Tuberculosis Case Management Manual

Introduction

Missouri statutes have been developed to meet the need for more comprehensive and specific TB control measure to:

• Help ensure that potentially infectious TB cases are made non-infectious as quickly as possible,
• Help ensure that TB cases complete a prescribed regimen, and
• Prevent the emergence and spread of multidrug-resistant TB (MDR-TB).

When infectious TB patients are not complying with treatment regimens or following other protocols (such as isolation) to ensure that they do not infect others, public health agencies must consider committing them to a facility that provides treatment. Committing an infectious TB patient to a treatment facility requires collaboration between courts and public health agencies to minimize the spread of TB. This collaboration assures TB cases are made non-infectious as quickly as possible.

This manual shows how the courts can assure the public’s health by restricting movements of infectious persons. It contains sample documents that can be used during the commitment process, a fact sheet on tuberculosis for officers of the court and transporters of TB patients, definitions, as well as Missouri statues and regulations that pertain to TB.

7.02 Sample Documents and the Commitment Process

Sample forms and guidelines that can be used in the commitment process are provided in the handbook. The following outline describes the process and when to use the forms.

1. TB patient is identified.
   The patient responsibility notification is completed (see example 7.02.1). The local public health agency (LPHA) initiates this notification when the patient is identified. At this time, the nurse informs the patient of their responsibility to adhere to the treatment plan. The nurse also informs the patient that they could be involuntarily committed to a facility designated by the Missouri Department of Health and Senior Services (DHSS) for treatment if they do not follow the plan.
2. TB patient is not complying with treatment plan.
   If the patient does not comply with the treatment plan (not taking medications, not making appointments for directly observed therapy (DOT), not appearing for follow-up doctor’s appointments, etc.) or if they are infectious and refuse to stay at home or wear a mask, the nurse informs the director of the LPHA who prepares and sends a warning letter to the patient (see example 7.02.2). All instances of noncompliance shall be documented and maintained in the patients chart.
3. TB patient still is not complying with the treatment plan.
   If the patient is still not complying with the treatment plan or if an infectious patient is not complying with orders to stay at home and wear a mask when appropriate, the LPHA prepares an affidavit (see example 7.02.3). The LPHA also notifies DHSS, which prepares the certification for the nurse (see example 7.02.4). The nurse collects all the available documentation of noncompliance. The evidentiary tuberculosis information sheet for attorneys lists different types of appropriate evidence (see example 7.02.5). The certification state that the records that are transferred from DHSS are bona fide records. The LPHA then contacts the prosecuting attorney and sends all of the documentation.
4. The prosecuting attorney at this point should prepare the petition to the court and present it to the court for a hearing date (see example 7.02.6).
5. The petition is also used for 96-hour emergency commitment. Emergency commitment is utilized for a contagious noncompliant individual while the court date for commitment is being scheduled.

7.04.1 Missouri Revised Statutes on TB

Missouri Revised Statutes

Chapter 192

Department of Health and Senior Services

Section 192.005.1

May 29, 2020

Department of health and senior services created--division of health abolished--duties.

192.005. Department of health and senior services created — division of health abolished — duties. — There is hereby created and established as a department of state government the “Department of Health and Senior Services”. The department of health and senior services shall supervise and manage all public health functions and programs. The department shall be governed by the provisions of the Omnibus State Reorganization Act of 1974, Appendix B, RSMo, unless otherwise provided in sections 192.005 to 192.014. The division of health of the department of social services, chapter 191, this chapter, and others, including, but not limited to, such agencies and functions as the state health planning and development agency, the crippled children's service*, chapter 201, the bureau and the program for the prevention of developmental disability, the hospital subsidy program, chapter 189, the state board of health and senior services, section 191.400, the student loan program, sections 191.500 to 191.550, the family practice residency program, the licensure and certification of hospitals, chapter 197, the Missouri chest hospital, sections 199.010 to 199.070**, are hereby transferred to the department of health and senior services by a type I transfer, and the state cancer center and cancer commission, chapter 200, is hereby transferred to the department of health and senior services by a type III transfer as such transfers are defined in section 1 of the Omnibus State Reorganization Act of 1974, Appendix B, RSMo Supp. 1984. The provisions of section 1 of the Omnibus State Reorganization Act of 1974, Appendix B, RSMo Supp. 1984, relating to the manner and procedures for transfers of state agencies shall apply to the transfers provided in this section. The division of health of the department of social services is abolished.

(L. 1985 S.B. 25 § 1, A.L. 1993 S.B. 52, A.L. 2011 H.B. 555 merged with H.B. 648, A.L. 2018 S.B. 843)

*Section 201.020 as amended in H.B. 1270, 2010, changed the name to the “Children's Special Health Care Needs Service”.

**Section 199.070 was repealed by S.B. 19, 1985.

7.04.2 Missouri Revised Statutes on TB

Missouri Revised Statutes

Chapter 192

Department of Health and Senior Services

Section 192.067.1

May 29, 2020

Patients' medical records, department may receive information from--purpose-- confidentiality--immunity for persons releasing records, exception--penalty--costs, how paid.

192.067. Patients' medical records, department may receive information from — purpose — confidentiality — immunity for persons releasing records, exception — reimbursement of costs of abstracting data — penalty. —

1. The department of health and senior services, for purposes of conducting epidemiological studies to be used in promoting and safeguarding the health of the citizens of Missouri under the authority of this chapter is authorized to receive information from patient medical records. The provisions of this section shall also apply to the collection, analysis, and disclosure of nosocomial infection data from patient records collected pursuant to section 192.667 and to the collection of data under section 192.990.
2. The department shall maintain the confidentiality of all medical record information abstracted by or reported to the department. Medical information secured pursuant to the provisions of subsection 1 of this section may be released by the department only in a statistical aggregate form that precludes and prevents the identification of patient, physician, or medical facility except that medical information may be shared with other public health authorities and coinvestigators of a health study if they abide by the same confidentiality restrictions required of the department of health and senior services and except as otherwise authorized by the provisions of sections 192.665 to 192.667, or section 192.990. The department of health and senior services, public health authorities and coinvestigators shall use the information collected only for the purposes provided for in this section, section 192.667, or section 192.990.
3. No individual or organization providing information to the department in accordance with this section shall be deemed to be or be held liable, either civilly or criminally, for divulging confidential information unless such individual organization acted in bad faith or with malicious purpose.
4. The department of health and senior services is authorized to reimburse medical care facilities, within the limits of appropriations made for that purpose, for the costs associated with abstracting data for special studies.
5. Any department of health and senior services employee, public health authority or coinvestigator of a study who knowingly releases information which violates the provisions of this section shall be guilty of a class A misdemeanor and, upon conviction, shall be punished as provided by law.

(L. 1988 H.B. 1134 § 3, A.L. 2004 S.B. 1279, A.L. 2019 S.B. 514)

7.04.3 Missouri Revised Statutes on TB

Missouri Revised Statutes

Chapter 199 Rehabilitation Center--Head Injury--Tuberculosis Testing and Commitment

Section 199.170.1

May 29, 2020

Definitions.

199.170. The following terms, as used in sections 199.170 to 199.350, mean:

1. "Active tuberculosis", tuberculosis disease caused by the mycobacterium tuberculosis complex that is demonstrated to be contagious by clinical, bacteriological, or radiological evidence. Tuberculosis is considered active until cured;
2. "Cure" or "treatment to cure", the completion of a recommended course of therapy as defined in subdivision (11) of this section and as determined by the attending physician in conjunction with the local public health authority or the department of health and senior services;
3. "Department", the department of health and senior services;
4. "Directly observed therapy" or "DOT", a strategy in which a health care provider or other trained person watches a patient swallow each dose of prescribed antituberculosis medication;
5. "Facility", any hospital licensed under chapter 197, any public nonlicensed hospital, any long-term care facility licensed under chapter 198, any health care institution, any correctional or detention facility, or any mental health facility approved by the local public health authority or the department;
6. "Immediate threat", a rebuttable presumption that a person has active tuberculosis and:
   1. Is not taking medications as prescribed;
   2. Is not following the recommendations of the treating physician, local public health authority, or the department;
   3. Is not seeking treatment for signs and symptoms compatible with tuberculosis; or
   4. Evidences a disregard for the health of the public;
7. "Isolation", the physical separation in a single-occupancy room to isolate persons with suspected or confirmed infectious tuberculosis disease. An isolation should provide negative pressure in the room, an airflow rate of six to twelve air changes per hour, and direct exhaust of air from the room to the outside of the building or recirculation of the air through a high efficiency particulate air (HEPA) filter;
8. "Latent tuberculosis infection", infection with mycobacterium tuberculosis without symptoms or signs of disease. Patients with such infection do not have tuberculosis disease, are not infectious and cannot spread tuberculosis infection to others;
9. "Local public health authority", any legally constituted local city or county board of health or health center board of trustees or the director of health of the city of Kansas City, the director of the Springfield-Greene County health department, the director of health of St. Louis County or the commissioner of health of the City of St. Louis, or in the absence of such board, the county commission or the county board of tuberculosis hospital commissioners of any county; 
10. "Potential transmitter", any person who has the diagnosis of pulmonary or laryngeal tuberculosis but has not begun a recommended course of therapy, or who has the diagnosis of pulmonary tuberculosis and has started a recommended course of therapy but has not completed the therapy. This status applies to any individual with tuberculosis, regardless of his or her current bacteriologic status;
11. "Recommended course of therapy", a regimen of antituberculosis chemotherapy in accordance with medical standards of the American Thoracic Society, the Centers for Disease Control and Prevention, the Infectious Diseases Society of America, or the American Academy of Pediatrics;
12. "Targeted testing program", a program that screens all faculty and students to identify those at high risk for latent tuberculosis infection and persons at high risk for developing tuberculosis disease, and includes testing of identified high-risk populations to determine those that would benefit from treatment. Screening shall require the completion of a tuberculosis risk assessment questionnaire form recommended by the American College of Health Association or the Centers for Disease Control and Prevention. High-risk populations include students from countries where tuberculosis is endemic or students with other risk factors for tuberculosis as identified by the Centers for Disease Control and Prevention.

(L. 1961 p. 518 § 1, A.L. 1986 H.B. 1554 Revision, A.L. 1990 H.B. 1739 merged with S.B. 742, A.L. 1999 H.B. 721 merged with S.B. 261, A.L. 2001 S.B. 266, A.L. 2013 S.B. 197)

7.04.4 Missouri Revised Statutes on TB

Missouri Revised Statutes

Chapter 199

Rehabilitation Center--Head Injury--Tuberculosis Testing and Commitment

Section 199.180.1

May 29, 2020

Local health agency may institute proceedings for commitment--emergency temporary commitment permitted, when.

199.180.

1. A person found to have tuberculosis shall follow the instructions of the local public health authority or the department, shall obtain the required treatment, and shall minimize the risk of infecting others with tuberculosis.
2. When a person with active tuberculosis, or a person who is a potential transmitter, violates the rules, regulations, instructions, or orders promulgated by the department of health and senior services or the local public health authority, and is thereby conducting himself or herself so as to expose other persons to danger of tuberculosis, after having been directed by the local public health authority to comply with such rules, regulations, instructions, or orders, the local public health authority may institute proceedings by petition for DOT or commitment, returnable to the circuit court of the county in which such person resides, or if the person be a nonresident or has no fixed place of abode, then in the county in which the person is found. Strictness of pleading shall not be required and a general allegation that the public health requires DOT or commitment of the person named therein shall be sufficient.
3. If the public health authority determines that a person with active tuberculosis, or a person who is a potential transmitter, poses an immediate threat by conducting himself or herself so as to expose other persons to an immediate danger of tuberculosis, the public health authority may file an ex parte petition for emergency temporary commitment pursuant to subsection 5 of section 199.200.

(L. 1961 p. 518 § 2, A.L. 1990 H.B. 1739 merged with S.B. 742, A.L. 1999 H.B. 721 merged with S.B. 261, A.L. 2001 S.B. 266, A.L. 2013 S.B. 197)

7.04.5 Missouri Revised Statutes on TB

Missouri Revised Statutes

Chapter 199

Rehabilitation Center--Head Injury--Tuberculosis Testing and Commitment

Section 199.190.1

May 29, 2020

Patients not to be committed, when.

199.190. No potential transmitter who in his or her home or other place obeys the rules and regulations of the public health authority or the department of health and senior services, and the policies of the treating facility, for the control of tuberculosis or who voluntarily accepts care in a tuberculosis institution, hospital, home, or other place and obeys the rules and regulations of the public health authority or the department of health and senior services for the control of contagious tuberculosis shall be committed under the provisions of sections 199.170 to 199.350.

(L. 1961 p. 518 § 8, A.L. 1990 H.B. 1739 merged with S.B. 742, A.L. 2013 S.B. 197)

7.04.6 Missouri Revised Statutes on TB

Missouri Revised Statutes

Chapter 199

Rehabilitation Center--Head Injury--Tuberculosis Testing and Commitment

Section 199.200.1

May 29, 2020

Procedure in circuit court--duties of local prosecuting officers--costs--emergency temporary commitment, procedures.

199.200.

1. Upon filing of the petition, the court shall set the matter down for a hearing either during term time or in vacation, which time shall be not less than five days nor more than fifteen days subsequent to filing. A copy of the petition together with summons stating the time and place of hearing shall be served upon the person three days or more prior to the time set for the hearing. Any X-ray picture and report of any written report relating to sputum examinations certified by the department of health and senior services or local public health authority shall be admissible in evidence without the necessity of the personal testimony of the person or persons making the examination and report.
2. The prosecuting attorney or the city attorney shall act as legal counsel for their respective local public health authorities in this proceeding and such authority is hereby granted. The court shall appoint legal counsel for the individual named in the petition if requested to do so if such individual is unable to employ counsel.
3. All court costs incurred in proceedings under sections 199.170 to 199.350, including examinations required by order of the court but excluding examinations procured by the person named in the petition, shall be borne by the county in which the proceedings are brought.
4. Summons shall be served by the sheriff of the county in which proceedings under sections 199.170 to 199.350 are initiated and return thereof shall be made as in other civil cases.
5. Upon the filing of an ex parte petition for emergency temporary commitment pursuant to subsection 3 of section 199.180, the court shall hear the matter within ninety-six hours of such filing. The local public health authority shall have the authority to detain the individual named in the petition pending the court's ruling on the ex parte petition for emergency temporary commitment. If the petition is granted, the individual named in the petition shall be confined in a facility designated by the department of health and senior services in accordance with section 199.230 until a full hearing pursuant to subsections 1 to 4 of this section is held.

(L. 1961 p. 518 § 3, A.L. 2001 S.B. 266, A.L. 2010 S.B. 1007, A.L. 2013 S.B. 197)

7.04.7 Missouri Revised Statutes on TB

Missouri Revised Statutes

Chapter 199

Rehabilitation Center--Head Injury--Tuberculosis Testing and Commitment

Section 199.210.1

May 29, 2020

Rights of patient, witnesses--order of court--transportation costs--department may contract for care.

199.210.

1. Upon the hearing set in the order, the individual named in the order shall have a right to be represented by counsel, to confront and cross-examine witnesses against him or her, and to have compulsory process for the securing of witnesses and evidence in his or her own behalf. The court may in its discretion call and examine witnesses and secure the production of evidence in addition to that adduced by the parties; such additional witnesses being subject to cross-examination by either or both parties.
2. Upon a consideration of the petition and evidence, if the court finds that the person named in the petition is a potential transmitter and conducts himself or herself so as to be a danger to the public health, an order shall be issued committing the individual named in the petition to a facility designated by the department of health and senior services and directing the sheriff to take such individual into custody and deliver him or her to the facility or designated pickup location. If the court does not so find, the petition shall be dismissed. The cost of transporting the person to the facility or pickup location designated by the department of health and senior services shall be paid out of general county funds.
3. The department may contract for the care of any tuberculosis patient. Such contracts shall provide that state payment shall be available for the treatment and care of such patients only after benefits from all third-party payers have been exhausted.

(L. 1961 p. 518 § 4, A.L. 1971 H.B. 581, A.L. 1985 S.B. 19, A.L. 1990 H.B. 1739 merged with S.B. 742, A.L. 1996 S.B. 540, A.L. 2010 S.B. 1007, A.L. 2013 S.B. 197)

7.04.8 Missouri Revised Statutes on TB

Missouri Revised Statutes

Chapter 199

Rehabilitation Center--Head Injury--Tuberculosis Testing and Commitment

Section 199.220.1

May 29, 2020

Order appealable.

199.220. The order shall be subject to review at the instance of either party, as in other civil cases.

(L. 1961 p. 518 § 5)

7.04.9 Missouri Revised Statutes on TB

Missouri Revised Statutes

Chapter 199

Rehabilitation Center--Head Injury--Tuberculosis Testing and Commitment

Section 199.230.1

May 29, 2020

Confinement on order, duration.

199.230. Upon commitment, the patient shall be confined in a facility designated by the department of health and senior services until such time as the patient's discharge will not endanger public health.

(L. 1961 p. 518 § 6, A.L. 1971 H.B. 581, A.L. 1985 S.B. 19, A.L. 1996 S.B. 540, A.L. 1999 H.B. 721 merged with S.B. 261, A.L. 2010 S.B. 1007)

7.04.10 Missouri Revised Statutes on TB

Missouri Revised Statutes

Chapter 199

Rehabilitation Center--Head Injury--Tuberculosis Testing and Commitment

Section 199.240.1

May 29, 2020

Consent required for medical or surgical treatment.

199.240. No person committed to a facility designated by the department of health and senior services under sections 199.170 to 199.350 shall be required to submit to medical or surgical treatment without such person's consent, or, if incapacitated, without the consent of his or her legal guardian, or, if a minor, without the consent of a parent or next of kin, unless authorized by a written order of the circuit court under section 199.200 or as otherwise permitted by law.

(L. 1961 p. 518 § 9, A.L. 1971 H.B. 581, A.L. 1983 S.B. 44 & 45, A.L. 1985 S.B. 19, A.L. 1996 S.B. 540, A.L. 2010 S.B. 1007, A.L. 2013 S.B. 197)

7.04.11 Missouri Revised Statutes on TB

Missouri Revised Statutes

Chapter 199

Rehabilitation Center--Head Injury--Tuberculosis Testing and Commitment

Section 199.250.1

May 29, 2020

Facilities, contracts with, costs, how paid.

199.250.

1. The department of health and senior services may contract for such facilities as are necessary to carry out the functions of sections 199.010 to 199.350. Such contracts shall be exempt from the competitive bidding requirements of chapter 34.
2. State payment shall be available for the treatment and care of individuals committed under section 199.210 only after benefits from all third-party payers have been exhausted.

(L. 1961 p. 518 §§ 10, 11, A.L. 1971 H.B. 581, A.L. 1985 S.B. 19, A.L. 1991 H.B. 218 merged with S.B. 125 & 341, A.L. 1996 S.B. 540, A.L. 2010 S.B. 1007, A.L. 2013 S.B. 197)

7.04.12 Missouri Revised Statutes on TB

Missouri Revised Statutes

Chapter 199

Rehabilitation Center--Head Injury--Tuberculosis Testing and Commitment

Section 199.260.1

May 29, 2020

Apprehension and return of patient leaving rehabilitation center without discharge.

199.260. Any person committed under the provisions of sections 199.170 to 199.350 who leaves the facility designated by the department of health and senior services without having been discharged by the director of the facility or other officer in charge or by order of court shall be taken into custody and returned thereto by the sheriff of any county where such person may be found, upon an affidavit being filed with the sheriff by the director of the facility, or duly authorized officer in charge thereof, to which the person had been committed. The action may be prosecuted under section 199.275, if appropriate.

(L. 1961 p. 518 § 12, A.L. 1971 H.B. 581, A.L. 1985 S.B. 19, A.L. 1996 S.B. 540, A.L. 2010 S.B. 1007, A.L. 2013 S.B. 197).

7.04.13 Missouri Revised Statutes on TB

Missouri Revised Statutes

Chapter 199

Rehabilitation Center--Head Injury--Tuberculosis Testing and Commitment

Section 199.270.1

May 29, 2020

Proceedings for release of patient.

199.270. Any time after commitment, the patient or, if incapacitated, the patient's legal guardian, or if a minor, a parent or next of kin having reason to believe that such patient no longer has contagious tuberculosis or that his or her discharge will not endanger public health, may institute proceedings by petition, in the circuit court of the county that originally issued the order for commitment, whereupon the court shall set the matter down for a hearing before the court within fifteen days requiring the local public health authority to show cause on a day certain why the patient should not be released. The court shall also require that the patient be allowed the right to be examined prior to the hearing by a licensed physician of the patient's own choice, if so desired, and at the patient's own personal expense. Thereafter all proceedings shall be conducted the same as on the proceedings for commitment with the right of appeal by either party as herein provided; provided, however, such petition for discharge shall not be brought or renewed more than once every six months.

(L. 1961 p. 518 § 7, A.L. 2013 S.B. 197)

7.04.14 Missouri Revised Statutes on TB

Missouri Revised Statutes

Chapter 199

Rehabilitation Center--Head Injury--Tuberculosis Testing and Commitment

Section 199.275.1

May 29, 2020

Active tuberculosis, infected persons, unlawful acts--violation, penalty.

199.275.

1. It shall be unlawful for any person knowingly infected with active pulmonary or laryngeal tuberculosis to:
   1. Act in a reckless manner by exposing another person to tuberculosis without the knowledge and consent of such person to be exposed to tuberculosis; or
   2. Report to work with active contagious tuberculosis. The person may report to work if adhering to his or her prescribed treatment regimen and is deemed noninfectious by the attending physician in conjunction with the department or the local public health authority; or
   3. Violate the requirements of a commitment order.
2. Any person who violates subdivision* (1), (2), or (3) of subsection 1 of this section is guilty of a class B misdemeanor unless the victim contracts tuberculosis from such contact, in which case it is a class A misdemeanor.

(L. 2013 S.B. 197)

*Word "subdivisions" appears in original rolls.

7.04.15 Missouri Revised Statutes on TB

Missouri Revised Statutes

Chapter 199

Rehabilitation Center--Head Injury--Tuberculosis Testing and Commitment

Section 199.280.1

May 29, 2020

Department authority in response to outbreaks.

199.280. The department retains all powers granted under section 192.020 in responding to tuberculosis cases, outbreaks, and tuberculosis disease investigations.

(L. 2013 S.B. 197)

7.04.16 Missouri Revised Statutes on TB

Missouri Revised Statutes

Chapter 199

Rehabilitation Center--Head Injury--Tuberculosis Testing and Commitment

Section 199.290.1 May 29, 2020

Mandatory testing of health care facility workers--higher education, students and faculty, testing program required--rulemaking authority.

199.290.

1. All employees and volunteers of a health care facility shall receive a tuberculin skin test or interferon gamma release assay (IGRA) test upon employment as recommended in the most recent version of the Centers for Disease Control and Prevention (CDC) Guidelines for Preventing Transmission of Mycobacterium Tuberculosis in Health Care Settings. If the screening test is positive, appropriate evaluation and follow-up shall be done in accordance with such CDC guidelines. This provision shall not be construed to prohibit any institution from establishing requirements for employees or volunteers that exceed those stated in the CDC guidelines.
2. All institutions of higher education in Missouri shall implement a targeted testing program on their campuses for all on-campus students and faculty upon matriculation. If an institution does not have a student health center or similar facility, such person identified by the targeted testing program to be at high risk for latent tuberculosis infection or for developing tuberculosis disease shall be referred to a local public health agency for a course of action consistent with sections 199.170 to 199.350.
3. Any entering student of an institution of higher education in Missouri who does not comply with the targeted testing program shall not be permitted to maintain enrollment in the subsequent semester at such institution.
4. Any rule or portion of a rule, as that term is defined in section 536.010, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536 and, if applicable, section 536.028. This section and chapter 536 are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536 to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2013, shall be invalid and void.

(L. 2013 S.B. 197)

7.05.17 Missouri Revised State Rules

Missouri Revised Statutes

Chapter 199

Rehabilitation Center--Head Injury--Tuberculosis Testing and Commitment

Section 199.350.1

May 29, 2020

Nursing homes and correctional centers, authority to promulgate rules for testing.

199.350. The department shall have the authority to promulgate rules and regulations which require the preadmission testing for tuberculosis of all residents in nursing homes in the state and the annual testing of all health care workers and volunteers in nursing homes in the state, and residents and staff of state correctional centers. The department shall annually issue screening guidelines on other groups determined by the department to be at high risk for tuberculosis.

(L. 1992 S.B. 511 & 556 § 2)

7.06 Information Contacts

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Traci Hadley, RN, BSN, TB Controller

Public Health Consultant Nurse Missouri Department of Health and Senior Services

TB Elimination Program

1110 East 7th Street, Suite 12

Joplin, MO 64801

(417) 629-3487

Bev Myers, RN,

Public Health Senior Nurse Missouri Department of Health and Senior Services

TB Elimination Program

930 Wildwood Dr., PO Box 570

Jefferson City, Mo 65109

(573) 518-2697

Terry Eslahi, TB Program Manager

Missouri Department of Health and Senior Services

TB Elimination Program

930 Wildwood Dr., PO Box 570

Jefferson City, Mo 65109

(573) 522-2728

Diana Winder, MPA, BAA, AA

Health Program Representative/DSP Manager Missouri Department of Health and Senior Services

TB Elimination Program

930 Wildwood Dr., PO Box 570

Jefferson City, MO 65109

(573) 526-5832

Miranda Schloman, MPH, MPA

Epidemiology Specialist Missouri Department of Health and Senior Services

TB Elimination Program

930 Wildwood Dr., PO Box 570

Jefferson City, Mo 65109

(573) 751-6411

Opeyemi Faseyitan, MBBS, MPH

Epidemiology Specialist Missouri Department of Health and Senior Services

TB Elimination Program

930 Wildwood Dr., PO Box 570

Jefferson City, Mo 65109

(573) 751-6496