# Presentation: 519059

## PUBLIC HEALTH COMMUNITY PREPAREDNESS for SARSSeptember 23, 2003

**LEGAL ASPECTS**
**Gene W. Matthews, J.D.**
**Legal Advisor to CDC**
**1600 Clifton Road, Atlanta, GA 30333**
**(404) 639-7200**
**“****GMatthews@cdc.gov”**

**PUBLIC HEALTH LAW**
**I.  ****	****HISTORICAL CONTEXT**
**II.****	****CURRENT SITUATION**
**III.****	****PRACTICAL STEPS FOR SARS  “LEGAL PREPAREDNESS”**

## Quarantine

**Quarantine**

***A collective action for the common good***

**Public good**

**Individual liberties**

***Paramount to meet needs of  individuals infected and exposed****** ***

_**HISTORICAL CONTEXT**_
**1954: Two Ships Passed in the Night!**
- 	_**Salk Polio Vaccine**_** – 1954**
**    ****(END IN U.S. OF COMMUNITY-WIDE PUBLIC**
**     ****HEALTH CONTROL MEASURES—300 years!)**
_**Brown v. Board of Education**_** 1954**
**  ****(BEGINNING OF MODERN EVOLUTION OF PROCEDURAL PROTECTIONS OF INDIVIDUAL LIBERTIES AGAINST GOVERNMENT ACTION)**

##  HISTORICAL CONTEXT

**PUBLIC HEALTH ******** **_**POLICE**_** POWER**
**10****TH**** AMENDMENT ******** RESERVED TO **_**STATES**_
_**Federal**_** Functions**
- International
- Interstate
- Federal Funding & Assistance

## FEDERAL, STATE, & LOCAL “LEGAL PREPAREDNESS”THE SILOS

|  | 
PUBLIC HEALTH | LAW
ENFORCE
    MENT | EMER.
MGMT. | MED.
CARE
SERVICE | COURTS |
| --- | --- | --- | --- | --- | --- |
| FEDERAL | P.H. | L.E. | EMA | MED   CARE | FED.
 CTS. |
| STATE
 | P.H. | L.E. | EMA | MED    CARE | STATE
  CTS. |
| LOCAL
 | P.H. | L.E. | EMA | MED   CARE | LOCAL
  CTS. |

## CURRENT SITUATIONSTATE AND LOCAL LAWS

**IN GENERAL: Individual states are responsible for **_**intrastate**_** public health control measures using **_**their laws**_**.**
**Significant **_**variation**_** among state laws.**
**Some **_**local**_** jurisdictions may have p. h. control provisions that are easier to use.**
**State/local p.h. officers have experiences with **_**individual**_** control measures ******** T.B.; School Immunizations; Mental Commitments; etc**

## CURRENT SITUATIONFEDERAL LAW

**Federal Government also has **_**concurrent**_** power to **_**apprehend, detain, or conditionally release**_** individuals to prevent the interstate spread or international importation of **_**certain**_** diseases. (42 U.S.C. 264)**
**Such federally “quarantinable” diseases must first be listed in an **_**Executive Order**_** signed by the President.**

## CURRENT SITUATIONFEDERAL LAW

_**Executive Order 13295 of April 4,2003 **__**added**__** **__**SARS**__** to this list, as a prudent public health  preparedness measure**_**. **
**Other 7 diseases: ****Cholera, Diptheria, Infectious T.B., Plague, Smallpox, Yellow Fever, & Viral Hemorrhagic Fevers (like Ebola).**
**Violation ******** Criminal Misdemeanor**

## INTERPLAY OF FEDERAL AND STATE/LOCAL LAWS

_**State & Local**_** have primary responsibility for Q/I.**
_**Federal**_** has authority to prevent **_**interstate**_** spread of disease, plus **_**int’l importation**_**.**
**HHS Secretary may accept state & local assistance in enforcement of **_**federal**_** Q regulations**
**HHS may assist state & local officials in **_**their**_** ****	****control of communicable diseases.**
**HHS provides BT Infrastructure Grant $**
**Includes funds for state “legal preparedness” assessments**

## INTERPLAY OF FEDERAL AND STATE/LOCAL LAWS

_**FEDERAL CONTROL & SARS**_
**Due to the **_**potential**_** for a case of SARS to spread interstate, it is clear that the Federal quarantine authority **_**could**_** be applied to a single SARS case **_**inside**_** a state or local jurisdiction, **_**if**_** **_**necessary**_**.**
**	****--CDC would **_**not**_** **_**have**_** to **_**wait**_** for an interstate SARS  spread to **_**actually**_** take place before acting.**
**	****--BUT any such CDC action on SARS would be **_**carefully**_** **_**coordinated**_** with the appropriate **_**state**_** or **_**local officials.**_

## INTERPLAY OF FEDERAL AND STATE/LOCAL LAWS

**It is possible for federal, state, AND local laws to **_**ALL**_** come into play in a particular situation. (EXAMPLE: An arriving aircraft at a large city airport.  Hence **_**coordination**_** is crucial.)**
**ENFORCEMENT ISSUE:**
**	****Each level of **_**P.H. Officials**_** must effectively connect with their respective **_**Law Enforcement**_** counterparts to assist as necessary in carrying out a mandatory public health order.**

## 2003 SARS Lessons

**CANADIAN EXPERIENCE WITH SARS**
**	****--OVER 13,000 PERSONS ****	****QUARANTINED ****	****IN TORONTO****	**
**	****--27 **_**FORMAL**_** QUARANTINE**
**       ****ORDERS NEEDED TO BE **_**SERVED**_
**	****--**_**1 FORMAL APPEAL**_** **
**	****	****(LATER WITHDRAWN AFTER  ****	****  ****	****	****EXPOSURE WAS EXPLAINED)**

## 2003 SARS Lessons

_**PRACTICAL EXPERIENCE IN TORONTO**_** **
**                        ****= **_**“DEMYSTIFIED” QUARANTINE**_
**Experienced “Social Cohesion” in PH Emergency**
**RESPONSIBILITY<-------------> DIVISIVENESS**
**  ****COOPERATION                            PANIC**
**Lesson => **_**“When Presented With Clear Communication & Guidance, Public Behavior Can Be Very Responsible in a Public Health Emergency”**_

## 2003 SARS Lessons 

_**LEVELS OF QUARANTINE HAVE EVOLVED**_
**--USE OF MASKS, GLOVES, ETC.**
**--“SNOW DAY” and “SHELTER-IN-PLACE”**
**--VOLUNTARY ISOLATION / QUARANTINE**
**--TELEPHONE MONITORING IN THE HOME**
**--GOV’T ORDERED ISOLATION / QUARANTINE**
**--INVENTED CONCEPT OF “WORK QUARANTINE”**
**--ACTIVE USE OF LAW ENFORCEMENT OFFICERS**
**         ****TO SERVE PROCESS AND MONITOR**

## 2003 SARS Lessons

**“****Public Health Must Be Prepared to Act**
_**BOLDLY**_** AND **_**SWIFTLY**_
**And To Treat Individuals With**
_**DIGNITY**_** AND **_**FAIRNESS**_**.”**
**Dr. Julie L. Gerberding**

## PRACTICAL STEPS FOR SARS “LEGAL PREPAREDNESS”

**1. KNOW YOUR LEGISLATION**
**2. PLAN “DUE PROCESS”**
**3. DRAFT DOCUMENTS IN ADVANCE**
**4. CONTACT OTHER JURISDICTIONS**
**5. ENGAGE THE COURTS IN ADVANCE**
**6. ANTICIPATE PRACTICAL PROBLEMS**
**7. COMMUNICATION,...COMMUNICATION,**
**	****...****COMMUNICATION**

## SARS Legal Preparedness

**1. KNOW YOUR LEGISLATION**
**	****--Does  your Q authority ****	****	****	****	****currently cover SARS?**
**	****--Identify Decision-makers**

## SARS LEGAL PREPAREDNESS

**2. PLAN “DUE PROCESS”**
_**STATE**_** PROCEDURES WILL **_**VARY**_**, OR **_**MAY**_** **_**NOT**_** DIRECTLY ADDRESS **_**DUE PROCESS**_** ISSUES FOR QUARANTINE AND ISOLATION ORDERS.**
_**COURTS**_** MAY ULTIMATELY **_**REVIEW**_** QUARANTINE / ISOLATION  ORDERS**
**DUE PROCESS IS A **_**FLEXIBLE**_** CONCEPT**

## SARS Legal Preparedness

**2. PLAN FOR “DUE PROCESS” (cont.)**
**COMMON ELEMENTS OF DUE PROCESS****:**
**	****--Adequate **_**Notice**_** (a written order).**
**	****--A **_**Right to Be Heard**_
**	****	****---to present evidence and witnesses**
**	****	****---to confront the evidence of the agency****	**
**	****--**_**Access to Legal Counsel**_
**	****--A **_**Final Decision**_** that a Court Can Review.**

## SARS Legal Preparedness

**3. DRAFT DOCUMENTS IN ADVANCE**
**	****	****--Quarantine Order**
**	****	****--Supporting Affidavits**
**	****	****--Explanation of Due Process ****	****	****	****Procedures**

## SARS Legal Preparedness

**4. CONTACT OTHER JURISDICTIONS**
**--**_**Vertical Legal Connections**_
**	**** ****(Local + State + Federal)**
**--**_**Horizontal Legal Connections**_
**	**** ****(P.H. + Law Enf. + EMA’s + H. Care)**
**--**_**Geographical “Clusters”**_
**	**** ****(Overlapping State/Local Neighbors)**

## Slide 23

## SARS Legal Preparedness

**5. ENGAGE THE COURTS IN ADVANCE**
**--MANY JUDGES ARE UNAWARE OF 50+ YEAR-OLD PUBLIC HEALTH EMERGENCY POWERS.**
**--In Toronto, judges were surprised at health officers broad **_**ex parte**_** authority under rarely used laws.**
**--Important for due process review.**

## SARS Legal Preparedness

**6. ANTICIPATE PRACTICAL PROBLEMS**
**--ARRANGE FOR ELECTRONIC APPEARANCES / REPRESENTATION**
**--SERVICE OF PROCESS**
**	****(Likely by Law Enforcement Officers)**
**--ISOLATION ARRANGEMENTS FOR TRANSIENTS AND HOMELESS**

## SARS Legal Preparedness

**7. **_**COMMUNICATION PLNG. IS VITAL**_
**-****Public Health Agency Attorneys Need to Be Aware of Media Training**
**-PHLP Is Establishing Health Agency  Attny. “Real Time” **_**Communication**_** **_**Linkages**_** since SARS & Monkeypox **
**-Plans Underway for Outreach to Local Bar Groups on Emergency P.H. Issues**

## PRACTICAL STEPS FOR SARS “LEGAL PREPAREDNESS”

**1. KNOW YOUR LEGISLATION**
**2. PLAN “DUE PROCESS”**
**3. DRAFT DOCUMENTS IN ADVANCE**
**4. CONTACT OTHER JURISDICTIONS**
**5. ENGAGE THE COURTS IN ADVANCE**
**6. ANTICIPATE PRACTICAL PROBLEMS**
**7. COMMUNICATION,...COMMUNICATION,**
**	****...****COMMUNICATION**

## RESOURCES

_**3 KEY CASES**_
_**Jacobson v. Massachusetts**_**, 197 U.S. 11 (1905)**
_**United States ex rel. Siegal v. Shinnick**_**, 219 F.Supp. 789 (E.D.N.Y. 1963)**
_**Souvannarath v. Hadden**_**, 95 Cal.App.4th 1115 (Cal. Ct. App. 2002)**
_**URL RESOURCES**_
**Federal SARS Executive Order Q&As****: **_[http://](http://www.cdc.gov/ncidod/sars/quarantineqa.htm)__[www.cdc.gov/ncidod/sars/quarantineqa.htm](http://www.cdc.gov/ncidod/sars/quarantineqa.htm)_
**Fact Sheet on Legal Authorities for Isolation /Quarantine**** **_[http://](http://www.cdc.gov/ncidod/sars/factsheetlegal.htm)__[www.cdc.gov/ncidod/sars/factsheetlegal.htm](http://www.cdc.gov/ncidod/sars/factsheetlegal.htm)_
**Forensic Epidemiology For Law Enforcement & P.H.**
**	****http://www.phppo.cdc.gov/od/phlp**

## CDC Public Health
Law Program Website

www.phppo.gov/od/phlp

**Law Program Website**
**www.phppo.gov/od/phlp**