Example of Declaration of Disease Control Officer in Hypothetical TB Case

I, xxxxxxx, , declare as follows:

1. I am over the age of eighteen and make this declaration based upon my own personal knowledge, and after personally reviewing the records of this office concerning Respondent.

2. I am a licensed physician in the State of Washington, and the Tuberculosis Control Officer and Director of the Tuberculosis Control Program for the Seattle-King County Department of Public Health. I am responsible for programs to control tuberculosis within King County pursuant to chapter 70.28 RCW and chapter 246-170 WAC.

3. Tuberculosis (TB) is a respiratory illness. It is transmitted when an infectious person expels airborne droplets that are inhaled into the lungs of an exposed person. TB usually remains dormant and latent in an exposed person. A person with latent TB does not have symptoms and is not infectious to other people. TB can become active, however, especially in persons with weakened immune systems. Impaired immune systems can result from poor health and abuse of alcohol or illicit drugs. A person with active infectious TB may develop symptoms and deteriorate if not treated. Treatment for drug-sensitive TB consists of a six- to nine-month course of medication. Medications can be taken twice weekly after the initial two weeks of a daily regimen, although a client could choose to take smaller dosages daily because of the number of pills. A new client typically starts on a medication schedule of seven days per week, with Directly Observed Therapy (DOT) on weekdays and self-administration on weekends. In DOT, the client is observed ingesting the medication.

4. Persons with active TB often are infectious during the first two to eight weeks of treatment and then non-infectious for the duration of the treatment. In a small portion of cases with severe TB, infectiousness can continue beyond eight weeks. Preliminary indication of infectiousness is based on results of follow-up sputum smear examinations. Persons with active TB are considered infectious until they have received at least two weeks of treatment and have three consecutive negative sputum smears.

5. Even after a person is considered non-infectious, the entire course of treatment must be completed. A person likely will become infectious again if treatment is interrupted. Furthermore, when TB resurges, it may become a multi-drug resistant strain. Persons with multi-drug resistant TB have a higher mortality rate, stay infectious for longer periods of time, and require at least 18 to 24 months of treatment. Multi-drug resistant strains can be transmitted during the infectious stage. Multi-drug resistant strains can be confirmed only in cultures grown from sputum, not in sputum smears. Cultures are grown from sputum collections, which takes up to ten weeks to provide the final results.

6. The Respondent, xxxxxxxx, is a confirmed case of TB. The xxxxxxx Hospital laboratory reported a positive bacteriologic culture for mycobacterium tuberculosis on January _____, 2006.

7. The Respondent was registered with the PHSKC Tuberculosis Control Program on January _______, 2006. She signed the “Counseling for Directly Observed Therapy (DOT) for Tuberculosis.” xxxxxxx was assigned as her Nursing Case Manager (NCM). The Respondent was discharged from xxxxxx Hospital on January _____, 2006.

8. My designees and I have made repeated and reasonable efforts to obtain Respondent’s voluntary compliance with requests for examination and treatment.

9. Beginning January _____10, 2006, Outreach Worker (ORW) administered DOT to the Respondent at her apartment. On January _____, 2006, the Respondent signed the “Acknowledgement of Tuberculosis Counseling.” The Respondent received all scheduled doses through February ______, 2006.

10. On February _______, 2006, the ORW xxxxxxx could not locate the Respondent at her apartment. From February______, 2006, through March _____, 2006, the Respondent was not available for DOT. On March 10, 2006, the Respondent told the ORW that she had been on a drinking binge.

11. From March ______, 2006, through April _____, 2006, the Respondent was generally compliant with the DOT requirement.

12. From April ______, 2006, through April _______, 2006, the Respondent was not available for DOT. On April ______, 2006, ORW located the Respondent, but she refused to take the medication.

13. ORW located Respondent at her apartment on April _____, 2006, and she was intoxicated. The Respondent then missed appointments on April _____, _____, and _____, 2006. On May _______, 2006 ORW brought the Respondent to the TB Clinic. I delivered a Public Health Directive to the Respondent, directing her to comply with treatment requirements and refrain from use of alcohol. Since that date Respondent has not been available for DOT.

14. I cannot predict when the Respondent will no longer be infectious. The Respondent’s sputum smears should be tested once a week, and there must be three consecutive negative tests before the Respondent will be considered non-infectious. Until then, the Respondent must remain isolated.

15. I believe that the following detention or other measure(s) is necessary in order to ensure that Respondent is appropriately tested or treated: (1) isolation for the 72-hour period permitted by WAC 246-170-051 at a location approved by PHSKC; (2) continued isolation as needed and treatment for the 45-day period permitted by WAC 246-170-055 at a location approved by PHSKC; and (3) continued testing, monitoring and treatment determined necessary by myself and my designees. The Respondent may go outside if she wears a mask. PHSKC will provide a room at the designated motel, delivery of groceries, and DOT on weekdays.

16. I believe that detention or other measure(s) is necessary because Respondent must be considered to be infectious, and has demonstrated her unwillingness to comply with voluntary measures for treatment and to prevent the spread of TB to others.

17. I request that the Court order:

    (1) Respondent’s detention for the 72-hour period permitted by WAC 246-170-051, excluding weekends and holidays, to occur at: See Sealed Data, filed with the Court.

    (2) Respondent’s continued detention or the imposition of less restrictive measures for the additional 45-day period permitted by WAC 246-170-055, to occur at: See Sealed Data, filed with the Court.

18. I further request that the Court order Respondent to comply with examination, testing, treatment, and infection control directives determined necessary by myself and my designees. I do not request an order for compelled testing and treatment.

19. Testimony concerning this case will be received primarily from the following persons:

    1. xxxxx, Tuberculosis Control Officer and Director
       Tuberculosis Control Program
       Harborview Medical Center
       325 9^th Avenue, Box 359776
       Seattle, WA 98104

    2. xxxxxx, Nursing Case Manager
       Tuberculosis Control Program
       Harborview Medical Center
       325 9^th Avenue, Box 359776
       Seattle, WA 98104

    3. xxxxxx, ORW
       Tuberculosis Control Program
       Harborview Medical Center
       325 9^th Avenue, Box 359776
       Seattle, WA 98104

I declare under penalty of perjury under laws of the State of Washington that the foregoing is true and correct.

DATED this ________day of ___________________, 200____ at ______________, Washington.

By: ________________________________
Signature

Dr. ________________________________
Printed Name