By: Truan, Madla S.B. No. 269 A BILL TO BE ENTITLED AN ACT 1-1 relating to the identification of children suffering from lead 1-2 poisoning. 1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-4 SECTION 1. Subtitle D, Title 2, Health and Safety Code, is 1-5 amended by adding Chapter 88 to read as follows: 1-6 CHAPTER 88. REPORTS OF CHILDHOOD LEAD POISONING 1-7 Sec. 88.001. DEFINITIONS. In this chapter: 1-8 (1) "Child care" includes a school, preschool, 1-9 kindergarten, nursery school, or other similar activity that 1-10 provides care or instruction for young children. 1-11 (2) "Child care facility" means a public place or a 1-12 residence in which a person furnishes child care. 1-13 (3) "Health authority" means a physician appointed as 1-14 such under Chapter 121. 1-15 (4) "Health professional" means an individual whose: 1-16 (A) vocation or profession is directly or 1-17 indirectly related to the maintenance of health in another 1-18 individual; and 1-19 (B) duties require a specified amount of formal 1-20 education and may require a special examination, certificate or 1-21 license, or membership in a regional or national association. 1-22 (5) "Lead" includes metallic lead and materials 1-23 containing metallic lead with a potential for release in sufficient 1-24 concentrations to pose a threat to public health. 2-1 (6) "Blood lead levels of concern" means the presence 2-2 of blood lead concentrations suspected to be associated with mental 2-3 and physical disorders due to absorption, ingestion, or inhalation 2-4 of lead as specified in the most recent criteria issued by the 2-5 United States Department of Health and Human Services, United 2-6 States Public Health Service, Centers for Disease Control and 2-7 Prevention of the United States Public Health Service. 2-8 (7) "Lead poisoning" means the presence of a confirmed 2-9 venous blood level established by board rule in the range specified 2-10 for medical evaluation and possible pharmacologic treatment in the 2-11 most recent criteria issued by the United States Department of 2-12 Health and Human Services, United States Public Health Service, 2-13 Centers for Disease Control and Prevention of the United States 2-14 Public Health Service. 2-15 (8) "Local health department" means a department 2-16 created under Chapter 121. 2-17 (9) "Physician" means a person licensed to practice 2-18 medicine by the Texas State Board of Medical Examiners. 2-19 (10) "Public health district" means a district created 2-20 under Chapter 121. 2-21 (11) "Regional director" means a physician appointed 2-22 by the board as the chief administrative officer of a public health 2-23 region under Chapter 121. 2-24 Sec. 88.002. CONFIDENTIALITY. (a) Except as specifically 2-25 authorized by this chapter, reports, records, and information 2-26 furnished to a health authority, a regional director, or the 2-27 department that relate to cases or suspected cases of children with 3-1 blood lead levels of concern or lead poisoning are confidential and 3-2 may be used only for the purposes of this chapter. 3-3 (b) Reports, records, and information relating to cases or 3-4 suspected cases of childhood lead poisoning and children with blood 3-5 lead levels of concern are not public information under the open 3-6 records law, Chapter 552, Government Code, and may not be released 3-7 or made public on subpoena or otherwise except as provided by this 3-8 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 and Prevention of the United States 3-21 Public Health Service, except that the information must be limited 3-22 to the 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. 3-26 (d) The commissioner, a regional director or other 3-27 department employee, a health authority or employee of a public 4-1 health district, a health authority or employee of a county or 4-2 municipal health department, or a public official of a county or 4-3 municipality may not be examined in a civil, criminal, special, or 4-4 other proceeding as to the existence or contents of pertinent 4-5 records of or reports or information about a child identified, 4-6 examined, or treated for lead poisoning or about a child possessing 4-7 blood lead levels of concern by the department, a public health 4-8 district, a local health department, or a health authority without 4-9 the consent of the child's parents, managing conservator, guardian, 4-10 or other person authorized by law to give consent. 4-11 Sec. 88.003. REPORTABLE HEALTH CONDITION. (a) Childhood 4-12 blood lead levels of concern are reportable. 4-13 (b) The board by rule may designate: 4-14 (1) blood lead concentrations in children that must be 4-15 reported; and 4-16 (2) the ages of children for whom the reporting 4-17 requirements apply. 4-18 (c) The board may adopt rules that establish a registry of 4-19 children with blood lead levels of concern and lead poisoning. 4-20 Sec. 88.004. PERSONS REQUIRED TO REPORT. (a) A person 4-21 required to report childhood blood lead levels of concern shall 4-22 report to the department in the manner specified by board rule. 4-23 Except as provided by this section, a person required by this 4-24 section to report must make the report immediately after the person 4-25 gains knowledge of the case or suspected case of a child with a 4-26 blood lead level of concern. 4-27 (b) A physician shall report a case or suspected case of 5-1 childhood lead poisoning or of a child with a blood lead level of 5-2 concern after the physician's first examination of a child for whom 5-3 reporting is required by board rule. 5-4 (c) A person in charge of an independent clinical 5-5 laboratory, a hospital or clinic laboratory, or other facility in 5-6 which a laboratory examination of a specimen derived from the human 5-7 body yields evidence of a child with a blood lead level of concern 5-8 shall report the findings to the department as required by board 5-9 rule. 5-10 (d) If a report is not made as required by Subsection (b) or 5-11 (c), the following persons shall report a case or suspected case of 5-12 a child with lead poisoning or a blood lead level of concern and 5-13 all information known concerning the child: 5-14 (1) the administrator of a hospital licensed under 5-15 Chapter 241; 5-16 (2) a professional registered nurse; 5-17 (3) an administrator or director of a public or 5-18 private child care facility; 5-19 (4) an administrator of a home health agency; 5-20 (5) an administrator or health official of a public or 5-21 private institution of higher education; 5-22 (6) a superintendent, manager, or health official of a 5-23 public or private camp, home, or institution; 5-24 (7) a parent, managing conservator, guardian, or 5-25 residence owner; and 5-26 (8) a health professional. 5-27 Sec. 88.005. REPORTING PROCEDURES. (a) The board shall 6-1 prescribe the form and method of reporting under this chapter, 6-2 including a report in writing, by telephone, or by electronic data 6-3 transmission. 6-4 (b) Board rules may require the reports to contain any 6-5 information relating to a case that is necessary for the purposes 6-6 of this chapter, including: 6-7 (1) the child's name, address, age, sex, and race; 6-8 (2) the child's blood lead concentration; 6-9 (3) the procedure used to determine the child's blood 6-10 lead concentration; and 6-11 (4) the name of the attending physician. 6-12 (c) The commissioner may authorize an alternate routing of 6-13 information in particular cases if the commissioner determines that 6-14 the customary reporting procedure would cause the information to be 6-15 unduly delayed. 6-16 Sec. 88.006. REPORTS OF HOSPITALIZATION; DEATH. (a) A 6-17 physician who attends a child during the child's hospitalization 6-18 shall immediately notify the department if the physician knows or 6-19 suspects that the child has lead poisoning or a blood lead level of 6-20 concern and the physician believes the lead poisoning or blood lead 6-21 level of concern resulted from the child's exposure to a dangerous 6-22 level of lead that may be a threat to the public health. 6-23 (b) A physician who attends a child during the child's last 6-24 illness shall immediately notify the department if the physician: 6-25 (1) knows or suspects that the child died of lead 6-26 poisoning; and 6-27 (2) believes the lead poisoning resulted from the 7-1 child's exposure to a dangerous level of lead that may be a threat 7-2 to the public health. 7-3 (c) An attending physician, health authority, or regional 7-4 director, with the consent of the child's survivors, may request an 7-5 autopsy if the physician, health authority, or regional director 7-6 needs further information concerning the cause of death in order to 7-7 protect the public health. The health authority or regional 7-8 director may order the autopsy to determine the cause of death if 7-9 the child's survivors do not consent to the autopsy. The autopsy 7-10 results shall be reported to the department. 7-11 (d) A justice of the peace acting as coroner or a medical 7-12 examiner in the course of an inquest under Chapter 49, Code of 7-13 Criminal Procedure, who finds that a child's cause of death was 7-14 lead poisoning that resulted from exposure to a dangerous level of 7-15 lead that the justice of the peace or medical examiner believes may 7-16 be a threat to the public health shall immediately notify the 7-17 health authority or the regional director in the jurisdiction in 7-18 which the finding is made. 7-19 SECTION 2. This Act takes effect January 1, 1996. 7-20 SECTION 3. The importance of this legislation and the 7-21 crowded condition of the calendars in both houses create an 7-22 emergency and an imperative public necessity that the 7-23 constitutional rule requiring bills to be read on three several 7-24 days in each house be suspended, and this rule is hereby suspended.