Section 144-258-9 - DUTIES OF THE DEPARTMENT FOR DISEASE INVESTIGATION AND INTERVENTIONA. The Department will routinely make current information available to practicing Health Care Providers regarding the occurrence, prevention, and control of Notifiable Diseases and Conditions. In addition, the Department will use all reasonable means to: 1. Confirm, in a timely manner, any case or suspected case of a Notifiable Disease or Condition;2. Ascertain, so far as possible, all sources of infection and exposures to the infection;3. Identify exposures to environmental hazards;4. Institute control measures for Notifiable Diseases and Conditions consistent with the currently accepted standards as found in the Control of Communicable Diseases Manual 20th Edition, published in 2015, or any subsequent edition, which is the official report of the American Public Health Association, unless specified otherwise by the State Epidemiologist. Copies of the manual may be obtained from the American Public Health Association, 800 I Street NW, Washington, DC 20001-3710; and5. Determine whether isolation and/or quarantine measures may be necessary.B.ScopeThe scope and extent of the duties for disease investigation and intervention may vary depending upon the circumstances of the cases, falling into one of four broad categories:
2. Non-Compliant Persons;3. Outbreaks or epidemics; or4. Extreme Public Health Emergencies.C.Routine Case Investigation and Intervention1. Providers and Public Health Health Care Providers must instruct their patients diagnosed with Notifiable Diseases or Conditions, or who have recently been exposed to such conditions or diseases, regarding precautions to be taken to prevent spread of the disease or condition. The Department will make current information available to practicing health care providers regarding the prevention and control of Notifiable Conditions or Diseases. The Department will be available to consult with healthcare providers regarding appropriate treatment and notification.
2. Interviews In order to assure rapid and timely implementation of control measures, including contact notification and referral services, the Department may interview all persons either treated for or recently exposed to Notifiable Conditions or Diseases, their health providers, and such other persons as the Department determines may have relevant information relating to the onset or contraction of such conditions or diseases. Cases of Notifiable Diseases or Conditions may require further interview under the following conditions:
a. Specific public health disease intervention strategies are required;b. The case is part of an ongoing cluster or outbreak of disease or exposure to toxic agents or environmental hazards investigation; orc. The epidemiology of the disease or condition is not clearly understood or defined. When practical, the Department will contact and inform the healthcare provider of plans to interview the case in order to foster communication and collaboration in disease control efforts.
3. Interventions Public health workers will recommend or take actions that they deem necessary to implement interventions with each case and that are consistent with currently accepted standards as found for the notifiable condition or disease in the 20th Edition published in 2015 of Control of Communicable Diseases Manual, or any subsequent edition, published by the American Public Health Association, unless specified otherwise by the State Epidemiologist. Copies of the manual may be obtained from the American Public Health Association, 800 I Street NW, Washington, DC 20001-3710.
D.Non-Compliant Persons and Public Health Threats1. Background Nothing in this rule will be construed to deny persons the right to rely solely upon exercise of their philosophical, religious or other personal beliefs, if that reliance is based upon sincere religious or conscientious objection to standard treatment and/or public health interventions and if alternative public health measures, even if more restrictive, are available to address the public health threat posed by the infectiousness. If such persons endanger the public through their infectiousness or through their behaviors while infected, the Department may use public health disease control methods, up to and including involuntary confinement, isolation and medical treatment, as necessary to protect the public, as authorized by 22 MRS Ch. 250 and this rule.
2. Investigation a. The Department begins investigating a complaint when a complaint is made by any person with sufficient reason and evidence to believe that another person has either contracted or been exposed to Notifiable Diseases or Conditions and is engaged in behavior that may transmit that condition. During such an investigation, the Department will determine whether it needs to impose any public health control measures. Anonymous complaints or complaints based only on second-hand information will be investigated at the Department's discretion. A report made by a Health Care Provider or other reporter of a Non-Compliant Person or a Public Health Threat may be considered a complaint.b. Upon the initiation of an investigation of a valid complaint, the Department will document the following reported information in the investigative record: i. Contact information for the individual making the complaint, as provided by the reporter;ii. Name, contact and locating information for the alleged Non-Compliant Person against whom the complaint is made; andiii. Specific allegations of the non-compliant behavior.c. Investigations will be conducted in a systematic fashion utilizing appropriate public health workers with expertise in the Notifiable Disease or Condition. Investigations will be conducted under the direction of the Department and concluded within 15 business days of the complaint being received.d. Each investigation will establish and document whether the alleged non-compliant person is infected with the Notifiable Disease or Condition and whether the alleged Non-Compliant Person is engaging in behavior that exposes others to infection with the Notifiable Disease or Condition. If the public health worker is unable to establish that the person is infected or that the alleged behavior exposing others to infection is occurring, the investigation must cease immediately.e. If there is credible evidence to substantiate the allegation of non-compliance, the Department must make all reasonable attempts to locate the subject of the complaint to conduct a personal interview to assess the individual's current understanding of the exposure to infection with the Notifiable Disease or Condition, its treatment, and the behaviors that are placing others at risk of infection. The interview must establish and document whether the person: i. Knows that (s)he is infected or has been exposed;ii. Has received appropriate education and counseling about the infection or exposure;iii. Understands the modes of transmission of the Notifiable Disease or Condition and methods to prevent transmission; and iv. Is engaging in non-compliant behavior or is a Public Health Threat. The complete documentation of the investigation, findings and recommendations will be submitted electronically to the Department.
3. Treatment a. Temporary custody and treatment of those persons who have either contracted or been exposed to a Notifiable Disease or Condition and who pose an immediate Public Health Threat may be imposed by a court on an involuntary basis pursuant to 22 MRS§§810 - 812, in the event such persons refuse appropriate countermeasures or public health interventions, as indicated above in Section 9(C), paragraph 3 or conduct themselves in a manner which constitutes a Public Health Threat. For the purpose of this subsection, persons who have either contracted or been exposed to Notifiable Diseases and Conditions who knowingly expose others to the danger thereof, pose a Public Health Threat and are considered to be non-compliant.b. The Commissioner or the Commissioner's designee may initiate judicial proceedings to seek an order that a Non-Compliant Person submit to involuntary medical treatment and other control measures to protect the public health, in accordance with 22 MRS chapter 250, subchapter 2.c. Treatment must be in accord with the most current treatment recommendations and standards of care for the Notifiable Disease or Condition, as advised by U.S. CDC and infectious disease providers. In imposing treatment and related public health disease control measures on an individual, the least restrictive measures will be utilized to ensure effective medical treatment of the disease or condition and to limit the spread of the Notifiable Disease or Condition or other infectious disease, which pose a threat to public health. The Department will adopt medical treatment and public health disease control strategies, as described in Section 9(D) of this rule whenever practical and as long as doing so does not unreasonably increase the threat to the public health.4. Other Interventions a. For each investigation that substantiates a case of non-compliance, or a Public Health Threat, and where recommendations approved by the Department do not resolve the case or threat, the Department will establish a Standing Committee that is chaired by the Department's designee for the coordination of public health control measures responsive to the situation. The Standing Committee will include as many as possible of the following professionals:i. The person's health care provider;ii. Professional staff from other health or social service agencies serving the Non-Compliant Person;iii. The Director of the Maine CDC or designee;iv. The appropriate Maine CDC Associate Division Director;v. The public health worker investigating the case;vi. The State Epidemiologist or designee; and vii. The Department program manager with expertise in the particular Notifiable Disease or Condition. The Standing Committee will be represented by and may seek legal advice from a representative of the Office of the Attorney General.
b. These interventions which may be imposed include, but are not limited to: i. Face-to-face counseling by a public health educator, epidemiologist, public health nurse, disease intervention specialist or other public health professional regarding the infected individual's notifiable disease or condition, its cause and treatment and the necessity for disease control measures.ii. Recommended measures individualized into a documented plan for the infected individual, including such supported services as: * Direct observation of the individual taking required medications on a daily basis;
* Transportation to treatment facilities;
* Individual or group supportive counseling or therapy; and
* Financial support for shelter and food for the duration of medical treatment.
iii. A Cease and Desist Order, signed by the Commissioner, directing the infected individual to comply with medical treatment and specifying public health disease control measures to be followed. * Upon receipt of information that the Department's Cease and Desist Order has been violated, the Department may contact the Office of the Attorney General to pursue a civil fine and/or injunctive relief pursuant to 22 MRS §804(2), or civil commitment or other relief under 22 MRS, §§810 or 812, to enforce the Cease and Desist Order being violated.
iv. The Standing Committee may, at its discretion, not issue a Department Cease and Desist Order and instead directly request the Office of the Attorney General to pursue a court order pursuant to 22 MRS Ch 250. In taking the step of seeking court-ordered confinement, isolation, quarantine and treatment, the Standing Committee should minimally base its actions on one or both of the following factors:
* Whether, based on laboratory tests or clinical signs and symptoms, the individual has a great likelihood of active disease that is extremely contagious; or
* The risk of infecting others, taking into consideration the individual's housing and employment situation.
E.Investigation and Intervention of Outbreaks or Epidemics1. Control Measures In the event of an outbreak or epidemic of a notifiable disease or condition or of a potential epidemic, the Department will institute public health disease control measures consistent with national standards as published in the 20th Edition published in 2015 Control of Communicable Diseases Manual, or any subsequent edition, published by the American Public Health Association. Copies of the manual may be obtained from the American Public Health Association, 800 I Street NW, Washington, DC 20001-3710.2. Common Source of an Outbreak or Epidemic In accordance with 22 MRS §2159 and the Maine Food Code at 10-144 CMR Ch. 200, §8-702, any public or private enterprise, utility, lodging area, food market, or other entity which provides food or water which has been determined by either laboratory or epidemiological methods to be a source or likely source of outbreak or epidemic may be ordered by the Department to end the use or distribution of said food or water until the source of contamination is found and corrected and the food or water has been proven safe for consumption.3. Vaccine-Preventable Outbreaks or Epidemics a. The Department may offer immunization, including mass immunization clinics, to the public for protection in case of an Epidemic or threatened Epidemic, as ordered by the Commissioner, pursuant to 22 MRS §§1061 - 1063.b. In the event of an Outbreak, an Epidemic, or a single case of, and potential, Epidemic, due to a vaccine-preventable disease in a child care facility or a school, the Department may recommend that the superintendent of that district or the administrator of the child care facility exclude all children from school or the center who have not already experienced the illness or who are not immunized against the epidemic disease. If an Epidemic of a vaccine-preventable disease in a child-care center or school district continues in spite of exclusion of unimmunized children, or if such exclusion is not possible, the Department has the discretion to exclude any susceptible pupils, as authorized in 22 MRS §806.10-144 C.M.R. ch. 258, § 9