety Code is
amended to read:
104191. (a) There is hereby created in the department the Lyme
Disease Advisory Committee composed of, but not limited to, the
following nine members:
(1) One who is a member of the board of directors of the
Lyme Disease Resource Center. An alternative board member from the
Lyme Disease Resource Center may attend in place of this member if
the member is unable to attend due to illness. Lyme
Disease Resource Center.
(2) Three who are Lyme disease patients, with a preference for the
following distribution:
(A) One from a Lyme disease support group who is the coordinator
of a patient support group in northern California.
(B) One from a Lyme disease support group who is the coordinator
of a patient support group in southern California.
(C) One who contracted Lyme disease as an occupational injury and
who is covered by workers' compensation.
(3) Two from the California Medical Association
who are practicing physicians who are knowledgeable of, and whose
ongoing practice includes the treatment of, both early-
and late-stage Lyme disease. These physicians shall be from
different geographic areas of the state.
(4) One local health officer, preferably from a Lyme disease
endemic county.
(5) One who is a university or research scientist, preferably one
with acknowledged expertise of the entomology of the western
black-legged tick.
(6) One who is a university immunology or research scientist,
preferably one with acknowledged expertise in spirochetes and related
infectious diseases.
(7) The department shall also designate a member of its Vector
Borne Disease Section or administration or Surveillance and
Statistics Section or administration, to serve ex officio on
the LDAC.
(b) Members of the committee shall be appointed by the director.
In making these appointments, the director shall consider
recommendations forwarded by the Lyme Disease Resource Center.
(c) Members of the committee shall serve without compensation, but
after January 1, 2006, may be reimbursed for travel and necessary
expenses incurred in the performance of their duties on the
committee. In the interim, annual travel expense reimbursement to
all committee members may not exceed $2,500.
(d) The Lyme Disease Advisory Committee shall meet no less than
three times a year and the committee may, from its own membership,
elect its own chair and elect its own secretary .
(e) On an annual basis, the committee shall conduct an assessment
of its membership and recommend any needed changes in composition to
the director. The director shall make appointments to fill vacancies
as they occur.
(f) (1) To facilitate a cohesive working
relationship among committee members and provide added stability to
the committee's composition, each current and new member meeting the
specifications detailed in subdivision (a) shall be eligible to serve
a three-year term on or after January 1, 2004.
(2) During the year commencing with January 1, 2006, the committee
shall establish a rotational designation to begin January 1, 2007,
for one-third of its membership to be replaced annually by new
three-year term members appointed by the director to fill vacated
positions.
(3) Of the three members designated by the committee to rotate
commencing January 1, 2007, and in subsequent years, if one of those
members is considered by the committee to have made an exceptional
contribution to the committee's work, and he or she has expertise
that is difficult to replace, the committee may request that the
director reappoint that member to a new three-year term.
(g) In order to facilitate accomplishment of the committee's
activities using existing resources of the department, the committee
may consult with or advise department staff regarding the
prioritization of Lyme disease-related work, or the division of Lyme
disease-related work between the department and, on a volunteer
basis, individual committee members.
(h) The meetings of the committee shall be publicly announced at
least one month prior to a meeting, and all meetings shall be open to
the public. These meetings shall have a twofold purpose. The
first purpose is to conduct the formal business of the committee and
to consider new developments in the understanding of Lyme disease,
its treatment, laboratory
evaluation, and prevention measures and changes in the incidence of
the disease in California. The second purpose is to provide a public
forum in which Lyme patients may alert the committee to key problems
in their access to treatment by physicians and other health care
providers and to health care coverage.
(i) In order to assure accurate minutes, both the formal part of
the meeting and subsequent discussion with persons in the audience
shall be recorded, and all substantive input shall be part of the
minutes of the meeting. The minutes of each meeting shall be sent to
all committee members for review and approval within six weeks of
the meeting. The final decision on what shall be included in
the minutes shall be that of the committee.
(j) On a voluntary basis, the committee may encourage the
formation of a subgroup among its members to develop proposed
solutions for a specific problem aspect of Lyme disease on the
members' own time.
SEC. 4.
SEC. 5. Section 104193 of the Health and Safety Code is
amended to read:
104193. The department shall do all of the following:
(a) Establish a Lyme disease information program that provides
educational materials and information services on Lyme disease to the
general public and the medical community. The Lyme disease
information program shall provide information on all of the
following:
(1) The disease in general, including its symptoms.
(2) Activities that increase one's risk of contracting the
disease.
(3) If and when a safe and effective vaccine is developed, use of
vaccines to prevent the disease.
(4) The ways to protect oneself from contracting the disease,
including the use of protective clothing and tick repellents, such as
an acaricide or pesticide sprayed on clothing before being worn.
Protective clothing includes light-colored long pants and long
sleeves.
(b) Provide detailed but broad and inclusive information regarding
Lyme disease, its varied and common symptoms, and its treatment to
physicians and surgeons and other health care providers, such as
nurse practitioners, in affected areas, including information
concerning the use of both oral and intravenous antibiotics, and
other evidence-based effective treatments, as they are recognized and
publicly available. The department may fulfill this requirement by
providing the information to professional associations representing
these providers. If the department provides the information to
professional associations, the department shall request that these
professional associations make the information available to
association members who request the information.
(c) Identify those segments of the population that are especially
at risk of contracting Lyme disease and may provide workshops, with
detailed information on the disease in those areas or communities,
considering recommendations for these workshops by the Lyme Disease
Advisory Committee.
(d) Provide information to the Occupational Safety and Health
Standards Board about risk factors for exposure to Lyme disease.
(e) With the recommendation of the Lyme Disease Advisory
Committee, and to the extent that departmental resources allow,
consider the potential of new diagnostic and treatment procedures
that have scientific foundation, particularly those that may be
effective for the later stages of Lyme disease.
(f) Given that Lyme disease and its coinfections are emerging
diseases and are not yet fully understood, the department shall not
adopt rigid diagnostic or treatment limitations.
(g) In collaboration with interested counties, communities,
research scientists, universities, health care providers,
or members of the Lyme Disease Advisory Committee, the committee
shall encourage the conduct of professional training or
research and the funding of its funding by
grants or other support to increase the professional competence of
health care providers in the treatment of Lyme disease or increase
research to identify the risk of Lyme disease in counties or
areas of California where Lyme disease is considered to be endemic.
(h) Encourage the use of integrated pest management to control and
reduce tick populations.
SEC. 6. Section 104195 is added to the Health and Safety Code, to
read:
104195. (a) Notwithstanding any other provision of law, Lyme
disease shall be reportable by both state-licensed physicians and
health care practitioners upon positive diagnosis, and shall also be
laboratory reportable, based on positive test results. The
department shall develop a two-tiered system of counting Lyme disease
cases. The first tier shall be based upon CDC criteria and the
second tier of reporting shall be centralized and involve an
automated clinical system based on an unduplicated count of patients
who have a positive laboratory report of Lyme disease for the year
the count is submitted.
(b) The primary report and diagnosis of Lyme disease shall be by a
state-licensed physician or health care provider. However, if the
diagnosing provider has treated few Lyme patients and is not certain
of the diagnosis, then the provider should seek a second opinion from
a provider who is experienced in diagnosing lyme disease who has
examined the patient or seek laboratory test confirmation. If Lyme
disease is confirmed, the diagnosis shall be fully reportable and any
laboratory reports shall be submitted directly to the department's
Surveillance and Statistics Section and shall be accepted and
recorded by the department, as received. Reports of Lyme disease to
the department can only be denied or challenged by a licensed
practicing physician experienced in the treatment of Lyme disease who
has examined the patient. This centralized clinical reporting
system shall become effective when the department's new computer
resources, now in pilot testing, are operational for reporting
purposes. The computer resources are expected to reduce staff burden
and enable a two-tiered reporting system.
(c) The Lyme Disease National Surveillance Case Definition (DHS
form 8470 of 10/01) may be used for departmental research but shall
not be cited or used by staff in any way to preclude the recognition
and recording of a diagnosis by a physician or health care
practitioner or laboratory evidence of Lyme disease.
(d) When the department has the capacity to receive and record the
electronic reporting of Lyme disease and major coinfections by
licensed physicians, other appropriate health care providers, and
licensed laboratories, then this reporting shall be encouraged, to
the extent feasible.