P1. Is there a duty to report COVID-19 cases to state or local health authorities?

Yes. Generally, health care providers — including doctors, nurses, physician assistants, among others — at UC student health centers, health care clinics and medical centers who know of, or are in attendance on, a case or suspected case of COVID-19 are required to report it to the local health department immediately, by telephone, in accordance with internal administrative procedures. Where no health care provider is in attendance, any individual who knows of, or suspects that, someone has COVID-19 is permitted to report it to the local health department.[1] Local health departments, in turn, notify the CDPH.

Contact information for the local health officers may be found at the CDPH website.

[1] 17 C.C.R. §§ 2500(b), 2500(c), 2500(a)(14), 2500(h)(i).

P2. What are the responsibilities of the local and/or state health departments once they have been notified of a case of COVID-19?

Health officers are legally required to take whatever steps are deemed necessary for the investigation and control of the reported disease. This includes the power to isolate and quarantine individuals per their site-specific isolation/quarantine protocol; inspect and disinfect property; require the examination of a person to verify the diagnosis; investigate to determine the source of the infection; determine the contacts subject to quarantine; issue appropriate instructions; and take appropriate steps to prevent or control the spread of the disease.[2] Health officers may, for purposes of their investigation, disclose the information contained in an individual case report, including personal information, as may be necessary to prevent the spread of the disease or occurrence of additional cases.[3] If the disease requires isolation, the health officer must ensure that instructions are given to the patient and members of their household that define the area within which the patient is to be isolated and state what measures should be taken to prevent the spread of the disease, including the isolation technique to be followed.[4]

UC medical centers and locations should plan to work closely with local health officers who may be authorized to take appropriate action on behalf of UC or able to provide UC with approval and/or authority to take appropriate remedial action. Any such authority given or action taken by the local health officer should be documented.

[2] Health & Saf. Code §§ 120130(c), 120145, 120175, 17 C.C.R. §§ 2501, 2520.
[3] 17 C.C.R. § 2502 (f) (2).
[4] 17 C.C.R. §§ 2516, 2518.

P3. May student health care providers disclose personal information related to a student suspected to have, or known to have, COVID-19, without consent, as necessary to control the disease?

Yes. Student health center personnel may alert the residence halls and instructors about a student who is a carrier of COVID-19 if the student does not comply with instructions to leave UC locations, to stop attending class and/or to go home or to an appropriate health facility for treatment.

The Family Educational Rights and Privacy Act[5] (FERPA) permits disclosure of student treatment records for purposes other than treatment to “appropriate persons [to protect others] in connection with an emergency if knowledge of the information is necessary to protect the health or safety of the student or other individuals.” The Health Insurance Portability and Accountability Act[6] (HIPAA) provides that such disclosure of protected health information without patient consent is permitted if there is a good faith belief that the disclosure is “necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public; and ...[the disclosure] is to a person or persons reasonably able to prevent or lessen the threat.”[7] California case law holds that health care providers have a duty to take reasonable steps, including breaching patient confidentiality, to warn and protect others at risk from a patient with a communicable disease.[8] California regulations regarding communicable diseases obligate a health care provider in attendance on a case of suspected communicable disease to breach confidentiality to give detailed instructions to household members of a sick person regarding precautionary measures to be taken for preventing the spread of the disease or condition.[9]

Even when circumstances warranting disclosure exist, the disclosure should be as limited as possible; only necessary information should be shared and disclosures should be made only to those people with a need to know.

A local health department may also provide a UC location with advance written approval in order to disclose such information in such circumstances. Further, as previously indicated, a health official may release personal information, as necessary, to prevent the spread of disease or the occurrence of additional cases.

[5] http://www.ed.gov/policy/gen/guid/fpco/ferpa/index.html
[6] http://www.hhs.gov/ocr/privacy/
[7] 45 C.F.R. 164.512(j)(i).) This provision should be relied upon only in extraordinary circumstances.
[8] Reisner v. Regents of the University of California (1995) 31 Cal. App.4th 1195.
[9] 17 C.C.R. § 2514.