H. B. 2885
(By Delegates Perdue, Long and Hatfield)
[Introduced March 4, 2005; referred to the
Committee on Health and Human Resources then Finance.]
A BILL to repeal §16-3-4a of the Code of West Virginia, 1931, as
amended; to repeal §26-5A-1, §26-5A-2, §26-5A-3, 26-5A-4,
26-5A-5, §26-5A-6 and §26-5A-7 of said code; and to amend said
code by adding thereto a new article, designated §16-3D-1,
§16-3D-2, §16-3D-3, §16-3D-4, §16-3D-5, §16-3D-6, §16-3D-7,
§16-3D-8 and §16-3D-9 all relating to tuberculosis testing,
control, treatment and commitment.
Be it enacted by the Legislature of West Virginia:
That §16-3-4a of the Code of West Virginia, 1931, as amended,
be repealed; and that §26-5A-1, §26-5A-2, §26-5A-3, 26-5A-4,
26-A-5, §26-5A-6 and §26-5A-7 of said code be repealed; and that
said code be amended by adding thereto a new article, designated
§16-3D-1, §16-3D-2, §16-3D-3, §16-3D-4, §16-3D-5, §16-3D-6,
§16-3D-7, §16-3D-8 and §16-3D-9, all to read as follows:
ARTICLE 3D. TUBERCULOSIS TESTING, CONTROL, TREATMENT AND COMMITMENT.
§16-3D-1. Purpose and legislative findings.
(a) The purpose of this article to bring together the state
law governing compulsory testing for tuberculosis (TB) of students
and school personnel as well as the statutes pertaining to the
treatment, control and commitment of persons with the disease at
hospitals, clinics and other health care facilities throughout the
(b) The targeted tuberculin testing and treatment guidelines
published by the Centers for Disease Control and Prevention (CDC)
in the year two thousand recommends that routine testing of
low-risk populations for administrative purposes be discontinued.
The elimination of routine retesting of school personnel in
accordance with this recommendation will result in significant
savings to the state.
(c) According to the CDC, high risk groups or persons that
should be tested for latent TB infection include:
(1) Close contacts of a person known or suspected to have TB;
(2) Foreign-born persons from areas where TB is common;
(3) Residents and employees of high-risk congregate settings;
(4) Health care workers who serve high-risk clients;
(5) Medically underserved, low-income populations;
(6) High-Risk racial or ethnic minority populations;
(7) Children exposed to adults in high-risk categories;
(8) Persons who inject illicit drugs;
(9) Persons with HIV infection; and
(10) Persons with certain medical conditions, such as
substance abuse, chest X-ray findings suggestive of previous TB,
diabetes mellitus, silicosis, prolonged corticosteroid therapy,
other immunosuppressive therapy, cancer of the head and neck,
end-stage renal disease, intestinal bypass or gastrectomy, chronic
malabsorption syndromes, or low body weight of ten percent or more
below the ideal.
(d) Early diagnosis, proper and complete treatment for people
with active TB disease prevents transmission to others as well as
preventing the emergence of multidrug resistant TB.
(e) The TB Control Program should be funded at levels
necessary to accomplish directly observed therapy for all patients
with active TB disease in West Virginia and to implement targeted
testing of high-risk groups.
As used in this article:
(1) "Tuberculosis" means a communicable disease caused by the
bacteria, Mycobacterium tuberculosis, which is demonstrated by
clinical, bacteriological, radiographic or epidemiological
(2) "Bureau" means the Bureau for Public Health in the
Department of Health and Human Resources;
(3) "Commissioner" means the Commissioner of the Bureau for
Public Health, who is the state health officer;
(4)"Local board of health," "local board" or "board" means a
board of health serving one or more counties or one or more
municipalities or a combination thereof;
(5) "Local health department" means the staff of the local
board of health; and
(6) "Local health officer" means the individual physician with
a current West Virginia license to practice medicine who supervises
and directs the activities of the local health department services,
staff and facilities and is appointed by the local board of health
with approval by the Commissioner.
§16-3D-3. Compulsory testing for tuberculosis of school children
and school personnel; Commissioner to approve the
test; X-rays required for reactors; suspension from
school or employment for pupils and personnel found
to have tuberculosis.
(a) All students transferring from a school located outside
this state or enrolling for the first time from outside the state
shall furnish a certification from a licensed physician stating
that a tuberculin skin test, approved by the Commissioner, has been
made within four months prior to the beginning of the school year.
If the student cannot produce certification from a physician as
required by this section then the student shall have an approved tuberculin skin test done with the result read and evaluated prior
to admittance to school.
(b) Test results must be recorded on the certification
required by subsection (a) of this section. Positive reactors to
the skin test must be immediately evaluated by a physician and, if
medically indicated, X-rayed, and receive periodic X-rays
thereafter, when medically indicated. Pupils found to have
tuberculosis shall be temporarily removed from school while their
case is reviewed and evaluated by their physician and the local
health officer. Pupils shall return to school when the local
health officer indicates that it is safe and appropriate for them
(c) Notwithstanding any other provision of this code to the
contrary, all school personnel shall have one approved tuberculin
skin test at the time of employment performed by the local health
department or the person's physician. Additional tuberculosis skin
tests or other medical screens may be required by the local health
department or Commissioner, if medically indicated. Positive
reactors and those with previous positive skin tests are to be
immediately referred to a physician for evaluation and treatment or
further studies. School personnel found to have tuberculosis shall
have their employment suspended until the local health officer, in
consultation with the Commissioner, approves a return to work.
School personnel who have not had the required examination will be suspended from employment until reports of examination are
confirmed by the local health officer.
(d) The local health officer shall be responsible for
arranging proper follow-up of school personnel and students who are
unable to obtain physician evaluation for a positive tuberculin
(e) The Commissioner shall have the authority to require
selective testing of students and school personnel for tuberculosis
when there is reason to believe that they may have been exposed to
the tuberculosis organism. School nurses shall identify and refer
any students or school personnel to the local health officer in
instances where they have reason to suspect that the individual has
been exposed to tuberculosis or has symptoms indicative of the
§16-3D-4. Report of cases, admissions, registration of patients.
(a) Every physician practicing in this state, every public
health officer in the state, and every chief medical officer having
charge of any hospital or clinic or other similar public or private
institution in the state shall report electronically or in writing
to the local health department in the patient's county of residence
all information required by the Commissioner for every person
having tuberculosis who comes under his or her observation or care.
Such report shall be made within twenty-four hours after diagnosis.
(b) Every local health department shall forward all reports of tuberculosis cases filed pursuant to this section to the Bureau
tuberculosis program within twenty-four hours of receipt of such
(c) The chief medical officer of each tuberculosis
institution, hospital or other health care facility shall report
the admission of any patient with tuberculosis to the Bureau
together with any other information the Commissioner may require.
He or she shall make a similar report of the discharge or death of
any patient. From such reports and other sources, the Bureau shall
prepare and keep current a register of persons in this state with
tuberculosis. The name of a person so registered shall not be made
public nor shall the register be accessible to anyone except by
order of the Bureau, the patient, or by the order of the judge of
a court of record.
§16-3D-5. Forms for reporting and committing patients; other
(a) The Bureau shall prescribe the written and electronic
forms for reporting all required information regarding patients
(b) The Bureau shall prescribe the written and electronic
forms to be used in committing patients to any state hospital or
other health care facility where care and treatment of tuberculosis
patients is conducted.
§16-3D-6. Cost of maintenance and treatment of patients.
The cost of maintenance and treatment of patients admitted to
state designated tuberculosis institutions shall be paid out of
funds appropriated for the respective institutions. No patient
shall be required to pay for such maintenance and treatment, but
the institutions are authorized to receive any voluntary payments
§16-3D-7. Procedure when patient is a health menace to others;
court ordered treatment; requirements for discharge;
(a) If any practicing physician, public health officer, or
chief medical officer having under observation or care any person
with tuberculosis is of the opinion that the environmental
conditions of that person are not suitable for proper isolation or
control by any type of local quarantine as prescribed by the
Bureau, and that the person is unable or unwilling to conduct
himself or herself and to live in such a manner as not to expose
members of his or her family or household or other persons with
whom he or she may be associated to danger of infection, he or she
shall report the facts to the Bureau which shall investigate or
have investigated the circumstances alleged.
(b) If the Commissioner or local health officer finds that any
person's physical condition is a health menace to others, the
Commissioner or local health officer shall petition the circuit
court of the county in which the person resides, requesting an individualized course of treatment to deal with the person's
current or inadequately treated tuberculosis. Refusal to adhere to
prescribed treatment may result in an order of the court committing
the person to a health care facility equipped for the treatment of
That if the Commissioner or local health
officer determines that an emergency situation exists which
warrants the immediate detention and commitment of a person with
tuberculosis, an application for immediate involuntary commitment
may be filed pursuant to section nine of this article.
(c) Upon receiving the petition, the court shall fix a date
for hearing thereof and notice of the petition and the time and
place for hearing shall be served personally, at least seven days
before the hearing, upon the person with tuberculosis alleged to be
dangerous to the health of others.
(d) If, upon hearing, it appears that the complaint of the
Bureau is well founded, that other less restrictive treatment
options have been exhausted, that the person has tuberculosis, and
that the person is a danger to others, the court shall commit the
individual to a health care facility equipped for the care and
treatment of persons with tuberculosis. The person shall be deemed
to be committed until discharged in the manner authorized in
subsection (e) of this section: Provided,
That the hearing and
notice provisions of this subsection do not apply to immediate
involuntary commitments as provided in section nine of this article.
(e) The chief medical officer of the institution to which any
person with tuberculosis has been committed may discharge that
person when, after consultation with the Commissioner and the local
health officer in the patient's county of residence, it is agreed
that the person may be discharged without danger to the health of
others. The chief medical officer shall report immediately to the
Commissioner and to the local health officer in the patient's
county of residence each discharge of a person with tuberculosis.
(f) Every person committed under the provisions of this
section shall observe all the rules of the institution. Any
patient so committed may, by direction of the chief medical officer
of the institution, be placed apart from the others and restrained
from leaving the institution so long as he or she continues to have
tuberculosis and remains a health menace.
(g) Nothing in this section may be construed to prohibit any
person committed to any institution under the provisions of this
section from applying to the Supreme Court of Appeals for a review
of the evidence on which the commitment was made. Nothing in this
section may be construed or operate to empower or authorize the
Commissioner or the chief medical officer of the institution to
restrict in any manner the individual's right to select any method
of tuberculosis treatment offered by the institution.
§16-3D-8. Return of escapees from state tuberculosis institutions.
If any person confined in a state tuberculosis institution by
virtue of an order of a circuit court as provided in sections seven
and nine of this article shall escape, the chief medical officer
shall issue a notice giving the name and description of the person
escaping and requesting his or her apprehension and return to the
hospital. The chief medical officer shall issue a warrant directed
to the sheriff of the county commanding him or her to arrest and
carry the escaped person back to the hospital, which warrant may be
executed in any part of the state. If the person flees to another
state, the chief medical officer shall notify the appropriate state
health official in the state where the person has fled, and that
state health official may take the actions that are necessary for
the return of the person to the hospital.
§16-3D-9. Procedures for immediate involuntary commitment; rules.
(a) An application for immediate involuntary commitment of a
person with tuberculosis may be filed by the Commissioner or local
health officer, in the circuit court of the county in which the
person resides. The application shall be filed under oath, and
shall present information and facts which establish that the person
with tuberculosis has been uncooperative or irresponsible with
regard to treatment, quarantine or safety measures, presents a
health menace to others, and is in need of immediate
(b) Upon receipt of the application, the circuit court may enter an order for the individual named in the action to be
detained and taken into custody for the purpose of holding a
probable cause hearing. The order shall specify that the hearing
be held forthwith and shall appoint counsel for the individual:
That in the event immediate detention is believed to be
necessary for the protection of the individual or others at a time
when no circuit court judge is available for immediate presentation
of the application, a magistrate may accept the application and,
upon a finding that immediate detention is necessary, may order the
individual to be temporarily committed until the earliest
reasonable time that the application can be presented to the
circuit court, which period of time shall not exceed twenty-four
hours except as provided in subsection (c) of this section.
(c) A probable cause hearing shall be held before a magistrate
or circuit judge of the county in which the individual is a
resident or where he or she was found. If requested by the
individual or his or her counsel, the hearing may be postponed for
a period not to exceed forty-eight hours, or as soon thereafter as
(d) The individual shall be present at the probable cause
hearing and shall have the right to present evidence, confront all
witnesses and other evidence against him or her, and to examine
testimony offered, including testimony by the Bureau or its
(e) At the conclusion of the hearing the magistrate or circuit
court judge shall enter an order stating whether there is probable
cause to believe that the individual is likely to cause serious
harm to himself, herself or others as a result of his or her
disease and actions. If probable cause is found, the individual
shall be immediately committed to a health care facility equipped
for the care and treatment of persons with tuberculosis. The
person shall remain so committed until discharged in the manner
authorized pursuant to subsection (e), section seven of this
That in the case of an alcoholic or drug user,
the judge or magistrate shall first order the individual committed
to a detoxification center for detoxification prior to commitment
to health care facility equipped for the care and treatment of
persons with tuberculosis.
(f) The Bureau shall propose rules for legislative approval in
accordance with the provisions of article three, chapter
twenty-nine-a of this code to implement the provisions of this
article, including, but not limited to, rules relating to the
transport and temporary involuntary commitment of patients.
NOTE: This bill will significantly reduce the cost and the
burden of repeated tuberculosis skin testing for school personnel.
The current statutory requirement for skin testing every other year
is unnecessary. Records show that this group of people has
historically been a low-risk population for tuberculosis. No known
school personnel tested in the past 20 years in West Virginia have been found to have tuberculosis by routine tuberculin skin testing.
The bill also allows a physician or local health officer to seek an
individualized course of treatment for persons with tuberculosis
and thereby reduces their risk of developing multidrug resistant
TB. The bill further updates and modernizes the language relating
to tuberculosis testing, treatment, control and commitment.
Much of the language in this new article is from the existing
article on tuberculosis in chapter 26, article 5A, and also from
the section on compulsory testing of school students and personnel
in chapter 16, article 3, section 4a.
This article is new; therefore, strike-throughs and
underscoring have been omitted.