The Tuberculosis Epidemic: Legal and Ethical Issues for Alcohol and Other Drug Treatment Providers
Treatment Improvement Protocol (TIP) Series 18

THE TB/METHADONE REGISTRY MATCH PROCEDURE

1. Each participating MMTP provider will enter into a QSOA with Creative SocioMedics (CSM) to receive the TB information generated by the cross-matching of the two tapes.
2. CSM will receive a tape of clients who are on the NYC Department of Health (CDoH) TB registry (for the period 1992 to present) as: open i.e. a patient diagnosed with active TB who has not completed treatment according to CDoH's registry; lost to follow-up i.e. a patient diagnosed with active TB who has not completed treatment according to CDoH's registry and who the Bureau cannot locate to obtain follow-up information; or refused treatment i.e. a patient diagnosed with active TB who has not completed treatment, and who has refused to continue treatment according to CDoH's registry. This tape will be compared with the enrollment registry of MMTP patients. CDoH will send the TB registry tape to CSM for match and distribution by the first of each month.
3. CSM will inform each participating MMTP provider of those patients who appear on both registries (a match is defined if two of the following parameters: Name; SS; DoB are the same.)
4. Aggregate data on the total number of matches would be shared with CDoH, OASAS and COMPA by CSM.
5. The MMTP provider will ascertain the patient's medical status, and ensure that proper TB treatment is being provided either on site at the MMTP or by another medical provider.
6. If the MMTP is a TB medical care provider (Diagnosis and treatment on site):
   1. Then the MMTP would seek a signed consent form from the patient for the program to initiate contact with CDoH and share relevant medical information to ensure continuity of treatment. The MMTP will then send a letter to the Director of Surveillance at CDoH informing this staff of the names of patients who have signed a consent (see attached sample letter).
   2. The Drug Treatment Liaison at CDoH will telephone a designated MMTP representative on a monthly basis (as per NYC Health Code Section 11.47) to obtain information on patient adherence and TB drug regimen. Alternatively, the MMTP provider may submit a TB 65 monthly TB reporting form.
7. If the MMTP is a non-medical care provider:
   1. For patients identified by the match the MMTP will seek a consent form to notify CDoH of the name of the client, and the name of the client's primary medical care provider (see attached sample letter for non-medical care provider). The MMTP provider is not required to report to CDoH active cases of TB (TB cases should be reported by the diagnosing physician).
   2. If the MMTP provider is satisfied that the patient is receiving proper TB treatment and is posing no health danger to him/herself or to others, and the patient does not consent to release information to CDoH, this information would be entered in the patient's medical record and no information will be shared with the TB registry or any other third party.
   3. If the patient does not consent and is non-compliant with TB care, a second attempt at receiving consent would be tried. Finally, a court order to allow disclosure of the patient's treatment status and non-compliance with TB care will be sought. This court order would not compel the patient to accept treatment; it would authorize the MMTP provider to report the specific information to the CDoH, which is necessary for them to locate the patient and attempt to secure compliance with medical treatment. If the program is unsure whether a court order would be appropriate, the program or its attorney may contact OASAS Counsel's Office for assistance.

[Name of MMTP Contact person]

[MMTP Address]

[Date]

Mr. Michael Williams,

Director of Surveillance

NYC Department of Health

Bureau of TB Control

125 Worth Street, Box 74

New York, NY 10001

Re: [Name of client]

DOB:

SS#:

Dear Mr. Williams:

Please be advised that the above referenced person has been identified through the TB Cross Match and is under our care for both a substance abuse disorder and for tuberculosis.

This information has been disclosed to you with the consent of the patient from records protected by Federal confidentiality rules pertaining to the records of alcohol/drug abuse program (42 CFR Part 2). The Federal rules prohibit you from making any further disclosure of this information unless further disclosure is otherwise permitted by 42 CFR Part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose. The Federal rules restrict any use of the information to criminally investigate or prosecute any alcohol or drug abuse patients.

I trust this information is sufficient for this purposes.

Sincerely,
 
 
  [Name of MMTP Contact person]
(TO BE USED IF YOUR MMTP IS A TB MEDICAL CARE PROVIDER)

QUALIFIED SERVICE ORGANIZATION AGREEMENT

_________________________________________ (hereinafter referred to as "the Program")
(Name of Methadone Maintenance Treatment Program)
and Creative Socio-Medics (hereinafter referred to as "CSM") do hereby enter into a Qualified Service Organization Agreement, whereby CSM agrees to provide the Program with relevant information, received from the New York City Department of Health, regarding the diagnosis or treatment for tuberculosis of a patient in the Program.

Furthermore, both parties to this Agreement:
(1) acknowledge that in receiving, storing, processing or otherwise dealing with any information received, they are fully bound by the provisions of the federal regulation governing Confidentiality of Alcohol and Drug Abuse Patient Records, 42 C.F.R. Part 2; and
(2) undertake to resist in judicial proceedings any effort to obtain access to information pertaining to patients otherwise than is expressly provided for in the federal confidentiality regulations, 42 C.F.R. Part 2.

Executed this ________ day of ____________________, 199__.
___________________________________________________________________
[Print Name of Person Signing]
[Title of Person signing]
[Name of the Program]
[Address of the Program]
[Print Name of Person Signing]
[Title of Person signing]
[Name of the Program]
[Address of the Program]