HB384 By Representatives Rafferty, Robertson, Estes and Hall RFD Health Rd 1 03-MAR-20

SYNOPSIS: This bill would establish the Alabama Injection-Associated Infectious Disease Elimination Act.

This bill would authorize a local health authority within the most populous county in the state according to the most recent decennial census to establish injection-associated infectious disease elimination pilot programs in that county.

This bill would provide guidelines for injection-associated infectious disease elimination pilot programs.

This bill would also provide criminal and civil immunity to certain individuals and entities participating in infectious disease elimination programs.

A BILL TO BE ENTITLED AN ACT

Relating to infectious diseases; to create the Alabama Injection-Associated Infectious Disease Elimination Act; to authorize a local health authority within the most populous county in the state according to the most recent decennial census to establish injection-associated infectious disease elimination pilot programs; to provide guidelines for injection-associated infectious disease elimination pilot programs; and to provide criminal and civil immunity to certain individuals and entities.

BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:

Section 1. This act shall be known and may be cited as the Alabama Injection-Associated Infectious Disease Elimination Act.

Section 2. For the purposes of this act, the following words have the following meanings:

(1) CONTROLLED SUBSTANCE. As defined in Section 20-2-2, Code of Alabama 1975.

(2) INDIVIDUAL WHO INJECTS DRUGS. An individual who uses a syringe or hypodermic needle to inject a controlled substance into his or her own body.

(3) INFECTIOUS DISEASE. A disease that may be spread by intentional or unintentional needle sticks, including, but not limited to, the Human Immunodeficiency Virus (HIV) and the Hepatitis C Virus (HCV).

(4) LOCAL HEALTH AUTHORITY. A county board of health constituted under Section 22-3-1, Code of Alabama 1975.

(5) PROGRAM. An injection-associated infectious disease elimination pilot program established pursuant to Section 4.

(6) PROGRAM PARTICIPANT. An individual who injects drugs and who is an active registered participant in a program and who is provided an official certificate card from a program.

Section 3. (a) A local health authority within the most populous county in the state according to the most recent decennial census may establish and operate injection-associated infectious disease elimination pilot programs in that county, either directly or through an agreement with another organization, that promotes scientifically proven ways of mitigating health risks associated with controlled substance use and other high-risk behaviors. The duration of a pilot program shall be no more than five years. The objectives of the program include all of the following:

(1) Reduce the spread of the (HIV), (HCV), and other injection-associated infectious diseases.

(2) Reduce the risk of infectious diseases from needle stick injuries to health care providers, law enforcement officers, first responders, other emergency personnel, sanitation workers, and the general public.

(3) Encourage individuals who inject drugs to enroll in evidence-based treatment for substance use disorder.

(b) Programs established pursuant to this section, at a minimum, shall do all of the following with respect to the program's operation and its participants:

(1) Safely dispose of used needles, hypodermic syringes, and other injection supplies.

(2) Provide needles, hypodermic syringes, and other injection supplies at no cost and in quantities sufficient to reduce sharing or reuse of needles, hypodermic syringes, and other injection supplies. Funds appropriated by the Legislature as part of the annual budget process may not be used to purchase needles, hypodermic syringes, or other injection supplies.

(3) Provide educational materials on each of the following:

a. Overdose prevention.

b. Prevention of infectious diseases.

c. Drug abuse prevention.

d. Treatment for mental illness, including treatment referrals.

e. Treatment for substance abuse disorder, including referrals for medication-assisted treatment.

(4) Provide access to naloxone hydrochloride, or equivalent, that is approved by the federal Food and Drug Administration (FDA) for the treatment of an opioid drug overdose, or referrals to programs that provide access to naloxone hydrochloride, or equivalent, that is approved by the FDA for the treatment of an opioid drug overdose.

(5) For each individual requesting service under the program, provide personal consultations concerning substance use disorder treatment as appropriate, either directly or through a partner organization.

(6) Offer each individual who injects drugs, either directly or by referral, appropriate screening and treatment for infectious diseases.

(7) Encourage each individual who injects drugs to seek other medical, mental health, or social services as appropriate.

(8) Use a recordkeeping system that ensures the identity of each individual who injects drugs remains anonymous.

(9) Notify relevant local law enforcement agencies regarding the program, including information on the limited immunity from criminal liability granted by subsection (d).

(10) Provide an official certificate card to each individual served by the program so law enforcement personnel, employees, and volunteers of the program can quickly identify the individual. This certificate card shall also serve as proof of the limited immunity from criminal liability granted by subsection (d), and shall bear relevant information produced according to standards to be issued by the local health authority within the most populous county in the state according to the most recent decennial census.

(11) Provide emergency medical care or referrals for program participants in need of immediate medical attention at the time they receive services through the program.

(12) Comply with applicable state and federal rules and regulations governing participant confidentiality.

(c)(1) Before establishing a program, the following interested parties in the area to be served shall be consulted:

a. Local government officials.

b. Law enforcement representatives.

c. Prosecutors.

d. Representatives of substance use disorder treatment facilities certified by the Department of Mental Health.

e. Individuals who inject drugs and individuals in recovery from substance use disorder, to the extent practicable.

f. Nonprofit organizations focused on HIV, HCV, substance use disorders, and mental health, to the extent practicable.

g. Residents of the geographical area to be served by the program, to the extent practicable.

(2) When consulting with interested parties, the program is encouraged to consider the following:

a. The population to be served.

b. Concerns of law enforcement representatives and prosecutors.

c. Day-to-day administration of the program, including security of program sites, equipment, personnel, and use of volunteers.

(d)(1) a. An individual who injects drugs and who is an active participant in a program and in possession of an official program certificate card has immunity from and is not subject to criminal prosecution or liability under Sections 13A-12-202, 13A-12-203, 13A-12-204, 13A-12-205, 13A-12-212, 13A-12-260, or 13A-12-281, Code of Alabama 1975, in relation to the possession or use of a needle, hypodermic syringe, or other injection supply obtained from a program established pursuant to this section, or in relation to the return for disposal of a used needle or hypodermic syringe containing residual amounts of a controlled substance to a program established pursuant to this section.

b. The immunity provided in this subsection applies to an individual who injects drugs and who is an active program participant only if the individual claiming immunity provides an official certificate card stating that the individual is or was an active participant in a program at the time the act for which immunity is sought was committed. Provision of the card at any point from initial contact with a law enforcement officer and throughout the judicial process shall entitle the individual to a presumption that the individual is immune from criminal liability as provided in this subsection.

(2) In addition to any other applicable immunity from civil liability, a law enforcement officer who arrests or charges a individual who is thereafter determined to be entitled to immunity from prosecution under this subsection shall not be subject to civil liability for the arrest of, or the filing of charges against, the individual, unless the card was provided to the officer prior to the arrest or prior to charging the individual under circumstances where there could be no reasonable doubt that the card provided was legitimate, and unless the circumstances faced by the officer during the encounter created no reasonable fear of risk to the safety of the officer, fellow officers, the individual, or other individuals present at the time of the encounter, or the public at large.

(3) All of the following are immune from criminal prosecution as a result of participation, affiliation, association, contribution, assistance, conduct, consultation, or provision of emergency care, referrals, education, needles, hypodermic syringes, other injection supplies, or any other related materials:

a. An officer, employee, agent of, or volunteer for, a local health authority within the most populous county in the state according to the most recent decennial census.

b. A program, profit or nonprofit, including, but not limited to, any licensed physician or other health care provider or health care facility that participates in, contributes funds to, provides assistance to, or conducts activities in conjunction with, providing consultations, emergency care, referrals, education, needles, hypodermic syringes, other injection supplies, or any other materials, in accordance with the program.

(4) The immunity from criminal liability provided in this act shall also extend to the members of any local health authority establishing, sponsoring, operating, or administering a program. It is the express intention of this act that the employees, officers, and agents of the state be provided immunity for personal injury, damage to or loss of property, or other civil liability caused or arising out of, or in relation to, an actual or alleged act, error, or omission that occurred in relation to or in conjunction with the program in accordance with Section 36-1-12, Code of Alabama 1975. This section expressly incorporates Section 36-1-12, Code of Alabama 1975, and neither expands nor limits the protections provided under that section. Nothing in this section shall be deemed to impair, derogate, or otherwise limit any other immunity of any individual or entity under constitutional, statutory, or common law.

(e) Not later than one year after commencing operations of a program established pursuant to this section, and every 12 months thereafter, a local health authority within the most populous county in the state according to the most recent decennial census operating such a program, either directly or through agreement with an outside organization, shall compile a report including all of the following information and forward that report to the Senate Healthcare Committee and the House Health Committee:

(1) The number of individuals served by the programs.

(2) The number of needles, hypodermic syringes, and other injection supplies dispensed by the program and a weight-based estimate of those returned to the program.

(3) The number of naloxone kits, or equivalent, distributed by the program or the number of referrals made to programs that provide access to naloxone kits, or equivalent.

(4) The number and type of substance abuse treatment referrals, including referrals for medication assisted treatment, provided for individuals served by the program.

(5) The number and type of medical, mental health, and social services referrals provided to individuals served by the program.

(f) Nothing in this act shall be construed to establish a standard of care for physicians or otherwise modify, amend, or supersede any provision of the Alabama Medical Liability Act of 1987 or the Alabama Medical Liability Act of 1996, commencing with Section 6-5-540, et seq., Code of Alabama 1975, or any amendment thereto, or any judicial interpretation thereof.

Section 4. (a) The State Board of Health shall adopt rules concerning the operation of programs pursuant to this act, including, but not limited to, all of the following:

(1) Counseling.

(2) Referrals of program participants.

(3) Dispensing of needles.

(b) A physician shall not be liable, vicariously or otherwise, when he or she is in compliance with this act and the rules adopted by the State Board of Health pursuant to this act.

Section 5. 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.

Health

Diseases

Drugs

Controlled Substances