Tuberculosis

Caring for the Community

Tuberculosis

Tuberculosis remains a real threat in public health today. I was in Hawaii recently working and they were reporting more cases this year than they ever had before. The rise in tuberculosis has been attributed to the HIV virus, immigration from countries with a high TB prevalence, substance abuse, homelessness, poverty and deterioration in public health infrastructure among other factors. Now comes the challenge of controlling TB in its tradition/new multidrug-resistant form. In order to do this the government will need new tools in the form of laws. These laws will support efforts to effectively control the known and suspected cases of TB. The government can make new laws concerning any disease but they also have certain rules and regulations according to the constitution that they must follow. This is where putting a new law into action becomes complicated. It is kind of, like "you can lead a horse to water type thing but you can't make him drink". After the disease is reported then the basic legal framework begins.
A. Separation of powers
B. Federalism and Distribution of Governmental powers.
1. Federal powers
2. State powers
3. Local powers
4. Tribal powers
C. Limitations on Governmental powers – this is to limit the ability of the government to violate individual rights, freedoms and liberties even when attempting to protect the public health. Many individual rights grounded in federal/state constitutional provision limit the government to protect community health. These include:
1. Freedom of expression and assembly under the first amendment.
2. Freedom from religious persecution, also under the first amendment.
3. Bear Arms second amendment.
4. Avoid unwarranted searches or seizures fourth amendment
5. Avoid cruel and unusual punishment Eighth amendment
6. Privacy pursuant to the fourth, ninth and fourteenth amendments.
You have so many rights being protected that you cannot get anything put into place. The goal of the state TB control programs should be to prevent, control and eventually eliminate TB. To protect the public from TB. It should also require the application to recommended infection control measures in health care facilities and congregate – living settings, (e.g. correctional facilities). The time frame for reporting TB varies, Thirteen states require reporting at the time of diagnosis, 14 states within 24 hours of diagnosis, 7 states within 48 hours of diagnosis, 3 states within 72 hours and 6 states do not specify a time frame for reporting. In nine states, the period for reporting cases of TB depends on the reporting source. For example, Dr's may be required to report cases of TB within 7 days of the diagnosis. Whereas institutions in the same state are required to report cases within 48 hours. Failure to report cases come with a penalty; Twenty-nine states have statutory authority to impose a penalty on persons who are required to report TB, but fail to do so. Five states impose a penalty only when the failure is willful. Those persons found guilty may be fined from $5 to $500 and be convicted of a misdemeanor. Management of TB: Sixteen states supported outpatient treatment. Twenty-nine states recommended that TB patients voluntarily seek treatment before health officials seek state intervention. State laws (should) require that all TB patients receive immediate treatment according to the most recent ATS/CDC and ACET treatment guidelines. Which include: examination of the person exposed to TB or suspected of having TB. Treatment