A. Health Officer Authority and Orders.
- Health officer authority. Each health officer is invested with full powers of inspection, examination, treatment, and quarantine or isolation of all persons known to be infected with tuberculosis in an infectious stage or persons who have been previously diagnosed as having tuberculosis and who are under medical orders for treatment or periodic follow-up examinations and is hereby directed:
- To make such examinations as are deemed necessary of persons reasonably suspected of having tuberculosis in an infectious stage and isolate and treat or isolate, treat, and quarantine such persons whenever deemed necessary for the protection of the public health. RCW 70.28.031(a).
- To make such examinations as are deemed necessary of persons who have been previously diagnosed as having tuberculosis and who are under medical orders for periodic follow-up examinations. RCW 70.28.031(b).
- To follow local rules and regulations regarding examinations, treatment, quarantine, or isolation, and all rules, regulations, and orders of the state board of health and of the state department of health in carrying out examination, treatment, quarantine, or isolation. RCW 70.28.031(c).
- Examination or treatment. Whenever the health officer determines on reasonable grounds that an examination or treatment of any person is necessary for the protection of the public health, he or she shall make an examination order in writing, setting forth:
i. The name of the person to be examined;
ii. The time and place of the examination;
iii. The treatment; and
iv. Such other terms and conditions as necessary to protect the public health. RCW 70.28.031(d).
- Treatment, isolation, or quarantine. Whenever the health officer determines that treatment, isolation, or quarantine, is necessary for the protection of the public health, he or she shall make an order in writing, setting forth:
i. The name of the person;
ii. The period of time during which the order shall remain effective;
iii. The place of treatment, isolation, or quarantine; and
iv. Such other terms and conditions as necessary to protect the public health. RCW 70.28.031(e).
- Service of orders. A copy of the order shall be served upon the person named in the order. RCW 70.28.031(f).
- Right to choose physician. A person is not prevented from receiving examination or treatment from a physician of his or her choice under terms and conditions that the health office shall determine on reasonable grounds to be necessary to protect the public health. RCW 70.28.031(d).
- Right to rely on spiritual means. The right of any person to rely exclusively on spiritual means is not abridged, nor may a person be prohibited from isolation or quarantine in a private place of choice provided it is approved by the local health officer. RCW 70.28.031(i).
- Violation of orders.
i. Notice to prosecuting attorney. Upon receipt of information that an order has been violated, the health officer shall advise the prosecuting attorney of the county in which the violation occurred, in writing, and shall submit to the prosecuting attorney information relating to the order and violations thereof. RCW 70.28.031(g).
ii. Misdemeanor. A violation of an order of a health officer directing treatment, isolation, or examination, is a misdemeanor. A person convicted may be ordered confined until the order of the health officer is complied with but not to exceed six months. Alternatively, the court may place the person upon probation for a period not to exceed two years. RCW 70.28.033.
B. Involuntary Detention.
- In whom powers vested.
- State Board of Health authority to adopt rules. The State Board of Health shall adopt rules establishing requirements for due process standards for health officers exercising their authority to involuntarily detain, test, treat, or isolate persons with suspected or confirmed tuberculosis under RCW 70.28.031 and 70.05.070. The standards are to provide for release from involuntary detention, testing, treatment, or isolation as soon as the health officer determines that the patient no longer represents a risk to the public's health. RCW 70.28.032.
- Local health officer authority to implement isolation and quarantine. The State Board of Health has adopted rules containing procedures for local health officers to initiate involuntary detention. See generally WAC 246-170-051 to -065.
- Reasonable efforts to obtain voluntary compliance. The local health officer shall make reasonable efforts to obtain voluntary compliance with requests for examination, testing, and treatment prior to initiating the procedures for involuntary detention. WAC 246-170-051(1).
C. Types of Detention.
- Emergency detention.
- Basis for local health officer to initiate. The local health officer may initiate detention if he or she has reason to believe that:
i. A person is a suspected case and has failed to comply with a documented request from a health care practitioner or the local health officer to submit to examination and testing;
ii. A person with confirmed tuberculosis is failing to comply with an individual treatment plan approved by the local health officer;
iii. A person is either a suspected or confirmed case and is failing to comply with infection control directives issued by the local health officer; or
iv. A person is a suspected or confirmed case based upon generally accepted standards of medical and public health science. WAC 246-170-051(2).
- Alternative procedures for emergency detention. The local health officer may:
i. Detain the person;
ii. Cause the person to be detained by written order; or
iii. Petition the superior court ex parte for an order to take the person into emergency detention. Id.
- Notice at time of detention. At the time of detention the person detained shall be given the following written notice.
NOTICE: You have the right to a superior court hearing within seventy-two hours of detention, excluding holidays and weekends. You have the right to legal counsel. If you are unable to afford legal counsel, then counsel will be appointed for you at government expense and you should request the appointment of counsel at this time. If you currently have legal counsel, then you have an opportunity to contact that counsel for assistance.
You have the right to contest the facts alleged against you, to cross-examine witnesses, and to present evidence and witnesses on your behalf.
You have a right to appeal any decision made by the court.
You may be given appropriate TB medications only on your informed consent, or pursuant to a court order.
- Continued detention.
i. Timing. Within one (1) judicial day of initial detention, the local health officer shall file with the superior court in the county of detention a petition for detention. WAC 246-170-051(4).
ii. Contents. The petition shall specify:
(A) The basis for the local health officer's belief that the respondent is either a suspected or confirmed case; including the name, address and phone numbers of the persons whom the health officer expects to testify and the medical tests and records relied upon by the local health officer;
(B) The specific actions taken by the local health officer to obtain voluntary compliance with recommended examination and testing or treatment;
(C) The nature and duration of further detention or other court-ordered action that the local health officer believes is necessary in order to assure that the respondent is appropriately tested or treated;
(D) The basis for believing that further detention or other court-ordered action is necessary to protect the public health; and
(E) Other information the local health officer believes is pertinent to the proper resolution of the petition. Id.
iii. Service. The health officer shall serve a copy of the petition on the individual named therein at the time of the detention. If the person informs the health officer that he or she is represented by legal counsel, service on such counsel shall be made by delivering a copy of the petition to the attorney's office no later than the time of filing the petition. WAC 246-170-051(5).
i. Timing. The superior court shall hold a hearing on a petition for detention within seventy-two (72) hours of initial detention, excluding weekends and holidays. WAC 246-170-055(1).
ii. Burden of proof. The local health officer shall have the burden of proving the allegations in the petition by a preponderance of the evidence. Id.
iii. Rights of respondent. The person named in the petition shall have the right to cross-examine witnesses, present evidence, and be represented by an attorney. If the person is indigent and requests appointment of legal counsel, legal counsel shall be appointed at public expense at least twenty-four (24) hours prior to the superior court hearing. Id.
iv. Court action at conclusion of hearing. At the conclusion of the hearing, the court shall consider the evidence, the action taken by the health officer to secure voluntary compliance by the patient, and the purpose and intent of the public health laws, and may take one of the following actions:
(A) Suspected case. If the court finds that the respondent is a suspected case, the court may enter an order requiring further examination, testing, and treatment. If the court finds that further detention is necessary in order to assure that the examination, testing, and treatment occurs, or to protect the public health, the court may order detention for an additional period not to exceed forty-five (45) days. The results of testing shall be provided to the court and the person detained as soon as they are available. The court may conduct an additional hearing. WAC 246-170-055(2)(a).
(B) Confirmed case / less restrictive measures. If the court finds that a person is a confirmed case, that further measures less restrictive than detention are necessary to assure appropriate treatment, and that less restrictive measures will be sufficient to protect the public health, the court may enter an order setting forth such measures. WAC 246-170-055(2)(b).
(C) Confirmed case / detention. If the court finds that a person is a confirmed case, that further detention is necessary to protect the public health, and that less restrictive measures will not be sufficient to protect the public health, the court may enter an order for detention for an additional period not to exceed forty-five (45) days. WAC 246-170-055(2)(c).
(D) Insufficient evidence. If the court finds that there is insufficient evidence to support the petition for detention, the court shall immediately release the person detained. WAC 246-170-055(2)(d).
- Additional period(s) of continued detention. The court may extend a period of court-ordered detention for additional periods not to exceed one hundred eighty (180) days each following a hearing. As an alternative to extending the period of detention, the court may order less restrictive measures if they are sufficient to protect the public health. WAC 246-170-055(4).
- Release from detention. A person detained may be released prior to the expiration of court-ordered detention if less restrictive measures are sufficient to protect the public health. The court may impose conditions on the release as the court finds necessary to protect the public health. A person detained may petition the court for release based upon new evidence or a change in circumstances. WAC 246-170-055(3).
- Failure to complete treatment after release from detention. If a person has been released from detention and fails to comply with the prescribed course of treatment, the health officer where the individual is found may detain the person, and any court having jurisdiction of the person may order the person detained for an additional period or periods, not to exceed one hundred eighty (180) days each, as the court finds necessary to protect the public health. WAC 246-170-055(5).
- Detention in other county. If a person has been detained in a county other than the county in which the court that originally ordered the detention is located, venue may remain in the original county, or may be transferred to the county of detention. Change in venue may be sought either by the local health officer in the original county or in the county of detention, or by the person detained. Except as otherwise agreed between the original health officer and the health officer in the county of detention, the original health officer retains jurisdiction over the detained person, including financial responsibility for costs incurred in implementing and continuing the detention. WAC 246-170-055(6).
- Rights of respondent at hearings. Court orders shall be entered only after a hearing at which the respondent is accorded the same rights as at the initial hearing on the petition for detention. WAC 246-170-055(7).
- Notice to transporting law enforcement agency and receiving facility. When a court order for detention is issued, the transporting law enforcement agency and the receiving facility shall be informed of the infectious TB status of the person prior to the transport. Disclosure shall be accompanied by a statement in writing which includes the following or substantially similar language: "This information has been disclosed to you from records whose confidentiality is protected by state law. State law prohibits you from making any further disclosure of it except as authorized by state law." WAC 246-170-055(8).
- Initiation of testing or treatment of detained persons. If a person has been detained, the health officer may begin testing or treatment, with informed consent, or pursuant to a court order as appropriate, pending the required hearing. WAC 246-170-061.
- Not applicable to persons already detained. The provisions for involuntary testing, treatment, and detention do not apply to persons who have been detained to the custody of a penal institution, a mental health facility, or another public or private institution. WAC 246-170-065.