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AB-511 Tuberculosis risk assessment and examination.(2017-2018)

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Date Published: 03/28/2017 04:00 AM
AB511:v98#DOCUMENT

Amended  IN  Assembly  March 27, 2017

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 511


Introduced by Assembly Member Arambula

February 13, 2017


An act to amend Sections 1812.541 and 1812.542 of the Civil Code, to amend Section 33195.6 of, and to repeal Section 59150 of, the Education Code, to amend Section 8732 of the Family Code, to amend Sections 1226.1, 1526.8, 1796.43, 1796.45, and 121525 of the Health and Safety Code, and to amend Sections 5163 and 5163.1 of the Public Resources Code, relating to tuberculosis.


LEGISLATIVE COUNSEL'S DIGEST


AB 511, as amended, Arambula. Tuberculosis risk assessment and examination.

Existing law requires an employment agency that refers temporary certified nurse assistants or temporary licensed nursing staff to an employer who is a licensed long-term health care facility to provide the employer with verification that the individual has had tuberculosis screening within 90 days prior to employment and annually thereafter.

This bill would instead require the employment agency to verify that the individual has submitted to a tuberculosis risk assessment, developed by the State Department of Public Health and the California Tuberculosis Controllers Association, within 90 days prior to employment and annually thereafter, and, if risk factors are present, an examination to determine that he or she is free of infectious tuberculosis.

Existing law requires employees and volunteers of a heritage school to be in good health, as verified by a health screening, including a test for tuberculosis, as specified specified.
This bill would instead require the health screening to include a tuberculosis risk assessment within the prior 60 days of initial employment or volunteer assignment, and every 4 years thereafter, and, if risk factors are present, an examination to determine that he or she is free of infectious tuberculosis.
Existing law requires students attending specified schools for blind and deaf persons to be tested for exposure to tuberculosis at least every 2 years.
This bill would repeal those provisions.
Existing law requires a foster parent applicant and each adult residing in the applicant’s home to receive a test for communicable tuberculosis.
This bill would instead require those individuals to receive a tuberculosis risk assessment, and, if risk factors are present, an examination to determine that he or she is free of infectious tuberculosis.

Existing law requires an individual working in a primary care clinic to comply with specified requirements regarding health examinations and public health protections, including testing for tuberculosis.

This bill would instead require those individuals to receive a tuberculosis risk assessment, and, if risk factors are present, an examination consisting of a test for tuberculosis infection. The bill would require a positive tuberculosis test to be followed by a chest X-ray to determine if the employee is free of infectious tuberculosis.

Existing law requires a volunteer caregiver in a crisis nursery to be in good physical health and be tested for tuberculosis, not more than one year prior to, or 7 days after, initial presence in the facility.
This bill would instead require those individuals to submit to a tuberculosis risk assessment, and, if risk factors are present, an examination to determine that he or she is free of infectious tuberculosis.
Existing law requires an affiliated home care aide employed by a home care organization to demonstrate that he or she is free from tuberculosis, by submitting to an examination 90 days prior to, or 7 days after, employment, to determine that he or she is free of active tuberculosis. Under existing law, an affiliated home care aide whose test for tuberculosis infection is negative is required to undergo an examination at least once every 2 years.
This bill would instead prohibit an affiliated home care aide from being initially employed by a home care organization unless he or she has submitted to a tuberculosis risk assessment within the prior 90 days, or within 7 days after employment, and, if risk factors are present, an examination, as specified. The bill would extend the required period for subsequent examinations to once every 4 years for affiliated home care aides with no identified tuberculosis risk, or a negative tuberculosis test.
Existing law prohibits a person from being initially employed by a private or parochial elementary or secondary school, or a nursery school, unless that person produces or has on file with the school a certificate showing that he or she has submitted to a tuberculosis risk assessment, and, if risk factors are present, an examination to determine that he or she is free of infectious tuberculosis.
This bill would replace obsolete references to “nursery school” in these provisions to refer instead to “preschool” for purposes of tuberculosis risk assessment.
Existing law prohibits a person from being initially employed in connection with specified city or county public recreation areas and facilities unless that person produces or has on file with the city or county a certificate showing that within the prior 2 years he or she has been examined and found to be free of communicable tuberculosis. Existing law requires an employee with a negative skin test to repeat the test once every 4 years and, if a subsequent skin test is positive, to have an X-ray and a referral to the local health officer for followup care.
This bill would instead require the employees to submit to a tuberculosis risk assessment, and, if risk factors are present, an examination to determine that he or she is free of infectious tuberculosis. Employees with a negative test or no identified risk factors would be required to repeat the test every 4 years and receive an examination and followup care if a subsequent test is positive, as specified. This bill would require the examination to consist of any test for tuberculosis infection recommended by the federal Centers for Disease Control and Prevention and licensed by the federal Food and Drug Administration.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.Section 1812.541 of the Civil Code is amended to read:
1812.541.

Every employment agency that refers temporary certified nurse assistants to an employer that is a long-term health care facility shall provide the employer with all of the following:

(a)Written verification that the employment agency has verified that any certified nurse assistant referred by the agency is registered on the state registry of certified nurse assistants and is in good standing. The employment agency shall provide to the employer the certified nurse assistant’s professional certification number and date of expiration.

(b)A statement that the certified nurse assistant has at least six months of experience working in a long-term health care facility.

(c)A statement that the certified nurse assistant has had a health examination within 90 days prior to employment with the employment agency or seven days after employment with the employment agency and at least annually thereafter by a person lawfully authorized to perform that procedure. Each examination shall include a medical history and physical evaluation. The employment agency shall also provide verification that the individual has submitted to a tuberculosis risk assessment developed by the State Department of Public Health and the California Tuberculosis Controllers Association within 90 days prior to employment and annually thereafter, and, if risk factors are present, an examination to determine that he or she is free of infectious tuberculosis.

(d)A statement that the certified nurse assistant will participate in the facility’s orientation program and any in-service training programs at the request of the long-term health care employer.

(e)A statement that a certified nurse assistant is in compliance with the in-service training requirements of paragraph (1) of subdivision (a) of Section 1337.6 of the Health and Safety Code.

SEC. 2.Section 1812.542 of the Civil Code is amended to read:
1812.542.

Every employment agency that refers temporary licensed nursing staff to an employer who is a licensed long-term health care facility shall provide the employer with all of the following:

(a)Written verification that the individual is in good standing with the Board of Registered Nursing or the Board of Vocational Nursing and Psychiatric Technicians, as applicable, and has successfully secured a criminal record clearance. The employment agency shall provide to the employer the individual’s professional license and registration number and date of expiration.

(b)A statement that the licensed nursing staff person has had a health examination within 90 days prior to employment with the employment agency or seven days after employment with the employment agency and at least annually thereafter by a person lawfully authorized to perform that procedure. Each examination shall include a medical history and physical evaluation. The employment agency shall also provide verification that the individual has submitted to a tuberculosis risk assessment developed by the State Department of Public Health and the California Tuberculosis Controllers Association within 90 days prior to employment and annually thereafter, and, if risk factors are present, an examination to determine that he or she is free of infectious tuberculosis.

SEC. 3.SECTION 1.

 Section 33195.6 of the Education Code is amended to read:

33195.6.
 (a) A director of a heritage school shall undergo at least 15 hours of health and safety training. The training shall include all of the following components:
(1) Pediatric first aid.
(2) Pediatric cardiopulmonary resuscitation (CPR).
(3) A preventive health practices course or courses that include instruction in the recognition, management, and prevention of infectious diseases, including immunizations, and prevention of childhood injuries.
(4) Training in pediatric first aid and CPR pursuant to paragraphs (1) and (2) shall be provided by a program approved by the American Red Cross, the American Heart Association, or the Emergency Medical Services Authority pursuant to Section 1797.191 of the Health and Safety Code.
(5) Training in preventive health practices pursuant to paragraph (3) shall be provided by a training program approved by the Emergency Medical Services Authority.
(6) In addition to the training programs specified in paragraphs (4) and (5), training programs or courses in pediatric first aid, pediatric CPR, and preventive health practices offered or approved by an accredited postsecondary educational institution are considered to be approved sources of training that may be used to satisfy the training requirements of paragraphs (1) to (3), inclusive.
(7) Persons who, prior to the effective date of this section, have completed a course or courses in preventive health practices as described in paragraph (3), and have a certificate of completion of a course or courses in preventive health practices, or certified copies of transcripts that identify the number of hours and the specific course or courses taken for training in preventive health practices, shall be deemed to have met the training requirement for preventive health practices pursuant to paragraph (3).
(b) All employees and volunteers of a heritage school shall be in good health, as verified by a health screening performed by, or under the supervision of, a licensed physician and surgeon. The screening shall include a tuberculosis risk assessment developed by the State Department of Public Health and the California Tuberculosis Controllers Association within the prior 60 days of initial employment or volunteer assignment and every four years thereafter, and, if risk factors are present, an examination to determine that he or she is free of infectious tuberculosis.
(c) Pupils attending heritage schools shall have access to working sinks, toilets, and drinking water.
(d) No pupil attending a heritage school shall have access to medication or cleaning supplies, except as otherwise provided by law.
(e) A heritage school, as defined in Section 33195.4, shall not be subject to licensure by the State Department of Social Services as a child day care center pursuant to Chapter 3.4 (commencing with Section 1596.70) or Chapter 3.5 (commencing with Section 1596.90) of Division 2 of the Health and Safety Code.
(f) Upon a pupil’s enrollment in a heritage school, the heritage school shall provide a notice to the pupil’s parent or guardian stating that the heritage school is exempt from child care licensure, and that attendance at a heritage school does not satisfy California’s compulsory education requirements pursuant to Section 48200.

SEC. 4.SEC. 2.

 Section 59150 of the Education Code is repealed.

SEC. 5.SEC. 3.

 Section 8732 of the Family Code is amended to read:

8732.
 A report of a medical examination of the foster parent with whom the child has lived for a minimum of six months or the relative caregiver who has had an ongoing and significant relationship with the child shall be included in the assessment of each applicant unless the department, county adoption agency, or licensed adoption agency determines that, based on other available information, this report is unnecessary. The assessment shall require certification that the applicant and each adult residing in the applicant’s home has received a tuberculosis risk assessment developed by the State Department of Public Health and the California Tuberculosis Controllers Association, and, if risk factors are present, an examination to determine that he or she is free of infectious tuberculosis.

SEC. 6.Section 1226.1 of the Health and Safety Code is amended to read:
1226.1.

(a)A primary care clinic shall comply with the following requirements regarding health examinations and other public health protections for individuals working in a primary care clinic:

(1)An employee working in a primary care clinic who has direct contact with patients shall have a health examination within six months prior to employment or within 15 days after employment. Each examination shall include a medical history and physical evaluation. A written examination report, signed by the person performing the examination, shall verify that the employee is able to perform his or her assigned duties.

(2)At the time of employment, an employee shall receive a tuberculosis risk assessment developed by the State Department of Public Health and the California Tuberculosis Controllers Association, and, if risk factors are present, an examination. The examination for tuberculosis shall consist of a test for tuberculosis infection recommended by the federal Centers for Disease Control and Prevention (CDC) and licensed by the federal Food and Drug Administration (FDA). If a test for tuberculosis is positive, the test shall be followed by an X-ray of the lungs and subsequently interpreted by a physician to determine if the employee is free of infectious tuberculosis. Annual examinations shall be performed only when medically indicated.

(3)The clinic shall maintain a health record for each employee that includes reports of all employment-related health examinations. These records shall be kept for a minimum of three years following termination of employment.

(4)An employee known to have or exhibiting signs or symptoms of a communicable disease shall not be permitted to work until he or she submits a physician’s certification that the employee is sufficiently free of the communicable disease to return to his or her assigned duties.

(b)Any regulation adopted before January 1, 2004, that imposes a standard on a primary care clinic that is more stringent than described in this section is void.

SEC. 7.SEC. 4.

 Section 1526.8 of the Health and Safety Code is amended to read:

1526.8.
 (a) It is the intent of the Legislature that the department develop modified staffing levels and requirements for crisis nurseries, provided that the health, safety, and well-being of the children in care are protected and maintained.
(1) All caregivers shall be certified in pediatric cardiopulmonary resuscitation (CPR) and pediatric first aid. Certification shall be demonstrated by current and valid pediatric CPR and pediatric first aid cards issued by the American Red Cross, the American Heart Association, by a training program that has been approved by the Emergency Medical Services Authority pursuant to Section 1797.191, or from an accredited college or university.
(2) The licensee shall develop, maintain, and implement a written staff training plan for the orientation, continuing education, on-the-job training and development, supervision, and evaluation of all lead caregivers, caregivers, and volunteers. The licensee shall incorporate the training plan in the crisis nursery plan of operation.
(3) The licensee shall designate at least one lead caregiver to be present at the crisis nursery at all times when children are present. The lead caregiver shall have one of the following education and experience qualifications:
(A) Completion of 12 postsecondary semester units or equivalent quarter units, with a passing grade, as determined by the institution, in classes with a focus on early childhood education, child development, or child health at an accredited college or university, as determined by the department, and six months of work experience in a licensed group home, licensed infant care center, or comparable group child care program or family day care. At least three semester units, or equivalent quarter units, or equivalent experience shall include coursework or experience in the care of infants.
(B) A current and valid Child Development Associate (CDA) credential, with the appropriate age level endorsement issued by the CDA National Credentialing Program, and at least six months of on-the-job training or work experience in a licensed child care center or comparable group child care program.
(C) A current and valid Child Development Associate Teacher Permit issued by the California Commission on Teacher Credentialing pursuant to Sections 80105 to 80116, inclusive, of Title 5 of the California Code of Regulations.
(4) Lead caregivers shall have a minimum of 24 hours of training and orientation before working with children. One year experience in a supervisory position in a child care or group care facility may substitute for 16 hours of training and orientation. The written staff training plan shall require the lead caregiver to receive and document a minimum of 20 hours of annual training directly related to the functions of his or her position.
(5) Caregiver staff shall complete a minimum of 24 hours of initial training within the first 90 days of employment. Eight hours of training shall be completed before the caregiver staff are responsible for children, left alone with children, and counted in the staff-to-child ratios described in subdivision (c). A maximum of four hours of training may be satisfied by job shadowing.
(b) The department shall allow the use of fully trained and qualified volunteers as caregivers in a crisis nursery, subject to the following conditions:
(1) Volunteers shall be fingerprinted for the purpose of conducting a criminal record review as specified in subdivision (b) of Section 1522.
(2) Volunteers shall complete a child abuse central index check as specified in Section 1522.1.
(3) Volunteers shall be in good physical health and shall submit to a tuberculosis risk assessment developed by the State Department of Public Health and the California Tuberculosis Controllers Association, and, if risk factors are present, an examination to determine that he or she is free of infectious tuberculosis, not more than one year prior to, or seven days after, initial presence in the facility.
(4) Volunteers shall complete a minimum of 16 hours of training as specified in paragraphs (5) and (6).
(5) Prior to assuming the duties and responsibilities of a crisis caregiver or being counted in the staff-to-child ratio, volunteers shall complete at least five hours of initial training divided as follows:
(A) Two hours of crisis nursery job shadowing.
(B) One hour of review of community care licensing regulations.
(C) Two hours of review of the crisis nursery program, including the facility mission statement, goals and objectives, child guidance techniques, and special needs of the client population they serve.
(6) Within 90 days, volunteers who are included in the staff-to-child ratios shall do both of the following:
(A) Acquire a certification in pediatric first aid and pediatric cardiopulmonary resuscitation.
(B) Complete at least 11 hours of training covering child care health and safety issues, trauma informed care, the importance of family and sibling relationships, temperaments of children, self-regulation skills and techniques, and program child guidance techniques.
(7) Volunteers who meet the requirements of paragraphs (1), (2), and (3), but who have not completed the training specified in paragraph (4), (5), or (6) may assist a fully trained and qualified staff person in performing child care duties. However, these volunteers shall not be left alone with children, shall always be under the direct supervision and observation of a fully trained and qualified staff person, and shall not be counted in meeting the minimum staff-to-child ratio requirements.
(c) The department shall allow the use of fully trained and qualified volunteers to be counted in the staff-to-child ratio in a crisis nursery subject to the following conditions:
(1) The volunteers have fulfilled the requirements in paragraphs (1) to (6), inclusive, of subdivision (b).
(2) There shall be at least one fully qualified and employed staff person on site at all times.
(3) (A) There shall be at least one employed staff person or volunteer caregiver for each group of six children, or fraction thereof, who are 18 months of age or older, and one employed staff person or volunteer caregiver for each group of three children, or fraction thereof, who are under 18 months of age from 7 a.m. to 7 p.m.
(B) There shall be at least one employed staff person or volunteer caregiver for each group of six children, or fraction thereof, who are 18 months of age or older, and one employed staff person or volunteer caregiver for each group of four children, or fraction thereof, who are under 18 months of age from 7 p.m. to 7 a.m.
(C) There shall be at least one employed staff person present for every volunteer caregiver used by the crisis nursery for the purpose of meeting the minimum caregiver staffing requirements.
(D) The crisis nursery’s plan of operation shall address how it will deal with unexpected circumstances related to staffing and ensure that additional caregivers are available when needed.
(d) There shall be at least one staff person or volunteer caregiver awake at all times from 7 p.m. to 7 a.m.
(e) (1) When a child has a health condition that requires prescription medication, the licensee shall ensure that the caregiver does all of the following:
(A) Assists children with the taking of the medication as needed.
(B) Ensures that instructions are followed as outlined by the appropriate medical professional.
(C) Stores the medication in accordance with the label instructions in the original container with the original unaltered label in a locked and safe area that is not accessible to children.
(D) Administers the medication as directed on the label and prescribed by the physician in writing.
(i) The licensee shall obtain, in writing, approval and instructions from the child’s authorized representative for administration of the prescription medication for the child. This documentation shall be kept in the child’s record.
(ii) The licensee shall not administer prescription medication to a child in accordance with instructions from the child’s authorized representative if the authorized representative’s instructions conflict with the physician’s written instructions or the label directions as prescribed by the child’s physician.
(2) Nonprescription medications may be administered without approval or instructions from the child’s physician if all of the following conditions are met:
(A) Nonprescription medications shall be administered in accordance with the product label directions on the nonprescription medication container or containers.
(B) (i) For each nonprescription medication, the licensee shall obtain, in writing, approval and instructions from the child’s authorized representative for administration of the nonprescription medication to the child. This documentation shall be kept in the child’s record.
(ii) The licensee shall not administer nonprescription medication to a child in accordance with instructions from the child’s authorized representative if the authorized representative’s instructions conflict with the product label directions on the nonprescription medication container or containers.
(3) The licensee shall develop and implement a written plan to record the administration of the prescription and nonprescription medications and to inform the child’s authorized representative daily, for crisis day services, and upon discharge for overnight care, when the medications have been given.
(4) When no longer needed by the child, or when the child is removed or discharged from the crisis nursery, all medications shall be returned to the child’s authorized representative or disposed of after an attempt to reach the authorized representative.

SEC. 8.SEC. 5.

 Section 1796.43 of the Health and Safety Code is amended to read:

1796.43.
 (a) Home care organizations that employ affiliated home care aides shall ensure the affiliated home care aides are cleared on the home care aide registry before placing the individual in direct contact with clients. In addition, the home care organization shall do all of the following:
(1) Ensure any staff person, volunteer, or employee of a home care organization who has contact with clients, prospective clients, or confidential client information that may pose a risk to the clients’ health and safety has met the requirements of Sections 1796.23, 1796.24, 1796.25, 1796.26, and 1796.28 before there is contact with clients or prospective clients or access to confidential client information.
(2) Require home care aides to submit to a screening or examination for tuberculosis to determine that he or she is free of infectious tuberculosis, pursuant to Section 1796.45.
(3) Immediately notify the department when the home care organization no longer employs an individual as an affiliated home care aide.
(b) This section shall not prevent a licensee from requiring a criminal record clearance of any individual exempt from the requirements of this section, provided that the individual has client contact.

SEC. 9.SEC. 6.

 Section 1796.45 of the Health and Safety Code is amended to read:

1796.45.
 (a) Affiliated home care aides shall not be initially employed by a home care organization unless the person has submitted to a tuberculosis risk assessment developed by the State Department of Public Health and the California Tuberculosis Controllers Association within the prior 90 days or within seven days after employment, and, if risk factors are present, an examination.
(b) For purposes of this section, “examination” means a test for tuberculosis infection that is recommended by the federal Centers for Disease Control and Prevention (CDC) and licensed by the federal Food and Drug Administration (FDA) and, if that test is positive, an X-ray of the lungs. The aide shall not work as an affiliated home care aide unless the licensee obtains documentation from a licensed medical professional that he or she is free of infectious tuberculosis.
(c) After submitting to an examination, an affiliated home care aide who has no identified tuberculosis risk factors or whose test for tuberculosis infection is negative shall be required to undergo an examination at least once every four years. Once an affiliated home care aide has a documented positive test for tuberculosis infection that has been followed by an X-ray, the examination is no longer required.
(d) After each examination, an affiliated home care aide shall submit, and the home care organization shall keep on file, a certificate from the examining practitioner showing that the affiliated home care aide was examined and found free from infectious tuberculosis disease.
(e) The examination is a condition of initial and continuing employment with the home care organization.
(f) An affiliated home care aide who transfers employment from one home care organization to another shall be deemed to meet the requirements of subdivision (a) or (c) if the affiliated home care aide can produce a certificate showing that he or she submitted to the examination within the past two years and was found to be free of active tuberculosis disease, or if it is verified by the home care organization previously employing him or her that it has a certificate on file that contains that showing and a copy of the certificate is provided to the new home care organization prior to the affiliated home care aide beginning employment.

SEC. 10.SEC. 7.

 Section 121525 of the Health and Safety Code is amended to read:

121525.
 (a) Except as provided in Section 121555, a person shall not be initially employed, or employed under contract, by a private or parochial elementary or secondary school, or any preschool, unless that person produces or has on file with the school a certificate showing that within the last 60 days the person has submitted to a tuberculosis risk assessment and, if tuberculosis risk factors are identified, has been examined and has been found to be free of infectious tuberculosis. If no risk factors are identified, an examination is not required. A person who is subject to the requirements of this subdivision may submit to an examination that complies with the requirements of Section 121530 instead of submitting to a tuberculosis risk assessment.
(b) Thereafter, an employee who has no identified risk factors or who tests negative for the tuberculosis infection by either the tuberculin skin test or any other test for tuberculosis recommended by the federal Centers for Disease Control and Prevention (CDC) and licensed by the federal Food and Drug Administration (FDA), shall be required to undergo the foregoing tuberculosis risk assessment and, if risk factors are identified, the examination, at least once each four years, or more often if directed by the governing authority of the school upon recommendation of the local health officer. Once an employee has a documented positive test for the tuberculosis infection conducted pursuant to this subdivision, the tuberculosis risk assessment is no longer required. A referral shall be made within 30 days of completion of the examination to the local health officer to determine the need for followup care.
(c) At the discretion of the governing authority of a private school, this section shall not apply to employees who are employed for any period of time less than a school year whose functions do not require frequent or prolonged contact with pupils.
(d) The governing authority of a private school providing for the transportation of pupils under authorized contract shall require as a condition of the contract that every person transporting pupils produce a certificate showing that within the last 60 days the person has submitted to a tuberculosis risk assessment, and, if tuberculosis risk factors are identified, has been examined and has been found to be free of infectious tuberculosis. At the discretion of the governing authority of the school, this section shall not apply to a private contracted driver who transports pupils infrequently and without prolonged contact with the pupils.
(e) The examination attested to in the certificate required pursuant to subdivision (d) shall be made available without charge by the local health officer.
(f) “Certificate,” as used in this chapter, means a document signed by the examining physician and surgeon who is licensed under Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code, or a notice from a public health agency that indicates freedom from infectious tuberculosis.
(g) Nothing in this section shall prevent the governing authority of a private, parochial, or preschool, upon recommendation of the local health officer, from establishing a rule requiring a more extensive or more frequent examination than required by this section.
(h) The State Department of Public Health, in consultation with the California Tuberculosis Controllers Association, shall develop a risk assessment questionnaire, to be used to conduct tuberculosis risk assessments pursuant to this section. The risk assessment questionnaire shall be administered by a health care provider, which shall be specified on the questionnaire. This risk assessment questionnaire shall be exempt from the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).

SEC. 11.SEC. 8.

 Section 5163 of the Public Resources Code is amended to read:

5163.
 (a) No person shall initially be employed in connection with a park, playground, recreational center, or beach used for recreational purposes by a city or county in a position requiring contact with children, or as a food concessionaire or other licensed concessionaire in that area, unless the person submits to a tuberculosis risk assessment developed by the State Department of Public Health and the California Tuberculosis Controllers Association, and, if risk factors are present, an examination as described in Section 5163.1.
(b) Thereafter, those employees who do not have identified tuberculosis risk factors, or whose test for tuberculosis infection is negative shall be required to undergo the foregoing examination at least once each four years. Once an employee has a documented positive skin test which has been followed by an X-ray, and subsequently determined by a physician to be free of infectious tuberculosis, the foregoing examination is no longer required and a referral shall be made within 30 days of the examination to the local health officer to determine the need for followup care.
“Certificate” means a document signed by the examining physician and surgeon who is licensed under Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code, or a notice from a public health agency or unit of the tuberculosis association which indicates freedom from infectious tuberculosis.

SEC. 12.SEC. 9.

 Section 5163.1 of the Public Resources Code is amended to read:

5163.1.
 If tuberculosis risk factors are present, the employee shall be examined to determine that he or she is free of infectious tuberculosis. The examination shall consist of any test for tuberculosis infection that is recommended by the federal Centers for Disease Control and Prevention and licensed by the federal Food and Drug Administration, which, if positive, shall be followed by an X-ray of the lungs.
Sections 5163 to 5163.2, inclusive, do not prevent the governing body of any city or county, upon recommendation of the local health officer, from establishing a rule requiring a more extensive or more frequent examination than required by Section 5163 and this section.