N.J. Admin. Code § 8:57-5.10

Current through Register Vol. 52, No. 3, February 3, 2020
Section 8:57-5.10 - Management of non-adherent patients requiring a diagnostic evaluation or DOT
(a) This section is applicable to patients with suspected or confirmed infectious or potentially infectious TB disease, identified contacts and Class B1 or B2 referrals that require a diagnostic evaluation to determine their TB status.
1. A public health nurse case manager, when issuing a public health warning notice to a patient, shall seek a diagnostic evaluation on the patient to assess his or her TB status to adequately protect the public health.
2. A health officer, when issuing a health officer order to a patient, shall require a diagnostic evaluation of the patient to assess his or her TB status to adequately protect the public health.
i. A health officer order for diagnostic evaluation of a contact to a patient with suspected or confirmed infectious or potentially infectious TB disease or Class B1 or B2 referral shall remain in force until a diagnostic evaluation is completed and infectious or potentially infectious TB disease is ruled out by a health care provider.
ii. A health officer order for diagnostic evaluation of a patient with suspected infectious or potentially infectious TB disease shall remain in force until infectious or potentially infectious TB disease is ruled out by a health care provider.
iii. A health officer order for diagnostic evaluation of a patient determined by a health care provider to have infectious or potentially infectious TB disease shall remain in force until treatment is completed as determined by a health care provider.
3. A health officer, when initiating a commitment hearing on a patient, shall require a diagnostic evaluation of the patient to assess his or her TB status to adequately protect the public health.
(b) This section is also applicable to persons with suspected or confirmed infectious or potentially infectious TB disease who are non-adherent with prescribed TB treatment recommendations.
1. A public health nurse case manager, when issuing a public health warning notice to a patient, shall seek DOT to monitor adherence with prescribed treatment to protect the public health.
2. A health officer, when issuing a health officer order to a patient, shall require DOT to monitor adherence with prescribed treatment to protect the public health.
i. A health officer order for DOT of a patient with suspected or confirmed infectious or potentially infectious TB disease shall remain in force until either DOT is discontinued by a health care provider or treatment is completed, as determined by a health care provider.
3. A health officer, when initiating a commitment hearing on a patient, shall require DOT to monitor adherence with prescribed treatment to protect the public health.
(c) If a public health warning notice or health officer order is made pursuant to this section, the health officer or designee shall serve the notice or order by certified mail, return receipt requested or by hand delivery.
1. Successful hand delivery shall include a face-to-face encounter with the patient.
2. Hand delivery by the public health nurse case manager or health officer or designee is preferred, because receipt is witnessed and conditions can be discussed with the patient.
3. The public health nurse case manager, health officer or designee, depending upon who had the face-to-face encounter shall document clearly in the patient's medical record the date and time of the encounter and the patient's response to the conditions of the notice or order.
(d) A health officer order issued pursuant to this section authorizes local law enforcement officers to assist the health officer or designee in hand delivery of the order upon request of the health officer in accordance with 26:1A-9.
(e) A public health nurse case manager or designee in the patient's health jurisdiction of residence shall issue a public health warning notice, as set forth in this section, to a person identified in (a) or (b) above within two business days of when the patient:
1. Misses two consecutive scheduled appointments;
2. Falls below a medication adherence rate of 80 percent on a treatment regimen of DOT over a one-month period; or
3. Refuses diagnostic evaluation or DOT.
(f) The public health warning notice shall:
1. State the nature of the non-adherence;
2. Require the patient to contact the health care provider or clinic indicated in the notice within three business days of receipt of the notice to schedule an appointment for diagnostic evaluation or begin or resume a treatment regimen of DOT, whichever is applicable;
3. State the consequences of not satisfying the conditions of the notice; and
4. Be copied and filed in the patient's medical record by the public health nurse case manager or designee.
(g) If the patient described in (e) above fails to meet the conditions of the public health warning notice, the public health nurse case manager shall notify the health officer of the patient's health jurisdiction of residence within two business days of this failure to request a health officer order.
1. If the person is institutionalized or hospitalized, the health officer in the health jurisdiction where the institution or hospital is located shall issue the order.
(h) The health officer shall issue a health officer order within three business days of request by the public health nurse case manager.
(i) The health officer order shall:
1. State the nature of the non-adherence;
2. State the public health consequences of continued non-adherence;
3. Require the patient to contact the health care provider or clinic indicated in the order to schedule an appointment for diagnostic evaluation or begin or resume a treatment regimen of DOT within three working days of receipt of the order; and
4. State the consequences of not satisfying the conditions of the order.
(j) The public health nurse case manager or designee shall copy and file the health officer order for diagnostic evaluation or DOT in the patient's medical record.
(k) The health officer that issued the order may petition the Superior Court for commitment of the patient violating the order for diagnostic evaluation or DOT pursuant to the hearing process established at 8:57-5.14, if the conditions of a health officer order are not met within three business days.
1. The health officer is required to consult with the Department's TB Program or State Epidemiologist or designee before petitioning the Superior Court.
(l) If, at any time during the intervention process described in (e) through (k) above, the patient becomes adherent, the process shall be immediately interrupted.
1. If the patient with suspected or confirmed infectious or potentially infectious TB disease becomes non-adherent again prior to the completion of treatment, the intervention process shall resume at whatever step was next applicable when the patient became adherent.

N.J. Admin. Code § 8:57-5.10