A BILL TO BE ENTITLED
AN ACT TO PROMOTE READINESS FOR AND TO IMPROVE MANAGEMENT OF A PUBLIC HEALTH THREAT THAT MAY RESULT FROM AN ACT OF TERRORISM USING nuclear, BIOLOGICAL, or CHEMICAL AGENTS AS RECOMMENDED BY THE NORTH CAROLINA PUBLIC HEALTH STUDY COMMISSION.
The General Assembly of North Carolina enacts:
SECTION 1.  Chapter 130A of the General Statutes is amended by adding the following new Article to read:
"Article 22.
"Bioterrorism.
"§ 130A-475.  Suspected terrorist attack.
(a)	If the State Health Director reasonably suspects that a public health threat may exist and that the threat may have been caused by an act of terrorism using nuclear, biological, or chemical agents, the State Health Director shall conduct an investigation. The State Health Director is authorized to:
(1)	Require any person or animal to submit to examinations and tests to determine possible exposure to the nuclear, biological, or chemical agents;
(2)	Test any real or personal property necessary to determine the presence of nuclear, biological, or chemical agents;
(3)	Order the evacuation or closure of any real property, including any building, structure, or land when necessary to investigate suspected contamination of the property. The period of closure during an investigation shall not exceed 10 calendar days. If the State Health Director determines that a longer period of closure is necessary to complete the investigation, the Director may institute an action in superior court to order the property to remain closed until the investigation is completed;
(4)	Limit the freedom of movement or action of a person or animal that is contaminated with, or reasonably suspected of being contaminated with, a chemical or nuclear agent that may be conveyed to other persons or animals, until the risk of conveyance is eliminated; and
(5)	Limit access by any person or animal to an area or facility that is contaminated with, or reasonably suspected of being contaminated with, a chemical or nuclear agent that may be conveyed to other persons or animals.
(b)	If the State Health Director determines that there exists a public health threat that may have been caused by an act of terrorism using nuclear, biological, or chemical agents, the State Health Director shall notify the Secretary of Crime Control and Public Safety.
(c)	Nothing in this section shall limit any authority otherwise granted to local or State public health officials under this Chapter."
SECTION 2.(a)  G.S. 130A‑149, "Biological Agents Registry; Rules; Penalties," is recodified as G.S. 130A‑476.
SECTION 2.(b)  G.S. 130A‑29(c)(10) reads as rewritten:
"(10)	Pertaining to the biological agents registry in accordance with 
 G.S. 130A-476."
SECTION 3.  G.S. 166A‑5(2) is amended by adding a new sub-subdivision to read:
"c1.	To coordinate with the State Health Director to amend or revise the State Emergency Operations Plan regarding public health matters. At a minimum, the revisions to the Plan shall provide for the following:
1.	The epidemiologic investigation of a known or suspected threat caused by nuclear, biological, or chemical agents;
2.	The examination and testing of persons and animals that may have been exposed to a nuclear, biological, or chemical agent;
3.	The procurement and allocation of immunizing agents and prophylactic antibiotics;
4.	The allocation of the National Pharmaceutical Stockpile;
5.	The appropriate conditions for quarantine and isolation in order to prevent further transmission of disease;
6.	Immunization procedures; and
7.	The issuance of guidelines for prophylaxis and treatment of exposed and affected persons."
SECTION 4. G.S. 130A‑133(4) reads as rewritten:
"(4)	"Quarantine authority" means the authority to limit the freedom of movement or action of persons or animals which have been exposed to or are reasonably suspected of having been exposed to a communicable disease or communicable condition for a period of time as may be necessary to prevent the spread of that disease. Quarantine authority also means the authority to limit access by any person or animal to an area or facility that may be contaminated with an infectious agent. The term also means the authority to limit the freedom of movement or action of persons who have not received immunizations against a communicable disease when the State Health Director or local health director determines that such immunizations are required to control an outbreak of that disease."
SECTION 5.  G.S. 130A‑145 reads as rewritten:
"§ 130A‑145.  Quarantine and isolation authority.
(a)	The State Health Director and a local health director are empowered to exercise quarantine and isolation authority. Quarantine and isolation authority shall be exercised only when and so long as the public health is endangered, all other reasonable means for correcting the problem have been exhausted, and no less restrictive alternative exists.
(b)	No person other than a person authorized by the State Health Director or local health director shall enter quarantine or isolation premises. Nothing in this subsection shall be construed to restrict the access of authorized health care, law enforcement or emergency medical services personnel to quarantine or isolation premises as necessary in conducting their duties."
SECTION 6.  G.S. 130A‑20 reads as rewritten:
"§ 130A‑20. Abatement of an imminent hazard.
(a)	If the Secretary or a local health director determines that an imminent hazard exists, the Secretary or a local health director may order the owner, lessee, operator or other person in control of the property to abate the imminent hazard or may, after notice to or reasonable attempt to notify the owner, lessee, operator, or other person in control of the property enter upon any property and take any action necessary to abate the imminent hazard. If the Secretary or a local health director abates the imminent hazard, the Department or the local health department shall have a lien on the property for the cost of the abatement of the imminent hazard in the nature of a mechanic's and materialmen's lien as provided in Chapter 44A of the General Statutes, and the lien may be enforced as provided in that Chapter. The lien may be defeated by a showing that an imminent hazard did not exist at the time the Secretary or the local health director took the action.
(b)	The Secretary of Environment and Natural Resources and a local health director shall have the same rights enumerated in subsection (a) of this section to enforce the provisions of Articles 8, 9, 10, 11, and 12 of this Chapter."SECTION 7.  Article 1 of Chapter 130A of the General Statutes is amended by adding a new section to read:
"§ 130A-12.1. Access to health information.
(a)	Notwithstanding any other provision of law, a health care provider or a unit of State or local government may report to the State Health Director or a local health director any events that may indicate the existence of a communicable disease or condition, or a case or outbreak of an illness or condition that may have been caused by use of a nuclear, biological, or chemical weapon of mass destruction as defined in G.S. 14-288.21(c). Events that may be reported include unusual types or numbers of symptoms or illnesses presented to the provider, unusual trends in health care visits, or unusual trends in prescriptions or purchases of over-the-counter pharmaceuticals. A person disclosing or not disclosing information pursuant to this subsection is immune from any civil or criminal liability that might otherwise be incurred or imposed based on the disclosure or lack of disclosure provided that the health care provider was acting in good faith and without malice. In any proceeding involving liability, good faith and lack of malice are presumed.
(b)	The State Health Director may issue a temporary order requiring health care providers to report symptoms, diseases, conditions, trends in use of health care services, or other health-related information when necessary to conduct public health investigations or surveillance of diseases or health hazards that may have been caused by use of a nuclear, biological, or chemical weapon of mass destruction as defined in G.S. 14-288.21(c) or that may indicate the existence of a communicable disease or condition. The order shall specify which health care providers must report, what information is to be reported, and the period of time for which reporting is required. The period of time for which reporting is required pursuant to a temporary order shall not exceed 90 days. The rule-making provisions of Chapter 150B of the General Statutes shall not apply to the State Health Director’s temporary order. The Commission may adopt temporary or permanent rules to continue the reporting requirement when necessary to protect the public health.
(c)	The State Health Director and a local health director may examine, review, and obtain a copy of records containing confidential or protected health information, or a summary of pertinent portions of those records, that:
(1)	Pertain to a report authorized by subsection (a) or required by subsection (b) of this section;
(2)	Pertain to the diagnosis, treatment, or prevention of a communicable disease or communicable condition, as defined in Article 6 of this Chapter, for a person infected, exposed, or reasonably suspected of being infected or exposed to such a disease or condition; or
(3)	The State Health Director determines is necessary for investigating a disease or health hazard that presents a clear danger to the public health.
(d)	A person who makes a report pursuant to subsection (a) or (b) of this section or permits examination, review or copying of medical records pursuant to subsection (c) is immune from any civil or criminal liability that otherwise might be incurred or imposed as a result of complying with those subsections.
(e)	For purposes of this section, the term "health care provider" means a physician licensed to practice medicine in North Carolina or a person who is licensed, certified, or credentialed to practice or provide health care services, including, but not limited to, pharmacists, dentists, physician assistants, registered nurses, licensed practical nurses, chiropractors, and emergency medical technicians."
SECTION 8.  G.S. 130A‑5 reads as rewritten:
"§ 130A‑5. Duties of the Secretary.
The Secretary shall have the authority:
(1)	To enforce the State health laws and the rules of the Commission;
(2)	To investigate the causes of epidemics and of infectious, communicable and other diseases affecting the public health in order to control and prevent these diseases; to provide, under the rules of the Commission, for the prevention, detection, reporting and control of communicable, infectious or any other diseases or health hazards considered harmful to the public health;  
(3)	To develop and carry out reasonable health programs that may be necessary for the protection and promotion of the public health and the control of diseases. The Commission is authorized to adopt rules to carry out these programs;
(4)	To make sanitary and health investigations and inspections;
(5)	To investigate occupational health hazards and occupational diseases and to make recommendations for the elimination of the hazards and diseases. The Secretary shall work with the Industrial Commission and shall file sufficient reports with the Industrial Commission to enable it to carry out all of the provisions of the Workers' Compensation Act with respect to occupational disease;
(6)	To receive donations of money, securities, equipment, supplies, realty or any other property of any kind or description which shall be used by the Department for the purpose of carrying out its public health programs;
(7)	To acquire by purchase, devise or otherwise in the name of the Department equipment, supplies and other property, real or personal, necessary to carry out the public health programs;
(8)	To use the official seal of the Department. Copies of documents in the possession of the Department may be authenticated with the seal of the Department, attested by the signature or a facsimile of the signature of the Secretary, and when authenticated shall have the same evidentiary value as the originals;
(9)	To disseminate information to the general public on all matters pertaining to public health; to purchase, print, publish, and distribute free, or at cost, documents, reports, bulletins and health informational materials. Money collected from the distribution of these materials shall remain in the Department to be used to replace the materials;
(10)	To be the health advisor of the State and to advise State officials in regard to the location, sanitary construction and health management of all State institutions; to direct the attention of the State to health matters which affect the industries, property, health and lives of the people of the State; to inspect at least annually State institutions and facilities; to make a report as to the health conditions of these institutions or facilities with suggestions and recommendations to the appropriate State agencies. It shall be the duty of the persons in immediate charge of these institutions or facilities to furnish all assistance necessary for a thorough inspection;
(11)	To establish a schedule of fees based on income to be paid by a recipient for services provided by Migrant Health Clinics and Development Evaluation Centers;
(12)	To establish fees for the sale of specimen containers, vaccines and other biologicals. The fees shall not exceed the actual cost of such items, plus transportation costs;
(13)	To establish a fee to cover costs of responding to requests by employers for industrial hygiene consultation services and occupational consultation services. The fee shall not exceed two hundred dollars ($200.00) per on site inspection; and
(14)	To establish a fee for companion animal certificate of examination forms to be distributed, upon request, by the Department to licensed veterinarians. The fee shall not exceed the cost of the form and shipping costs."
SECTION 9.  G.S. 130A‑143 reads as rewritten:
"§ 130A‑143. Confidentiality of records.
All information and records, whether publicly or privately maintained, that identify a person who has AIDS virus infection or who has or may have a disease or condition required to be reported pursuant to the provisions of this Article shall be strictly confidential. This information shall not be released or made public except under the following circumstances:
(1)	Release is made of specific medical or epidemiological information for statistical purposes in a way that no person can be identified;
(2)	Release is made of all or part of the medical record with the written consent of the person or persons identified or their guardian;
(3)	Release is made to health care personnel providing medical care to the patient;
(4)	Release is necessary to protect the public health and is made as provided by the Commission in its rules regarding control measures for communicable diseases and conditions;
(5)	Release is made pursuant to other provisions of this Article;
(6)	Release is made pursuant to subpoena or court order. Upon request of the person identified in the record, the record shall be reviewed in camera. In the trial, the trial judge may, during the taking of testimony concerning such information, exclude from the courtroom all persons except the officers of the court, the parties and those engaged in the trial of the case;
(7)	Release is made by the Department or a local health department to a court or a law enforcement official for the purpose of enforcing the provisions of this  Article, Article 22 of this Chapter, or G.S. 14-288.22. A law enforcement official who receives the information shall not disclose it further, except (i) when necessary to enforce the provisions of this Article, Article 22 of this Chapter, or G.S. 14-288.22, or (ii) when the Department or a local health department seeks the assistance of the law enforcement official in preventing or controlling the spread of the disease or condition and expressly authorizes the disclosure as necessary for that purpose;
(8)	Release is made by the Department or a local health department to another federal, state or local public health agency for the purpose of preventing or controlling the spread of a communicable disease or communicable condition;
(9)	Release is made by the Department for bona fide research purposes. The Commission shall adopt rules providing for the use of the information for research purposes;
(10)	Release is made pursuant to G.S. 130A‑144(b); or
(11)	Release is made pursuant to any other provisions of law that specifically authorize or require the release of information or records related to AIDS."
SECTION 10.  G.S. 106‑24.1 reads as rewritten:
"§ 106‑24.1.  Confidentiality of information collected and published.
All information published by the Department of Agriculture and Consumer Services pursuant to this Part shall be classified so as to prevent the identification of information received from individual farm operators. All information received pursuant to this Part from individual farm operators shall be held confidential by the Department and its employees. Information collected by the Department from individual farm operators for the purposes of its animal health programs may be disclosed by the State Veterinarian when, in his judgment, the disclosure will assist in the implementation of these programs. Animal disease diagnostic tests that identify the owner of the animal shall not be disclosed without the permission of the owner unless the State Veterinarian determines that disclosure is necessary to prevent the spread of an animal disease or to protect the public health."
SECTION 11.  G.S. 106‑307.2 reads as rewritten:
"§ 106‑307.2. Reports of infectious disease in livestock and poultry to State Veterinarian.
(a)	All persons practicing veterinary medicine in North Carolina shall report promptly to the State Veterinarian the existence of any contagious or infectious disease in livestock and poultry.
(b)	The State Veterinarian shall notify the State Health Director and the Director of the Division of Environmental Health in The Department of Environment and Natural Resources when the State Veterinarian receives a report indicating a potential outbreak of a disease or condition that can be transmitted to humans including communicable diseases or conditions required to be reported by G.S. 130A-134."
SECTION 12.  G.S. 130A‑152(b) is repealed.
SECTION 13.  G.S. 143‑518 reads as rewritten:
"§ 143‑518.  Confidentiality of patient information.
(a)	Medical records compiled and maintained by the Department or EMS providers in connection with dispatch, response, treatment, or transport of individual patients or in connection with the statewide trauma system pursuant to Article 7 of Chapter 131E of the General Statutes may contain patient identifiable data which will allow linkage to other health care‑based data systems for the purposes of quality management, peer review, and public health initiatives.
These medical records and data shall be strictly confidential and shall not be considered public records within the meaning of G.S. 132‑1 and shall not be released or made public except under any of the following conditions:
(1)	Release is made of specific medical or epidemiological information for statistical purposes in a way that no person can be identified.
(2)	Release is made of all or part of the medical record with the written consent of the person or persons identified or their guardians.
(3)	Release is made to health care personnel providing medical care to the patient.
(4)	Release is made pursuant to a court order. Upon request of the person identified in the record, the record shall be reviewed in camera. In the trial, the trial judge may, during the taking of testimony concerning such information, exclude from the courtroom all persons except the officers of the court, the parties, and those engaged in the trial of the case.
(5)	Release is made to a Medical Review Committee as defined in 
G.S. 131E‑95, 90‑21.22A, or 130A‑45.7 or to a peer review committee as defined in G.S. 131E‑108, 122C‑30, or 131D‑21.1.
(6)	Release is made for use in a health research project under rules adopted by the North Carolina Medical Care Commission. The Commission shall adopt rules that allow release of information when an institutional review board, as defined by the Commission, has determined that the health research project:
a.	Is of sufficient scientific importance to outweigh the intrusion into the privacy of the patient that would result from the disclosure;
b.	Is impracticable without the use or disclosure of identifying health information;
c.	Contains safeguards to protect the information from redisclosure;
d.	Contains safeguards against identifying, directly or indirectly, any patient in any report of the research project; and
e.	Contains procedures to remove or destroy at the earliest opportunity, consistent with the purposes of the project, information that would enable the patient to be identified, unless an institutional review board authorizes retention of identifying information for purposes of another research project.
(7)	Release is made to a statewide data processor, as defined in Article 11A of Chapter 131E of the General Statutes, in which case the data is deemed to have been submitted as if it were required to have been submitted under that Article.
(8)	Release is made to the State Health Director for the purpose of protecting the public health.
(b)	Charges, accounts, credit histories, and other personal financial records compiled and maintained by the Department or EMS providers in connection with the admission, treatment, and discharge of individual patients are strictly confidential and shall not be released."
SECTION 14.  This act becomes effective October 1, 2002.