TITLE X
PUBLIC HEALTH

Chapter 141-G
NOTIFICATION OF EMERGENCY RESPONSE/PUBLIC SAFETY WORKERS AFTER EXPOSURE TO INFECTIOUS DISEASE

Section 141-G:1

    141-G:1 Definitions. –
In this chapter:
I. "Blood or other potentially infectious material" means human blood, human blood components, products made from human blood, sputum or any such other body fluid, tissue, or organ that may be designated by the director by rule adopted under RSA 141-G:6.
II. "Commissioner" means the commissioner of the department of health and human services.
III. "Department" means the department of health and human services.
IV. "Emergency response/public safety worker" means firefighters; police officers; employees of any prison, jail, corrections institution, or other detention facility where persons are held pending arraignment, adjudication, or disposition of a criminal charge or in protective custody, as defined in RSA 172-B:1, XIII; emergency care providers licensed under RSA 153-A; persons using wreckers as defined in RSA 259:126 for towing purposes; and other similar care providers, whether paid or volunteer.
V. "Exposed worker" means an emergency response/public safety worker who sustains or suspects such worker has sustained an unprotected exposure.
VI. "Infectious disease" means any infectious disease that is designated by the commissioner by rule adopted under RSA 141-G:6.
VII. "Source individual" means any person whose blood, body fluids, tissue, or organs were specifically identified as the source of an exposure to an emergency response/public safety worker.
VIII. "Unprotected exposure" includes instances of direct mouth-to-mouth resuscitation or the commingling of blood or other potentially infectious material of a source individual and an emergency response/public safety worker, which is capable of transmitting an infectious disease or any other such type of exposure that may be designated by the commissioner by rule adopted under RSA 141-G:6.

Source. 1989, 374:1. 1991, 175:2. 1993, 16:2. 1995, 310:98, 183. 1996, 145:1. 2008, 358:10, eff. Sept. 9, 2008.

Section 141-G:2

    141-G:2 Medical Referral Consultant. –
I. Each employer of emergency response/public safety workers shall identify a medical referral consultant who has agreed to accept referrals and to evaluate and follow up such workers' unprotected exposures. The medical referral consultant shall be a licensed physician, a registered nurse, advanced practice registered nurse or licensed physician assistant. If none of these is available the employer shall request written approval from the department for an alternate. For purposes of this chapter, in such case involving an individual protected under RSA 508:12 the department shall act as the medical referral consultant.
II. The medical referral consultant shall:
(a) Receive emergency response/public safety worker incident report forms.
(b) Receive information from the infection control officer, the exposed worker's private physician, or both, regarding the worker's exposure to an infectious disease, as appropriate.
(c) Conduct a medical examination, evaluate the exposure, and give appropriate prophylactic treatment and follow-up treatment and advice, or, if the medical referral consultant is not a licensed physician, refer the exposed worker immediately to a licensed physician for such examination, evaluation, treatment and advice.
(d) Make all reasonable efforts to request and obtain a blood specimen from a source individual when, in the opinion of the medical referral consultant, a test on such blood specimen from a source individual when, in the opinion of the medical referral consultant, a test on such blood specimen is necessary in order to determine the proper prophylactic treatment or advice for the exposed worker, provided that the source individual or the source individual's legal guardian consents to such test and the disclosure of such test results.
(e) Maintain a record relating to any emergency response/public safety worker's exposure to an infectious disease. The manner of recordkeeping shall assure the confidentiality of all information.

Source. 1989, 374:1. 1995, 310:175. 1996, 145:2. 2009, 54:5. 2012, 152:4, eff. Jan. 1, 2013.

Section 141-G:3

    141-G:3 Infection Control Officer. –
I. The senior facility administrator of each health care facility licensed under RSA 151 shall designate an infection control officer for the purpose of carrying out this chapter. That person shall be the infection control practitioner, hospital epidemiologist, hospital infection control chairman or a licensed physician or registered nurse who is knowledgeable of the facility's infection control policies and procedures.
II. When the source individual is transported to a health care facility, the infection control officer shall:
(a) Receive copies of emergency response/public safety worker incident report forms and coordinate the acquisition of any source individual information required for evaluating an emergency care worker's possible exposure and for evaluating the possible exposure of an individual protected under RSA 508:12, if any.
(b) Review the incident report form and source individual medical information.
(c) Notify the medical referral consultant, in accordance with RSA 141-G:5, of any source individual infection which, in the event that an unprotected exposure occurred, may place an emergency response/public safety worker at significant risk for disease.
(d) Notify public health in accordance with RSA 141-C:7, of any source individual infection which, in the event that an unprotected exposure occurred, may place an individual protected under RSA 508:12 at tangible risk for disease.

Source. 1989, 374:1. 2012, 152:1, eff. Jan. 1, 2013.

Section 141-G:4

    141-G:4 Notification by Emergency Response/Public Safety Workers. –
I. Any emergency response/public safety worker who, while in the line of duty, sustains an unprotected exposure to himself or herself or another individual protected under RSA 508:12, or who suspects such an exposure, shall, as soon as possible, provide a copy of the emergency response/public safety worker incident report form to the worker's medical referral consultant. If the source individual is transported to a health care facility licensed under RSA 151, the exposed worker shall also provide a copy of the incident report form to the infection control officer of the facility as soon as possible after arrival of the source individual at the facility.
II. The department shall prepare and distribute the emergency response/public safety worker incident report form. The form shall include, at a minimum, the names of persons who believe they have sustained an unprotected exposure, the manner in which the exposure occurred, the name of the employer's medical referral consultant and such other relevant information that the department may require by rule adopted under RSA 141-G:6.
III. Nothing in this section shall be construed as negating whatever responsibility the fire department, police department, correctional facility, or emergency medical services unit might have for the protection and care of its employees, or the responsibility of any emergency care worker to safeguard such emergency care worker's health by using all appropriate protective equipment provided by the employer, by following appropriate procedures, and by seeking medical advice and attention when prudent.

Source. 1989, 374:1. 1993, 16:3. 1995, 310:175. 1996, 145:3, 4. 2012, 152:2, eff. Jan. 1, 2013.

Section 141-G:5

    141-G:5 Notification by Health Care Facilities; Duties of Department; Confidentiality. –
I. When the source individual is transported to a health care facility licensed under RSA 151, the infection control officer shall receive and review a copy of the emergency response/public safety worker incident report form. If the transported source individual is diagnosed as having an infectious disease which could have been transmitted via the unprotected exposure, the infection control officer shall orally notify within 48 hours and in writing notify within 72 hours of the determination, the medical referral consultant listed on the form. The notice shall include, but not be limited to, the finding, if any, that an unprotected exposure may have occurred and the identity of such infectious disease. The infection control officer or health care facility shall provide the source individual diagnosed as having the infectious disease with the names of persons who were informed of the source individual's condition.
II. The department shall determine the method by which the written notification of the incident report is conveyed to the medical referral consultant.
III. When the source individual is transported to a health care facility licensed under RSA 151, the testing performed on the transported source individual to complete the diagnosis under paragraph I shall not be in addition to any testing which would be conducted during the care and treatment of the individual, unless additional tests are determined as necessary by the infection control officer and the individual's attending physician because of the nature of the unprotected exposure, and the individual consents to the tests.
IV. Notwithstanding the provisions of this chapter, any drawing of blood and testing carried out under this chapter for the presence of the human immunodeficiency virus, any notifications of persons about such test results, and the confidentiality of such test results shall be in accordance with the provisions of RSA 141-F.

Source. 1989, 374:1. 1995, 310:175. 1996, 145:5, eff. July 23, 1996.

Section 141-G:6

    141-G:6 Rulemaking. –
The commissioner shall adopt rules under RSA 541-A relative to:
I. Form, content and distribution of the standardized emergency response/public safety worker incident report form required under RSA 141-G:4.
II. A definition of blood or other potentially infectious material.
III. A definition of infectious disease.
IV. Manner of recordkeeping to ensure confidentiality under RSA 141-G:2, II(e).
V. Further definition of an unprotected exposure.
VI. Content and format of all notices and forms required under this chapter.
VII. Minimal requirements for a medical referral consultant alternate as required under RSA 141-G:2, I.
VIII. Preparation and distribution of the incident report form as required under RSA 141-G:4, II.

Source. 1989, 374:1. 1995, 310:183, eff. Nov. 1, 1995.

Section 141-G:7

    141-G:7 Immunity From Civil Liability. – No facility licensed under RSA 151 or agent, employee, administrator, physician, official, other representative of such facility, or emergency response/public safety worker shall be held jointly or severally liable, either as a facility or personally, for reporting as required under this chapter, if such report was made in good faith and was in accordance with the confidentiality procedures of the facility and RSA 141-F. All such parties who have acted in good faith shall have total immunity from civil or criminal liability for any act performed in the fulfillment of the duties imposed by this chapter.

Source. 1989, 374:1. 2012, 152:3, eff. Jan. 1, 2013.

First Responder and Healthcare Provider Exposure Blood Testing

Section 141-G:8

    141-G:8 Definitions. –
As used in this subdivision:
I. "Advanced practice registered nurse" means a registered nurse licensed by the state of New Hampshire pursuant to RSA 326-B:18.
II. "Applicant" means a person who applies for a testing order or on whose behalf an application for a testing order is made.
III. "Bloodborne pathogens" means pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV).
IV. "Court" means the district division of the circuit court.
V. "Commissioner" means the commissioner of the department of health and human services.
VI. "Healthcare provider" means all persons working in a healthcare setting who have the potential for exposure to infectious materials, including, but not limited to, body substances.
VII. "Physician" means a medical practitioner licensed by the state of New Hampshire pursuant to RSA 329:12.
VIII. "Physician assistant" means a physician assistant licensed by the state of New Hampshire pursuant to RSA 328-D:2.
IX. "Source individual" means any person whose blood, body fluids, tissue, or organs were specifically identified as the source of a bloodborne pathogen exposure to an applicant under this subdivision.
X. "Test results" means results of an analysis conducted for the purposes referred to in this subdivision.
XI. "Testing order" means an order under RSA 141-G:11, I.
XII. "Unprotected exposure" includes instances of commingling of blood or other potentially infectious material of a source individual and an applicant, which is capable of transmitting a bloodborne pathogen or any other such type of exposure that may be designated by the commissioner by rule adopted under RSA 141-G:19.

Source. 2017, 208:1, eff. Sept. 8, 2017.

Section 141-G:9

    141-G:9 Notice of Intention. – A person who intends to apply under RSA 141-G:10, I for a testing order after an unprotected exposure to a source individual shall provide notice of that intention to the source individual in accordance with rules adopted under RSA 141-G:19.

Source. 2017, 208:1, eff. Sept. 8, 2017.

Section 141-G:10

    141-G:10 Application for Testing Order. –
I. Subject to RSA 141-G:9, a person may apply to the court for a testing order if such person has had an unprotected exposure to blood or body fluids from a source individual in any of the following circumstances:
(a) While providing or receiving emergency health services; or
(b) While performing his or her duties as a firefighter, emergency medical technician, paramedic or other emergency medical care provider, police officer, probation officer, peace officer, person who gives aid at the scene of an emergency or to the victim of crime under RSA 508:12, or healthcare provider; or
(c) While being involved in activities defined in rules adopted under RSA 141-G:19.
II. If a person who had an unprotected exposure to blood or body fluids from a source individual in a circumstance referred to in paragraph I is unable to apply for a testing order under paragraph I, a representative of the person may apply on behalf of the person.
III. An application for a testing order shall:
(a) Include a medical evaluation, including a blood test, by a physician, physician assistant, or advanced practice registered nurse confirming that the exposure to the source individual puts the applicant at reasonable risk for possible exposure to a bloodborne pathogen;
(b) Be made within 20 days of the date of the exposure referred to in paragraph I;
(c) Be made in accordance with the rules adopted under this subdivision; and
(d) Be served on the source individual at least 4 days before the court hears the application.
IV. The court shall hear an application for a testing order as soon as practicable and may, on application or on the court's own motion, order that the public is excluded from all or part of a hearing.
V. If giving notice is impossible or impracticable, the court may hear ex parte an application made under paragraph I without notice to the source individual if the applicant satisfies the court by a preponderance of the evidence that complying with paragraph II or subparagraph III(d) within a reasonable time is impossible or impracticable and is necessary to decrease or eliminate the risk to the health of the applicant as a result of the exposure.

Source. 2017, 208:1, eff. Sept. 8, 2017.

Section 141-G:11

    141-G:11 Testing Order. –
I. On an application made under RSA 141-G:10, I, the court may issue an order requiring testing if the court, having considered the medical evaluation and any other evidence the court considers relevant, is satisfied of the following:
(a) The applicant has complied with RSA 141-G:9 and RSA 141-G:10;
(b) The applicant has had an unprotected exposure to blood or bodily fluids from the source individual in one of the circumstances set out in RSA 141-G:10, I;
(c) There are reasonable grounds to believe that the applicant may have been exposed, as a result of the exposure, to a bloodborne pathogen that causes a communicable disease;
(d) An analysis of the applicant's blood and bodily fluids would not determine, in a timely manner, whether the applicant has been infected by a bloodborne pathogen;
(e) Taking a blood sample from the source individual would not endanger the source individual's life or health;
(f) The information to be obtained under the testing order cannot reasonably be obtained in any other manner; and
(g) The testing order is necessary to decrease or eliminate the risk to the health of the applicant as a result of the exposure.
II. A testing order:
(a) Shall require the source individual, within the time specified in the order, to attend the health facility identified in the order so that a blood sample may be taken from the source individual for the purpose of determining whether the source individual is infected with a bloodborne pathogen that causes a communicable disease listed in rules adopted under RSA 141-G:19.
(b) Shall require the health facility identified in the order to ensure that a blood sample from the source individual is taken.
(c) Shall require the applicant to have the testing order served and any other information required by rules, within the time specified in the order, on the source individual and the health facility identified in the order.
(d) Shall not require testing for any substance in the blood other than bloodborne pathogens.
III. If the source individual named in a testing order is a minor or an incapacitated adult, the testing order shall require the guardian of the minor or the person responsible for the incapacitated adult under rules adopted by the commissioner under RSA 141-G:19 to take all reasonable steps to ensure that the source individual complies with the testing order.
IV. The blood sample taken in compliance with an order issued under this section shall not be tested at any time for any civil or criminal matter or for any purpose not authorized in this subdivision.
V. A decision of the court under paragraph I may be appealed to the superior court.

Source. 2017, 208:1, eff. Sept. 8, 2017.

Section 141-G:12

    141-G:12 Obligations of Person Who Takes Sample. –
A person at a health facility who, pursuant to a testing order, takes from the source individual a blood sample shall:
(a) Deliver the sample, a copy of the testing order, and any other required information to a laboratory licensed under RSA 151 for the purpose of having the sample analyzed; and
(b) Not use the sample for any purpose or test the sample for any organisms or substances other than those stated in the order.

Source. 2017, 208:1, eff. Sept. 8, 2017.

Section 141-G:13

    141-G:13 Test Results. –
I. Test results shall be promptly provided by the licensed laboratory in a written report to the applicant's physician, physician assistant, or advanced practice registered nurse and the source individual's physician, physician assistant, or advanced practice registered nurse.
II. The applicant's physician, physician assistant, or advanced practice registered nurse shall notify the applicant of the test results.
III. The source individual's physician, physician assistant, or advanced practice registered nurse shall notify the source individual of the test results.

Source. 2017, 208:1, eff. Sept. 8, 2017.

Section 141-G:14

    141-G:14 Confidentiality. –
I. No person shall use or disclose any information concerning an applicant or a source individual if that information becomes known to the person in the course of carrying out his or her responsibilities under this subdivision or as a result of obtaining a testing order.
II. Paragraph I shall not apply to disclosure in the following circumstances:
(a) In the course of carrying out a duty imposed or exercising a power conferred under this subdivision.
(b) As required by law.
(c) With the consent of the person who is the subject of the information.
(d) In the course of a consultation between qualified health professionals.
(e) In the case of information about a minor to a guardian of that minor.
(f) As provided in rules adopted under RSA 141-G:19.
III. No person who is subpoenaed or otherwise compelled to give evidence in a legal proceeding, other than a proceeding for the purposes of RSA 141-G:11, I or an appeal under RSA 141-G:11, V, shall disclose information described in paragraph I, unless the court first examines the information, with the public excluded, and determines that the information may be disclosed. The court shall consider:
(a) The probative value of the information;
(b) The relevance of the information to the proceeding; and
(c) The effect of the disclosure on the privacy of the person who is the subject of the information.

Source. 2017, 208:1, eff. Sept. 8, 2017.

Section 141-G:15

    141-G:15 Costs. – Subject to rules adopted by the commissioner under RSA 141-G:19, an applicant's workers' compensation insurance carrier shall be responsible for paying the costs of the test, including the charges of the health care facility taking the blood sample and the charges of the laboratory for the analysis of the sample. An applicant without insurance coverage may request testing under this subdivision, however, he or she shall be responsible for paying for the testing order and may be required to pay for testing in advance.

Source. 2017, 208:1, eff. Sept. 8, 2017. 2018, 201:1, eff. June 8, 2018.

Section 141-G:16

    141-G:16 Immunity. –
No legal proceeding for damages may be commenced or maintained against a person who in good faith, and not in a wanton or reckless manner, engages in any act or omission:
I. In the exercise or intended exercise of any power under this subdivision;
II. In the performance or intended performance of any duty under this subdivision; or
III. In the taking, under a testing order, of a sample from a source individual.

Source. 2017, 208:1, eff. Sept. 8, 2017.

Section 141-G:17

    141-G:17 Notice and Service. –
I. All documents or notifications required to be given to or served on a person shall be given or served in accordance with the rules adopted by the commissioner, in collaboration with the judicial branch, under RSA 141-G:19.
II. If a person is required under this subdivision to provide a notice to or serve a document on another person, notice or service may be made on an authorized representative of the source individual.

Source. 2017, 208:1, eff. Sept. 8, 2017.

Section 141-G:18

    141-G:18 Penalties. –
I. Any source individual who purposely contravenes a testing order shall be guilty of a violation.
II. Any person who purposely violates the provisions of RSA 141-G:14, shall be guilty of a misdemeanor.
III. If an offense under this subdivision continues for more than one day, a fine may be imposed for each day the offense continues, provided that the sum of such fines shall not exceed the maximum fine for the offense.

Source. 2017, 208:1, eff. Sept. 8, 2017.

Section 141-G:19

    141-G:19 Rules. –
I. The commissioner shall be responsible for the statewide supervision of first responder and healthcare provider exposure blood testing.
II. The commissioner shall adopt rules under RSA 541-A, relative to:
(a) Defining diseases or conditions as bloodborne pathogens for the purposes of this subdivision.
(b) Providing the notice required under RSA 141-G:9, including developing forms for that purpose.
(c) Identifying circumstances and activities eligible for a blood testing order under RSA 141-G:10, I.
(d) Developing applications for testing orders, including forms for that purpose.
(e) Medical evaluation reports pursuant to RSA 141-G:10, III(a).
(f) The taking and analysis of blood samples under the authority of a testing order.
(g) Identifying eligible health facilities.
(h) Information required for completing a testing order.
(i) The reporting procedures for test results if the applicant's or source individual's physician, physician assistant, or advanced practice registered nurse is not known or the applicant or source individual does not have one.
(j) Circumstances when confidential information under this subdivision may be disclosed.
(k) Circumstances in which workers' compensation insurance and the government shall be responsible for paying the costs referred to in RSA 141-G:15.
(l) Notice and service, including identifying authorized persons who may be notified or served instead of the source individual of the notice or service.

Source. 2017, 208:1, eff. Sept. 8, 2017. 2018, 201:2, eff. June 8, 2018.