ESTABLISHMENT OF PROGRAM.

SEC. 411. ESTABLISHMENT OF PROGRAM. (a) In General.— Title XXVI of the Public Health Service Act (as amended by section 401) is further amended by adding at the end the following new part: “Part E— Emergency Response Employees “Subpart I— Guidelines and Model Curriculum “SEC. 2680. GRANTS FOR IMPLEMENTATION. “(a) In General.— With respect to the recommendations contained in the guidelines and the model curriculum developed under section 253 of Public Law 100–607, the Secretary shall make grants to States and political subdivisions of States for the purpose of assisting grantees regarding the initial implementation of such portions of the recommendations as are applicable to emergency response employees. “(b) Requirement of Application.— The Secretary may not make a grant under subsection (a) unless an application for the grant is submitted to the Secretary and the application is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this section. 104 STAT. 623 “(c) Authorization of Appropriations.— For the purpose of carrying out this section, there is authorized to be appropriated $5,000,000 for each of the fiscal years 1991 through 1995. “Subpart II— Notifications of Possible Exposure to Infectious Diseases “SEC. 2681. INFECTIOUS DISEASES AND CIRCUMSTANCES RELEVANT TO NOTIFICATION REQUIREMENTS. “(a) In General.— Not later than 180 days after the date of the enactment of the Ryan White Comprehensive AIDS Resources Emergency Act of 1990, the Secretary shall complete the development of— “(1) a list of potentially life-threatening infectious diseases to which emergency response employees may be exposed in responding to emergencies; “(2) guidelines describing the circumstances in which such employees may be exposed to such diseases, taking into account the conditions under which emergency response is provided; and “(3) guidelines describing the manner in which medical facilities should make determinations for purposes of section 2683(d). “(b) Specification of Airborne Infectious Diseases.— The list developed by the Secretary under subsection (a)(1) shall include a specification of those infectious diseases on the list that are routinely transmitted through airborne or aerosolized means. “(c) Dissemination.— The Secretary shall— “(1) transmit to State public health officers copies of the list and guidelines developed by the Secretary under subsection (a) with the request that the officers disseminate such copies as appropriate throughout the States; and “(2) make such copies available to the public. “SEC. 2682. ROUTINE NOTIFICATIONS WITH RESPECT TO AIRBORNE INFECTIOUS DISEASES IN VICTIMS ASSISTED. “(a) Routine Notification of Designated Officer.— “(1) Determination by treating facility.— If a victim of an emergency is transported by emergency response employees to a medical facility and the medical facility makes a determination that the victim has an airborne infectious disease, the medical facility shall notify the designated officer of the emergency response employees who transported the victim to the medical facility of the determination. “(2) Determination by facility ascertaining cause of death.— If a victim of an emergency is transported by emergency response employees to a medical facility and the victim dies at or before reaching the medical facility, the medical facility ascertaining the cause of death shall notify the designated officer of the emergency response employees who transported the victim to the initial medical facility of any determination by the medical facility that the victim had an airborne infectious disease. “(b) Requirement of Prompt Notification.— With respect to a determination described in paragraph (1) or (2), the notification required in each of such paragraphs shall be made as soon as is practicable, but not later than 48 hours after the determination is made. 104 STAT. 624 “SEC. 2683. REQUEST FOR NOTIFICATIONS WITH RESPECT TO VICTIMS ASSISTED. “(a) Initiation of Process by Employee.— If an emergency response employee believes that the employee may have been ex-posed to an infectious disease by a victim of an emergency who was transported to a medical facility as a result of the emergency, and if the employee attended, treated, assisted, or transported the victim pursuant to the emergency, then the designated officer of the employee shall, upon the request of the employee, carry out the duties described in subsection (b) regarding a determination of whether the employee may have been exposed to an infectious disease by the victim. “(b) Initial Determination by Designated Officer.— The duties referred to in subsection (a) are that— “(1) the designated officer involved collect the facts relating to the circumstances under which, for purposes of subsection (a), the employee involved may have been exposed to an infectious disease; and “(2) the designated officer evaluate such facts and make a determination of whether, if the victim involved had any infectious disease included on the list issued under paragraph (1) of section 2681(a), the employee would have been exposed to the disease under such facts, as indicated by the guidelines issued under paragraph (2) of such section. “(c) Submission of Request to Medical Facility.— “(1) In general.— If a designated officer makes a determination under subsection (b)(2) that an emergency response employee may have been exposed to an infectious disease, the designated officer shall submit to the medical facility to which the victim involved was transported a request for a response under subsection (d) regarding the victim of the emergency involved. “(2) Form of request.— A request under paragraph (1) shall be in writing and be signed by the designated officer involved, and shall contain a statement of the facts collected pursuant to subsection (b)(1). “(d) Evaluation and Response Regarding Request to Medical Facility.— “(1) In general.— If a medical facility receives a request under subsection (c), the medical facility shall evaluate the facts submitted in the request and make a determination of whether, on the basis of the medical information possessed by the facility regarding the victim involved, the emergency response employee was exposed to an infectious disease included on the list issued under paragraph (1) of section 2681(a), as indicated by the guidelines issued under paragraph (2) of such section. “(2) Notification of exposure.— If a medical facility makes a determination under paragraph (1) that the emergency response employee involved has been exposed to an infectious disease, the medical facility shall, in writing, notify the designated officer who submitted the request under subsection (c) of the determination. “(3) Finding of no exposure.— If a medical facility makes a determination under paragraph (1) that the emergency response employee involved has not been exposed to an infectious disease, 104 STAT. 625the medical facility shall, in writing, inform the designated officer who submitted the request under subsection (c) of the determination. “(4) Insufficient information.— “(A) If a medical facility finds in evaluating facts for purposes of paragraph (1) that the facts are insufficient to make the determination described in such paragraph, the medical facility shall, in writing, inform the designated officer who submitted the request under subsection (c) of the insufficiency of the facts. “(B) (i) If a medical facility finds in making a determination under paragraph (1) that the facility possesses no information on whether the victim involved has an infectious disease included on the list under section 2681(a), the medical facility shall, in writing, inform the designated officer who submitted the request under subsection (c) of the insufficiency of such medical information. “(ii) If after making a response under clause (i) a medical facility determines that the victim involved has an infectious disease, the medical facility shall make the determination described in paragraph (1) and provide the applicable response specified in this subsection. “(e) Time for Making Response.— After receiving a request under subsection (c) (including any such request resubmitted under subsection (g)(2)), a medical facility shall make the applicable response specified in subsection (d) as soon as is practicable, but not later than 48 hours after receiving the request. “(f) Death of Victim of Emergency.— “(1) Facility ascertaining cause of death.— If a victim described in subsection (a) dies at or before reaching the medical facility involved, and the medical facility receives a request under subsection (c), the medical facility shall provide a copy of the request to the medical facility ascertaining the cause of death of the victim, if such facility is a different medical facility than the facility that received the original request. “(2) Responsibility of facility.— Upon the receipt of a copy of a request for purposes of paragraph (1), the duties otherwise established in this subpart regarding medical facilities shall apply to the medical facility ascertaining the cause of death of the victim in the same manner and to the same extent as such duties apply to the medical facility originally receiving the request. “(g) Assistance of Public Health Officer.— “(1) Evaluation of response of medical facility regarding insufficient facts.— “(A) In the case of a request under subsection (c) to which a medical facility has made the response specified in subsection (d)(4)(A) regarding the insufficiency of facts, the public health officer for the community in which the medical facility is located shall evaluate the request and the response, if the designated officer involved submits such documents to the officer with the request that the officer make such an evaluation. “(B) As soon as is practicable after a public health officer receives a request under paragraph (1), but not later than 48 hours after receipt of the request, the public health officer shall complete the evaluation required in such para-104 STAT. 626graph and inform the designated officer of the results of the evaluation. “(2) Findings of evaluation.— “(A) If an evaluation under paragraph (1)(A) indicates that the facts provided to the medical facility pursuant to subsection (c) were sufficient for purposes of determinations under subsection (d)(1)— “(i) the public health officer shall, on behalf of the designated officer involved, resubmit the request to the medical facility; and “(ii) the medical facility shall provide to the designated officer the applicable response specified in subsection (d). “(B) If an evaluation under paragraph (1)(A) indicates that the facts provided in the request to the medical facility were insufficient for purposes of determinations specified in subsection (c)— “(i) the public health officer shall provide advice to the designated officer regarding the collection and description of appropriate facts; and “(ii) if sufficient facts are obtained by the designated officer— “(I) the public health officer shall, on behalf of the designated officer involved, resubmit the request to the medical facility; and “(II) the medical facility shall provide to the designated officer the appropriate response under subsection (c). “SEC. 2684. PROCEDURES FOR NOTIFICATION OF EXPOSURE. “(a) Contents of Notification to Officer.— In making a notification required under section 2682 or section 2683(d)(2), a medical facility shall provide— “(1) the name of the infectious disease involved; and “(2) the date on which the victim of the emergency involved was transported by emergency response employees to the medical facility involved. “(b) Manner of Notification.— If a notification under section 2682 or section 2682(d)(2) is mailed or otherwise indirectly made— “(1) the medical facility sending the notification shall, upon sending the notification, inform the designated officer to whom the notification is sent of the fact that the notification has been sent; and “(2) such designated officer shall, not later than 10 days after being informed by the medical facility that the notification has been sent, inform such medical facility whether the designated officer has received the notification. “SEC. 2685. NOTIFICATION OF EMPLOYEE. “(a) In General.— After receiving a notification for purposes of section 2682 or 2683(d)(2), a designated officer of emergency response employees shall, to the extent practicable, immediately notify each of such employees who— “(1) responded to the emergency involved; and “(2) as indicated by guidelines developed by the Secretary, may have been exposed to an infectious disease. 104 STAT. 627 “(b) Certain Contents of Notification to Employee.— A notification under this subsection to an emergency response employee shall inform the employee of— “(1) the fact that the employee may have been exposed to an infectious disease and the name of the disease involved; “(2) any action by the employee that, as indicated by guide-lines developed by the Secretary, is medically appropriate; and “(3) if medically appropriate under such criteria, the date of such emergency. “(c) Responses Other Than Notification of Exposure.— After receiving a response under paragraph (3) or (4) of subsection (d) of section 2683, or a response under subsection (g)(1) of such section, the designated officer for the employee shall, to the extent practicable, immediately inform the employee of the response. “SEC. 2686. SELECTION OF DESIGNATED OFFICERS. “(a) In General.— For the purposes of receiving notifications and responses and making requests under this subpart on behalf of emergency response employees, the public health officer of each State shall designate 1 official or officer of each employer of emergency response employees in the State. “(b) Preference in Making Designations.— In making the designations required in subsection (a), a public health officer shall give preference to individuals who are trained in the provision of health care or in the control of infectious diseases. “SEC. 2687. LIMITATIONS WITH RESPECT TO DUTIES OF MEDICAL FACILITIES. “The duties established in this subpart for a medical facility— “(1) shall apply only to medical information possessed by the facility during the period in which the facility is treating the victim for conditions arising from the emergency, or during the 60-day period beginning on the date on which the victim is transported by emergency response employees to the facility, whichever period expires first; and “(2) shall not apply to any extent after the expiration of the 30-day period beginning on the expiration of the applicable period referred to in paragraph (1), except that such duties shall apply with respect to any request under section 2683(c) received by a medical facility before the expiration of such 30-day period. “SEC. 2688. RULES OF CONSTRUCTION. “(a) Liability of Medical Facilities and Designated Officers.— This subpart may not be construed to authorize any cause of action for damages or any civil penalty against any medical facility, or any designated officer, for failure to comply with the duties established in this subpart. “(b) Testing.— This subpart may not, with respect to victims of emergencies, be construed to authorize or require a medical facility to test any such victim for any infectious disease. “(c) Confidentiality.— This subpart may not be construed to authorize or require any medical facility, any designated officer of emergency response employees, or any such employee, to disclose identifying information with respect to a victim of an emergency or with respect to an emergency response employee. 104 STAT. 628 “(d) Failure to Provide Emergency Services.— This subpart may not be construed to authorize any emergency response employee to fail to respond, or to deny services, to any victim of an emergency. “SEC. 2689. INJUNCTIONS REGARDING VIOLATION OF PROHIBITION. “(a) In General.— The Secretary may, in any court of competent jurisdiction, commence a civil action for the purpose of obtaining temporary or permanent injunctive relief with respect to any violation of this subpart. “(b) Facilitation of Information on Violations.— The Secretary shall establish an administrative process for encouraging emergency response employees to provide information to the Secretary regarding violations of this subpart. As appropriate, the Secretary shall investigate alleged such violations and seek appropriate injunctive relief. “SEC. 2690. APPLICABILITY OF SUBPART. “This subpart shall not apply in a State if the chief executive officer of the State certifies to the Secretary that the law of the State is in substantial compliance with this subpart.”. (b) Effective Date.— Sections 2680 and 2681 of part E of title XXVI of the Public Health Service Act, as added by subsection (a) of this section, shall take effect upon the date of the enactment of this Act. Such part shall otherwise take effect upon the expiration of the 30-day period beginning on the date on which the Secretary issues guidelines under section 2681(a).