Ordinance on the Federal Act of 13 June 1928 on Measures Against Tuberculosis - Cantonal Introductory Decree

1. Pursuant to Art. 19 of the Federal Act concerning Measures against Tuberculosis (hereinafter referred to as BGT), as well as Art. 48 of the Federal Execution Ordinance of June 20, 1930 (hereinafter referred to as Ordinance), and the Federal Ordinance concerning the Granting of Federal Contributions for the Combat against Tuberculosis of January 4, 1929, the Cantonal Council, based on Art. 48, Number 4 of the Cantonal Constitution, enacts the following provisions necessary for the implementation of the BGT and the Ordinance in the Canton of Appenzell A.Rh.

1. Cantonal Supervisory Authority in accordance with Art. 19 of the BGT and Art. 6 of the Ordinance is the Governing Council. It delegates direct supervision and enforcement to the Sanitation Commission or its President. The President is responsible for monitoring the implementation of the BGT and the enforcement ordinances. Important issues will be presented to the Sanitation Commission for decision-making.

2. The cantonal enforcement authority issues all major orders in conjunction with a physician familiar with local conditions.

3. Additional enforcement bodies include the local health commissions and their subcommissions, the Child and Adult Protection Authority, school and welfare physicians, the Board of Trustees of the Foundation for Combating Tuberculosis and Lung Diseases, and the Appenzell A.Rh. League for Combating Tuberculosis with their welfare commissions (hereinafter referred to as welfare offices) to be maintained in all municipalities.

4. The powers and duties of the enforcement bodies are derived from the following provisions of this cantonal enforcement ordinance.

1. In every municipality, a school and welfare physician is elected by the Health Commission from among the local or regularly practicing doctors in the municipality, upon the proposal of the municipal council. The elections are subject to the approval of the government council.

2. The duties of the school and welfare physician include

1. Observation for tuberculosis in schools and institutions according to Article 27 of the regulation and for foster children according to Article 18 hereinafter;

2. Ordering necessary measures, provided such measures have not already been taken by the attending physician;

3. Advising the welfare offices (see Article 6, paragraph 3, number 4);

4. Performing additional tasks assigned to him by the executive or supervisory authority.

3. The school and welfare physician performs his duties as a secondary occupation. His remuneration is the responsibility of the state. The municipalities bear 20% of the costs remaining after deduction of federal subsidies.

4. The school medical service is under the supervision of the president of the cantonal health commission.

1. The Foundation Council of the Tuberculosis Care Foundation and the welfare offices in the municipalities are primarily responsible for the welfare measures (cf. Art. 6 paragraph 3 number 4).

2. The Foundation Council of the Tuberculosis Care Foundation combats tuberculosis according to the foundation deed and the regulations for the Foundation Council in its causes and effects.

3. Applications for support of sanatorium treatment and other therapies, as well as applications for support in endeavors corresponding to the purpose of the foundation, are to be directed by the welfare offices to the respective President of the Foundation Council.

4. According to the statutes of the Appenzell A.Rh. League for Combating Tuberculosis, the welfare offices are elected by the Foundation Council of the Tuberculosis Care Foundation upon the proposal of the section boards of the Red Cross.

5. In the election of the welfare offices, the municipal councils have the right to be consulted.

1. The following powers and duties are assigned to the welfare offices

1. identifying individuals suspected of having tuberculosis and referring them to a physician;

2. examining the circumstances of reported cases on behalf of the school and welfare doctor and, concerning housing conditions, the local health commissions;

3. maintaining index cards with personal details and measures taken, etc., according to the form;

4. immediately reporting any changes in the status of patients (change of residence, admission to a hospital, death, etc.) to the secretariat of the health commission;

5. monitoring the measures prescribed by the attending physician or the school and welfare doctor for the patient and those for the protection of the at-risk environment.

2. No treatment of patients takes place in the welfare office or by welfare organizations as such.

3. Municipal councils are obliged to provide the welfare offices with a trained nurse; this requirement can also be met through agreements with existing nursing associations in the municipalities.

1. The cantonal reporting office is designated as the Secretariat of the Sanitation Commission. Reporting parties, doctors, hospitals, and welfare offices are provided with reporting forms and envelopes (with free postage) free of charge.

2. Reports are to be sent directly or through welfare offices to the Secretariat of the Sanitation Commission.

3. The duties of the cantonal reporting office include

1. Maintaining the register of reported cases and the measures taken, as well as deleting cases that have been cured;

2. Weekly reporting of new cases to the federal Health Office;

3. Forwarding reports to reporting offices outside the canton, federal authorities, and welfare institutions;

4. Reporting new cases sent directly to welfare offices if welfare support seems necessary.

4. Reporting offices must observe confidentiality. For each timely submitted medical report, a compensation of 2 francs is paid by the state.

1. The institutions and facilities for the prevention and control of tuberculosis mentioned in Art. 10 of the BGT can either be established and operated directly by the canton, or their establishment and operation can be left to private initiative and supported by cantonal subsidies.

2. Insofar as contracts with other cantons or institutions are concluded, the conclusion is the responsibility of the government council.

1. Applications for obtaining federal contributions must be submitted to the cantonal enforcement authority in accordance with the regulations of the Ordinance of January 4, 1929, Section B, I, II, and III.

1. Every physician who reports a tuberculosis case in accordance with Article 9 of the Ordinance must order the necessary measures as per BGT Article 3 and either personally oversee the implementation or assign it to the welfare office. If the case involves the care of a patient in a sanatorium or hospital, the welfare office will arrange for the necessary funds and may consult the board of trustees if necessary. These measures must be taken in the most considerate manner possible.

2. Registration is conducted by the cantonal reporting office as well as by the welfare offices using official registration cards.

3. The welfare offices periodically send their registration cards, or upon request, to the secretary of the Sanitary Commission to be forwarded to the cantonal enforcement authority for entry and subsequent return. If the measures appear insufficient, the enforcement authority will directly contact the treating physician.

4. The school and welfare physician regularly reviews the registration at his welfare office. Where necessary, he provides his remarks.

5. In communities with multiple physicians, any treating physician may involve the school and welfare physician to lend additional emphasis to his measures if needed.

1. The costs of the necessary welfare measures are to be borne primarily by the patient or their family alone, or in conjunction with the Foundation Council for Tuberculosis Welfare and the welfare offices of the municipalities, possibly with the competent authorities of the patient’s home municipality, where the financial and income circumstances permit.

2. For the implementation of the measures required by the BGT and the enforcement ordinances, the canton will annually provide the necessary credit.

3. The municipalities subsidize the welfare offices annually with an amount corresponding to the number of treated cases of illness and the costs incurred by them.

1. The provisions of Art. 3 of the BGT and Arts. 27 to 30 of the regulation also apply to private schools and institutions. Art. 34 para. 2 of the regulation applies in the sense that the medical service can be entrusted to the doctor chosen by the schools or institutions, under the supervision of the school and welfare doctor of the relevant municipality[22].

1. For the registration of medical findings collected upon the admission of students and pupils, and periodically during their stay in the school or institution, individual personnel cards are to be used for children with tuberculosis or at risk of tuberculosis. These personnel cards shall be kept in the school classes and institutions and be delivered to the new school or institution when the student or pupil transfers. Upon definitive school departure, the personnel cards are to be forwarded to the secretariat of the Health Commission for safekeeping.

2. The individuals entrusted with the execution of these measures are subject to confidentiality obligations in accordance with Art. 2 of the BGT.

1. The examination upon admission must also be conducted in institutions that accommodate children of preschool or school age (children's homes). These children are to be placed under continuous medical observation for tuberculosis.

1. Tuberculosis-exposed and suspected children shall receive the care deemed necessary by the attending physician or by the school and welfare doctor. They must be reported to the parents and welfare agencies in the same manner as children with tuberculosis and at risk of contagion and shall be subjected to special supervision by the teaching and care staff.

1. The decision regarding the permanent removal of contagiously dangerous children from the school or institution is made by the cantonal enforcement authority in consultation with the doctor appointed by it and the Department of Education and Culture. These offices are responsible for ensuring that children excluded from public schools receive an appropriate education wherever possible; if necessary, they must take further measures.

1. Examination and Supervision of Teaching and Care Staff are assigned to the School and Welfare Doctor, including the examination in cases of suspected tuberculosis, the verification of private medical certificates, and any necessary official follow-up examinations.

1. Tuberculous, contagious teachers and caregivers are to be removed from the school or institution.

2. The definitive dismissal occurs upon the request of the cantonal enforcement authority and the physician consulted by them, as well as the Department of Education and Culture, by the executive council.

3. Pension-eligible personnel will receive a disability pension in accordance with the statutes of the teachers' pension fund.

4. Personnel not eligible for a pension, and personnel of private schools and institutions subordinated to the BGT, may, provided they have complied with the regulations upon employment or the enactment of this ordinance and have fallen into need through no fault of their own, be granted assistance for a limited duration, the amount of which is determined by the executive council. These aids will be charged to the credit allocated for combating tuberculosis as per Art. 10 paragraph 2 above. The owners of the respective private enterprises may be required to contribute up to the amount provided by the canton, insofar as their income and financial circumstances justify it.

5. To minimize the employment of teachers and caregivers suspected of having tuberculosis, teachers and caregivers must be carefully examined for tuberculosis before their employment in public and private institutions.

1. Regarding the care of endangered children, see Art. 14 above.

2. The procedure to be observed for the removal of endangered children by the Child and Adult Protection Authority is governed by the relevant provisions of federal law.

3. The cantonal enforcement authority is authorized, in conjunction with the doctors it has consulted, to order the provisional removal of the child in urgent cases upon the request of the school and welfare doctor of the child's residential community.

1. The provisions of the agreement between the Canton of Appenzell A.Rh. and the district hospitals, as well as the agreement between the government of the Canton of Appenzell A.Rh. and the Hygiene Institute in Zurich concerning bacteriological examinations, are authoritative for bacteriological investigations. According to the governmental council's decision of September 6, 1919, these examinations are free of charge.

1. The housing inspections necessary in the interest of combating the danger of tuberculosis shall be conducted by the local health commissions.

2. All official bodies mentioned in this regulation are required to report dwellings that facilitate the spread of tuberculosis to the local health commission, which, in conjunction with the school and welfare physician, shall issue the necessary orders regarding housing prohibition, improvement of unhealthy dwellings, etc.

3. Appeals against orders of the local health commissions and the school and welfare physicians may be made to the sanitary commission, and against their decisions to the government council.

1. Education about Tuberculosis is the responsibility of the Board of Trustees of the Foundation for Tuberculosis Care and the Care Centers, which are supported in their efforts by the cantonal enforcement authority, the Health Commission, and the Red Cross, particularly through the free distribution of informational leaflets, etc., as well as through the subsidization of educational events.

1. The implementation of the provisions of Art. 9 of the BGT and Art. 44 of the Regulation is entrusted to the Sanitary Commission.

1. Apart from the appeal procedure ordered in Article 19 (Removal of Endangered Children), this is established in such a way that appeals can be lodged against the measures and orders of the school and welfare doctor, as well as welfare offices, and, insofar as the BGT and the related decrees are concerned, also the local health commissions, with the President of the Sanitation Commission. In important cases, the same forwards the appeal for decision to the Sanitation Commission. Appeals against decisions of the President of the Sanitation Commission and the Sanitation Commission may be made to the Government Council.

2. The appeal periods are in all cases 14 days and begin on the day following the delivery of the written decision. Furthermore, Article 17 of the Introductory Act to the Civil Code (ZGB) is decisive.

1. The Government Council shall submit an annual report on the implementation of the BGT to the Federal Council.

2. The cantonal enforcement authority is responsible for ensuring that individual reports and accounts from the offices and private institutions entrusted with the implementation of the BGT are submitted to it in a timely manner.

1. Offenses against the BGT are punished in accordance with Art. 17 of the BGT.

2. Competent to adjudicate these offenses in the first instance are the district courts.

1. This regulation shall enter into force upon adoption by the Cantonal Council and approval by the Federal Council.