Procedures for Obtaining Emergency Detention Order and Court-Ordered Isolation

1. The Local Health Director serves as the primary local point of contact on all matters related to the legal isolation of persons with active tuberculosis disease. As such, all requests to the State Health Commissioner for Emergency Detention Orders or for a petition for Court Ordered Isolation must be made by the Local Health Director or if by his/her designee, then only with the knowledge and approval of the Local Health Director.

2. Once the decision has been made to proceed with legal isolation, the Local Health Director or designee should contact the Division of Disease Prevention TB Control (DDP TB) for assistance in initiating the emergency detention process (see pp. 15-16 in the Guidebook to the VA TB Control Laws).

3. The following TB Control staff members have been designated as initial points of contact regarding enforcement of TB control statutes:

• Jane L. Moore, RN, MHSA

At least one of these individuals will be available at all times (including nights, weekends, and holidays) to assist the Local Health Director/designee with answers to questions on the process of legal isolation, serve as liaison to the Office of the Attorney General, and in obtaining the signed Order from the State Health Commissioner.

4. While TB Control is obtaining the signed Emergency Detention Order, the Local Health Director or designee will be responsible for obtaining and delivering copies of appropriate medical records to TB Control for subsequent transfer to the Attorney General's office.

a) At a minimum, the records required by TB Control and the Attorney Generals' office for development of the Emergency Detention Order and Petition for Court Hearing, include:

• Copy of medical evaluation describing in detail the basis for the diagnosis of active TB disease as defined by the Code of Virginia
• Copies of pertinent chest x-ray reports
• Copies of pertinent sputum/specimen results including reports of smears, cultures and sensitivity results, if available.
• Documentation of local efforts to counsel and education patient regarding disease, treatment, expected behaviors related to treatment compliance and isolation.
• Documentation of patient non-adherence to recommendations and orders and basis of determination that patient poses an imminent danger to the health of the public
• Copies of any formal Requests and Orders issued by the local health director.

The TB Control contact will provide further clarification or explanation of these items if needed.

b) The Local Health Director or designee must contact appropriate local law enforcement officials (police, sheriff, etc.) so that they may prepare for the arrival of the Commissioner's order and develop a plan for its implementation.

c) The Local Health Director or designee must identify the "least restrictive willing facility," at which the patient may be confined under the Commissioner's Order until the court hearing is held. Per Virginia Code §32.1-§48.03, the place of temporary detention may not be a jail or a correctional facility.