By Van de Putte H.B. No. 1456 A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to the identification of children suffering from lead 1-3 poisoning and to control measures for lead contamination; providing 1-4 penalties. 1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-6 SECTION 1. Subtitle D, Title 2, Health and Safety Code, is 1-7 amended by adding Chapter 88 to read as follows: 1-8 CHAPTER 88. REPORTS OF CHILDHOOD LEAD POISONING 1-9 Sec. 88.001. DEFINITIONS. In this chapter: 1-10 (1) "Child care" includes a school, preschool, 1-11 kindergarten, nursery school, or other similar activity that 1-12 provides care or instruction for young children. 1-13 (2) "Child care facility" means a public place or a 1-14 residence in which a person furnishes child care. 1-15 (3) "Health authority" means a physician appointed as 1-16 such under Chapter 121. 1-17 (4) "Health professional" means an individual whose: 1-18 (A) vocation or profession is directly or 1-19 indirectly related to the maintenance of health in another 1-20 individual; and 1-21 (B) duties require a specified amount of formal 1-22 education and may require a special examination, certificate or 1-23 license, or membership in a regional or national association. 2-1 (5) "Lead" includes metallic lead and lead-containing 2-2 materials. 2-3 (6) "Lead poisoning" means the presence of blood lead 2-4 concentrations known to be associated with mental and physical 2-5 disorders due to absorption, ingestion, or inhalation of lead as 2-6 specified in the most recent criteria issued by the United States 2-7 Department of Health and Human Services, United States Public 2-8 Health Service, Centers for Disease Control of the United States 2-9 Public Health Service, or other national public health organization 2-10 specified by board rule. 2-11 (7) "Local health department" means a department 2-12 created under Chapter 121. 2-13 (8) "Physician" means a person licensed to practice 2-14 medicine by the Texas State Board of Medical Examiners. 2-15 (9) "Public health district" means a district created 2-16 under Chapter 121. 2-17 (10) "Public place" means all or any portion of an 2-18 area, building or other structure, or conveyance that is not used 2-19 for private residential purposes, regardless of ownership. 2-20 (11) "Regional director" means a physician appointed 2-21 by the board as the chief administrative officer of a public health 2-22 region under Chapter 121. 2-23 Sec. 88.002. CONFIDENTIALITY. (a) Except as specifically 2-24 authorized by this chapter, reports, records, and information 2-25 furnished to a health authority, a regional director, or the 3-1 department that relate to cases or suspected cases of childhood 3-2 lead poisoning are confidential and may be used only for the 3-3 purposes of this chapter. 3-4 (b) Reports, records, and information relating to cases or 3-5 suspected cases of childhood lead poisoning are not public 3-6 information under the open records law, Chapter 552, Government 3-7 Code, and may not be released or made public on subpoena or 3-8 otherwise except as provided by this chapter. 3-9 (c) Medical, epidemiologic, or toxicologic information may 3-10 be released: 3-11 (1) for statistical purposes if released in a manner 3-12 that prevents the identification of any person; 3-13 (2) with the consent of each person identified in the 3-14 information; 3-15 (3) to medical personnel, appropriate state agencies, 3-16 health authorities, regional directors, and public officers of 3-17 counties and municipalities as necessary to comply with this 3-18 chapter and related rules; 3-19 (4) to appropriate federal agencies, such as the 3-20 Centers for Disease Control of the United States Public Health 3-21 Service, except that the information must be limited to the 3-22 information requested by the agency; or 3-23 (5) to medical personnel to the extent necessary in a 3-24 medical emergency to protect the health or life of the child 3-25 identified in the information. 4-1 (d) The commissioner, a regional director or other 4-2 department employee, a health authority or employee of a public 4-3 health district, a health authority or employee of a county or 4-4 municipal health department, or a public official of a county or 4-5 municipality may not be examined in a civil, criminal, special, or 4-6 other proceeding as to the existence or contents of pertinent 4-7 records of or reports or information about a child identified, 4-8 examined, or treated for lead poisoning by the department, a public 4-9 health district, a local health department, or a health authority 4-10 without the consent of the child's parents, managing conservator, 4-11 guardian, or other person authorized by law to give consent. 4-12 Sec. 88.003. REPORTABLE HEALTH CONDITIONS. (a) Early 4-13 childhood lead poisoning is a reportable health condition. 4-14 (b) The board by rule may designate: 4-15 (1) blood lead concentrations in children that must be 4-16 reported; and 4-17 (2) the ages of children for whom the reporting 4-18 requirements apply. 4-19 (c) The board may adopt rules that establish a registry of 4-20 children with lead poisoning. 4-21 Sec. 88.004. PERSONS REQUIRED TO REPORT. (a) A person 4-22 required to report early childhood lead poisoning shall report to 4-23 the department in the manner specified by board rule. Except as 4-24 provided by this section, a person required by this section to 4-25 report must make the report immediately after the person gains 5-1 knowledge of the case or suspected case of childhood lead 5-2 poisoning. 5-3 (b) A physician shall report a case or suspected case of 5-4 childhood lead poisoning after the physician's first examination of 5-5 a child for whom reporting is required by board rule. 5-6 (c) A person in charge of an independent clinical 5-7 laboratory, a hospital or clinic laboratory, or other facility in 5-8 which a laboratory examination of a specimen derived from the human 5-9 body yields evidence of childhood lead poisoning shall report the 5-10 findings to the department as required by board rule. 5-11 (d) If a report is not made as required by Subsection (b) or 5-12 (c), the following persons shall report a case or suspected case of 5-13 childhood lead poisoning and all information known concerning the 5-14 child: 5-15 (1) the administrator of a hospital licensed under 5-16 Chapter 241; 5-17 (2) a professional registered nurse; 5-18 (3) an administrator or director of a public or 5-19 private child care facility; 5-20 (4) an administrator of a home health agency; 5-21 (5) an administrator or health official of a public or 5-22 private institution of higher education; 5-23 (6) a superintendent, manager, or health official of a 5-24 public or private camp, home, or institution; 5-25 (7) a parent, managing conservator, guardian, or 6-1 residence owner; and 6-2 (8) a health professional. 6-3 Sec. 88.005. REPORTING PROCEDURES. (a) The board shall 6-4 prescribe the form and method of reporting under this chapter, 6-5 including a report in writing, by telephone, or by electronic data 6-6 transmission. 6-7 (b) Board rules may require the reports to contain any 6-8 information relating to a case that is necessary for the purposes 6-9 of this chapter, including: 6-10 (1) the child's name, address, age, sex, and race; 6-11 (2) the child's blood lead concentration; 6-12 (3) the procedure used to determine the child's blood 6-13 lead concentration; and 6-14 (4) the name of the attending physician. 6-15 (c) The commissioner may authorize an alternate routing of 6-16 information in particular cases if the commissioner determines that 6-17 the customary reporting procedure would cause the information to be 6-18 unduly delayed. 6-19 Sec. 88.006. REPORTS OF HOSPITALIZATION; DEATH. (a) A 6-20 physician who attends a child during the child's hospitalization 6-21 shall immediately notify the department if the physician knows or 6-22 suspects that the child has lead poisoning and the physician 6-23 believes the lead poisoning resulted from the child's exposure to a 6-24 dangerous level of environmental lead that may be a threat to the 6-25 public health. 7-1 (b) A physician who attends a child during the child's last 7-2 illness shall immediately notify the department if the physician: 7-3 (1) knows or suspects that the child died of lead 7-4 poisoning; and 7-5 (2) believes the lead poisoning resulted from the 7-6 child's exposure to a dangerous level of environmental lead that 7-7 may be a threat to the public health. 7-8 (c) An attending physician, health authority, or regional 7-9 director, with the consent of the child's survivors, may request an 7-10 autopsy if the physician, health authority, or regional director 7-11 needs further information concerning the cause of death in order to 7-12 protect the public health. The health authority or regional 7-13 director may order the autopsy to determine the cause of death if 7-14 the child's survivors do not consent to the autopsy. The autopsy 7-15 results shall be reported to the department. 7-16 (d) A justice of the peace acting as coroner or a medical 7-17 examiner in the course of an inquest under Chapter 49, Code of 7-18 Criminal Procedure, who finds that a child's cause of death was 7-19 lead poisoning that resulted from exposure to a dangerous level of 7-20 environmental lead that the justice of the peace or medical 7-21 examiner believes may be a threat to the public health shall 7-22 immediately notify the health authority or the regional director in 7-23 the jurisdiction in which the finding is made. 7-24 SECTION 2. This Act takes effect January 1, 1996. 7-25 SECTION 3. The importance of this legislation and the 8-1 crowded condition of the calendars in both houses create an 8-2 emergency and an imperative public necessity that the 8-3 constitutional rule requiring bills to be read on three several 8-4 days in each house be suspended, and this rule is hereby suspended.