WAC 246-100-203   Special diseases -- Sexually transmitted diseases -- Health officer orders.  (1) A state or local health officer within his or her jurisdiction may, in accordance with RCW 70.24.024, issue orders for medical examination, testing, and/or counseling, as well as orders to cease and desist specific activities, when he or she knows or has reason to believe that a person has a sexually transmitted disease and is engaging in conduct endangering the public health.

     (a) For purposes of this section, "reason to believe" means a health officer's belief that is based on:

     (i) Laboratory test results confirming or suggestive of a STD; or

     (ii) A health care provider's direct observation of clinical signs confirming an individual has or is likely to have a STD; or

     (iii) Information obtained directly from an individual infected with a STD about the identity of his or her sexual or needle-sharing contacts when:

     (A) Contact with the infected individual occurred during a period when the disease may have been infectious; and

     (B) The contact was sufficient to transmit the disease; and

     (C) The infected individual is, in the health officer's judgment, credible and believable.

     (b) "Conduct endangering the public health" for the purposes of RCW 70.24.024 and this section, means:

     (i) Anal, oral, or vaginal intercourse for all sexually transmitted diseases;

     (ii) For HIV and Hepatitis B:

     (A) Anal, oral, or vaginal intercourse; and/or

     (B) Sharing of injection equipment; and/or

     (C) Donating or selling blood, blood products, body tissues, or semen; and

     (iii) Activities described in (b)(i) and (ii) of this subsection resulting in introduction of blood, semen, and/or vaginal fluids to:

     (A) Mucous membranes;

     (B) Eyes;

     (C) Open cuts, wounds, lesions; or

     (D) Interruption of epidermis.

     (c) State and local health officers and their authorized representatives shall have authority to issue written orders for medical examination, testing, and/or counseling under chapter 70.24 RCW, only after:

     (i) All other efforts to protect public health have failed, including reasonable efforts to obtain the voluntary cooperation of the person to be affected by the order; and

     (ii) They have sufficient evidence to "reasonably believe" the individual to be affected by the order:

     (A) Has a sexually transmitted disease; and

     (B) Is engaging in "conduct endangering public health"; and

     (iii) They have investigated and confirmed the existence of "conduct endangering the public health" by:

     (A) Interviewing sources to assess their credibility and accuracy; and

     (B) Interviewing the person to be affected by the order; and

     (iv) They have incorporated all information required in RCW 70.24.024 in a written order.

     (d) State and local health officers and their authorized representatives shall have authority to issue written orders for treatment under RCW 70.24.022 only after laboratory test results or direct observation of clinical signs or assessment of clinical data by a physician confirm the individual has, or is likely to have, a sexually transmitted disease.

     (e) State and local health officers and their authorized representatives shall have authority to issue written orders to cease and desist from specified activities under RCW 70.24.024 only after:

     (i) They have determined the person to be affected by the order is engaging in "conduct endangering public health"; and

     (ii) Laboratory test results, or direct observation of clinical signs or assessment of clinical data by a physician, confirm the individual has, or is likely to have, a sexually transmitted disease; and

     (iii) They have exhausted procedures described in subsection (8)(a) of this section; and

     (iv) They have enlisted, if appropriate, court enforcement of the orders described in (c) and (d) of this subsection.

     (f) Written orders to cease and desist from specified activities shall be for an initial period of time not to exceed three months, and may be renewed by the health officer for periods of time not to exceed three months provided all requirements of RCW 70.24.024 regarding notification, confidentiality, right to a judicial hearing, and right to counsel are met again at the time of renewal.

     (2) A state or local health officer within his or her jurisdiction may, in accordance with RCW 70.24.034, bring action in superior court to detain a person in a designated or approved facility when he or she knows or has reason to believe that person has a sexually transmitted disease and continues to engage in behaviors that present an imminent danger to the public health.

     (a) "Behaviors that present an imminent danger to public health" or "BPID" for the purposes of detention in accordance with RCW 70.24.034 and this section means the following activities, under conditions specified below, performed by an individual with a laboratory-confirmed HIV infection:

     (i) Anal or vaginal intercourse without a latex condom; or

     (ii) Shared use of blood-contaminated injection equipment;

     (iii) Donating or selling HIV-infected blood, blood products, or semen; and

     (iv) Activities described in (a)(i) and (ii) of this subsection constitute BPID only if:

     (A) The infected individual received post-test counseling as described in WAC 246-100-209 prior to repeating activities; and

     (B) The infected individual did not inform the persons with whom the activities occurred of his or her infectious status.

     (b) State and local health officers and their authorized representatives shall have authority to seek court orders for detainment under RCW 70.24.034 only for persons infected with HIV and only after:

     (i) Exhausting procedures described in subsection (1) of this section; and

     (ii) Enlisting, if appropriate, court enforcement of orders to cease and desist; and

     (iii) Having sufficient evidence to "reasonably believe" the person is engaging in BPID.

     (c) A local health officer may notify the state health officer if he or she determines:

     (i) The criteria for BPID are met by an individual; and

     (ii) Such individual fails to comply with a cease and desist order affirmed or issued by a court.

     (d) A local or state health officer may request the prosecuting attorney to file an action in superior court to detain an individual specified in this subsection. The requesting local or state health officer or authorized representative shall:

     (i) Notify the department prior to recommending the detainment setting where the individualized counseling and education plan may be carried out consistent with subsection (9)(d), (e), and (f) of this section;

     (ii) Make a recommendation to the court for placement of such individual consistent with (e), (f), and (g) of this subsection; and

     (iii) Provide to the court an individualized plan for education and counseling consistent with (f) of this subsection.

     (e) State board of health requirements for detainment of individuals demonstrating BPID include:

     (i) Sufficient number of staff, caregivers, and/or family members to:

     (A) Provide round-the-clock supervision, safety of detainee, and security; and

     (B) Limit and restrict activities to prevent BPID; and

     (C) Make available any medical, psychological, or nursing care when needed; and

     (D) Provide access to AIDS education and counseling; and

     (E) Immediately notify the local or state health officer of unauthorized absence or elopement; and

     (ii) Sufficient equipment and facilities to provide:

     (A) Meals and nourishment to meet nutritional needs; and

     (B) A sanitary toilet and lavatory; and

     (C) A bathing facility; and

     (D) Bed and clean bedding appropriate to size of detainee; and

     (E) A safe detention setting appropriate to chronological and developmental age of detainee; and

     (F) A private sleeping room; and

     (G) Prevention of sexual exploitation;

     (iii) Sufficient access to services and programs directed toward cessation of BPID and providing:

     (A) Linguistically, socially, culturally, and developmentally appropriate ongoing AIDS education and counseling; and

     (B) Psychological and psychiatric evaluation and counseling; and

     (C) Implementation of court-ordered plan for individualized counseling and education consistent with (g) of this subsection;

     (iv) If required, provide access to isolation and/or restraint in accordance with restraint and seclusion rules in WAC 275-55-263 (2)(c);

     (v) Maintain a safe, secure environment free from harassment, physical danger, and sexual exploitation.

     (f) Washington state board of health standards for an individualized counseling and education plan for a detainee:

     (i) Consideration of detainee's personal and environmental characteristics, culture, social group, developmental age, and language;

     (ii) Identification of habitual and addictive behavior and relapse pattern;

     (iii) Identification of unique risk factors and possible cross-addiction leading to behavior presenting imminent danger to public health;

     (iv) Identification of obstacles to behavior change and determination of specific objectives for desired behavior;

     (v) Provision of information about acquisition and transmission of HIV infection;

     (vi) Teaching and training of individual coping skills to prevent relapse to BPID;

     (vii) Specific counseling for chemical dependency, if required;

     (viii) Identification of and assistance with access to community resources, including social services and self-help groups appropriate to provide ongoing support and maintenance of behavior change; and

     (ix) Designation of a person primarily responsible for counseling and/or education who:

     (A) Completed pretest and post-test counselor training approved by the office on AIDS; and

     (B) Received training, as approved by the office on AIDS, focused on facilitating behavior change related to preventing BPID; and

     (C) Has a postgraduate degree in social work, psychology, counseling, psychosocial nursing, or other allied profession; and

     (D) Completed at least one year clinical experience after postgraduate education with a primary focus on individualized behavior change; and

     (E) Is a certified counselor under chapter 18.19 RCW;

     (x) Designation and provision of a qualified counselor under WAC 275-19-145 when the detainee is assessed to have a drug or alcohol problem.

     (g) The state board of health designates the following settings appropriate for detainment provided a setting meets requirements in (e)(i), (ii), (iii), (iv), and (v) of this subsection:

     (i) Homes, care facilities, or treatment institutions operated or contracted by the department;

     (ii) Private homes, as recommended by the local or state health officer;

     (iii) Boarding homes licensed under chapter 18.20 RCW;

     (iv) Nursing homes licensed under chapter 18.51 RCW;

     (v) Facilities licensed under chapter 71.12 RCW, including:

     (A) Psychiatric hospitals, per chapter 246-322 WAC;

     (B) Alcoholism treatment centers if certified for substance use under chapter 275-19 WAC;

     (C) Adult residential rehabilitation centers, per chapter 246-325 WAC;

     (D) Private adult treatment homes, per chapter 246-325 WAC;

     (E) Residential treatment facilities for psychiatrically impaired children and youth, per chapter 246-323 WAC;

     (vi) A hospital licensed under chapter 70.41 RCW.



[Statutory Authority: RCW 70.24.130 and 70.24.380. 05-11-110, § 246-100-203, filed 5/18/05, effective 6/18/05.]