[30 Pa.B. 2715]
[Continued from previous Web Page]
Subchapter C. QUARANTINE AND ISOLATION
GENERAL PROVISIONS § 27.60. Disease control measures.
The Department or local health authority shall direct isolation of a person or an animal with a communicable disease or infection; surveillance, segregation, quarantine or modified quarantine of contacts of a person or an animal with a communicable disease or infection; and any other disease control measure the Department or the local health authority considers to be appropriate for the surveillance of disease, when the disease control measure is necessary to protect the public from the spread of infectious agents. If a local health authority is not a local health department, it shall consult with and receive approval from the Department prior to taking any disease control measure.
§ 27.61. [Prompt isolation] Isolation.
When the isolation of [an individual ill with any communicable disease, or the quarantine of susceptible contacts, is required by the provisions of Subchapter E (relating to procedure for treating each reportable disease), the] a person or animal that is suspected of harboring an infectious agent is appropriate, the Department or local health [officer] authority shall cause the isolation [or quarantine] to be done promptly following receipt of the case report.
(1) If the local health authority is not an LMRO, the local health officer shall consult with and receive approval from the Department prior to requiring isolation.
(2) If more than one jurisdiction is involved, the local health officer shall cause a person or animal to be isolated only after consulting with and receiving approval from the Department.
(3) The Department or local health authority shall ensure that instructions are given to the case or persons responsible for the care of the case and to members of the household or appropriate living quarters, defining the area within which the case is to be isolated and identifying the measures to be taken to prevent the spread of disease.
§ 27.62. [Isolation instructions] (Reserved).
[If the disease is one requiring isolation, the local health authority shall insure that instructions are given to the patient and members of the household defining the area within which the patient is to be isolated and stating the measures to be taken to prevent the spread of the disease.]
§ 27.63. [Modified isolation] (Reserved).
[If the disease is one for which only a modified isolation is required the local health authority shall issue appropriate instructions, prescribing the isolation technique to be followed. The isolation technique shall depend upon the disease.]
§ 27.64. [Isolation within hospitals] (Reserved).
[A case of a communicable disease may be treated in any hospital, if the patient is isolated in a private room, cubicle or ward where none but patients with the same disease are segregated, and if the isolation technique is observed. The requirements of the rule relating to isolation for a specific disease which the patient experienced, as described in Subchapter E (relating to procedure for reporting each reportable disease), shall be observed while the patient is hospitalized; however, the removal of the patient to his home during the period of isolation or quarantine may be permitted if the requirements of § 27.67 (relating to the movement of persons subject to isolation or quarantine) are observed.]
§ 27.65. Quarantine [instructions].
If the disease is one [requiring] which the Department, or a local health authority which is also an LMRO, determines the quarantine of [the] contacts in addition to isolation of the case, the Department or local health [authority] officer of the LMRO shall determine [the] which contacts [who are subject to quarantine] shall be quarantined, specify the place to which they shall be quarantined, and issue appropriate instructions.
(1) When any other local health authority is involved, the local health officer shall quarantine contacts only after consulting with and receiving approval from the Department.
(2) The Department or local health [authority] officer shall [insure] ensure that provisions are made for the medical observation of the contacts as frequently as necessary during the quarantine period.
§ 27.66. Placarding.
Whenever the Department or a local health [authority is unable to enforce] officer has reason to believe that a case, a contact or others will not fully comply with the isolation or quarantine as required for the protection of the public health and [he] the Department or local health officer deems it necessary to use placards, placards may be utilized [in its jurisdiction]. Placards may be utilized by a local health officer of a local health authority that is not an LMRO only if the specific use is approved by the Department.
§ 27.67. Movement of persons and animals subject to isolation or quarantine by action of a local health authority or the Department.
(a) A person [under] or animal subject to isolation or quarantine by action of a local health authority or the Department may be removed to another [dwelling or a hospital] location only with permission of the local health [officer concerned,] authority or the Department. If the local health authority is not an LMRO, the local health authority shall consult with and receive approval from the Department prior to permitting removal. Permission for removal may be given by the Department if the local health officer is not available.
(b) Removal of a [patient] person or animal under isolation or quarantine by action of the Department or a local health authority, from [one health] the jurisdiction [to another within this Commonwealth] of the Department or a local health authority to the jurisdiction of the Department or another local health authority may [be made] occur only with permission of [the health officers concerned, or] the Department, if it is involved, and with the permission of the local health [officer] authorities concerned [is not available]. If both of the local health authorities involved are not LMROs, the local health authorities shall consult with and receive approval from the Department prior to permitting removal. Permission for removal may be given by the Department if a local health officer from whom permission would otherwise be required is not available.
(c) Interstate [removal] transportation to or from this Commonwealth of a person or animal under isolation or quarantine may be made only with permission of the Department.
(d) Transportation of a person or animal under isolation or quarantine shall be made by private conveyance or as otherwise ordered by the local health [officer] authority or the Department. If the local health authority is not an LMRO, it shall consult with the Department prior to issuing an order. [Due] The sender, the receiver and the transporter of the animal shall be responsible to take due care [shall be taken] to prevent the spread of the disease.
(e) [Immediately upon the arrival of the patient at the point of destination, isolation, or quarantine shall be resumed for the period of time required for the specific disease.] When a person or animal under isolation or quarantine is transported, isolation or quarantine shall be resumed for the period of time required for the specific disease immediately upon arrival of the person or animal at the point of destination.
§ 27.68. Release from isolation [and] or quarantine.
The Department or [the] a local health [officer] authority may order [release] that a person or animal isolated or quarantined under the direction of the Department or the appropriate health authority be released from isolation or quarantine when [the provisions of this title of the Department have been met] the Department or the local health authority determines that the person or animal no longer presents a public health threat. If the local health authority involved is not an LMRO, it shall consult with, and receive approval from, the Department prior to making the order.
§ 27.69. Laboratory analysis.
Whenever [the regulations of the Department provide for the submission of] a laboratory [specimens] specimen is to be examined for the presence of [micro-] etiologic organisms [in order] to determine the duration of isolation or quarantine or to determine the eligibility of a person or animal for release from isolation or quarantine, the [specimens] specimen shall be examined in a laboratory [of the Department or in one] approved by the Department [for] to conduct that type of examination [of the specimens].
COMMUNICABLE DISEASES IN [SCHOOL] CHILDREN AND STAFF ATTENDING SCHOOLS AND CHILD CARE GROUP SETTINGS § 27.71. Exclusion of pupils and staff for specified diseases and infectious conditions.
[Each teacher, principal, superintendent or other] A person in charge of a public, private, parochial, Sunday or other school or college [or preschool] shall exclude [students] from school [who have been diagnosed by a physician or are suspected of having the disease by the school nurse for the indicated period of time for the following diseases:] a pupil, or a staff person who has contact with pupils, who is suspected by a physician or the school nurse of having any of the following communicable diseases, infections or conditions. Readmission shall be contingent upon the school nurse or, in the absence of the school nurse, a physician, verifying that the criteria for readmission have been satisfied. The diseases, the periods of exclusion and the criteria for readmission are as follows:
(1) Diphtheria--Two weeks from the onset or until appropriate negative culture tests. [Reference should be made to § 27.108 (relating to diphtheria).]
(2) Measles--Four days from the onset of rash. [Reference should be made to § 27.121 (relating to measles (rubeola)).] Exclusion may also be ordered by the Department as specified in § 27.160 (relating to special requirements for measles).
(3) Mumps--Nine days from the onset or until subsidence of swelling. [Reference should be made to § 27.124 (relating to mumps).]
(4) Pertussis--[Four] Three weeks from the onset or [7] 5 days from institution of appropriate antimicrobial therapy. [Reference should be made to § 27.126 (relating to pertussis (whooping cough)).]
(5) Rubella--[Four] Seven days from the onset of rash. [Reference should be made to § 27.134 (relating to Rubella (German measles) and congenital rubella syndrome).]
(6) Chickenpox--[Six] Five days from the [last crop of vesicles] appearance of the first crop of vesicles, or when all the lesions have dried and crusted, which ever is sooner.
(7) Respiratory streptococcal infections including scarlet fever--[Not less than 7] At least 10 days from the onset if no physician is in attendance or 24 hours [from] after institution of appropriate antimicrobial therapy.
(8) [Acute contagious] Infectious conjunctivitis (pink eye)--[Twenty-four hours from institution of appropriate therapy] Until judged not infective, that is, without a discharge.
(9) Ringworm--[all types--Until judged noninfective by the nurse in school, college or preschool, or child's physician.] The person shall be allowed to return to school, child care or other group setting immediately after the first treatment, if body lesions are covered. Neither scalp nor body lesions that are dried need to be covered.
(10) Impetigo contagiosa--[Until judged noninfective by the nurse in school, college or preschool, or by the child's physician] Twenty-four hours after the institution of appropriate treatment.
(11) Pediculosis capitis--[Until judged noninfective by the nurse in school, college or preschool, or by the child's physician.] The person shall be allowed to return to either the school, child care or other group setting immediately after first treatment. The person shall be reexamined for infestation by the school nurse, or other health care practitioner, 7 days posttreatment.
(12) Pediculosis corpora--[Until judged noninfective by the nurse in school, college or preschool, or by child's physician] After completion of appropriate treatment.
(13) Scabies--[Until judged noninfective by the nurse in school, college or preschool, or by child's physician] After completion of appropriate treatment.
(14) [Tonsillitis--Twenty-four hours from institution of appropriate therapy.
(15)] Trachoma--Twenty-four hours [from] after institution of appropriate [therapy] treatment.
(15) Tuberculosis--Following a minimum of 2 weeks adequate chemotherapy and three consecutive negative morning sputum smears, if obtainable. In addition, a note from the attending physician that the person is noncommunicable shall be submitted prior to readmission.
§ 27.72. Exclusion of pupils and staff showing symptoms.
(a) A [teacher, principal, superintendent or other] person in charge of a public, private, parochial, Sunday or other school or college shall, following consultation with a physician or school nurse, exclude immediately a [person] pupil or staff person showing [an unusual skin eruption, having soreness of the throat or having signs or symptoms of whooping cough or diseases of the eyes. The exclusion and the reasons prompting it shall be reported to the health authority of the municipality or county in which the school is situated, together with the name and address of the person excluded.] any of the following symptoms, unless that person is determined by the school nurse, or a physician, to be noncommunicable:
(1) Mouth sores associated with inability to control saliva.
(2) Rash with fever or behavioral change.
(3) Purulent discharge from the eyes.
(4) Productive cough with fever.
(5) Oral or axillary temperature equal to or greater than 102°F.
(6) Unusual lethargy, irritability, persistent crying, difficulty breathing or other signs of severe illness.
(7) Vomiting.
(b) The school shall maintain a record of the exclusion and the reasons prompting the exclusion, and shall review the record to determine when unusual rates of absenteeism occur. The Department will periodically determine and publish in the Pennsylvania Bulletin what increase in absenteeism constitutes an unusual rate of absenteeism.
§ 27.73. Readmission of excluded pupils [showing symptoms] and staff.
(a) [No person] A pupil or staff person excluded from a public, private, parochial or other school or college under [the provisions of] § 27.72 (relating to exclusion of pupils and staff showing symptoms) may not be readmitted until the school nurse [in the school, college or preschool] or, in the absence of a school nurse, a physician, is satisfied that the condition for which the [child] person was excluded is not communicable or until the [child] person presents a [certificate of recovery or noninfectiousness] statement from [the] a physician that the person has recovered or is noninfectious.
(b) A pupil or staff person excluded for the following reasons shall be readmitted only when a physician has determined the illness to be either resolved, noncommunicable or in a noncommunicable stage:
(1) Rash with fever or behavioral change.
(2) Productive cough with fever.
§ 27.74. [Admission] Readmission of exposed or isolated pupils and staff.
[No person] A pupil or staff person who has been absent from school by reason of having had or because of residing on premises where there has been a disease for which isolation is required may not be readmitted to school without the permission of the [health authorities] LMRO. [The person shall be required to secure permission whether or not there has been a physician in attendance or whether or not isolation has been established in the household.]
§ 27.75. Exclusion of pupils and staff during a measles [(rubeola)] outbreak.
Pupils [who are presumed susceptibles may] and staff shall be excluded from school during a measles [(rubeola)] outbreak under the procedures described in § [27.121] 27.160 (relating to special requirements for measles [(rubeola)]).
§ 27.76. Exclusion and readmission of children and staff in child care group settings.
(a) Sections 27.71--27.75 apply to child care group settings, with the exception that readmission of excluded persons as provided in those sections, as well as provided in this subsection, shall be contingent upon a physician verifying that the criteria for readmission have been satisfied. The following conditions and circumstances also govern exclusion from and readmission to a child care group setting of a child or a staff person who has contact with children attending the child care group setting:
(1) Meningococcal meningitis or meningococcemia. Until made noninfective by a course of rifampin or other drug which is effective against the nasopharyngeal carriage stage of this disease, or otherwise shown to be noninfective.
(2) Haemophilus influenzae (H. flu) meningitis or other invasive H. flu disease. Until made noninfectious by a course of rifampin or other drug which is effective against the nasopharyngeal carriage stage of this disease, or otherwise shown to be noninfective.
(3) Diarrhea. Until resolved or judged to be noninfective when associated with any of the following:
(i) Inability to prevent contamination of the environment with feces.
(ii) Fever.
(iii) Identified bacterial or parasitic pathogen.
(4) Fever in children younger than 4 months of greater than 101° F. rectally or 100° F. axillary; in children 4--24 months of greater than 102° F. rectally or 101° F. axillary. Until resolved or judged to be noninfective.
(5) Hepatitis A, viral hepatitis unspecified, or jaundice of unspecified etiology. Until 1 week following the onset of jaundice, or 2 weeks following symptom onset or IgM antibody positivity if jaundice is not present.
(6) Shigellosis. Until the etiologic organism is eradicated. See § 27.158 (relating to special requirements for shigellosis).
(7) Typhoid fever or paratyphoid fever. Until the etiologic organism is eradicated. See § 27.159 (relating to special requirements for typhoid fever and paratyphoid fever).
(8) Exposure to an individual with invasive H. influenza disease if children less than 4 years of age attend the child care group setting in the same room as the exposed person. Until the institution of treatment with appropriate antibiotic to eradicate the nasopharyngeal carrier state, or until proven noninfectious with nasopharyngeal cultures, or until 30 days following the exposure. Exclusion shall be postponed, until the second day following notice that exclusion will be required, to give the individual sufficient time to arrange for institution of appropriate antibiotic treatment.
(9) Exposure to an individual with meningococcal disease. Until the institution of treatment with appropriate antibiotic to eradicate the nasopharyngeal carrier state, or until proven noninfectious with nasopharyngeal cultures, or until 30 days following the exposure. Exclusion shall be postponed, until the second day following notice that exclusion will be required, to give the individual sufficient time to arrange for institution of appropriate antibiotic treatment.
(b) To facilitate the proper exclusion of sick children and staff, the caregiver at a child care group setting shall arrange for the following:
(1) Instruction of staff regarding exclusion and screening criteria which apply to themselves and attending children.
(2) Instruction of parents and guardians regarding exclusion criteria and that they are to notify the caregiver within 24 hours after it is determined or suspected that a child has an illness or condition for which exclusion is required.
(3) Screening of each child by staff at the time the child is brought to the child care group setting for the presence of a condition which requires exclusion. The screening shall be conducted each day while the parent, guardian or other person bringing the child to the child care group setting is present.
§ 27.77. Immunization requirements for children in child care group settings.
(a) Caregiver responsibilities.
(1) Except as exempted in subsection (d), effective _____ (Editor's Note: The blank refers to a date 60 days after the effective date of adoption of this proposal.), the caregiver at a child care group setting may not accept or retain a child 2 months of age or older at the setting, for more than 60 days, unless the caregiver has received a written objection to a child being vaccinated on religious grounds from a parent or guardian, or one of the following:
(i) For all children not exempt under the subsection (d)(1)(ii), an initial written verification from a physician, the Department or a local health department of the dates (month, day and year) the child was administered any vaccines recommended by ACIP. The verification shall also specify any vaccination not given due to medical condition of the child and shall state whether the condition is temporary or permanent. The verification shall show compliance with the vaccination requirements in subsection (b).
(ii) For all children for whom vaccinations remain outstanding following the caregiver's receipt of the initial written verification, subsequent written verifications from a physician, the Department or a local health department as additional vaccinations become due. These verifications shall be prepared in the same manner as set forth in subparagraph (i), but need not repeat information contained in a previously submitted verification. The verifications shall demonstrate continuing compliance with the vaccination requirements in subsection (b).
(2) If the caregiver receives a written verification under paragraph (1) explaining that timely vaccination did not occur due to a temporary medical condition, the caregiver shall exclude the child from the child care group setting after an additional 30 days unless the caregiver receives, within that 30-day period, written verification from a physician, the Department or a local health department that the child was vaccinated or that the temporary medical condition still exists. If the caregiver receives a written verification that vaccination has not occurred because the temporary condition persists, the caregiver shall require the presentation of a new verification at 30-day intervals. If a verification is not received as required, the caregiver shall exclude the child from the child care group setting and not readmit the child until the caregiver receives a verification that meets the requirements of this section.
(3) The caregiver shall retain the written verification or objection referenced in paragraphs (1) and (2) for 60 days following the termination of the child's attendance.
(4) The caregiver shall ensure that a certificate of immunization is completed and signed for each child enrolled in the child care group setting. The certificates shall be periodically updated by the caregiver to include the information provided to the caregiver under subsection (a). The immunization status of each enrolled child shall be summarized and reported on an annual basis to the Department at the time prescribed by the Department and on the form provided by the Department.
(b) Vaccination requirements. Each child enrolled in a child care group setting shall be immunized in accordance with ACIP standards in effect on January 1, 1999, governing the issuance of ACIP recommendations for the immunization of children.
(1) The standards are as follows:
(i) The immunization practice is supported by both published and unpublished scientific literature as a means to address the morbidity and mortality of the disease.
(ii) The labeling and packaging inserts for the immunizing agent are considered.
(iii) The immunizing agent is safe and effective.
(iv) The schedule for use of the immunizing agent is administratively feasible.
(2) The Department will deem an ACIP recommendation pertaining to the immunization of children to satisfy the standards in this subsection unless ACIP alters its standards for recommending immunizations for children by eliminating a standard set forth in this subsection and the recommendation is issued under those changed standards.
(c) Notice. The Department will place a notice in the Pennsylvania Bulletin listing publications containing ACIP recommendations issued under the standards in subsection (b). The Department will publish the initial notice contemporaneously with the publication of this chapter. The Department will update that list in a notice which it will publish in the Pennsylvania Bulletin within 30 days after ACIP issues a recommendation which satisfies the criteria of this section.
(d) Exemptions.
(1) This section does not apply to the following:
(i) Kindergarten, elementary school or higher school. These caregivers shall comply with §§ 23.81--23.87 (relating to immunization).
(ii) Children who are known by the caregiver to be 6 years of age or older or to attend a kindergarten, elementary school or high school.
(iii) A caregiver who does not serve as a caregiver for at least 40 hours during at least 1 month.
(2) The requirement imposed by subsection (a), to not accept a child into a child care group setting without receiving an initial written verification or objection specified in subsection (a), does not apply during a month the caregiver does not serve as a caregiver for at least 40 hours.
(e) Exclusion when disease is present. Whenever one of the diseases mentioned in § 27.76 (relating to exclusion and readmission of children and staff in child caregiver settings) has been identified within a child care group setting, the Department or a local health department may order the exclusion from the child care group setting or any other child care group setting which is determined to be at high-risk of transmission of that disease, of an individual susceptible to that disease in accordance with public health standards as determined by the Department.
Subchapter D. [VENEREAL DISEASES] SEXUALLY TRANSMITTED DISEASES, TUBERCULOSIS AND OTHER COMMUNICABLE DISEASES § 27.81. Examination of persons suspected of being infected.
Whenever the Department or a local [qualified medical] health [officer] authority has reasonable grounds to suspect a person of being infected with an organism causing a [venereal] sexually transmitted disease, tuberculosis or other communicable disease, or of being a carrier, but lacks confirmatory medical or laboratory evidence, the Department or the [officer will] local health authority may require the person to undergo a medical examination and any other approved diagnostic procedure to determine whether or not [he] the person is infected or is a carrier. If the local health authority involved is not an LMRO, the local health authority shall consult with and receive approval from the Department prior to requiring any medical examination or other approved diagnostic procedure.
§ 27.82. Refusal to submit to examination.
(a) [Section 7 of the act (35 P. S. § 521.7) provides that in the event] If a person refuses to submit to the examination required in § 27.81 (relating to examination of persons suspected of being infected), the Department or the local [qualified medical] health [officer] authority may [take one of the following actions:
(1) Cause] direct the person to be quarantined until it is determined that [he is not infected with a venereal disease, tuberculosis or other communicable disease, or he is not a carrier] the person does not pose a threat to the public health by reason of being infected with a disease causing organism or being a carrier.
[(2) File] (b) If the person refuses to abide by an order issued under subsection (a), the Department or local health authority may file a petition in the court of common pleas of the county in which the person is present. The petition shall have a statement attached, given under oath by a physician licensed to practice in this Commonwealth, that the person is suspected of being infected with [venereal] an organism causing a sexually transmitted disease, tuberculosis or other communicable disease, or that the person is suspected of being a carrier. Upon the filing of the petition, the court shall, within 24 hours after service of a copy upon the respondent, hold a hearing without a jury to ascertain whether the person named in the petition has refused to submit to an examination to determine whether the person is infected with [venereal disease, tuberculosis or other communicable disease] the suspected disease causing organism, or that the person is a carrier. Upon a finding that the person has refused to submit to an examination and that there is no valid reason for the person to do so, the court may forthwith order the person to submit to the examination. The certificate of the physician attached to the petition shall be received in evidence and shall constitute prima facie evidence that the person named is suspected of being infected with [venereal disease, tuberculosis or other communicable disease] the disease causing organism, or that the person is a carrier.
[(b) Section 7 of the act (35 P. S. § 521.7) provides that a] (c) A person refusing to undergo an examination as [provided in subsection] required under subsections (a) and (b) may be committed by the court to an institution in this Commonwealth determined by the Department to be suitable for the care of [the cases] persons infected with the suspected disease causing organism.
§ 27.83. Court ordered examinations.
The examination ordered by the court [as provided in] under § 27.82 (relating to refusal to submit to examination) may be performed by a physician chosen by the person at [his] the person's own expense. The examination shall include an appropriate physical examination and laboratory tests performed in a clinical laboratory approved by the Department to conduct the tests, and shall be conducted in accordance with accepted professional practices. The results shall be reported to the local health [board or health department] authority or the Department on case report forms furnished by the Department.
§ 27.84. Examination for a sexually transmitted disease of persons detained by police authorities.
(a) [Section 8(a) of the act (35 P. S. § 521.8(a)) provides that a] A person taken into custody and charged with a crime involving lewd conduct or a sex offense, or a person to whom the jurisdiction of a juvenile court attaches may be examined for a [venereal] sexually transmitted disease by a qualified physician appointed by the Department [or], by the local [board or department of health] health authority or [appointed] by the court having jurisdiction over the person so charged. If the person refuses to permit an examination or provide a specimen for laboratory tests as requested by the physician designated by the Department, a local health authority or a court, judicial action may be pursued by the Department or local health authority to secure an appropriate remedy.
(b) [Section 8(b) of the act (35 P. S. § 521.8(b)) provides that a] A person convicted of a crime or pending trial, who is confined in or committed to a State or local penal institution, reformatory or other house of correction or detention, may be examined for [venereal] a sexually transmitted disease by a qualified physician appointed by the Department or by the local [board] health authority. If the person refuses to permit an examination or provide a specimen for laboratory tests as requested by the physician, judicial action may be pursued by the Department or local health authority to secure an appropriate remedy.
(c) [Section 8(c) of the act (35 P. S. § 521.8(c)) provides that a] A person described in subsections (a) or (b) found, upon examination, to be infected with a [venereal] sexually transmitted disease shall be given appropriate treatment by [constituted] the local health [authorities or their deputies] authority, the Department or [by] the attending physician of the institution[, if any].
§ 27.85. Diagnosis and treatment of [venereal] a sexually transmitted disease.
(a) [Section 9(a) of the act (35 P. S. § 521.9(a)) provides that the] The Department [shall] will provide or designate adequate facilities for the free diagnosis and, [where] when necessary for the preservation of public health, free treatment of persons infected with [venereal diseases] sexually transmitted diseases. [The diagnosis shall include blood tests and other tests.]
(b) [Section 9(b) of the act (35 P. S. § 521.9(b)) provides that upon] Upon approval of the Department, a local [board or department of health may] health authority shall undertake to share the expense of furnishing free diagnosis and free treatment of [venereal] a sexually transmitted disease, or [the local board or department of health may take over, entirely or in part, the furnishing of] shall furnish free diagnosis and free treatment of [venereal] the sexually transmitted disease [with or] without financial assistance from the Department.
§ 27.86. [Sale of drugs for venereal disease] (Reserved).
[Section 10 of the act (35 P. S. § 521.10) provides that the sale of drugs or other remedies for the treatment of venereal disease shall be prohibited, except under prescription of physicians licensed to practice in this Commonwealth.]
§ 27.87. Refusal to submit to treatment for communicable diseases.
(a) If the Department or a local health [officer] authority finds that a person who is infected with [venereal] a sexually transmitted disease, tuberculosis or other communicable disease in a communicable stage refuses to submit to treatment approved by the Department or by a local [board] health authority, the Department or the local health [officer] authority [may take the following action:
(1) Under section 11(a) of the act (35 P. S. § 521.11(a)), isolate the person], if it determines the action advances public health interests, shall order the person to be isolated in an appropriate institution designated by the Department or by the local [board] health authority for safekeeping and treatment until the disease has been rendered noncommunicable. If the disease is one which may be significantly reduced in its communicability following short-term therapy, but is likely to significantly increase in its communicability if that therapy is not continued, such as tuberculosis, the Department or local health authority may order the person to complete therapy which is designed to prevent the disease from reverting to a communicable stage, including completion of an inpatient treatment regimen. See, also, § 27.161 (relating to special requirements for tuberculosis). If the local health authority involved is not an LMRO, the local health authority shall consult with and receive approval from the Department prior to taking action under this subsection.
[(2) Under section 11(a) of the act (35 P. S. § 521.11(a)),]
(b) If a person refuses to comply with an order issued under subsection (a), the Department or local health authority shall file a petition in the court of common pleas of the county in which the person is present to commit the person to an appropriate institution designated by the Department or by the local [board] health authority for safekeeping and treatment [until such time as the disease has been rendered noncommunicable] as specified in subsection (a). Upon the filing of a petition, the court shall, within 24 hours after service of a copy upon the respondent, hold a hearing without a jury to ascertain whether the person named in the petition has refused to submit to treatment. Upon a finding that the person has refused to submit to treatment, the court shall [forthwith order him to be committed to an appropriate institution or hospital designated by the Department or by the local board] issue an appropriate order.
[(b)] (c) For the purpose of this section, [it is understood that] treatment approved by the Department or by a local [board shall] health authority may include treatment by an accredited practitioner of a well recognized church or religious denomination which relies on prayer or spiritual means alone for healing, if requirements relating to sanitation, isolation or quarantine are [complied with] satisfied.
§ 27.88. [Quarantine in jails] Isolation and quarantine in appropriate institutions.
[Section 11(b) of the act (35 P. S. § 521.11(b)) provides that a county jail or other appropriate institution may receive persons who are isolated or quarantined by the Department or by a local board by reason of a venereal disease for the purpose of safekeeping and treatment.]
(a) When the Department or a local health authority orders a person with or suspected of having a sexually transmitted disease to be isolated or quarantined for the purpose of safekeeping and treatment, it may order that the isolation or quarantine take place in an institution where the person's movement is physically restricted.
(b) The Department or the local [board or department of health] health authority shall reimburse an institution which accepts the [persons] person at the rate of maintenance that prevails in the institution, and shall furnish the necessary medical treatment to the [persons committed to] person isolated or quarantined within the institution.
§ 27.89. [Premarital examination for syphilis] Examinations for syphilis.
[Section 12(a) of the act (35 P. S. § 521.12(a)) provides that no license to marry may be issued until there is in the possession of the clerk of the orphans' court a statement signed by a licensed physician of this Commonwealth, or of other state or territory, or a commissioned medical officer in the United States Armed Forces or a physician of the United States Public Health Service that the applicant within 30 days of the issuance of the marriage license has submitted to an examination to determine the existence or nonexistence of syphilis. The examination shall include a standard serological test for syphilis and a statement that, in the opinion of the examining physician, the applicant is not infected with syphilis, or if so infected, is not in a stage of the disease which is likely to become communicable. The statement of the physician shall be accompanied by a statement from the person in charge of the laboratory making the test, or from some other person authorized to make a statement, setting forth the name of the test, the date is was made, the name and address of the physician to whom a report was sent and the exact name and address of the person whose blood was tested, but not setting forth the result of the test.]
(a) Prenatal examination for syphilis.
(1) A physician who attends, treats or examines a pregnant woman for conditions relating to pregnancy during the period of gestation or delivery shall inform the woman that he intends to take or cause to be taken, unless the woman objects, a sample of her blood at the time of the first examination (including the initial visit when a pregnancy test is positive), or within 15 days after the first examination, and shall submit the sample to a clinical laboratory for an approved test for syphilis. A physician shall similarly collect and have tested a sample of the pregnant woman's blood during the third trimester of her pregnancy, in those counties of this Commonwealth where the annual rate of infectious syphilis is at a rate of syphilis occurring in a given population for which the CDC has determined it is cost-effective to require special precautions. The Department will publish this rate in the Pennsylvania Bulletin as necessary. Other persons permitted by law to attend pregnant women, but not permitted by law to take blood samples, shall, unless the woman objects, cause a blood sample to be taken and submitted to a clinical laboratory for an approved test for syphilis. If the pregnant woman objects, it shall be the duty of the person seeking to have the woman give a blood sample to explain to her the desirability of the test.
(2) The serological test required by subsection (b)(1) will be made without charge, by the Department, upon the request of the physician submitting the blood sample and the submission of a certificate by the physician that the patient is unable to pay.
(b) Examination for syphilis in mother of newborn. A test for syphilis shall be done, unless the mother objects, on the blood of the mother of every newborn delivered in those counties of this Commonwealth where the annual rate of infectious syphilis is at a rate of syphilis occurring in a given population for which the CDC has determined it is cost-effective to require special precautions.
(1) The Department will publish this rate in the Pennsylvania Bulletin as necessary.
(2) The results of the test shall be recorded both in the mother's medical record and in the newborn's medical record prior to discharge.
(c) Examination for syphilis in mother of stillborn. A test for syphilis shall be done, unless the mother objects, on the blood of the mother of every stillborn child delivered in those counties of this Commonwealth where the annual rate of infectious syphilis is at a rate of syphilis occurring in a given population for which the CDC has determined it is cost-effective to require special precautions. The Department will publish this rate in the Pennsylvania Bulletin as necessary. The Department will be responsible for alerting physicians about this standard. The blood shall be collected within 2 hours after delivery and the result entered into the mother's medical record prior to discharge. See also, § 27.95 (relating to reporting syphilis examination information for births and fetal deaths).
§ 27.90. [Appeal from denial of statement of the physician] (Reserved).
[Section 12(b) of the act (35 P. S. § 521.12(b)) provides that an applicant for a marriage license who has been denied a statement of the physician as required by § 27.89 (relating to premarital examination for syphilis) shall have the right of appeal to the Department for a review of the case and the Department will, after appropriate investigation, issue or refuse to issue a statement in lieu of the required statement of the physician.]
§ 27.91. [Form for statement of physician] (Reserved).
[Section 12(c) of the act (35 P. S. § 521.12(c)) provides that the statements required of the physician who examined the applicant and of the person in charge of the laboratory which made the serological or other test shall be uniform throughout this Commonwealth and shall be upon forms provided by the Department or upon any comparable forms provided by other states. These forms shall be filed by the clerk of the orphan's court separately from the applications for marriage licenses, and shall be regarded as confidential by every person whose duty it may be to obtain, make, transmit or receive the information or report.]
§ 27.92. [Misrepresentation of facts and release of information] (Reserved).
[Section 12(d) of the act (35 P. S. § 521.12(d)) provides that it shall be unlawful for an applicant for a marriage license, physician or representative of a laboratory to misrepresent the facts prescribed by the act. It shall be unlawful for a licensing officer who fails to receive the statements prescribed by the act or who has reason to believe that the facts have been misrepresented to issue a marriage license. It shall also be unlawful for a person to disregard the confidential character of the information or reports required by the act or for a person to otherwise fail to comply with the provisions of §§ 27.89--27.91, 27.93 and this section (relating to premarital examination for syphilis; appeal from a denial of statement of the physician; form for statement of physician; and waiver of syphilis examination).]
§ 27.93. [Waiver of syphilis examination] (Reserved).
[Section 12(e) of the act (35 P. S. § 521.12(e)) provides that a judge of an orphans' court within the county in which the license is to be issued is authorized, on joint application by both applicants for a marriage license, to waive the requirements as to medical examination, laboratory tests and certificates, and to authorize the clerk of the orphans' court to issue the license, if other requirements of the marriage laws have been complied with, and the judge is satisfied by affidavit or other proof that the examination or tests are contrary to the tenets or practices of the religious creed to which the applicant is an adherent, and that the public health and welfare will not be injuriously affected by the waiver and authorization.]
§ 27.94. [Prenatal examination for syphilis] (Reserved).
[(a) Section 13(a) of the act (35 P. S. § 521.13(a)) provides that every physician who attends, treats or examines a pregnant woman for conditions relating to pregnancy during the period of gestation or delivery, shall take or cause to be taken, unless the woman objects, a sample of her blood at the time of first examination or within 15 days and shall submit the sample to an approved laboratory for an approved serological test for syphilis. Other persons permitted by law to attend pregnant women, but not permitted by law to take blood samples, shall, unless the woman objects, cause a blood sample to be taken by a physician licensed in this Commonwealth and shall submit it to an approved laboratory for an approved serological test. If the pregnant woman objects it shall be the duty of the physician to explain to her the desirability of the test.
(b) The serological test required by subsection (a) will be made without charge by the Department upon the request of the physician submitting the sample, if he submits a certificate that the patient is unable to pay.]
§ 27.95. Reporting [birth] syphilis examination information for births and fetal deaths.
[Section 13(b) of the act (35 P. S. § 521.13(b)) provides that in] In reporting [every] a birth [and] or fetal death, physicians and others required to make the reports shall state [upon the certificate] in the medical record whether or not the blood [test] tests required by § [27.94] 27.89(b) (relating to [prenatal examination] examinations for syphilis) [was] were made. If [the] a test was made, the date of the test shall be given, and if [the] a test was not made [it may be stated whether it was not made because, in the opinion of the physician, the test was not advisable or because the woman objected], the reason the test was not made shall be given.
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