Menu of Suggested Provisions For State Tuberculosis Prevention and Control Laws

Introduction

Tuberculosis (TB) laws provide authority for state and local TB programs to prevent and control TB, an airborne infectious disease that sickens approximately 11,000 to 12,000 people each year in the United States. Prompted by an initial request of the Advisory Council for the Elimination of Tuberculosis (ACET) for a model TB control act, and with support from the National Tuberculosis Controllers Association (NTCA), CDC’s Division of Tuberculosis Elimination and Public Health Law Program commenced work on a “Menu of Suggested Provisions for State Tuberculosis Prevention and Control Laws” ¹ during the summer of 2009. We researched, reviewed, and categorized the TB prevention and control statutes and regulations of all 50 states (plus the District of Columbia and New York City) based on ACET recommendations and on the framework used in the article “Tuberculosis control laws—United States,1993: recommendations of the Advisory Council for the Elimination of Tuberculosis (ACET),” published in the Morbidity and Mortality Weekly Report.² We re-organized, modified, and condensed the Menu to provide a set of options within each section that are believed to be effective in the jurisdictions in which they are in place.

We then convened a workshop on February 4-5, 2010 comprising TB controllers, TB program staff, legal counsel to state and local TB programs, representatives from partner organizations (NTCA, Association of State and Territorial Health Officials, and National Association of County and City Health Officials), and federal public health attorneys and policy staff, with a wide range of TB prevention and control responsibility, experience, and expertise. Workshop participants reviewed and analyzed the draft Menu’s provisions, and provided valuable input concerning retention, modification, deletion, or addition of provisions. ACET members also reviewed the draft Menu and added valuable perspective on recommended revisions. In addition, the Association of Public Health Laboratories (APHL) TB Steering Committee provided feedback and input on the laboratory provisions in the draft Menu. This document is the product of those efforts. We hope that the document will be of immediate practical value to public health officials and their legal counsel in the enactment, promulgation, amendment, or implementation of TB prevention and control laws in a variety of jurisdictions.

While this document is intended to provide impetus for consideration of TB-related legal issues, and to suggest possible approaches for addressing those issues, the suggested provisions obviously must be considered within the policy and legal frameworks of the jurisdiction contemplating adoption of the suggested provisions. For example, implementation of some of the provisions is dependent on the resources available to the jurisdiction. States will be mindful of their resources when contemplating actions or duties that will be required of public health officials (i.e., states may not want to adopt laws that result in “unfunded mandates”). The same holds true when imposing timeframes for reporting or laboratory testing.

Similarly, when deciding whether to adopt any of the provisions in the Menu, careful consideration should be given to whether a provision should appear in statute or regulation. States may wish to adopt broad or general statutes that confer discretion to the regulatory process, which can be more expeditiously exercised to make changes or updates. Regulations must be authorized by statute (i.e., there can be a statute without a regulation, but not a regulation without an authorizing statute). Some of the factors that go into this decision are: the timeframe in which the regulation may be promulgated by the authorized agency or the statute enacted by the legislature, how often changes might need to be made to the law, whether the subject matter of the legal provision is technical and regular updates are likely according to advances in technology or practice, and whether statutory authority exists to promulgate a regulation. Finally, some states do not have TB-specific laws (other than reporting laws). We do not intend to recommend that such states adopt TB-specific laws, as these states may have concluded that their general communicable disease control laws provide adequate legal authority to prevent and control TB. Indeed, some of the provisions in the Menu are taken from general communicable disease control codes and are not specific to TB. States using the Menu to assist in the development of TB prevention and control statutes or regulations should therefore carefully tailor those provisions to meet their specific needs.

Each section of the Menu commences with a brief note describing the purpose of provisions included within the section. Provisions in each section are in turn organized under sub-headings. Bulleted provisions within each section and under each sub-heading are mutually exclusive; i.e., a bulleted provision should be viewed as alternative to, rather than supplemental to, other provisions.

Based upon recommendations of workshop participants, ACET, APHL, or other reviewers within CDC, some provisions based on existing state laws were substantively modified or revised. No legal citation is provided for these provisions. Legal citations are included where the exact language of the provision was retained with the following exceptions: 1) the term “quarantine” was either deleted or replaced with the term “isolation”; 2) public health official titles such as “Commissioner” or “Director” were consistently replaced with the generic term “health officer” or “public health official”; 3) names of state health departments (e.g., South Carolina Department of Health and Environmental Control) or components of a state health department (e.g., Division of Infectious Diseases) were replaced with the generic term “department”; 4) cited state code sections within the text of a law were deleted and replaced with a brief description of the cited law in brackets; 5) names of states were replaced with the generic term “state” in brackets; 6) at the recommendation of Workshop participants, bracketed terminology replaced terms such as “afflicted person,” “carrier,” and “tuberculous person”; 7) the term “Mycobacterium tuberculosis” was italicized; 8) for consistency purposes, sub-bullets are numbered in some instances, where the language in the existing law may have organized the text according to letters or roman numerals; and 9) in a few instances, bracketed terminology was added to an existing provision with a note specifying that the change was made and the purpose behind it.

1 Although the title of the document and the descriptive notes refer to “states,” the Menu’s provisions are also available for consideration by tribes, territories, or localities.

2 Centers for Disease Control and Prevention. Tuberculosis control laws—United States,1993: recommendations of the Advisory Council for the Elimination of Tuberculosis (ACET). MMWR 1993;42(No. RR-15):[1-28].