2003 Legislative Compendium: Public Health

[ Immunizations | Border Health | Child and Adolescent Health | Bioterrorism/Public Health Preparedness | Public Health Prevention ]

In the early 1990s, Texas launched a massive immunization program, Shots Across Texas. The campaign, which TMA strongly backed, helped boost the state's immunization rates for children and improve public health. The campaign lasted only a few years, however, and without a focused, statewide educational effort on the importance of immunizations in preventing serious childhood illnesses, Texas' immunization rates again fell behind, plummeting to 50th in the nation. Today, Texas' immunization rates hover at 43rd. Outbreaks of pertussis, measles, and other contagious illnesses have been common in recent years. To reverse this trend, TMA placed a high priority during the 78th legislative session on enacting legislation to reinstate a statewide immunization campaign. TMA also advocated legislation to simplify the state's immunization registry, ImmTrac. The current registration process is so cumbersome that many physicians do not want to participate. TMA worked closely with the Texas Pediatric Society (TPS) to coordinate message and advocacy efforts.

TMA scored big on its public health legislative goals, passing all the bills it set out to accomplish. A last-minute amendment to another bill, House Bill 2292, smudged TMA's otherwise flawless record. Sen. Craig Estes (R-Wichita Falls) attached a "conscientious objector" (CO) amendment to HB 2292 on the Senate floor with no discussion with local physicians, TMA, or the pediatric society. The antiimmunization group PROVE - Parents for Responsible and Open Vaccine Education - pushed vigorously for the language. Since the bill already had cleared the House, the only opportunity to fix organized medicine's concerns with the amendment was in conference committee. TMA, again working closely with TPS, did soften the language in conference (see description below), yet in the end, the association was unable to repeal the objectionable provision.

While immunizations were the top public health priority for TMA, medicine also worked on scores of other public health bills. New legislation will improve nutrition education for children, the state's preparedness for a bioterrorist attack, and data collection for newborn hearing testing and birth defects.

On the horizon…

TMA already is in discussions with the Texas Department of Health (TDH) to implement the statewide vaccine education project and ImmTrac improvement bill. TMA also is working closely with TPS to convey medicine's policy concerns regarding the CO language. TDH is currently drafting rules to implement the new provision by Sept. 1 of this year. TDH already has committed to collect data to evaluate the impact of the CO provision. TMA will use the data to make any necessary changes to the law in 2005.

IMMUNIZATIONS

Statewide Immunization Education Program

Senate Bill 40 by Sen. Judith Zaffirini (D-Laredo) calls on TDH to establish a continuous statewide public education program on the importance of fully immunizing children. This bill asks the department to increase coordination among public and private local, regional, and statewide entities that have an interest in immunizations.

Study of TPS Physician Education Pilot Program

SB 43 by Senator Zaffirini requires TDH shall report to the legislature the results of the Educating Physicians in Your Community pilot program operated by TPS. The report must include and analysis of the program's effect on immunization rates; a statement on the cost-effectiveness of the program; recommendations for expanding the program; and a list of possible sources to fund the program.

Immunization Awareness and Limited Liability

SB 486 by Senator Zaffirini requires TDH to develop new public-private partnerships and work with existing such partnerships to increase awareness of and support for early childhood immunizations. This bill provides for immunity from liability for persons administering vaccinations and requires all state agencies that have contact with families to develop a strategy for increasing public awareness of the need for early childhood immunizations.

Physician Education and Streamlining of VFC Enrollment Process

HB 1920 by Rep. Jaime Capelo (D-Corpus Christi) calls on TDH to convene a workgroup to develop materials and continuing medical education programs for physicians relating to immunizations and the Vaccines for Children (VFC) program. It requires TDH to streamline the VFC application process by allowing physicians to sign up for VFC on the same form they use to apply for Medicaid or the Children's Health Insurance Program and to report vaccines administered under VFC through the immunization registry. A provision in the original bill to allow providers a reasonable profit from the administration of vaccines was removed from the bill.

Immunization Registry

HB 1921 by Representative Capelo should produce a more functional statewide immunization registry. While the original intent of making the registry "opt-out" was met with considerable resistance, compromise language was developed to keep the registry as "opt-in," yet provide substantial improvements in placing the responsibility of verifying consent at the central agency. Written consent is required only one time and is valid until the child is 18 years of age. Written consent may be through electronic signature on the birth certificate, or parents may provide an immunization history directly to the registry. Withdrawal of consent may be made at any time in writing. This bill also provides immunity from liability for health care providers. The department and health care providers may use the registry for the purposes of reminder and recall for immunizations due.

Health Plan Coverage for Childhood Immunizations

HB 2922 by Rep. Kenny Marchant (R-Coppell) and SB 541 by Sen. Tommy Williams (R-The Woodlands) both require health plans to provide coverage for childhood immunizations. Specifically, HB 2922 requires a health plan to provide immunizations to children from birth through their sixth birthday for the following diseases: diphtheria, haemophilus influenza type B, hepatitis B, measles, mumps, pertussis, polio, rubella, tetanus, varicella, and any other immunizations required by law. Additionally, the bill requires HMOs to provide immunization against rotovirus. Immunizations may not be subject to a deductible, copayment, or coinsurance requirement, but health providers are not prohibited from charging for other services provided in conjunction with the administration of an immunization.

Conscientious Objection and Prohibition of Punitive Actions for Failure to Immunize

Two amendments to HB 2292, the health and human services agency reorganization bill, allow for conscientious objection in addition to religious objections for refusal to immunize, and prohibit punitive action for failure to immunize. To receive exemption from immunization, the child's parent or guardian must fill out a specified form, have it notarized, and submit it within 90 days of notarization.

BORDER HEALTH

Pilot Program to Promote and Facilitate the Operation of Diabetes Groups

HB 2692 by Rep. Ryan Guillen (D-Rio Grande City) directs the Texas Diabetes Council to develop a pilot program to promote and facilitate support groups to enable persons with diabetes to exchange information and strategies to manage the disease and obtain relevant information and education. The pilot program will be operated in no more than two border counties with a high proportion of low-income households. Not later than Dec. 1, 2004, the council shall submit a report summarizing the results of the pilot program to the governor, lieutenant governor, and speaker of the House of Representatives.

Study of Border Health Issues

Senate Concurrent Resolution 21 by Sen. Eliot Shapleigh (D-El Paso) and Rep. Norma Chavez (D-El Paso) memorializes the U.S. Congress to fund a benchmark study coordinated by the United States-Mexico Border Health Commission and conducted by universities from the border area of each of the adjoining border states. The purpose of the study should be to engage each state's health policy with respect to border health issues and goals outlined in Healthy Border 2010/Frontera Saludable 2010, a border-wide program of health promotion and disease prevention that defines an agenda for improving health in the border region. Additionally, the study should address early intervention and preventive strategies; water and wastewater issues; immunization; behavioral health issues, including nutrition and exercise; elimination of health disparities among the border population; and response to disaster and disease outbreak.

Border Health Foundation

Provisions in HB 2292 establish a Border Health Foundation to raise money from other foundations, governmental entities, and other sources to finance health programs in areas adjacent to the Mexican border.

Funds for Hospital Inpatient Services in Border Counties

HB 2292 authorizes that unclaimed lottery proceeds up to $5 million may be appropriated to provide inpatient hospital services in hospitals located in the 15 counties that compose the Texas-Mexico border.

CHILD AND ADOLESCENT HEALTH

Birth Defects Program

HB 1097 by Representative Capelo mandates the maintenance of a statewide birth defects registry and allows for both active and passive collection of birth defects information.

Child Advocacy Centers

HB 263 by Rep. Toby Goodman (R-Arlington) allows for the establishment of community-based child advocacy centers to investigate and prosecute child abuse cases, and to provide mental health and other supportive services to child abuse victims. Each center shall have a multidisciplinary team that must include at least one member of each of the following entities: law enforcement, child protective services, and a county or district attorney's office that is involved in prosecuting child abuse cases. This bill also specifies a list of persons for whom the Department of Protective or Regulatory Services is entitled to obtain criminal history information.

Childhood Lead Poisoning

HB 3264 by Bob Hunter (R-Abilene) authorizes the Texas Board of Health to adopt measures to (1) significantly reduce the incidence of childhood lead poisoning throughout Texas; (2) improve public awareness of lead safety issues and educate both property owners and tenants about practices that can reduce the incidence of lead poisoning; and (3) encourage testing of children likely to suffer the consequences of lead poisoning so that prompt diagnosis, treatment, and prevention of harm are possible.  This is significantly different from the original language of the bill that called for increasing the availability of lead-free affordable housing and a much more prescriptive education program along with prompt pay of medical, rehabilitative, and relocation measures for victims of childhood lead poisoning.

Investigation of Child Abuse

SB 669 by Sen. Steve Ogden (R-Bryan) amends the Family Code to require a joint investigation - by a peace officer and an agent of the department responsible for conducting an investigation - of immediate physical or sexual abuse of a child that could result in the death or serious harm to the child. This requirement applies to a report assigned the highest priority in accordance with department rules or a report that alleges immediate physical or sexual abuse of a child that could result in the death or serious harm to the child. This bill clarifies that physicians need report only to the department responsible for conducting an investigation, rather than having to notify law enforcement but still negates physicians' professional judgment in determining what constitutes abuse.

Change in SB 19 Provisions and Accountability

As originally written, SB 1357 by Sen. Jane Nelson (R-Flower Mound) would have significantly improved school districts' accountability by requiring them to collect certain data items in the Public Education Information Management System (PEIMS) Report to the Texas Education Agency regarding activities of the district's school health advisory committee. As a result of the bill having been gutted, however, the legislation now only requires school districts to make available for reasonable public inspection (1) items regarding policies related to the 135 minutes of physical activity per week outlined in SB 19, (2) the number of times the school health advisory committee met, (3) whether the district has policies related to compliance with limited access to vending machines, (4) and whether the district has policies related to tobacco use on school campuses or at school-sponsored or school-related activities. This bill changes SB 19's language requiring the adoption of a coordinated school health program to that requiring "one or more" coordinated school health programs and adds to the duties of the school health advisory committee integration of additional strategies into the curriculum: (1) school health services, (2) counseling and guidance services, (3) a safe and healthy school environment, and (4) school employee wellness. In addition, this bill negates the work of the previous Texas Education Agency (TEA) Statewide School Health Coalition (in which TMA participated) by establishing criteria for the selection of a coordinated school health program that TEA is to provide to school districts for adoption. Prior to establishing criteria for selection, TEA must request review and comment by the TDH School Health Advisory Committee. (TMA has a representative on this committee.)

Youth Camp Safety

The original language in SB 253 by Sen. Todd Staples (R-Palestine) was clarified in the finally passed version to exempt youth camps operated on facilities or campuses of institutions of higher education from regulation under the Texas Youth Camp Safety and Health Act if the camp is regularly inspected by one or more local governmental entities for compliance with health and safety standards.

Statistical and Aggregated Information Regarding Newborn Hearing Loss Screening

As finally passed, SB 739 by Sen. Rodney Ellis (D-Houston) establishes that statistical or aggregated information that is about activities conducted by the screening program for hearing loss in newborns and that cannot be used to individually identify a newborn, infant, or patient, or a parent or guardian of a newborn, infant, or patient is not confidential.

Cardiopulmonary Resuscitation Certification in School Personnel

SB 741 by Sen. Leticia Van de Putte (D-San Antonio) adds the head director of a school marching band to the list of school district employees who must maintain current certification in first aid and cardiopulmonary resuscitation.

Death of or Injury to an Unborn Child

SB 319 by Sen. Ken Armbrister (D-Victoria) expands the definition of "individual" to include an unborn child at every stage of gestation from fertilization until birth; and the definition of "death" to include, for an individual who is an unborn child, the failure to be born alive. This bill provides penalties for injury to or causing the death of an unborn child. Specifically exempt from the provisions of this bill, are (1) conduct committed by the mother of the unborn child, (2) a lawful medical procedure performed by a licensed physician or other licensed health care professional with requisite consent, and (3) the dispensation or administration of a drug prescribed in accordance with law. Additionally, the prosecutor must present medical or other evidence to prove that the mother was pregnant at the time of the injury to or death of the unborn child.

School Nutrition

SB 474 by Sen. Eddie Lucio (D-Brownsville), which addresses the problem of childhood obesity in the state of Texas, has been reduced to the creation of an interim joint committee to conduct hearings and study issues related to nutrition in school-age children. This committee's charge is to determine the nutritional content of food served to public school children, evaluate the impact of obesity among public school children, assess the value of a universal breakfast and lunch program in public schools, and evaluate school contracts related to competitive food products and vending machines.

Expulsion of Students for Criminal Acts Against Another Person

HB 567 by Rep. Leo Berman (R-Tyler) authorizes expulsion of students who commit a criminal act at school or at school-related or school-sponsored events for specified reasons. These conditions include false alarms, reports, and terrorist threats as well as assault, murder, attempted murder, possession of controlled substances, robbery, etc.

Nutrition in Schools Study

Senate Concurrent Resolution 49 by Senator Lucio calls for the study delineated in his bill SB 474 on nutrition among public school children.

BIOTERRORISM/PUBLIC HEALTH PREPAREDNESS

Homeland Security

HB 9 by Rep. Kino Flores (D-Mission) requires the governor to develop a statewide homeland security strategy to coordinate activities among local, state, and federal agencies and the private sector. It specifies membership of the Critical Infrastructure Protection Council and allows the governor to appoint special advisory committees to assist the council in the performance of its duties.

This bill:

Provides immunity from liability to anyone performing an activity under its provisions;

Requires the governor to allocate available grants and other funding related to homeland security;

Specifies the types of information to be held confidential, including information related to emergency response providers, risk or vulnerability assessment, construction or assembly of weapons, certain encryption codes and security keys for communications systems, information provided to the United States, critical infrastructure, and security systems;

Specifies conditions for disclosure of confidential information;

Establishes a Texas Infrastructure Protection Communications Center within the Department of Public Safety (DPS);

Provides for supplemental "mission-ready" volunteer military forces in addition to the Texas National Guard for use by the state in homeland security and community service activities;

Establishes Sept. 11 as Texas First Responders Day;

Amends the list of professionals required to report suspected communicable diseases to include emergency medical service personnel, peace officers, and firefighters;

Requires pharmacists to report to the TDH any unusual or increased prescription rates, unusual types of prescriptions, or unusual trends in pharmacy visits that may be caused by bioterrorism, epidemic, or pandemic disease, or novel and highly fatal infectious agents or biological toxins that might pose a substantial risk of a significant number of human fatalities or incidents of permanent or long-term disability; and

Requires veterinarians, veterinary diagnostic laboratories, or persons having care, custody, or control of animals to report specific suspected disease conditions among livestock, exotic livestock, bison, domestic fowl, or exotic fowl.

Area Quarantine

HB 627 by Rep. Elvira Reyna (R-Mesquite) authorizes the establishment of area quarantine in response to the introduction of an environmental or toxic agent into the environment. This bill also provides for penalties to be levied against anyone who knowingly fails or refuses to obey instructions under quarantine.

Use of Drivers License Information

HB 2292 authorizes, in the event of an emergency or epidemic, the release of information from the DPS drivers license records pertaining to name, date of birth, and most recent address in order to notify persons in need of immunization or diagnostic, evaluation, and treatment for suspected communicable diseases.

Release of Information to Law Enforcement Personnel

HB 2292 authorizes, in the event of an emergency or epidemic, the release of records, reports, and information regarding suspected cases of communicable diseases and certain health conditions to law enforcement personnel.

Right of Entry or Access

HB 2292 allows for right of entry or access for the purpose of inspection or investigation related to the possible transmission of communicable diseases and allows for penalties for concealment or denial of access.

Public Health Disaster Control Measures

HB 2292 establishes authorization of control measures in the event of a public health disaster. Control measures may include immunization, detention, restriction, disinfection, decontamination, isolation, quarantine, disinfestation, chemoprophylaxis, preventive therapy, prevention, and education. Additionally, it provides for disposition of the human remains of a person suspected of dying from certain communicable diseases.

Continuing Medical Education for Registered Nurses

HB 1483 by Rep. Ray Allen (R-Grand Prairie) requires registered nurses to participate during each two-year licensing period in at least two hours of continuing medical education relating to preparing for, reporting medical events from, and responding to the consequences of an incident of bioterrorism.

PUBLIC HEALTH PREVENTION

Use of Tobacco Fund Dollars

HB 2292 allows for permanent health and tobacco fund dollars to be spent on the following initiatives: (1) smoking cessation programs; (2) enforcement of laws pertaining to distribution and use of cigarettes and tobacco for minors; (3) public awareness and educational programs directed to youth regarding cigarettes and tobacco products; (4) preventive medical and dental services to children eligible for Medicaid; (5) developing cost-effective strategies for improved health outcomes for children and the public; (6) providing grants to local communities to address specific public health priorities including sickle cell anemia, diabetes, high blood pressure, cancer, heart attack, stroke, keloid tissues and scarring, and respiratory disease; (7) providing grants to local communities for essential public health services; (8) providing grants to schools of public health located in Texas; and (9) providing funds to Early Childhood Intervention to provide services to children with developmental delays and their families.

Statewide Health Coordinating Council

HB 2292 specifies the composition of the Statewide Health Coordinating Council.

Acanthosis Nigricans Screening Program

HB 2721 by Rep. Roberto Gutierrez (D-McAllen) expands the acanthosis nigricans screening program into Texas Education Regional Service Centers 4, 10, and 11.

Regulation and Enforcement of Certain Licensing Programs (Midwives)

SB 161 by Senator Nelson authorizes the Midwifery Board or a three-member committee of midwifery board members to suspend the letter of documentation or certification of registration of a midwife if evidence or information indicates that continued practice by a particular midwife would constitute a continuing and imminent threat to the public welfare. This bill provides for administrative, civil, and criminal penalties.

Testing for Hepatitis

SB 401 by Senator Van de Putte authorizes hospitals to take reasonable efforts to test patients who have been admitted to a hospital in case of emergency for hepatitis B or hepatitis C. If the report shows a significant risk to persons exposed, the hospital shall report the results to TDH or the local health authority to notify the patient and any public safety personnel (emergency medical service, firefighter, peace officer, first responder) who may have been exposed accidentally to the body fluids of the patient. The organization that employs the person or for which the person provides volunteer services for assistance is responsible for paying for the test. The hospital is under no obligation to perform any further services.

Nonresident Admittance to State Chest Hospitals

SB 1024 by Sen. Frank Madla (D-San Antonio) allows the state to enter into an agreement with other states for the admission of nonresident patients with tuberculosis to a Texas chest hospital if space is available after the needs of eligible state residents are met and the other state is responsible for paying all costs of the hospitalization and treatment under the agreement. This bill also authorizes commitment of persons through foreign court orders under the same type of contractual agreement.

Tattoos and Body Piercing

Originally, SB 1317 by Senator Van de Putte required tattoo artists and persons who perform body piercing to complete a specified number of hours of training offered by the Occupational Safety and Health Administration. As passed, the bill calls for regulation of tattooists, persons performing body piercing, tattoo studios, and certain body piercing studios. The bill also prohibits the performance of tongue splitting and provides penalties for noncompliance with regulations. In addition, a person under 18 years of age may obtain a tattoo only in order to cover up a previous tattoo that is inappropriate and must have parental consent for the procedure. The state agency responsible for regulating these operators and facilities must prepare or approve a training course for persons involved in performing these procedures sufficient to meet the requirements for application for registration.

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