Amended in Senate June 23, 2014

Amended in Senate June 9, 2014

Amended in Assembly May 23, 2014

Amended in Assembly April 2, 2014

Amended in Assembly March 24, 2014

California Legislature—2013–14 Regular Session

Assembly Bill No. 1667

Introduced by Assembly Member Williams

February 12, 2014

An act to amend Section 49406 of the Education Code, and to amend Sections 121525, 121535, 121545, and 121555 of the Health and Safety Code, relating to tuberculosis testing.

LEGISLATIVE COUNSEL’S DIGEST

AB 1667, as amended, Williams. Tuberculosis testing in schools.

Existing law prohibits a person being initially employed by a school district in a certificated or classified position, or who is employed or volunteering at a private or parochial school or nursery school, unless the person has submitted to a tuberculosis examination within the past 60 days, and requires the person to undergo an examination by a physician and surgeon or a physician assistant, as specified, to determine that he or she is free of active tuberculosis at least once every 4 years thereafter. Existing law requires the governing board of a school district to reimburse the employee for the cost of the examination.

This bill would instead require a person to submit to a tuberculosis risk assessment, and, if risk factors are identified, would then require the person to submit to a tuberculosis examination to determine that the person is free of infectious tuberculosis. The bill would allow a person who is subject to these requirements to begin delete take end delete begin insert submit to end insert an examination instead of submitting to a tuberculosis risk assessment, as specified. The bill would also make those provisions applicable to persons under contract in any school or volunteering in a public school, except as specified. begin insert With respect to school district personnel, the bill would also authorize nurse practitioners to administer the examination. end insert

The bill would require the State Department of Public Health, in consultation with the California Tuberculosis Controllers Association, to develop a risk assessment questionnaire, to be administered by a health care provider, to conduct the tuberculosis risk assessments. To the extent that this bill imposes a new duty on a school district, the bill would impose a state-mandated local program. The bill would make other conforming and nonsubstantive changes.

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.

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.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.

The people of the State of California do enact as follows:

SECTION 1.  

Section 49406 of the Education Code is amended
to read:

49406.  

(a) (1) (A) Except as provided in subdivision (j), a
person shall not be initially employed by a school district, or
employed under contract, in a certificated or classified position
unless the person has submitted to a tuberculosis risk assessment
within the past 60 days, and, if tuberculosis risk factors are
identified, has been examined to determine that he or she is free
of infectious tuberculosis by a physician and surgeon licensed
under Chapter 5 (commencing with Section 2000) of Division 2
of the Business and Professions begin delete Code or end delete begin insert Code, end insert a physician assistant
practicing in compliance with Chapter 7.7 (commencing with
Section 3500) of Division 2 of the Business and Professions begin delete Code. end delete
begin insert Code, or a nurse practitioner practicing in compliance with
Chapter 6 (commencing with Section 2700) of Division 2 of the
Business and Professions Code. end insert If no risk factors are identified,
an examination is not required. A person who is subject to the
requirements of this subdivision may begin delete take end delete begin insert submit to end insert an examination
that complies with subparagraph (B) instead of submitting to a
tuberculosis risk assessment.

(B) The examination required by this subdivision shall consist
of either an approved intradermal tuberculin test or any other test
for tuberculosis infection that is recommended by the federal
Centers for Disease Control and Prevention (CDC) and licensed
by the federal Food and Drug Administration (FDA). If the test is
positive, the test shall be followed by an X-ray of the lungs in
accordance with subdivision (f) of Section 120115 of the Health
and Safety Code.

(2) The X-ray may be taken by a competent and qualified X-ray
technician if the X-ray is subsequently interpreted by a physician
and surgeon licensed under Chapter 5 (commencing with Section
2000) of Division 2 of the Business and Professions Code.

(3) The district superintendent of schools or his or her designee
may exempt, for a period not to exceed 60 days following
termination of the pregnancy, a pregnant employee from the
requirement that a positive test for tuberculosis infection be
followed by an X-ray of the lungs.

(b) Thereafter, an employee who has no identified risk factors
or who tests negative for the tuberculosis infection shall be required
to undergo the tuberculosis risk assessment and, if risk factors are
identified, the examination, at least once each four years or more
often if directed by the governing board of the school district upon
recommendation of the local health officer. Once an employee has
a documented positive test for tuberculosis infection conducted
pursuant to this subdivision that has been followed by an X-ray,
the tuberculosis risk assessment is no longer required. A referral
shall be made within 30 days of completion of the examination to
the local health officer to determine the need for followup care.

(c) After the tuberculosis risk assessment and, if indicated, the
examination, the employee shall file with the district superintendent
of schools a certificate from the examining physician and begin delete surgeon
or end delete begin insert surgeon, end insert physician begin delete assistant end delete begin insert assistant, or nurse practitioner end insert
showing the employee was examined and found free from
infectious tuberculosis. The county board of education may require,
by rule, that the certificates be filed in the office of the county
superintendent of schools or maintained in the office of the county
superintendent of schools if a majority of the governing boards of
the school districts within the county petition the county board of
education. A school district, or school districts with a common
governing board, having an average daily attendance of 60,000 or
more may elect to maintain the files for its employees in that school
district.

(d) As used in this section, “certificate” means a certificate
signed by the examining physician and surgeon begin delete or end delete begin insert licensed under
Chapter 5 (commencing with Section 2000) of Division 2 of the
Business and Professions Code, a end insert physician assistant practicing
in compliance with Chapter 7.7 (commencing with Section 3500)
of Division 2 of the Business and Professions begin delete Code end delete begin insert Code, or a
nurse practitioner practicing in compliance with Chapter 6
(commencing with Section 2700) of Division 2 of the Business and
Professions Code, end insert or a notice from a public health agency that
indicates freedom from infectious tuberculosis. The latter,
regardless of form, shall constitute evidence of compliance with
this section.

(e) Nothing in this section shall prevent the governing board of
a school district, upon recommendation of the local health officer,
from establishing a rule requiring a more extensive or more
frequent physical examination than required by this section. The
rule shall provide for reimbursement on the same basis as required
in this section.

(f) The tuberculosis risk assessment and, if indicated, the
examination is a condition of initial employment and the expense
shall be borne by the applicant unless otherwise provided by rules
of the governing board of the school district. However, the
governing board of a school district may, if an applicant is accepted
for employment, reimburse that person in a like manner prescribed
in this section for employees.

(g) The governing board of a school district shall reimburse the
employee for the cost, if any, of the tuberculosis risk assessment
and the examination. The governing board of a school district may
provide for the tuberculosis risk assessment and examination
required by this section or may establish a reasonable fee for the
examination that is reimbursable to employees of the school district
complying with this section.

(h) At the discretion of the governing board of a school district,
this section shall not apply to those employees not requiring
certification qualifications who are employed for any period of
time less than a school year whose functions do not require frequent
or prolonged contact with pupils.

(i) If the governing board of a school district determines by
resolution, after hearing, that the health of pupils in the school
district would not be jeopardized, this section shall not apply to
an employee of the school district who files an affidavit stating
that he or she adheres to the faith or teachings of a well-recognized
religious sect, denomination, or organization and, in accordance
with its creed, tenets, or principles, depends for healing upon prayer
in the practice of religion, and that to the best of his or her
knowledge and belief, he or she is free from infectious tuberculosis.
If at any time there is probable cause to believe that the affiant is
afflicted with infectious tuberculosis, he or she may be excluded
from service until the governing board of the school district is
satisfied that he or she is not afflicted.

(j) A person who transfers employment from one school or
school district to another school or school district shall be deemed
to meet the requirements of subdivision (a) if that person can
produce a certificate that shows he or she was found to be free of
infectious tuberculosis within 60 days of initial hire, or the school
previously employing the person verifies that the person has a
certificate on file showing that the person is free from infectious
tuberculosis.

(k) A person who transfers his or her employment from a private
or parochial elementary school, secondary school, or nursery school
to a school or school district subject to this section shall be deemed
to meet the requirements of subdivision (a) if that person can
produce a certificate as provided for in Section 121525 of the
Health and Safety Code that shows that he or she was found to be
free of infectious tuberculosis within 60 days of initial hire, or if
the school previously employing the person verifies that the person
has a certificate on file showing that the person is free from
infectious tuberculosis.

(l) A governing board or county superintendent of schools
providing for the transportation of pupils under contract authorized
by Section 39800, 39801, or any other provision of law shall
require as a condition of the contract the tuberculosis risk
assessment and, if indicated, the examination for infectious
tuberculosis within 60 days of initial hire, as provided by
subdivision (a), of all drivers transporting pupils. At the discretion
of the governing board or county superintendent of schools, this
begin delete paragraph end delete begin insert subdivision end insert shall not apply to a private contracted driver
who transports pupils infrequently without prolonged contact with
the pupils.

(m) A volunteer in a school shall also be required to have on
file with the school a certificate showing that, upon initial volunteer
assignment, the person submitted to a tuberculosis risk assessment
and, if tuberculosis risk factors were identified, was examined and
found to be free of infectious tuberculosis. If no risk factors are
identified, an examination is not required. At the discretion of the
governing board of a school district, this section shall not apply
to a volunteer whose functions do not require frequent or prolonged
contact with pupils.

(n) The State Department of Public Health, in consultation with
the California Tuberculosis Controllers Association, shall develop
a risk assessment questionnaire, to be used to conduct tuberculosis
risk assessments pursuant to this section. The questionnaire shall
be administered by a health care provider, which shall be specified
on the questionnaire.

SEC. 2.  

Section 121525 of the Health and Safety Code is
amended to read:

121525.  

(a) Except as provided in Section 121555, a person
shall not be initially employed, or employed under contract, by a
private or parochial elementary or secondary school, or any nursery
school, unless that person produces or has on file with the school
a certificate showing that within the last 60 days the person has
submitted to a tuberculosis risk assessment and, if tuberculosis
risk factors are identified, has been examined and has been found
to be free of infectious tuberculosis. If no risk factors are identified,
an examination is not required. A person who is subject to the
requirements of this subdivision may begin delete take end delete begin insert submit to end insert an examination
that complies with the requirements of begin delete subdivision (b) end delete begin insert Section
121530 end insert instead of submitting to a tuberculosis risk assessment.

(b) Thereafter, an employee who has no identified risk factors
or who tests negative for the tuberculosis infection by either the
tuberculin skin test or any other test for tuberculosis recommended
by the federal Centers for Disease Control and Prevention (CDC)
and licensed by the federal Food and Drug Administration (FDA),
shall be required to undergo the foregoing tuberculosis risk
assessment and, if risk factors are identified, the examination, at
least once each four years, or more often if directed by the
governing authority of the school upon recommendation of the
local health officer. Once an employee has a documented positive
test for the tuberculosis infection conducted pursuant to this
subdivision, the tuberculosis risk assessment is no longer required.
A referral shall be made within 30 days of completion of the
examination to the local health officer to determine the need for
followup care.

(c) At the discretion of the governing authority of a private
school, this section shall not apply to employees who are employed
for any period of time less than a school year whose functions do
not require frequent or prolonged contact with pupils.

(d) The governing authority of a private school providing for
the transportation of pupils under authorized contract shall require
as a condition of the contract that every person transporting pupils
produce a certificate showing that within the last 60 days the person
has submitted to a tuberculosis risk assessment, and, if tuberculosis
risk factors are identified, has been examined and has been found
to be free of infectious tuberculosis. At the discretion of the
governing authority of the school, this section shall not apply to a
private contracted driver who transports pupils infrequently and
without prolonged contact with the pupils.

(e) The examination attested to in the certificate required
pursuant to subdivision (d) shall be made available without charge
by the local health officer.

(f) “Certificate,” as used in this chapter, means a document
signed by the examining physician and surgeon who is licensed
under Chapter 5 (commencing with Section 2000) of Division 2
of the Business and Professions Code, or a notice from a public
health agency that indicates freedom from infectious tuberculosis.

(g) Nothing in this section shall prevent the governing authority
of a private, parochial, or nursery school, upon recommendation
of the local health officer, from establishing a rule requiring a more
extensive or more frequent examination than required by this
section.

(h) The State Department of Public Health, in consultation with
the California Tuberculosis Controllers Association, shall develop
a risk assessment questionnaire, to be used to conduct tuberculosis
risk assessments pursuant to this section. The questionnaire shall
be administered by a health care provider, which shall be specified
on the questionnaire.

SEC. 3.  

Section 121535 of the Health and Safety Code is
amended to read:

121535.  

The X-ray may be taken by a competent and qualified
X-ray technician if the X-ray is subsequently interpreted by a
licensed physician and surgeon.

SEC. 4.  

Section 121545 of the Health and Safety Code is
amended to read:

121545.  

(a) A volunteer in a school subject to this chapter
shall also be required to have on file with the school a certificate
showing that, upon initial volunteer assignment, the person
submitted to a tuberculosis risk assessment, and, if tuberculosis
risk factors were identified, the person was examined and found
to be free of infectious tuberculosis. If no risk factors are identified,
an examination is not required. A person who is subject to the
requirements of this subdivision may take an examination that
complies with the requirements of begin delete subdivision (b) of Section
121525 end delete begin insert Section 121530 end insert instead of submitting to a tuberculosis risk
assessment.

(b) At the discretion of the governing authority of a school
subject to this chapter this section shall not apply to a volunteer
whose functions do not require frequent or prolonged contact with
pupils.

SEC. 5.  

Section 121555 of the Health and Safety Code is
amended to read:

121555.  

(a) A person who transfers his or her employment
from one of the schools specified in subdivision (a) of Section
121525 to another shall be deemed to meet the requirements of
subdivision (a) of Section 121525 if the person can produce a
certificate that shows that he or she was found to be free of
infectious tuberculosis within 60 days of initial hire, or the school
previously employing the person verifies that the school has a
certificate on file showing that the person is free from infectious
tuberculosis.

(b) A person who transfers his or her employment from a public
elementary school or secondary school to any of the schools
specified in subdivision (a) of Section 121525 shall be deemed to
meet the requirements of subdivision (a) of Section 121525 if that
person can produce a certificate as provided for in begin delete Section 11708 end delete
begin insert subdivision (c) of Section 49406 end insert of the Education Code that shows
that he or she was found to be free of infectious tuberculosis within
60 days of initial hire, or if the school district previously employing
the person verifies that the school district has a certificate on file
showing that the person is free from infectious tuberculosis.

SEC. 6.  

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.