SB 138 TUBERCULOSIS CONTROL  Number 374 CHAIRMAN GREEN introduced SB 138 as the next order of business before the committee. RUSSELL WEBB, Division of Public Health, said that tuberculosis remains a serious public health problem in Alaska. There have been several serious outbreaks in the last year. Current law makes it difficult to combat tuberculosis and its threat to the public's health. He explained that tuberculosis is an airborne disease that is easily spread by routine contact such as coughing in a confined area. Tuberculosis can be successfully treated, however, the treatment can be lengthy. He specified that treatment can take 6 to 24 months and may require taking multiple drugs. Some persons may find it difficult to voluntarily complete treatment. Mr. Webb emphasized that it is critical to complete the entire treatment because tuberculosis can develop a resistance to drugs. He informed the committee that there are strains that are resistant to all known antibiotics. Therefore, someone who does not complete treatment could possibly pass on a drug resistant strain to others. Mr. Webb emphasized the importance of having the tools to ensure that people who fail to voluntarily comply with treatment are required to comply with treatment. SB 138 would provide such tools and update the current law. SB 138 would provide some constitutional safeguards for persons who are involuntarily required to comply with treatment. He anticipated that quarantine and isolation would be necessary in rare cases, however, when that is necessary the ability to implement that is critical. In conclusion, Mr. Webb reiterated the importance of SB 138 to Alaska and the efforts to control tuberculosis. SENATOR LEMAN asked if there were other diseases such as tuberculosis where this type of action, quarantine, may be necessary. He also asked what was being done about those disease if they exist. RUSSELL WEBB clarified that he was not a medical doctor. Mr. Webb said that he had been informed, after discussions with Dr. Nakamura and Dr. Middaugh, that tuberculosis is a particular case because of the manner in which the disease is spread as well as the difficulty faced in treatment. Treatment for tuberculosis often requires taking a combination of drugs for a lengthy time period. Number 443 ELFRIDA NORD, Chief of Public Health Nursing, explained that there are no other diseases that are like tuberculosis as far as quarantine is concerned. The air-sharing nature of tuberculosis allows a person to get the disease without any effort on their part; that is the specialness of tuberculosis. Most other diseases require an individual to have some part in getting the disease. SENATOR LEMAN said that he did not have a problem with this procedure. However, there may be other diseases which could have a better effort to protect the public for the same reasons as SB 138. Why are those aggressive procedures not being done with those other diseases? He commended everyone for bringing this issue to everyone's attention. RUSSELL WEBB pointed out that there are a variety of other control mechanisms being used for other diseases and those mechanisms are being utilized. Tuberculosis is a special case which requires a change in the law in order to address the disease. CHAIRMAN GREEN asked if tuberculosis was more of a problem in Alaska because of the circumstances of Alaska. ELFRIDA NORD replied no. Ms. Nord specified that with tuberculosis the problem stems from the nature of the disease and the nature by which this disease is spread to others. Furthermore, the long term aspect of tuberculosis also poses problems. Ms. Nord indicated that the goal is to keep a person with tuberculosis under surveillance while the treatment is given to the person regularly. Number 474 SENATOR MILLER informed the committee that he had a proposed amendment from the department. Senator Miller moved that Amendment 1 be adopted. RUSSELL WEBB explained that the amendment provides for protection of the privacy rights by allowing the option of closed court proceedings relating to a tuberculosis court order. The other portion of the amendment would eliminate the criminal penalty for failure to comply with a tuberculosis order. He noted that provision had been left in due to a drafting error. He indicated that the criminal penalty is ineffective and unnecessary. SB 138 provides more effective civil means in which to protect the public health. DHSS and the Division of Public Health are interested in protecting the public health without imposing criminal penalties. CHAIRMAN GREEN asked if there was any objection to Amendment 1. Hearing no objection, Amendment 1 was adopted. KRISTEN BOMENGEN, Human Services Section with the Department of Law, explained that currently in tuberculosis cases the State Medical Officer can order an examination and quarantine. The next tool is the enforcement of the order by notifying law enforcement officials and leveling a criminal charge for failure to follow a medical order. SB 138 would provide the needed intermediate steps between the initial order and the enforcement of the order. She noted that the bill is designed to provide due process considerations such as a hearing before an impartial decision- maker, an opportunity to be represented by council and raise constitutional issues. Ms. Bomengen informed the committee that this was before the legislature now because of a case encountered in the past year in which the department was before the courts with a criminal order to enforce the quarantine provisions. In regards to the amendment, the criminal penalties were not necessary when the intermediate steps were in place; a civil contempt proceeding is more appropriate to enforce the order. SENATOR MILLER moved that CS SB 138(HES) be moved out of committee with individual recommendations. Hearing no objection, it was so ordered.