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 * * * * *