ASSEMBLY, No. 1608
STATE OF NEW JERSEY
INTRODUCED FEBRUARY 29, 1996
By Assemblywoman WRIGHT and Assemblyman DORIA
An Act protecting the public health against tuberculosis infection, supplementing Title 26 of the Revised Statutes and repealing R.S.30:9-57.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. 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.
2. When the commissioner determines that the public health or the health of any person is endangered by a case of tuberculosis (TB), 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.
3. 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 2 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.
4. a. An order of the commissioner pursuant to section 2 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.
5. a. A person who is committed solely pursuant to subsection a. of section 2 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 2 of this act.
b. A person who is committed solely pursuant to subsection d. of section 2 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 2 of this act shall not continue to be held after he has completed an appropriate prescribed course of medication.
6. The commissioner shall designate inpatient facilities which shall be used for persons transferred for examination or treatment pursuant to section 2 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.
7. 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.
8. R.S.30:9-57 is repealed.
9. This act shall take effect on the 60th day after the date of enactment.
STATEMENT
This bill grants the Commissioner of Health 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; and 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. 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.
The bill 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.
The bill 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 bill.
The bill would take effect on the 60th day after the date of enactment.
Permits Commissioner of Health to commit persons with actual or suspected TB for examination or treatment in certain cases.