The targeted testing program is a screening process that would identify individuals who have a much higher risk of spreading tuberculosis. Bill sponsor Rep. Keith Frederick, R-Rolla, said the testing program will be implemented in universities in Missouri, where the population is more concentrated. The screening would require the completion of a TB risk assessment questionnaire form recommended by the American College of Health Association.
TB is a contagious bacterial infection that develops in the lungs. It is contracted by breathing in air droplets from a cough or sneeze from an infected person. The typical treatment for the disease requires four oral doses of TB medications. Bert Malone, a public health administrator at the Kansas City Health Department, said one-third of individuals are infected with TB.
The bill would grant local public health authorities or departments the power to require individuals they suspect are infected with TB to get treatment. The bill deems any individual knowingly infected with TB, who acts in a reckless manner or violates the requirements of treatment, guilty of a class C felony.
Malone said he believes the U.S. has had great success with preventing and treating TB and he said the bill will help identify cases of infection sooner. Malone also said that the state should "fish where the fish are," and target individuals with an increased risk.
In the last year, 107 cases of TB were reported in Missouri and 2,974 infections were reported.
"There are very few cases in Missouri each year, but each case has the potential to impact many people by infecting them with tuberculosis," Frederick said.
Frederick said treatment of TB in Missouri is good. He said many patients are compliant in completing the regiment.
Frederick said treatment of mentally ill or incapacitated patients is typically where the system breaks down. He said the non-compliant patients acting in a reckless manner are a threat, because they can infect a large group of people.
Currently the only avenue the Department of Health and Senior Services has is to commit infected patients to an inpatient treatment program. Frederick said this program is very expensive to the state.
"This bill provides for the ability of the Department of Health and Senior Services to require what's called 'DOT,' direct observed therapy," Frederick said.
DOT would require a member of the health care team to watch the patient take the medication. Frederick said this alternative is cheaper to the state than inpatient care. Frederick said he plans to create an amendment that would only require DOT for non-compliant patients.
"Certainly a much more reasonable and common sense method of handling it than committing the patient to inpatient stay 24 hours a day," Frederick said.
The DHSS would have the power to investigate suspected TB cases and to provide treatment.
The bill would require all faculty and students of universities to participate in the targeted testing program and to identify high risk populations.
Rep. Margo McNeil, D-Florissant, said she is in support of the bill. She mentioned a physical education teacher at a school where she previously worked that infected at least 50 percent of the students and parents because he was unaware of his infection.
Frederick said the DHSS identified these needs as necessary to protect the public health.
Christine Bartels, a program director from the Jefferson County Health Department, said there have been higher incidents of multidrug-resistant tuberculosis in Missouri. She said this is caused by more people living in close quarters and an increase in immigrants to the state.
No one testified in opposition at the hearing and no action has been taken on the bill.