ASSEMBLY, No. 1045
STATE OF NEW JERSEY
Introduced Pending Technical Review by Legislative Counsel
PRE-FILED FOR INTRODUCTION IN THE 1996 SESSION
By Assemblymen DORIA and ROMANO
An Act concerning the prevention and control of tuberculosis, supplementing Title 26 of the Revised Statutes, repealing R.S.30:9-57, and making an appropriation.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. This act shall be known and may be cited as the "Comprehensive Tuberculosis Prevention and Control Act."
2. The Legislature finds and declares that:
a. Tuberculosis (TB) is an airborne, infectious disease which presents a serious public health threat to the citizens of our State where active TB has increased by 26% since 1986.
b. Although TB was considered 100% preventable and curable, resurgence of the disease began in 1985 with increased incidence among vulnerable persons, those with acquired immunodeficiency syndrome, drug users and the homeless. Active TB is also increasing among non-risk groups.
c. The resurgence of TB in the State has been particularly evident in Newark, Paterson, Jersey City and Elizabeth which have some of the highest rates of active TB in the nation.
d. TB is generally treatable and curable with a treatment regimen which must be strictly adhered to for a period of six to 12 months. If the full course of treatment is not completed, the disease is likely to become infectious again with an increased probability of being resistant to standard TB medications. This strain of TB, multi-drug resistant TB (MDR-TB), is as infectious as active TB; one non-compliant patient can infect dozens of people.
e. MDR-TB is more difficult to prevent, treat or cure and, because it is increasing at an alarming rate in this State, may endanger the State's ability to control TB altogether.
3. As used in this act:
"Active tuberculosis" or "active TB" means the diagnosis of a person who has had a sputum smear or culture taken from a pulmonary or laryngeal source which has tested positive for tuberculosis and the person has not completed an appropriate prescribed course of medication for tuberculosis. The diagnosis also applies to a person who has had a smear or culture taken from an extra pulmonary source which has tested positive for tuberculosis, and there is clinical evidence or clinical suspicion of pulmonary tuberculosis disease and the person has not completed an appropriate prescribed course of medication for tuberculosis. A person also has active tuberculosis when, in those cases where sputum smears or cultures are unobtainable, the radiographic evidence, in addition to current clinical evidence and laboratory tests is sufficient to establish a medical diagnosis of pulmonary tuberculosis for which treatment is indicated. A person who has active tuberculosis shall be considered infectious until three consecutive sputum smears from a pulmonary or laryngeal source collected on separate days at medically appropriate intervals have tested negative for tuberculosis and the clinical symptoms of tuberculosis have resolved or significantly improved.
"Commissioner" means the Commissioner of Health.
"Department" means the Department of Health.
"Health care provider" means a person who is directly involved in making a clinical diagnosis and the prescribing of medication for which the person is professionally qualified and is licensed or certified as required by State law.
"Specialized TB treatment and detention facility" means a building, section of a building or a unit specifically designed to treat a person with TB who requires a specialized level of care, otherwise unavailable in an acute care hospital, long-term care facility or outpatient clinic, by means of medical specialty training, environmental controls to prevent TB transmission, infection controls or security enforcement.
"TB prevention and control center" means an outpatient ambulatory care facility specifically designated to provide TB or chest clinic services, including, but not limited to, clinical diagnosis, treatment, case management, outreach prevention, contact tracing and follow-up services.
4. The Department of Health shall provide support, to the extent that resources permit, to TB prevention and control centers which operate in accordance with policies established by the department. At a minimum, these facilities shall be eligible to receive department-purchased medications for the treatment of individuals who have no source of payment therefor and are diagnosed as, or are suspected of, having TB.
The centers shall:
a. provide testing for tuberculosis for persons who are symptomatic, have suspected TB, or are contacts to persons with diagnosed or suspected active TB;
b. provide preventive therapy to prevent the progression to clinical disease;
c. identify active cases of tuberculosis and provide treatment for the clinical disease, including directly observed therapy;
d. provide community outreach services to patients to assure compliance with treatment regimens;
e. provide case management for all cases of tuberculosis, including testing, medications and tracking;
f. identify patients not in compliance with treatment regimens and ensure their treatment until cure; and
g. obtain reimbursement from eligible health care payers, including State and federal sources.
5. An employee of a State facility operated by the Department of Corrections and an employee of a State facility operated by the Department of Human Services shall be tested initially upon employment and periodically thereafter for the presence of tuberculosis, in accordance with the rules of their respective departments, and in consultation with the Department of Health. An employee who tests positive for tuberculosis or is determined to have active TB, shall be referred to a private physician or a TB prevention and control center for a chest x-ray or further diagnostic examination and, if necessary, establishment of an appropriate treatment regimen.
6. A health care worker, including, but not limited to a physician or a nurse, who is employed in a hospital, nursing home or residential health care facility shall be tested initially upon employment and periodically thereafter for the presence of tuberculosis, in accordance with the standards of the department. A health care worker who tests positive for tuberculosis or is determined to have active TB, shall be referred to a private physician or a TB prevention and control center for a chest x-ray or further diagnostic examination and, if necessary, establishment of an appropriate treatment regimen.
7. A patient in a health care facility who is in a high-risk group for tuberculosis, as defined by the federal Centers for Disease Control and Prevention and as determined by the patient's history, shall, upon admittance to that facility, be tested for the presence of tuberculosis. No other tests used to establish the existence of high-risk category status shall be conducted without the patient's consent. A patient who tests positive for tuberculosis or is determined to have active TB shall be evaluated and treated for tuberculosis in the appropriate health care setting and, upon discharge from the health care facility, if necessary, referred to a private physician or a TB prevention and control center for a chest x-ray or further diagnostic examination and, if necessary, appropriate treatment follow-up.
8. a. The mantoux tuberculin skin test shall be the sole test used for the testing required pursuant to sections 5 through 7 of this act.
b. The results of all tests conducted pursuant to this act shall be reported to the department at least semi-annually on forms provided by the department.
9. A person with active TB who is infectious shall be excluded from attendance at the workplace or school until three consecutive sputum smears from a pulmonary or laryngeal source collected on separate days at medically appropriate intervals have tested negative for tuberculosis and the clinical symptoms of TB have resolved or significantly improved.
10. a. All active or suspected cases of tuberculosis shall be reported to the department in accordance with regulations adopted by the commissioner.
b. All actions taken to investigate reported cases of active TB, isolate or restrict individuals to control or prevent the spread of TB, and to perform medical examinations and submit test specimens for evaluation, shall be done in accordance with regulations adopted by the commissioner.
11. When the commissioner determines that the public health or the health of any person is endangered by a case of tuberculosis, or a suspected case of tuberculosis, he may issue an order necessary to protect the public health and may make application to the court for enforcement of such an order. In a court proceeding for enforcement, the commissioner shall demonstrate the particular circumstances constituting the necessity for the order. An order may include, but not be limited to:
a. An order authorizing the commitment to a hospital or other treatment facility for appropriate examination for tuberculosis of a person who has active TB or who is suspected of having active TB and who is unable or unwilling voluntarily to submit to an examination by a physician or the department;
b. An order requiring a person who has active TB to complete an appropriate prescribed course of medication for tuberculosis and, if necessary, to follow required contagion precautions for tuberculosis;
c. An order requiring a person who has active TB and who is unable or unwilling otherwise to complete an appropriate prescribed course of medication for tuberculosis to follow a course of directly observed therapy. For the purposes of this subsection, "directly observed therapy" means a course of treatment for tuberculosis in which the prescribed anti-tuberculosis medication is administered to the person or taken by the person under direct observation of a health care provider or his designee;
d. An order authorizing the transfer to a hospital or other treatment facility of a person (1) who has active TB that is infectious or who presents a substantial likelihood of having active TB that is infectious, based upon epidemiologic evidence, clinical evidence, X-ray readings or laboratory test results; and (2) when the department finds, based on recognized infection control principles, that there is a substantial likelihood the person may transmit tuberculosis to others because of his inadequate separation from others; and
e. An order authorizing the transfer to a hospital or other treatment facility of a person who (1) has active TB, or who has been reported to the department as having active TB with no subsequent report to the department of the completion of an appropriate prescribed course of medication for tuberculosis; and (2) when there is a substantial likelihood, based on the person's past or present behavior, that he cannot be relied upon to participate in or to complete an appropriate prescribed course of medication for tuberculosis and, if necessary, to follow required contagion precautions for tuberculosis. Such behavior may include, but is not limited to, refusal or failure to take medication for tuberculosis, or refusal or failure to keep appointments for treatment of tuberculosis, or refusal or failure to complete treatment for tuberculosis or disregard for contagion precautions for tuberculosis.
12. The commissioner may temporarily commit a person to a hospital or other place for examination or treatment if the person is the subject of an order pursuant to section 11 of this act, without prior court order. The commissioner shall thereafter make an application for a court order continuing the commitment within five days after the commitment, or, if the five-day period ends on a Saturday, Sunday or legal holiday, by the end of the first business day following the Saturday, Sunday or legal holiday, which application shall include a request for an expedited hearing. In no event shall a person be held for more than 10 days without a court order authorizing the commitment. The commissioner shall seek further court review of the commitment within 90 days following the initial court order authorizing transfer and thereafter within 90 days of each subsequent court review. In any court proceeding to enforce an order of the commissioner for the commitment of a person issued pursuant to this section or for review of the status of the person committed, the commissioner shall prove the particular circumstances constituting the necessity for the order by clear and convincing evidence. A person who is subject to a commitment order shall have the right to be represented by counsel and upon this request, counsel shall be provided.
13. a. An order of the commissioner pursuant to section 11 of this act shall set forth:
(1) the legal authority under which the order is issued;
(2) an individualized assessment of the person's circumstances or behavior constituting the basis for the issuance of the order; and
(3) the less restrictive treatment alternatives that were attempted and were unsuccessful or the less restrictive treatment alternatives that were considered and rejected, and the reasons for their rejection.
b. In addition to the requirements set forth in subsection a. of this section, an order for the commitment of a person for examination or treatment shall:
(1) include the purpose of the transfer;
(2) advise the person being committed that, whether or not he requests release, the commissioner must obtain a court order authorizing the transfer for examination or treatment within 10 days following the initial commitment order, and that in no event shall the person be held for more than 10 days without a court order, and that the commissioner must thereafter seek court review of the commitment within 90 days of that court order and within 90 days of each subsequent court review; and
(3) advise the person being committed that he has the right to arrange to be advised and represented by counsel or to have counsel provided to him.
14. a. A person who is committed solely pursuant to subsection a. of section 11 of this act shall not continue to be held beyond the minimum period of time required, with the exercise of all due diligence, to make a medical determination of whether a person who is suspected of having tuberculosis has active TB or whether a person who has active TB is infectious. Further detention of the person shall be authorized only upon the issuance of the commissioner's order pursuant to subsections d. or e. of section 11 of this act.
b. A person who is committed solely pursuant to subsection d. of section 11 of this act shall not continue to be held after he ceases to be infectious or after the department ascertains that changed circumstances exist that permit him to be adequately separated from others so as to prevent transmission of tuberculosis after his release.
c. A person who is committed solely pursuant to subsection e. of section 11 of this act shall not continue to be held after he has completed an appropriate prescribed course of medication.
15. The commissioner shall designate inpatient facilities which shall be used for persons transferred for examination or treatment pursuant to section 11 of this act. In making this determination, the commissioner shall consider petitioning the federal government for use of vacant federal property in the State which would be suitable as an inpatient facility for tuberculosis patients.
16. The commissioner, with the assistance or cooperation of any federal government agency, hospital, long-term care facility, or other entity, as necessary, may seek to develop one or more specialized TB treatment and detention facilities to which patients who require longer-term and more specialized care, including security enforcement, than is available in an acute-care hospital may be referred. The facilities shall be authorized to obtain reimbursement from eligible health care payers, including State and federal sources. The establishment of this facility shall not relieve any acute-care hospital of its responsibility to accept infectious TB patients, evaluate their needs and begin treatment.
17. The commissioner shall submit an annual report to the Governor and the Legislature regarding the progress of the TB prevention and control centers and their effectiveness in preventing and controlling the incidence of tuberculosis in this State.
18. The commissioner, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations to effectuate the purposes of this act, including, but not limited to, those governing actions taken to ensure that: a person with active TB completes his medication as prescribed, infection control procedures are followed, and appropriate action is taken under legal authority to implement the provisions of this act.
19. There is appropriated $8,000,000 from the General Fund to the Department of Health to implement the provisions of this act.
20. R.S.30:9-57 is repealed.
21. This act shall take effect on the 60th day after the date of enactment.
STATEMENT
The bill which is designated the "Comprehensive Tuberculosis Prevention and Control Act," does the following:
Provides funding from the Department of Health (DOH) to TB prevention and control centers which provide clinical diagnosis, treatment, case management, outreach, prevention, contact tracing and follow-up services;
Requires mandatory TB testing of (1) employees of State facilities operated by the Departments of Corrections and Human Services; (2) health care workers employed in hospitals, nursing homes and residential health care facilities; and (3) patients in health care facilities who are in a high-risk group for TB as defined by the federal Centers for Disease Control and Prevention and as determined by the patient's history;
Stipulates that the mantoux tuberculin skin test shall be the sole test used for the testing required under the substitute;
Requires that the results of all tests conducted pursuant to the substitute, and all active or suspected cases of TB, be reported to DOH;
Prohibits persons with active TB from attending the workplace or school until three consecutive sputum smears from a pulmonary or laryngeal source collected on separate days at medically appropriate intervals have tested negative for tuberculosis and the clinical symptoms of TB have resolved or significantly improved;
Grants the commissioner the authority to issue an order protecting the public health if the public health or the health of any person is endangered by a case of TB or a suspected case of TB, and to make application to the court for enforcement of that order;
Grants the commissioner the authority to temporarily commit a person to a hospital or other place for examination or treatment if the person is the subject of an order issued by the commissioner, without prior court order; however, the commissioner is required to make an application for a court order continuing the commitment within five days after the commitment, or, if the five-day period ends on a Saturday, Sunday or legal holiday, by the end of the first business day following the Saturday, Sunday or legal holiday, which application shall include a request for an expedited hearing;
Provides that a person shall not be held for more than 10 days without a court order authorizing the commitment, and that the commissioner shall seek further court review of the commitment within 90 days following the initial court order authorizing transfer and thereafter within 90 days of each subsequent court review;
Grants the commissioner the authority to develop one or more specialized TB treatment and detention facilities to which patients who require longer-term and more specialized care, including security enforcement, than is available in an acute-care hospital may be referred;
Requires the commissioner to report annually to the Governor and Legislature on the effectiveness of the TB prevention and control centers in preventing and controlling the spread of TB in the State;
Repeals R.S.30:9-57 (which provides for the commitment of persons with communicable TB to a hospital or other institution designated by the Commissioner of Health), the provisions of which are obviated by this substitute; and
Appropriates $8 million to DOH to implement the provisions of the bill.
The bill would take effect on the 60th day after the date of enactment.
Designated the "Comprehensive Tuberculosis Prevention and Control Act;" appropriates $8 million.