1-1  By:  Truan                                             S.B. No. 269
    1-2        (In the Senate - Filed January 19, 1995; January 23, 1995,
    1-3  read first time and referred to Committee on Health and Human
    1-4  Services; April 20, 1995, reported adversely, with favorable
    1-5  Committee Substitute by the following vote:  Yeas 7, Nays 0;
    1-6  April 20, 1995, sent to printer.)
    1-7  COMMITTEE SUBSTITUTE FOR S.B. No. 269             By:  Truan, Madla
    1-8                         A BILL TO BE ENTITLED
    1-9                                AN ACT
   1-10  relating to the identification of children suffering from lead
   1-11  poisoning.
   1-12        BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
   1-13        SECTION 1.  Subtitle D, Title 2, Health and Safety Code, is
   1-14  amended by adding Chapter 88 to read as follows:
   1-15           CHAPTER 88.  REPORTS OF CHILDHOOD LEAD POISONING
   1-16        Sec. 88.001.  DEFINITIONS.  In this chapter:
   1-17              (1)  "Child care" includes a school, preschool,
   1-18  kindergarten, nursery school, or other similar activity that
   1-19  provides care or instruction for young children.
   1-20              (2)  "Child care facility" means a public place or a
   1-21  residence in which a person furnishes child care.
   1-22              (3)  "Health authority" means a physician appointed as
   1-23  such under Chapter 121.
   1-24              (4)  "Health professional" means an individual whose:
   1-25                    (A)  vocation or profession is directly or
   1-26  indirectly related to the maintenance of health in another
   1-27  individual; and
   1-28                    (B)  duties require a specified amount of formal
   1-29  education and may require a special examination, certificate or
   1-30  license, or membership in a regional or national association.
   1-31              (5)  "Lead" includes metallic lead and materials
   1-32  containing metallic lead with a potential for release in sufficient
   1-33  concentrations to pose a threat to public health.
   1-34              (6)  "Blood lead levels of concern" means the presence
   1-35  of blood lead concentrations suspected to be associated with mental
   1-36  and physical disorders due to absorption, ingestion, or inhalation
   1-37  of lead as specified in the most recent criteria issued by the
   1-38  United States Department of Health and Human Services, United
   1-39  States Public Health Service, Centers for Disease Control and
   1-40  Prevention of the United States Public Health Service.
   1-41              (7)  "Lead poisoning" means the presence of a confirmed
   1-42  venous blood level established by board rule in the range specified
   1-43  for medical evaluation and possible pharmacologic treatment in the
   1-44  most recent criteria issued by the United States Department of
   1-45  Health and Human Services, United States Public Health Service,
   1-46  Centers for Disease Control and Prevention of the United States
   1-47  Public Health Service.
   1-48              (8)  "Local health department" means a department
   1-49  created under Chapter 121.
   1-50              (9)  "Physician" means a person licensed to practice
   1-51  medicine by the Texas State Board of Medical Examiners.
   1-52              (10)  "Public health district" means a district created
   1-53  under Chapter 121.
   1-54              (11)  "Regional director" means a physician appointed
   1-55  by the board as the chief administrative officer of a public health
   1-56  region under Chapter 121.
   1-57        Sec. 88.002.  CONFIDENTIALITY.  (a)  Except as specifically
   1-58  authorized by this chapter, reports, records, and information
   1-59  furnished to a health authority, a regional director, or the
   1-60  department that relate to cases or suspected cases of children with
   1-61  blood lead levels of concern or lead poisoning are confidential and
   1-62  may be used only for the purposes of this chapter.
   1-63        (b)  Reports, records, and information relating to cases or
   1-64  suspected cases of childhood lead poisoning and children with blood
   1-65  lead levels of concern are not public information under the open
   1-66  records law, Chapter 552, Government Code, and may not be released
   1-67  or made public on subpoena or otherwise except as provided by this
   1-68  chapter.
    2-1        (c)  Medical, epidemiologic, or toxicologic information may
    2-2  be released:
    2-3              (1)  for statistical purposes if released in a manner
    2-4  that prevents the identification of any person;
    2-5              (2)  with the consent of each person identified in the
    2-6  information;
    2-7              (3)  to medical personnel, appropriate state agencies,
    2-8  health authorities, regional directors, and public officers of
    2-9  counties and municipalities as necessary to comply with this
   2-10  chapter and related rules;
   2-11              (4)  to appropriate federal agencies, such as the
   2-12  Centers for Diseases Control and Prevention of the United States
   2-13  Public Health Service, except that the information must be limited
   2-14  to the information requested by the agency; or
   2-15              (5)  to medical personnel to the extent necessary in a
   2-16  medical emergency to protect the health or life of the child
   2-17  identified in the information.
   2-18        (d)  The commissioner, a regional director or other
   2-19  department employee, a health authority or employee of a public
   2-20  health district, a health authority or employee of a county or
   2-21  municipal health department, or a public official of a county or
   2-22  municipality may not be examined in a civil, criminal, special, or
   2-23  other proceeding as to the existence or contents of pertinent
   2-24  records of or reports or information about a child identified,
   2-25  examined, or treated for lead poisoning or about a child possessing
   2-26  blood lead levels of concern by the department, a public health
   2-27  district, a local health department, or a health authority without
   2-28  the consent of the child's parents, managing conservator, guardian,
   2-29  or other person authorized by law to give consent.
   2-30        Sec. 88.003.  REPORTABLE HEALTH CONDITION.  (a)  Childhood
   2-31  blood lead levels of concern are reportable.
   2-32        (b)  The board by rule may designate:
   2-33              (1)  blood lead concentrations in children that must be
   2-34  reported; and
   2-35              (2)  the ages of children for whom the reporting
   2-36  requirements apply.
   2-37        (c)  The board may adopt rules that establish a registry of
   2-38  children with blood lead levels of concern and lead poisoning.
   2-39        Sec. 88.004.  PERSONS REQUIRED TO REPORT.  (a)  A person
   2-40  required to report childhood blood lead levels of concern shall
   2-41  report to the department in the manner specified by board rule.
   2-42  Except as provided by this section, a person required by this
   2-43  section to report must make the report immediately after the person
   2-44  gains knowledge of the case or suspected case of a child with a
   2-45  blood lead level of concern.
   2-46        (b)  A physician shall report a case or suspected case of
   2-47  childhood lead poisoning or of a child with a blood lead level of
   2-48  concern after the physician's first examination of a child for whom
   2-49  reporting is required by board rule.
   2-50        (c)  A person in charge of an independent clinical
   2-51  laboratory, a hospital or clinic laboratory, or other facility in
   2-52  which a laboratory examination of a specimen derived from the human
   2-53  body yields evidence of a child with a blood lead level of concern
   2-54  shall report the findings to the department as required by board
   2-55  rule.
   2-56        (d)  If a report is not made as required by Subsection (b) or
   2-57  (c), the following persons shall report a case or suspected case of
   2-58  a child with lead poisoning or a blood lead level of concern and
   2-59  all information known concerning the child:
   2-60              (1)  the administrator of a hospital licensed under
   2-61  Chapter 241;
   2-62              (2)  a professional registered nurse;
   2-63              (3)  an administrator or director of a public or
   2-64  private child care facility;
   2-65              (4)  an administrator of a home health agency;
   2-66              (5)  an administrator or health official of a public or
   2-67  private institution of higher education;
   2-68              (6)  a superintendent, manager, or health official of a
   2-69  public or private camp, home, or institution;
   2-70              (7)  a parent, managing conservator, guardian, or
    3-1  residence owner; and
    3-2              (8)  a health professional.
    3-3        Sec. 88.005.  REPORTING PROCEDURES.  (a)  The board shall
    3-4  prescribe the form and method of reporting under this chapter,
    3-5  including a report in writing, by telephone, or by electronic data
    3-6  transmission.
    3-7        (b)  Board rules may require the reports to contain any
    3-8  information relating to a case that is necessary for the purposes
    3-9  of this chapter, including:
   3-10              (1)  the child's name, address, age, sex, and race;
   3-11              (2)  the child's blood lead concentration;
   3-12              (3)  the procedure used to determine the child's blood
   3-13  lead concentration; and
   3-14              (4)  the name of the attending physician.
   3-15        (c)  The commissioner may authorize an alternate routing of
   3-16  information in particular cases if the commission determines that
   3-17  the customary reporting procedure would cause the information to be
   3-18  unduly delayed.
   3-19        Sec. 88.006.  REPORTS OF HOSPITALIZATION; DEATH.  (a)  A
   3-20  physician who attends a child during the child's hospitalization
   3-21  shall immediately notify the department if the physician knows or
   3-22  suspects that the child has lead poisoning or a blood lead level of
   3-23  concern and the physician believes the lead poisoning or blood lead
   3-24  level of concern resulted from the child's exposure to a dangerous
   3-25  level of lead that may be a threat to the public health.
   3-26        (b)  A physician who attends a child during the child's last
   3-27  illness shall immediately notify the department if the physician:
   3-28              (1)  knows or suspects that the child died of lead
   3-29  poisoning; and
   3-30              (2)  believes the lead poisoning resulted from the
   3-31  child's exposure to a dangerous level of lead that may be a threat
   3-32  to the public health.
   3-33        (c)  An attending physician, health authority, or regional
   3-34  director, with the consent of the child's survivors, may request an
   3-35  autopsy if the physician, health authority, or regional director
   3-36  needs further information concerning the cause of death in order to
   3-37  protect the public health.  The health authority or regional
   3-38  director may order the autopsy to determine the cause of death if
   3-39  the child's survivors do not consent to the autopsy.  The autopsy
   3-40  results shall be reported to the department.
   3-41        (d)  A justice of the peace acting as coroner or a medical
   3-42  examiner in the course of an inquest under Chapter 49, Code of
   3-43  Criminal Procedure, who finds that a child's cause of death was
   3-44  lead poisoning that resulted from exposure to a dangerous level of
   3-45  lead that the justice of the peace or medical examiner believes may
   3-46  be a threat to the public health shall immediately notify the
   3-47  health authority or the regional director in the jurisdiction in
   3-48  which the finding is made.
   3-49        SECTION 2.  This Act takes effect January 1, 1996.
   3-50        SECTION 3.  The importance of this legislation and the
   3-51  crowded condition of the calendars in both houses create an
   3-52  emergency and an imperative public necessity that the
   3-53  constitutional rule requiring bills to be read on three several
   3-54  days in each house be suspended, and this rule is hereby suspended.
   3-55                               * * * * *