A2836

An Act concerning Legionnaires’ disease and supplementing P.L.1977, c.224 (C.58:12A-1 et seq.) and Title 26 of the Revised Statutes.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. a. Notwithstanding any other provision of law, or rule or regulation adopted pursuant thereto, to the contrary, the owner or operator of a public water system shall:

(1) maintain a minimum detectable disinfectant residual of free chlorine of at least 0.3 milligrams per liter in all active parts of the public water system at all times; and

(2) conduct disinfectant residual testing at frequent and regular intervals to determine the amount and type of detectable disinfectant residual existing at different points in the public water system.

b. (1) If the owner or operator of a public water system repeatedly fails to meet the minimum detectable disinfectant residual of chlorine targets established pursuant to paragraph (1) of subsection a. of this section and the violations are reported to the Department of Environmental Protection, the public water system shall conduct an internal investigation of the violations. If, after the public water system conducts an investigation, subsequent failures to meet the targets are reported, the Department of Environmental Protection shall conduct an investigation of the subsequent violations or, at its discretion, authorize a third-party entity to conduct the investigation.

(2) The Department of Environmental Protection shall develop procedures and guidelines regarding the investigation of an owner or operator of a public water system conducted pursuant to paragraph (1) of this subsection, including but not limited, to:

(a) the definition of what constitutes a repeated failure to meet the minimum detectable disinfectant residual of chlorine targets;

(b) the requirements for reporting violations of the chlorine targets;

(d) the establishment of penalties for a violation of chlorine targets, if the department determines that a violation has occurred;

(e) the development of a notice to inform consumers if a public water system fails to maintain the minimum detectable disinfectant residual of chlorine targets established pursuant to paragraph (1) of subsection a. of this section; and

(f) the criteria used by the department to select appropriate third party entities to conduct investigations of additional violations of chlorine targets.

c. The Department of Environmental Protection, in consultation with the Department of Health, may adopt rules and regulations pursuant to the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), if determined to be appropriate, to require additional disinfectant requirements or testing requirements of public water systems, or to increase the minimum detectable disinfectant residual, in order to minimize the growth and transmission of Legionella bacteria, and requirements for the monitoring of public water systems during construction activities that may impact the public water system. The Department of Environmental Protection shall not reduce the minimum detectable disinfectant residual of chlorine targets established pursuant to paragraph (1) of subsection a. of this section.

d. The Department of Environmental Protection shall submit an annual report to the Governor and to the Legislature, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), containing its recommendations as to whether the minimum detectable disinfectant residual of chlorine targets established pursuant to paragraph (1) of subsection a. of this section should be increased in order to minimize the growth and transmission of Legionella bacteria.

2. a. The owner or operator of a public water system shall provide a timely written notice, in a form and manner as determined by the Department of Environmental Protection pursuant to subsection c. of this section, to all residential, commercial, and institutional customers and residents served by the public water system and located in an affected area of disruptions in the water distribution system that could result in increased levels of Legionella bacteria being present in the public water system.

The notice shall include, but need not be limited to:

(1) notification that planned construction, maintenance, repair, or replacement of a part of the system may affect Legionella bacteria in the water distribution system and temporarily increase the level of Legionella bacteria in the public water system;

(2) the estimated length of time that the level of Legionella bacteria may remain elevated, as determined by the department;

(3) general information on the possible sources of Legionella bacteria in the public water system, and the health effects of Legionnaires’ disease and related illnesses to at-risk populations; and

(4) measures consumers can take to reduce or eliminate exposure to Legionella bacteria, including, but not limited to, ensuring hot water heaters are working properly and maintaining a temperature of at least 130 degrees Fahrenheit at the water heater outlet, flushing water lines, including the hot water heater drain and external hose connections,during and after completion of construction work, removing and cleaning faucet aerator screens and showerheads, and installing a water filter or water treatment device certified to remove Legionella bacteria.

b. (1) The owner or operator of a public water system shall provide a written record of a disruption in the water distribution system to the Department of Environmental Protection within 24 hours of the occurrence of the disruption in the water distribution system.

(2) The Department of Environmental Protection shall establish on its Internet website a publicly accessible database of the records of a disruption in the water distribution system received by the department pursuant to paragraph (1) of this subsection.

c. No later than 120 days after the effective date of P.L. , c. (C. ) (pending before the Legislature as this bill), the Department of Environmental Protection, in consultation with the Department of Health and the Department of Community Affairs, shall publish a public notice in the New Jersey Register and on its Internet website specifying the form and manner of:

(1) the notice required pursuant to subsection a. of this section, the circumstances under which the owner or operator of a public water system is required to provide the notice pursuant to subsection a. of this section, including when a notice is to be provided if the disruption in the water distribution system is related to Legionella bacteria in ground water and when the disruption is related to Legionella bacteria in surface water, and the specific information to be included in the notice; and

(2) the record of a disruption in the water distribution system required pursuant to subsection b. of this section and the specific information to be included in the record.

d. If a public water system serves a municipality in which the primary language of 10 percent or more of the residents is a language other than English, the water purveyor shall provide the notice required pursuant to subsection a. of this section in both English and the other language to the residents.

e. The owner or operator of a public water system shall not be required to provide the notice required pursuant to subsection a. or b. of this section until the department has published the public notice required pursuant to subsection c. of this section.

f. As used in this section, “disruption in the water distribution system” means any disruption to normal water transmission, including, but not limited to: a change in the water treatment process, including temporary changes from a chloramine residual to a free chlorine residual or vice versa; any planned or unplanned event that reduces water delivery pressure below 20 pounds per square inch; a lead service line replacement; a new construction tie-in; a source water change; water treatment plant maintenance or changes; changes in directional water flow; flooding; replacement of valves, hydrants, or meters; pumping failures; pipeline or water main breaks; system repairs; or emergency conditions.

3. a. For every reported diagnosis of Legionnaires’ disease, the Department of Health shall:

(1) conduct an investigation into the reported case; and

(2) advise the individual diagnosed with Legionnaires’ disease about the availability of testing by the Department of Health of the fixtures and water-using equipment in the individual’s residence, locations frequently visited, and places of employment in the 45 days immediately prior to the individual’s diagnosis. In a manner consistent with the consent provided by the individual diagnosed with Legionnaires’ disease or the owner of the property, the Department of Health shall sample and test the fixtures and water-using equipment for the presence of Legionella bacteria. Each test shall be conducted by a laboratory certified for this purpose by the Department of Health, and in accordance with the sampling and testing methods established and provided by the department.

b. The Department of Health shall develop procedures and guidelines regarding the investigation of every reported diagnosis of Legionnaires’ disease pursuant to paragraph (1) of subsection a. of this section, including, but not limited to:

(1) documentation of any disruption in the water distribution system as defined in subsection f. of section 2 of P.L. , c. (C. ) (pending before the Legislature as this bill), serving the primary residence or water exposure points frequented by the infected individual in the 45 days preceding infection, that may have caused the release of Legionella bacteria into the home or other water exposure point frequented by the infected individual during that period;

(2) investigation of potential sources of exposure to Legionella bacteria from fixtures, water-using equipment, or features at the individual’s residence including water exposures external to the residence such as irrigation, hoses, or water-based equipment and devices; and

(3) investigation of potential sources of exposure to Legionella bacteria from other identified water exposure points such as visits to buildings, water features, car washes, irrigation systems, exposure to pressure washing, car windshield fluids, public fountains or toilets, or other aspects of daily travel and activities.

c. The Department of Health may delegate its responsibilities and duties pursuant to this section as deemed appropriate for administering the testing and investigatory provisions of this section to a local health officer having jurisdiction over the locality in which a patient diagnosed with Legionnaires’ disease lives, frequently visits, or is employed.

d. The Department of Health shall establish on its Internet website a registry accessible to the public of de-identified data related to each case of Legionnaires’ disease reported to the department.

As used in this subsection, “de-identified data” means information that does not identify an individual and for which there is no reasonable basis to believe that the information can be used to identify an individual, and which meets the requirements for de-identification of protected health information under the "Health Insurance Portability and Accountability Act of 1996," Pub.L.104-191, and any regulations adopted pursuant thereto by the Secretary of the United States Department of Health and Human Services. However, the Commissioner of Health shall make every effort to provide information on the approximate location of a case of Legionnaires’ disease to the nearest city block or general neighborhood description.

4. a. No later than one year after the effective date of P.L. , c. (C. ) (pending before the Legislature as this bill), the owner or operator of a building that meets any of the criteria set forth in paragraphs (1) through (5) of this subsection shall implement a water management program to minimize the growth and transmission of Legionella bacteria in the building’s water system, consistent with the American Society of Heating, Refrigeration, and Air Conditioning Engineers (ASHRAE) Standard 188-2018 or comparable standards adopted by a nationally-recognized, accepted, and appropriate organization:

(1) a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) where patient stays exceed 24 hours;

(2) a building containing one or more areas for the purpose of housing or treating occupants receiving treatment for burns, chemotherapy, solid organ transplantation, or bone marrow transplantation;

(3) a building containing one or more areas for the purpose of housing or treating occupants that are immunocompromised, at-risk, on medications that weaken the immune system, or have renal disease, diabetes, or chronic lung disease;

(4) a building containing a whirlpool; spa; pool; open- or closed-circuit cooling tower or evaporative condenser that provides cooling or refrigeration for a heating, ventilation, air conditioning, or refrigeration system; ornamental fountain; mister; atomizer; air wash; humidifier; or other non-potable water system or device that releases water aerosols in the building or on the property upon which the building is located; and

(5) a building that is more than 10 stories high, including any level that is below grade, with a centralized potable water-heater system.

b. The owner or operator of a facility or building required to implement a water management program pursuant to this section shall make the water management program available upon request to an employee of the Department of Community Affairs, the Department of Environmental Protection, the Department of Health, or any other department or agency with license or inspection authority for the facility or building.

c. When testing for Legionella bacteria consistent with a building’s water management program pursuant to subsection a. of this section, the testing shall include, but not be limited to, Legionella Pneumophila, and be conducted:

(1) in a manner consistent with consistent with the American Society of Heating, Refrigeration, and Air Conditioning Engineers (ASHRAE) Standard 188-2018 or comparable standards adopted by a nationally recognized, accepted, and appropriate organization; and

(2) by individuals whose qualifications include:

(a) certification in accordance with ASSE Series 12000-2018, Professional Qualifications Standards for Infection Control Risk Assessment for all Building Systems, or comparable standards adopted by a nationally recognized, accepted, and appropriate organization; or

(b) the completion of continuing education or a training course of no less than four hours concerning testing, handling, and safety precautions related to Legionella bacteria offered in the State by a vocational or community college, non-profit organization, professional association, trade association, trade or labor union, or similar organization.

d. (1) An owner or operator of a facility or building who fails to implement a water management program or fails to demonstrate compliance with a water management program required pursuant to this section shall be subject to a penalty of not more than $2,000 for a first violation, and not more than $5,000 for a second or subsequent violation, except that the owner or operator shall be subject to a penalty of not more than $10,000 for any violation which causes serious injury or death to any person, to be collected by the State in a civil action by a summary proceeding under the "Penalty Enforcement Law of 1999," P.L.1999, c.274 (C.2A:58-10 et seq.). The Superior Court and the municipal court shall have jurisdiction over proceedings for the enforcement of the penalty provided by this section.

(2) The Department of Community Affairs, the Department of Environmental Protection, or the Department of Health may institute a civil action for injunctive relief in the Superior Court to enforce the provisions of this section and to prohibit and prevent a violation of this section, and the court may proceed in the action in a summary manner.

e. The provisions of this section shall not apply to a residential property with four or less dwelling units.

5. No later than 180 days after the effective date of P.L. , c. (C. ) (pending before the Legislature as this bill), the Department of Health, in consultation with the Department of Community Affairs, Department of Environmental Protection, and a public stakeholder group that shall be comprised of no more than five public members, including one representative of a public health organization dedicated to eradicating Legionnaires’ disease and one representative of an organization representing water purveyors, shall adopt rules and regulations pursuant to the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), as necessary to implement the provisions of P.L. , c. (C. ) (pending before the Legislature as this bill).

The rules and regulations adopted pursuant to this section shall be consistent with the American Society of Heating, Refrigeration, and Air Conditioning Engineers (ASHRAE) Standard 188-2018 or comparable standards adopted by a nationally recognized, accepted, and appropriate organization.

6. No later than one year after the effective date of P.L. c. (C. ) (pending before the Legislature as this bill), and annually thereafter, the Department of Health, in conjunction with the Department of Environmental Protection and the Department of Community Affairs, shall submit a report to the Governor, and, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), to the Legislature, which shall include:

a. the number of cases of Legionnaires’ disease in the State reported in each of the previous 10 years;

b. the number of reported test results received by the Department of Community Affairs, the Department of Environmental Protection, or the Department of Health which indicate the presence of Legionella bacteria;

c. the number and type of violations of P.L. , c. (C. ) (pending before the Legislature as this bill) for which penalties were assessed; and

d. recommendations for legislative action as may be necessary to further control Legionella bacteria in the public water supply and affected buildings.

7. The Department of Health shall develop a public awareness campaign and targeted consumer education program to educate consumers, especially vulnerable populations, on the environmental sources of Legionella bacteria, the movement of Legionella bacteria through water distribution systems, the notification requirements of P.L. , c. (C. ) (pending before the Legislature as this bill) and how the requirements impact consumers, and the methods to control Legionella bacteria in a person’s home. The public awareness campaign and education program shall include, but not be limited to, information on the relationship between the risks of the proliferation of Legionella bacteria and hot water and the temperature requirements for medical devices, expansion tanks, hot tubs, whirlpools, spas, pools, air conditioning, ornamental fountains, or other equipment or device that releases water aerosols in a person’s home or on the person’s property and the related risks associated with the inhalation by vulnerable populations of water droplets containing Legionella bacteria.

8. This act shall take effect immediately.

STATEMENT

This bill would require the Department of Environmental Protection (DEP), the Department of Health (DOH), owners or operators of public water systems, and the owners or operators of certain types of buildings to take specified actions to help inform citizens of the State about, and prevent and control cases of, Legionnaires’ disease.

The bill would require the owner or operator of a public water system to maintain a minimum detectable disinfectant residual of free chlorine of at least 0.3 milligrams per liter in all active parts of the public water system at all times and to conduct disinfectant residual testing at frequent and regular intervals to determine the amount and type of detectable disinfectant residual existing at different points in the public water system. The DEP would be authorized to adopt rules and regulations to require additional disinfectant requirements or testing requirements of public water systems, or to increase the minimum detectable disinfectant residual, in order to minimize the growth and transmission of Legionella bacteria.

The bill would require the owner or operator of a public water system to provide written notice to its residential, commercial, and institutional customers and to residents located in an affected area of disruptions in the water distribution system that could result in increased levels of Legionella bacteria being present in the public water system. The bill would also require the owner or operator of a public water system to provide a written record of a reported disruption in the water distribution system to the DEP within 24 hours of the occurrence of the disruption. The bill would require the DEP to establish on its Internet website a publicly accessible database of the records of a disruption in the water distribution system submitted to the DEP pursuant to the bill. The bill would require the DEP to publish a public notice in the New Jersey Register and on its Internet website specifying the form and manner of the notice and records required by the bill and the specific information to be included in the notice and records.

The bill would require the DOH to conduct an investigation into every reported diagnosis of Legionnaires’ disease and require the DOH to advise an individual diagnosed with Legionnaires’ disease about the availability of testing by the DOH of the fixtures and water-using equipment in the individual’s residence, locations frequently visited, and places of employment in the 45 days immediately prior to the individual’s diagnosis. The bill would require the DOH to develop procedures and guidelines regarding investigations of reported cases of Legionnaires’ disease. The bill would authorize the DOH to delegate certain responsibilities and duties for administering the testing and investigatory provisions of section 3 of the bill to a local health officer having jurisdiction over the locality in which a patient diagnosed with Legionnaires’ disease lives, frequently visits, or is employed. The bill would also require the DOH to establish on its Internet website a registry accessible to the public of de-identified data related to each case of Legionnaires’ disease reported to the DOH. “De-identified data” is defined in the bill as information that does not identify an individual and for which there is no reasonable basis to believe that the information can be used to identify an individual, and which meets the requirements for de-identification of protected health information under the federal "Health Insurance Portability and Accountability Act of 1996," Pub.L.104-191, and any regulations adopted pursuant.

Section 4 of the bill would require the owner or operator of certain types of buildings to implement a water management program to minimize the growth and transmission of Legionella bacteria in the building water system. This requirement would apply to:

(1) certain health care facilities where patient stays exceed 24 hours;

(2) buildings containing one or more areas for the purpose of housing or treating occupants receiving treatment for burns, chemotherapy, solid organ transplantation, or bone marrow transplantation;

(3) buildings containing one or more areas for the purpose of housing or treating occupants that are immunocompromised, at-risk, on medications that weaken the immune system, or have renal disease, diabetes, or chronic lung disease;

(4) buildings containing a whirlpool, spa, pool, open- or closed-circuit cooling tower or evaporative condenser that provides cooling or refrigeration for a heating, ventilation, air conditioning, or refrigeration system, ornamental fountain, mister, atomizer, air wash, humidifier, or other non-potable water system or device that releases water aerosols in the building or on the property upon which the building is located; and

(5) buildings that are more than 10 stories high, including any level that is below grade, with a centralized potable water-heater system.

The bill requires that testing conducted as part of a building’s water management program is to be conducted in a manner consistent with consistent with the American Society of Heating, Refrigeration, and Air Conditioning Engineers (ASHRAE) Standard 188-2018 or comparable standards adopted by a nationally recognized, accepted, and appropriate organization, and specifies the qualifications of individuals who may conduct the required testing.

The bill provides for penalties for the owner or operator of a facility or building who fails to implement a water management program or fails to demonstrate compliance with a water management program. A violator would be subject to a penalty of not more than $2,000 for a first violation, and not more than $5,000 for a second or subsequent violation, except that an owner or operator would be subject to a penalty of not more than $10,000 for any violation which causes serious injury or death to any person.

The bill would require the DOH, in consultation with the DEP, the DCA, and a public stakeholder group, to adopt rules and regulations as necessary to implement the provisions of the bill. The bill requires that the rules and regulations be consistent with the ASHRAE Standard 188-2018 or comparable standards adopted by a nationally recognized, accepted, and appropriate organization.

The bill would require the DOH, in conjunction with the DEP and the DCA, to prepare an annual report including information on reported cases of Legionnaires’ disease reported in each of the previous 10 years, test results indicating the presence of Legionella bacteria, and recommendations for such legislative action as may be necessary to further control Legionella bacteria in the public water supply and affected buildings.

Lastly, the bill would require the DOH to develop a public awareness campaign and targeted consumer education program to educate consumers, especially vulnerable populations, on the environmental sources of Legionella bacteria, the movement of Legionella bacteria through water distribution systems, the notification requirements required by the bill and how the requirements impact consumers, and on methods to control Legionella bacteria in a person’s home.