121350-121460

HEALTH AND SAFETY CODE
SECTION 121350-121460




121350.  The department shall maintain a program for the control of
tuberculosis. The department shall administer the funds made
available by the state for the care of tuberculosis patients.



121355.  Notwithstanding any other provision of this chapter a
county that has elected to come under Section 14150.1 of the Welfare
and Institutions Code shall not receive any tuberculosis subsidy or
reimbursement from the state under the provisions of this chapter.




121357.  The state department shall be the lead agency for all
tuberculosis control and prevention activities at the state level.



121358.  (a) Notwithstanding any other provision of law, individuals
housed or detained through the tuberculosis control, housing, and
detention program shall not reside in correctional facilities, and
the funds available under that program with regard to those
individuals shall not be disbursed to, or used by, correctional
facilities. This section shall not be interpreted to prohibit the
institutionalization of criminals with tuberculosis in correctional
facilities.
   (b) The department shall work with local health jurisdictions to
identify a detention site for recalcitrant tuberculosis patients
appropriate for each local health jurisdiction in the state. The
department shall notify all counties of their designated site by
January 1, 1998.



121360.  Pulmonary tuberculosis is an infectious and communicable
disease, dangerous to the public health, and all proper expenditures
that may be made by any county, pursuant to this chapter, are
necessary for the preservation of the public health of the county.




121360.5.  (a) Any city or county health department that elects to
participate in this program shall provide for one-year certification
of tuberculin skin test technicians by local health officers.
   (b) For purposes of this section, a "certified tuberculin skin
test technician" is an unlicensed public health tuberculosis worker
employed by, or under contract with, a local public health
department, and who is certified by a local health officer to place
and measure skin tests in the local health department's jurisdiction.
   (c) A certified tuberculin skin test technician may perform the
functions for which he or she is certified only if he or she meets
all of the following requirements:
   (1) The certified tuberculin skin test technician is working under
the direction of the local health officer or the tuberculosis
controller.
   (2) The certified tuberculin skin test technician is working under
the supervision of a licensed health professional. For purposes of
this section, "supervision" means the licensed health professional is
immediately available for consultation with the tuberculin skin test
technician through telephonic or electronic contact.
   (d) A certified tuberculin skin test technician may perform
intradermal injections only for the purpose of placing a tuberculin
skin test and measuring the test result.
   (e) A certified tuberculin skin test technician may not be
certified to interpret, and may not interpret, the results of a
tuberculin skin test.
   (f) In order to be certified as a tuberculin skin test technician
by a local health officer, a person shall meet all of the following
requirements, and provide to the local health officer appropriate
documentation establishing that he or she has met those requirements:
   (1) The person has a high school diploma, or its equivalent.
   (2) (A) The person has completed a standardized course approved by
the California Tuberculosis Controllers Association (CTCA), which
shall include at least 24 hours of instruction in all of the
following areas: didactic instruction on tuberculosis control
principles and instruction on the proper placement and measurement of
tuberculin skin tests, equipment usage, basic infection control,
universal precautions, and appropriate disposal of sharps, needles,
and medical waste, client preparation and education, safety,
communication, professional behavior, and the importance of
confidentiality.
   (B) A certification of satisfactory completion of this
CTCA-approved course shall be dated and signed by the local health
officer, and shall contain the name and social security number of the
tuberculin skin test technician, and the printed name, the
jurisdiction, and the telephone number of the certifying local health
officer.
   (3) The person has completed practical instruction including
placing at least 30 successful intradermal tuberculin skin tests,
supervised by a licensed physician or registered nurse at the local
health department, and 30 correct measurements of intradermal
tuberculin skin tests, at least 15 of which are deemed positive by
the licensed physician or registered nurse supervising the practical
instruction. A certification of the satisfactory completion of this
practical instruction shall be dated and signed by the licensed
physician or registered nurse supervising the practical instruction.
   (g) The certification may be renewed, and the local health
department shall provide a certificate of renewal, if the certificate
holder has completed in-service training, including all of the
following:
   (1) At least three hours of a CTCA-approved standardized training
course to ensure continued competency. This training shall include,
but not be limited to, fundamental principles of tuberculin skin
testing.
   (2) Practical instruction, under the supervision of a licensed
physician or registered nurse at the local health department,
including the successful placement and correct measurement of 10
tuberculin skin tests, at least five of which are deemed positive by
the licensed physician or registered nurse supervising the practical
instruction.
   (h) The local health officer or the tuberculosis controller may
deny or revoke the certification of a tuberculin skin test technician
if the local health officer or the tuberculosis controller finds
that the technician is not in compliance with this section.
   (i) Each county or city participating in the program under this
section using tuberculin skin test technicians, that elects to
participate on or after January 1, 2005, shall submit to the CTCA a
survey and an evaluation of its findings, including a review of the
aggregate report, by July 1, 2006, and by July 1 of each year
thereafter to, and including, July 1, 2011. The report shall include
the following:
   (1) The number of persons trained and certified as tuberculin skin
test technicians in that city or county.
   (2) The estimated number of tuberculin skin tests placed by
tuberculin skin test technicians in that city or county.
   (j) By July 1, 2008, the CTCA shall submit a summary of barriers
to implementing the tuberculosis technician program in the state to
the department and to the appropriate policy and fiscal committees of
the Legislature.
   (k) The local health officer of each participating city or county
shall report to the Tuberculosis Control Branch within the department
any adverse event that he or she determines has resulted from
improper tuberculin skin test technician training or performance.



121361.  (a) (1) A health facility, local detention facility, or
state correctional institution shall not discharge or release any of
the following persons unless subdivision (e) is complied with:
   (A) A person known to have active tuberculosis disease.
   (B) A person who the medical staff of the health facility or of
the penal institution has reasonable grounds to believe has active
tuberculosis disease.
   (2) In addition, persons specified in this subdivision may be
discharged from a health facility only after a written treatment plan
described in Section 121362 is approved by a local health officer of
the jurisdiction in which the health facility is located. Any
treatment plan submitted for approval pursuant to this paragraph
shall be reviewed by the local health officer within 24 hours of
receipt of that plan.
   (3) The approval requirement of paragraph (2) shall not apply to
any transfer to a general acute care hospital when the transfer is
due to an immediate need for a higher level of care, nor to any
transfer from any health facility to a correctional institution.
Transfers or discharges described in this paragraph shall occur only
after the notification and treatment plan required by Section 121362
have been received by the local health officer.
   (4) This subdivision shall not apply to any transfer within the
state correctional system or to any interfacility transfer occurring
within a local detention facility system.
   (b) No health facility shall, without first complying with
subdivision (e), transfer a person described in subparagraph (A) or
(B) of paragraph (1) of subdivision (a) to another health facility.
This subdivision shall not apply to any transfer within the state
correctional system or to any interfacility transfer occurring within
a local detention facility system.
   (c) No state correctional institution or local detention facility
shall transfer a person described in subparagraph (A) or (B) of
paragraph (1) of subdivision (a) from a state to a local, or from a
local to a state, penal institution unless notification and a written
treatment plan are received by the chief medical officer of the
penal institution receiving the person.
   (d) No local detention facility shall transfer a person described
in subparagraph (A) or (B) of paragraph (1) of subdivision (a) to a
local detention facility in another jurisdiction unless subdivision
(e) is complied with and notification and a written treatment plan
are received by the chief medical officer of the local detention
facility receiving the person.
   (e) (1) Any discharge, release, or transfer described in
subdivisions (a), (b), (c), and (d) may occur only after notification
and a written treatment plan pursuant to Section 121362 has been
received by the local health officer. When prior notification would
jeopardize the person's health, the public safety, or the safety and
security of the penal institution, the notification and treatment
plan shall be submitted within 24 hours of discharge, release, or
transfer.
   (2) When a person described in paragraph (1) of subdivision (a) is
released on parole from a state correctional institution, the
notification and written treatment plan specified in this subdivision
shall be provided to both the local health officer for the county in
which the parolee intends to reside and the local health officer for
the county in which the state correctional institution is located.
   (3) Notwithstanding any other provision of law, the Department of
Corrections shall inform the parole agent, and other parole officials
as necessary, that the person described in paragraph (1) of
subdivision (a) has active or suspected active tuberculosis disease
and provide information regarding the need for evaluation or
treatment. The parole agent and other parole officials shall
coordinate with the local health officer in supervising the person's
compliance with medical evaluation or treatment related to
tuberculosis, and shall notify the local health officer if the person'
s parole is suspended as a result of having absconded from
supervision.
   (f) No health facility that declines to discharge, release, or
transfer a person pursuant to this section shall be civilly or
criminally liable or subject to administrative sanction therefor.
This subdivision shall apply only if the health facility complies
with this section and acts in good faith.
   (g) Nothing in this section shall relieve a local health officer
of any other duty imposed by this chapter.



121362.  Each health care provider who treats a person for active
tuberculosis disease, each person in charge of a health facility, or
each person in charge of a clinic providing outpatient treatment for
active tuberculosis disease shall promptly report to the local health
officer at the times that the health officer requires, but no less
frequently than when there are reasonable grounds to believe that a
person has active tuberculosis disease, and when a person ceases
treatment for tuberculosis disease. Situations in which the provider
may conclude that the patient has ceased treatment include times when
the patient fails to keep an appointment, relocates without
transferring care, or discontinues care. The initial disease
notification report shall include an individual treatment plan that
includes the patient's name, address, date of birth, tuberculin skin
test results or the results of any other test for tuberculosis
infection recommended by the federal Centers for Disease Control and
Prevention and licensed by the federal Food and Drug Administration,
pertinent radiologic, microbiologic, and pathologic reports, whether
final or pending, and any other information required by the local
health officer. Subsequent reports shall provide updated clinical
status and laboratory results, assessment of treatment adherence,
name of current care provider if the patient transfers care, and any
other information required by the local health officer. A facility
discharge, release, or transfer report shall include all pertinent
and updated information required by the local health officer not
previously reported on any initial or subsequent report, and shall
specifically include a verified patient address, the name of the
medical provider who has specifically agreed to provide medical care,
clinical information used to assess the current infectious state,
and any other information required by the local health officer. Each
health care provider who treats a person with active tuberculosis
disease, and each person in charge of a health facility or a clinic
providing outpatient treatment for active tuberculosis disease, shall
maintain written documentation of each patient's adherence to his or
her individual treatment plan. Nothing in this section shall
authorize the disclosure of test results for human immunodeficiency
virus (HIV) unless authorized by Chapter 7 (commencing with Section
120975) of, Chapter 8 (commencing with Section 121025) of, and
Chapter 10 (commencing with Section 121075) of Part 4 of Division
105.
   In the case of a parolee under the jurisdiction of the Department
of Corrections and Rehabilitation, the local health officer shall
notify the assigned parole agent, when known, or the regional parole
administrator, when there are reasonable grounds to believe that the
parolee has active tuberculosis disease and when the parolee ceases
treatment for tuberculosis. Situations where the local health officer
may conclude that the parolee has ceased treatment include times
when the parolee fails to keep an appointment, relocates without
transferring care, or discontinues care.



121363.  Each health care provider who treats a person for active
tuberculosis disease shall examine, or cause to be examined, all
household contacts or shall refer them to the local health officer
for examination. Each health care provider shall promptly notify the
local health officer of the referral. When required by the local
health officer, nonhousehold contacts and household contacts not
examined by a health care provider shall submit to examination by the
local health officer or designee. If any abnormality consistent with
tuberculosis disease is found, steps satisfactory to the local
health officer shall be taken to refer the person promptly to a
health care provider for further investigation, and if necessary,
treatment. Contacts shall be reexamined at times and in a manner as
the local health officer may require. When requested by the local
health officer, a health care provider shall report the results of
any examination related to tuberculosis of a contact.



121364.  (a) Within the territory under his or her jurisdiction,
each local health officer may order examinations for tuberculosis
infection for the purposes of directing preventive measures for
persons in the territory, except those incarcerated in a state
correctional institution, for whom the local health officer has
reasonable grounds to determine are at heightened risk of
tuberculosis exposure.
   (b) An order for examination pursuant to this section shall be in
writing and shall include other terms and conditions as may be
necessary to protect the public health.



121365.  Each local health officer is hereby directed to use every
available means to ascertain the existence of, and immediately
investigate all reported or suspected cases of active tuberculosis
disease in the jurisdiction, and to ascertain the sources of those
infections. In carrying out the investigations, each local health
officer shall follow applicable local rules and regulations and all
general and special rules, regulations, and orders of the state
department. If the local health officer determines that the public
health in general or the health of a particular person is endangered
by exposure to a person who is known to have active tuberculosis
disease, or to a person for whom there are reasonable grounds to
believe has active tuberculosis disease, the local 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 the orders. 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.
   The orders may include, but shall not be limited to, any of the
following:
   (a) An order authorizing the removal to, detention in, or
admission into, a health facility or other treatment facility for
appropriate examination for active tuberculosis disease of a person
who is known to have active tuberculosis disease, or a person for
whom there are reasonable grounds to believe that the person has
active tuberculosis disease and who is unable or unwilling
voluntarily to submit to the examination by a physician or by the
local health officer. Any person whom the health officer determines
should have an examination for tuberculosis disease may have the
examination made by a physician and surgeon of his or her own choice
who is licensed to practice medicine under Chapter 5 (commencing with
Section 2000) of Division 2 of the Business and Professions Code
under terms and conditions as the local health officer shall
determine on reasonable grounds to be necessary to protect the public
health. This section does not authorize the local health officer to
mandate involuntary anergy testing.
   (b) An order requiring a person who has active tuberculosis
disease to complete an appropriate prescribed course of medication
for tuberculosis disease and, if necessary, to follow required
infection control precautions for tuberculosis disease. This
subdivision does not allow the forceable or involuntary
administration of medication.
   (c) An order requiring a person who has active tuberculosis
disease and who is unable or unwilling otherwise to complete an
appropriate prescribed course of medication for tuberculosis disease
to follow a course of directly observed therapy. This subdivision
does not allow forceable or involuntary administration of medication.
   (d) An order for the removal to, detention in, or admission into,
a health facility or other treatment facility of a person if both of
the following occur:
   (1) The person has infectious tuberculosis disease, or who
presents a substantial likelihood of having infectious tuberculosis
disease, based upon proven epidemiologic evidence, clinical evidence,
X-ray readings, or tuberculosis laboratory test results.
   (2) The local health officer finds, based on recognized infection
control principles, that there is a substantial likelihood the person
may transmit tuberculosis to others because of his or her inadequate
separation from others.
   (e) An order for the removal to, detention in, or admission into,
a health facility or other treatment facility of a person if both of
the following occur:
   (1) The person has active tuberculosis disease, or has been
reported to the health officer as having active tuberculosis disease
with no subsequent report to the health officer of the completion of
an appropriate prescribed course of medication for tuberculosis
disease.
   (2) There is a substantial likelihood, based on the person's past
or present behavior, that he or she cannot be relied upon to
participate in or complete an appropriate prescribed course of
medication for tuberculosis disease and, if necessary, follow
required infection control precautions for tuberculosis disease. The
behavior may include, but is not limited to, refusal or failure to
take medication for tuberculosis disease, refusal or failure to keep
appointments or treatment for tuberculosis disease, refusal or
failure to complete the treatment for tuberculosis disease, or
disregard for infection control precautions for active tuberculosis
disease.
   (f) An order for exclusion from attendance at the workplace for
persons with infectious tuberculosis disease. The order may, also,
exclude the person from any place when the local health officer
determines that the place cannot be maintained in a manner adequate
to protect others against the spread of tuberculosis disease.
   (g) An order for isolation of persons with infectious tuberculosis
disease to their place of residence until the local health officer
has determined that they no longer have infectious tuberculosis
disease.
   (h) This section shall apply to all persons except those
incarcerated in a state correctional institution.
   (i) This section shall not be construed to require a private
hospital or other private treatment facility to accept any patient
without a payment source, including county responsibilities under
Section 17000 of the Welfare and Institutions Code, except as
required by Sections 1317 et seq. or by federal law.



121366.  The local health officer may detain in a hospital or other
appropriate place for examination or treatment, a person who is the
subject of an order of detention issued pursuant to subdivision (a),
(d), or (e) of Section 121365 without a prior court order except that
when a person detained pursuant to subdivision (a), (d), or (e) of
Section 121365 has requested release, the local health officer shall
make an application for a court order authorizing the continued
detention within 72 hours after the request or, if the 72-hour 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.
After the request for release, detention shall not continue for more
than five business days in the absence of a court order authorizing
detention. However, in no event shall any person be detained for more
than 60 days without a court order authorizing the detention. The
local health officer shall seek further court review of the detention
within 90 days following the initial court order authorizing
detention and thereafter within 90 days of each subsequent court
review. In any court proceeding to enforce a local health officer's
order for the removal or detention of a person, the local health
officer shall prove the particularized circumstances constituting the
necessity for the detention by clear and convincing evidence. Any
person who is subject to a detention order shall have the right to be
represented by counsel and upon the request of the person, counsel
shall be provided.



121367.  (a) An order of a local health officer pursuant to Section
121365 shall set forth all of the following:
   (1) The legal authority under which the order is issued, including
the particular sections of state law or regulations.
   (2) An individualized assessment of the person's circumstances or
behavior constituting the basis for the issuance of the order.
   (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 the
alternatives were rejected.
   (4) The orders shall be in writing, and shall include the name of
the person, the period of time during which the order shall remain
effective, the location, payer source if known, and other terms and
conditions as may be necessary to protect the public health. Upon
issuing an order, a copy of the order shall be served upon the person
named in the order.
   (b) An order for the detention of a person shall do all of the
following:
   (1) Include the purpose of the detention.
   (2) Advise the person being detained that he or she has the right
to request release from detention by contacting a person designated
on the local health officer's order at the telephone number stated on
the order and that the detention shall not continue for more than
five business days after the request for release, in the absence of a
court order authorizing the detention.
   (3) Advise the person being detained that, whether or not he or
she requests release from detention, the local health officer is
required to obtain a court order authorizing detention within 60 days
following the commencement of detention and thereafter shall further
seek court review of the detention within 90 days of the court order
and within 90 days of each subsequent court review.
   (4) Advise the person being detained that he or she has the right
to arrange to be represented by counsel or to have counsel provided,
and that if he or she chooses to have counsel provided, the counsel
will be notified that the person has requested legal representation.
   (5) Be accompanied by a separate notice that shall include, but
not be limited to, all of the following additional information:
   (A) That the person being detained has the right to request
release from detention by contacting a person designated on the local
health officer's order at a telephone number stated on the order,
and that the detention shall not continue for more than five business
days after the request in the absence of a court order authorizing
the detention.
   (B) That he or she has the right to arrange to be advised and
represented by counsel or to have counsel provided, and that if he or
she chooses to have counsel provided, the counsel will be notified
that the person has requested legal representation.
   (C) That he or she may supply the addresses or telephone numbers
of not more than two individuals to receive notification of the
person's detention, and that the local health officer shall, at the
patient's request, provide notice within the limits of reasonable
diligence to those people that the person is being detained.



121368.  Notwithstanding any inconsistent provision of Section
121365, 121366 or 121367, all of the following shall apply:
   (a) A person who is detained solely pursuant to subdivision (a) of
Section 121365 shall not continue to be detained 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 disease, has active tuberculosis or whether a
person who has active tuberculosis disease has infectious
tuberculosis disease. Further detention of the person shall be
authorized only upon the issuance of a local health officer's order
pursuant to subdivision (d) or (e) of Section 121365.
   (b) A person who is detained solely for the reasons described in
subdivision (d) of Section 121365 shall not continue to be detained
after he or she ceases to be infectious or after the local health
officer ascertains that changed circumstances exist that permit him
or her to be adequately separated from others so as to prevent
transmission of tuberculosis disease after his or her release from
detention.
   (c) A person who is detained for the reasons described in
subdivision (e) of Section 121365 shall not continue to be detained
after he or she has completed an appropriate prescribed course of
medication.


121369.  For the purposes of Sections 121365, 121366, and 121367,
all of the following shall apply:
   (a) If necessary, language interpreters and persons skilled in
communicating with vision and hearing impaired individuals shall be
provided in accordance with applicable law.
   (b) Nothing in those sections shall be construed to permit or
require the forcible administration of any medication without a prior
court order.
   (c) Any and all orders authorized under those sections shall be
made by the local health officer. His or her authority to make the
orders may be delegated to the person in charge of medical treatment
of inmates in penal institutions within the local health officer's
jurisdiction, or pursuant to Section 7. The local health officer
shall not make any orders incorporating by reference any other rules
or regulations.



121370.  No examination or inspection shall be required of any
person who depends exclusively on prayer for healing in accordance
with the teachings of any well recognized religious sect,
denomination or organization and claims exemption on that ground,
except that the provisions of this code regarding compulsory
reporting of communicable diseases and isolation and quarantine shall
apply where there is probable cause to suspect that the person is
infected with the disease in a communicable stage. Such person shall
not be required to submit to any medical treatment, or to go to or be
confined in a hospital or other medical institution; provided, he or
she can be safely quarantined and/or isolated in his or her own home
or other suitable place of his or her choice.



121375.  The department may inspect and have access to all records
of all institutions and clinics, both public and private, where
tuberculosis patients are treated.



121380.  The department may advise officers of state educational,
correctional, and medical institutions regarding the control of
tuberculosis and the care of tuberculosis patients.



121390.  The department shall lease any facilities it deems
necessary to care for persons afflicted with active contagious
tuberculosis who violate the quarantine or isolation orders of the
health officer as provided in Section 120280.



121395.  Whenever any person confined in any state institution, as
provided in Section 120280, subject to the jurisdiction of the
Director of Corrections, dies, and any personal funds or personal
property of the person remains in the hands of the Director of
Corrections, those funds may be applied in an amount not exceeding
three hundred dollars ($300) to the payment of expenses relating to
burial; provided, however, that if no such funds are available, the
department shall reimburse the Director of Corrections for the
expenses in an amount not exceeding three hundred dollars ($300).



121400.  If the place of confinement of a person confined under the
provisions of Section 120280 is in a county other than the county
where he or she was convicted, upon release he or she shall be
released in the custody of the sheriff of the county where he or she
was convicted, and the sheriff shall forthwith return him or her to
the place where he or she was convicted without the necessity of a
court order or other process. The sheriff shall prior to the return
of the person notify the health officer having jurisdiction of the
area to which he or she will be returned of the date he or she will
reach that area.


121450.  The department may distribute for the purpose of
tuberculosis control an annual subvention, paid quarterly, to any
local health department that maintains a tuberculosis control program
consistent with standards and procedures established by the
department. This annual subvention shall be used primarily for the
strengthening of tuberculosis prevention activities by local health
departments. Further, the department may allocate additional funds to
selected local health departments based on high disease incidence,
or other standards established by the department. These additional
funds shall be expended primarily for the cost of diagnosis,
treatment, and followup services required for an effective
tuberculosis control program. Services rendered under this section
may not be made dependent on status of residence.



121455.  The department may establish standards and procedures for
the operation of local tuberculosis control programs. Such standards
shall include, but not be limited to, the maintenance of records and
reports relative to services rendered and to expenditures made that
shall be reported semiannually to the department in a manner as it
may specify.



121460.  Of the annual appropriation made to the department for
tuberculosis control, the department may expend a sum not to exceed
7.5 percent of the total, for administrative costs. In addition, it
may, if it deems necessary, withhold a portion of the appropriation
to pay for the cost of regional laboratory services and regional
hospitalization facilities for patients whose care cannot be
reasonably accomplished in facilities available within a local health
department, or it may contract with physicians to supervise the
medical care of tuberculosis patients in areas where the specialized
care is not available. Further, the appropriation shall be available
to purchase materials or drugs used in tuberculosis control for
distribution to local health departments.