WSR 09-11-110



[ Filed May 19, 2009, 5:14 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 08-24-036.

Title of Rule and Other Identifying Information: WAC 246-100-202 Sexually transmitted diseases -- Duties and authorities.

Hearing Location(s): The Inn at Port Hadlock, 310 Hadlock Bay Road, Port Hadlock, WA 98339, phone (360) 385-7030, toll free 800-785-7030,, on July 8, 2009, at 1:30 p.m.

Date of Intended Adoption: July 8, 2009.

Submit Written Comments to: Bat-Sheva Stein, Department of Health, P.O. Box 47880, Olympia, WA 98504, web site, fax (360) 586-7868, by July 1, 2009.

Assistance for Persons with Disabilities: Contact Bat-Sheva Stein by June 8, 2009, TTY (800) 833-6388 or 711.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The revisions to this rule are necessary to prevent ophthalmia neonatorum in newborns. The proposed rule revision would: (1) Revise WAC 246-100-202 [(1)](e) to list medications in the rule so they reflect current practice; (2) incorporate the treatment options within subsection (1)(e) of WAC 246-100-202, and (3) instruct the healthcare provider to document the refusal in the newborn's medical record.

Reasons Supporting Proposal: The proposed revision will update the rule to reflect current medications that are being administered to newborns to prevent ophthalmia neonatorum, and incorporating the treatment section within the rule will make it easier for those wishing to reference the treatment. The proposed rule also adds language that instructs healthcare providers to document when parents or legal guardians refuse the treatment. This will provide consistent guidance to providers on what to do when parents refuse treatment.

Statutory Authority for Adoption: RCW 70.24.130.

Statute Being Implemented: RCW 70.24.130.

Rule is not necessitated by federal law, federal or state court decision.

Name of Proponent: State board of health, governmental.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Bat-Sheva Stein, 111 Israel Road S.E., Tumwater, WA 98504, (360) 236-3582.

No small business economic impact statement has been prepared under chapter 19.85 RCW. The proposed rule would not impose more than minor costs on businesses in an industry.

A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Bat-Sheva Stein, Department of Health, P.O. Box 47880, Olympia, WA 98504, phone (360) 236-3582, fax (360) 586-7868, e-mail The agency did not complete a cost-benefit analysis under RCW 34.05.328. RCW 34.05.328 (5)(b)(iii) exempts rules that adopt or incorporate by reference without material change federal statutes or regulations, the rules of other Washington state agencies, or national consensus codes that generally establish industry standards.

May 19, 2009

Craig McLaughlin

Executive Director


AMENDATORY SECTION(Amending WSR 05-11-110, filed 5/18/05, effective 6/18/05)

WAC 246-100-202   Special diseases -- Sexually transmitted diseases -- Duties and authorities.   (1) Health care providers shall:

(a) Report each case of sexually transmitted disease as required in chapter 246-101 WAC; and

(b) At each medical encounter, when providing treatment for an infectious sexually transmitted disease, provide instruction, appropriate to each patient regarding:

(i) Communicability of the disease; and

(ii) Requirements to refrain from acts that may transmit the disease to another; and

(c) Ensure completion of a prenatal serologic test for syphilis in each pregnant woman pursuant to RCW 70.24.090 including:

(i) Submitting a blood sample for syphilis to a laboratory approved to perform prenatal serologic tests for syphilis, as required in RCW 70.24.090, at the time of the first prenatal visit; and

(ii) Deciding whether or not to omit the serologic test for syphilis if the test was performed elsewhere during the current pregnancy; and

(d) When diagnosing or caring for a patient with gonococcal or chlamydial ophthalmia neonatorum, reporting the case to the local health officer or local health department in accordance with the provisions of chapter 246-101 WAC; and

(e) ((When attending or assisting in the birth of any infant or caring for an infant after birth, ensure instillation of a department-approved prophylactic ophthalmic agent into the conjunctival sacs of the infant within the time frame established by the department in policy statement of ophthalmia agents approved for the prevention of ophthalmia neonatorum in the newborn, issued June 19, 1981.)) Health care providers shall instill a prophylactic ophthalmic agent into both eyes of the newborn as prophylaxis against ophthalmia neonatorum up to two hours after the delivery, whether the delivery occurred vaginally or by Cesarean section. Acceptable ophthalmic prophylactic regimens are application of tetracycline or erythromycin. If the newborn's parent(s) or legal guardian refuses this procedure, the health care provider will document the refusal in the newborn's medical record.

(2) Laboratories, health care providers, and other persons shall deny issuance of a certificate or statement implying an individual is free from sexually transmitted disease.

(3) State and local health officers or their authorized representatives shall have authority to conduct or cause to be conducted an interview and investigation of persons infected or reasonably believed to be infected with a sexually transmitted disease.

(a) For the purpose of this section, "reasonable belief" and "reasonably believed" shall mean a health officer's belief based upon a credible report from an identifiable individual indicating another person is likely to have a sexually transmitted disease (STD) or to have been exposed to a STD;

(b) Investigations shall be conducted using procedures and measures described in WAC 246-100-036(4).

(4) Local health officers, health care providers, and others shall comply with the provisions in chapter 70.24 RCW, in addition to requirements in chapters 246-100 and 246-101 WAC.

(5) Any person who violates a rule adopted by the board for the control and treatment of a sexually transmitted disease is subject to penalty under RCW 70.24.080.

[Statutory Authority: RCW 70.24.130 and 70.24.380. 05-11-110, 246-100-202, filed 5/18/05, effective 6/18/05.]

Washington State Code Reviser's Office