Title 4
Disease Control
Subtitle 1
General Provisions
§ 4-101. Nature of reports.
(a) Reporting does not breach confidentiality.
The making of a report as required or permitted by this title is not a breach of a patient's confidentiality.
(b) Confidentiality of reports.
Except as otherwise required by law, all reports made under this title are confidential and not open to public inspection.
§ 4-102. Form and contents of reports.
(a) Form.
All reports must be made in writing, in the form that the Commissioner requires.
(b) Contents.
In addition to any other information specified in this title or required by the Commissioner, all reports must contain the following patient information, to the extent known:
(1) name;
(2) place of dwelling;
(3) date of birth or, if not known, approximate age;
(4) sex;
(5) race/ethnicity; and
(6) occupation.
§ 4-103. Inspection of records.
The Commissioner may inspect the records of any person or facility subject to this title to determine compliance with this title.
Subtitle 2
Reporting Diseases — In General
Part I
By Health Care Practitioners
§ 4-201. Physicians.
(a) Duty to report.
Every physician must report to the Commissioner of Health every confirmed or suspected diagnosis of any disease or condition that, the Commissioner specifies by rule or regulation adopted under § 2-106 {"Rules and regulations"} of this article for purposes of this section .
(b) When to report.
Unless a different time is set by the Commissioner or by State law, the report must be made within 48 hours of the diagnosis.
(c) Contents of report.
In addition to the information required by § 4-102 {"Form and contents of reports"} of this title, the report must contain the following information:
(1) the identity of the disease or condition; and
(2) the date of its onset.
§ 4-202. Health care facilities.
(a) Reporting officer.
The chief administrative officer of each hospital, related institution, clinic, pharmacy, or other health care facility must appoint an individual from the facility's full-time staff to serve as the facility's reporting officer.
(b) Duty to report.
The reporting officer must report to the Commissioner every confirmed or suspected diagnosis of any disease or condition that the Commissioner specifies by rule or regulation adopted under § 2-106 {"Rules and regulations"} of this article for purposes of this section.
(c) When to report.
Except for specified diseases or conditions that the Commissioner or State law requires to be reported on a more timely basis, the report must be made within 48 hours for all patients who have been:
(1) newly admitted to the facility;
(2) admitted to an isolation ward;
(3) treated on an emergency or out-patient basis; or
(4) discharged without having been previously reported.
(d) Contents of report.
In addition to the information required by § 4-102 {"Form and contents of reports"} of this title, the report must contain the following information:
(1) the identity of the disease or condition; and
(2) the date of its onset.
(e) Nature of report.
The reporting of a disease or condition under this section does not absolve the attending physician of the duty to report the same disease or condition under § 4-201 {"Physicians"} of this subtitle.
§ 4-203. Laboratories — in general.
(a) Duty to report.
The individual in charge of any public or private medical laboratory must report to the Commissioner the result of any test of a specimen from a human body that is microscopic cultural, histological, pathological, immunological, serological, or other confirmed or suspected evidence of any disease or condition that the Commissioner specifies by rule or regulation adopted under § 2-106 {"Rules and regulations"} of this article for purposes of this section.
(b) When to report.
(1) Unless a different time is set by the Commissioner or by State law, the report must be made within 48 hours of obtaining the test results.
(2) When more than 1 specimen is taken from the same patient during a single disease episode, the individual in charge of the laboratory need not report every test result that shows evidence of the same disease if:
(i) at least 1 positive test report is reported; and
(ii) the Commissioner approves in writing the reporting of less than all test results.
(c) Contents of report.
In addition to the information required by § 4-102 {"Form and contents of reports"} of this title, the report must contain the following information:
(1) the date and type of test performed;
(2) the results of the test;
(3) the name and address of the physician for whom the examination was performed; and
(4) if applicable, an enumeration of colonies of acid-fast bacilli, according to Diagnostic Standards of the American Thoracic Society.
(d) Test result not final diagnosis.
The result of a laboratory test:
(1) is not to be considered a final diagnosis; and
(2) does not absolve the attending physician of the duty to report her or his diagnosis of the case under § 4-201 {"Physicians"} of this subtitle.
§ 4-204. Laboratories — referral of cultures.
(a) When referral required.
The Commissioner may require that cultures containing acid-fast bacilli be referred to the Maryland State Laboratory unless they have been identified in accordance with standards set by the Commissioner.
(b) Effect of referral.
The referral of cultures does not:
(1) satisfy the reporting requirements of § 4-203 {"Laboratories — in general"} of this subtitle; or
(2) excuse delay in transmitting a presumptive culture result to the attending physician.
4-205 to 4-206. {Reserved}
Part II
By Others
§ 4-207. Lodging facilities.
(a) "Lodging facility" defined.
In this section, "lodging facility" means any:
(1) hotel or motel;
(2) rooming house;
(3) apartment house;
(4) dwelling house; or
(5) public or private institution in which individuals abide temporarily or permanently.
(b) Duty to report.
The individual in charge of a lodging facility must report to the Commissioner anyone in the lodging facility who is suffering from any disease or condition that the Commissioner specifies by rule or regulation adopted under § 2-106 {"Rules and regulations"} of this article for purposes of this section.
(c) When to report.
Unless a different time is set by the Commissioner or by State law, the report must be made within 24 hours of the individual's being told or otherwise becoming aware of the disease or condition.
§ 4-208. Vessels in harbor.
(a) Scope of section.
This section does not apply to a vessel that is in medical isolation.
(b) Duty to report.
The master, chief officer, or consignee of a vessel must report to the Commissioner anyone on board who is suspected of suffering from a communicable disease.
(c) When to report.
The report must be made immediately on the vessel's coming within ¼ mile of any dock, wharf, or building in the City.
(d) Contents of report.
In addition to the information required by § 4-102 {"Form and contents of reports"} of this title, the report must contain the following information:
(1) the name and location of the vessel;
(2) the name of the suspected communicable disease; and
(3) the name and condition of all individuals on board suffering from the disease.
Subtitle 3
Reporting Diseases — Tuberculosis
§ 4-301. Laboratory test results.
(a) Duty to report.
If a medical laboratory performs mycobacterial drug susceptibility tests of cultures that are identified as M. tuberculosis and that have not been referred to the Maryland Laboratories Administration for this determination, the individual in charge of the laboratory must report the test results to the Commissioner.
(b) When to report.
Unless a different time is set by the Commissioner or by State law, the report must be made within 48 hours of obtaining the test results.
§ 4-302. Drugs suggesting treatment.
(a) Duty to report.
The individual in charge of any public or private pharmacy, other than a facility operated by the Department, must report to the Commissioner of Health whenever it dispenses any anti- tuberculosis medication that the Commissioner specifies by rule or regulation adopted under § 2-106 {"Rules and regulations"} of this article for purposes of this section.
(b) When to report.
Unless a different time is set by the Commissioner or by State law, the report must be made within 48 hours of having dispensed the medication.
(c) Contents of report.
In addition to the information required by § 4-102 {"Form and contents of reports"} of this title, the report must contain the following information:
(1) the type, and strength of medication issued;
(2) the daily dosage;
(3) the dosing schedule;
(4) the total amount prescribed;
(5) the name and address of the physician who issued the prescription; and
(6) the date the medication was dispensed.
(d) Report not final diagnosis.
The prescription of medication:
(1) is not to be considered a final diagnosis; and
(2) does not absolve the attending physician of the duty to report her or his diagnosis of the case under § 4-201 {"Physicians"} of this subtitle.
§ 4-303. Physician's contact investigation.
(a) Duty to conduct.
A physician who treats a patient with tuberculosis must:
(1) thoroughly investigate all individuals who might have been exposed to the patient at home, work, or otherwise; or
(2) request the Commissioner to undertake this investigation.
(b) Duty to report.
If the physician undertakes the investigation required by this section, the physician must report the results to the Commissioner.
(c) Contents of report.
In addition to any other information that the Commissioner requires, the report must contain:
(1) evidence that an investigation has been thoroughly conducted;
(2) the identity of the source case; and
(3) the following information about each individual tested:
(i) the date and type of test performed;
(ii) the results of the test; and
(iii) the personal information listed in § 4-102 {"Form and contents of reports"} of this title.
§ 4-304. Patient leaving hospital or institution.
(a) Duty to notify.
If a patient with a confirmed or suspected diagnosis of tuberculosis leaves a ward, emergency room, or outpatient department of a hospital or other institution without the consent or against the advice of a physician or other individual in charge, the physician or other individual in charge must notify the Commissioner of the patient's departure.
(b) When to notify.
Unless a different time is set by the Commissioner or by State law, the notice must be given within 24 hours of the patient's departure.
(c) Action by Commissioner.
The Commissioner may take whatever action is needed to protect the public from that patient.
§ 4-305. Discontinued treatment.
(a) Duty to notify.
If any patient being treated for tuberculosis discontinues treatment before the period that the Commissioner sets for that treatment, the attending physician must notify the Commissioner of the discontinuance.
(b) When to notify.
Unless a different time is set by the Commissioner or by State law, the notice must be given within 24 hours of the discontinuance.
(c) Action by Commissioner.
The Commissioner may take whatever action is needed to protect the public from that patient.
§ 4-306. Death from tuberculosis.
(a) Duty to report.
Every physician or medical examiner must report to the Commissioner if he or she believes that an individual he or she attended or examined has died of tuberculosis.
(b) When to report.
Unless a different time is set by the Commissioner or by State law, the report must be made within 48 hours of the death or the discovery of the disease, whichever is later.
(c) Contents of report.
In addition to the information required by § 4-102 {"Form and contents of reports"} of this title, the report must contain the place of death.
Subtitle 4
Controlling Communicable Diseases
§ 4-401. "Communicable disease" defined.
In this subtitle, "communicable disease" means any contagious, infectious, or communicable disease or condition that the Commissioner specifies by rule or regulation adopted under § 2-106 {"Rules and regulations"} of this article for purposes of this subtitle.
§ 4-402. Investigations generally.
The Commissioner may investigate any report of a case or suspected case of a communicable disease or communicable disease carrier, to determine the source of infection and the need for restricting movement or isolating affected individuals.
§ 4-403. Examinations of individuals.
(a) Scope of section.
(1) Except as specified in paragraph (2) of this subsection, this section applies to any individual:
(i) who has or whom the Commissioner of Health suspects on reasonable grounds of having a communicable disease;
(ii) who is or whom the Commissioner suspects on reasonable grounds of being a communicable disease carrier; or
(iii) who is or whom the Commissioner suspects on reasonable grounds of having been in contact with any individual described in item (i) or (ii) of this subsection.
(2) This section may not be applied to interfere with any individual who is a bona fide practicing Christian Scientist and who receives treatment from registered Christian Science practitioners.
(b) Examination required.
On request of the Commissioner, any individual described in subsection (a) of this section must, for the purpose of determining if she or he has a communicable disease or is a carrier:
(1) undergo a medical examination; and
(2) submit specimens of body fluids, secretion, excretion, or discharge for laboratory examination.
(c) By whom made.
The medical examination may be made by:
(1) the Commissioner or a physician selected by the Commissioner; or
(2) at the option of the individual to be examined, any physician qualified to make this sort of examination.
(d) Report of physician.
The examining physician must promptly report the results of the examination to the Commissioner.
§ 4-404. Action to prevent spread; public notice of disease.
Whenever a communicable disease is found to exist, the Commissioner may:
(1) take all possible action to prevent the disease from spreading; and
(2) give public notice of the disease and of affected places, by all means that the Commissioner believes would be effective, including the posting of affected places.
§ 4-405. Vacating premises.
(a) In general.
Whenever an infectious agent is discovered in any dwelling or other building that is overcrowded, in a filthy and neglected state, or located in an unhealthy or crowded part of the City, the Commissioner, with the approval of the Mayor, may require the inhabitants of the building to move elsewhere while the City cleans and disinfects the building.
(b) City to bear expenses.
All expenses incurred under this section for moving, temporary housing, cleaning, and disinfecting are to be borne by the City.
§ 4-406. Medical isolation — in general.
In the rules and regulations adopted under § 2-106 {"Rules and regulations"} of this article, the Commissioner may require the medical isolation of individuals having a communicable or potentially communicable disease or condition dangerous to the public health.
§ 4-407. Medical isolation — court papers to be sealed.
In any court proceeding brought to enforce a medical isolation, all papers filed with the court:
(1) must be sealed; and
(2) may be inspected only by order of the court, on notice to the individual named in those papers and for good cause shown.
4-408 to 4-409. {Reserved}
§ 4-410. Prohibited conduct.
No person may:
(1) refuse, neglect, or otherwise fail to undergo an examination as required by § 4-403{"Examinations of individuals"} of this subtitle;
(2) remove or deface any notice posted under § 4-404 {"Action to prevent spread; public notice of disease"} of this subtitle;
(3) refuse, neglect, or otherwise fail to comply fully with an order for medical isolation issued under authority of § 4-406 {"Medical isolation"} of this subtitle;
(4) needlessly expose others to the risk of a communicable disease, whether by exposure of him- or herself, another person, a dead body, or any infected material; or
(5) otherwise, by reason of non-cooperation or carelessness, endanger the public health.
Subtitle 5
Immunizations
Part I
Purpose and Need
§ 4-501. In general.
Immunizations are a proven preventive measure in reducing the morbidity and mortality associated with childhood communicable diseases. Accordingly, to safeguard the public health and welfare, the City needs to attain and sustain an immunization coverage rate of at least 90% for age-appropriate vaccinations among infants and preschool children residing in the City.
4-502. {Reserved}
Part II
Immunization Required
§ 4-503. Parental responsibility.
Except as specified in § 4-506 {"Exceptions"} of this subtitle, every parent and guardian must provide for the timely and appropriate immunization of their minor children against all immunization-preventable childhood diseases, as specified by rule or regulation that the Commissioner adopts under § 2-106 {"Rules and regulations"} of this article.
§ 4-504. Scope of enforcement.
In enforcing this Part II, each child who is not properly immunized as required is considered a separate offense.
§ 4-505. Rules and regulations.
In adopting rules and regulations under this Part II, the Commissioner must consider the recommendations of the Advisory Committee on Immunization Practices.
§ 4-506. Exceptions.
This Part II does not apply:
(1) to any child whose parent or guardian, in accordance with the rules and regulations of the State Secretary of Health and Mental Hygiene, objects to immunization on the ground that it conflicts with the parent's or guardian's bona fide religious beliefs and practices; or
(2) if, because of a child's medical condition, the administration of an immunizing agent could precipitate a medical emergency.
4-507 to 4-508. {Reserved}
Part III
Pediatric Registry
§ 4-509. Commissioner to establish registry.
The Commissioner of Health is directed to adopt rules and regulations under § 2-106 {"Rules and regulations"} of this article to implement a registry of immunization history for children residing in the City.
§ 4-510. Reports by health care providers.
(a) Duty to report.
Each pediatric, family, and general health care provider must report to the Commissioner whenever that provider administers an immunizing agent to any child who is less than 5 years old and resides in the City.
(b) When to report.
The report must be made within 14 days after administering the immunizing agent.
§ 4-511. Civil penalties: $1,000.
(a) Fine.
Any health care provider who violates any provision of this Part III or of a rule or regulation adopted under it is subject to a civil penalty of not more than $1,000 for each violation.
(b) Withholding assistance; records audit.
In addition to imposing a fine, the court may:
(1) issue an order for withholding publicly distributed vaccines or pediatric primary care funding or both vaccines and funding; and
(2) order the Department to conduct a medical records audit of the health care provider, the cost of the audit to be paid by the health care provider.
(c) Subtitle 9 inapplicable.
Subtitle 9 {"Penalties"} of this title does not apply to violations of this Part III.
Subtitle 6
Lead Poisoning
Part I
Screening Required
§ 4-601. Parental responsibility.
Except as specified in § 4-603 {"Exceptions"} of this subtitle, every parent and guardian must provide for the timely and appropriate testing for lead poisoning of his or her minor children, as specified by the rules and regulations that the Commissioner adopts under § 2-106 {"Rules and regulations"} of this article.
§ 4-602. Provider's responsibility.
Except as specified in § 4-603 {"Exceptions"} of this subtitle, every pediatric and primary care health provider must order the timely and appropriate testing for lead poisoning of his or her minor patients, as specified by the rules and regulations that the Commissioner adopts under § 2-106 {"Rules and regulations"} of this article.
§ 4-603. Exceptions.
This Part I does not apply to any child whose parent or guardian, in accordance with the rules and regulations of the State Secretary of Health and Mental Hygiene, objects to testing on the ground that it conflicts with the parent's or guardian's bona fide religious beliefs and practices.
§ 4-604. Enforcement.
(a) Separate offenses.
In enforcing this Part I, each child who is not properly tested as required is considered a separate violation.
(b) Civil penalties — Parents and guardians.
§ 4-601{"Parental responsibility"} of this subtitle may be enforced by issuance of an environmental citation under Article 1, Subtitle 40 {"Environmental Control Board"} of the City Code.
(c) Civil penalties — Providers.
Any provider who violates any provision of § 4-602 {"Provider's responsibility"} of this subtitle or of a rule or regulation adopted under it is subject to a civil penalty of not more than $100 for each violation.
(d) Subtitle 9 inapplicable.
Subtitle 9 {"Penalties"} of this title does not apply to violations of this Part I.
4-605. {Reserved}
Part II
Registry; Reports
§ 4-606. Commissioner to establish registry.
The Commissioner of Health is directed to adopt rules and regulations under § 2-106 {"Rules and regulations"} of this article to implement a registry of screening history for children residing in the City.
§ 4-607. Reports by medical laboratories.
(a) Duty to report.
Each medical laboratory must report to the Commissioner whenever that laboratory tests for lead poisoning any child who is less than 7 years old and who resides in the City.
(b) When to report.
The report must:
(1) be made within 14 days after the test is conducted; and
(2) contain the information that the Commissioner requires, as specified by the Commissioner's rules and regulations.
§ 4-608. Reports by child care facilities.
(a) "Child care facility" defined.
(1) In this section, "child care facility" means any facility that:
(i) provides for the care, custody, or control of a minor child; and
(ii) is required to be licensed by or registered with the State for that purpose.
(2) Subject to the criteria contained in paragraph (1) of this subsection, "Child care facility" includes any:
(i) child care center;
(ii) child care home;
(iii) child care institution;
(iv) family day care home;
(v) non-public nursery school; or
(vi) non-public kindergarten.
(b) Duty to report.
Each child care facility must report to the Commissioner whenever that facility receives a State Health Inventory or other report that contains information on whether a child who resides in the City has been tested for lead poisoning.
(c) When to report.
The report must:
(1) be made within 14 days after the State Health Inventory or other report is received by the facility; and
(2) contain the information that the Commissioner requires, as specified by the Commissioner's rules and regulations.
§ 4-609. Civil penalties: $100.
(a) Fine.
Any person who violates any provision of this Part II or of a rule or regulation adopted under it is subject to a civil penalty of not more than $100 for each violation.
(b) Subtitle 9 inapplicable.
Subtitle 9 {"Penalties"} of this title does not apply to violations of this Part II.
4-610. {Reserved}
Part III
Public School Water Fountains
§ 4-611. Inspections required.
(a) In general.
Every 2 years, the Health Commissioner shall test all activated water fountains at each of 10 randomly-selected public schools.
(b) Expenses.
Testing shall be conducted at the expense of the Baltimore City School System.
§ 4-612. Failing fountains.
Any water fountain that fails to meet EPA standards must be taken out of service.
Subtitle 7
Biological Terrorism Reporting
§ 4-701. Definitions.
(a) In general.
In this subtitle, the following terms have the meanings indicated.
(b) Suspect symptoms.
"Suspect symptoms" means those symptoms that, by rule or regulation adopted under § 2-106 of this article, the Commissioner designates as being indicative of a possible biological terrorist attack.
§ 4-702. In general.
(a) When reports to be made.
Unless the Commissioner's rules or regulations specify otherwise, each report required by this subtitle must be made daily for all events occurring within the preceding 24 hours.
(b) How reports to be made.
Each report required by this subtitle must be made electronically, by a method and in the form the Commissioner's rules or regulations specify.
(c) Contents of reports.
Each report required by this subtitle must contain:
(1) all of the information specified in this subtitle for that report; and
(2) all other information that the Commissioner requires by rule or regulation.
§ 4-703. EMS calls.
(a) Duty to report.
The Emergency Medical System of the Baltimore City Fire Department must report to the Commissioner on all calls made to assist individuals who evidence suspect symptoms.
(b) Contents of report.
In addition to any other information required by rule or regulation, the report must specify for each reporting period:
(1) the aggregate number of calls subject to the report; and
(2) for each of these calls, the specific suspect symptom or symptoms identified.
§ 4-704. Animal carcasses.
(a) Duty to report.
The Department of Public Works, the Department of Transportation, and the Health Department's Bureau of Animal Control must report to the Commissioner on animal carcasses that the Commissioner specifies by rule or regulation.
(b) Contents of report.
In addition to any other information required by rule or regulation, the report must specify for each reporting period:
(1) the aggregate number of carcasses subject to the report; and
(2) the number of carcasses for each species.
§ 4-705. School absences.
(a) Duty to report.
The Baltimore City Public School System must report to the Commissioner on all elementary school absences.
(b) Contents of report.
In addition to any other information required by rule or regulation, the report must specify for each reporting period:
(1) the aggregate percentage of absences Citywide; and
(2) the percentage of absences by grade.
§ 4-706. Health Center treatments.
(a) Duty to report.
The Baltimore City Community Health Centers must report to the Commissioner on all patients who evidence suspect symptoms.
(b) Contents of report.
In addition to any other information required by rule or regulation, the report must specify for each reporting period:
(1) the aggregate number of patients subject to the report; and
(2) for each of these patients, the specific suspect symptom or symptoms identified.
§ 4-707. Emergency department visits.
(a) Duty to report.
The reporting officer of each hospital, related institution, clinic, or other health care facility, as appointed under § 4-202 of this title, must report to the Commissioner on all emergency department visits by individuals who evidence suspect symptoms.
(b) Contents of report.
In addition to any other information required by rule or regulation, the report must specify for each reporting period:
(1) the aggregate number of patients subject to the report; and
(2) for each of these patients, the specific suspect symptom or symptoms identified.
§ 4-708. Medications.
(a) Duty to report.
The individual in charge of any public or private pharmacy must report to the Commissioner on all sales of any over-the-counter medication that the Commissioner designates by rule or regulation as being a medication used for the treatment of suspect symptoms.
(b) Contents of report.
In addition to any other information required by rule or regulation, the report must specify, for each medication sold during a reporting period:
(1) the type and strength of that index medication; and
(2) the aggregate number of units sold during the reporting period.
Subtitle 8
[Reserved]
Subtitle 9
Penalties
§ 4-901. Violation a misdemeanor.
Except as otherwise specified in this title, any person who violates any provision of this title is guilty of a misdemeanor and, on conviction, is subject to the penalties provided in this subtitle.
§ 4-902. Basic penalty: $1,000 and 12 months.
Except as otherwise specified in this title, the penalty for a violation of this title is a fine of not more than $1,000 or imprisonment for not more than 12 months or both fine and imprisonment for each offense.
§ 4-903. Failure to vaccinate: $500.
The penalty for a violation of § 4-503 {"Parental responsibility"} of this title is a fine of not more than $500 for each offense.