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 and to amend the north Carolina Medical care commission's rule-making authority regarding standards and criteria for the education and credentialing of persons to administer treatment for anaphylaxis.
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 is authorized to issue an order 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)	Evacuate or close 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. 
(5)	Limit access by any person or animal to an area or facility that is housing persons or animals whose movement or action has been limited under subdivision (4) of this subsection or 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.
(6)	Exercise quarantine authority and isolation authority under G.S. 130A‑145.
(b)	The authority under subsection (a) of this section shall be exercised only when and so long as a public health threat may exist, all other reasonable means for correcting the problem have been exhausted, and no less restrictive alternative exists. Before applying the authority under subdivision (4) or (5) of subsection (a) of this section to livestock or poultry for the purpose of preventing the direct or indirect conveyance of a chemical or nuclear agent to persons, the State Health Director shall consult with the State Veterinarian in the Department of Agriculture and Consumer Services.
The period of limited freedom of movement or access under subdivisions (4) and (5) of subsection (a) of this section shall not exceed 10 calendar days. Any person substantially affected by that limitation may institute in superior court in Wake County or in the county in which the limitation is imposed an action to review the limitation. If a person or a person's representative requests a hearing, the hearing shall be held within 72 hours of the filing of the request, excluding Saturdays and Sundays. The court shall reduce the limitation if it determines, by the preponderance of the evidence, that the limitation is not reasonably necessary to prevent or limit the conveyance of chemical or nuclear agents to others.
If the State Health Director determines that a 10-calendar-day limitation on freedom of movement or access is not adequate to protect the public health, the State Health Director may institute in superior court in Wake County or in the county in which the limitation is imposed an action to obtain an order extending the period limiting the freedom of movement or access. The court shall continue the limitation for a period not to exceed 30 days if it determines, by the preponderance of the evidence, that the limitation is reasonably necessary to prevent or limit the conveyance of chemical or nuclear agents to others. Before the expiration of an order issued under this section, the State Health Director may move to continue the order for additional periods not to exceed 30 days each.
(c)	If the State Health Director reasonably suspects 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. If the Secretary of Crime Control and Public Safety 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 Secretary shall notify the State Health Director.
(d)	For the purpose of this Article, the term "public health threat" means a situation that is likely to cause an immediate risk to human life, an immediate risk of serious physical injury or illness, or an immediate risk of serious adverse health effects.
(e)	Nothing in this section shall limit any authority otherwise granted to local or State public health officials under this Chapter.
"§ 130A-476. Access to health information.
(a)	Notwithstanding any other provision of law, a health care provider, a person in charge of a health care facility, 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 case or outbreak of an illness, condition, or health hazard that may have been caused by an act of terrorism using nuclear, biological, or chemical agents. 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. To the extent practicable, a person who makes a report under this subsection shall not disclose personally identifiable information. 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. Notwithstanding the foregoing, if a health care provider or unit of State or local government willfully does not disclose information pursuant to this subsection, the immunity from civil or criminal liability provided under this subsection shall not be available if the person had actual knowledge that a condition or illness was caused by use of a nuclear, biological, or chemical weapon of mass destruction as defined in G.S. 14-288.21(c).
(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 a public health investigation or surveillance of an illness, condition, or health hazard that may have been caused by an act of terrorism using nuclear, biological, or chemical agents. 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 Commission may adopt 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 pertain to a report authorized by subsection (a) or required by subsection (b) of this section.
(d)	A person who makes a report pursuant to subsection (b) of this section or permits examination, review, or copying of medical records pursuant to subsection (c) of this section is immune from any civil or criminal liability that otherwise might be incurred or imposed as a result of complying with those subsections.
(e)	Confidential or protected health information received by the State Health Director or a local health director pursuant to this section shall be confidential and shall not be released, except when the release is:
(1)	Made pursuant to any other provision of law;
(2)	To another federal, state, or local public health agency for the purpose of preventing or controlling a public health threat; or
(3)	To a court or law enforcement official for the purpose of enforcing the provisions of this Chapter or for the purpose of investigating an act of terrorism using nuclear, biological, or chemical agents. A law enforcement official who receives the information shall not disclose it further, except (i) when necessary to conduct an investigation of an attack using nuclear, biological, or chemical agents, or (ii) when the State Health Director or a local health director seeks the assistance of the law enforcement official in preventing or controlling the public health threat and expressly authorizes the disclosure as necessary for that purpose.
(f)	In this section the following terms shall include:
(1)	"Health care provider" includes 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, respiratory care therapists, and emergency medical technicians; and 
(2)	"Health care facility" includes hospitals, skilled nursing facilities, intermediate care facilities, psychiatric facilities, rehabilitation facilities, home health agencies, ambulatory surgical facilities, or any other health care related facility, whether publicly or privately owned."
SECTION 2.(a)  G.S. 130A‑149, "Biological agents registry; rules; penalties", is recodified as G.S. 130A‑477.
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-477."
SECTION 3.  G.S. 130A‑133 is repealed.
SECTION 4. G.S. 130A‑2 reads as rewritten:
"§ 130A‑2.  Definitions.
The following definitions shall apply throughout this Chapter unless otherwise specified:
(1)	"Commission" means the Commission for Health Services.
(1a)	"Communicable condition" means the state of being infected with a communicable agent but without symptoms.
(1b)	"Communicable disease" means an illness due to an infectious agent or its toxic products which is transmitted directly or indirectly to a person from an infected person or animal through the agency of an intermediate animal, host or vector, or through the inanimate environment.
(2)	"Department" means the Department of Health and Human Services.
(3)	"Imminent hazard" means a situation that is likely to cause an immediate threat to human life, an immediate threat of serious physical injury, an immediate threat of serious adverse health effects, or a serious risk of irreparable damage to the environment if no immediate action is taken.
(3a)	"Isolation authority" means the authority to issue an order to limit the freedom of movement or action of a person or animal with a communicable disease or communicable condition for the period of communicability to prevent the direct or indirect conveyance of the infectious agent from the person or animal to other persons or animals who are susceptible or who may spread the agent to others.
(4)	"Local board of health" means a district board of health or a public health authority board or a county board of health.
(5)	"Local health department" means a district health department or a public health authority or a county health department.
(6)	"Local health director" means the administrative head of a local health department appointed pursuant to this Chapter.
(6a)	"Outbreak" means an occurrence of a case or cases of a disease in a locale in excess of the usual number of cases of the disease.(7)	"Person" means an individual, corporation, company, association, partnership, unit of local government or other legal entity.
(7a)	"Quarantine authority" means the authority to issue an order 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 a local health director determines that the immunizations are required to control an outbreak of that disease.
(8)	"Secretary" means the Secretary of Health and Human Services.
(9)	"Unit of local government" means a county, city, consolidated city‑county, sanitary district or other local political subdivision, authority or agency of local government.
(10)	"Vital records" means birth, death, fetal death, marriage, annulment and divorce records registered under the provisions of Article 4 of this Chapter."
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.
(c)	Before applying quarantine or isolation authority to livestock or poultry for the purpose of preventing the direct or indirect conveyance of an infectious agent to persons, the State Health Director or a local health director shall consult with the State Veterinarian in the Department of Agriculture and Consumer Services.(d)	When quarantine or isolation limits the freedom of movement of a person or animal or of access to a person or animal whose freedom of movement is limited, the period of limited freedom of movement or access shall not exceed 10 calendar days. Any person substantially affected by that limitation may institute in superior court in Wake County or in the county in which the limitation is imposed an action to review that limitation. If a person or a person's representative requests a hearing, the hearing shall be held within 72 hours of the filing of that request, excluding Saturdays and Sundays. The court shall reduce the limitation if it determines, by the preponderance of the evidence, that the limitation is not reasonably necessary to prevent or limit the conveyance of a communicable disease or condition to others.
If the State Health Director or the local health director determines that a 10‑calendar‑day limitation on freedom of movement or access is not adequate to protect the public health, the State Health Director or local health director may institute in superior court in Wake County or in the county in which the limitation is imposed an action to obtain an order extending the period of limitation of freedom of movement or access. The court shall continue the limitation for a period not to exceed 30 days if it determines, by the preponderance of the evidence, that the limitation is reasonably necessary to prevent or limit the conveyance of a communicable disease or condition to others. Before the expiration of an order issued under this section, the State Health Director or local health director may move to continue the order for additional periods not to exceed 30 days each."
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.  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  this Article or Article 22 of this Chapter, or investigating an act of terrorism using nuclear, biological, or chemical agents. A law enforcement official who receives the information shall not disclose it further, except (i) when necessary to enforce this Article or Article 22 of this Chapter, or when necessary to conduct an investigation of an act of terrorism using nuclear, biological, or chemical agents, 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 8.  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 9.  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 reportable contagious or infectious disease in livestock and poultry. The Board of Agriculture shall establish by rule a list of animal diseases and conditions to be reported and the time and manner of reporting.
(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 an occurrence or potential outbreak of anthrax, arboviral infections, brucellosis, epidemic typhus, hantavirus infections, murine typhus, plague, psittacosis, Q fever, hemorrhagic fever virus infections, and any other disease or condition transmissible to humans that the State Veterinarian determines may have been caused by a terrorist act."
SECTION 10.  G.S. 130A‑152(b) is repealed.
SECTION 11.  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 pursuant to any other law.
(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 12. G.S. 166A‑5(3) is amended by adding a new sub‑subdivision to read:
"b1.	Coordination with the State Health Director to amend or revise the North Carolina 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.
7.	The issuance of guidelines for prophylaxis and treatment of exposed and affected persons."
SECTION 13.  G.S. 143‑508(d)(11) reads as rewritten:
"(11)	Establish standards and criteria for the education and credentialing of persons trained to administer lifesaving treatment to a person who suffers a severe adverse reaction to agents that might cause anaphylaxis."
SECTION 14.  This act becomes effective October 1, 2002.