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Key: (1) language to be deleted (2) new language

  
    Laws of Minnesota 1993 

                        CHAPTER 167-S.F.No. 521 
           An act relating to health; permitting minors to give 
          consent for a hepatitis B vaccination; establishing 
          procedures and programs relating to tuberculosis; 
          proposing coding for new law in Minnesota Statutes, 
          chapter 144. 
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
     Section 1.  [144.3441] [HEPATITIS B VACCINATION.] 
    A minor may give effective consent for a hepatitis B 
vaccination.  The consent of no other person is required. 
    Sec. 2.  [144.441] [TUBERCULOSIS SCREENING IN SCHOOLS.] 
    Subdivision 1.  [DEFINITIONS.] As used in sections 2 to 5, 
the following terms have the meanings given them: 
    (a) "Person employed by a school or school district" means 
a person employed by a school, school district, or by an 
educational cooperative services unit as a member of the 
instructional, supervisory, or support staff including, but not 
limited to, superintendents, principals, supervisors, teachers, 
librarians, counselors, school psychologists, school nurses, 
school social workers, audiovisual directors or coordinators, 
recreation personnel, media generalists or supervisors, speech 
therapists, athletic coaches, teachers' aids, clerical workers, 
custodians, school bus drivers, and food service workers. 
    (b) "Person enrolled in a school" means a person enrolled 
in grades kindergarten through 12 and a handicapped child 
receiving special instruction and services in a school. 
    (c) "School" includes any public elementary, middle, 
secondary, or vocational center school as defined in section 
120.05, or nonpublic school, church, or religious organization 
in which a child is provided instruction in compliance with 
sections 120.101 and 120.102. 
    Subd. 2.  [DESIGNATION OF SCHOOLS.] Based on the occurrence 
of active tuberculosis or evidence of a higher than expected 
prevalence of tuberculosis infection in the population attending 
or employed by one or more schools in a school district, the 
commissioner of health may designate schools or a school 
district in which screening of some or all persons enrolled in 
or employed by the school or school district for tuberculosis is 
a necessary public health measure.  In making the designation, 
the commissioner shall also determine the frequency with which 
proof of screening must be submitted.  In determining whether 
the population attending or employed by a school or school 
district has a higher than expected prevalence of tuberculosis 
infection, the commissioner shall consider factors such as race 
or ethnicity, age, and the geographic location of residence of 
the student population; the expected background prevalence of 
tuberculosis infection in the community; and currently accepted 
public health standards pertaining to the control of 
tuberculosis. 
    Subd. 3.  [SCREENING OF STUDENTS.] As determined by the 
commissioner under subdivision 2, no person may enroll or remain 
enrolled in any school which the commissioner has designated 
under subdivision 2 until the person has submitted to the 
administrator or other person having general control and 
supervision of the school, one of the following statements: 
    (1) a statement from a physician or public clinic stating 
that the person has had a negative Mantoux test reaction within 
the past year, provided that the person has no symptoms 
suggestive of tuberculosis or evidence of a new exposure to 
active tuberculosis; 
    (2) a statement from a physician or public clinic stating 
that a person who has a positive Mantoux test reaction has had a 
negative chest roentgenogram (X-ray) for tuberculosis within the 
past year, provided that the person has no symptoms suggestive 
of tuberculosis or evidence of a new exposure to active 
tuberculosis; 
    (3) a statement from a physician or public health clinic 
stating that the person (i) has a history of adequately treated 
active tuberculosis; (ii) is currently receiving tuberculosis 
preventive therapy; (iii) is currently undergoing therapy for 
active tuberculosis and the person's presence in a school 
building will not endanger the health of other people; or (iv) 
has completed a course of tuberculosis preventive therapy or was 
intolerant to preventive therapy, provided the person has no 
symptoms suggestive of tuberculosis or evidence of a new 
exposure to active tuberculosis; or 
    (4) a notarized statement signed by the minor child's 
parent or guardian or by the emancipated person stating that the 
person has not submitted the proof of tuberculosis screening as 
required by this subdivision because of the conscientiously held 
beliefs of the parent or guardian of the minor child or of the 
emancipated person.  This statement must be forwarded to the 
commissioner. 
    Subd. 4.  [SCREENING OF EMPLOYEES.] As determined by the 
commissioner under subdivision 2, a person employed by the 
designated school or school district shall submit to the 
administrator or other person having general control and 
supervision of the school one of the following: 
    (1) a statement from a physician or public clinic stating 
that the person has had a negative Mantoux test reaction within 
the past year, provided that the person has no symptoms 
suggestive of tuberculosis or evidence of a new exposure to 
active tuberculosis; 
    (2) a statement from a physician or public clinic stating 
that a person who has a positive Mantoux test reaction has had a 
negative chest roentgenogram (X-ray) for tuberculosis within the 
past year, provided that the person has no symptoms suggestive 
of tuberculosis or evidence of a new exposure to active 
tuberculosis; 
    (3) a statement from a physician or public health clinic 
stating that the person (i) has a history of adequately treated 
active tuberculosis; (ii) is currently receiving tuberculosis 
preventive therapy; (iii) is currently undergoing therapy for 
active tuberculosis and the person's presence in a school 
building will not endanger the health of other people; or (iv) 
has completed a course of preventive therapy or was intolerant 
to preventive therapy, provided the person has no symptoms 
suggestive of tuberculosis or evidence of a new exposure to 
active tuberculosis; or 
    (4) a notarized statement signed by the person stating that 
the person has not submitted the proof of tuberculosis screening 
as required by this subdivision because of conscientiously held 
beliefs.  This statement must be forwarded to the commissioner 
of health. 
    Subd. 5.  [EXCEPTIONS.] Subdivisions 3 and 4 do not apply 
to: 
    (1) a person with a history of either a past positive 
Mantoux test reaction or active tuberculosis who has a 
documented history of completing a course of tuberculosis 
therapy or preventive therapy when the school or school district 
holds a statement from a physician or public health clinic 
indicating that such therapy was provided to the person and that 
the person has no symptoms suggestive of tuberculosis or 
evidence of a new exposure to active tuberculosis; and 
    (2) a person with a history of a past positive Mantoux test 
reaction who has not completed a course of preventive therapy. 
This determination shall be made by the commissioner based on 
currently accepted public health standards and the person's 
health status. 
    Subd. 6.  [PROGRAMS USING SCHOOL FACILITIES.] The 
commissioner may require the statements described in 
subdivisions 3 and 4 to be submitted by participants or staff of 
a program or activity that uses the facilities of a school or 
school district on a regular and ongoing basis, if the 
commissioner has determined that tuberculosis screening is 
necessary. 
    Subd. 7.  [IMPLEMENTATION.] The administrator or other 
person having general control and supervision of the school or 
school district designated by the commissioner under subdivision 
2 shall take the measures that are necessary, including the 
exclusion of persons from the premises of a school, to obtain 
the proof of screening required by subdivisions 3 and 4. 
    Subd. 8.  [ACCESS TO RECORDS.] The commissioner shall have 
access to any school or school district records, including 
health records of persons enrolled in or employed by a school or 
school district, that are needed to determine whether a 
tuberculosis screening program is necessary, or to administer a 
screening program. 
    Subd. 9.  [REPORTS.] The administrator or other person 
having general control and supervision of a school or school 
district that the commissioner has designated under subdivision 
2 shall provide the commissioner with any reports determined by 
the commissioner to be necessary to implement a screening or 
control program or to evaluate the need for further tuberculosis 
screening or control efforts in a school. 
    Subd. 10.  [WAIVER.] The commissioner may waive any portion 
of the requirements of subdivisions 3 to 9 if the commissioner 
determines that it is not necessary in order to protect the 
public health. 
     Sec. 3.  [144.442] [TESTING IN SCHOOL CLINICS.] 
    Subdivision 1.  [ADMINISTRATION; NOTIFICATION.] In the 
event that the commissioner designates a school or school 
district under section 2, subdivision 2, the school or school 
district or board of health may administer Mantoux screening 
tests to some or all persons enrolled in or employed by the 
designated school or school district.  Any Mantoux screening 
provided under this section shall be under the direction of a 
licensed physician. 
    Prior to administering the Mantoux test to such persons, 
the school or school district or board of health shall inform in 
writing such persons and parents or guardians of minor children 
to whom the test may be administered, of the following: 
    (1) that there has been an occurrence of active 
tuberculosis or evidence of a higher than expected prevalence of 
tuberculosis infection in that school or school district; 
    (2) that screening is necessary to avoid the spread of 
tuberculosis; 
    (3) the manner by which tuberculosis is transmitted; 
    (4) the risks and possible side effects of the Mantoux 
test; 
    (5) the risks from untreated tuberculosis to the infected 
person and others; 
    (6) the ordinary course of further diagnosis and treatment 
if the Mantoux test is positive; 
    (7) that screening has been scheduled; and 
    (8) that no person will be required to submit to the 
screening if he or she submits a statement of objection due to 
the conscientiously held beliefs of the person employed or of 
the parent or guardian of a minor child. 
    Subd. 2.  [CONSENT OF MINORS.] Minors may give consent for 
testing as set forth in sections 144.341 to 144.347. 
    Subd. 3.  [SCREENING OF MINORS.] Prior to administering a 
Mantoux test to a minor, the school or school district or board 
of health shall prepare a form for signature in which the parent 
or guardian shall consent or submit a statement of objection to 
the test.  The parent or guardian of a minor child shall return 
a signed form to the school or school district or board of 
health which is conducting the screening indicating receipt of 
the notice and consent or objection to the administration of the 
test.  In the event that the form with a signed consent or 
objection is not returned, the school or school district or 
board of health may undertake such steps as are reasonable to 
secure such consent or objection.  If after such steps the 
school or school district or board of health chooses to screen 
the minor without consent, it shall send a notice of intent to 
test by certified mail, restricted delivery with return receipt, 
to the address given to the school or school district by the 
parent or guardian for emergency contact of the parent or 
guardian.  The accuracy of the address shall be checked with the 
person enrolled, if possible.  Placing notice as specified in 
this subdivision shall constitute service.  Reasonable efforts 
shall be made to provide this notice in a language understood by 
the parent or guardian.  If this notice cannot be delivered or a 
form with a signed consent or objection is not returned, the 
school or school district or board of health shall check the 
permanent medical record required by section 144.29 to determine 
if the parent or guardian previously withheld consent to 
immunizations or other medical treatment because of 
conscientiously held beliefs.  If there is such a statement on 
file or if the school district otherwise has notice of such a 
statement, the school or school district or board of health 
shall not administer the Mantoux test unless the consent of the 
parent or guardian is obtained.  If there is no such statement 
in the permanent medical record or known to exist otherwise, the 
school or school district or board of health may administer the 
Mantoux test at the time and place specified in the notice 
unless medically contraindicated.  The school or school district 
or board of health shall document in the permanent medical 
record its efforts to notify the parent or guardian of the minor 
child, and its efforts to check the permanent medical records. 
    Subd. 4.  [CONSENT FOR SUBSEQUENT TESTING OR TREATMENT.] In 
the event the Mantoux test is positive, no further diagnosis of 
or treatment for tuberculosis in a minor child shall be 
undertaken without the signed consent of the parent or guardian 
of the minor child. 
    Sec. 4.  [144.443] [TUBERCULOSIS HEALTH THREAT TO OTHERS.] 
    A "health threat to others" as defined in section 144.4172, 
subdivision 8, includes a person who, although not currently 
infectious, has failed to complete a previously prescribed 
course of tuberculosis therapy, demonstrates an inability or 
unwillingness to initiate or complete, or shows an intent to 
fail to complete, a prescribed course of tuberculosis drug 
therapy, if that failure could lead to future infectiousness. 
    Sec. 5.  [144.444] [TUBERCULOSIS EMERGENCY HOLD.] 
    A temporary emergency hold under section 144.4182 may be 
placed on a person who is a health threat to others when there 
is reasonable cause to believe that the person may be 
unlocatable for the purposes of applying the procedures 
described in sections 144.4171 to 144.4186, or when medical or 
epidemiologic evidence suggests that the person is or may become 
infectious before the conclusion of court proceedings and 
appeals. 
    Sec. 6.  [144.445] [TUBERCULOSIS SCREENING IN CORRECTIONAL 
INSTITUTIONS AND FACILITIES.] 
    Subdivision 1.  [SCREENING OF INMATES.] All persons 
detained or confined for seven consecutive days or more in 
facilities operated, licensed, or inspected by the department of 
corrections shall be screened for tuberculosis with either a 
Mantoux test or a chest roentgenogram (X-ray) as consistent with 
screening and follow-up practices recommended by the United 
States Public Health Service or the department of health, as 
determined by the commissioner of health.  Administration of the 
Mantoux test or chest roentgenogram (X-ray) must take place on 
or before the seventh day of detention or confinement. 
    Subd. 2.  [SCREENING OF EMPLOYEES.] All employees of 
facilities operated, licensed, or inspected by the department of 
corrections shall be screened for tuberculosis before employment 
in the facility and annually thereafter, with either a Mantoux 
test or a chest roentgenogram (X-ray) as consistent with 
screening and follow-up practices recommended by the United 
States Public Health Service or the department of health, as 
determined by the commissioner of health. 
    Subd. 3.  [EXCEPTIONS.] Subdivisions 1 and 2 do not apply 
to: 
    (1) a person who is detained or confined in a juvenile 
temporary holdover facility, provided that the person has no 
symptoms suggestive of tuberculosis, evidence of a new exposure 
to active tuberculosis, or other health condition that may 
require a chest roentgenogram (X-ray) be performed to rule out 
active tuberculosis; 
    (2) a person who is detained or confined in a facility 
operated, licensed, or inspected by the department of 
corrections where the facility holds a written record of a 
negative Mantoux test performed on the person (i) within three 
months prior to intake into the facility; or (ii) within 12 
months prior to intake into the facility if the person has 
remained under the continuing jurisdiction of a correctional 
facility since the negative Mantoux test, provided that the 
person has no symptoms suggestive of tuberculosis, evidence of a 
new exposure to active tuberculosis, or other health condition 
that may require a chest roentgenogram (X-ray) be performed to 
rule out active tuberculosis; 
    (3) a person who is detained or confined in a facility 
operated, licensed, or inspected by the department of 
corrections where the facility has a written record of (i) a 
history of adequately treated active tuberculosis; (ii) 
compliance with currently prescribed tuberculosis therapy or 
preventive therapy; or (iii) completion of a course of 
preventive therapy, provided the person has no symptoms 
suggestive of tuberculosis, evidence of a new exposure to active 
tuberculosis, or other health condition that may require a chest 
roentgenogram (X-ray) to rule out active tuberculosis; 
    (4) a person who is detained or confined in a facility 
operated, licensed, or inspected by the department of 
corrections where the facility holds a written record of a 
negative chest roentgenogram (X-ray) (i) within six months; or 
(ii) within 12 months prior to intake in the facility if the 
person has remained under the continuing jurisdiction of a 
correctional facility since the negative chest roentgenogram 
(X-ray), provided that the person has no symptoms suggestive of 
tuberculosis, evidence of a new exposure to active tuberculosis, 
or other health condition that may require a new chest 
roentgenogram (X-ray) to rule out active tuberculosis; 
    (5) an employee with a record of either a past positive 
Mantoux test reaction or active tuberculosis who is currently 
completing or has a documented history of completing a course of 
tuberculosis therapy or preventive therapy, provided the 
employee has no symptoms suggestive of tuberculosis, evidence of 
a new exposure to active tuberculosis, or other health condition 
that may require a chest roentgenogram (X-ray) be performed to 
rule out active tuberculosis; 
    (6) an employee with a positive or significant Mantoux test 
reaction in preemployment screening who does not complete a 
course of preventive therapy may be exempt from annual Mantoux 
testing or other screening.  This determination shall be made by 
the commissioner of health based on currently accepted public 
health standards and the person's health status; and 
    (7) the commissioner may exempt additional employees or 
persons detained or confined in facilities operated, licensed, 
or inspected by the department of corrections based on currently 
accepted public health standards or the person's health status. 
    Subd. 4.  [REPORTS.] The administrator or other person 
having general control and supervision of a facility operated, 
licensed, or inspected by the department of corrections shall 
provide the commissioner with any reports determined by the 
commissioner of health to be necessary to evaluate the need for 
further tuberculosis screening or control efforts in a facility 
or facilities. 
    Subd. 5.  [WAIVER.] The commissioner may waive any portion 
of the requirements of subdivisions 1 to 4 if the commissioner 
of health determines that it is not necessary to protect the 
public health or if the screening may have a detrimental effect 
on a person's health status. 
    Sec. 7.  [REPORT.] 
    The commissioner, after consulting with representatives of 
local health departments, affected school districts, 
corrections, and medical providers shall determine the costs 
associated with tuberculosis control measures, and recommend to 
the legislature by February 1, 1994, mechanisms to provide 
adequate ongoing funding for tuberculosis control activities. 
    Sec. 8.  [EFFECTIVE DATE.] 
    Sections 1 to 5 and 7 are effective the day following final 
enactment.  Section 6 is effective January 1, 1994. 
    Presented to the governor May 11, 1993 
    Signed by the governor May 14, 1993, 1:29 p.m.

Official Publication of the State of Minnesota Revisor of Statutes