[Added 5-11-1999 by Res. No. 142-1999,[1] approved 5-14-1999]
[1]
Editor's Note: This resolution also provided for the renumbering of former Arts. I through XII as Arts. I, II, IIA, and III through XI, respectively.
Where used herein, unless otherwise expressly stated, the following terms shall have the meanings indicated:
ACTIVE TUBERCULOSIS
A person has active tuberculosis when a sputum smear or culture taken from a pulmonary or laryngeal source has tested positive for tuberculosis and the person has not completed an approved course of treatment for tuberculosis; there is clinical evidence of tuberculosis disease and the person has not completed an approved course of treatment for tuberculosis; or a smear or culture from an extra-pulmonary source has tested positive 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/or laboratory tests, is sufficient to establish a medical diagnosis of active tuberculosis for which treatment is indicated.
APPROVED COURSE OF TREATMENT FOR TUBERCULOSIS
One of the treatment regimens articulated by the American Thoracic Society and the Centers for Disease Control guidelines for the diagnosis, treatment, prevention and control of tuberculosis and set forth in their official joint statements.
CONTACT TO ACTIVE TUBERCULOSIS
A person who has been exposed to a person with active tuberculosis.
DETENTION
The holding, in a hospital or treatment facility, of a person with active or suspected tuberculosis who is not compliant with order(s) of the Director.
DIRECTOR
The Monroe County Health Director or the Deputy Director.
HEALTH DEPARTMENT
The Department of Health of the Monroe County Health District.
INFECTIOUS PERIOD
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.
REMOVAL
The transporting to a hospital or treatment facility of a person with active or suspected tuberculosis who is not compliant with order(s) of the Director.
SUSPECT FOR TUBERCULOSIS
A person is a suspect for tuberculosis when he or she exhibits clinical signs and/or symptoms consistent with tuberculosis, and a diagnosis of tuberculosis is being considered, whether or not treatment has been started, until diagnostic procedures have been completed.
TESTING OF CONTACTS
Includes a tuberculin test and/or a chest x-ray, unless the person presents satisfactory proof that he or she was treated for or diagnosed as having tuberculosis in the past or had reacted positively to a tuberculin test.
The purpose of this resolution is to empower the Director to temporarily detain and examine non-compliant persons who have been diagnosed with active or suspected tuberculosis, pending court authorization for continued detention and examination and for possible treatment. This is to be accomplished while ensuring that the Health Department's actions are governed by the sound principles of procedural due process and respect for civil liberties.
A person with active or suspected tuberculosis shall be removed to a hospital or treatment facility if he or she is not compliant with order(s) of the Director.
A physician who attends a person with active or suspected tuberculosis or the person in charge of a hospital, dispensary or clinic giving out-patient treatment to such a person shall report the following to the Health Department: whether the person is still under treatment; the address of the person; the stage, clinical status and treatment of the disease; and the dates and results of sputum and x-ray examinations and any other information required by the Health Department at such time that the Health Department requires. The physician who attends the person or the person in charge of a hospital, dispensary or clinic giving out-patient care to such a person shall report promptly to the Health Department when the person ceases to receive treatment and the reason for the cessation of treatment.
A physician who attends a person with active or suspected tuberculosis shall examine or cause all close contacts to be examined or shall refer them to the Health Department for examination. The physician shall promptly notify the Health Department of such referral. Upon receipt of a report of active or suspected tuberculosis, the Health Department shall initiate an investigation. which may include testing of close and/or casual contacts not examined by the private physician. If the person examined reacts positively to a tuberculin test, a chest x-ray shall be taken. If any suspicious abnormality is found, steps satisfactory to the Health Department shall be taken to refer the person promptly to a physician or appropriate medical facility for further investigation and, if necessary, treatment. Contacts shall be reexamined at such times and in such manner as the Health Department may require. When requested by the Health Department, a physician shall report the results of any examination or x-ray of a contact.
The Director shall exclude from attendance at workplace or school a person with active or suspected tuberculosis during the infectious period. The return to workplace or school will not occur until the person receives the approval of the Health Department. Such person may also be excluded from such premises or facilities as the Health Department determines cannot be maintained in a manner adequate to protect others against spread of the disease.
Where the Director determines that the public health or the health of any other person is endangered by a person with active or suspected tuberculosis, the Director may issue any orders he or she deems necessary to protect the public health or the health of any other person. Such orders may include, but shall not be limited to:
A. 
An order directing the removal to and/or detention in a hospital or other treatment facility for appropriate examination for tuberculosis of a person who has active or suspected tuberculosis and who is unable or unwilling voluntarily to submit to such examination by a physician or by the Health Department.
B. 
An order requiring a person who has active tuberculosis to complete an approved course of treatment for tuberculosis and, if necessary, to follow required contagion exclusion precautions for tuberculosis as defined by the Director.
C. 
An order requiring a person who has active tuberculosis and who is unable or unwilling otherwise to complete an approved course of treatment for tuberculosis to follow a course of directly observed therapy. For the purposes of this provision, "directly observed therapy" shall mean 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 as specified by the Health Department.
D. 
An order directing the removal to and/or detention in a hospital or other treatment facility of a person who has active or suspected tuberculosis during the infectious period and is unable or unwilling voluntarily to follow requirements for contagion/exclusion precautions for tuberculosis.
E. 
An order directing the removal to and/or detention in a hospital or other treatment facility of a person:
(1) 
Who has active or suspected tuberculosis, or who has been reported to the Health Department as having active tuberculosis with no subsequent report to the Health Department of the completion of an approved course of treatment for tuberculosis; and
(2) 
Where there is a substantial likelihood, based on such person's past or present behavior, that he or she cannot be relied upon to participate in and/or to complete an approved course of treatment for tuberculosis and/or, if necessary, to follow required contagion/exclusion 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.
A. 
An order of the Director pursuant to § 569-83 of this article shall set forth:
(1) 
The legal authority under which the order is issued, including the particular sections of this article or other law or regulation.
(2) 
An individualized assessment of the person's circumstances and/or behavior constituting the basis for the issuance of such order.
(3) 
The less restrictive treatment alternatives that were attempted and were unsuccessful and/or the less restrictive treatment alternatives that were considered and rejected, and the reasons such alternatives were rejected.
B. 
In addition, an order for the removal and/or detention of a person shall:
(1) 
Include the purpose of the detention.
(2) 
Advise the person being detained that, within 24 hours after such removal or detention, the Director shall submit, by affidavit and other supporting documents, an application for a court order authorizing the detention, on the grounds that the person poses a health threat to him or herself and/or to the public health.
(3) 
Advise the person being detained that the detention shall not continue for more than five business days after such removal and/or detention in the absence of the scheduling of a hearing for a court order authorizing such detention.
(4) 
Advise the person being detained that the Director must obtain a court order authorizing detention within 60 days following the commencement of detention. Thereafter, the Director must further seek court review of the detention within 90 days of such court order and within 90 days of each subsequent court review.
(5) 
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 qualifies to have counsel provided, such counsel will be provided.
(6) 
Advise the person that he or she may supply the addresses and/or telephone numbers of friends and/or relatives to receive notification of the person's detention, and that the Health Department shall, at the patient's request, provide notice to a reasonable number of such people that the person is being detained.
The Director may remove to and/or detain in a hospital or other place for examination or treatment a person who is the subject of an order of removal or detention issued pursuant to § 569-83 of this article without prior court order. However, for each such removal and/or detention, the Director shall submit, by affidavit and other documents supporting the Director's assessment that the patient poses a threat to him or herself and/or to the public health, an application for a court order authorizing such detention within 24 hours after such removal or detention or, if such twenty-four-hour period ends on a Saturday, Sunday or legal holiday, at the end of the first business day following such Saturday, Sunday or legal holiday. The application shall include a request for an expedited hearing. After any such removal or detention, detention shall not continue for more than five business days in the absence of the scheduling of a hearing for a court order authorizing detention. Notwithstanding the foregoing provisions, in no event shall any person be detained for more than 60 days without a court order authorizing such detention. The Director shall seek further court review of such 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 Director's order for the removal or detention of a person issued pursuant to this subsection or for review of the continued detention of a person, the Director shall prove the particularized circumstances constituting the necessity for such 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, if he or she qualifies to have counsel provided and so requests, counsel shall be provided.
Notwithstanding any inconsistent provision of this section:
A. 
A person who is detained solely pursuant to Subsection A of § 569-83 of this article shall not continue to be detained beyond the minimum period of time required by the Health Department to make a medical determination of whether a person who is suspected of having tuberculosis has active tuberculosis or whether a person who has active tuberculosis is infectious. Further detention of such person shall be authorized only upon the issuance of the Director's order pursuant to Subsection D or Subsection E of § 569-83 of this article.
B. 
A person who is detained pursuant to this section solely for the reasons described in Subsection D of § 569-83 this article shall not continue to be detained after he or she ceases to be infectious or after the Health Department ascertains that changed circumstances exist that permit him or her to be adequately separated from others so as to prevent transmission of tuberculosis after his or her release from detention.
C. 
A person who is detained pursuant to this section for the reasons described in Subsection B of § 569-83 of this article shall not continue to be detained after he or she has completed an appropriate prescribed course of medication, as approved by the Director.