**The Social Distancing Law**

**Assessment Template**

**A Practical, Field-Tested Methodology to Assess Your Jurisdiction's**

**Legal Preparedness for Pandemic Influenza**

**The Association of State and Territorial Health Officials**

**and**

**The Centers for Disease Control and Prevention**

**Public Health Law Program**

**July 2008**

**Contents**

**I. Background: the Social Distancing Law Project**

A.  Introduction

B.  Responding to HSC and HHS Directives

C.  The Role of Public Health Law

D.  The Social Distancing Law Project in 2007

E.  The Template: Product of the Social Distancing Law Project

    **II. The Social Distancing Law Template**

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A.  Purpose

B.  Planning Your Jurisdiction's Social Distancing Law Project

C.  Assessing Your Jurisdiction's Legal Authorities for Social
    Distancing

    -   *Legal Assessment Instrument*

D.  Your Jurisdiction's Legal Consultation Meeting

    -   *Suggested Legal Consultation Meeting Agenda*

        **III. Note from ASTHO and the CDC Public Health Law Program**

        **Appendices**

    A.  Hypothetical Scenario: *"Outbreak of Pandemic Influenza"*

    B.  Homeland Security Council Directives

    C.  Michigan Legal Assessment Example

    D.  Michigan After Action Report Example

    E.  Texas Decision-making Matrix Example

    F.  Additional Resources

**I. BACKGROUND: THE SOCIAL DISTANCING LAW ASSESSMENT PROJECT**

**A. Introduction**

This report has two purposes. First, it describes the Social Distancing
Law Project as conducted by 15 states, the District of Columbia, and
Puerto Rico in 2007 to assess their legal preparedness to implement
social distancing measures during a potential influenza pandemic.
Second, it provides all jurisdictions with a template they may use in
conducting similar assessments.

History teaches that the recurrence of a widespread influenza pandemic
is not a question of if, but of when. Some one hundred years since the
deadly 1918 influenza pandemic, the possibility looms large as health
officials monitor the H5N1 avian influenza virus for mutation and
efficient human to human spread. Even if H5N1 does not ultimately become
a pandemic-causing virus, the risk of a pandemic is inevitable.

Global efforts to combat the next influenza pandemic will rely on both
pharmaceutical and non-pharmaceutical interventions. Community infection
control measures (referred to in this project as "social distancing
measures") comprise a variety of non-pharmaceutical strategies designed
to limit the transmission of pandemic influenza. These measures work by
reducing the opportunity for people to come in contact with infected
persons and thus for the virus to spread, reducing the total number of
persons affected and helping to "buy time" until sufficient supplies of
vaccines or antivirals become available to support a mass response
effort.

Historical studies and modeling projects suggest that social distancing
measures can help mitigate the severity of an influenza pandemic or
other infectious disease epidemic. Analysis of responses to the
1918-1919 influenza pandemic in the United States, for example,
indicates that early, sustained, and layered implementation of social
distancing measures in St. Louis, Missouri, lowered the overall and peak
attack rates of the disease as compared with some other
jurisdictions.[^1] These measures, even when not perfectly implemented,
can decrease transmission rates.[^2] Even a so-called "leaky
quarantine"---quarantine with gaps in its implementation---can quench an
emerging epidemic.[^3]

The use of law-based community-wide infection control procedures,
however, has not been widely practiced in the United States since the
first half of the 20^th^ Century.[^4] New and re-emerging infections and
the threat of an influenza pandemic have made it necessary to take a
fresh look at the legal underpinnings of community infection control
measures, especially at the state level where public health and other
officials will direct front-line responses to the emergence of such a
potentially catastrophic thereat.

Sponsored by the U.S. Centers for Disease Control and Prevention (CDC)
and directed by the Association of State and Territorial Health
Officials (ASTHO), the Social Distancing Law Project was conducted in 17
jurisdictions in 2007 to assess the sufficiency of their legal
preparedness to implement social distancing effectively. In addition,
the participating jurisdictions assessed their legal authority to
prescribe and dispense pharmaceutical drugs on a mass basis as a key
potential countermeasure for an influenza pandemic.

**B. Responding to HSC and HHS Directives**

In the fall of 2005, the President released the *National Strategy for
Pandemic Influenza*,[^5] which was followed in 2006 by the detailed
*National Strategy for Pandemic Influenza Implementation Plan*[^6] ("HSC
Implementation Plan") from the U.S. Homeland Security Council (HSC). The
HSC Implementation Plan assigned tasks across the federal government to
improve pandemic influenza preparedness. Nearly 200 of these action
items were assigned to the U.S. Department of Health and Human Services
(HHS). Many of those were assigned, in turn, to CDC and managed by the
agency's Influenza Coordination Unit.

The HSC Implementation Plan acknowledged the important role social
distancing measures will play in helping to reduce the impact of
pandemic influenza and, also, the need for governments at all levels to
assess their legal capacity to flexibly respond to shifting
circumstances during a pandemic.[^7] The action items assigned to CDC
stimulated creation and implementation of the Social Distancing Law
Project. Generally, Chapter 6 of the HSC Implementation Plan, which
dealt with the protection of human health, called for providing guidance
to all levels of government "...on the range of options for infection
control and containment, including those circumstances where social
distancing measures, limitations on gatherings, or quarantine authority
may be an appropriate public health intervention."[^8] The specific
action items pertinent to the Social Distancing Law Project appear in
Appendix B.

As part of its plan to address these action items, HHS asked CDC to
evaluate the sufficiency of states' existing legal authorities to
implement such social distancing measures as suspension of public
gatherings, quarantine, and curfew, among other limits on movement, as
well as their legal authority to dispense antiviral and other
prescription drugs on a mass or community-wide basis. (The related issue
of the legal basis for student dismissal and school closure had been
addressed in a separate CDC-sponsored project and thus was not addressed
in the Social Distancing Law Project, but questions on this topic have
been included in this document.[^9])

**C. The Role of Public Health Law**

Law has long played a critical role in addressing both acute and chronic
public health problems, dating back to Dr. John Snow's legendary and
legally authorized intervention to remove the handle of the
cholera-tainted Broad Street pump in London in 1855. Law was a direct
and critical underpinning of the great public health achievements of the
20^th^ Century, including, for example, improved motor vehicle safety,
vaccination, safer and healthier food, and safer workplaces.[^10] Law
and legal preparedness will be crucial tools against new and emerging
threats to the public's health.

State and local governments have made important improvements in their
legal preparedness for public health emergencies following the Sept. 11
and anthrax attacks of 2001, the 2003 SARS outbreak, and the 2005 Gulf
Coast hurricanes. Few U.S. jurisdictions, however, have had experience
with community-wide infection control since the mid-1950s, raising
questions about the adequacy of the underlying legal authorities and
about the capacity of public health agencies to implement them
effectively in the novel and potentially highly charged setting of an
influenza pandemic.

The federal government's approach to social distancing in the context of
an influenza pandemic emphasizes reliance on an informed public's
voluntary compliance with the recommendations of public health
officials. In most cases, voluntary compliance is believed to be
sufficient to achieve the desired level of mitigation of the spread of
pandemic influenza. Mandatory social distancing measures raise
fundamental questions about the balance between individual rights and
protection of the health of the larger community. The HSC directives
referenced above, and the Social Distancing Law Project itself are
attempts to clarify understanding of the legal bases for officials'
issuance of recommendations, both voluntary and mandatory, recognizing
that the clear preference will be for voluntary measures.

**D. The Social Distancing Law Project in 2007**

CDC's Influenza Coordination Unit requested assistance from the CDC
Public Health Law Program to address the HSC action items. Created in
2000, the Public Health Law Program's strategic goal is improvement of
the public's health through law. More specifically, the program develops
and disseminates tools to state, tribal, and local public health
officials and their partners to improve the understanding and practical
use of law to support effective public health interventions. Among these
tools are training curricula, model intergovernmental and intersectoral
mutual aid agreements, legal preparedness checklists, the 2007 National
Action Agenda for Public Health Legal Preparedness, and the guidance and
template that the participating jurisdictions used in conducting their
Social Distancing Law Project assessments and exercises. (Additional
information on these and other legal preparedness tools is available at
http://www.cdc.gov/phlp.)

The Public Health Law Program has long-standing partnerships with public
health practitioners and the professional associations that serve them,
including ASTHO. ASTHO's members, the chief health officials of all the
states and U.S. territories, are dedicated to formulating and
influencing sound public health policy, and to assuring excellence in
state-based public health practice.[^11]

Recognizing the central role ASTHO plays in supporting state and
territorial health officials, the CDC Public Health Law Program engaged
that organization's experts in conceptualizing and conducting the Social
Distancing Law Project. ASTHO's expertise and relationship with those
officials was critically important to the success of the project.

**[Project Goals]{.underline}**

The overall purpose of the Social Distancing Law Project was to assist
the participating states in assessing the sufficiency or adequacy of
their legal authorities -- their legal preparedness \-- to support
effective social distancing measures in the context of an influenza
pandemic. (The participating jurisdictions also reviewed their legal
authorities to support mass distribution of prescription drugs, e.g.,
antiviral drugs, to the communities they serve.)

**[Project Methods]{.underline}**

Practical and resource considerations prevented conducting the Social
Distancing Law Project assessments in all 50 states. For this reason,
CDC chose to focus on 17 jurisdictions (including both states and
territories) that either host CDC quarantine stations or that border on
jurisdictions that host those stations. This selection criterion was
used because of the central role CDC's quarantine stations play in
detecting travelers who have infectious disease, because they typically
are located in populous states that experience high levels of
international traveler traffic, and because most are located in areas
with multiple and overlapping government jurisdictions that pose
challenges to effective implementation of social distancing measures.
The 17 participating jurisdictions were: Alaska, California,
Connecticut, the District of Columbia, Florida, Georgia, Hawaii,
Illinois, Maryland, Massachusetts, Michigan, New Jersey, New York,
Puerto Rico, Texas, Virginia, and Washington.

A key feature of the Social Distancing Law Project methodology was that
the assessments of each jurisdiction's legal preparedness for
implementing social distancing measures were conducted by its public
health officials, their legal counsel and public health emergency
preparedness staff, and by other key state personnel. This element of
the project design ensured that those most familiar with the provisions
and implementation of a given jurisdiction's relevant social distancing
laws were those who identified, interpreted, and assessed their
sufficiency.

As implemented in 2007, the Social Distancing Law Project had two
primary components, as specified by CDC and ASTHO:

-   **Legal Assessments**

> Legal counsel to the public health agency for each of the 17
> participating jurisdictions conducted an analysis of its social
> distancing laws and prepared a report detailing the sufficiency of
> those laws both during and absent declared public health emergencies.
> The purpose of the legal assessments was to: 1) identify and assess
> the sufficiency of the legal authorities to support implementation of
> social distancing measures (and to issue mass prescriptions of
> antiviral drugs); and 2) identify any gaps, uncertainties, or
> ambiguities in those authorities.
>
> As one of its contributions to the project, CDC's Public Health Law
> Program developed a set of standard questions the 17 participating
> jurisdictions used in their assessments, helping to assure that the
> legal assessments addressed the Homeland Security Council action
> items. The questions focused on such key points as: which officials
> are legally permitted to authorize the use of social distancing
> measures; which agencies are responsible for implementing and
> enforcing those measures; the penalties, if any, for violations of
> such measures; due process protections for those affected by social
> distancing measures; and liability issues potentially faced by the
> officials involved in implementing social distancing measures.
>
> Following completion of this analysis, each jurisdiction reported on
> its assessment of the sufficiency or adequacy of its legal basis for
> implementing social distancing measures and additional issues or
> concerns that surfaced during the analysis. They also pointed out any
> unique features of their laws or preparedness plans pertinent to
> pandemic influenza.

-   **Legal Consultation Meetings and After-Action Reports**

> Twelve of the Social Distancing Law Project jurisdictions also
> conducted "Legal Consultation Meetings" which were designed as one-day
> exercises that combined on-site review of the results of the legal
> assessments with a tabletop scenario to assess the sufficiency of
> legal authority for social distancing in the setting of a simulated
> influenza pandemic.[^12] The project guidance document included a
> scenario developed by the CDC Public Health Law Program that could be
> adapted to each jurisdiction's specific laws, along with suggestions
> for participants and for approaches to conducting the meetings. (It
> was suggested that jurisdictions provide participants with a copy of
> their legal assessment report two weeks before the meeting so they
> could be familiar with the existing legal authorities.)
>
> The guidance document recommended that the legal consultation meetings
> include representatives from all the government agencies and
> private-sector organizations likely to be involved in implementing
> social distancing measures during an influenza pandemic, for example:
>
> \-- State and local health officers and counsel
>
> \-- Counsel to the Governor and counsel from the office of the
> attorney general
>
> \-- State legislative counsel
>
> \-- Senior preparedness officials from agencies responsible for law
> enforcement, emergency response, homeland security, education, and
> transportation
>
> \-- Members of state and local boards of health and education
>
> \-- Representatives of the judiciary
>
> \-- Tribal leaders and their health and legal officials
>
> \-- Representatives from the business community (e.g., health care,
> hospitals, chambers of commerce)
>
> \-- Members of the private bar (e.g., attorneys for health care and
> other relevant organizations), and
>
> \-- CDC quarantine station officers and other appropriate federal
> officials (e.g., attorneys from the U.S. Department of Health and
> Human Services).

The number of participants in the 12 legal consultation meetings ranged
from 25 to 130. The majority of the project jurisdictions held their
meetings between August and early November 2007. As per the project
guidance provided by ASTHO and CDC, the states that conducted legal
consultation meetings included summaries of the proceeding and key
findings, along with any revisions to their legal assessment reports, in
final after-action reports.

E.  **The Template: Product of the Social Distancing Law Project**

In addition to the assessments of the sufficiency of their social
distancing laws that the Social Distancing Law Project facilitated, the
17 jurisdictions that participated in the project also demonstrated the
practical value of the two-part methodology they used. Each jurisdiction
appropriately modified the standard methodology that ASTHO and CDC staff
had prepared for the project to reflect specific issues and concerns of
special interest. This experience substantiated that the standard
methodology, in part because of its flexibility, has broad utility to
states and other jurisdictions beyond those 17. Section II of this
document presents this methodology in the form of "The Social Distancing
Law Assessment Template" for use by public health officials throughout
the United States as part of their continuing work to strengthen their
preparedness for an influenza pandemic and for potential outbreaks of
other highly virulent infectious disease outbreaks.

**II. THE SOCIAL DISTANCING LAW ASSESSMENT TEMPLATE**

**A. Purpose**

The Social Distancing Law Assessment Template is intended to be used by
the public health officials of any state, tribe, locality, or territory
as a tool in assessing their jurisdiction's legal preparedness for
implementing social distancing measures in the context of an influenza
pandemic or an outbreak of a similar highly infectious, contagious
disease.

An earlier version of the template was used in the Social Distancing Law
Project co-sponsored by the Centers for Disease Control and Prevention
(CDC) and the Association of State and Territorial Health Officials
(ASTHO) and conducted by 15 states, the District of Columbia, and Puerto
Rico in 2007 to assess the sufficiency of their legal preparedness for
pandemic influenza. That version of the template was modified, based on
that experience, to be used by any state, tribe, locality, or territory.
The scenario used in Part 2 of the template can itself easily be
modified to address other issues and fact patterns of interest to the
public health officials of any jurisdiction.

The Social Distancing Law Template has three parts:

-   Planning your jurisdiction's Social Distancing Law Project

-   Assessing your jurisdiction's legal authorities for social
    distancing and presenting the results of that assessment in a
    written report; and

-   Conducting a legal consultation meeting and preparing an
    after-action report on the sufficiency of your jurisdiction's social
    distancing law together with recommendations for any steps to
    address observed weaknesses and opportunities for improvement

The following sections offer guidance for your Social Distancing Law
Project based on the experience of the initial 17 jurisdictions.

**B. Planning Your Jurisdiction's Social Distancing Law Project**

The chief public health official, commissioner, or director should take
overall leadership of your jurisdiction's Social Distancing Law Project
because of its significance to developing comprehensive preparedness for
pandemic influenza and because the project has far-reaching implications
for many other government agencies and private-sector organizations.
(Hereafter, this official is referred to as the chief public health
official.)

Key steps in organizing and planning for the project include:

-   **Designating the Project Lead**

> The chief public health official in the jurisdiction should designate
> a senior official to serve as project lead. In many jurisdictions this
> likely will be the chief legal counsel to the public health agency.
> Co-leads may be designated where another agency (for example, the
> jurisdiction's emergency management or law enforcement agency) will
> have a prominent role in the project. Whoever leads the project should
> have be well-versed in the jurisdiction's public health laws,
> regulations, policies, and procedures, especially as they relate to
> public health emergencies and infectious disease outbreaks.

-   **Identifying Project Team Members and Forming the Project Team**

> The project lead should work with senior staff of all the agencies
> with roles to play in implementing social distancing measures---and
> with counterparts in health care and other private sectors---to
> identify and enroll members of the project team. Many of the 17
> jurisdictions that conducted the Social Distancing Law Project in 2007
> engaged team members from emergency management, education, law
> enforcement, and other government agencies as well as representatives
> of health care providers, private employers, and state and local
> elected officials.

-   **Developing a Plan for the Project**

> Once the Social Distancing Law Project team has been formed, it can
> meet to develop a plan for conducting the project's assessment of
> legal authorities for social distancing measures and the legal
> consultation meeting in which representatives of explore issues
> related to implementing those authorities. Important elements of the
> plan will be the project timeline, designation of responsibility for
> conducting the assessment of legal authorities (presumably the
> responsibility of legal counsel to the public health agency),
> designation of responsibility for organizing and conducting the legal
> consultation meeting, and designation of responsibility for preparing
> reports on that meeting and on findings and implications of the entire
> project.

**C. Assessing Your Jurisdiction's Legal Authorities for Social
Distancing**

This part of the project involves an analysis of your jurisdiction's
laws, regulations, policies, and plans related to social distancing
measures. The purpose of the analysis is to identify the full range of
all such legal authorities available to the public health agency of your
jurisdiction and to the other agencies that would be involved in
supporting social distancing measures against an influenza pandemic or a
similar, highly virulent infectious disease.

The results and findings of the legal assessment can be used for at
least two important purposes in the context of the Social Distancing Law
Project. First, they will portray the relevant laws and legal
authorities in your jurisdiction and thus offer a basis for identifying
potential gaps, ambiguities, or opportunities for improving social
distancing law. Second, as an inventory of your jurisdiction's relevant
public health laws they will serve as a critical, factual basis for the
legal consultation meeting that your jurisdiction can conduct as part of
its Social Distancing Law Project, as described below.

The legal counsel to your jurisdiction's public health agency should
conduct the legal assessment. The following sections offer a series of
questions legal counsel may use in conducting the legal assessment.
These are the questions addressed by the legal counsel to the 17
jurisdictions that conducted such legal assessments in 2007, as
described in section I of this document. (Of course, additional
questions and topics may be explored to suit specific priorities or
concerns of any given jurisdiction.) The template also is, in effect,
the table of contents of the written report the legal counsel will
prepare with the results and findings of the legal assessment.

**[Definitions of Terms]{.underline}**

As legal counsel identify and review the relevant legal authorities of
your jurisdiction, they will want to use generally accepted definitions
of key terms. The following definitions were used by the 17
jurisdictions that participated in the Social Distancing Law Project in
2007 and are recommended for use in your jurisdiction's assessment of
its social distancing legal authorities:

-   "Legal authority" means any provision of law or regulation that
    carries the force of law, including, for example, statutes, rules
    and regulations, and court rulings.

-   "Procedures" means any procedures established by your jurisdiction
    relating to the legal question being researched, regardless of
    whether the procedures have the force of law.

-   "Restrictions on the movement of persons" means any limit or
    boundary placed on the free at-will physical movement of adult
    natural persons in the jurisdiction.

-   "Closure of public places" means an instruction or order that has
    the effect of prohibiting persons from entering a public place.

-   "Public place" means a fixed space, enclosure, area, or facility
    that is usually available for entry by the general public without a
    specific invitation, whether possessed by government or private
    parties.

-   "Curfew" means an order or regulation prohibiting persons from being
    in certain public places at certain times.

-   "Person" means a natural person, whether or not individually
    identified.

-   "Public health emergency" means any acute threat, hazard, or danger
    to the health of the population of the jurisdiction, whether
    specific or general, whether or not officially declared.

-   "Superior jurisdiction" means the federal government in respect to a
    state, or a state in respect to a locality.

-   "Inferior jurisdiction" means a state in respect to the federal
    government, or a locality in respect to a state government.

    **[The Legal Assessment Instrument]{.underline}**

The following legal assessment instrument contains a series of legal
assessment questions that is organized to aid legal counsel in
identifying and characterizing the jurisdiction's legal authorities that
support four types of social distancing measures -- restrictions on the
movement of persons, curfew, interjurisdictional cooperation in
restricting the movement of persons, and closure of schools and public
places -- and in clarifying a number of critical operational issues
associated with those measures. In addition, a set of questions is
provided to aid in understanding the legal authorities, and related
operational issues, associated with mass prophylaxis, i.e., with
issuance of blanket prescriptions for emergency, mass distribution of
antiviral medications, vaccines and other countermeasures. While mass
prophylaxis is not a type of social distancing measure, it is included
in the Social Distancing Law Project legal assessment because of its
potentially key role in the portfolio of state, tribal, and local
responses to an influenza pandemic or similar disease outbreak.

Within each of these five topical areas, questions are posed -- both in
the context of an officially declared public health emergency and in the
absence of such a declaration -- regarding the legal basis for
activating a given type of social distancing, the locus of authority for
exercise of those measures, procedures for their implementation, due
process and other protections for those subject to the measures, and
other related issues.

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***LEGAL ASSESSMENT INSTRUMENT***

I.  **Restrictions on the Movement of Persons**

    A.  *Legal authorities to restrict movement of persons [during a
        declared public health emergency]{.underline}*

> Identify the legal authorities that could enable, support, authorize,
> or otherwise provide a legal basis for any restrictions on the
> movement of persons during a declared public health emergency? List
> all legal powers, authorities, and procedures (including, but not
> limited to, police powers, umbrella powers, general public health
> powers, or emergency powers or authorities) that could be used to
> authorize specific restrictions on movement. (Examples: state's legal
> powers, authorities, or doctrines for quarantine (see also subsection
> I-C below), isolation, separation, or other orders for persons to
> remain in their homes.)
>
> This set of questions includes all provisions of law or procedure
> that:

1.  Regulate the initiation, maintenance, or release from restrictive
    measures, including, but not limited to:

> a\. Which official(s) are authorized to declare or establish such
> restrictions?
>
> b\. Which official(s) are authorized to enforce such restrictions?
>
> c\. What legal authorities exist for group quarantine?
>
> d\. What legal authorities exist for area quarantine?
>
> e\. What penalties, if any, are there for violations of restrictions
> on movement?

2.  Provide any due process measures for a person whose movement is
    restricted.

3.  Relate to how long such measures can last, whether and how they can
    be renewed, and the authority/process/notice requirements for ending
    the measures.

4.  May create liability for ordering the restriction of movement of
    persons.

5.  Would otherwise tend to limit the legal basis of the jurisdiction.

    A.  *Sufficiency of legal authorities [during a declared public
        health emergency]{.underline}*

> Assess the sufficiency of existing legal authorities to restrict the
> movement of persons during a [declared]{.underline} emergency and
> identify any potential gaps or uncertainties in those powers and
> authorities.

1.  Are there gaps or shortcomings in these legal authorities?

2.  Are there uncertainties about the sufficiency of these legal
    authorities?

3.  Do any existing legal provisions inhibit, limit, or modify the
    jurisdiction's legal authority to restrict the movement of persons?
    (Examples could include state administrative practice acts and
    specific provisions in law related to movement restrictions, among
    others.)

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B.  *Legal authorities specifically related to quarantine enforcement
    [during a declared public health emergency]{.underline}*

> With specific respect to quarantine orders, identify all state and/or
> local legal authorities to enable, support, authorize, or otherwise
> provide a legal basis for *enforcement* of individual and group
> quarantine during a public health emergency.

1.  Do law enforcement agencies have legal authority to enforce
    quarantine orders issued by the jurisdiction's public health agency?

2.  Do any laws prohibit or inhibit law enforcement agencies'
    enforcement of an official quarantine order?

3.  Do law enforcement agencies have legal authority to enforce a
    quarantine order issued by the federal government?

4.  Do any specific legal authorities prohibit or inhibit the use of law
    enforcement agencies to enforce a federal quarantine order?

5.  What are the legal powers and authorities prohibiting or inhibiting
    the use of law enforcement to assist the federal government in
    executing a federal quarantine order?

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C.  *Sufficiency of legal authorities to enforce quarantine [during a
    declared public health emergency]{.underline}*

> Assess the sufficiency of legal authorities to enforce quarantine
> orders and identify any potential gaps or uncertainties in those
> powers and authorities.

1.  Are there any potential gaps in those legal authorities?

2.  Are there any uncertainties in those legal authorities?

3.  Are there any other legal provisions not listed in I-C above that
    could inhibit, limit, or modify the jurisdiction's legal basis to
    restrict the movement of persons? (Examples could include state
    administrative practice acts and specific provisions in law related
    to quarantine, among others.)

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D.  *Legal authorities to restrict movement of persons [in the absence
    of a declared public health emergency]{.underline}*

> Identify legal authorities and procedures that could enable, support,
> authorize, or otherwise provide a legal basis for any restrictions on
> the movement of persons in the absence of a declared public health
> emergency? (Examples could include, among others, the jurisdiction's
> legal authorities and procedures for quarantine, isolation,
> separation, or other orders for persons to remain in their homes.)
>
> The following questions address all provisions of law or procedure
> that regulate the initiation, maintenance, or release of persons from
> restrictions on movement, including, but not limited to:
>
> 1\. Which officials are authorized to declare or establish such
> restrictions?
>
> 2\. Which officials are authorized to enforce such restrictions?
>
> 3\. What are the legal authorities for group quarantine?
>
> 4\. What are the legal authorities for area quarantine?
>
> 5\. What are the penalties, if any, for violations of restrictions on
> movement?
>
> 6\. What due process measures are provided for those whose movement is
> restricted?
>
> 7\. How long may such measures continue; can they can be renewed; what
> are the
>
> legal and procedural requirements for ending the measures?
>
> 8\. Are officials who order restrictions on the movement of persons at
> risk of legal

liability?

E.  *Sufficiency of legal authorities [in the absence of a declared
    public health emergency]{.underline}*

> Assess the sufficiency of the jurisdiction's legal authorities to
> restrict the movement of persons [in the absence]{.underline} of a
> declared emergency, and any potential gaps or uncertainties in those
> powers and authorities.

1.  Are there potential gaps in those legal authorities?

2.  Are there potential uncertainties about those legal authorities?

3.  Are there any legal provisions that could inhibit, limit, or modify
    the jurisdiction's legal basis to restrict the movement of persons?
    (Examples could include state administrative practice acts and
    specific provisions in law related to movement restrictions, among
    others.)

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II. **Curfew**

    A.  *Legal authorities for curfew [during a declared public health
        emergency]{.underline}*

> Identify the legal authorities and procedures that could enable,
> support, authorize, or otherwise provide a legal basis for curfew
> during pandemics when a public health emergency has been declared?

1.  What legal authorities exist to institute curfews? Can local
    governments institute their own curfews under state and/or local
    law?

2.  Which officials are authorized to order a curfew, and, if different,
    which are authorized to make the decision to institute a curfew?

3.  What is the process for mobilizing public health/law enforcement for
    curfew?

4.  Which officials are authorized to enforce curfew?

5.  What penalties, if any, are available for curfew violations?

6.  How long may a curfew last? Describe the legal authorities and
    procedures required to extend a curfew.

7.  How can a curfew be renewed or extended? Describe the legal
    authorities and procedures required to renew or extend a curfew.

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B.  *Sufficiency of legal authorities [during a declared public health
    emergency]{.underline}*

> Assess the sufficiency of the jurisdiction's legal authorities to
> institute or maintain curfew during a [declared]{.underline} public
> health emergency and identify any potential gaps or uncertainties in
> those legal authorities.

1.  Are there potential gaps in those legal authorities?

2.  Are there potential uncertainties about those legal authorities?

3.  Are there any legal provisions that could inhibit, limit, or modify
    the jurisdiction's legal basis to institute or maintain curfew?
    (Examples could include state administrative practice acts and
    specific provisions in law related to curfew, among others.)

    A.  *Legal authorities for curfew [in the absence of declared public
        health emergency]{.underline}*

> Identify the legal authorities and procedures that could enable,
> support, authorize, or otherwise provide a legal basis for curfew
> during pandemics, in the absence of a declared public health
> emergency?

1.  What are the legal authorities to institute curfews absent a
    declared public health emergency? Can local governments institute
    their own curfews under state and/or local law?

2.  Which officials can order curfew, and, if different, which are
    authorized to make the decision to institute a curfew?

3.  What is the process for implementing curfew?

4.  What is the process for mobilizing public health/law enforcement for
    curfew?

5.  Which officials are authorized to enforce curfew?

6.  What penalties, if any, are available for violations of curfew?

7.  How long may a curfew last? Describe the legal authorities and
    procedures required to extend a curfew.

8.  How can a curfew be renewed or extended? Describe the legal
    authorities and procedures required to renew or extend a curfew.

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B.  *Sufficiency of legal authorities [in the absence of a declared
    emergency]{.underline}*

> Discuss the sufficiency of legal authorities to institute or maintain
> curfew [in the absence]{.underline} of a declared emergency and
> identify any potential gaps or uncertainties in those powers and
> authorities.

1.  Are there any potential gaps in those legal authorities?

2.  Are there any potential uncertainties in those legal authorities?

3.  Are there any legal provisions that could inhibit, limit, or modify
    the jurisdiction's legal basis to institute or maintain curfew?
    (Examples could include state administrative practice acts and
    specific provisions in law related to curfew, among others.)

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III. **Inter-jurisdictional Cooperation in Restrictions on the Movement
     of Persons**

     A.  *Legal provisions/procedures for inter-jurisdictional
         cooperation on restricting the movement of persons [during a
         declared public health emergency]{.underline}*

> Identify legal provisions and procedures that apply to giving and
> receiving assistance across jurisdictional boundaries and to
> coordinating with other jurisdictions in implementing restrictions on
> movement of persons during a [declared]{.underline} public health
> emergency?

1.  What legal provisions or procedures govern coordination among
    superior jurisdictions, e.g., among states? Which govern
    relationships among inferior jurisdictions, e.g., among local
    governments?

2.  What legal provisions or procedures govern coordination between
    superior and inferior jurisdictions? (Include relationships across
    all levels of government and the federal government. See also
    section I-C above specifically related to quarantine orders.)

3.  What legal authority does the jurisdiction have to accept, utilize,
    or make use of federal assistance?

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B.  *Sufficiency of legal authorities to cooperate with other
    jurisdictions in restricting the movement of persons [during a
    declared public health emergency]{.underline}*

> Assess the sufficiency of existing legal authorities for the
> jurisdiction's cooperation with other jurisdictions during a declared
> public health emergency and identify any potential gaps or
> uncertainties in those powers and authorities.

1.  Are there potential gaps in those legal authorities?

2.  Are there potential uncertainties in those legal authorities?

3.  Are there any legal provisions that could inhibit, limit, or modify
    the jurisdiction's legal basis to cooperate with other
    jurisdictions? (Examples could include state administrative practice
    acts and specific provisions in law related to inter-jurisdictional
    cooperation, among others.)

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C.  *Legal provisions/procedures for inter-jurisdictional cooperation in
    restricting the movement of persons [in the absence of a declared
    public health emergency]{.underline}*

> Identify legal provisions or procedures that apply to giving and
> receiving assistance, and otherwise working with other jurisdictions,
> in applying restrictions on the movement of persons in the absence of
> a declared public health emergency.

1.  What legal provisions or procedures govern coordination among
    superior jurisdictions, e.g., among states? Which govern
    relationships among inferior jurisdictions, e.g., among local
    governments?

2.  What legal provisions or procedures govern coordination between
    superior and inferior jurisdictions? (Include relationships across
    all levels of government and the federal government. See also
    section I-C above specifically related to quarantine orders.)

3.  What legal authority does the jurisdiction have to accept, utilize,
    or make use of federal assistance?

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D.  *Sufficiency of legal authorities for cooperation with other
    jurisdictions [in the absence]{.underline} [of a declared public
    health emergency]{.underline}*

> Assess the sufficiency of the jurisdiction's legal authorities and
> powers to cooperate with other jurisdictions in restricting the
> movement of persons in the absence of a declared public health
> emergency and identify any potential gaps or uncertainties in those
> powers and authorities.

1.  Are there any potential gaps in those legal authorities?

2.  Are there any potential uncertainties in those legal authorities?

3.  Are there any legal provisions that could inhibit, limit, or modify
    the jurisdiction's legal basis to cooperate with other
    jurisdictions? (Examples could include state administrative practice
    acts and specific provisions in law related to inter-jurisdictional
    cooperation, among others.)

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E.  *Interagency/inter-jurisdictional agreements on restricting movement
    of persons*

> Where available, identify and compile copies of all interagency and
> inter-jurisdictional agreements relating to restrictions on the
> movement of persons during public health emergencies and to the
> enforcement of such restrictions.

IV. **Closure of Schools**

    A.  *Legal powers/authorities to authorize closure of schools during
        a [declared]{.underline} public*

> *health emergency*
>
> What are the powers, authorities, or procedures to enable, support,
> authorize, or otherwise provide a legal basis for school closure by
> state or local officials (e.g., public schools, private schools,
> universities, day care centers) during a declared public health
> emergency? For each of the jurisdiction's relevant legal powers,
> authorities, and procedures including, but not limited to, umbrella,
> general public health, or emergency powers or authorities, that could
> be used to authorize, prohibit, or limit closure, please address the
> following issues:

1.  What are the powers and authorities authorizing closure?

2.  What are the powers and authorities prohibiting closure?

3.  Who can declare or establish closure?

4.  Who makes the decision to close schools (i.e. to implement a
    declaration of closure)?

5.  What is the process for initiating and implementing closure?

6.  Are there plans in place to continue reduced and free lunches to
    students who receive those services while schools are open?

7.  Are there plans in place to use school facilities and/or employees
    for other functions/services while classes are not in session?

8.  How long can a closure last?

9.  How can it be renewed?

10. Describe the authority/process/notice requirements for ending
    closure/reopening schools?

B.  *Sufficiency of powers/authorities to authorize closure of schools
    during a [declared]{.underline} public health emergency*

> Discuss the [sufficiency]{.underline} of the authorities and powers to
> authorize closure of schools during a declared public health
> emergency, and any potential gaps or uncertainties in those powers and
> authorities.

1.  Potential gaps?

2.  Uncertainties?

3.  Legal provisions that could inhibit, or restrict the jurisdiction's
    authority to close schools? (Examples: state administrative practice
    acts, specific provisions in law related to closure.)

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C.  *Legal powers/authorities to authorize closure of schools [in the
    absence]{.underline} of a declared public health emergency*

> What are the powers, authorities, or procedures to enable, support,
> authorize, or otherwise provide a legal basis for school closure by
> state or local officials (e.g., public schools, private schools,
> universities, day care centers) in the absence of a declared public
> health emergency? For each of the jurisdiction's legal powers,
> authorities, and procedures that could be used to authorize, prohibit,
> or limit closure, please address the following issues:

1.  What are the powers and authorities authorizing closure?

2.  What are the powers and authorities prohibiting closure?

3.  Who can declare or establish closure?

4.  Who makes the decision to close schools?

5.  What is the process for initiating and implementing closure?

6.  Are there plans in place to continue reduced and free lunches to
    students who receive those services while schools are open?

7.  Are there plans in place to use school facilities and/or employees
    for other functions/services while classes are not in session?

8.  How long can a closure last?

9.  How can it be renewed?

10. Describe the authority/process/notice requirements for ending
    closure/reopening schools?

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D.  *Sufficiency of powers/authorities to authorize closure of public
    places [in the absence]{.underline} of a declared public health
    emergency*

> Discuss the sufficiency of the authorities and powers to authorize
> closure of schools in the absence of a declared public health
> emergency, and any potential gaps or uncertainties in those powers and
> authorities.

1.  Potential gaps?

2.  Uncertainties?

3.  Legal provisions that could inhibit, limit, or modify the
    jurisdiction's authority to close schools? (Examples: state
    administrative practice acts, specific provisions in law related to
    closure.)

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V.  **Closure of Public Places**

> *A. Legal authorities to order closure of public places [during a
> declared public health emergency]{.underline}*
>
> Identify the legal authorities and procedures that enable, support,
> authorize, or otherwise provide a legal basis for state or local
> officials' closure of public places (e.g., public facilities, private
> facilities, and businesses) during a declared public health emergency.
> For each of the jurisdiction's relevant legal powers, authorities, and
> procedures\--including, but not limited to, umbrella/overarching,
> general public health, or emergency powers or authorities.

1.  Which officials are authorized to declare closure of public places?

2.  Which officials are authorized to implement closure of public
    places?

3.  What is the process for initiating and implementing closure?

4.  What is the process for enforcing closure; which officials are
    authorized to enforce closure?

5.  What, if any, are the penalties for violating closure orders?

6.  What procedural and due process requirements are associated with
    closure?

7.  Is compensation available for closure? If so, what is it and how is
    it accessed?

8.  How long may closure of a public place last?

9.  How can a closure order be renewed or extended?

10. What legal authorities and procedures are associated with ending a
    closure order?

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A.  *Sufficiency of legal authorities to authorize closure of public
    places [during a declared public health emergency]{.underline}*

> Assess the sufficiency of the jurisdiction's legal authorities to
> close public places during a declared public health emergency and
> identify any potential gaps or uncertainties in those powers and
> authorities.

1.  Are there potential gaps in those legal authorities?

2.  Are there potential uncertainties in those legal authorities?

3.  Are there any legal provisions that could inhibit, limit, or modify
    the jurisdiction's authority to close public places? (Examples could
    include state administrative practice acts and specific provisions
    in law related to closure, among others.)

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B.  *Legal authorities to order closure of public places [in the absence
    of a declared public health emergency]{.underline}*

    1.  Which officials are authorized to declare closure of public
        places?

    2.  Which officials are authorized to implement closure of public
        places?

    3.  What is the process for initiating and implementing closure?

    4.  What is the process for enforcing closure; which officials are
        authorized to enforce closure?

    5.  What, if any, are the penalties for violating closure orders?

    6.  What procedural and due process requirements are associated with
        closure?

    7.  Is compensation available for closure? If so, what is it and how
        is it accessed?

    8.  How long may closure of a public place last?

    9.  How can a closure order be renewed or extended?

    10. What legal authorities and procedures are associated with ending
        a closure order?

C.  *Sufficiency of legal authorities to close public places [in the
    absence of a declared public health emergency]{.underline}*

> Assess the sufficiency of the jurisdiction's legal authorities to
> close public places in the absence of a declared public health
> emergency and identify any potential gaps or uncertainties in those
> powers and authorities.

1.  Are there any potential gaps in those legal authorities?

2.  Are there any potential uncertainties about those legal authorities?

3.  Are there any legal provisions that could inhibit, limit, or modify
    the jurisdiction's authority to close public places? (Examples could
    include state administrative practice acts and specific provisions
    in law related to closure, among others.)

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VI. **Mass Prophylaxis Legal Readiness**

    A.  *Legal authorities for issuance of blanket prescriptions and use
        of other mass prophylaxis measures [during a declared public
        health emergency]{.underline}*

> If it became necessary during a declared public health emergency to
> issue blanket prescriptions or order the use of other mass prophylaxis
> measures to enable emergency mass distribution of medical
> countermeasures (e.g., antiviral drugs and vaccines), what legal
> authorities and procedures would enable, support, authorize or
> otherwise provide a legal basis for doing so? List all the legal
> powers and authorities, policies, and procedures that could be used to
> authorize blanket prescriptions or other mass prophylaxis measures.
> For each of the identified powers and authorities, determine:

1.  Which officials are authorized to make the decision to issue blanket
    prescriptions or other mass prophylaxis measures?

2.  Which officials are authorized to implement blanket prescriptions or
    other mass prophylaxis measures?

3.  What legal authorities would determine how countermeasures would be
    distributed?

    A.  *Sufficiency of legal authorities and procedures to issue
        blanket prescriptions or order the use of other mass prophylaxis
        measures [during a declared public health
        emergency]{.underline}*

> Assess the sufficiency of the jurisdiction's legal authorities to
> issue blanket prescriptions or order the use of other mass prophylaxis
> measures during a declared public health emergency and identify any
> potential gaps or uncertainties in those powers and authorities.

1.  Are there any potential gaps in those legal authorities?

2.  Are there any potential uncertainties about those legal authorities?

3.  Are there any legal provisions that could inhibit, limit, or modify
    the jurisdiction's authority to issue blanket prescriptions or order
    the use of other mass prophylaxis measures? (Examples could include
    state administrative practice acts and specific provisions in law
    related to blanket prescriptions/mass prophylaxis, among others.)

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B.  *Legal powers/authorities for issuance of blanket prescriptions and
    use of other mass prophylaxis measures [in the absence of a declared
    public health emergency]{.underline}*

> If it became necessary in the absence of a declared public health
> emergency to issue blanket prescriptions or order the use of other
> mass prophylaxis measures to enable emergency mass distribution of
> medical countermeasures (e.g., antiviral drugs and vaccines), what
> legal authorities and procedures would enable, support, authorize or
> otherwise provide a legal basis for doing so? List all the legal
> powers and authorities, policies, and procedures that could be used to
> authorize such blanket prescriptions or order the use of other mass
> prophylaxis measures. For each of the powers and authorities listed,
> determine:

1.  Which officials are authorized to make the decision to issue blanket
    prescriptions or other mass prophylaxis measures?

2.  Which officials are authorized to implement blanket prescriptions or
    other mass prophylaxis measures?

3.  What legal authorities would determine how countermeasures would be
    distributed?

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C.  *Sufficiency of authorities/procedures to issue blanket
    prescriptions or order the use of other mass prophylaxis measures
    [in the absence of a declared public health emergency]{.underline}*

> Assess the sufficiency of the jurisdiction's legal authorities to
> issue blanket prescriptions or order the use of other mass prophylaxis
> measures in the absence of a declared public health emergency and
> identify any potential gaps or uncertainties in those powers and
> authorities.

1.  Are there any potential gaps in those legal authorities?

2.  Are there any potential uncertainties about those legal authorities?

3.  Are there any legal provisions that could inhibit, limit, or modify
    the jurisdiction's authority to issue blanket prescriptions or order
    the use of other mass prophylaxis measures? (Examples could include
    state administrative practice acts and specific provisions in law
    related to blanket prescriptions mass prophylaxis, among others.)

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VII. **Overall Considerations**

     **As you work through the specific questions above, the following
     are some overall**

> **considerations for obtaining optimum value as you modify the
> template for your**
>
> **own jurisdiction.**

A.  Explore whether there are other resources (e.g., legal powers and
    authorities, policies, and procedures) your jurisdiction might
    employ or rely upon to implement social distancing measures or
    assure mass prophylaxis readiness in responding to an influenza
    pandemic.

B.  Determine whether there are other resources (e.g., laws,
    regulations, or policies; money, personnel, training, applied
    research, and financial resources) your jurisdiction should have to
    improve its legal readiness for pandemic influenza and, if so, how
    they could be developed or acquired.

C.  Explore whether there are features unique to your jurisdiction that
    could serve to facilitate or impede the use of legal authorities to
    support social distancing measures and mass prophylaxis in response
    to an influenza pandemic or an outbreak of a similar, highly
    virulent infectious disease.

\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*

**[The Legal Assessment Report]{.underline}**

The responses to the questions presented in the legal assessment
instrument above will be captured in your jurisdiction's legal
assessment report. It is recommended that the report also include a
"table of authorities", as an appendix, that presents citations to all
the relevant legal authorities and procedures (including, for example,
statutes, regulations, case law, and attorney general opinions), the
texts of those authorities and procedures, and hyperlink, if available,
to relevant statutes, regulations, court rulings, and other legal
resources.

The written report will serve at least two important purposes:

-   It will report on the sufficiency of your jurisdiction's legal
    authorities to support social distancing measures (as well as mass
    prophylaxis) in the context of an influenza pandemic. In addition,
    as determined by the legal counsel who conducts the assessment, in
    consultation with officials of the jurisdiction's public health
    agency and partnering agencies, it may point to actual or potential
    gaps and ambiguities in those authorities and to impediments to
    their effective implementation. The findings presented in the report
    thus may give assurance that the jurisdiction's legal authorities
    vis-à-vis pandemic influence are sufficient or, alternatively, may
    indicate that steps should be taken to correct problems identified
    through the assessment.

-   It will be an important resource for your jurisdiction's "legal
    consultation meeting," the third essential part of your
    jurisdiction's Social Distancing Law Project. The legal consultation
    meeting will take the form of a table-top exercise in which key
    officials from the jurisdiction's public health, emergency
    management, law enforcement, and other agencies (joined by elected
    officials and representatives of the judiciary and of critical
    private-sector organizations) will use a standardized scenario to
    test their ability to implement social distancing and other
    law-based measures effectively in an influenza pandemic or a
    similarly virulent infectious disease outbreak.

**D. YOUR JURISDICTION'S LEGAL CONSULTATION MEETING**

This section outlines an approach your jurisdiction can take toward
convening a "legal consultation meeting" in which key actors from
multiple jurisdictions and sectors test their capacity to implementing
social distancing measures based on the legal authorities identified
earlier in the legal ass assessment. The majority of the twelve states
that conducted legal consultation meetings in 2007 as part of their
Social Distancing Law projects devoted a full day to them.

**[Objectives of the Legal Consultation Meeting]{.underline}**

The objectives of the legal consultation meeting are to:

-   Convene executives, senior program managers, and legal counsel to
    the agencies that have critical roles in preparing for, and
    responding to public health emergencies and specifically those
    emergencies caused by a potential influenza pandemic or similar
    outbreak of a virulent and highly contagious, infectious disease.

-   Using the "Outbreak of Pandemic Influenza" hypothetical scenario
    provided below, explore the participants' understanding of the
    jurisdiction's social distancing legal authorities, the sufficiency
    of those authorities to support implementation of restrictions on
    movement, curfew, and closure of public places, and the capacity of
    the involved agencies to coordinate in their implementation across
    jurisdictions and sectors.

-   Identify any ambiguities or potential gaps in the jurisdiction's
    social distancing legal authorities, in their implementation, or in
    related matters, that may surface during the legal consultation
    meeting.

-   Serve as a foundation for steps officials may consider taking to
    address issues spotlighted during the legal consultation meeting.

The vehicle for the explorations and dialogue that take place during the
legal consultation meeting is the hypothetical scenario "Outbreak of
Pandemic Influenza" provided in Appendix A. This standardized scenario
should be tailored to reflect the contours of your jurisdiction's public
agencies, laws, and pandemic influenza plan.

**[Participation in the Legal Consultation Meeting]{.underline}**

Participation in your jurisdiction's legal consultation meeting ideally
would include representatives of all the organizations and sectors that
will play significant roles during response to an actual influenza
pandemic, for example:

-   From the public health sector: the jurisdiction's chief public
    health official, the public health agency's emergency preparedness
    director and other senior managers with preparedness roles, the
    agency's legal counsel, and the board of health (if your
    jurisdiction is a state, public health officials and legal counsel
    from tribal and local jurisdictions should participate as well)

-   Counterparts from the jurisdiction's other agencies with emergency
    preparedness roles, for example: the jurisdiction's emergency
    management, law enforcement, homeland security, education,
    transportation, and corrections agencies

-   Judges and court administrators

-   Elected officials and their legal counsel (e.g., from the offices of
    the jurisdiction's chief executive officer, the office of general
    counsel, and legislative officials)

-   Representatives from non-profit organizations that have emergency
    response roles and from the private business sector

-   Officers from CDC quarantine stations located in, or near, your
    jurisdiction

-   Legal counsel to hospitals and other health care organizations, and

-   Representatives of other organizations and sectors critical to
    successful implementation of social distancing measures in your
    jurisdiction.

If possible, your jurisdiction's chief public health official should
sponsor the legal consultation meeting and consider moderating it as
well. Legal counsel to the public health agency should play a central
role during the meeting.

**[Planning the Legal Consultation Meeting]{.underline}**

Leadership for the legal consultation meeting should come from the
jurisdiction's lead public health agency. A planning committee should be
formed shortly after the decision is made to conduct a legal
consultation meeting, with members drawn from all the agencies and
sectors that would participate in response to an actual influenza
pandemic.

Some of the key steps in planning the meeting and in following up on it,
once completed, include:

-   Identifying the moderator and facilitator for the legal consultation
    meeting moderator

-   Developing the agenda and program for the meeting

-   Identify and invite persons to the meeting.

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-   Address logistics needs for the meeting logistics

-   Develop a briefing book or manual to be given to the meeting
    participants no later than two weeks before the meeting and
    including, in addition to the agenda and roster of participants, a
    report on the findings from the legal assessment conducted earlier
    with leadership from legal counsel to the jurisdiction's public
    health agency

-   Following the meeting, developing a report on the meeting\--together
    with recommendations for any actions to be taken based on the
    meeting\-- to be shared with participants and officials who are
    positioned to initiate such actions.

    **[Meeting Agenda and Format]{.underline}**

A suggested agenda for a one-day legal consultation meeting is presented
below. Your jurisdiction's planning committee will make adjustments to
this draft reflecting its decisions on the goals, content, and
participants in the meeting. The planning committee is encouraged to
plan the agenda to take greatest advantage of the expertise of the
meeting participants, to maximize opportunities for active participation
by attendees, and to ensure in-depth dialogue about the sufficiency of
the jurisdiction's legal preparedness for pandemic influenza.

**\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\***

***SUGGESTED LEGAL CONSULTATION MEETING AGENDA***

**Session One: Introduction**

*(Approx. 1 to 2 hours)*

This session includes:

-   Introduction of the meeting participants

-   An overview of the meeting's goals and methodology by the moderator

-   A brief presentation on the jurisdiction's social distancing laws
    and their sufficiency by the jurisdiction's chief public health
    legal counsel. The presentation will summarize the findings of the
    legal assessment and of any other memoranda or reports on the
    jurisdiction's pandemic influenza legal preparedness

-   Question and answers between the moderator, public health legal
    counsel, other exercise participants, and observers.

    **Session Two: Exercise**

*(Approx. 3 to 4 hours)*

In this session participants exercise the jurisdiction's legal
authorities to implement social distancing measures in the context of
declared and undeclared public health emergencies. Resources for the
exercise include: the report on the jurisdiction's social distancing
legal authorities (prepared by legal counsel to the public health
agency), the hypothetical scenario presented below; and any additional
materials the planning committee may wish to provide, for example, the
jurisdiction's pandemic influenza preparedness plan.

The methodology of the exercise involves presenting the legal
consultation meeting participants with a chronological fact pattern
about an emerging influenza pandemic. The questions from the Legal
Assessment can then be posed where relevant at each stage for the
participants to discuss, giving them the opportunity to assess the legal
authorities, explore feasibility of implementing them through
coordination across the critical agencies and sectors, and identify
issues they may want to address following the meeting.

The planning committee may adopt any of several different approaches to
conducting the exercise, for example, by having participants interact as
one body or, alternatively, by dividing them into groups to discuss
specific legal authorities and then reporting back to the full body. The
scope of meeting discussion should generally cover the same topics and
areas of inquiry that appear in the legal assessment prepared by legal
counsel to the public health agency and be framed to address the use of
the relevant legal authorities in both declared and undeclared
emergencies.

**Session Three: Review and Next Steps**

*(Approx. 1.5 to 2 hours)*

The concluding session is the opportunity for meeting participants to
review what they learned from the exercise. Special focus should be
given to identifying both strengths and potential gaps or ambiguities in
legal authorities' support for social distancing measures revealed
during the exercise.

Following the meeting, the jurisdiction's public health agency should
prepare a report that captures the significant findings and "lessons
learned" from the exercise, reflecting the perspectives of all the
participants, and identifies any actions that should be taken to further
improve the jurisdiction's use of legal authorities to support effective
social distancing measures for a potential influenza pandemic or
outbreak of another, similarly virulent infectious disease.

**\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\***

**III. NOTE FROM ASTHO AND THE CDC PUBLIC HEALTH LAW PROGRAM**

ASTHO and the CDC Public Health Law Program, as co-sponsors of the
Social Distancing Law Project, are interested in learning about the use
states, tribes, and localities make of "The Social Distancing Law
Assessment Template" and about the information and findings they derive
from conducting their own legal assessments and legal consultation
meetings. Please share this information, as well as any comments you may
have, with both organizations by contacting the CDC Public Health Law
Program at 404-639-7204 and zrv7@cdc.gov.

**APPENDICES**

**APPENDIX A**

**LEGAL CONSULTATION MEETING HYPOTHETICAL SCENARIO**

***"OUTBREAK OF PANDEMIC INFLUENZA"***

**[Context]{.underline}**

The facts and events in this scenario are specific to \[[insert the name
of your jurisdiction]{.underline}\].

**[Scenario]{.underline}**

November 20: Within the past 30 days, the World Health Organization
(WHO), the U.S. Centers for Disease Control and Prevention (CDC), and
other agencies have confirmed the isolation of a novel and highly
virulent strain of influenza A(H5N1) from clinical specimens obtained
from persons on several continents. Four days ago, on November 16, CDC
announced confirmation of isolation of the same strain from ill persons
in several U.S. states, even though the strain had not yet been isolated
from any persons in your jurisdiction.

Preliminary findings from epidemiological investigations indicate the
following:

-   Illness typically presents as classical influenza with abrupt onset
    of fever, malaise, myalgia (muscle aches), cough, and runny nose.

-   In approximately 20% of cases, illness rapidly progresses to a
    primary viral pneumonia, acute respiratory distress syndrome, and
    death.

-   At-risk populations include persons in all age groups regardless of
    their previous health (i.e., includes persons who previously have
    been in good health, as well as those who with pre-existing chronic
    disease conditions).

-   The average incubation period (i.e., time from patient's exposure to
    an infected person to time of onset of initial symptoms) is
    approximately 36-48 hours.

    No information is available yet regarding the effectiveness of the
    current formulation of influenza vaccine administered to persons in
    settings worldwide prior to onset of this pandemic, and preliminary
    evaluation indicates that anti-viral chemotherapeutic agents
    administered both pre- and post-exposure are only marginally
    effective in preventing or attenuating severity of illness.

    On November 16, following CDC's announcement of the confirmation of
    the circulation of the pandemic strain in the United States, your
    jurisdiction's Communicable Disease Surveillance and Control Unit
    (CDSCU) fully activated its plan for intensified morbidity,
    virological, and mortality surveillance for influenza, including
    active daily surveillance for cases of influenza-like-illness (ILI)
    diagnosed in all hospital emergency rooms, selected urgent-care
    outpatient facilities, and in sentinel providers' offices located
    throughout the jurisdiction.

    Overnight and early this morning (November 20), the CDSCU received
    reports of ILI among persons visiting emergency rooms, urgent care
    facilities, and sentinel providers' offices located in the
    metropolitan area of the capital of your state, but also in
    scattered places elsewhere in your jurisdiction. The CDSCU
    immediately informed your jurisdiction's chief public health officer
    who then, according to your jurisdiction's pandemic preparedness
    plan, notified the office of the Governor or chief executive
    officer. Within a short time, she convened your jurisdiction's
    Pandemic Influenza Response Group, comprising representatives from
    your jurisdiction's homeland security task force, health department,
    attorney general's/legal counsel's office, public safety, civil
    defense, emergency management, and courts administrators office, as
    well as leaders from your jurisdiction's legislative body.

    The Governor/chief executive officer opened the meeting by asking
    the CDSCU to provide an update on the status of ILI reported from
    throughout your jurisdiction and other potentially relevant
    information. The CDSCU reports the following information, which is
    based on calls to local public health units and to the network of
    healthcare facilities comprising your jurisdiction's public health
    surveillance system, as well as additional reports CDSCU has
    received since the Governor/chief executive officer was first
    informed about these developments only a short time earlier.

-   Cases of ILI-like have been reported among a small number of persons
    of all age groups who live in the most populated area of your
    jurisdiction.

-   A cluster of ILI cases has occurred among residents and staff of one
    large stepped-care facility in that area. The stepped-care facility
    is affiliated with two acute-care hospitals and each day transfers
    some patients to the hospitals for management of intercurrent
    problems.

-   A cluster of ILI cases has occurred among students who attend, as
    well as teachers and other staff, at one middle school in the most
    populated area of your jurisdiction.

-   A small cluster of ILI cases also has been reported among city bus
    drivers and other transit workers who together just completed
    in-service training a few days earlier.

-   Only within the past 30 minutes, the CDC Quarantine Station, located
    at the international airport situated near your jurisdiction, has
    contacted the CDSCU and the coordinator of the Pandemic Influenza
    Response Group to report that the captains of two inbound
    transoceanic flights have radioed ahead that a small number of
    persons on board each plane have had onset of acute febrile and
    respiratory tract symptoms while the flights have been en route.
    Both flights have been airborne for over 12 hours and both
    originated in countries for which the novel strain of A(H5N1) had
    been isolated among residents.

    The Governor/chief executive officer requests staff and the Pandemic
    Influenza Response Group to enumerate major events known to be
    planned throughout your jurisdiction for the next week. At a
    minimum, these include:

-   Statewide pre-Thanksgiving school events planned for this year to
    commemorate new historical discoveries about the first Thanksgiving.

-   Traditional family and social seasonal Thanksgiving gatherings.

-   A sold-out Thanksgiving Day (November 22) professional football game
    to be played in an enclosed stadium.

-   The opening of a new, nationally promoted blockbuster film the day
    following Thanksgiving in movie theater chains.

-   Kickoff of the traditional post-Thanksgiving holiday shopping season
    in malls across your jurisdiction.

-   Multi-denominational services planned to be held in memory of
    victims of a recent flood disaster. The services are scheduled to be
    held on Thanksgiving eve and will include a candlelight vigil and
    walk to begin at 8:00 pm with a gathering in front of the state
    capitol/seat of government.

    Given this information, the Governor/chief executive officer has
    asked members of the Pandemic Influenza Response Group to assess the
    situation and offer opinions on the merits of declaring a public
    health emergency. As part of this deliberation, the Governor/chief
    executive officer is asking the Attorney General/legal counsel for
    key agencies---including the health department, public safety, and
    emergency management---to confirm the status and sufficiency of
    authorities for the spectrum of measures that the Governor/chief
    executive officer might need to order into effect imminently.

    \[Note: You may refer to page 28 of this template for more details
    on conducting your Legal Consultation Meeting. In general, the
    discussions based on this hypothetical should address the issues
    presented in the paragraph above, using the questions from the Legal
    Assessment to determine the legal authorities and actors implicated,
    and working through how they would be implemented under these
    circumstances.\]

    \*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*

    **APPENDIX B**

    **HOMELAND SECURITY COUNCIL DIRECTIVES**

```{=html}
<!-- -->
```
-   Action item 6.3.1 "\[e\]ncourage\[d\] all levels of government,
    domestically and globally, to take appropriate and lawful action to
    contain an outbreak within the borders of their community, province,
    State, or nation."[^13]

-   Action item 6.3.1.1 directed that "State, local, and tribal pandemic
    preparedness plans should address the implementation and enforcement
    of isolation and quarantine, the conduct of mass immunization
    programs, and provisions for release or exception."[^14]

-   Action item 6.3.2 directed federal agencies to "provide guidance,
    including decision criteria and tools, to all levels of government
    on the range of options for infection control and containment,
    including those circumstances where social distancing measures,
    limitations on gatherings, or quarantine authority may be an
    appropriate public health intervention."[^15]

-   Action item 6.3.2.1 called for HHS to "provide State, local, and
    tribal entities with guidance on the combination, timing,
    evaluation, and sequencing of community containment strategies
    (including travel restrictions, school closings, snow days,
    self-shielding, and quarantine during a pandemic)."[^16]

-   Action item 6.3.2.2 called for HHS to "provide guidance on the role
    and evaluation of the efficacy of geographic quarantine in efforts
    to contain an outbreak of influenza with pandemic potential at its
    source."[^17]

-   Action item 6.3.2.3 called for "research identifying optimal
    strategies for using voluntary home quarantine, school closure, snow
    day restrictions, and other community infection control
    measures."[^18]

    **APPENDIX C**

**MICHIGAN LEGAL ASSESSMENT EXAMPLE**

[Social Distancing Law Project Michigan Department of Community Health
Assessment of Legal Authorities
(08/13/2007)](http://www2a.cdc.gov/phlp/sdlp/docs/Final MI legal assessment Final.doc)

**APPENDIX D**

**MICHIGAN AFTER ACTION REPORT EXAMPLE**

**Social Distancing Law Project**

**Michigan Department of Community Health**

**After Action Report**

**[Introduction]{.underline}**

The Michigan Department of Community Health (MDCH) agreed to participate
in the Social Distancing Law Project (SDLP). The SDLP is an activity of
the Association of State and Territorial Health Officials (ASTHO) in
cooperation with the Centers for Disease Control and Prevention (CDC).

The SDLP is intended to assist selected states with assessing their
legal preparedness to implement social distancing measures in both
declared and undeclared public health emergencies. Specifically, the
SDLP seeks to ensure the presence of effective legal authorities for
social distancing measures, to establish and sustain the competencies of
public health professionals to apply those laws, to provide coordination
of such efforts across jurisdictions and sectors, and to make accessible
information about best practices.

**[Michigan's Participation]{.underline}**

MDCH established a project team responsible for carrying out activities
of the SDLP. This project team included representatives from relevant
areas of MDCH (epidemiology, surveillance, emergency preparedness,
legal), the Michigan Department of Attorney General, and the Officer in
Charge of the CDC Quarantine Station. The Project Team prepared a report
assessing the adequacy of Michigan law to implement social distancing
measures both during and in the absence of a declared emergency,
provisions for inter-jurisdictional cooperation for restricting the
movement of persons, and mass prophylaxis readiness. It also organized
and oversaw the legal consultation meeting.

**[Legal Consultation Meeting]{.underline}**

MDCH hosted a legal consultation meeting (LCM) on October 12, 2007, at
the Detroit Metropolitan Airport Westin. This site was chosen because it
and the federal Quarantine Station are both located at the airport's
McNamara International Terminal. LCM participants were provided with an
opportunity to sign up for a tour of the quarantine station and
associated screening areas at the airport led by the Quarantine Officer,
Gabriel Palumbo, and the Medical Director, Curie Kim, M.D. Tours were
provided to approximately twelve participants. Locating the LCM at
Detroit Metropolitan Airport resulted in participation by the Wayne
County Airport Authority, the Travel Security Association (TSA), and
their legal counsel. Their participation was very important since the
hypothetical scenario included legal issues related to the arrival of
two international flights with passengers potentially infected with, and
exposed to, pandemic influenza. Meeting at the international terminal of
Detroit Metropolitan Airport also imparted a sense of reality and
urgency to the scenario.

Peter Jacobson, Professor of Health Law and Policy, and Director of the
Center for Law, Ethics, and Health at the University of Michigan School
of Public Health, moderated the LCM. Richard Goodman, Director, Public
Health Law Program, CDC, and Janet Olszewski, Director, MDCH, opened the
LCM with their welcomes. Director Olszewski was able to join the LCM for
the morning session. As shown by the list of attendees, the group was
diverse with expertise and perspective in many relevant areas of public
health, emergency management, legal, and individual rights.

The morning focused on providing information about Michigan and federal
law that governs implementation of social distancing measures. The
afternoon was conducted as a tabletop using a hypothetical scenario that
was based on the scenario provided in the SDLP guidance document.
Break-out groups were used to discuss the scenario, consisting of eight
tables of 7-8 individuals. Individuals were assigned to tables to ensure
a mix of disciplines at each table, and included a legal expert and
public health expert at each table. Facilitators were appointed prior to
the LCM, and provided with the scenario and instructions. Scribes were
chosen by the 7 -- 8 participants at each table. All participants were
provided with the scenario and potential discussion questions in advance
of the LCM.

Each participant was provided with a notebook at the beginning of the
LCM that included:

-   Meeting agenda

-   List of LCM participants

-   Speakers biographical statements

-   Presentations on the law

-   Situation manual related to the tabletop, including goal,
    objectives, assumptions, the hypothetical scenario, and questions
    related to the scenario

-   Resource materials

-   Evaluation

These materials are being provided in electronic form with this after
action report.

Discussion questions were divided into three sets, focusing on the
following three parts of the scenario:

1.  Actions and responses related to the increase of influenza-like
    illness in Michigan.

2.  Actions and responses related to the impending arrival of two
    international flights with passengers who may be infectious with,
    and passengers and crew potentially exposed to, avian influenza.

3.  Responses and measures related to private and public gatherings in
    order to control the spread of pandemic influenza.

Between each segment, Professor Jacobson moderated discussion of the
group as a whole about the sufficiency of the law, questions, and
concerns that need to be addressed. Additional feedback was obtained by
note cards completed at tables as issues arose, evaluations that were
completed by participants, and information collected by experienced
evaluators who observed the exercise and filed an after action report
with the Department of Homeland Security.

**[Talking points captured during discussions]{.underline}**

The following points were captured during the table and group
discussions for each question set:

1.  Actions / considerations to respond to the increase of
    influenza-like illness in Michigan.

    a.  Personal protective equipment (PPE)

    b.  Infection control procedures

    c.  Laboratory testing; importance of case definition

    d.  HAN alerts to hospitals, health departments, primary care, etc.

    e.  School closing -- Thanksgiving holiday

    f.  Protection of healthcare response teams

    g.  Public communications

    h.  Control of supplies -- antivirals, etc

    i.  Be overly cautious

    j.  Voluntary isolation and quarantine

    k.  Warning letters

    l.  Public health advisories or warnings about increased risk of
        infection associated using certain business establishments (e.g.
        theaters)

    m.  Does this constitute a "significant threat" for MDCH orders?

    n.  Public awareness to cover all groups

    o.  Social distancing order -- state gives heads-up to Detroit for
        possible cancellation of events

    p.  Where do you draw the line for cancellation of events?

    q.  Emergency management would look to MDCH for advice

    r.  Would the government close everything with no exceptions?

    s.  Will an emergency declaration hold up in court? Disaster
        declaration?

    t.  MDCH in charge at this point

> [\* All felt that they have the legal authority to take actions they
> felt appropriate]{.underline}

2.  Actions / considerations to respond to the impending arrival of two
    international flights with passengers who may be infectious with,
    and passengers and crew potentially exposed to, avian influenza.

    a.  Imminent danger declared

    b.  Order quarantine for all passengers

    c.  CDC station will order isolation of ill passengers

    d.  Send locals home with education

    e.  Transients to be housed in designated building

    f.  CDC responsible under federal authority

    g.  Legal authority of quarantine station?

    h.  Can local and state health officials refuse transfer of
        quarantine and isolation patients in hospitals?

    i.  Legal authority is well defined for international flights

3.  Questions and considerations for imposing measures on private and
    public gatherings in order to control the spread of pandemic
    influenza

    a.  Need for social distancing at outdoor events

    b.  Supply caution advisories for all outdoor events

    c.  Distinction between public and private gatherings

    d.  Need to define "public gathering" in any order, warning,
        advisory

    e.  Practicality of implementing, enforcing orders imposing social
        distancing measures

    f.  Where do public health concerns fit in with political and
        economic effects?

    g.  What about disproportional impact of certain measures on certain
        populations (e.g. impact of discontinuing public transportation
        on people without cars)?

    h.  Need for "social distancing" of employees staffing the Emergency
        Operations Center and Community Health Emergency Center

    i.  Iceberg effect for decision making (only seeing the tip of the
        problem)

    j.  What if public PPE is not worn, if required?

    k.  Can local overrule Governor's Disaster Declaration?

    l.  28 day declaration -- what if legislature is unavailable to
        extend (due to illness)?

    m.  Need for providing due process to impose social distancing that
        restricts liberty, deprives individuals of their property

> [\* All felt that they have the legal authority to take actions they
> felt appropriate]{.underline}

Participants indicated there is sufficient legal authority to take
actions they felt appropriate. However, the following questions were
raised about implementation:

1.  Can warning notices, or similar notices, be used when the names of
    individuals within an at-risk group are unknown (e.g. a plane load
    of passengers)?

2.  Can the Governor order certain types of businesses (e.g. grocery
    stores) to stay OPEN during an emergency?

3.  Does the Governor have the legal authority to order a distribution
    or redistribution of resources prior to a declaration of an
    emergency or disaster?

4.  Do minors have the legal authority to make decisions to enter
    businesses or attend public gatherings where warnings or cautionary
    advisories are issued concerning associated dangers? E.g. A public
    health officer issues warnings that attending theaters, sporting
    events, etc. may place you at increased risk of infection. Can a
    minor legally decide to attend? Could a curfew order be issued to
    address this?

5.  Can state or local officials refuse the federal government's request
    to transfer jurisdiction and responsibility for passengers from an
    international flight from the federal government to the state or
    local level? What if sick individuals need to be transported to the
    hospital for evaluation; can they remain under the federal
    government's jurisdiction?

6.  How would unaccompanied minors, traveling on international flights,
    be handled? If they were sick, would unaccompanied minors be able to
    voluntarily choose to go to the hospital?

7.  Does the U.S. or Michigan Constitution allow the Governor or health
    officers to issue orders that prohibit religious gatherings?

**[Conclusions]{.underline}**

I.  **Michigan has sufficient legal authority to implement social
    distancing measures.**

There was no discussion of gaps in the Public Health Code or other
Michigan laws. Rather the discussion was how to implement authority and
factors to be considered and balanced for decision making (caution vs.
rapid response). Also, the importance of mutual aid agreements and joint
planning was emphasized, especially in working with law enforcement.

There are some legal questions related to implementation set out in the
section above, which need to be answered. Also, as set out in the
written assessment, there are jurisdictional questions related to
universities and federal lands that need to be submitted to the Attorney
General's office for review.

II. **Many key players in a pandemic have insufficient knowledge of
    Michigan legal authority, and how to use it to prevent the spread of
    pandemic influenza.**

Recommendations were made for further training and education efforts.

III. **Many "nuts and bolts" need further consideration and resolution
     to effectively respond to a pandemic.**

A lot of discussion focused on logistics, resources, and practicalities
of enforcement. The following are a few examples. The logistics of
handling large numbers of people for isolation or quarantine at
international borders was discussed. Hospital preparedness is necessary
to support large-scale efforts. How to prevent / address refusal by
health care workers to provide care to patients with pandemic influenza
is a concern. Other issues include transporting sick and exposed
individuals, equipping public with PPE such as masks, ensuring equitable
access to resources and services, and impact of contractual
relationships between hospitals and commercial laboratories.

Financial resources continue as a major concern. This concern is
reflected by one of the discussion table's questions regarding
international airline passengers: "Can local and state health officials
refuse transfer of responsibility and authority \[from federal
government\] for quarantine and isolation patients in hospitals?"

**[Follow-Up]{.underline}**

MDCH has greatly benefited from its work associated with this project,
and the stipend that allowed it to fund the LCM. From the evaluations,
it appears that most participants found the information and experience
generated from the LCM extremely valuable.

The project team is being reconvened to develop a plan for additional
activities to build upon this initial effort. Now that the LCM has been
created and tested, it should be shared with health and emergency
response staff from other areas of the state served by major airports,
including Flint-Saginaw-Midland, Grand Rapids-Kalamazoo, and Traverse
City. Additionally, while Michigan law might be sufficient to impose
social distancing measures, it is essential that public officials know
how to use the law to protect the public's health. Thus, the project
team will also consider taking the LCM to local health department staff
and their attorneys, and to judges who would review state actions to
control a pandemic. The extent of further activities will depend on
identifying resources or partners for funding.

In addition to future LCMs, the project team will review issues and
areas of uncertainty identified through this project for follow-up as
appropriate.

**APPENDIX E**

**TEXAS LEADERSHIP DECISION-MAKING MATRIX EXAMPLE**

[Texas Leadership Decision Matrix
(07/10/2008)](http://www2a.cdc.gov/phlp/sdlp/Docs/Leadership Decision Making Matrix.doc)

**APPENDIX F**

**ADDITIONAL RESOURCES**

The federal government's comprehensive website for information on
pandemic influenza is located at
[http://pandemidflu.gov](http://pandemidflu.gov/)

National Strategy for Pandemic Influenza:
<http://www.whitehouse.gov/homeland/pandemic-influenza.html>

The U.S. Department of Health and Human Services Pandemic Influenza
Plan: <http://www2a.cdc.gov/phlp/docs/PHLP_HHSPandemicInfluenzaPlan.pdf>

CDC Avian Influenza Information:
<http://www.cdc.gov/flu/avian/index.htm>

CDC Public Health Law Program: <http://www2a.cdc.gov/phlp/index.asp>.

Association of State and Territorial Health Officials:
<http://www.astho.org/>

National Association of County and City Health Officials:
[http://www.naccho.org](http://www.naccho.org/)

The Center for Law and the Public's Health at Georgetown and Johns
Hopkins universities report on school closure laws, *Legal Preparedness
for School Closures in Response to Pandemic Influenza and other
Emergencies*: <http://www2a.cdc.gov/phlp/avian.asp>

[^1]: Markel H et al. Nonpharmaceutical interventions implemented by US
    cities during the 1918-1919 influenza pandemic. JAMA.
    2007;298(6):644-654.

[^2]: Matthews, G, Abbott, E, Hoffman, R, Cetron, M. Legal Authorities
    for Interventions in Public Health Emergencies. In: Goodman R,
    Hoffman, R, Lopez, W, Matthews, G, Rothstein, M, Foster, K, eds.
    *Law in Public Health Practice*, *Second Edition*. New York, NY:
    Oxford; 2007:277.

[^3]: Matthews, G, Abbott, E, Hoffman, R, Cetron, M. Legal Authorities
    for Interventions in Public Health Emergencies. In: Goodman R,
    Hoffman, R, Lopez, W, Matthews, G, Rothstein, M, Foster, K, eds.
    *Law in Public Health Practice*, *Second Edition*. New York, NY:
    Oxford; 2007:277

[^4]: Matthews, G, Abbott, E, Hoffman, R, Cetron, M. Legal Authorities
    for Interventions in Public Health Emergencies. In: Goodman R,
    Hoffman, R, Lopez, W, Matthews, G, Rothstein, M, Foster, K, eds.
    *Law in Public Health Practice*, *Second Edition*. New York, NY:
    Oxford; 2007:267

[^5]: National Strategy for Pandemic Influenza (2005), available at
    http://www.whitehouse.gov/homeland/pandemic-influenza.html.

[^6]: National Strategy for Pandemic Influenza Implementation Plan
    (2006), available at
    http://www.whitehouse.gov/homeland/pandemic-influenza-implementation.html.

[^7]: National Strategy for Pandemic Influenza Implementation Plan, pp.
    107-109; 113-114, available at
    http://www.whitehouse.gov/homeland/pandemic-influenza-implementation.html.

[^8]: National Strategy for Pandemic Influenza Implementation Plan,
    p.130, available at
    http://www.whitehouse.gov/homeland/pandemic-influenza-implementation.html.

    .

[^9]: The Center for Law and the Public's Health: Legal Preparedness for
    School Closures in Response to Pandemic Influenza and other
    Emergencies. Available at http://www2a.cdc.gov/phlp/avian.asp.

[^10]: Moulton, A, Goodman, R, Parmet, W. Perspective: Law and Great
    Public Health Achievements*.* In: Goodman R, Hoffman, R, Lopez, W,
    Matthews, G, Rothstein, M, Foster, K, eds. *Law in Public Health
    Practice*, *Second Edition*. New York, NY: Oxford; 2007:5-6.

[^11]: See [www.astho.org](http://www.astho.org/).

[^12]: The states holding Legal Consultation Meetings were: Alaska,
    Florida, Georgia, Hawaii, Illinois, Massachusetts, Michigan, New
    Jersey, New York State, Texas, Virginia, and Washington. The
    District of Columbia and Maryland sent observers to Virginia's
    meeting.

[^13]: National Strategy for Pandemic Influenza Implementation Plan,
    2005**,** p.130, available at
    http://www.whitehouse.gov/homeland/pandemic-influenza-implementation.html.

[^14]: National Strategy for Pandemic Influenza Implementation Plan,
    2005, p.130, available at
    http://www.whitehouse.gov/homeland/pandemic-influenza-implementation.html.

[^15]: National Strategy for Pandemic Influenza Implementation Plan,
    2005, p.130, available at
    http://www.whitehouse.gov/homeland/pandemic-influenza-implementation.html.

[^16]: National Strategy for Pandemic Influenza Implementation Plan,
    2005, pp.130-131, available at
    http://www.whitehouse.gov/homeland/pandemic-influenza-implementation.html.
    The subject of school closure authorities was covered by a separate
    CDC research project, and was not directly addressed in the 2007
    Social Distancing Law Project. The report for the school closure
    project, entitled Legal Preparedness for School Closures in Response
    to Pandemic Influenza and other Emergencies, is available at
    http://www2a.cdc.gov/phlp/avian.asp.

[^17]: National Strategy for Pandemic Influenza Implementation Plan,
    2005, p.131, available at
    http://www.whitehouse.gov/homeland/pandemic-influenza-implementation.html.

[^18]: National Strategy for Pandemic Influenza Implementation Plan,
    2005, p.131, available at
    http://www.whitehouse.gov/homeland/pandemic-influenza-implementation.html.