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Menu of Suggested Provisions For State Tuberculosis Prevention and Control Laws

V. Case Management

A. Authority of Public Health Officials to Implement Disease Control Measures and Enforcement/Validation of Orders

1. Authority to Implement Disease Control Measure

Descriptive Note:  The majority of states have enacted laws authorizing public health officials to issue administrative orders (usually called “health officer orders”) for certain disease control measures rather than requiring a court order to compel behavior. These states may prefer administrative mechanisms because they tend to be faster and more efficient than seeking a court order in the first instance. This section contains examples of existing provisions that describe roles and responsibilities of public health officials and authorize them to implement a variety of different disease control measures. Conversely, some states have enacted laws authorizing public health officials to petition the court for an order in the first instance. These states may prefer this approach because they have experienced problems with enforcement of administrative orders as compared to court orders.

  • Special diseases-Tuberculosis.
    • Health care providers diagnosing or caring for a person with tuberculosis, whether pulmonary or nonpulmonary, shall:
      • 1) Report the case to the local health officer or local health department in accordance with the provisions of this chapter, and
      • 2) Report patient status to the local health officer every three months or as requested.
    • The local health officer or local health department shall:
      • 1) Have primary responsibility for control of tuberculosis within the designated jurisdiction;
      • 2) Maintain a tuberculosis control program including:
        • Prophylaxis,
        • Treatment,
        • Surveillance,
        • Case finding,
        • Contact tracing, and
        • Other aspects of epidemiologic investigation;
      • 3) Maintain a tuberculosis register of all persons with tuberculosis, whether new or recurrent, within the local jurisdiction including information about:
        • Identification of patient,
        • Clinical condition,
        • Epidemiology of disease,
        • Frequency of examinations;
      • 4) Impose isolation of a person with tuberculosis in an infectious stage if that person does not observe precautions to prevent the spread of the infection;
      • 5) Designate the place of isolation when imposed;
      • 6) Release the person from isolation when appropriate;
      • 7) Maintain and provide outpatient tuberculosis diagnostic and treatment services as necessary, including public health nursing services and physician consultation; and
      • 8) Submit reports of all cases to the department in accordance with the provisions of this chapter.
    • When a person with tuberculosis requires hospitalization:
      • 1) Hospital admission shall occur in accordance with procedures arranged by the local health officer and the medical director or administrator of the hospital, and
      • 2) The principal health care provider shall:
        • Maintain responsibility for deciding date of discharge, and
        • Notify the local health officer of intended discharge in order to assure appropriate outpatient arrangements. Wash. Admin. Code § 246-100-211 (2009).
    • Where the health officer determines that the public health or the health of any other person is endangered by a case of tuberculosis, or a suspected case of tuberculosis the health officer may issue any orders he or she deems necessary to protect the public health or the health of any other person, and may make application to a court for enforcement of such orders. In any court proceeding for enforcement, the health officer shall demonstrate the particularized circumstances constituting the necessity for an order. In any court proceeding for enforcement, the health officer shall demonstrate the particularized circumstances constituting the necessity for an order.  New York, N.Y., 24RCNY Health Code § 11.21 (2009).
    • The department may instruct a case or [person suspected of having TB] of a reportable disease regarding public health measures for preventing the spread of the disease and of the necessity for treatment until cured or free from the infection. If the department knows or has reason to believe, because of medical or epidemiological information, that a person has a reportable disease and is a health threat to others, it may issue a public health notice directing the person to take one or more of the following actions:
      • 1) To be examined or tested to determine whether the person has a reportable disease in an infectious stage;
      • 2) To report to a physician, health care worker, or authorized department representative for counseling on the reportable disease and for information on how to avoid infecting others;
      • 3) To receive treatment until cured or free from the infection and to follow measures for preventing reinfection;
      • 4) To cease from specified conduct which endangers the health of others; or
      • 5) To cooperate with the department in implementation of recommended public health measures.

      The department may use restrictive public health measures only if other measures to protect the public health have failed, including efforts to obtain the voluntary cooperation of the person who may be the subject of such measures. The department shall apply public health measures as necessary to achieve the desired purpose of protecting the public health, using the least intrusive measures first. S.D. Admin. R. 44:20:03:04 (2009).   
  • Whenever the health officer shall determine that treatment or isolation in a particular case is necessary for the preservation and protection of the public health, he or she shall make an order to that effect in writing, setting forth the name of the person, the period of time during which the order shall remain effective, the place of treatment or isolation and such other terms and conditions as may be necessary to protect the public health.
    • Upon the making of an examination, treatment, or isolation order as provided in this section, a copy of such order shall be served upon the person named in such order.
    • Upon the receipt of information that any examination, treatment, or isolation order, made and served as herein provided, has been violated, the health officer shall advise the prosecuting attorney of the county in which such violation has occurred, in writing, and shall submit to such prosecuting attorney the information in his or her possession relating to the subject matter of such examination, treatment, or isolation order, and of such violation or violations thereof.
    • Any and all orders authorized under this section shall be made by the health officer or his or her tuberculosis control officer. Wash. Rev. Code Ann. § 70-28-031 (LexisNexis 2009).

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2. Enforcement/Validation of Orders

Descriptive Note:  States may consider incorporating an enforcement mechanism in laws that authorize public health officials to issue administrative orders compelling behavior if the order is violated.  This section contains examples of enforcement provisions.

  • In addition to the proceedings set forth in [statutory provision on powers and duties of health officers], where a local health officer has reasonable cause to believe that an individual has tuberculosis as defined in the rules and regulations of the state board of health, and the individual refuses to obey the order of the local health officer to appear for an initial examination or a follow-up examination or an order for treatment, or isolation, the health officer may apply to the superior court for an order requiring the individual to comply with the order of the local health officer.  Wash. Rev. Code Ann. § 70-28-035 (LexisNexis 2009).
  • Upon the receipt of information that any order has been violated, the health officer shall advise the district attorney of the county in which the violation has occurred, in writing, and shall submit to the district attorney the information in his or her possession relating to the subject matter of the order, and of the violation or violations thereof. Cal. [Health & Safety] Code § 121365 (West 2009).

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