W. Va. Code R. § 64-76-8 - Procedure When Patient Is a Health Menace to Others

8.1. A health care provider shall consider a patient non-adherent if the patient is unable or unwilling to report for medical examinations or is unable or unwilling to adhere to prescribed treatment, such as refusing to take medications or showing other evidence of not taking medications as prescribed, e.g., failure to cooperate with DOT, an incorrect pill count, or a urine test showing no evidence of drug metabolites.

8.2. Any health care provider who is aware of a non-adherent tuberculosis patient shall contact the local health officer for necessary interventions. The local health officer:

8.2.a. Shall meet with the patient to determine why the patient is non-adherent to therapy;

8.2.b. May request an opportunity to examine the non-adherent patient;

8.2.c. May offer the non-adherent patient a course of treatment;

8.2.d. May prescribe DOT for the non-adherent patient; and

8.2.e. May institute proceedings for involuntary commitment or emergency involuntary commitment of the non-adherent patient, if, in the judgment of the health officer, the measures are necessary to protect the public health and safety.

8.3. A patient with tuberculosis will be isolated while he or she is in a communicable stage. The patient will be restricted to his or her isolation room or primary residence until he or she is no longer infectious. The health care provider shall advise immunocompromised individuals and guardians of children of the need for them to be removed from the household, if the patient stays there while infectious.

8.4. Patients unable to adhere to therapy or isolate themselves from others, may voluntarily admit themselves to an institution equipped for the care and treatment of tuberculosis. The local health department shall assist with the admission by following protocols available at Division.

8.5. A patient who has tuberculosis demonstrated by clinical, bacteriological, radiographic or epidemiological evidence will be considered a health menace and considered for commitment to an institution equipped for the care and treatment of tuberculosis if the patient:

8.5.a. Had previous treatment for tuberculosis but failed to complete therapy for reasons unrelated to access to treatment or medication;

8.5.b. Failed to adhere to present prescribed therapy;

8.5.c. Risks infecting others because of inadequate environmental conditions for proper isolation;

8.5.d. Has laboratory tests or a history of nonadherence to anti-tuberculosis medication which indicate possible infection with drug-resistant mycobacterium tuberculosis; or

8.5.e. Has an initial infection with multidrug resistant TB (MDRTB) or extensively drug resistant TB (XDRTB).

8.6. When the local health officer determines that commitment is necessary to protect the health of the public, the local health officer, through the prosecuting attorney, shall petition the circuit court in the county where the patient is a resident for a hearing before the circuit judge to obtain an order to commit the patient to an institution equipped for the care and treatment of persons with tuberculosis. The local health officer shall personally serve notice upon the patient seven days prior to the date of the scheduled hearing.

8.7. The patient has a right to be present at the hearing and has the right to present evidence, confront witnesses and evidence against him or her, and examine testimony offered. The patient should wear a surgical mask or cover their mouth with tissue to contain possible cough secretions and reduce the risk of transmitting the disease.

8.8. The hearing should be conducted in a well-ventilated room.

8.9. If probable cause is found, the patient will be immediately committed to an institution equipped and maintained for the care and treatment of patients afflicted with tuberculosis.

8.10. If the patient being committed has a history of alcohol or other drug abuse, he or she will be committed to an institution equipped for the care and treatment of emotional health for assessment and if needed for complete detoxification, prior to commitment to an institution equipped for the care and treatment of tuberculosis.

8.11. A patient with confirmed or suspected active tuberculosis should be transported with a surgical mask covering his or her nose and mouth. The windows of the vehicle should be kept open and the heating and air-conditioning system should be set on a non-recirculating cycle. Because engineering controls cannot be ensured, personnel transporting the patient should wear respiratory protection meeting current United States Centers for Disease Control and Prevention guidelines.

8.12. Every patient committed to an institution shall observe all the rules of the institution. The patient may be placed apart from others and restrained from leaving the institution as long as he or she continues to be afflicted with tuberculosis and remains a health menace.

8.13. Nothing in this rule may be construed to prohibit any patient committed to any institution from applying to the West Virginia Supreme Court of Appeals for a review of the evidence on which the commitment was made. Nothing in this rule may be construed or operate to empower or authorize the Bureau, the Department or an authorized designee thereof or the chief medical officer of the institution, or their representatives, to restrict in any manner the individual's right to select any method of tuberculosis treatment offered by the institution.

Notes

W. Va. Code R. § 64-76-8