BILL ANALYSIS C.S.H.B. 1456 By: Van de Putte 04-26-95 Committee Report (Substituted) BACKGROUND Lead poisoning of small children often results in severe mental retardation and possibly death. Modest exposure to lead can cause reduced learning capacity, hypertension, and destroy the body's defense against chemical damage to the nervous system. The Texas Department of Health (Department) has applied for a grant from the Center for Disease Control to collect the necessary data to determine the scope of the lead poisoning problem in Texas. Currently, the only testing of blood lead levels in children occurs through the Medicaid Early Periodic Screening, Detection and Treatment (EPSDT) program. Of the total number of children tested, recent statistics show that the following percentages were shown as having elevated blood lead levels: Bexar County, 9.8% of children tested, or 1,616 children; Dallas County, 8.9%, or 2,688 children; Harris County, 8.4%, or 2,487 children; Nueces County, 5.2%, or 143 children; El Paso County, 7.6%, or 1,151 children; and statewide, 8.3%, or 7,095 children. PURPOSE This bill amends the Health and Safety Code by making childhood lead poisoning a reportable condition. RULEMAKING AUTHORITY It is the committee's opinion that Section I of this bill grants the Texas Department of Health additional rulemaking authority in the following sections of the Health and Safety Code: Sec. 88.003, Sec. 88.004, and Sec. 88.005. SECTION BY SECTION ANALYSIS SECTION 1. Adds Chapter 88 to Subtitle D, Title 2, Health and Safety Code, "REPORTS OF CHILDHOOD LEAD POISONING," as follows: Sec. 88.001. DEFINITIONS. Provides definitions of facilities, physicians, health professionals, materials and locations related to this Chapter. Sec. 88.002. CONFIDENTIALITY. (a) States that reports, records and information furnished to specified health authorities are confidential, except as authorized under this chapter. (b) States that reports, records and information of this chapter are not public information under the Open Records Act nor are they subject to release by subpoena or for any purpose not specified by this chapter. (c) Stipulates that medical, epidemiologic, or toxicologic information may be released under the following conditions: (1) for statistical purposes without identifiers; (2) with the consent of each person identified; (3) to medical personnel, health authorities, or public officials acting in compliance with this chapter; (4) to federal agencies at their request; or, (5) to medical personnel to the extent necessary to protect the health or life of the child identified. (d) Prohibits any of the involved public health professionals from testifying or revealing the existence or contents of the treatment records of an identified child without the approval of an adult authorized to give consent for the child. Sec. 88.003. REPORTABLE HEALTH CONDITIONS. (a) States that early childhood lead poisoning is a reportable health condition. (b) Allows the Texas Board of Health (Board), by rule, to designate the level of blood lead concentrations to be reported and the ages of children for whom reporting requirements apply. (c) Gives the Board authority to establish, by rule, a registry of children with lead poisoning. Sec. 88.004. PERSONS REQUIRED TO REPORT. (a) States that a person required to report early childhood lead poisoning must report to the Department in the manner specified by Board rule. The reports must be made immediately after the person required to report acquires the knowledge of the case or suspected case. (b) Requires a physician to report a case of childhood lead poisoning or suspected poisoning upon the first examination of a child for whom reporting is required by Board rule. (c) Requires a person in charge of a laboratory to report evidence of childhood lead poisoning as required by Board rules. (d) Specifies the persons who must report a case or suspected case of childhood lead poisoning if a report is not made according to Subsections (b) and (c) of this section. Sec. 88.005. REPORTING PROCEDURES. (a) The Board must prescribe the necessary form and method of reporting, including a report in writing, by telephone, or by electronic data transmission. (b) States that Board rules may require the reports to contain any information necessary to carry out the purposes of this Chapter, and outlines specific points of information Board rule may require. (c) Allows the commissioner to authorize alternate methods of reporting in particular cases if the customary reporting procedure would cause the information to be unduly delayed. Sec. 88.006. REPORTS OF HOSPITALIZATION; DEATH. (a) Requires immediate notification of the Department by the physician treating a hospitalized child with lead poisoning if the physician knows or suspects that the source of the child's exposure is a public health risk. (b) Requires immediate notification of the Department by a physician if that physician knows or suspects that a child died of lead poisoning and if the physician believes the source of the child's exposure to be a public health threat. (c) An attending physician or a health authority may request an autopsy, with consent of the child's survivors, if further information is needed concerning the cause of death in order to protect the public health. The health authority or regional director may order the autopsy if the child's survivors do not consent to the autopsy; the results must be reported to the Department. (d) Requires the medical examiner or acting coroner, conducting an inquest under Chapter 49 of the Code of Criminal Procedure, to immediately notify the health authority or the regional director if a child's cause of death is determined to be lead poisoning and resulted from exposure to a dangerous level of environmental lead that is considered to pose a threat to the public health. SECTION 2. Effective date. January 1, 1996. SECTION 3. Emergency clause. COMPARISON OF ORIGINAL TO SUBSTITUTE The substitute for H.B. 1456 contains non-substantive language changes as recommended by the Legislative Council. SUMMARY OF COMMITTEE ACTION H.B. 1456 was considered by the Public Health Committee in a public hearing on April 19, 1995. The following persons testified in favor of the bill: Rebecca Rex, representing self. Timothy G. Lignoul, representing City of Houston. Representative Van de Putte, author of the bill. The following person testified neutrally on the bill: R. Kinnan Goleman, representing ASARCO Incorporated. The bill was left pending. The bill was considered by the committee as pending business on April 26, 1995. The committee considered a complete substitute for the bill. The substitute was adopted without objection. The bill was reported favorably as substituted with the recommendation that it do pass and be printed, by a record vote of 7 AYES, 0 NAYS, 0 PNV, and 2 ABSENT. COMPARISON OF ORIGINAL TO SUBSTITUTE SUMMARY OF COMMITTEE ACTION