Louisiana Administrative Code › Title 51 - PUBLIC HEALTH-SANITARY CODE › Part II - The Control of Diseases › Chapter 1 - Disease Reporting Requirements › Section II-121 - Special Tuberculosis Control Measures [formerly paragraph 2:014-1 and Appendix A]

Current through Register Vol. 50, No. 6, June 20, 2024
A. Louisiana is
				changing its method of treating tuberculosis due to recent recommendations of
				the federal Centers for Disease Control and Prevention as set forth in its
				Morbidity and Mortality Weekly Report, Volume 42, Issue RR-7, dated May 21,
				1993. These new and revised recommendations have become necessary because the
				majority of tuberculosis patients on daily self-administered medications do not
				comply with a full course of therapy which leads to drug resistance and
				secondary spread of the disease.
B.
				This Section contains a step-wise approach for encouraging compliance with
				treatment and for managing the non-compliant patient. The steps in the process
				begin with a voluntary patient compliance agreement, meant to spell out the
				time and place of directly-observed therapy negotiated between the healthcare
				provider and the patient and to inform the patient of the possible consequences
				of non-compliance with the course of therapy.
C. If the patient does not comply with the
				terms of this agreement, a quarantine order for directly-observed therapy
				follows. This order from the state health officer or his designee reinforces
				the need for compliance with therapy.
D. If the patient continues to be
				uncooperative, the state health officer or his designee may issue a formal
				quarantine order for hospitalization. This assigns the patient to a specific
				hospital facility for care of tuberculosis as an inpatient, with detailed
				warning of the consequences of non-compliance with therapy. It is to be noted
				that the patient must agree to be transported to the selected hospital
				facility, and to further comply with the quarantine order to remain in the
				hospital until his/her condition improves, and the patient may be discharged
				and placed under a new quarantine order for continued directly observed therapy
				treatment, as needed, outside of the hospital facility's restrictive
				environment.
E. In certain cases,
				where the OPH disease intervention specialist and supervisor anticipate that a
				given uncooperative patient will refuse to be voluntarily transported to a
				hospital facility under a formal quarantine order for hospitalization, the
				state health officer may authorize and instruct the OPH disease intervention
				specialist supervisor or other appropriate OPH official, to fill out a request
				for a court order for hospitalization, and present it to the district attorney
				in the parish wherein the patient is known to be situated. (In rare instances,
				the district attorney may see that criminal charges for violation(s) of the
				quarantine order for directly observed therapy are filed at this point, instead
				of the OPH requested civil court order).
F. It is hoped that in most instances of
				initial non-compliance with the required treatment, an uncooperative patient
				will agree to be transported to a specific hospital facility for inpatient care
				under a formal quarantine order issued by the state health officer or his
				designee, without court intervention.
G. In the event a patient under a formal
				quarantine order for hospital care becomes uncooperative within the hospital
				facility's restrictive environment, or a patient continues to be non-compliant
				with therapy after isolation/quarantine by a civil court order, the hospital
				facility or state health officer may seek to have criminal charges filed
				pursuant to
				R.S.
				40:6.B, and upon conviction, the patient may
				be sentenced to the hospital unit of a state prison and placed in the custody
				of the Department of Corrections.
H. This Section contains suggested forms with
				instructions for the steps prior to the filing of criminal charges.
I. Louisiana is following the recommendations
				of the federal Centers for Disease Control and Prevention by placing all
				tuberculosis patients initially under a voluntary program of "Directly Observed
				Therapy" pursuant to a "Patient Compliance Agreement" signed by the patient. A
				sample "Patient Compliance Agreement" form follows:
J. Tuberculosis Control Sample Form 1
VOLUNTARY PATIENT COMPLIANCE AGREEMENT
Plan of therapy
				  for______________________________________
Full Name
Date of birth_________ Social Security
				  #____________________
Whose residence is__________________________
Parish _______________ Date this regimen
				  begins______________
For the Patient: NOTE: All statements are to be read to
				  patient (or patient may read).
1. You
				are being treated for suspected tuberculosis; therefore, it is essential that
				you take your medication.
2. To
				avoid long-term isolation or quarantine, you will be expected to follow your
				drug therapy schedule. No dose of medication is to be missed.
3. State law requires that the Office of
				Public Health assist you in controlling your disease. The only way to cure your
				disease is by regular use of drug therapy.
4. The following therapy schedule requires
				that you report to __________________________________________________ on
				_______, at ________o'clock to receive your medications under supervision. The
				staff will work with you in arranging special schedules for your therapy as
				necessary. You will be expected to call and report any difficulties in keeping
				your appointments.
5. Failure to
				comply with these guidelines may result in quarantine, involuntary confinement
				to a hospital or possible criminal charges for violations of quarantine.
(If patient states any barriers to compliance, list them
				  here.)
I agree that I understand the above therapy schedule and
				  will make every effort to comply with the full course of my therapy.
Patient's
				  Signature_______________________________________
Date__________
Public Health Nurse or Disease Inter. Spec.
Copy received by patient _____________________
Patient Initials