SB405 By Senator Melson RFD Health and Human Services Rd 1 23-APR-15

SYNOPSIS: Under existing law, infected health care workers are defined as health care workers who are infected with Human Immunodeficiency Virus (HIV) or hepatitis B virus (HBV).

This bill would add to the definition of infected health care workers those health care workers infected with hepatitis C virus (HCV) for purposes of reporting to the State Health Officer.

This bill would also authorize the State Board of Health to designate by rule other diseases that infected health care workers must report to the State Health Officer.

A BILL TO BE ENTITLED AN ACT

Relating to public health; to amend Sections 22-11A-60, 22-11A-61, 22-11A-62, 22-11A-63, 22-11A-66, 22-11A-67, and 22-11A-73, Code of Alabama 1975; to add to the definition of infected health care workers those health care workers infected with hepatitis C virus (HCV) for purposes of reporting to the State Health Officer; and to authorize the State Board of Health to designate by rule other diseases that infected health care workers must report to the State Health Officer.

BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:Section 1. Sections 22-11A-60, 22-11A-61, 22-11A-62, 22-11A-63, 22-11A-66, 22-11A-67, and 22-11A-73, Code of Alabama 1975, are amended to read as follows:

§22-11A-60.

"As used in this article, the following words shall have the following meanings:

"(1) HEALTH CARE FACILITY. A hospital, nursing home, ambulatory surgical center, outpatient surgical facility, ambulance service, rescue squad, paid fire department, volunteer fire department, or any other clinic, office, or facility in which medical, dental, nursing, or podiatric services are offered.

"(2) HEALTH CARE WORKER. Physicians, dentists, nurses, respiratory therapists, phlebotomists, surgical technicians, physician assistants, podiatrist, dialysis technicians, emergency medical technicians, paramedics, ambulance drivers, dental hygienists, dental assistants, students in the healing arts, or any other individual who provides or assists in the provision of medical, dental, or nursing services.

"(3) HEPATITIS B VIRUS (HBV) INFECTION. The presence of the HBV as determined by the presence of hepatitis B(e) antigen for six months or longer or by other means as determined by the State Board of Health.

"(4) HEPATITIS C VIRUS (HCV) INFECTION. The presence of the HCV as determined by the presence of antibodies to HCV or by other means as determined by rules of the State Board of Health.

"(4) (5) HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION. The presence of antibodies to Human Immunodeficiency Virus as determined by enzyme immunoassay and Western Blot or the presence of the HIV infection as determined by viral culture, or by other means as determined by the State Board of Health.

"(5) (6) INFECTED HEALTH CARE WORKER. A health care worker infected with HIV, or HBV, HCV, or other disease designated by the State Board of Health by a rule adopted pursuant to the Alabama Administrative Procedure Act as defined herein.

"(6) (7) INVASIVE PROCEDURES.

"(a) Those medical or surgical procedures characterized by the digital palpation of a needle tip in a body cavity or by the simultaneous presence of the health care worker's fingers and a needle or other sharp instrument or object in a poorly visualized or highly confined anatomic site.

"(b) Invasive dental procedures shall include those that provide the opportunity for an intraoral percutaneous injury to the dental health care worker and could result in the blood of the health care worker coming in contact with the blood or mucous membrane of the patient as adopted by the Board of Dental Examiners in rules developed pursuant to Section 22-11A-70.

"(c) These procedures shall not include physical examinations; blood pressure checks; eye examinations; phlebotomy; administering intramuscular, intradermal, or subcutaneous injections; needle biopsies; needle aspirations; lumbar punctures; angiographic procedures; vaginal, oral, or rectal exams; endoscopic or bronchoscopic procedures; or placing and maintaining peripheral and central intravascular lines, nasogastric tubes, endotracheal tubes, rectal tubes, and urinary catheters.

§22-11A-61.

"(a) Any health care worker infected with HIV, or HBV, HCV, or other disease designated by the State Board of Health who performs an invasive procedure shall notify the State Health Officer, or his or her designee, of the infection in a time and manner prescribed by the State Board of Health.

"(b) Any physician providing care to an infected health care worker shall notify the State Health Officer, or his or her designee, about the presence of the infection in the health care worker in a time and manner prescribed by the State Board of Health.

§22-11A-62.

"No health care worker having knowledge that he or she is infected with either HIV, or HBV, HCV, or other disease designated by the State Board of Health shall perform or assist in the performance of an invasive procedure unless and until he or she has notified the State Health Officer, as provided in Section 22-11A-61, and agrees to cooperate with any investigation authorized in Section 22-11A-63 and any necessary practice modifications.

§22-11A-63.

"(a) Upon notification of the existence of an infected health care worker, the State Health Officer shall undertake an investigation of the practice of the health care worker. In the investigation, the State Health Officer shall seek advice of individuals and organizations deemed necessary. The investigation shall determine if the infected health care worker performs invasive procedures. If the health care worker is determined not to perform invasive procedures, no review panel shall be established, no restrictions shall be placed on his or her practice, and all information obtained in the investigation shall be confidential as provided for in Section 22-11A-69. If the infected health care worker is determined to perform invasive procedures, the State Health Officer shall cause an expert review panel to be formed. To the extent possible, the review shall be conducted so that the identity of the health care worker shall not be disclosed to the expert review panel. However, disclosure of the health care worker's identity shall be made when any member of the review panel shall deem it necessary to make a recommendation to the State Health Officer or by the attendance of the infected health care worker at the expert review panel.

"(b) The expert review panel may include the physician of the infected health care worker, and shall include the following:

"(1) A health care worker with expertise in procedures performed by the infected health care worker chosen by the licensing board of the health care worker, if licensed.

"(2) A physician appointed by the State Health Officer with expertise in infectious diseases other than one providing care to the infected health care worker.

"(3) A public health physician appointed by the State Health Officer.

"(4) Two representatives of the licensing board of the infected health care worker, if licensed, and if the health care worker's practice is institutionally based, a representative of the affected institution appointed by the institution.

"(5) Other individuals determined necessary by the State Health Officer.

"(c) The expert review panel formed pursuant to this section shall review the overall practice and procedures performed by the infected health care worker and shall consider:

"(1) The procedures performed by the infected health care worker.

"(2) The adherence to universal precautions by the infected health care worker.

"(3) The past history of the health care worker of occupational injury while performing the invasive procedures.

"(4) Any prior evidence of the health care worker related to patient transmission of HIV, or HBV, HCV, or other disease designated by the State Board of Health.

"(5) The presence of conditions such as dermatitis, dementia, neuropathy, or other conditions that may increase the risk of transmission.

"(6) Current Centers for Disease Control and Prevention guidelines on the management of infected health care workers.

"(d) The performance of invasive procedures alone shall not present sufficient cause to limit the practice of the infected health care worker. The health care worker is entitled to be present at meetings of the expert review panel and to present any information pertinent to the panel deliberations. All meetings of the expert review panel shall be held in executive session and shall not be open to the public.

"(e) The expert review panel shall recommend to the State Health Officer limitations, if any, on the practice of the infected health care worker that are reasonable and necessary to protect the patients of the health care worker and the public. The expert review panel shall also provide recommendations to the State Health Officer about the need to notify patients who previously may have had an invasive procedure performed by an infected health care worker. The State Health Officer shall accept the recommendations of the expert review panel and issue a final order based on the recommendations.

"(f) The State Health Officer shall provide a written final order to the infected health care worker specifying those restrictions, limitations, conditions, or prohibitions with which the infected health care worker shall comply in order to continue to engage in medical, dental, podiatric, or nursing practice, or to continue to be employed at a health care facility. If restrictions or conditions limit the practice of the health care worker, the administrator of the institution in which the health care worker practices, the employer of the infected health care worker, and the appropriate licensing board of the infected health care worker shall be provided a copy of the final order of the State Health Officer. For health care workers no longer performing invasive procedures, the final order shall include those notifications as may have been deemed necessary in Section 22-11A-69.

"(g) The final order of the State Health Officer may be appealed to the State Committee of Public Health by delivery of written notice of appeal to the State Health Officer not more than 30 days after the date of the State Health Officer's final order. The appeal may be heard by the State Committee of Public Health in its entirety or may be assigned to an administrative law judge or hearing officer for trial and recommended decision. All hearings, administrative proceedings, and deliberations of the committee in connection with the appeal shall be held in executive session and shall not be open to the public. The committee shall accept, modify, or reject the final order of the State Health Officer.

§22-11A-66.

"In addition to any other law or regulation, it shall be grounds for the revocation, suspension, or restriction of the professional license of any health care worker who is infected with HIV, or HBV, HCV, or other disease designated by the State Board of Health if the infected health care worker is found to be practicing in violation of this article.

§22-11A-67.

"(a) Any health care worker found to have HBV, or HIV, or HCV infection or other disease designated by the State Board of Health and any health care facility at which an infected health care worker is employed or practices shall make available to the State Board of Health, and to the expert review panel, any and all patient medical records and other records requested by those groups, except that records or documents greater than three years old shall not be provided.

"(b) The following persons and facilities shall provide to the State Board of Health and the expert review panel all requested documents or records three years old or less:

"(1) Any person having knowledge of a health care worker diagnosed as infected with HIV, or HBV, HCV, or other disease designated by the State Board of Health infection.

"(2) The administrator of any health facility having knowledge of a health care worker diagnosed as infected with HIV, or HBV, HCV, or other disease designated by the State Board of Health infection.

"(3) Any person serving as the guardian of or the conservator of any health care worker diagnosed with HIV, or HBV, or HCV infection, or other disease designated by the State Board of Health, or any person who is the administrator or executor of the estate of any health care worker diagnosed with HIV, or HBV, or HCV infection or other disease designated by the State Board of Health.

"(4) Any person serving as the custodian of patient records of any HBV, or HIV, or HCV, or other disease designated by the State Board of Health, infected health care worker.

"(5) Any facility employing a worker diagnosed with HIV, or HBV, or HCV infection or other disease designated by the State Board of Health.

"(c) The hospital or other individual or organization providing records may collect the usual fee for copies of records or documents.

§22-11A-73.

"Nothing in this article is intended to impose any reporting requirements on life, health, or disability income insurers who learn that an applicant or insured is infected with HIV, or HBV, HCV, or other disease designated by the State Board of Health solely through the application, underwriting, or claims processes, which insurer may have no means of knowing or verifying that a particular applicant or insured is a health care worker within the meaning of this article."

Section 2. This act shall become effective on the first day of the third month following its passage and approval by the Governor, or its otherwise becoming law.

Hepatitis

Diseases

Health

Health Care

Public Health

Board of Health, State

State Health Officer

Public Health Department

Code Amended