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.