Public Health Guidance for Community-Level Preparedness and Response to
Severe Acute Respiratory Syndrome (SARS) Version 2

Supplement A: Command and Control

Appendix A2

Checklist of Legal Considerations for SARS Preparedness in Your
Community

# 

The global emergence of SARS-CoV presents challenges to the public
health system at all levels of government. If SARS-CoV transmission
recurs, the potential exists for implementation of isolation and/or
quarantine within a given community. There is great variation among
state and local laws regarding compelled isolation and quarantine.

The following checklist is a planning tool for lawyers highlighting the
relevant partners, resources, planning considerations, due process
considerations, and issues of legal liability and immunity that may
arise in the context of any public health emergency whether natural or
manmade. This checklist specifically addresses SARS. Next to each
consideration are listed the legal partners (e.g., public health,
hospitals, public safety, emergency management, judiciary) who may be
called upon to address these considerations as part of the affected
community's response. The challenge of the public health response is to
protect the health of many, while safeguarding the rights of the
individual. An integrated and coordinated response by attorneys at all
levels in the community is essential to achieving this goal.

The checklist format is not intended to set forth mandatory requirements
or establish a national standard for legal preparedness. Rather, each
state and local jurisdiction should determine for itself whether it is
adequately prepared for disease outbreaks in accordance with its own
laws and procedures.

### 

### Planning Considerations

-   Ensure that public health personnel have a basic understanding of
    the **intersection among federal, state, and local laws** regarding
    quarantine and isolation as they relate to international airports
    and interstate border crossings. \[public health/public
    safety/emergency management\]

-   Where applicable, draft legal orders, motions, and templates
    authorizing **medical evaluation of non-compliant persons** who meet
    the SARS case definition and have symptoms of SARS-CoV disease.
    \[public health/hospitals\]

-   Ensure that legal counsel has reviewed the feasibility of requiring
    persons to **self-monitor for medical conditions** (e.g.,
    temperature checks) and (where applicable) drafted legal orders or
    agreements. \[public health\]

-   Ensure that legal counsel has reviewed the feasibility of issuing
    **"exclusion" orders** (i.e., excluding contacts from using public
    transportation, attending public meetings) and, where applicable,
    drafted templates and legal orders. \[public health/public
    safety/emergency management\]

-   Ensure the existence of a statute, regulation, or other
    administrative mechanism authorizing SARS isolation/quarantine.
    \[public health/public safety/judiciary\]

-   Draft legal orders, motions, and templates for isolation/quarantine
    in **homes, hospitals, or other designated facilities**. \[public
    health/hospitals/

> emergency management/public safety\]

-   Ensure that legal counsel has reviewed the feasibility of using
    **electronic methods to monitor** suspected non-compliant
    individuals in home isolation and/or quarantine. \[public
    health/public safety\]

-   Ensure that legal counsel has reviewed draft legal orders, motions,
    and templates to **quarantine facilities** and to credential ingress
    and egress into such facilities. \[public health/public
    safety/emergency management\]

-   Ensure that legal counsel has reviewed the feasibility of using
    **faith-based organizations** to assist or provide services to
    persons in isolation and quarantine. \[public health\]

-   Ensure that public health officials have reviewed the availability
    of workers' compensation and/or other forms of **financial support**
    for persons unable to return to work because of a
    isolation/quarantine order. \[public health\]

-   Ensure that legal counsel has considered whether the health
    department should issue documents designed to assist with
    **reintegration of persons** subject to isolation/quarantine order
    (e.g., letter to employer or school explaining that patient is no
    longer infectious). \[public health\]

-   Ensure that legal counsel has reviewed agreements relating to
    **overtime and/or flexibility of hours** for staff during public
    health emergencies. \[public health/hospitals/public
    safety/emergency management\]

-   Ensure that legal counsel has a clear understanding of legal
    authorities relevant to **environmental remediation** of buildings.
    \[public health/

> hospitals/emergency management\]

### 

### Partnerships/Outreach

-   Assemble a **legal preparedness task force** with representation
    from public health, public safety, hospitals, emergency management,
    judiciary, and other relevant individuals and/or organizations at
    various levels of authority (federal, state, local, cross-border).
    \[public health/public safety/hospitals/

> emergency management/judiciary\]

-   Establish procedures for **enforcement of isolation/quarantine
    orders**. \[public health/public safety\]

-   Provide public safety personnel with **educational materials**
    relating to SARS and have a clear understanding for how to enforce
    an isolation/quarantine order. \[public health/public safety\]

-   Ensure that procedures or protocols exist between hospitals and
    public health to manage a possible or known SARS case-patient who
    attempts to **leave the hospital against medical advice**. \[public
    health/hospitals/public safety\]

-   Where applicable, draft memoranda of agreement (MOA) or
    understanding (MOU) to allow for the **loaning of facilities or
    other services** necessary to implement a quarantine and/or
    isolation order for person who cannot be isolated at home (e.g.,
    travelers, homeless populations). \[public health/

> hospitals/emergency management\]

-   Ensure that judges and attorneys in the area, through **local bar
    organizations** or other entities, have received educational
    materials, training, or information related to SARS and the
    potential use of isolation/quarantine to interrupt disease
    transmission. \[public health/

> judiciary\]

-   Ensure that legal counsel has reviewed and/or drafted **data
    sharing/data use/confidentiality agreements** related to sharing of
    confidential patient medical information between public health and
    other partners. \[public health/hospitals/public safety/emergency
    management\]

-   Consider the implementation of a **"Forensic Epidemiology" training
    course** in the jurisdiction. \[public health/public safety\]

### Due Process Considerations

-   Draft legal orders and templates using terms such as "quarantine,"
    "isolation," and "detention" **consistently**. \[public
    health/judiciary)

-   Ensure that legal counsel has reviewed all draft
    isolation/quarantine orders and forms, as well as applicable
    administrative hearing procedures, to ensure concurrence with
    **basic elements of due process** (e.g., adequate notice,
    opportunity to contest, administrative determination) \[public
    health/

> judiciary\]

-   Ensure that procedures or protocols exist to ensure that persons
    subject to an isolation/quarantine order have **access to legal
    counsel**, if desired (e.g., list of attorneys willing to provide
    services at little or no cost). \[public health/

> judiciary\]

-   Ensure that legal counsel has analyzed procedures needed to satisfy
    **due process** in **different isolation/quarantine scenarios
    (**e.g., "voluntary" home isolation, isolation in a guarded
    facility, exclusion from certain public activities). \[public
    health/judiciary\]

-   Where applicable, ensure that public health officials have worked
    with the local court system to develop a 24/7 **"on call" list of
    judges or hearing officers** to review emergency requests for
    isolation/quarantine. \[public health/judiciary\]

-   Ensure that public health officials have worked with the local court
    system to develop a **plan for hearing cases and/or appeals** for
    persons subject to isolation/quarantine orders (e.g., participation
    via telephone, video conference). \[public health/judiciary\]

# 

### Legal Resources and Statutes

-   Ensure that legal counsel has reviewed and has a clear understanding
    of the **legal resources and tools** relevant to a community's
    public health response. \[public health/judiciary/emergency
    management\]

> Such resources and tools include:

-   Draft Model State Emergency Health Powers Act

> [www.publichealthlaw.net/MSEHPA/MSEHPA2.pdf](http://www.publichealthlaw.net/MSEHPA/MSEHPA2.pdf)

-   Emergency Management Assistance Compact (model agreement)

> [www.emacweb.org/EMAC/About_EMAC/Model_Legislation.cfm](http://www.emacweb.org/EMAC/About_EMAC/Model_Legislation.cfm)

-   Emergency Management Assistance Compact (as implemented in a state
    or jurisdiction)

```{=html}
<!-- -->
```
-   Memorandum of Understanding for Establishment of Local Public Health
    Mutual Aid and Assistance System

> [www.publichealthlaw.net/Resources/ResourcesPDFs/MOU.pdf](http://www.publichealthlaw.net/Resources/ResourcesPDFs/MOU.pdf)

-   American Bar Association Draft Checklist for State and Local
    Government

> Attorneys to Prepare for Possible Disasters
>
> [www.publichealthlaw.net/Resources/ResourcesPDFs/ABA_checklist.pdf](http://www.publichealthlaw.net/Resources/ResourcesPDFs/ABA_checklist.pdf)

-   Buncombe County Health Center Forensic Epidemiology Quarantine Task
    Force Report

> [www.phppo.cdc.gov/od/phlp/](http://www.phppo.cdc.gov/od/phlp/) (to be
> posted)

-   Communicable Disease Control Measures in Texas: A Guide for Health
    Authorities in a Public Health Emergency

[www.tdh.state.tx.us/ophp/phwd/commdis.htm](http://www.tdh.state.tx.us/ophp/phwd/commdis.htm).

> Additional materials and resources may be posted at
> [www.phppo.cdc.gov/od/phlp/](http://www.phppo.cdc.gov/od/phlp/)

-   Distribute draft letters or fact sheets to hospitals and other
    healthcare providers describing permissible uses and disclosures of
    health information for public health purposes under the **Privacy
    Rule of the Health Insurance Portability and Accountability Act
    (HIPAA)** ([www.hhs.gov/ocr/hipaa/](http://www.hhs.gov/ocr/hipaa/)).
    \[public health/hospitals\]

-   Where applicable, ensure that legal counsel understands procedures
    for **declaring a public health emergency** (at various levels of
    government) and consequences of such a declaration. \[public
    health/public safety/emergency management\]

-   Ensure that legal counsel is familiar with the requirements of the
    **Emergency Medical Treatment and Active Labor Act (EMTALA)**
    ([www.aaem.org/emtala/index.shtml](http://www.aaem.org/emtala/index.shtml))
    and has determined if such requirements have been incorporated into
    public health and hospital planning for SARS. \[public
    health/hospitals\]

-   Ensure that legal counsel has reviewed **hospital screening and
    admission procedures** for potential SARS patients (e.g.,
    establishment of evaluation clinics for persons with SARS-like
    symptoms) for compliance with **EMTALA** \[public health/hospitals\]

-   Ensure that legal counsel has reviewed potential **EMTALA**
    implications of a **community-wide EMS protocol** for transport of
    SARS patients (e.g., protocol requiring transport of SARS patients
    to a hospital or facility other than the hospital that owns the
    ambulance). \[public health/hospitals/emergency management\]

# 

### Legal Liability and Immunity

-   Ensure that legal counsel has reviewed the potential legal liability
    of implementing **"working" quarantine for essential service
    personnel**. \[public health/hospitals\]

-   Ensure that legal counsel has reviewed the potential legal liability
    of housing SARS patients in **home isolation with non-exposed
    residents** subject to infection control precautions. \[public
    health\]

-   Ensure that legal counsel has reviewed liability/immunity for
    **volunteers** providing assistance or services to persons in
    isolation/quarantine. \[public health/emergency management\]

For more information, visit
[www.cdc.gov/ncidod/sars](http://www.cdc.gov/ncidod/sars/) or call the
CDC public response hotline\
at (888) 246-2675 (English), (888) 246-2857 (Español), or (866) 874-2646
(TTY)