Report Title:

Vaccinations; Exemptions Allowed on Any Grounds

Description:

Makes all vaccinations in the State non-compulsory but only recommended unless there is danger of an epidemic from any communicable disease.  Allows exemptions from vaccinations on any grounds.

HOUSE OF REPRESENTATIVES	H.B. NO.	2683
TWENTY-FOURTH LEGISLATURE, 2008
STATE OF HAWAII

A BILL FOR AN ACT

relating to IMMUNIzations.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

     SECTION 1.  Section 302A-1154, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

     "(a)  [No] A child [shall] may attend any school in the State [unless] if the child presents to the appropriate school official documentation satisfactory to the department of health that the child has received immunizations against communicable diseases as [required] recommended by the department of health[.]; provided that any parent, custodian, guardian, or any other person in loco parentis to a child may object to immunization on any grounds pursuant to section 302A‑1156, and upon showing the appropriate school official satisfactory evidence of the exemption, no certificate or other evidence of immunization shall be required for the child's entry into school."

     SECTION 2.  Section 302A-1155, Hawaii Revised Statutes, is amended to read as follows:

     "§302A-1155  Provisional entrance to school.  (a)  A child may enter school provisionally upon submitting written documentation from a licensed physician, advanced practice registered nurse, or an authorized representative of the department of health, stating that the child is in the process of receiving the [required] recommended immunizations.  Further documentation showing that the [required] recommended immunizations have been completed shall be submitted to the appropriate school official no later than three months after the child first entered the school.  If all of the [required] recommended immunizations cannot be completed within three months due to the length of the minimum intervals between doses of a particular vaccine [required] recommended by the department of health, provisional admission may be extended so long as the child's parent or guardian provides documentation that appointments for [required] recommended immunizations have been made and that progress toward completing the immunizations continues in accordance with the requirements of the department of health.

     (b)  Provisional entrance to school may be suspended by the department of health when there is danger of an epidemic from any of the communicable diseases for which immunization is [required.] recommended."

     SECTION 3.  Section 302A-1156, Hawaii Revised Statutes, is amended to read as follows:

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

     (1)  If a licensed physician certifies that the physical condition of the child is such that immunizations would endanger the child's life or health; or

     (2)  If any parent, custodian, guardian, or any other person in loco parentis to a child objects to immunization in writing on any grounds, including the grounds that the immunization conflicts with that person's bona fide religious tenets and practices.  Upon showing the appropriate school official satisfactory evidence of the exemption, no certificate or other evidence of immunization shall be required for the child's entry into school."

     SECTION 4.  Section 302A-1157, Hawaii Revised Statutes, is amended to read as follows:

     "[[]§302A-1157[]]  Exemptions from immunization; not recognized; epidemic conditions.  If at any time there is, in the opinion of the department of health, danger of an epidemic from any of the communicable diseases for which immunization is [required] recommended under sections 302A-1154 to 302A-1163, no exemption from immunization against the disease shall be recognized.  Quarantine shall be a legal alternative to immunization."

     SECTION 5.  Section 302A-1161, Hawaii Revised Statutes, is amended to read as follows:

     "§302A-1161  Notification for noncompliance.  If a child does not complete the [immunizations required]:

(1) Immunizations recommended under section 302A‑1154; or [the]

(2) The physical examination required under section 302A‑1159

within the period provided by section 302A‑1155 after provisional entry into school, the administrator of the school shall cause a notice to be sent to the parent or guardian of the child stating that if the [required] recommended immunizations, unless an exemption is obtained pursuant to section 302A‑1156, or physical examination is not completed within thirty days of the date of the notice, the child shall not be admitted to school."

     SECTION 6.  Section 302A-1162, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

     "(a)  The department of health shall adopt rules under chapter 91 relating to immunization, physical examination, and tuberculin testing under sections 302A-1154 to 302A-1163.  Immunizations [required,] recommended, and the manner and frequency of their administration, shall conform with recognized standard medical practices.  The list of diseases and minimum requirements for protection under sections 302A-1154 to 302A-1163 may be revised whenever the department of health deems it necessary for the protection of public health."

     SECTION 7.  Section 321-11, Hawaii Revised Statutes, is amended to read as follows:

     "§321-11  Subjects of health rules, generally.  The department pursuant to chapter 91 may adopt rules that it deems necessary for the public health and safety respecting:

     (1)  Nuisances, foul or noxious odors, gases, vapors, waters in which mosquitoes breed or may breed, sources of filth, and causes of sickness or disease, within the respective districts of the State, and on board any vessel;

     (2)  Adulteration and misbranding of food or drugs;

     (3)  Location, air space, ventilation, sanitation, drainage, sewage disposal, and other health conditions of buildings, courts, construction projects, excavations, pools, watercourses, areas, and alleys;

     (4)  Privy vaults and cesspools;

     (5)  Fish and fishing;

     (6)  Interments and dead bodies;

     (7)  Disinterments of dead human bodies, including the exposing, disturbing, or removing of these bodies from their place of burial, or the opening, removing, or disturbing after due interment of any receptacle, coffin, or container holding human remains or a dead human body or a part thereof and the issuance and terms of permits for the aforesaid disinterments of dead human bodies;

     (8)  Cemeteries and burying grounds;

     (9)  Laundries, and the laundering, sanitation, and sterilization of articles including linen and uniforms used by or in the following businesses and professions: barber shops, manicure shops, beauty parlors, electrology shops, restaurants, soda fountains, hotels, rooming and boarding houses, bakeries, butcher shops, public bathhouses, midwives, masseurs, and others in similar calling, public or private hospitals, and canneries and bottling works where foods or beverages are canned or bottled for public consumption or sale; provided that nothing in this chapter shall be construed as authorizing the prohibiting of laundering, sanitation, and sterilization by those conducting any of these businesses or professions where the laundering or sterilization is done in an efficient and sanitary manner;

    (10)  Hospitals, freestanding surgical outpatient facilities, skilled nursing facilities, intermediate care facilities, adult residential care homes, adult foster homes, assisted living facilities, special treatment facilities and programs, home health agencies, hospices, freestanding birthing facilities, adult day health centers, independent group residences, and therapeutic living programs, but excluding youth shelter facilities unless clinical treatment of mental, emotional, or physical disease or handicap is a part of the routine program or constitutes the main purpose of the facility, as defined in section 346-16 under "child care institution".  For the purpose of this paragraph, "adult foster home" has the same meaning as provided in section 321-11.2;

    (11)  Hotels, rooming houses, lodging houses, apartment houses, tenements, and residences for persons with developmental disabilities including, but not limited to, those built under federal funding;

    (12)  Laboratories;

    (13)  Any place or building where noisome or noxious trades or manufacturers are carried on, or intended to be carried on;

    (14)  Milk;

    (15)  Poisons and hazardous substances, the latter term including but not limited to any substance or mixture of substances which:

         (A)  Is corrosive;

         (B)  Is an irritant;

         (C)  Is a strong sensitizer;

         (D)  Is inflammable; or

         (E)  Generates pressure through decomposition, heat, or other means,

          if the substance or mixture of substances may cause substantial personal injury or substantial illness during or as a proximate result of any customary or reasonably foreseeable handling or use, including reasonably foreseeable ingestion by children;

    (16)  Pig and duck ranches;

    (17)  Places of business, industry, employment, and commerce, and the processes, materials, tools, machinery, and methods of work done therein; and places of public gathering, recreation, or entertainment;

    (18)  Any restaurant, theater, market, stand, shop, store, factory, building, wagon, vehicle, or place where any food, drug, or cosmetic is manufactured, compounded, processed, extracted, prepared, stored, distributed, sold, offered for sale, or offered for human consumption or use;

    (19)  Foods, drugs, and cosmetics, and the manufacture, compounding, processing, extracting, preparing, storing, selling, and offering for sale, consumption, or use of any food, drug, or cosmetic;

    (20)  Devices as defined in section 328-1;

    (21)  Sources of ionizing radiation;

    (22)  Medical examination, vaccination, revaccination, and immunization of school children.  No child shall be subjected to medical examination, vaccination, revaccination, or immunization[, whose] if the child's parent or guardian objects in writing thereto on any grounds, including grounds that the requirements are not in accordance with the religious tenets of an established church of which the parent or guardian is a member or adherent, but no objection shall be recognized when, in the opinion of the department, there is danger of an epidemic from any communicable disease;

    (23)  Disinsectization of aircraft entering or within the State as may be necessary to prevent the introduction, transmission, or spread of disease or the introduction or spread of any insect or other vector of significance to health;

    (24)  Fumigation, including the process by which substances emit or liberate gases, fumes, or vapors which may be used for the destruction or control of insects, vermin, rodents, or other pests, which, in the opinion of the department, may be lethal, poisonous, noxious, or dangerous to human life;

    (25)  Ambulances and ambulance equipment;

    (26)  Development, review, approval, or disapproval of management plans submitted pursuant to the Asbestos Hazard Emergency Response Act of 1986, Public Law 99-519; and

    (27)  Development, review, approval, or disapproval of an accreditation program for specially trained persons pursuant to the Residential Lead-Based Paint Hazard Reduction Act of 1992, Public Law 102-550.

     The department may require any certificates, permits, or licenses that it may deem necessary to adequately regulate the conditions or businesses referred to in this section."

     SECTION 8.  Section 325-32, Hawaii Revised Statutes, is amended to read as follows:

     "§325-32  Immunization against infectious diseases.  The department of health may adopt rules [requiring] recommending and governing immunization against typhoid fever, pertussis (whooping cough), diphtheria, tetanus, poliomyelitis, measles, mumps, hepatitis B, rubella, haemophilus influenzae type B, and any other communicable disease, if a suitable immunizing agent is available for the disease and a need for immunization against it exists within the State.  The department may also provide vaccines and other immunizing agents to private and public health care providers for administration to the general public."

     SECTION 9.  Section 325-33, Hawaii Revised Statutes, is amended to read as follows:

     "§325-33  Performance of vaccination and immunization.  Vaccinations or immunizations [required of] recommended for any person under this chapter shall be performed by duly licensed physicians or paramedical personnel under their direction, advanced practice registered nurses, or by authorized representatives of the department of health.  A record of the immunization shall be maintained by the physician or advanced practice registered nurse and shall be available to the department of education for school entry requirements and the department of health."

     SECTION 10.  Section 325-34, Hawaii Revised Statutes, is amended to read as follows:

     "§325-34  Exemptions. (a)  Section 325-32 shall be construed not to require the vaccination or immunization of any person for three months after a duly licensed physician or an authorized representative of the department of health has signed two copies of a certificate, stating the name and address of the person and that because of a stated cause the health of the person would be endangered by the vaccination or immunization, and has forwarded the original copy of the certificate to the person or, if the person is a minor or under guardianship, to the person's parent or guardian[,] and has forwarded the duplicate copy of the certificate to the department for its files.

(b)  No person shall be subjected to vaccination, revaccination, or immunization[,] who [shall] objects in writing [object thereto] on any grounds, including the grounds that the requirements are not in accordance with the religious tenets of an established church of which the person is a member or adherent[,] or, if the person is a minor or under guardianship, whose parent or guardian [shall] objects in writing [object thereto] on any such grounds, but no objection shall be recognized when, in the opinion of the director of health, there is danger of an epidemic from any communicable disease."

     SECTION 11.  Section 325-36, Hawaii Revised Statutes, is amended to read as follows:

     "§325-36  Duty of adult, or of parent, guardian, or caregiver.  (a)  Every adult person [required] recommended to be immunized, or to do any other act, unless the person is a minor or incompetent, shall cause the immunization or other act to be performed[.] unless exempted under section 325‑34.

     (b)  If the person is a minor or incompetent, the person's parent, or guardian having the person's care, custody, and control, shall cause the immunization or other related act to be performed[.] unless exempted under section 325‑34.

     (c)  If reasonable efforts have been made to obtain consent from the person's parent or guardian, and consent is not obtainable because the parent or guardian cannot be located or contacted, a caregiver with whom the minor or incompetent person lives, or a non-custodial parent, may cause the immunization or other related act to be performed[.] unless exempted under section 325‑34."

     SECTION 12.  Section 325-37, Hawaii Revised Statutes, is amended to read as follows:

     "§325-37  Fraud; wilful misrepresentation; failure to comply; penalties.  Any person who by fraud or wilful misrepresentation circumvents or defeats or attempts to circumvent or defeat any purpose [or provision of any] of sections 325-32 to 325-34 or who, [required by any provision of] pursuant to section 325-32, is recommended to be vaccinated or immunized, fails to be so vaccinated or immunized shall be fined not more than $25 or imprisoned not more than thirty days, or both[.] unless exempted under section 325‑34."

     SECTION 13.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 14.  This Act shall take effect upon its approval.

INTRODUCED BY:

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