Creates an exemption on religious grounds from tuberculin skin testing as a prerequisite for school entry, clarifies "vaccination" requirements for school entry, and requires informed consent procedures for vaccination and tuberculin skin testing performed by health care workers.

A BILL FOR AN ACT

SECTION 1. The legislature finds that, based on reports issued by the American Thoracic Society and the Centers for Disease Control and Prevention, a majority of children entering school nationwide are subject to mandatory tuberculin skin testing, despite their low 0.1 to 1 per cent likelihood of contracting a tuberculosis infection. When a positive result is found among these low-risk children, more often than not, it is a false-positive result caused by nonspecific reactivity or exposure to nontuberculous mycobacteria in the environment. These unfortunate false-positives can lead to unnecessary health-care expenditures and anxiety for the child, family, school, and health care workers.

A recent California study revealed widespread TB screening of kindergarten and high school students yielded a low prevalence of skin test reactors and only a limited number of cases of TB. It is already common knowledge that risk factors that dramatically increase the likelihood of tuberculosis infection among children include the incidence of foreign birth, exposure to a foreign-born person in the home, and recent travel to certain parts of the world. In a cost-benefit analysis, mandatory screening of all students could be expected to prevent 14.9 cases/10,000 children screened, whereas a testing method that was narrowly targeted toward higher-risk populations could prevent 84.9 cases/10,000 screened, and would be less costly. Therefore, a more effective approach would be to perform tuberculin skin testing only on those children with specific risk factors for infection.

The legislature further finds that tuberculin skin testing is closely related to vaccination in that both involve similar physical and immunological processes that violate fundamental religious teaching and natural hygiene laws which require strict blood purity and genetic integrity. While current law provides a religious exemption from vaccination, it only makes sense to create an additional exemption from tuberculin skin testing, also on religious grounds.

Additionally, the legislature finds that the term "immunization" does not exclusively imply "vaccination," and vaccinations do not necessarily infer immunity against infectious diseases. Thus, the word "immunization" has been misapplied in the state statutes pertaining to vaccinations, and should be changed to "vaccination" where it appears.

Last, the legislature finds that parents and legal guardians of children are entitled to a full disclosure of risks from vaccination and tuberculin skin testing, and the availability of alternatives to these medical procedures. One way to provide personal assistance to persons lacking the capacity to make decisions about such complex health matters, and to promote communication and understanding between health practitioners and their patients, is to require compliance with certain informed consent procedures before the administration of vaccinations and tuberculin skin testing.

The purpose of this act is to clarify the vaccination, tuberculosis skin testing and exemption standards for children who are entering school. It creates an exemption from tuberculin skin testing as a prerequisite for school entry on religious grounds, replace the ambiguous term "immunization" with "vaccination" where it pertains to vaccination, and require informed consent procedures for vaccination and tuberculin skin testing performed by health practitioners.

SECTION 2. Section 302A-1156, Hawaii Revised Statutes, is amended to read as follows:

"§302A-1156 Exemptions. A child may be exempted from the required immunizations:

SECTION 3. Sections 302A-1154 through 302A-1158, and 302A-1160 through 302A-1163, Hawaii Revised Statutes, are amended by substituting the terms "vaccination" or "vaccinated" for "immunization" and "immunized" wherever those terms appear.

SECTION 4. Section 671-3, Hawaii Revised Statutes, is amended to read as follows:

"§671-3 Informed consent. (a) The board of medical examiners may establish standards for health care providers to follow in giving information to a patient, or to a patient's guardian or legal surrogate if the patient lacks the capacity to give an informed consent, to ensure that the patient's consent to vaccination, tuberculin skin testing, or treatment is an informed consent. The standards shall be consistent with subsection (b) and may include:

(b) The following information shall be supplied to the patient or the patient's guardian or legal surrogate prior to obtaining consent to a proposed medical or surgical treatment, [or] a diagnostic or therapeutic procedure, a vaccination, or tuberculin skin testing:

(c) On or before January 1, 1984, the board of medical examiners shall establish standards for health care providers to follow in giving information to a patient or a patient's guardian, to ensure that the patient's consent to the performance of a mastectomy is an informed consent. The standards shall include the substantive content of the information to be given, the manner in which the information is to be given by the health care provider and the manner in which consent is to be given by the patient or the patient's guardian. The substantive content of the information to be given shall include information on the recognized alternative forms of treatment.

(d) Nothing in this section shall require informed consent from a patient or a patient's guardian or legal surrogate when emergency treatment or an emergency procedure is rendered by a health care provider and the obtaining of consent is not reasonably feasible under the circumstances without adversely affecting the condition of the patient's health.

(e) For purposes of this section, "legal surrogate" means an agent designated in a power of attorney for health care or surrogate designated or selected in accordance with chapter 327E."

SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 6. This Act shall take effect upon its approval.