CSSB 138(HES): "An Act relating to the state's tuberculosis control program; and providing for an effective date."
00CS FOR SENATE BILL NO. 138(HES) 01 "An Act relating to the state's tuberculosis control program; and providing for 02 an effective date." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. FINDINGS. The legislature finds that tuberculosis is a disease that can be 05 easily spread, is sometimes fatal, and constitutes a serious threat to the public health and 06 welfare. The state medical officers of the Department of Health and Social Services, division 07 of public health, must use every available means to ascertain the existence of, and immediately 08 investigate all reported or suspected cases of tuberculosis in the state, and to ascertain the 09 sources of that disease. The legislature further finds that, in order to protect the public health 10 from the few persons with tuberculosis who pose a threat to the public, it is necessary to 11 establish a system of mandatory contact identification, treatment, hospitalization, and isolation 12 for infectious cases and a system of voluntary care and monitoring in all other tuberculosis 13 cases. 14 * Sec. 2. AS 18.15.120 is amended to read:
01 Sec. 18.15.120. TUBERCULOSIS CONTROL PROGRAM AUTHORIZED. 02 The department may establish a comprehensive program for the control of tuberculosis 03 in the state, and may 04 (1) arrange means by which persons in the state may be X-rayed to 05 determine the presence of tuberculosis; 06 (2) establish necessary out-patient clinics for the care of tuberculosis; 07 (3) encourage and promote the establishment of adequate health care 08 [SANATORIUM] facilities within the state to care for persons suffering from 09 tuberculosis and allied conditions; 10 (4) under the provisions of AS 36.30 (State Procurement Code), obtain, 11 by purchase or donation from surplus federal property or otherwise, medical supplies 12 and equipment useful in carrying out this program and allot or resell these supplies and 13 equipment to private institutions engaged by the department to carry out this program; 14 (5) under the provisions of AS 36.30, contract with hospitals, 15 associations, or other health care facilities [SANATORIUM] qualified and equipped 16 to give adequate care inside or outside the state; 17 (6) employ necessary and trained personnel to carry out the purposes 18 of AS 18.15.120 - 18.15.149 [AS 18.15.120 - 18.15.140]; 19 (7) pay the costs of care and incidental expenses for residents of the 20 state, in whole or in part, depending on the ability of each patient to pay, and the 21 temporary costs of care and transportation for nonresidents on the same basis until they 22 can be transferred to their residence; 23 (8) enlist the cooperation of state, [AND] federal, and local agencies 24 operating in the state for the furtherance of this program; 25 (9) establish standards in accordance with department procedure for the 26 care of persons with tuberculosis [TUBERCULARS] receiving treatment under 27 AS 18.15.120 - 18.15.149; 28 (10) adopt regulations to implement and interpret AS 18.15.120 - 29 18.15.149 [AS 18.15.120 - 18.15.140]. 30 * Sec. 3. AS 18.15.130 is amended to read: 31 Sec. 18.15.130. DEPARTMENT TO COOPERATE WITH OTHER
01 AGENCIES. The department, in establishing [CONDUCTING] a comprehensive 02 program for [STUDY AND CASE FINDING SURVEY OF] the control of 03 tuberculosis in the state [PROBLEM], shall cooperate with state, [AND] federal, and 04 local agencies operating in the state, and obtain as much information and data as 05 possible from them. 06 * Sec. 4. AS 18.15 is amended by adding new sections to read: 07 Sec. 18.15.131. REPORTS TO STATE MEDICAL OFFICERS; 08 DOCUMENTATION OF TREATMENT. (a) A health care provider and a laboratory 09 administrator shall report, within five working days, to a state medical officer when 10 that provider or administrator diagnoses a case of tuberculosis or has reasonable 11 grounds to believe that a patient has tuberculosis, or when a patient ceases treatment 12 for tuberculosis. A health care provider and a laboratory administrator may presume 13 that a patient has ceased treatment if the patient fails to keep an appointment or 14 relocates without transferring medical treatment to another health care provider. A 15 health care provider who treats a patient with tuberculosis, and a person in charge of 16 a health care facility that provides treatment for tuberculosis to a patient, shall maintain 17 written documentation of the patient's adherence to the patient's treatment plan. 18 (b) A person required to report under (a) of this section shall permit a state 19 medical officer to examine patient records, reports, and other data related to the 20 required report. 21 Sec. 18.15.133. EXAMINATION OF PERSONS EXPOSED TO 22 TUBERCULOSIS. (a) A health care provider who treats a patient for tuberculosis 23 shall 24 (1) examine all other persons in the household who have had contact 25 with the patient; 26 (2) refer those persons to another health care provider for examination 27 and notify the other health care provider and a state medical officer of the referral; or 28 (3) refer those persons to a state medical officer for examination and 29 promptly notify the state medical officer of the referral. 30 (b) A health care provider who examines other persons in a household under 31 (a)(1) or (2) of this section shall report to a state medical officer, within 10 days after
01 the examination, the results of the examination. 02 (c) Under AS 18.15.135, a state medical officer may order an examination of 03 a person to detect tuberculosis, for the purpose of directing preventive measures for 04 the person, if the state medical officer has reasonable grounds to believe that the 05 person is at heightened risk of exposure to tuberculosis. 06 * Sec. 5. AS 18.15.135 is amended to read: 07 Sec. 18.15.135. TUBERCULOSIS EXAMINATIONS; EXAMINATION 08 ORDERS. (a) A person shall submit to an examination to detect [AN ACTIVE 09 CASE OF PULMONARY] tuberculosis whenever, in the opinion of a state medical 10 officer [OF THE DIVISION OF PUBLIC HEALTH], an examination is necessary to 11 preserve and protect public health. 12 (b) An examination under this section shall be by written order issued by a 13 state medical officer that must specify the name of the person to be examined and the 14 time and place of the examination. The person to be examined shall be personally 15 served with a copy of the order within a reasonable period of time before the 16 examination is to take place. 17 (c) An examination under this section shall be performed by a physician who 18 may lawfully practice [LICENSED] in the state. The person to be examined may, 19 under conditions specified by the state medical officer, choose the physician who will 20 perform the examination. 21 * Sec. 6. AS 18.15.136 is repealed and reenacted to read: 22 Sec. 18.15.136. ADDITIONAL ORDERS TO PROTECT THE PUBLIC 23 HEALTH. (a) In addition to orders issued under AS 18.15.135, if a state medical 24 officer determines that the public health in general, or the health of a particular person, 25 is endangered by exposure to a person who is known to have tuberculosis, or by 26 exposure to a person for whom there are reasonable grounds to believe has 27 tuberculosis, a state medical officer may issue the orders that the medical officer finds 28 necessary to protect the public from a threat to the public health. An examination 29 ordered under this section shall be performed by a physician who may lawfully 30 practice in the state. Under conditions specified by the state medical officer who 31 issued the order, the person to be examined may choose the physician who will
01 perform the examination. A state medical officer may not under this section order the 02 forcible or involuntary administration of medicine. The state medical officer, through 03 the Department of Law, may make application to a court for enforcement of an order 04 issued under this section. 05 (b) An order issued under (a) of this section may include 06 (1) an authorization for the removal to or admission into a health care 07 facility for appropriate examination for infectious tuberculosis of a person who is 08 known to have tuberculosis, or of a person for whom there are reasonable grounds to 09 believe that the person has tuberculosis and who is unable or unwilling to submit to 10 an examination ordered under AS 18.15.135; 11 (2) a requirement that a person who has tuberculosis complete an 12 appropriate treatment plan for tuberculosis and, if necessary, follow required infection 13 control precautions for tuberculosis; 14 (3) a requirement that a person be removed to, admitted into, and 15 subsequently detained in, a health facility, if 16 (A) the person has infectious tuberculosis, or presents a 17 substantial likelihood of having infectious tuberculosis, based upon 18 epidemiologic information, clinical findings, X-ray readings, or tuberculosis 19 laboratory test results; and 20 (B) the state medical officer finds that a substantial likelihood 21 exists that the person may transmit tuberculosis to others because of the 22 person's inadequate separation from others; 23 (4) a requirement that a person be removed to, admitted into, and 24 subsequently detained in a health care facility for treatment if 25 (A) the person has infectious tuberculosis, or has been reported 26 to a state medical officer as having infectious tuberculosis, and the state 27 medical officer has no knowledge that the person has completed an appropriate 28 treatment plan for tuberculosis; and 29 (B) substantial likelihood exists, based on the person's past or 30 present behavior, that the person cannot be relied upon to participate in or 31 complete an appropriate treatment plan for tuberculosis or, if necessary, follow
01 required infection control precautions for tuberculosis; the state medical officer 02 may consider as indicators of unreliability the person's refusal or failure to take 03 medication for tuberculosis, refusal or failure to keep appointments for 04 treatment for tuberculosis, refusal or failure to complete a treatment plan for 05 tuberculosis, or disregard for infection control precautions prescribed by a 06 health care provider or a state medical officer; 07 (5) an authorization for isolation of a person with infectious 08 tuberculosis through detention at the person's place of residence until the state medical 09 officer has determined that the person no longer has infectious tuberculosis. 10 (c) A state medical officer shall issue an order under this section in writing, 11 and in the order shall set out the following: 12 (1) the name of the person required to comply with the order, the 13 period of time during which the order is in effect, and other terms and conditions that 14 the state medical officer determines to be necessary to protect the public health; 15 (2) the legal authority under which the order is issued; 16 (3) an assessment of the person's circumstances or behavior constituting 17 the basis for the issuance of the order; and 18 (4) any less restrictive treatment alternatives that were attempted and 19 were unsuccessful, or less restrictive treatment alternatives that were considered and 20 rejected, and the reasons for the rejection of those alternatives. 21 (d) In addition to the requirements of (c) of this section, an order for the 22 detention of a person must include 23 (1) the purpose of the detention; 24 (2) advice to the person being detained that the person has the right to 25 request release from detention by contacting the state medical officer at the telephone 26 number stated on the order and that, under AS 18.15.139, in the absence of a court 27 order authorizing the detention, the detention may not continue for more than five 28 business days after the request for release; 29 (3) advice to the person being detained that, under AS 18.15.139, the 30 state medical officer is required to obtain, within 60 days following the commencement 31 of detention, a court order authorizing the detention and after that must seek further
01 court review of the detention within 90 days after the court order and within 90 days 02 after each subsequent court review; 03 (4) advice to the person being detained that the person has the right to 04 arrange to be represented by counsel or, under AS 18.85.100, to have court-appointed 05 counsel provided; and 06 (5) advice to the person being detained that the person has the right to 07 elect whether a proceeding providing court review is open or closed to the public. 08 (e) A state medical officer is not required to obtain a court order before issuing 09 an order under this section for detention of a person. 10 * Sec. 7. AS 18.15.137 is repealed and reenacted to read: 11 Sec. 18.15.137. EMERGENCY DETENTION ORDERS. A state medical 12 officer, through the Department of Law, may request the court to issue an order for the 13 emergency detention of a person when the state medical officer finds that a substantial 14 likelihood exists that the person has infectious tuberculosis in order to prevent the 15 person from posing a threat to the public health. Upon issuance of an ex parte court 16 order, a peace officer or a state medical officer shall take the person into custody and 17 deliver the person to the nearest available health care facility or another location that 18 will provide for the protection of the public health. The state medical officer, through 19 the Department of Law, shall make application for a court order authorizing continued 20 detention of the person within 72 hours after the issuance of an ex parte order or, if 21 the 72-hour period ends on a Saturday, Sunday, or legal holiday, by the end of the first 22 state working day following the Saturday, Sunday, or legal holiday. The court shall 23 schedule a hearing within five state working days after receipt of an application for 24 authorization of continued detention. 25 * Sec. 8. AS 18.15 is amended by adding a new section to read: 26 Sec. 18.15.139. COURT AUTHORIZATION OF DETENTION. (a) If a 27 person detained under an order issued under AS 18.15.136 requests release from 28 detention, the state medical officer shall make an application for a court order 29 authorizing continued detention within 72 hours after the request or, if the 72-hour 30 period ends on a Saturday, Sunday, or legal holiday, by the end of the first state 31 working day following the Saturday, Sunday, or legal holiday. The court shall
01 schedule a hearing within five state working days after receipt of the state medical 02 officer's application. After a detained person requests release, detention of that person 03 may not continue for more than five business days in the absence of a court order 04 authorizing continued detention. However, no person may be detained under an order 05 issued under AS 18.15.136 for more than 60 days without a court order authorizing the 06 detention. A state medical officer, through the Department of Law, shall seek further 07 court review of a detention within 90 days following the initial court order authorizing 08 the detention and within 90 days after each subsequent court order authorizing 09 detention. 10 (b) In a court proceeding to authorize or enforce a state medical officer's order 11 under AS 18.15.136 for the detention of a person, the state medical officer must prove 12 the circumstances constituting the necessity for the detention by clear and convincing 13 evidence. 14 (c) A person who is subject to a detention order under AS 18.15.136 has the 15 right to be represented by counsel or to have, under AS 18.85.100, court-appointed 16 counsel provided. 17 (d) A person who is the subject of a court proceeding initiated under 18 AS 18.15.136 or 18.15.137 may elect to have the hearing open or closed to the public. 19 * Sec. 9. AS 18.15 is amended by adding a new section to read: 20 Sec. 18.15.143. RELIGIOUS TREATMENT FOR TUBERCULOSIS. (a) If 21 a person with infectious tuberculosis establishes that that person is being provided 22 treatment for tuberculosis by spiritual means or establishes that the person's sincerely 23 held religious beliefs prohibit medical treatment, a state medical officer or the court, 24 in issuing an order under AS 18.15.136, 18.15.137, or 18.15.139, may consider the 25 spiritual treatment or religious beliefs as well as the health of the person and may 26 order that the person only be isolated at the person's home, or other suitable place of 27 the person's choice, in a manner that will protect the public health. 28 (b) A person with infectious tuberculosis who is or might become subject to 29 an order issued under AS 18.15.136, 18.15.137, or 18.15.139, at any time may request 30 recognition and consideration of spiritual treatment or religious beliefs as described in 31 (a) of this section.
01 (c) In this section, "spiritual means" means prayer, or a substantially similar 02 activity, by an established practitioner of a recognized church or religious 03 denomination, in accordance with the tenets and practices of that church or religious 04 denomination. 05 * Sec. 10. AS 18.15.145(a) is amended to read: 06 (a) An employee of a public or private elementary or secondary school in the 07 state shall be tested annually to detect infectious [ACTIVE CASES OF 08 PULMONARY] tuberculosis. An employee who has never had a positive test result 09 from a tuberculin skin test shall obtain a tuberculin skin test. An employee whose skin 10 test result is positive or who has ever had a positive skin test result shall have an 11 appropriate health screening examination that may include obtaining [OBTAIN] 12 a chest X-ray. 13 * Sec. 11. AS 18.15 is amended by adding new sections to read: 14 Sec. 18.15.147. LIMITED IMMUNITY. A person may not bring an action for 15 damages based on the decision under AS 18.15.120 - 18.15.149 to detain or not to 16 detain a person unless the action is for damages caused by gross negligence or 17 intentional misconduct. 18 Sec. 18.15.149. DEFINITIONS. In AS 18.15.120 - 18.15.149, 19 (1) "department" means the Department of Health and Social Services; 20 (2) "division of public health" means the division of public health in 21 the department; 22 (3) "health care facility" means a hospital, specialty hospital, long-term 23 care facility, medical clinic, or similar facility for which a license has been issued by 24 this state and in which inpatient or outpatient medical services for tuberculosis are 25 provided; 26 (4) "health care provider" means an acupuncturist, nurse, nurse 27 practitioner, pharmacist, physician, or physician's assistant, hospital, or health clinic 28 who may lawfully practice in this state; 29 (5) "state medical officer" means a physician employed by the division 30 of public health; 31 (6) "tuberculosis" means a disease caused by mycobacterium
01 tuberculosis, mycobacterium bovis, or mycobacterium africanum. 02 * Sec. 12. AS 18.85.100(a) is amended to read: 03 (a) An indigent person who is being detained by a law enforcement officer in 04 connection with a serious crime, or is under formal charge of having committed, or is 05 being detained under a conviction of a serious crime, or is on probation or parole, or 06 is entitled to representation under the Supreme Court Delinquency or Child in Need 07 of Aid Rules, or is detained under an order issued under AS 18.15.120 - 18.15.149 08 or against whom commitment proceedings for mental illness have been initiated, is 09 entitled 10 (1) to be represented by an attorney to the same extent as a person 11 retaining an attorney is entitled; and 12 (2) to be provided with the necessary services and facilities of this 13 representation, including investigation and other preparation. 14 * Sec. 13. AS 18.15.138 is repealed. 15 * Sec. 14. The Department of Health and Social Services may immediately proceed to 16 adopt regulations to implement the changes made by this Act. The regulations take effect 17 under AS 44.62 (Administrative Procedure Act), but not before July 1, 1995. 18 * Sec. 15. Section 14 of this Act takes effect immediately under AS 01.10.070(c). 19 * Sec. 16. Except as provided in sec. 15 of this Act, this Act takes effect July 1, 1995.