BILL ANALYSIS
H.B. 2339
By: Hirschi
04-19-95
Committee Report (Unamended)
BACKGROUND
Tuberculosis (TB) has become epidemic in Texas. Cases of this
highly infectious, airborne disease have risen by 44 percent since
1987, when the number of TB cases in Texas was at a low point. In
1994, 2,542 cases were reported, a notable increase over the number
of cases reported in the 1970s and 1980s.
A small percentage of the TB cases in Texas pose a significant
threat to the public health. These are the cases in which an
individual is afflicted with a strain of TB that is resistant to
two or more TB drug treatments and in which an individual is
unwilling or unable to comply with prescribed therapy.
To deal with these exceptional cases, Chapter 81 of the Health and
Safety Code provides for court-ordered case management. Typically,
about 1 percent of TB cases are managed by court order each year.
However, there are inconsistencies and conflicts in the current
statute which lead to a great deal of confusion when the law is
applied.
PURPOSE
H.B. 2339 streamlines the process for court-ordered management of
hard-to-treat TB cases and clarifies the manner by which the state
is to be reimbursed for court costs associated with those cases. In
addition, the bill expedites the TB testing process (which can
often take up to three months) by placing specific requirements on
laboratories that culture mycobacteria.
RULEMAKING AUTHORITY
It is the committee's opinion that this bill grants rulemaking
authority to the Texas Board of Health in SECTION 1 (Section
81.095, Health and Safety Code).
SECTION BY SECTION ANALYSIS
SECTION 1. Adds Section 81.095 to Subchapter E, Chapter 81, Health
and Safety Code, as follows:
Sec. 81.095. REQUIRED LABORATORY TESTING OF MYCOBACTERIA.
Requires laboratories that culture mycobacteria to perform
tests to identify Mycobacterium TB complex and perform on-site
drug susceptibility studies in accordance with rules adopted
by the Texas Board of Health (TBH).
SECTION 2. Amends Sections 81.151(a) and (d), Health and Safety
Code, as follows:
(a) Changes current permissive language to a requirement, by
requiring municipal, county or district attorneys to file for
court-ordered management of a person with a communicable
disease, at the request of a local health authority. Adds a
provision requiring the attorney general to take the same
action at TDH's request.
(d) Declares that an application for outpatient treatment
does not have to be accompanied by a copy of TDH's or the
health authority's written orders made under Section 81.083.
SECTION 3. Amends Section 81.152(c), Health and Safety Code, as
follows:
(c)(4) Clarifies that the statement of a person's failure or
refusal to comply with the written orders made under Section
81.083 is to be included only with an application for
inpatient treatment.
SECTION 4. Amends Sections 81.154(a) and (c), Health and Safety
Code, as follows:
(a) Changes the time period within which a hearing date must
be set from 14 days after the application is filed to 14 days
after the application is served on the person.
(c) Changes the maximum time in which continuances of the
hearing are allowed. Requires the hearing to be held no later
than 30 days after the application is served on the person
instead of no later than 30 days after the application is
filed.
SECTION 5. Amends Section 81.157, Health and Safety Code, as
follows:
Sec. 81.157. DISTRICT COURT JURISDICTION. (a) Adds to the
existing provision regarding jurisdiction the county in which
the person resides or is receiving court-ordered health
services.
(b) Adds a subsection requiring the county in which a
temporary order was issued to pay transportation expenses
under circumstances in which a person is receiving services in
another county and requires extended management, unless
arrangements are made between the two counties to hold the
hearing on the application for extended order in the county in
which the person is receiving services before the expiration
of the temporary order.
SECTION 6. Amends Section 81.159, Health and Safety Code, as
follows:
(a) Renames section "DESIGNATION OF FACILITY."
(c) and (d) Delete the requirement for a health care facility
to file a treatment recommendation prior to the hearing date
and the prohibition against holding a hearing until the
recommendation is filed. Subsequent subsections are renumbered
to reflect deletion of (c) and (d).
SECTION 7. Amends Section 81.161(b), Health and Safety Code, to
require a motion for order of protective custody to be filed by the
attorney general at TDH's request, instead of on its behalf by a
municipal, county, or district attorney.
SECTION 8. Amends Section 81.167(c), Health and Safety Code, to
clearly stipulate the circumstances in which a person under a
protective custody order may be detained in a nonmedical facility.
Prohibits detaining such a person in a jail or similar law
enforcement facility unless the facility has respiratory isolation
capability for airborne communicable diseases. Deletes a
stipulation in current law allowing detainment in a jail or similar
facility if "an extreme emergency exists."
SECTION 9. Amends Section 81.170(f), Health and Safety Code, to
clarify that a jury must determine whether a person has refused or
failed to follow the health authority's orders only in the case of
an application for inpatient treatment.
SECTION 10. Amends Section 81.171(a), Health and Safety Code, to
loosen a restriction on court-ordered services. The section
requires a court to deny an application for court-ordered treatment
if, among other factors, the court finds that the person has not
failed to follow the health authority's orders. As amended, this
restriction applies only for court-ordered "inpatient" treatment,
not all court-ordered treatment.
SECTION 11. Amends Section 81.172, Health and Safety Code, by
amending Subsection (a) and adding Subsection (e) as follows:
(a) Qualifies the stipulation that a judge or jury can only
issue court-ordered remedies if, among other things, the
person has failed to follow a health authority's orders, by
adding that it applies only when court-ordered inpatient
treatment is being considered.
(e) Requires TDH, in cooperation with the head of the health
care facility, to submit to the court, within 14 days after
the order is issued, a general program of treatment which will
be incorporated into the court order.
SECTION 12. Amends Section 81.173, Health and Safety Code, by
amending Subsection (a) and adding Subsection (e) as follows:
(a) Adds that the judge or jury's determination regarding
failure to follow a health authority's orders pertains only in
the case of court-ordered inpatient treatment.
(e) Requires TDH, in cooperation with the head of the health
care facility, to submit to the court, within 14 days after
the order is issued, a general program of treatment which will
be incorporated into the court order.
SECTION 13. Amends Section 81.174(a), Health and Safety Code, to
apply the judge's decision regarding failure or refusal to follow
a health authority's orders only in the case of an application for
inpatient treatment.
SECTION 14. Amends Section 81.179(a), Health and Safety Code, as
follows:
(a) Modifies existing permissive language by requiring the
court to order specified local law enforcement officers to
transport the person to a designated health care facility.
SECTION 15. Amends Section 81.182(a), Health and Safety Code, to
allow a local health authority or the TDH to require the
appropriate public attorney to request the court to modify a
commitment order to provide for outpatient care, instead of the
local authority or TDH directly making the request themselves. As
amended, the subsection prescribes this duty to a municipal, county
or district attorney in the case of the local health authority and
to the attorney general in the case of the TDH.
SECTION 16. Amends Section 81.183(a), Health and Safety Code, as
follows:
(a) Specifies that the court may set a hearing to modify the
order on the motion of a municipal, county or district
attorney, or on the motion of the attorney general.
SECTION 17. Amends Section 81.184(a), Health and Safety Code, as
follows:
(a) Changes permissive language to require a municipal,
county or district attorney, at the local health authority's
request, to file an application for temporary detention
pending a modification hearing; requires the attorney general
to take the same action at TDH's request; deletes permissive
language referring to TDH and the head of an outpatient
facility.
SECTION 18. Amends Section 81.187(a), Health and Safety Code,
as follows:
(a) Modifies existing permissive language by requiring a
municipal, county or district attorney to file an application
for renewal of an order for extended management and requires
the attorney general to take the same action at TDH's request.
SECTION 19. Adds Section 81.210 to Subchapter G, Chapter 81,
Health and Safety Code, as follows:
Sec. 81.210. COSTS. (a) Requires a county to pay specified
costs if a health authority initiates an application for a
court order or has an application for court-ordered management
transferred to it.
(b) Specifies that costs include attorney's fees, physician
examination fees, compensation for court-ordered personal
services, security, and transportation to a designated
facility.
(c) Entitles a county to reimbursement for costs actually
paid by the county from the person who is subject of the
application or a person or estate liable for the person's
support.
(d) Requires TDH to pay the costs of returning a person
absent without authorization unless the person is able to pay.
SECTION 20. Declares that the Act applies to certain applications
filed on or after the effective date of the Act.
SECTION 21. Emergency clause. Effective immediately.
SUMMARY OF COMMITTEE ACTION
H.B. 2339 was considered by the Public Health Committee in a public
hearing on April 19, 1995.
The bill was reported favorably without amendment, with the
recommendation that it do pass and be printed, by a record vote of
7 Ayes, 0 Nays, 0 PNV, 2 Absent.