Date of Adoption: December 10, 2002.

     Purpose: To provide guidance to the first-responders in the event of a bioterrorism attack, chemical, or radiologic attack, or major infectious disease outbreak about the enforceability of local health officers' orders and the due process rights of individuals subject to isolation or quarantine orders.

     Citation of Existing Rules Affected by this Order: Amending WAC 246-100-011 and 246-101-505.

     Statutory Authority for Adoption: RCW 43.20.050 (2)(d).

     Other Authority: RCW 70.05.050 and 70.05.060.

      Adopted under notice filed as WSR 02-22-107 on November 6, 2002.

     Changes Other than Editing from Proposed to Adopted Version: Isolation and quarantine definitions reworded.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 2, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 2, Repealed 0.

     Other Findings Required by Other Provisions of Law as Precondition to Adoption or Effectiveness of Rule: The earlier effective date is necessary because of imminent peril to the public health, safety, or welfare. The nation is currently on orange - "high-risk" - terrorism alert. Government officials have warned attacks could involve biological devices.
     Effective Date of Rule: Immediately [February 19, 2003, 3:28 p.m.]

February 19, 2003

Don Sloma

Executive Director

OTS-5881.3

AMENDATORY SECTION(Amending WSR 00-23-120, filed 11/22/00, effective 12/23/00)

WAC 246-100-011   Definitions.   The following definitions shall apply in the interpretation and enforcement of chapter 246-100 WAC:

     (1) "Acquired immunodeficiency syndrome (AIDS)" means illness, disease, or conditions defined and described by the Centers for Disease Control, U.S. Public Health Service, Morbidity and Mortality Weekly Report (MMWR), December 18, 1992, Volume 41, Number RR-17. A copy of this publication is available for review at the department and at each local health department.

     (2) "AIDS counseling" means counseling directed toward:

     (a) Increasing the individual's understanding of acquired immunodeficiency syndrome; and

     (b) Assessing the individual's risk of HIV acquisition and transmission; and

     (c) Affecting the individual's behavior in ways to reduce the risk of acquiring and transmitting HIV infection.

     (3) "Board" means the Washington state board of health.

     (4) "Case" means a person, alive or dead, having been diagnosed to have a particular disease or condition by a health care provider with diagnosis based on clinical or laboratory criteria or both.

     (5) "Child day care facility" means an agency regularly providing care for a group of children for less than twenty-four hours a day and subject to licensing under chapter 74.15 RCW.

     (6) "Communicable disease" means an illness caused by an infectious agent which can be transmitted from one person, animal, or object to another person by direct or indirect means including transmission via an intermediate host or vector, food, water, or air.

     (7) "Contaminated" or "contamination" means containing or having contact with infectious agents or chemical or radiological materials that pose an immediate threat to present or future public health.

     (8) "Contamination control measures" means the management of persons, animals, goods, and facilities that are contaminated, or suspected to be contaminated, in a manner to avoid human exposure to the contaminant, prevent the contaminant from spreading, and/or effect decontamination.

     (9) "Department" means the Washington state department of health.

     (((8))) (10) "Detention" or "detainment" means physical restriction of activities of an individual by confinement ((, consistent with WAC 246-100-206(8),)) for the purpose of ((monitoring and eliminating behaviors presenting imminent danger)) controlling or preventing a serious and imminent threat to public health and may include physical plant, facilities, equipment, and/or personnel to physically restrict activities of the individual to accomplish such purposes.

     (((9))) (11) "Disease control measures" means the management of persons, animals, goods, and facilities that are infected with, suspected to be infected with, exposed to, or suspected to be exposed to an infectious agent in a manner to prevent transmission of the infectious agent to humans.

     (12) "Health care facility" means:

     (a) Any facility or institution licensed under chapter 18.20 RCW, boarding home, chapter 18.46 RCW, birthing centers, chapter 18.51 RCW, nursing homes, chapter 70.41 RCW, hospitals, or chapter 71.12 RCW, private establishments, clinics, or other settings where one or more health care providers practice; and

     (b) In reference to a sexually transmitted disease, other settings as defined in chapter 70.24 RCW.

     (((10))) (13) "Health care provider" means any person having direct or supervisory responsibility for the delivery of health care who is:

     (a) Licensed or certified in this state under Title 18 RCW; or

     (b) Is military personnel providing health care within the state regardless of licensure.

     (((11))) (14) "HIV testing" means conducting a laboratory test or sequence of tests to detect the human immunodeficiency virus (HIV) or antibodies to HIV performed in accordance with requirements to WAC 246-100-207. To assure that the protection, including but not limited to, pre- and post-test counseling, consent, and confidentiality afforded to HIV testing as described in chapter 246-100 WAC also applies to the enumeration of CD4 + (T4) lymphocyte counts (CD4 + counts) and CD4 + (T4) percents of total lymphocytes (CD4 + percents) when used to diagnose HIV infection, CD4 + counts and CD4 + percents will be presumed HIV testing except when shown by clear and convincing evidence to be for use in the following circumstances:

     (a) Monitoring previously diagnosed infection with HIV;

     (b) Monitoring organ or bone marrow transplants;

     (c) Monitoring chemotherapy;

     (d) Medical research; or

     (e) Diagnosis or monitoring of congenital immunodeficiency states or autoimmune states not related to HIV.

     The burden of proving the existence of one or more of the circumstances identified in (a) through (e) of this subsection shall be on the person asserting such existence.

     (((12) "Isolation" means the separation or restriction of activities of infected persons, or of persons suspected to be infected, from other persons to prevent transmission of the infectious agent.)) (15) "Infectious agent" means an organism such as a virus, rickettsia, bacteria, fungus, protozoan, or helminth that is capable of producing infection or infectious disease.

     (16) "Isolation" means the separation, for the period of communicability or contamination, of infected or contaminated persons or animals from others in such places and under such conditions as to prevent or limit the direct or indirect transmission of the infectious agent or contaminant from those infected or contaminated to those who are susceptible or who may spread the agent or contaminant to others.

     (((13))) (17) "Local health department" means the city, town, county, or district agency providing public health services to persons within the area, as provided in chapter 70.05 RCW and chapter 70.08 RCW.

     (((14))) (18) "Local health officer" means the individual having been appointed under chapter 70.05 RCW as the health officer for the local health department, or having been appointed under chapter 70.08 RCW as the director of public health of a combined city-county health department, or his or her delegee appointed by the local board of health.

     (((15))) (19) "Nosocomial infection" means an infection acquired in a hospital or other health care facility.

     (((16))) (20) "Outbreak" means the occurrence of cases of a disease or condition in any area over a given period of time in excess of the expected number of cases.

     (((17))) (21) "Post-test counseling" means counseling after the HIV test when results are provided and directed toward:

     (a) Increasing the individual's understanding of human immunodeficiency virus (HIV) infection;

     (b) Affecting the individual's behavior in ways to reduce the risk of acquiring and transmitting HIV infection;

     (c) Encouraging the individual testing positive to notify persons with whom there has been contact capable of spreading HIV;

     (d) Assessing emotional impact of HIV test results; and

     (e) Appropriate referral for other community support services.

     (((18))) (22) "Pretest counseling" means counseling provided prior to HIV testing and aimed at:

     (a) Helping an individual to understand:

     (i) Ways to reduce the risk of human immunodeficiency virus (HIV) transmission;

     (ii) The nature, purpose, and potential ramifications of HIV testing;

     (iii) The significance of the results of HIV testing; and

     (iv) The dangers of HIV infection; and

     (b) Assessing the individual's ability to cope with the results of HIV testing.

     (((19))) (23) "Principal health care provider" means the attending physician or other health care provider recognized as primarily responsible for diagnosis and treatment of a patient or, in the absence of such, the health care provider initiating diagnostic testing or therapy for a patient.

     (((20) "Quarantine" means the separation or restriction on activities of a person having been exposed to or infected with an infectious agent, to prevent disease transmission.

     (21))) (24) "Quarantine" means the limitation of freedom of movement of such well persons or domestic animals as have been exposed to, or are suspected to have been exposed to, an infectious agent, for a period of time not longer than the longest usual incubation period of the infectious agent, in such manner as to prevent effective contact with those not so exposed.

     (25) "School" means a facility for programs of education as defined in RCW 28A.210.070 (preschool and kindergarten through grade twelve).

     (((22))) (26) "Sexually transmitted disease (STD)" means a bacterial, viral, fungal, or parasitic disease or condition which is usually transmitted through sexual contact, including:

     (a) Acute pelvic inflammatory disease;

     (b) Chancroid;

     (c) Chlamydia trachomatis infection;

     (d) Genital and neonatal herpes simplex;

     (e) Genital human papilloma virus infection;

     (f) Gonorrhea;

     (g) Granuloma inguinale;

     (h) Hepatitis B infection;

     (i) Human immunodeficiency virus infection (HIV) and acquired immunodeficiency syndrome (AIDS);

     (j) Lymphogranuloma venereum;

     (k) Nongonococcal urethritis (NGU); and

     (l) Syphilis.

     (((23))) (27) "Spouse" means any individual who is the marriage partner of an HIV-infected individual, or who has been the marriage partner of the HIV-infected individual within the ten-year period prior to the diagnosis of HIV-infection, and evidence exists of possible exposure to HIV.

     (((24))) (28) "State health officer" means the person designated by the secretary of the department to serve as statewide health officer, or, in the absence of such designation, the person having primary responsibility for public health matters in the state.

     (((25))) (29) "Suspected case" ((means a person whose diagnosis is thought likely to be a particular disease or condition with suspected diagnosis based on signs and symptoms, laboratory evidence, or both)) or "suspected to be infected" means the local health officer, in his or her professional judgment, reasonably believes that infection with a particular infectious agent is likely based on signs and symptoms, laboratory evidence, or contact with an infected individual, animal, or contaminated environment.

     (((26))) (30) "Veterinarian" means an individual licensed under provisions of chapter 18.92 RCW, veterinary medicine, surgery, and dentistry and practicing animal health care.

[Statutory Authority: RCW 43.20.050. 00-23-120, § 246-100-011, filed 11/22/00, effective 12/23/00. Statutory Authority: RCW 70.24.022, [70.24].340 and Public Law 104-146. 97-15-099, § 246-100-011, filed 7/21/97, effective 7/21/97. Statutory Authority: Chapter 70.24 RCW. 93-08-036 (Order 354B), § 246-100-011, filed 4/1/93, effective 5/2/93. Statutory Authority: RCW 43.20.050 and 70.24.130. 92-02-019 (Order 225B), § 246-100-011, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.20.050. 91-02-051 (Order 124B), recodified as § 246-100-011, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 70.24 RCW. 89-07-095 (Order 325), § 248-100-011, filed 3/22/89; 88-17-057 (Order 317), § 248-100-011, filed 8/17/88. Statutory Authority: RCW 43.20.050. 88-07-063 (Order 308), § 248-100-011, filed 3/16/88; 87-11-047 (Order 302), § 248-100-011, filed 5/19/87.]

OTS-5882.2

AMENDATORY SECTION(Amending WSR 00-23-120, filed 11/22/00, effective 12/23/00)

WAC 246-101-505   Duties of the local health officer or the local health department.   Local health officers or the local health department shall:

     (1) Review and determine appropriate action for:

     (a) Each reported case or suspected case of a notifiable condition;

     (b) Any disease or condition considered a threat to public health; and

     (c) Each reported outbreak or suspected outbreak of disease, requesting assistance from the department in carrying out investigations when necessary; ((and

     (d) Instituting disease prevention and infection control, isolation, detention, and quarantine measures necessary to prevent the spread of communicable disease, invoking the power of the courts to enforce these measures when necessary.))

     (2) Establish a system at the local health department for maintaining confidentiality of written records and written and telephoned notifiable conditions case reports;

     (3) Notify health care providers, laboratories, and health care facilities within the jurisdiction of the health department of requirements in this chapter;

     (4) Notify the department of cases of any condition notifiable to the local health department (except animal bites) upon completion of the case investigation;

     (5) Distribute appropriate notification forms to persons responsible for reporting;

     (6) Notify the principal health care provider:

     (a) If possible, prior to initiating a case investigation by the local health department; and

     (b) For HIV infection, not contact the HIV-infected person directly without considering the recommendations of the principal health care provider on the necessity and best means for conducting the case investigation, unless:

     (i) The principal health care provider cannot be identified; or

     (ii) Reasonable efforts to reach the principal health care provider over a two-week period of time have failed;

     (7) Allow laboratories to contact the health care provider ordering the diagnostic test before initiating patient contact if requested and the delay is unlikely to jeopardize public health;

     (8) Conduct investigations and institute control measures ((consistent with those indicated in the seventeenth edition, 2000 of Control of Communicable Diseases Manual, edited by James Chin, published by the American Public Health Association (copy is available for review at the department and at each local health department), except:

     (a) When superseded by more up-to-date measures; or

     (b) When other measures are more specifically related to Washington state)) in accordance with chapter 246-100 WAC;

     (9) The local health department may negotiate alternate arrangements for meeting the reporting requirements under this chapter through cooperative agreement between the local health department and any health care provider, laboratory or health care facility;

     (10) Each local health officer has the authority to:

     (a) Carry out additional steps determined to be necessary to verify a diagnosis reported by a health care provider;

     (b) Require any person suspected of having a reportable disease or condition to submit to examinations required to determine the presence of the disease or condition;

     (c) Investigate any case or suspected case of a reportable disease or condition or other illness, communicable or otherwise, if deemed necessary;

     (d) Require the notification of additional conditions of public health importance occurring within the jurisdiction of the local health officer.

[Statutory Authority: RCW 43.20.050. 00-23-120, § 246-101-505, filed 11/22/00, effective 12/23/00.]

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