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The public health laboratory needs to remain under the control of the health officer. There are cogent reasons for this. We have already pointed out that the public health laboratory provides standardized test results. In addition to such data being useful in the prediction of health needs and planning indicated public health activities, it is also used in the exercise of the health officer's police powers. Public health laboratory data are often presented in court, where they are used to buttress legal opinions and decisions. With the laboratory reporting to the health officer, the latter has means of assuring that the laboratory is in compliance with State regulations governing public health laboratories. This provides the assurance to the health officer that the laboratory meets Section 1002 (H&SC). The health officer also can set the priority agenda in the public health laboratory in accordance with his/her needs. When a public health laboratory is combined with and under the general supervision of a clinical laboratory, the test agenda is set, usually, by the needs of individual patients. The decision on laboratory priority should never be subservient to personal care. In many cases the person being tested is not necessarily a patient seeking medical care, but perhaps a casual contact or even the source of an outbreak. Often times, individuals are tested by the public health laboratory pursuant to the request (or order) of the County Health Officer; it is impractical to compel these individuals being tested under such conditions to pay for tests that are deemed necessary to protect the public's health. For this reason,
Sections 2534 (H&SC) requires that whenever laboratory tests are required for the release of cases or carriers of specialized communicable diseases such tests shall be submitted to a public health laboratory. This stature is the basis for sections 2550, 2556, 2606, 2612, 2613, 2628, 2636 (CCR) which specify that specimens for release of cases or carrier of the following communicable diseases be sent to a public health laboratory; Amoebiasis, Diphtheria, Plague, Animal Rabies, Salmonellosis, Shigellosis, Typhoid Fever, Sexually Transmitted Disease.
Section 1276 (CCR) requires the public health laboratory to provide consultation and reference services to further the development of improved procedures related to the prevention and control of human disease. Towards this end, public health laboratories receive and test cultures for communicable diseases which require specialized materials and techniques. Examples of these include cultures to diagnose pertussis, diphtheria, cholera, and hemorrhagic E. coil infection, the cause of a major food poisoning outbreak in the Pacific Northwest and Southern California this year. Clinical laboratories typically use commercial kit systems to identify bacteria and yeast. While they provide rapid and economical results, there are organisms which cannot be identified using the limited battery of tests included in the kit. Public health laboratories typically are equipped to prepare the assortment of conventional test media necessary to identify these problematic cultures encountered in the clinical laboratory or in public health investigations.
Section 1244.3 (B&PC) gives local health officers or his or her designee, (usually the public health laboratory director) responsibility for the enforcement of regulations controlling the accuracy and safety of tests performed by non-diagnostic health assessment programs (e.g. cholesterol screening at health fairs, pharmacies, etc).
In the era of new federal regulations to implement the Clinical Laboratory Improvement Amendments of 1988; State statutes and regulations may be amended in the near future in order to establish standards for laboratory tests performed in previously unregulated environments (such as student health centers, correctional facilities, health fairs, and family planning clinics). With these changes, the public health laboratory's role in the development of improved laboratory procedures and practices continue to expand.
